[ Page 1091 ]

CONTENTS

Routine proceedings

Medical Centre of British Columbia Act (Bill 81). Second reading.

Motion to postpone second reading.

Mr. McClelland — 1091

Hon. Mr. Cocke — 1095

Mr. McGeer — 1095

Hon. Mr. Barrett — 1096

Mr. Williams — 1099

Mr. Wallace — 1100

Mr. Schroeder — 1102

Mr. Gardom — 1103

Mr. D.A. Anderson — 1104

Hon. Mr. Hartley — 1105

Mr. Smith — 1105

Mrs. Jordan — 1108

Division on motion to postpone second reading — 1108

Mr. Wallace — 1108

Mr. McGeer — 1111

Hon. Mr. Cocke — 1113

Division on second reading — 1115

TUESDAY, OCTOBER 30, 1973

The House met at 8 p.m.

Orders of the day.

HON. D. BARRETT (Premier): I move the House proceed to public bills and orders.

HON. MR. BARRETT: Adjourned debate on second reading of Bill 81, Mr. Speaker.

MEDICAL CENTRE OF BRITISH
COLUMBIA ACT

(continued)

MR. SPEAKER: The Hon. Member for North Okanagan (Mrs. Jordan) adjourned the debate.

MR. R.H. McCLELLAND (Langley): May another Hon. Member speak for her?

MR. SPEAKER: Well, if the Hon. Member wishes to speak. It is against the rules to speak from another person's seat because they might be blamed for what you say. Hon. Members, if the Member is not in her place we must proceed.

AN HON. MEMBER: Can we wait a moment, Mr. Speaker?

HON. MR. BARRETT: Mr. Speaker, could I ask leave of the House to wait for a moment for the Member to…

MR. SPEAKER: I have another suggestion perhaps. That is, with leave of the House the Hon. Member may be permitted to speak, although she is not here when the bill is called. That's the only way I can see that it can be done.

AN HON. MEMBER: Is she coming now?

AN HON. MEMBER: How come Bill 81 and not Bill 64?

MR. SPEAKER: Hon. Member for Langley, under the rules government bills can be taken up in any order. Does the Hon. Member wish to speak on the Medical Centre of British Columbia Act? Bill 81?

MR. McCLELLAND: Mr. Speaker, it concerns us somewhat that the Minister was very brief in his comments in the opening of the debate on this bill. He said very little. In fact the only thing he really said was that the medical centre….

HON. MR. BARRETT: You weren't here.

MR. McCLELLAND: We now have a Hansard Mr. Premier, which I read.

HON. MR. BARRETT: Oh! Courtesy of the new government.

MR. McCLELLAND: It didn't take me very long to read about what that Minister said about this important bill. About the only thing he really said was that this medical centre will be given some authority.

HON. MR. BARRETT: Vote against the bill.

MR. McCLELLAND: Some authority. It will be given all kinds of authority, Mr. Speaker.

AN HON. MEMBER: Sweeping.

MR. McCLELLAND: This is far more, far more, Mr. Speaker, than a simple little bill to run the Shaughnessy Hospital.

AN HON. MEMBER: Hear, hear!

MR. McCLELLAND: We didn't need this kind of legislation for that, or to establish a medical centre on the site of Shaughnessy Hospital.

Once again, Mr. Speaker, as is so evident in the bills that this government has presented all through this session of the legislature, we find them setting up some kind of colossal bureaucracy, and this time for the overall centralization of medical services in British Columbia.

AN HON. MEMBER: Ooh! Ooh!

MR. McCLELLAND: I had an interesting conversation today with one of the people in the health services department of the Province of British Columbia. He suggested to me at that time that the local authorities could no longer be trusted with their autonomy because they did it all wrong all of the time. So now we must centralize medical care in British Columbia. We're setting up a bureaucracy, Mr. Speaker, to intrude upon all aspects of hospital planning in this province …

AN HON. MEMBER: Do you want Ralph Loffmark back?

MR. McCLELLAND:…a bureaucracy which is unparalleled in this province, to intrude upon all aspects of medical and paramedical education, and is intruding to some degree — and we don't know how far because once again this is one of those

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deliberately vague bills — but intruding for sure on the degree-granting institutions of this province.

When we talked in this House, Mr. Speaker, about the labour bills, we were told that they could not be taken in isolation, they had to be taken in concert with each other. We should have been told the same thing about the health bills in this province in this session because, like Bill 10, which was the first major bill that was presented to this House — the amendment to the Medical Services Act, this bill too, Mr. Speaker — and I think that one of the few things that the Minister said when he opened debate on this bill, he admitted that this was umbrella legislation — has a far broader implication than this government would have us believe. He used the term himself when he opened debate, "umbrella legislation." Not just a simple little bill to run Shaughnessy Hospital or to set up a medical centre in Vancouver.

It would seem to me that because of this bill, Mr. Speaker, the writing is on the wall for this province's hospital boards. Their usefulness is certainly in jeopardy as centralized medicine hits British Columbia with a vengeance. And the writing, as well as being on the wall for the hospital boards of this province, is probably on the wall for the doctors.

If you put Bill 10 together with this bill, Mr. Speaker, then look at some of the comments of our province's health tsar, Dr. Richard Foulkes, particularly his off-the-cuff comments in the paper the other day where he talked about "the end of fee-for-service" in British Columbia and the beginning of "salaried doctors," Mr. Member for Oak Bay (Mr. Wallace)….

AN HON. MEMBER: Oh, he's going into politics.

AN HON. MEMBER: He's quitting. (Laughter.)

MR. McCLELLAND: Oh, he's quitting. He knows the writing's on the wall and he's getting out while the getting out is good.

AN HON. MEMBER: He'll be long gone.

AN HON. MEMBER: Wait till Hyndman gets him.

MR. McCLELLAND: All you really have to do is listen to the Cocke-and-Foulkes act and you find out where this province is heading with its health education.

AN HON. MEMBER: Cocke and Folk.

MR. McCLELLAND: Act 3: Cocke and Foulkes.

AN HON. MEMBER: That's rude.

MR. McCLELLAND: No, that's not rude; that's vaudeville. No that's not rude. No.

You know it might be nice to know who's running the health department in British Columbia. Is it Cocke or is it Foulkes? Who's running the health department? Where does your health tsar get off blasting away about a shake-up in the civil service? Did you give him that right to do that?

AN HON. MEMBER: What's that got to do…?

MR. McCLELLAND: Mr. Speaker, this has everything to do with this bill because that's what this bill is all about.

HON. MR. BARRETT: Where's Ralph Loffmark tonight?

MR. McCLELLAND: Where does the new health tsar get off blasting the civil service of this province? He says, "Oh, Foulkes raised too the possibility of a shake-up among the provincial civil servants to provide greater efficiency and expertise in the health care system." The health tsar is going to shake up the civil service just as the rest of the civil service has already been shaken up.

AN HON. MEMBER: That's what you call acupuncture. (Laughter.)

MR. McCLELLAND: He goes on and on, Mr. Speaker, announcing health policy before this Legislature ever has a chance to understand what has been happening in the last few months. He goes on to announce all kinds of health policy and he ends up by saying that all of these great and wonderful things that are going to happen in British Columbia health care can be done through policies and bureaucracy. That's the health tsar speaking.

HON. MR. BARRETT: He's Don Phillips' twin brother.

MR. McCLELLAND: I wonder how far this new medical Act Corporation will go, Mr. Speaker? Certainly it has exceptional powers once again to get into all kinds of health-related businesses. The question should be asked — and the question was asked the other evening by the Member for North Okanagan (Mrs. Jordan) — "What kind of businesses are you going to get into with this medical corporation?" section 8 indicates that the corporation has its greedy little eyes on just about everything.

AN HON. MEMBER: Heavy-hand business.

MR. McCLELLAND: Much more.

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MR. J.R. CHABOT (Columbia River): The iron heel.

MR. McCLELLAND: Mr. Speaker, much more than just a medical research centre for the lower mainland of British Columbia.

AN HON. MEMBER: A vague blank cheque.

MR. McCLELLAND: Section 16, Mr. Speaker, removes from this Legislature — and the Premier can laugh all he wants; he's in his jovial little manner; he doesn't have the opportunity at the moment to get up and do his song and dance and his vaudeville act but it's coming, I'm sure. Before the end of this evening is over he'll do it again.

AN HON. MEMBER: Oh, yes.

Interjection.

HON. MR. BARRETT: No, I'm not in the leadership race.

MR. McCLELLAND: Mr. Speaker, it might be nice if this Premier could understand that all we really want is for this Legislature to have the right to make the decisions that are right for the citizens of British Columbia.

This bill, in one of its sections at least, removes that responsibility and that opportunity from the Legislature — the right, for instance, to determine charges made for health care in this province. It's like so many of the Acts that we've been seeing before this session of the Legislature. We're taking once again major considerations away from the realm of this Legislature. And, Mr. Speaker, through you to the Premier, that's sick. We must protect the rights of this Legislature and not take them away.

The government that boasts so much about developing a meaningful role for the legislators is emasculating that role as fast as is decently possible.

Once again, Mr. Speaker….

MR. SPEAKER: Order.

MR. McCLELLAND: Who's that, Mr. Speaker? Who are you calling to order now? Is it the Premier or the press gallery or…?

MR. SPEAKER: Not the Hon. Member.

MR. McCLELLAND: Thank you very much, Mr. Speaker.

AN HON. MEMBER: Name names.

MR. McCLELLAND: You know, if there's another thing that we've seen happening in this session of the Legislature more often than anything else, it's the sort of idea that we cut out the local influence in many of the things that we direct in our lives. There's more proof in this bill that the local elected hospital boards are being cut out of the action because of one section in this bill — section 19. The corporation that is going to be implemented in this province is going to be given total power to interfere with local decisions.

We accused the Health Minister (Hon. Mr. Cocke) in the spring of wanting to do away with local hospital boards, and he protested very much about that. But this bill is the proof that he doesn't really believe in local hospital boards. Nor does he believe in local autonomy of any kind, because he really believes that it's centralization, that it's Victoria, that it's the Minister's office that knows best.

AN HON. MEMBER: State control.

MR. McCLELLAND: You know, it's funny; when the Premier was speaking this afternoon — it's funny how often the state creeps in. The Premier talks about "the state will do this," and "the state will do that," and "the state will do something else." The Premier knows that what he really wants is state control. And the Health Minister sure knows that what he wants is centralization of all health services in British Columbia.

This corporation, Mr. Speaker, has the power to impose its will on every local hospital board in British Columbia. The Greater Vancouver Regional Hospital District has been given a role in this corporation. Some role! It can be a part of the corporation but it sure can't vote. It's being emasculated. It's a sop to the local elected officials. But they're saying, "Don't vote; no, you will be a silent partner; Shut-up and don't bother us."

It was thrown out only as a sop. You'll allow them on the board but you won't give them a vote. What kind of government is that? What a slap in the face to local elected officials! And that minister stood here in the spring and said, "We want to give local autonomy its chance. We want to give the local hospital boards all the rights that they deserve.

And they say to the Greater Vancouver Regional Hospital Board, "You can join our organization, but you can't vote." It's a slap in the face; that's all it is.

HON. MR. BARRETT: Like Social Credit and Phil Gaglardi.

MR. McCLELLAND: The name of the game of this bill, Mr. Speaker, is centralization, without a doubt: removal of the rights of the community to decide what they would like, and what direction they'd like to go to provide the health needs of their community….planning its own destiny.

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AN HON. MEMBER: Bill 42 all over again.

MR. McCLELLAND: Sure, it's like all of the bills — not only Bill 42, but every bill that this government has brought forward, particularly in this session. Get rid of the local autonomy, and turn the rights over to some centralized bureau in Victoria, centralization….

Interjection.

MR. McCLELLAND: Don't feed me any more lines. (Laughter.) Mr. Speaker, there's an exceptional quest for power in that group over there. And they're certainly getting it quickly. They want total power in the hands of the Minister, more often than anyone else. And the Minister decides the direction that his civil service is going to go. He emasculates the rights of the local elected individuals. There isn't one statute that we've seen in this session of the Legislature that doesn't enumerate that concept.

HON. MR. BARRETT: Which ones have you voted against?

MR. McCLELLAND: We'd like to be able to accept your assurances, and the Health Minister's assurances….

HON. MR. BARRETT: You'll vote for it anyway. Talk one way and vote another way.

MR. McCLELLAND: This legislation doesn't promise anything except the kind of programme that the Minister's public announcements….

Interjections.

MR. SPEAKER: Order, please. Are the Hon. Members disturbing the Hon. Member's speech?

MR. McCLELLAND: No, I'll just wait till they're finished, Mr. Speaker — okay?

MR. SPEAKER: Please proceed, or let us hope.

MR. McCLELLAND: Thank you, Mr. Speaker. You know, we'd like to accept the Health Minister's assurances that this bill does what he says it does. But, you know, judging from the past performance by this government, we don't trust your motives any longer.

SOME HON. MEMBERS: Oh, oh.

MR. McCLELLAND: Because they've become extremely suspect. And until we know the real reasons behind this kind of legislation, I don't see how we can support this legislation. What I'd like to ask is that this government take another look at this legislation. Move it over for now and allow us to have a look at the Foulkes report.

AN HON. MEMBER: Hear, hear!

MR. McCLELLAND: Because this bill and the Foulkes report are tied in together.

MR. D.E. SMITH (North Peace River): We don't want to read it in the newspapers, piece by piece.

Interjections.

MR. McCLELLAND: You know, even the Liberals understand that this bill and the Foulkes report go hand in hand.

AN HON. MEMBER: That's right.

MR. McCLELLAND: You've had the opportunity, Mr. Minister, through you, Mr. Speaker, to study the Foulkes report. You know what's in it, but we don't.

We expect to have the opportunity to read that report, but we'd like to have the opportunity before we're asked to vote on this kind of legislation.

HON. D.G. COCKE (Minister of Health Services and Hospital Insurance): I haven't had the opportunity to read it either.

MR. McCLELLAND: Mr. Speaker, the Health Minister — the vaudeville partner of Richard Foulkes — says he hasn't had the chance to read that report. That Minister can't give us that kind of nonsense because he has read the report, he knows what's in the report and he's drafted this legislation on the basis of that report.

AN HON. MEMBER: He co-authored it.

MR. McCLELLAND: Not only this legislation but other legislation that's already been in.

We've been asked to hold off. In fact, the Premier sat here earlier in this session and suggested to the Health Minister, "If you need a little more time for the Foulkes report, take it, fellas; we don't want it coming in before the end of this session."

AN HON. MEMBER: Hear, hear!

MR. McCLELLAND: Yes. "We don't want these guys on this side of the House to see that report before we get our legislation in." The Premier said that, Mr. Speaker.

All we want to do is to see that Foulkes report so that we can then analyse this kind of legislation with

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some degree of intelligence. For that reason, Mr. Speaker, because we need to see that report before we can vote on this kind of legislation, I would move that Bill 81, the Medical Centre of British Columbia Act, be read a second time on this day six months hence.

HON. MR. COCKE: Mr. Speaker, speaking to the amendment….

AN HON. MEMBER: Speaking in favour of the amendment….

HON. MR. COCKE: Speaking to the amendment, Mr. Speaker, that kind of roadblock doesn't deserve any more than one or two words, and those are that we cannot possibly support it.

SOME HON. MEMBERS: Why?

MR. P.L. McGEER (Vancouver–Point Grey): Mr. Speaker, I'd like to say just a few words on behalf of this amendment from the point of view of a medical educator.

All my professional life, with the exception of a brief period when I was a research scientist in the United States, I've been concerned with the subject of medical education.

I have a great deal of respect for the Minister of Health and the job he is trying to do for the Province of British Columbia, but I think that with this piece of legislation he has made a monumental error. If it goes through in the form that it is in tonight, all of what he has done will have to be undone in the future. I'd like to explain my reasons for saying so.

This particular Act places two incompatible objectives under the aegis of a single, non-medical board. Those objectives are to provide referral care and service and to provide education at the same time. I know of no place in the world where these objectives have been successfully pursued together, even under the aegis of a professional board. What the Members of the official opposition really need to see, as well as the Members of the government, is not just the Foulkes report but the Shortliffe report as well.

The Shortliffe report was something commissioned by the Minister of Health and, even though it was presented to Foulkes and his committee, the recommendations of that report were, first of all, that the Shaughnessy site, which is to be selected as the B.C. medical centre and to be under the control of this super-board, should be only a regional hospital. Although I haven't read the report in detail, I suspect the reason for that was the disastrous experience occasioned in the Province of Ontario when the Sunnybrook Veterans Hospital was taken over by the University of Toronto for the purposes of teaching.

Secondly, the recommendation was made that, for proper teaching as it should be, an appropriate hospital should have been built on the University of British Columbia campus where there is approximately $30 million to $40 million worth of irreplaceable, basic medical facilities, including a library and all the training facilities for the basic medical sciences.

Thirdly, the Vancouver General Hospital, which has been the principal referral hospital for all the province of British Columbia and contains residual skills of a kind not found in any other hospital centre in British Columbia, should be retained and strengthened for that referral purpose.

But regardless of the recommendations of the Shortliffe report, the basic problem of the particular bill presented by the Minister of Health is simply this: he has placed all the power for education, whether it be for doctors, nurses, dentists, or paramedical personnel of any kind, under the aegis of this super-board which has as its president a pulp mill executive, however able he may be. It has a hospital administrator, an accountant, and a member of another integrated forest company.

MR. SPEAKER: Excuse me for interrupting the Hon. Member, but, as you know, the debate on a motion of this kind deals with the advisability of the matter being read a second time six months hence. You are apparently dealing with the merits of the bill itself which could well have been done in principle.

MR. McGEER: Mr. Speaker, please bear with me. (Laughter.)

MR. SPEAKER: How long?

MR. McGEER: With all due respect, Sir, it's important, I think, that all of the Members of the House as well as the public recognize what is required to provide appropriate education for people that we ultimately depend upon to save lives and to preserve health. When you place this responsibility in the hands of people appointed by the government, who are non-professionals — and who in turn appoint members of an education committee not defined at all in this Act — but have the power to appoint or terminate people who are not necessarily associated in any way with the skills that are vitally necessary to doing this job effectively, what you're effectively doing is placing in jeopardy the whole educational system in a field where competence is just as vital as in flying a jet aircraft.

HON. R.A. WILLIAMS (Minister of Lands, Forests, and Water Resources): Oh.

MR. McGEER: Mr. Speaker, it's all very well for the Minister of Lands and Forests to groan. You can

[ Page 1096 ]

afford to make mistakes in condominiums or pulp mills or land zoning. (Laughter.)

HON. MR. BARRETT: Doctors bury their mistakes.

MR. McGEER: Yes, they do, Mr. Speaker. What we want to do is develop a system where there are as few mistakes as it's possible to have considering the frailty and the inevitable errors that are occasioned by lack of human skill and lack of judgment.

Mr. Speaker, I can only say that the training of medical personnel is a very serious matter. Over many hundreds of years, it has been marshalled very carefully in the hands of people who are completely responsible and have had the torch of education passed down to them generation upon generation and have held to themselves, I think appropriately, the responsibility for setting forth the circumstances as well as the course of education that's appropriate to producing the essential skills.

What this particular piece of legislation does, Mr. Speaker, is to place in jeopardy that whole tradition because, quite clearly, this is taken away by the terms of the Act. It's to be placed in the hands of this super-board. This large medical centre is to be placed under their direct control, as well as the whole health planning of British Columbia which is to be placed in their direct control.

What is clearly needed, Mr. Speaker, in the Province of British Columbia now and in the future is to have a clear separation of the educational responsibilities — which quite properly belong with our medical schools and universities — separated entirely from the development of hospital and referral services which can appropriately be placed under the control of hospital boards. When you try and take education and mix it, as this bill does, ill-advised….

HON. A.B. MACDONALD (Attorney General): Bring it into the real world. (Laughter.)

AN HON. MEMBER: You don't believe that.

AN HON. MEMBER: He doesn't believe anything.

MR. McGEER: You could democratize the flying of jet aircraft just as you can democratize the skills that go with heart surgery, but it isn't likely to serve the passenger who depends upon the ultimate development of those skills. That doesn't go with control by lay personnel; it doesn't go with the kind of super-board which is envisioned in this Act.

Mr. Speaker, I'm not really criticizing the Minister of Health in a way. I think he's done an excellent job and I certainly admire his motivation. But as far as this particular Act is concerned, Mr. Speaker, he has received bad advice. If he doesn't seek better advice, if he doesn't bring in appropriate amendments that will take into account the separate requirements of education and service, then what he will succeed in doing is a disservice, not to the medical profession or the nursing profession or the orderlies or all the paramedical personnel who are responsible for looking after patients, but a disservice to the patients themselves.

In the long run, by the passing of this Act and the implementation of its intent, we are inevitably going to lower the standard of health services that we can deliver in this province. What will happen is that we will lower the level of medical skills that we have available to offer to the people of British Columbia.

Mr. Speaker, I don't care how much you set aside in the way of financial resources for health care. If you lack the skills that are required to deliver health care, then no amount of money is going to cure the problem.

Of course, what ultimately happens to so many people in this world is that they finally get to the point in life where they themselves and the state of their own health have reached the limit of available medical skills, and where they become the victims of the work that should have been done in past times and has not been done.

I just say in summing up, in supporting the amendment of the Member for Langley (Mr. McClelland), that he has a great deal of wisdom in bringing that amendment forward and that this House would be well advised to inspect very carefully the findings of the Foulkes report and the Shortliffe report. All Members should search their consciences individually and ask themselves this question: How best can we develop medical skills in this province? What vehicle will achieve that?

If we fail to answer that question well, then we're going to make the kinds of decisions in this House that will leave the citizens of British Columbia shortchanged in their hour of greatest need.

HON. MR. BARRETT: Mr. Speaker, I enjoy the opportunity of speaking in this debate because, really, this kind of amendment brings into focus the principle of the bill. In terms of the last Member who spoke, we were given a series of opinions that are based, frankly, on his work experience and his approach to the profession and to medical practice as he sees it. I find that somewhat different from what were nothing more than insults to the Minister and insults to Dr. Foulkes from the spokesman of the Social Credit opposition group.

AN HON. MEMBER: Arrrrgh! (Laughter.)

HON. MR. BARRETT: At least with the Liberal Party there was a statement of reason why he would

[ Page 1097 ]

support this amendment, not based on invective or personal attack. When we were in opposition, whenever there was any hint of that kind of thing, the immediate government reaction was, "There you are, attacking the civil servants." Some of you will remember that standard device.

MR. McCLELLAND: What civil servants?

HON. MR. BARRETT: Now let's deal with the statements given to us by the question raised by the former leader of the Liberal Party, Mr. Speaker. I must say that, in my opinion, his arguments are based on an elitist view of life. There is a presumption here on an élitist that only the doctors in the world know what's best for the education of doctors and paramedical services.

The parallel that he's offering us is that only teachers should be on school boards. That's really the parallel — the suggestion that the board is made up of representatives from the forest industry and from the community at large is an impression somehow that those people, as competent as they may be, can't make decisions about budgeting, about financing, about administrative planning, or construction — that it has to be just the élitist at the university.

I do not hold any brief for the former Minister of Health (Mr. Loffmark) but I will respect him for one particular thing that he tried to do, but was forced to knuckle under in that struggle. He tried to take on the medical profession in some of their worst aspects, in terms of their attempt to closet themselves away from the rest of the community around their planning. In that sense, Mr. Loffmark was attempting to break out of the mould. He got trapped into the exchange that led to his downfall in terms of that tape recording and the attacks on him — which we played a part in too.

But he had no support from his cabinet, and certainly no support from the former Premier. But he did have support from backbenchers who, down the line, spoke for the little people of this province, asking for better medical services and better health care delivery throughout the province — not at the centre of the University of British Columbia, but throughout the province.

For years we have paid millions of dollars for a medical school that, in my opinion, has deliberately kept down the number of students going through that school. Only 80 students last year. The amendment means that we're going to…. If you delay this bill it may mean the continuation of the kind of system that centralizes the control of that closed-union, backward shop in the hands of a few doctors who haven't looked forward for years in this province.

This Minister of Health has had more guts to tackle this issue head-on; and even the newspaper columnists who've written about this approach have said, "Well, he may not get political kudos for it, but at least he's had the guts to make a decision that every previous Minister has shied away from."

I support him completely. Eighty students, Mr. Speaker, when we should be graduating 160 medical students every single year…and only 80 in that closed shop. What is their monopoly on such genius and training? I tell you, I've worked with doctors too, and some doctors are dumb-bells, Mr. Speaker — just as some social workers are dumb-bells and some lawyers are dumb-bells.

Doctors do make mistakes. But the location of the medical school isn't going to make the change in whether or not they make a mistake. It's a question of facilities and the quality of the teachers that's going to make the difference and, more than anything else, the variety of experience of real life outside of that university world.

I want to give you an example of what went on at the University of British Columbia, and how the former government was trapped into planning a mental health centre that was a straight nonsense proposal. You want us to go back to that same bag? I ask you, Mr. Member, to go back and examine what happened when the mental health centre was built at the University of British Columbia.

It was planned by doctors. It was sold by doctors. The former administration, through Mr. Loffmark, finally gathered itself together to oppose the opening of that institution because at that time the rates for that hospital were outrageously high. This bill is an attempt to move away from that syndrome.

AN HON. MEMBER: Come back to the amendment.

HON. MR. BARRETT: Oh, yes. Come back to the amendment. You'd give him leeway and him leeway, but you don't want to deal with some facts related to that.

Interjection.

MR. SPEAKER: On a point of order?

MR. SMITH: Mr. Speaker, the House, except for you, gives no one leeway in debate. The opposition did not give anyone leeway in debate: the Premier, the previous speaker or anyone else. It's yourself, as the person who controls the debate in this House, who decides whether you will give leeway or not. No one else.

MR. SPEAKER: I've tried to indicate to the Hon. Members that they should direct their attention to the advisability of delaying this matter of debate on second reading to six months hence. The Hon. First Member for Vancouver–Point Grey (Mr. McGeer) did not receive objections to his stand although I, as

[ Page 1098 ]

Speaker, did object to the extent of his debate on what amounted to second reading of the bill in principle. He persisted, and the House seemed to go along.

I think it only fair on both sides of the House that if we're going to apply the rules, they be applied strictly or they be applied evenly: take your choice.

HON. MR. BARRETT: Mr. Speaker, the question of delaying this means a delay in training medical students and a delay in training paramedical students that are sorely needed throughout this whole province. The question of centrally locating at the university…and I refer you to the one decision that the former Minister of Health was forced into — that psych centre, that mental health centre, at UBC. It is totally unrealistic. Hopefully it is going to be incorporated in this new medical centre.

HON. MR. COCKE: It is.

HON. MR. BARRETT: I'm pleased to hear that, Mr. Minister.

But the doctors at UBC came and sold the former administration on a multi-million dollar construction for a mental health facility in which there is absolutely no relationship at this very day to the reality of mental health services in the community in this province.

It is an upper-middle class resort, Mr. Speaker, that is designed to teach student doctors about mental health facilities that don't even exist in the Province of British Columbia.

It is an anomaly in the total package of mental health services and the delivery of health services. If we are going to allow the continuation of that kind of élitist planning that has no connection whatsoever with what's going on in the real world, we would be failures as legislators, and any delay in passing that bill would continue it.

Mr. Speaker, when a mother of five children suffers the trauma of being deserted in Pouce Coupe in British Columbia, and she is asked to come down and spend two weeks at the Mental Health Centre at UBC, and be given her meals, and be given her services on a training schedule serving the training purposes of that institution that bears no relationship to her social and psychological problems as they relate to Pouce Coupe, then we're spending millions of dollars that are totally unrelated to the realistic experiences throughout this province.

I say that the doctors of this province must start to move away from that centralist concept and get out into the real world. This Minister has had the guts to say "That's how we're going to approach medical service training in the Province of British Columbia."

MR. McCLELLAND: The Minister never made the decision.

HON. MR. BARRETT: You know, Mr. Speaker…. "The Minister never made the decision." You have not followed what has gone on in the medical history of this province in the last 15 years. I hold no brief for Mr. Loffmark, but the one time that he attempted to stand up to that kind of decision-making that was made by vested interests in the medical profession, he was hammered down. Only his backbenchers supported him — not a single Member of his cabinet went with him.

Yes, yes, the Member that sits here in this House tonight. How ironic. Mr. LeCours, who for years from Richmond fought on this very issue as a grassroots Socred, and had the support of other grassroots Socreds. But where is that great party tonight, Mr. Speaker, on this issue? Six-month hoist! And what does a six-month hoist do for the people in the north, the Peace River that they talk about, and the Cariboo and the Okanagan and Invermere? Mr. Speaker, I suggest to you that this Minister of Health has given more leadership in one year in getting health services going in this province than we've had in 15 years under Social Credit.

Any attempt to delay this bill is a commitment to that old walk-step concept that only the élite in our society know best. Well I put trust in the ordinary people, Mr. Speaker. I don't insult these board members, some of them from industry and other walks of life, who give hours of their time voluntarily to guide the development of better medical services for the citizens of this province, and none of whom are NDP members. Leading industrial figures who have been willing to take this job on, none of whom are sympathetic to the NDP but who have said, "Okay, you've called on us."

You tell me that Mr. Christiansen of Tahsis is an NDP member? Mr. Speaker, I've got news for you….

MR. CHABOT: No, he's got bucks.

HON. MR. BARRETT: He's got bucks, eh? The most bucks are over there in the Socred free enterprise education fund, and you are not going to get near those, my friend, You can't tell me that these citizens who have come out from their own walk of life, who have donated their time under this Minister of Health, and who have said, "Yes, we go along with it," and they have their years of experience…. I say to you, Mr. Speaker, anybody who votes for this delay is against the ordinary people of British Columbia, and we reject it completely.

Interjections.

[ Page 1099 ]

MR. SPEAKER: Order, please!

MRS. P.J. JORDAN (North Okanagan): Hysterical maniac.

SOME HON. MEMBERS: Oh, oh!

MR. SPEAKER: Order, please! Will the Hon. Member kindly withdraw that remark?

MRS. JORDAN: I beg your pardon?

MR. SPEAKER: Would you kindly withdraw that remark?

MRS. JORDAN: Which remark?

MR. SPEAKER: Your remark.

MRS. JORDAN: Which remark? I want to know….

MR. SPEAKER: You know what you said and I know what you said and a lot of other people know what you said. I just simply ask you to kindly withdraw it.

MRS. JORDAN: That the Premier acted like an hysterical maniac, Mr. Speaker? If you insist, I'll withdraw it. But if the people of British Columbia could have seen that performance….

MR. SPEAKER: Order, please!

AN HON. MEMBER: Come on! Try to be a lady.

MRS. JORDAN: I don't care. I'm concerned about the people of British Columbia.

MR. SPEAKER: Order, please!

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Mr. Speaker, I'd like to rise in support of this motion. I hope that a matter as important as this can be dealt with this evening with some degree of care because it is a very important one for Members of this House — in fact for the entire Province of British Columbia — as to whether or not this bill is read now or some six months hence.

I listened with interest to what the Hon. Premier has to say and I was reminded, as any first year student of philosophy recognizes, that if you establish a false premise you can reach any conclusion. The Hon. Premier tonight, when discussing this amendment, chose as his false premise the fact that the medical profession are all elitists, that they have no concern with the medical services in the Province of British Columbia and that to delay this bill would in any way continue that existing situation.

HON. MR. BARRETT: Just that Member….

MR. WILLIAMS: The fact of the matter, Mr. Speaker, and the reason that I support this amendment, is that the Hon. Minister of Health, when opening this debate, did not in any way indicate that the principle of Bill 81 was what was enunciated by the Premier in his remarks a few moments ago.

The Premier seemed to indicate that this medical centre to be established in the City of Vancouver under some new administrative mechanism will suddenly remake medical education in British Columbia, and allow the mother of five children in Pouce Coupe to come to the City of Vancouver in this new medical centre and somehow or other enjoy the kind of treatment which she couldn't expect to receive in Pouce Coupe.

Mr. Speaker, this is the fallacy of what the Hon. Premier said and of this whole legislation, because all that we are going to create, if this is to be a medical training facility, is another first-class, stainless-steel, chromium-plated organization for the training of the medical profession within the Province of British Columbia.

The Minister did not give us one glimpse of what will be required if we are to have medical and paramedical people in this province trained with the understanding and the capabilities of carrying medical services to Pouce Coupe and similarly isolated communities in the province. Not one word did he say when moving the second reading of this debate.

As a matter of fact let us consider, Mr. Speaker, exactly what he did say. In a page-and-a-half of Hansard, — and that was how little the Minister thought about a bill which the Hon. Premier says is so important that we deal with now — he says:

In rising to open this debate I would just like to say what the purposes of this Act are. The reason that we mainly felt it to be absolutely essential was that the health services, as they relate to education, were having a great deal of difficulty.

He continues:

The health services as they relate to tertiary care were having a great deal of difficulty, and we just…

and I ask you, Mr. Speaker, to pay attention to these words —

…knew of no other way than to tie the services together under an umbrella organization that could best coordinate these activities. We just knew of no other way.

Mr. Speaker, I agree with the Hon. Premier that the Hon. Minister of Health has made significant advances in investigating the need for new, modern and in some cases experimental health care delivery facilities

[ Page 1100 ]

in British Columbia. He has done that, Mr. Speaker, with the assistance of a medical doctor, a man who I understand is of considerable skill in his field, and with the group that that doctor has organized around him — I speak of Dr. Foulkes.

I don't criticize Dr. Foulkes. I think that every Member in this House and every citizen of British Columbia should be proud that a doctor would give of his time and of his energies to undertake such a task as he has over the past year; and I think the Minister must be proud of Dr. Foulkes.

But Mr. Speaker, if I were Dr. Foulkes and his group, and if I had worked as hard as those men have worked, tirelessly, hour after hour in helping to bring to this government a report which would indicate the direction which health care delivery would take in British Columbia for the future years, only to find that the government had moved to establish a health science centre located in the City of Vancouver before that report indicating the new direction that we are to take in the province was even delivered to the Minister and tabled in this House, I would think that I had been betrayed. And this is a good reason to defer the second reading of this bill.

If we are to embark upon a new direction of health care delivery in this province which will serve the needs of these outlying communities such as Pouce Coupe, who have been so badly served over the years, and if as a companion to this new system of health care delivery we are to have new and exciting techniques in the training of medical and paramedical personnel, then let us make certain that the medical health sciences centre that we establish is going to be a centre established in the full knowledge of what Dr. Foulkes and his group are recommending to this government. And from the report that this government is prepared to bring into this House and support, we, the government and the people, will know that the health centre we establish is going to be a necessary adjunct to this new direction in health care that we are taking.

But no; the Minister says, "We just knew of no other way." But if the Minister hasn't seen the Foulkes report, then how dare he bring in this kind of legislation when it may not fit with what Dr. Foulkes is prepared to recommend?

I agree with the Hon. Premier; perhaps the medical profession has had its own way for too long, perhaps we have been training doctors and dentists and other paramedical personnel in the wrong way, perhaps we have been establishing a group entitled to respect within our society, but a greater measure of respect than in fact their talents deserve.

But if we are to go in this new direction, then let us do so on a sound basis. Why else have we had the Foulkes group moving about the province except to come back to the government and say, "Gentlemen, this is the way to go," and with that, to come before this Legislature with a clear indication that this government is prepared to follow the recommendations, in whole or in part, is prepared to finance whatever costs that new direction may take, and is prepared to establish the training facilities and the new direction in medical training that is necessary in order to fulfill the health delivery care requirements which this government is prepared to support.

It's easy to criticize this bill, and it's not appropriate during the discussion of this amendment. But what we are being offered by this government is their guess at what they think will best serve the training of medical personnel once we recognize what the new health care direction is going to be in this province. We're guessing, the government is guessing, and it's too important a matter for those people of this province who are in need of care and those who will finance future medical-care expense to take.

What's the rush? The Premier says that if we don't move now we're going to lose all of the opportunity to train these doctors. Mr. Speaker, if this government wishes to carry on the necessary discussions with the national government to make available Shaughnessy Hospital, if they wish to take the beginning steps in organizing the administration of such a centre in the hopes that it will be in accord with what Dr. Foulkes recommends, they can do this. We have a department in government whose responsibility it is to do such things. The Minister agrees, I understand.

Mr. Speaker, let the Minister with his department take these steps and, when he has seen the Foulkes report, when we have seen the Foulkes report, when the medical profession has seen the Foulkes report, and when the public recognizes the direction that we're going in health care, then let him bring in legislation which will ensure that future doctors, nurses, psychiatrists, whatever the case may be, will be trained to fulfill what Foulkes recommends.

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, I'd just like to preface my remarks by heartily refuting the conclusion of the Member for Langley (Mr. McClelland) that I've decided to leave medicine for a while because I see the Foulkes' writing on the wall. I would just like to regard that as just a typical remark that often follows the happy hour when we come back at night, Mr. Speaker, this is a very important bill, and I would have preferred to speak on the bill itself rather than on the amendment. But I find from past experience that usually when the amendment is voted on, the bill will go through very quickly. I prefer to make my comments on the amendment.

HON. MR. BARRETT: Like everybody else.

MR. WALLACE: Like everybody else.

[ Page 1101 ]

MR. SPEAKER: You won't be any more out of order than anyone else, I guess.

MR. WALLACE: Mr. Speaker, this bill, I'm sure, is written with the very best of intentions by the Minister and perhaps with a real sense of frustration at the lack of apparent progress in the existing structures which are available to provide expanded health care delivery and also expanded services to train people we need so badly.

A main emphasis of the bill is on education and a mention of paramedical personnel. The Minister knows as well as anybody in this House, and probably as well as anybody in the province, that we definitely do need more doctors. I agree with the Premier that the attitude of the former administration was shocking. The attitude of the former Premier (Hon. Mr. Bennett) was simply this: when we can draw on doctors from all over the globe, why bother to spend tax money training your own sons and daughters? This was a despicable, callous, indifferent attitude of Premier Bennett — the kind of attitude that could draw nothing but disdain from professional people and certainly from this backbencher.

SOME HON. MEMBERS: Here, here!

MR. WALLACE: While I hesitate to heap invective — and I've tried so very hard the four years I've been here not to do this — I have to say at this point and time that that was one of the coldest, callous, inhuman decisions that man ever made, perhaps second only to his attitude to the citizens of this province who required chronic health care.

While I have grave reservations about this bill, I have no hesitation standing here tonight and saying this represents a great progress and a sign of hope and a better, human attitude than ever existed with the former administration.

HON. G.V. LAUK (Minister of Industrial Development, Trade and Commerce): Nice shot, Scott.

MR. WALLACE: Having got that out of my system….

Mr. Speaker, I realize that that kind of attitude only defeats the purpose of trying to discuss this very important bill in a rational and objective way.

I sense in this bill a real intention and a hope to answer some of the problems facing British Columbia in trying to plan the programme of health delivery services and the training of the personnel required to provide these services.

I can only say that if you brought in this kind of bill relating to Victoria, I would be right behind you 100 per cent. The planning, the delay and the shocking indifference on the part of many people in this city regarding the planning of hospital health facilities is nothing short of a disgrace. I don't know what the answer is, but all I know is that in the 12 years I've been in this city as a resident it would be easier to get blood out of a stone sometimes than create facilities which everybody pays lip service to as being necessary but nobody seems to be able to get the action going.

If the Minister, Mr. Speaker, is frustrated, so am I. And I sense in this bill — much as there is wrong with it, with respect, Mr. Minister; there's a lot that I would like to see otherwise — some kind of despair in the bill saying: for God's sake, let's get something done; stop talking and get some action.

Frankly, if I might interject, I don't think it matters two hoots whether we have the Foulkes report tonight, next week, next year, or 50 years from now because I'm not sure that he knows what he's talking about. (Laughter.) That's a personal opinion based on off-the-cuff statements, and some of his own interpretations.

But regardless of that, let's stick to the bill. I would just say that this bill can be judged on its own merits, regardless of the Foulkes report. The fact is that the bill attempts to define a centre where highly specialized care — and I must confess that the word "tertiary" was new to me. I thought that tertiary treatment referred to sewage (Laughter), but I understand it can also be applied to the highly skilled level of care not available in a local or a provincial hospital. But the highly specialized facilities that are required should be developed in such a way to be a great pride to all of us in this province and, in fact, in Canada.

I support the concept of trying to develop such a centre, I have to wonder, however, if the Shaughnessy site….

MR. McCLELLAND: Point of order.

MR. SPEAKER: Yes, on your point of order?

MR. McCLELLAND: I understand that the Member doesn't want to wait to talk to the principle of the bill but, Mr. Speaker, the Member is talking to the principle of the bill and not to the amendment. I would ask that the Speaker ask that he speak to the amendment.

MR. SPEAKER: Well, I've tried to be as lenient as possible because much of the discussion goes on around the principle of the bill related to why it should be read six months hence or why it should be read now. Therefore you inevitably plunge into the debate on the principle of the bill. I would ask the Hon. Members to try to relate their remarks, if possible, to the advisability of the bill either being read now or being read six months hence.

[ Page 1102 ]

MR. WALLACE: If I could have the right to speak to the principle of the bill after the amendment, I'll be quite happy to do it.

HON. MR. BARRETT: Mr. Speaker, on a point of order, it's my understanding that your ruling was, when the same point was raised with me, that because previous speakers in the debate had also strayed, your approach was an even approach to all sides of the House. By the time I had spoken, the pattern was set in the debate that included the kinds of comments that the Member is now making, that I made and the Member for Vancouver–Point Grey made. I find that the point of order cannot be well taken when implying that what applies to one Member of the House doesn't apply to another. I say the Member is thoroughly entitled to expand on his remarks right now.

MR. McCLELLAND: Either we have rules in this House or we don't. As long as we have rules in this House then we stick by them, and if there's an amendment before the House we speak to the principle of the amendment, not to the principle of the bill.

MR. SPEAKER: May I point out to the Hon. Members that it's quite correct that we do have rules in the House. I pointed out what the rule is, but when Members infringe upon the rule there's another rule of the House that has always been applied too. If one opens the door, the other can walk in too.

AN HON. MEMBER: Hear, hear!

AN HON. MEMBER: Yes, but it was the Speaker who opened the door.

MR. SPEAKER: Order, please. It may be a criticism of the Speaker; I agree with you that I should be criticized for letting one side speak on wider matters and then not permitting other Members to do so.

AN HON. MEMBER: How long does that go on?

MR. SPEAKER: Well, it usually ends up in this way: you discuss the principle of the bill during your debate on the amendment, and by that time you've exhausted yourselves when it comes to the main part of the bill. So I certainly would ask the Hon. Member to try to confine his remarks to a certain extent at least, as some other Members have.

MR. H.S. SCHROEDER (Chilliwack): I hope the same lenient attitude you've had for some of the other speakers….

SOME HON. MEMBERS: Oh, no!

AN HON. MEMBER: We want to stick with the rules!

MR. SCHROEDER: Since we are the only party that has not yet spoken to the amendment I'm sure, Mr. Speaker, that the same lenient attitude that I must congratulate you for will pervade now during these next few moments.

MR. SPEAKER: I always believe that those who crave equity should do equity.

MR. SCHROEDER: Thank you, Mr. Speaker. Maybe you and I could have our debate outside, (Laughter.)

I'd like to support the amendment to have the bill read six months hence. I'd like to just give briefly some reasons why I believe the bill needs at least six months to cure.

I don't believe the government is secure at all in its position or in arguments that it has presented for this bill right now. I've listened to the Hon. Premier saying that the reason why we need to have this new corporation and this new location for a health facility is that the one that exists, namely the one at UBC, is an elitist facility and that only 80 students per year are being graduated there, supposedly because that's all the facility will accommodate. Then he suggests that we need to get going immediately to change the location of the facility, to shift the facility to another address in hopes that this will take away its artist quality. He even suggests that it may have some effect on someone who shifts all the way from Pouce Coupe, Alberta. (Laughter.)

AN HON. MEMBER: Wha-a-at!

MR. SCHROEDER: Pouce Coupe, B.C. (Laughter) to use your phrase, Mr. Member, I stand corrected.

But to dare to suggest that it will make a difference to a lady with five children, whether she's transported from Pouce Coupe to UBC or whether she's transported from there to an address now known as Shaughnessy Hospital — will make some difference to the kind of health care that is provided to her — is a ridiculous argument. If that were the only reason why we should act now, I'd say that that's not reason enough.

Also, with all due respect to the Member speaking just before me, to say "Let's do something now, we've waited for 15 years" — or 10 years, or 12 years or whatever the time was — "we've waited all this time to get some action, let's move in any direction right now," is as ridiculous an argument as the one I've just noted, because to move in any direction at all is not necessarily to move toward your goals.

[ Page 1103 ]

AN HON. MEMBER: You could move backwards.

MR. SCHROEDER: When you don't know what the Foulkes report is going to recommend, to move in any direction gives you 359 degrees chance out of 360 that you're going to move in the wrong direction. Therefore I would suggest: why not wait until we see the Foulkes report and find out what it recommends? Then let's move in that direction. At least it gives us one chance in 360 that we might be moving in the right direction if Mr. Foulkes is correct in his recommendations. For the Hon. Minister of Health (Hon. Mr. Cocke) to say that he has no knowledge of the Foulkes report, and yet to say adamantly that he knows what direction it is that he needs to move in, is also incongruous. Wait till it comes in, as I say, and read it. It may recommend the exact antithesis of the direction that we are going.

One of the reasons why I would like to say let's wait six months is because the government has suggested already that it is not sure of its direction. The Minister, in introducing second reading, was so brief in his remarks that it gave us every reason to believe that he's not sure what direction he needs to move in. When he is supported by the Hon. Premier, the Premier stands, he shouts, he rants, he raves and he falls suspect, because in the college which I attended and in which we learned supposedly the art of public speaking, we also learned this: whenever you haven't got much to say, then stand up and yell as you've never yelled before. You may impress somebody with the fact that you have convinced yourself.

AN HON. MEMBER: That's vaudeville!

MR. SCHROEDER: I say another reason why we need to pull the bill and have it read six months hence is that the government is not sure itself of its own direction.

I ask: what's the hurry? I would like to put my finger perhaps on a sore spot. Isn't the real hurry the fact that we have already committed funds that have not been provided for in any Act of legislation to be expended in the month of November, and that the reason for the hurry of this bill is that we've got to make sure that we can stick to those commitments, and that we have first to pass a piece of legislation in this House to make it all possible? Isn't that the hurry?

AN HON. MEMBER: That's right.

MR. SCHROEDER: I'm just wondering if that isn't the hurry. In either case, in any of the five instances that I have suggested, I see no reason to move now. The Minister has already given indication in at least one other instance that he has a tendency to jump the gun. I say, let's wait and see what those who are knowledgeable have to say, and I'd like to give that credit to Mr. Foulkes, although the former speaker doesn't believe that that's right. Let's at least allow the man the credibility that he deserves and let's listen to his report and look at it.

I say, Mr. Minister, that I appreciate your position, through you, Mr. Speaker. I appreciate what you are trying to do. I travelled the entire summer listening to people saying exactly what you're trying to say, I know that there is some sense of urgency to why we should be moving now and not waiting forever, but let's move in the right direction.

I know that you're doing a good job. I know that you're doing the best that you know how to do, but why not wait until the advice of the learned people, the wise men, the elitists even, give you what they have to say? I'm sure that both you and I can learn from it.

MR. G.B. GARDOM (Vancouver–Point Grey): I very much subscribe to the remarks of the last speaker. I think that he summed up in an exceptional fashion the very crunch of this argument.

You know the former administration, Mr. Speaker, would have untold commissions, royal and otherwise. We had the Clyne Commission on expropriation, the Morrow on liquor, the Carrothers on public service and the Perry report on education, but they would either never release the results or they wouldn't act upon them.

This administration then takes a 180-degree turn and orders reports, but it doesn't wait until they arrive and then it decides it's going to bring in very innovative legislation which could well superimpose upon the hearings, the studies and the findings of their very own requests that they've asked to come from the professional side, from the community, and from Dr. Foulkes.

I would suggest to you, Mr. Speaker, that in both cases the people who have been rooked as the result of this kind of attitude to the use of public funds are the public because it's their dollars that are being spent. They're not receiving value because either the results of these extremely expensive endeavours are not being received, disclosed, or acted upon or the results of these very expensive endeavours are being totally disregarded and legislation is being superimposed before they can even come before the House, before the cabinet, before the Ministers, before the Members of the government or before any people in the Province of B.C.

The Hon. Member for Oak Bay (Mr. Wallace) recognized extremely difficult problems in health care which I may say were appreciated and recognized by all Members of the opposition in years gone by. But it's rather peculiar to me that the Hon. Member for Oak Bay has found it very easy for himself to prejudge the results of Dr. Foulkes' report

[ Page 1104 ]

before it has even been before him or before anyone else in the province.

I think that very valid reasons were advocated by the First Member for Vancouver–Point Grey (Mr. McGeer) who just stated in simplistic terms that we have to have the most available professional skills. I also think that very valid attitudes were enunciated by the Premier when he talked about élitist abuse. There is perhaps élitist abuse in the medical profession but that's not just common to doctors; we find élitists abuse in every level of society. Make no mistake of that fact.

I think the very crunch of the argument, as I said at the outset, is that we have the government requesting this expertise, the government has total confidence, obviously, in Dr. Foulkes or they would not have given him the mandate to do the job, and you're absolutely pulling the carpet from under him and all of the people who have been working many, many months to try to come up with a valid direction to give intelligence, to give some kind of basis whereon the government can arrive at a pragmatic decision to act. You're ignoring all of that. I think that's shocking and that is the reason why I'm supporting the amendment.

MR. D.A. ANDERSON (Victoria): Mr. Speaker, the amendment is very simple. It's a question of time. And the only point of the amendment is for delay — a request for a delay of six months, a traditional motion — but basically delay until such time as the Foulkes report is presented.

The argument of the Member for Oak Bay was the only one so far presented that made sense in terms of accepting this legislation, because he doesn't believe in the Foulkes report, he has no faith in Dr. Foulkes; therefore there is no need to wait for any report to come forward. His was the only logical position in support of this bill.

For the government to accept his logic and vote for this bill would be, I think, an absurd situation, unless the Minister would like to tell us that he knows in this area that this is what Dr. Foulkes is going to recommend. That would be the only other excuse which, of course, he has not given us; indeed, he's said quite the reverse. He's said that he's not seen the report and he doesn't know what's in it.

Interjection.

MR. D.A. ANDERSON: Well the fact is that you cannot separate the two. The fact is that in this situation you can carry out all the proposals made by the Premier or by the Minister without the administrative re-organization that this bill entails.

As far as the arguments put forward really we've seen nothing except the traditional government approach: when faced with an argument that they cannot meet they either attack the individual who put the argument forward or they attack the individual's profession. This we saw tonight in the attack upon the University of British Columbia, in the attack upon the medical profession, but still no argument whatsoever directed to the need for speed to get this legislation through.

The Minister has indicated during this debate that pretty well everything that this board can do in terms of changing medical education in the province can be done by other presently-existing means. There is no need for this board at this time. Therefore the motion for the amendment, the motion in favour of giving this bill a six-month hoist is, I think, completely valid.

We can always bring forward legislation at another time when the Foulkes report is available and we've had a chance to examine it. But to bring this thing before us at this stage really doesn't make any sense at all in terms of having a rational acceptance of legislative proposals from the government following an examination of the difficulties and the problems.

It may be that the Foulkes report does suggest such a board. I don't know. I've no idea. I can't tell. And I presume that the Minister doesn't know either, from what he's said tonight. But if it does put forward such a report what are we going to do? Withdraw this amendment or have legislation repealing this legislation that we're going to pass this evening if the government has its way? Of course not. Apparently this is the direction that the Minister of Health wants regardless of any information that he may get from experts.

You know the argument that has been put forward about the woman in Pouce Coupe is great stuff, but this legislation doesn't deal with her problem. The argument's been put forward that we need it to get 160 places in the medical school, but this legislation doesn't give us those 160 places. This legislation is a reorganization of a type which may or may not make sense, depending on the acceptance of the Foulkes report. To put it forward at this time, to ask the opposition or the government backbench to accept this type of legislation in the dark is, I think, a very foolish point of view.

We have to have the basic material before we can proceed. This is the reason we in the opposition have, month after month, accepted the excuses of the government when it came to questions in the medical field, when it came to dealing with chronic care and the year that's gone by when the elderly people of this province have suffered badly as a result of indecision in this area. We've waited, we've waited; we've waited because of studies being done.

Now we see the government indeed say in this legislation that delay is not necessary, and of course the argument is true with everything else that's gone up to now. We feel that this amendment to delay is

[ Page 1105 ]

necessary in the light of the lack of knowledge put forward by the government, a lack of information put forward by it on government intentions in the future. The excuse they've used is the Foulkes report; therefore we think that there is no way this legislation should go forward without the Foulkes report.

HON. W.L. HARTLEY (Minister of Public Works): I think we can summarize what the former Member and what the opposition has been saying. They're asking for further procrastination.

In 1919 the Liberal Party of Canada promised Medicare. In 195 8 John Diefenbaker, a Conservative, set up a commission. And 49 years later, 1968, we finally got Medicare. This is the result of the sort of talk that we're listening to tonight.

They plead for the old people. How many people died bankrupt because of the Liberal Party and this kind of talk for over 50 years? This young man should be ashamed of himself to get up and speak the way he did tonight. Procrastinate, procrastinate, procrastinate. After 50 years, hang your head in shame!

MR. SMITH: Speaking to the amendment which is basically an amendment to read the bill a second time six months hence, the opposition have looked at the bill and listened to the Minister in the debate and in the remarks that he put forward when he moved second reading of the bill. We have to come to the conclusion that there can only be one of about three things really that have affected the Minister and made him come to the decision that he has with respect to introducing this bill at the present time.

One is the fact that he may not, at the present time, know of the full recommendations of the Foulkes report. But if the doctor himself, as he has done in the last few weeks, released information to the news media, then certainly as an appointee of the government, the Minister in charge of this department must know something about the recommendations that will at some time be presented to him by Dr. Foulkes. If he has no confidence in the doctor why did he appoint him to analyse the situation and come back with a report?

One of the conclusions that we can come to at this particular point in time is that the Minister is fully aware of the recommendations in the report, and that this bill, to a greater or lesser degree, is based upon those recommendations. If that is not so, then it must follow that the Minister knows the recommendations and he would be embarrassed to allow those recommendations to be known publicly before presenting this bill to the House. Therefore, the bill has come up at this particular time at this session prior to the time that the man who was appointed to look into this whole particular problem made his recommendations to the Minister.

It doesn't matter how you cut it or slice it, Mr. Speaker. In any respect, whatever the Minister's reasons, it is not fair to his own Members and to the Members of the opposition to bring this bill in prior to the time that the report has been tabled for examination by all the Members of this House.

The Hon. Premier, in the tirade that we heard for a short period of time this evening, referred to Pouce Coupe. He pronounced it Pouce Coupe. The people who live there pronounce it Pouce Coupe. Regardless of the pronunciation, it was nothing more than a smokescreen or a balloon floated by the Premier because, first of all, the facilities that the Premier referred to will never be available in a community the size of Pouce Coupe in the foreseeable future. So what does it really matter whether the person who is involved in a particular problem had to be moved by aircraft from Dawson Creek, the nearest airport, to Vancouver or to Prince George? The time involved is practically the same. So it is not an argument at all.

As a matter of fact, as the Hon. Member for South Peace River (Mr. Phillips) knows very well, one of the most modern medical facilities in northeastern British Columbia is in Dawson Creek, which happens to be seven miles from Pouce Coupe. Now if they couldn't handle the particular problems in Pouce Coupe or in Dawson Creek, it is certain that that particular lady with the five children would have had to fly to Vancouver, to Edmonton or to Prince George to receive whatever treatment was required. Really, in air time, it makes no difference, or very little difference.

So it is a specious argument, Mr. Speaker, for the Minister or the Hon. Premier to refer to that as a reason for bringing this bill before the House at this particular time.

Interjection.

MR. SMITH: Expediate?

Interjection.

MR. SMITH: If the Hon. Minister would care to look it up in a dictionary, there happens to be a word there of that particular pronunciation and that particular spelling in the dictionary, and it happens to mean the same thing as "expedite."

Interjection.

MRS. JORDAN: Now you've learned something tonight.

MR. SMITH: Look it up in Webster's dictionary if you would care to, Mr. Minister. It's there.

[ Page 1106 ]

Interjection.

MR. SMITH: It would seem to me, after all we have heard from the government about their intention to draw information and recommendations from appointed groups that they have appointed in large numbers in the last 12 months, that certainly they would want to know the recommendations of one particular Dr. Foulkes before proceeding with this bill in this House.

We have heard a great deal from the Hon. Ministers — and more so, I must admit, from other Ministers than from the Minister of Health — about public participation, about input and output and all the rest of the things that involve people in the process of governing the Province of British Columbia. After all, they were going to refer to expert advice and get the expertise of people who were intimately involved in whatever field we might be dealing with — in this case, the field of medicine and health care.

It seems to me, Mr. Speaker, that the Minister either moved very hastily, or he does know what was included or will be included in the report that is about to be brought in by Dr. Foulkes, and he based his recommendations and this bill upon those recommendations before we had an opportunity to see it or analyse it in this House.

It is not the first time that this has happened. As a matter of fact, it is becoming all too frequent…

HON. W.S. KING (Minister of Labour): No doubt.

MR. SMITH: …with respect to the Ministers of the Crown who like to sit over there and laugh and jest, particularly when they are not even in their own seats. I suggest that if you want to heckle me, go ahead and heckle me. But at least have the courtesy to sit in your own seat, because this is part of the parliamentary process. If you want to heckle, get in your seat. If you want to sit there as someone who is just observing, stay in the chairs at the back of the chamber and let somebody who is on his feet make his point.

Mr. Speaker, in speaking in support of the amendment, it's a mystery to me why the Hon. House Leader of the Conservative Party (Mr. Wallace) would be so concerned and make the statements that he did — at least, it looked to me — in anger over the fact that this particular bill may be delayed.

I realize what his position has been for some time, and nobody will deny that additional health facilities are needed in the Province of British Columbia. But for the Hon. Member to rise in this chamber and make the statements that he did tonight can only lead me to one conclusion: that is, that he may not agree with Dr. Foulkes. In that case, perhaps he, too, has read the report, and this bill is based upon his recommendations and no one else's.

MRS. JORDAN: In speaking to the amendment to this bill which, in effect, asks that the bill be hoisted for six months for study by the public and by people outside the so-called élitist realm that the Premier referred to, I would point out a number of things.

One is that in the previous debate on this bill last night, in speaking to this amendment, the Minister indicated that it was a very simple little bill. At that time I pointed out to the Minister that it was not a simple bill and that the debate should be adjourned until we had more time to discuss it in depth. This was a no-no situation. Yet when I began to point out what, in fact, were the powers in this bill, and the powers that were being conveyed outside this Legislature to the Minister and to the board, then very quickly the Minister and the Premier changed their minds, Mr. Speaker. I think that's very commendable. They did accept a motion to adjourn the debate so that we could discuss the bill in depth and, at this time now, move an amendment to the bill.

It is with respect to that decision yesterday in the previous debate, Mr. Speaker, that I would suggest that they again examine the situation, and examine the input that has been brought before this House by all Members of the opposition as to what their concerns are. They have pointed out very well, really, the weaknesses in the Minister's own argument or, in fact, perhaps some of the points he didn't realize were encompassed in this bill. We should lay the bill over — this is not setting a new precedent — and reconsider it. This, in itself, would be a commendable decision.

I think, Mr. Speaker, the actions of the Premier in this debate, as the second speaker in speaking to this amendment, are in themselves, without all the other input into the debate, reason to hold this bill over. The Premier gave every indication of confirming my statements yesterday as to what was in the bill and, secondly, to pointing out very clearly that, rather than being concerned about the genuine care of health of the people in the Province of British Columbia and some type of practical adaptation to the future in terms of economics and the geography of this province, he is on a binge of a personal vendetta.

He talks in terms of the élitist doctor. I wonder really where he goes for his medical care. Because, indeed, there are some !élitist doctors in this province, and some of them are very well entrenched in the University of British Columbia. I would be the last to deny this.

Some of them are very well entrenched in the Vancouver General Hospital, and some of them were very well entrenched in Shaughnessy, and there's a few well entrenched in various hospitals throughout this province. But they, Mr. Speaker, are very, very much in the minority.

[ Page 1107 ]

The majority of doctors in the Province of British Columbia are, to quote a popular phrase, "very much where it is at." They, Mr. Speaker, know what the practice of medicine is all about and they know what the training for medical people is all about. I speak in terms of nursing services and paramedical services when I say this.

There is always a small, élitist group; but to wrap a personal vendetta in the cloak of so serious a subject as health care in the Province of British Columbia is wrong. I suggest that the people of this province and the medical and health care in this province are worthy of a much better attitude than that. Everybody is entitled to something that raises their blood pressure and everybody is entitled to get up and react to that rise in blood pressure, but not when it involves a serious decision such as we're making in terms of this bill and this amendment.

If the Premier has these personal feelings — and I would suggest they are probably not shared by the Minister of Health (Hon. Mr. Cocke) — then he would be wise and it would be a credit to him to sit down and examine the matter more thoroughly.

There is some question as to whether, in fact, the Foulkes report might not reflect a good deal of another type of élitist attitude in the medical world, If we hoist this bill and if the Foulkes report is brought in, the doctors and the nurses and the paramedical services, who are where it is at out in the field, Mr. Minister, in Pouce Coupe, in Fort St. John, in Castlegar, in Armstrong, in Clearwater, in Quesnel, and the very few that are on the Indian reserves or in the northern reaches of this province, will have an opportunity to study that report and to examine how it is going to relate to practice outside the metropolitan area, or, conversely, the doctor who is in the East End of Vancouver working on Hastings Street. Let him have his input.

It's common knowledge around this province, both in and outside medical services, that the Minister has already started and is certainly anticipating extreme and radical changes to the medical practices and the health care practices in British Columbia. We don't want this type of action to presuppose the report. We don't feel that the legislation should presuppose the report, otherwise the report is of no value. If the Minister and the health staff in the Province of British Columbia knew the answers, why commission the report, why commission the study?

Mr. Minister, you're looking very bored and very fed-up, but you have a lot of responsibility on your shoulders. With all due respect to you, you have kept out of trouble in the last year, basically because most of what you're doing has been smiling, listening and puffing on your pipe. That's very charming.

But now, Mr. Minister, you are going to have to stand up, through you, Mr. Speaker, and be accountable for your actions. It's all very well to stand on pride and say, "I'm willing to be accountable," but you're not going to be the loser, Mr. Minister, only in terms of an election; it is the people of British Columbia who will be the losers if, in fact, you make a mistake.

The Hon. Member for Oak Bay (Mr. Wallace), in his statements pointed out what has been a very serious problem in medical care in British Columbia, probably in provinces across Canada, certainly in England, certainly in other parts of the world: the delivery of health care in the non-metropolitan areas is vastly different from the delivery of health care in the metropolitan areas.

The Member, with all due respect to him, who is indeed a fine practitioner — I know he's respected by his colleagues — speaks in terms of problems of the Victoria area largely, with the exception of chronic care. There are problems in Victoria, and I've never been able to understand why they couldn't solve them.

The danger in trying to bring in such sweeping legislation to solve the problems of a small, élitist group in Vancouver and Victoria is that a system around the province which has, in fact, been highly satisfactory — and certainly can be improved — will be brought to a detrimental stage.

The Minister, I am sure, would not disagree that the general health care facilities, with the exception of chronic care, and the delivery of health services in a majority of areas of British Columbia outside the metropolitan area are exceedingly high. These regional hospital boards and these medical people in the broadest sense have done an excellent job in working out needs of their areas.

To subject them to the terms that may well be within this bill of a corporate board in Vancouver would be the folly of all follies in this province. The corporate mind, Mr. Minister, is great in the board room and it's great in the forest but it doesn't belong to any large degree in the delivery of health care. The accountant is an accountant and the administrator is an administrator. If you look in Germany, if you look in Sweden, if you look in Manitoba when this corporate system of the administration of medical care was adopted, it is the patients who have lost out, not the doctors.

I'm a strong advocate of doctors, and if you want to put them on salary, judging by all the other salaries you pay, it's going to be fair. But what you're going to lose is the patient-doctor relationship, the patient-nurse relationship, the patient-nurse's aide relationship, and that is 50 per cent of the practice of medicine, that is 50 per cent of the guarantee of the patient's recovery.

In the places that I cited this board becomes subservient and dedicated to the structure, not to the patients. It's a Tinker-toy system where they tried to plug in every service and every care, Mr. Speaker, into

[ Page 1108 ]

a nucleus. The only thing wrong with it is that there is no niche for the patient in terms of human needs and human expression.

Mr. Speaker, I'm convinced that the Minister himself is deeply concerned about this. It is because of this concern on our part that we again make the suggestion that the bill be held over so that we don't make the same mistakes that have been made in other areas. We do have an opportunity with such sweeping legislation to have the input from the nurses and doctors in other centres.

Interjections.

MRS. JORDAN: You know, Mr. Speaker, the Minister of Lands, Forests and Water Resources (Hon. Mr. Williams) is so intolerant and so unconcerned about the needs of the people of British Columbia, why doesn't he resign? He never makes a constructive contribution to the debate. He himself probably is in need of some medical help.

Interjections.

MR. SPEAKER: Order, please.

MRS. JORDAN: Every logical reason has been put forth in speaking to this amendment by all Members on this side of the House as to why the Minister has nothing to lose, why the people of British Columbia have nothing to lose. The Minister and the people of British Columbia only have something to gain by a close examination of the' report, how the report relates to the report.

With this in mind, we do hope the Minister will accept this amendment and will lay the bill over for six months and allow this type of public and professional input.

MR. SPEAKER: The question is that Bill 81 be read a second time on this day six months hence.

Amendment negatived on the following division:

YEAS — 14

NAYS — 37

MR. WALLACE: Mr. Speaker, I would just like to make a few comments on the principle of the bill itself.

We've already covered the fact that the bill intends to improve teaching facilities and to coordinate the training and the distribution of medical and paramedical personnel. If there is one need in the health services field, Mr. Speaker, it is to utilize each individual member of the team to his or to her fullest capacity.

We needn't go over all the ground we've covered before about the fact that many doctors do jobs which could be done by a person with a lesser level of training. The whole idea is to coordinate and integrate every member of the team so that the fullest use can be made of all the time and money that is put into training these people.

I certainly welcome the obvious evidence from the Premier that we can anticipate a greater output of medical students in this province. He mentioned the figure of 160, which I hope is at least the figure that is being aimed at. I think it is very distressing that the sons and daughters of residents of British Columbia, who have something less than perhaps an 80 per cent average, cannot obtain access to the medical school in their own province. These are the facts.

The 1971 figures showed that anyone with an average below about 79.5 per cent was unable to get into the medical school at UBC. Some of the sons and daughters of B.C. residents travelled far and wide to New Zealand and Britain. Not that that is bad, but it adds expense…and I needn't go into that subject specifically.

For anyone to wish to delay a move which will bring this about is something I just cannot understand. This is one of the very strong reasons why I voted against the amendment. While there are many things in this bill on which I would like to offer some constructive criticism, there are also aspects of the bill which I strongly support. One of them is the point I've just made: that it endeavours to speed up and enhance the output of medical personnel.

One of the criticisms that I would offer, Mr. Speaker, and which concerns me is that the bill doesn't really clearly define the responsibility between the two particular functions: that of this medical centre and the function of the Minister of Education (Hon. Mrs. Dailly) through the universities.

[ Page 1109 ]

We do know that medical students are taught at the medical school, which is an arm of the university. But this centre, I guess, is going to be operated by a board of individuals who would appear to have authority in the field of education and training, authority which clearly clashes with the authority already vested in the university and the medical school.

It may well be that the Minister has some clear understanding of exactly how the authority and the administration of this centre will function. But, as I read it and as I re-read it many times and as I talked privately to several people in the medical field in Vancouver, there does seem to be this lack of understanding by any of these people as to exactly how this medical centre will be vested with the authority to train these people and the degree to which the diplomas….

There's one section where it mentions that it will award diplomas and certificates upon completion of training courses and so on. To me and to many medical people I've talked to, Mr. Minister, through you, Mr. Speaker, there is some uncertainty as to how authority and jurisdiction, if that's the right word, will be delegated to this medical board as compared to the authority already vested in existing educational locations such as the UBC medical school. That is one point in particular, Mr. Speaker, on which I hope the Minister would comment when he winds up the debate.

I'm sure that the various people in the medical school and on the teaching faculty must also be wondering exactly how many levels of medical personnel are to be trained through the aegis of this board. Or is it simply that the board will institute an additional intake of medical students to already existing facilities such as the medical school? If so, does this not clash with the pre-existing arrangement under the jurisdiction of the Minister of Education?

I recognize, Mr. Speaker, that section 17 mentions that the Minister will review and make recommendations in conjunction with the Minister of Education. But I would hope that perhaps amendments might be brought in to the bill by the Minister, making a clearer definition of authority and jurisdiction in the areas that I've mentioned.

The other big area which leaves me in some doubt and apprehension about the feasibility of this bill is the fact that, as the Minister well knows, there are regional boards set up throughout the province to deal with the coordinating and planning of hospital and health care facilities. Of course, there is a regional board in the Greater Vancouver area, as there is in the greater Victoria area.

I've already referred critically tonight to the lack of progress by the Regional Hospital Board in Vancouver. But I sense that progress is slow.

If experience in Victoria is anything to go by, there is a great degree of delay and passing back and forth of resolutions between different layers of authority and from subcommittee to committee, and committee to the board, and the board back to the committee. There is just so much discussion and debate which goes on that there seems to be, alas, too little action in the way of creation of the needed facilities.

Now, all I am saying, Mr. Minister, is that I shake a little bit when I read this bill because it seems that the bill is creating just one super regional board. I worry about the fact that if the regional board concept isn't working, does this bill in fact hold out any better hope of action by creating yet another board of planning and administration? In reading the bill it seems to me that this super-duper board has a measure of authority over the existing regional board, inasmuch as the regional board can have representation without a vote. The whole principle in setting up regional hospital boards was to avoid duplication of facilities — the construction of unnecessary costly facilities, let us say, in one area of the region, to be copied by some other hospital, when in fact the one facility in one location would have been adequate.

We all recognize this, Mr. Speaker, as a vital ingredient in the planning of health care facilities. It is such an expensive project, however you do it, that it goes without saying that it has to be done on the most economic basis that is compatible with meeting the needs of the sick people. That has been attempted by setting up regional hospital boards, and unfortunately this has not been a uniform success across the province.

While, as I said earlier, I fully accept the Minister's intent of creating more medical students and more paramedical personnel, promoting the education of the public generally in the health care activities and so on — this fitness seminar is typical of the kind of thing that the Minister is doing to bring this about, and this is very good.

What I would like to ask, and I wonder if the Minister would enlarge on this when he winds up the debate, is: does this board which he is creating not have all the inherent weaknesses of the already existing regional hospital board? I'm not trying to knock it. I hope it does work, but I'm a little cynical, based on the experience of the last few years, that regional boards have not fulfilled the hope and the concept on which they were set up. This particular board seems to have even more authority than the regional board and yet that very authority is spelled out in rather general terms.

Again, in conversation with people in Vancouver, I find that they are somewhat puzzled to know where the regional hospital board will fit into the new structure which is being created by superimposing this other board above the regional board.

A smaller point which came to my mind when

[ Page 1110 ]

reading the bill was the question of the ability to levy charges. I just wonder if for such facilities as the ones that are included in the board — the Vancouver General, the health sciences centre, the Children's Hospital, the G.F. Strong Rehab and the Cancer Foundation — there is to be any different application of BCHIS coverage to these hospitals once they come under the aegis of this new board, because….

HON. MR. COCKE: Scott, it's just a dollar a day or so, you know.

MR. WALLACE: Well maybe, Mr. Minister, you could just cover that point when you wind up the debate.

One of the other aspects of this that just bothers me a little bit is the question of centralizing the development on Shaughnessy, when in point of fact we haven't really got to the happy stage of having negotiated an agreement with the federal government. Again, I may be biased because of our experience in Victoria, but the delay, the fiddling around and the sheer frustration of trying to integrate hospital facilities in Victoria would drive Solomon crazy. The fact that we have tried repeatedly and persistently to tie in the Veterans' Hospital in Victoria with existing facilities makes me wonder if a bill like this should be so contingent upon acquiring Shaughnessy Hospital, when we've had so little success in trying to acquire the hospital in Victoria. Now that again may be a false fear and the Minister might be able to tell us of a finite date that has been arranged for takeover.

The other consequence of centralizing the centre on Shaughnessy: I would hope the Minister is well aware that despite the disadvantages of traffic and so on in the region of the Vancouver General, it is not a matter of letting certain established facilities at the Vancouver General run down or deteriorate or to do anything but to get 100 per cent performance out of existing facilities, and appear to be suddenly going off in another direction to develop the facilities at Shaughnessy.

While I don't wish to get back onto the subject of the Foulkes report, it was the kind of comment that I mentioned earlier in the House which Dr. Foulkes had made publicly that there could be such options as just leaving the old facilities without much attention and start off somewhere else completely fresh. In some of the figures that have been quoted — and again the Minister might wish to correct these figures — one of the criticisms that was offered when the Vancouver General Hospital wished to expand its facilities was that the figure of cost would be $100 million, and possibly with traffic and parking problems and congestion in the streets, and so on, this probably was not a good idea. But I do understand that figures have been mentioned which vary from $130 million to $200 million for the complete development for the Shaughnessy site.

Again, as a responsible Member of the opposition, I feel that I should ask very clearly: does the Minister know what the cost or the projected cost of the complete development of the Shaughnessy site will be, and how will it compare to the costs that were projected in developing Vancouver General?

To many of these questions, I realize, no one has a specific, precise answer, but I think these are very relevant points that any objective person would ask: First, the whole question of conflict of jurisdiction in terms of education, vis-à-vis the Minister of Education in universities; secondly the conflict of jurisdiction or the diluting of authority of the regional hospital boards. In an area such as this where you're tying together five or six different, separate facilities, it would be disastrous, I would think, if there is any further division or any conflict, shall be say, between the existing regional board and this new board. It would be just one new level for the confrontation and argument which would only slow down further the creation of facilities and the training centre which everybody recognizes is needed.

Thirdly, there is the question of cost. Is it going to be a judicious use of dollars? Is it going to be more or the same that would be anticipated if we simply developed Shaughnessy as a provincial referral hospital but not a tertiary centre? The word "tertiary" has maybe been confusing to some, and I think we should make it plain that a tertiary centre is the centre that seeks the most highly sophisticated and the most complicated forms of surgical and medical illness in adults and children, and the facilities to investigate them. I would like the Minister to comment as to why indeed he finally chose Shaughnessy in contrast to Vancouver General as being the most suitable site to develop the most highly specialized kinds of care and treatment available in this province.

These are questions, Mr. Speaker, which I think have to be answered. I think that the whole question of whether or not they can be answered now or six months from now is not as important as the Minister explaining his philosophy and his reasons for making a move in this direction and possibly also giving us some idea about the recommendations of the Shortliffe report, which I know he's been asked in this House many times. He may, for one reason or another, choose not to tell us about this Shortliffe report, but the sums of money…. If for no other reason, we are debating this bill because we want the best facilities to be available as soon as possible, and we want to expand our output of medically trained and paramedic ally trained personnel. But in so doing, and following what is a very worthwhile goal, we are looking at very large sums of money and we are looking at some very far-reaching consequences in terms of the already existing administration set up to

[ Page 1111 ]

run hospitals in this province locally, regionally, and now on a super-regional basis.

I think that perhaps the Minister would prefer to adjourn the debate and give us an explanation, or perhaps he can tell us in 10 minutes but I think the large sums of money that are involved here should not be explained away quickly or lightly, and I hope the Minister can give us some explanations.

MR. McGEER: Mr. Speaker, I'm going to have another try at explaining to the Minister….

HON. MR. COCKE: Forget it.

MR. McGEER: "Forget it," he says. But I don't think we can forget this, Mr. Speaker. Fifty years ago there was a famous report on medical education which was produced by a gentleman named Flexner. As a result of this report a large number of medical schools in North America closed their doors immediately. The reason was that they were turning out medical personnel who were not trained to the standards of skill that could and should have been achieved in North America. The model that was followed in those medical schools is precisely the one that we're slumping back toward with the concept of this particular bill.

I can only emphasize to the Members of the House, through you, Mr. Speaker, that the pursuit of educational skills is different from the delivery of health services. I'm pleased that the Member for Oak Bay (Mr. Wallace) recognized this fact in the remarks that he made during second reading, but there are other considerations too with this particular bill, Mr. Speaker. The priority developments at this Shaughnessy site are to be, first of all, replacing the children's hospital in Vancouver; secondly, rebuilding the obstetrics unit which is now at the Vancouver General Hospital; and after that, to develop the remainder of the Shaughnessy Hospital site.

It's questionable whether the hospital facilities that now exist on that site will be used at all in this renewed development in the way that they're being used at the present time. The costs are estimated to be at least $250 million.

Mr. Speaker, I mention these priorities and these costs because they are in some conflict with what I understand to be the contents of the Shortliffe report. The concept of the Shortliffe report was that one new hospital for educational purposes should be built on the University of British Columbia campus, that some relief should be brought to the hospital bed shortage in the lower mainland by continuing the use of Shaughnessy Hospital as a community centre, and that the delivery system should be improved by some upgrading — and I'm talking in the order of $10 million to $12 million — by development at the Vancouver General Hospital site. All of those developments which would lead to better training of health personnel could be achieved with the expenditure of well under $100 million.

If we have S250 million to spend — and I believe we should spend those amounts of money — then those funds should be spent to provide facilities that do not now exist. Among these, Mr. Speaker, are chronic care facilities in this Victoria area, in the lower mainland and throughout the rest of British Columbia.

On the priority list as well would be the initiation and commencement of another medical school here in the Victoria area. This development of a second medical school, the development of chronic care facilities in this metropolitan area and the metropolitan area of Vancouver, and the creation of a superior teaching facility could all be accomplished in a shorter period of time and with a lesser expenditure of money than is contemplated in the Act before us this evening.

But, Mr. Speaker, above and beyond the economies that I am describing here this evening, we have the fundamental and overriding principle that delivery of health care and education are separate objectives to be pursued by people who have a separate mission in life. This basic principle was discovered, if it had eluded politicians and others, with crystal clarity one half century ago when that Flexner report was brought forward.

Both the Premier and the Member for Oak Bay brought forward an argument that I've been hammering away at each year that I've been in this House, namely, the fact that in British Columbia we are training far too few doctors. Something in the order of 300 each year are licensed; only 60 per year are yet being graduated, it will go up to 80; between 500 and 600 apply, of which at least 200 would make outstanding members of the medical profession.

Mr. Speaker, I want to underline this particular point: the holdup has not been on the availability of clinical facilities, particularly of the kind contemplated for the Shaughnessy site — there are plenty of patients in hospital; the Vancouver General Hospital is the largest hospital in Canada.

The problem has been the lack of basic science facilities on the campus of the University of British Columbia. The most obvious and conspicuous of these lacks has been a dissecting room for human anatomy. Perhaps the most basic discipline that every medical student goes through is dissection of the human body so that they can learn at first hand the various parts that make up a living being. Because we simply have lacked the anatomical facilities it's been impossible to take more than the number of students that are now taken into that medical school, no matter how many applicants there are.

So when it comes to training doctors our lack has been a ridiculously simple one, easily cured by

[ Page 1112 ]

providing the funds to build a larger anatomy-dissecting theatre — not having beds with patients in them.

Our own students — talking about people from British Columbia — who are unable to get into the medical school, if they go to Mexico or Scotland or many other places who themselves should be training more doctors, and they get through those basic sciences and the dissection of the human body in Scotland, then they can come back and have no difficulty getting their remaining two years and their internship and residency in the clinical facilities that now exist in British Columbia.

So Mr. Speaker, I don't think that any Member of this House or any of the two million citizens of British Columbia should be under a delusion as to why we're turning out so few doctors. It isn't a lack of the medical centre at Shaughnessy. It's a lack of a dissecting room on the UBC campus that is large enough to take a class of 150 students.

When that problem can be cured in such a simple fashion, it's a mystery to me why the previous government or this government has not moved with the few thousand dollars it would take to correct this problem. I thought, Mr. Speaker, that the remarks of the Premier this evening were particularly unfortunate. I'm sure through lack of experience he attacked what is recognized as being one of the finest mental health centres in North America.

HON. MR. BARRETT: Oh, no!

MR. McGEER: The Premier may groan, but Mr. Speaker — and the Premier should know this — there are people coming not just from all over North America but from all over the world to see that facility and to look at what it is offering.

HON. MR. BARRETT: An island in the middle of nothing.

MR. McGEER: Mr. Speaker, it's not an island in the middle of nothing; it's a mental health facility set in the midst of one of the finest basic science complexes that exist in Canada or in North America. I think, Mr. Speaker, that it's about the level of the mentality of the Minister of Lands, Forests and Water Resources (Hon. Mr. Williams) that he'd equate that with a parking lot.

Mr. Speaker, the Premier should know — indeed, had he done his homework when he was Leader of the Opposition he perhaps would have come and looked at that facility and understood that that particular facility was to be the first major clinical complex which was to be built on that site to complement the already heavy investment that had been made in basic science and library facilities as well as the instructional resources.

HON. MR. BARRETT: Who cut out the services for children?

It was a professional decision by doctors because they wanted to serve that middle class interest.

MR. McGEER: Mr. Speaker, that just shows you the kind of class prejudice that plagues good decision-making on the part of this government.

HON. MR. BARRETT: We don't have any children's facilities because of that.

MR. McGEER: Mr. Speaker, the Premier is going to learn, and I think the Members of this government will learn…

SOME HON. MEMBERS: Never, never!

MR. McGEER: …that you can produce in the way of facilities what the financial commitment permits. It's all very well to be smug and say that facility shouldn't have been there, but then at the same time admit that it should have been there and he'd have been happy if it had been there if there'd just been more money spent so there were children's facilities there.

HON. MR. BARRETT: Priority should have been for the children.

Interjections.

MR. McGEER: That's what he keeps saying. Mr. Speaker, could we have some order?

SOME HON. MEMBERS: Oh, let's go home.

MR. SPEAKER: Order!

MR. McGEER: The Premier is showing the kind of prejudices that he's getting to be famous for in this House and he can go ahead when he doesn't have answers and enter into these hysterical attacks, which he is doing. The appropriate thing for him to have done if he felt — and I don't disagree with his feelings — that there should be children's facilities on that site, and I think there should, then he can go ahead and provide the money and they will be built.

Mr. Speaker, I never heard the Premier stating, when he was the Leader of the Opposition, where these children's facilities should be.

HON. MR. BARRETT: Do you want to stake your seat on that?

MR. McGEER: I never heard him making any statements that there should be this great medical centre at Shaughnessy. That's all a discovery that he

[ Page 1113 ]

has made as a result of advice that he has got from the Minister of Health, and we're not sure where he got his advice.

HON. MR. COCKE: From votes, we are.

SOME HON. MEMBERS: Votes, votes.

MR. McGEER: But what we're doing, Mr. Speaker, is going to spend a lot of money duplicating facilities that should be as a priority spent in providing a medical school in Greater Victoria and in providing chronic facilities that are now lacking. Those moneys that are committed to education should be spent where the educational result will be best — which is to complete a hospital where the mental health facility was constructed, where the basic science facilities are. If this commitment is to increase the size of the medical class, which he should do, then what he does is he increases the basic science facilities that are available. Instead, what we are doing is creating a monolith that will not succeed in any of the objectives that the Minister of Health has set forth in this particular bill.

MR. SPEAKER: The Hon. Minister closes the debate.

HON. MR. COCKE: Mr. Speaker, we've had an interesting and a long debate on Bill 81.

MRS. JORDAN: It's after 11 o'clock.

HON. MR. COCKE: With your indulgence, I think I can do this in a short time.

Mr. Speaker, I thought everybody here was really interested in some answers and it's better to get those answers while the questions are fresh in our minds. I think we are talking about a most important subject and that subject is delivery of health care together with education.

Mr. Speaker, I'm not going to deal too much with the last speaker's discussion because he has a particular point of view which, on this particular occasion, I just can't share. Unfortunately, experts sometimes follow the old dictum. That Member, for example, used two contrasting arguments: he used one argument when he was arguing in favour of that amendment, which came from somewhere, and I didn't particularly feel it should be discussed in great detail because it merited no discussion that I could see.

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: Mr. Speaker, it was a delaying tactic that was an unfortunate thing and I'm glad that they're on the record as trying to delay the delivery of a better kind of health care in this province.

Interjections.

HON. MR. COCKE: Mr. Speaker, the Member for Vancouver–Point Grey (Mr. McGeer) discussed the whole question of the Foulkes report — that is the medical care, the health care report — when he was discussing the amendment. Then he got into the education-centre thing which is completely contrasting when he was discussing the bill itself. Mr. Speaker, how can you go along?

Then, of course, he said the only reason we don't have a larger department at UBC is because we haven't got a big enough dissecting room. I don't want to interfere in any way with the university's autonomy, but I suggest to you that if they have that problem there are ways they can look after the problem — maybe a priorizing on the budget or, on the other hand, how about better utilization of what they've got? What about nights? What about weekends? What about holidays and that type of thing?

HON. MR. BARRETT: Summer holidays.

HON. MR. COCKE: Summer holidays — those long, long periods. Mr. Speaker, there are many ways around this.

I want to deal with some questions which were asked by the Member for Oak Bay (Mr. Wallace). The Member for Oak Bay, who has a tremendous stake in this whole question of the delivery of health care, asks the kind of questions that I think we should have been dealing with tonight. I appreciate those questions. Mr. Speaker, let me begin by suggesting some answers to some of the questions.

He asked how the board will operate with the GVRD and what will their relative position be. Let me suggest to you that BCHIS and GVRD have already got together and are forming a committee to deal directly with the medical centre.

Now, I want everybody to understand this, the medical centre is not geographically Shaughnessy Hospital; the medical centre is a group of health care facilities. It's G.F. Strong, that's not on the Shaughnessy site; it's Vancouver General Hospital, that's not on the Shaughnessy site; it's out at UBC as well because it takes in the health-science centre psychiatric hospital and all of those others. The children's hospital likely will go on the Shaughnessy site.

But that is what this board is all about. They're to be doing the building; they're to be doing the planning. Let's hope that they can plan it properly. They have the best people who can be brought into this particular area to do the job with them and for them, even without Shaughnessy.

[ Page 1114 ]

If that little thing happens that some people over there are praying for, that the federal government decides to change their attitude…. And their attitude now is that they want to get out of the…. The Veteran's Affairs Department wants to get out, totally out, of the delivery of that kind of service. Therefore we know perfectly well that they are going to be dealing with us. We are at a point now where it is pretty well a fait accomplis.

MR. PHILLIPS: Midnight legislation.

HON. MR. COCKE: Mr. Speaker, the Member also asked about a certain matter of levying charges. Well, the levying of charges is just the same as any other hospital has the right to do. They can levy charges at so much a day. If it wasn't that the medical centre board will be running at least some of the facility directly for the time being — they'll likely have their own separate board after, on the Shaughnessy site — but so that they can levy their $1 a day charge, $2 emergency charge, that has to be implicit in the Act. So we are just including that just like it is in any other Act.

How much will it cost? We are suggesting that the likely cost for the whole area…. Remember, we are not only just talking about teaching hospitals — the Member for Vancouver–Point Grey (Mr. McGeer) is seemingly only interested in that area — we are talking about tertiary care of children. We've been screaming for it. People have been screaming for tertiary care for children in Vancouver — that's the high-level care in Vancouver for the whole of the province. This is to deliver care for that high-risk child, or at least the high-risk proposition in Pouce Coupe — or Pouce "Coopey", if you want to pronounce it that way.

AN HON. MEMBER: What about the kids?

HON. MR. COCKE: Those children will be getting their hospital!

There were three different groups working around this question but they could never get together. We've given them an opportunity to get together. Don't forget that this board is composed of people from all of those different facilities. We are not going out and finding people. Where did we find our Mr. Christiansen? We found him at the VGH. Where did we find Donaldson? We found him at the children's hospital. Where did we find Mr. Bibbs? And I hate all these big forces, but we found him at the university, and so on, right down the line. And they will have their children's hospital.

Mr. Speaker, the $130 million that you read in the paper is something in a ballpark figure around what VGH was talking about. They were saying, "Look, we've got to do it all here." We're saying that you can't do it all there; it is far too congested. VGH is a huge edifice now. It's going to be a partnership, and they are going to be part of the medical centre; they are going to be part of the decision-making process. It's a great concept, Mr. Speaker. It's a concept that has been developed by a great number of people in concert. It is nothing to do with the Foulkes report from that standpoint. All those arguments about "hold it up until the Foulkes report….

Interjections.

HON. MR. COCKE: Because I happen to be the person, together with the Premier, who commissioned the Foulkes report. We know what we asked for.

Interjections.

HON. MR. COCKE: We asked for a report on coordinating the Department of Health, a system of delivery of care — but nothing to do with this educational concept.

Interjections.

HON. MR. COCKE: Mr. Speaker, this report was done in consultation. Now let me just go on.

Interjections.

HON. MR. COCKE: Mr. Speaker, I want to give you an idea. You know, we've had a lot of discussion over there about how this came about and we've also heard that there are a great many people…a great many people over there indicated that there's all sorts of outside people who are in conflict with this idea. Let me tell you, we did our homework on this.

Interjections.

HON. MR. COCKE: Yes, we did. That's traditional with this party; we do our homework.

Interjections.

HON. MR. COCKE: Just a minute. After I tell you one or two things, if you vote against this remember you're voting against the children's hospital, you're putting it back. That's right — you are voting against the children's hospital.

Interjections.

HON. MR. COCKE: You're saying, "Okay kids, suffer on. Suffer on children. Hang on." And that's not good enough, Mr. Speaker. That's not good enough.

[ Page 1115 ]

AN HON. MEMBER: You didn't do your homework.

HON. MR. COCKE: Let me talk about the homework for a second. Who did we consult?

Interjections.

HON. MR. COCKE: I'll tell you who we consulted.

MR. SPEAKER: Order! Order!

HON. MR. COCKE: Mr. Speaker, we went to the GVRD; we met with the whole of the GVRD, and you know what we got from them? Unanimous endorsation. Unanimous endorsation! All in the room, and they kept their mouths shut. What do you think about that?

Interjections.

HON. MR. COCKE: Something different — something that you will never understand,

Interjections.

HON. MR. COCKE: Who else did we consult, Mr. Speaker? We consulted with the university — the president, the dean of medicine and the former dean of medicine. Yes, we sat; we had a meeting on this, and what did we get? Support, Mr. Speaker! Mr. Speaker, who else did we consult?

Interjections.

HON. MR. COCKE: The BCMA, Madam Member. The BCMA. We sat down with the whole executive council of the BCMA.

Interjection.

HON. MR. COCKE: Mr. Speaker, that Member for North Okanagan (Mrs. Jordan) I don't know who she's been talking to, maybe her husband. I don't know who she's been talking to, but we got endorsation. This was sought out; this was well sought out, Mr. Speaker. And what did we do? We have looked at some of the disasters. Now let me tell you about a disaster.

AN HON. MEMBER: All sitting over there.

HON. MR. COCKE: That Member for Vancouver–Point Grey (Mr. McGeer) indicated those great health-science-centre hospitals. Let me tell you what Dr. Leclaire said publicly: "The biggest mistake I made in my life was Sherbrooke," and he was the guy who constructed it. That's right. "The biggest mistake I made in my life…."

Interjection.

HON. MR. COCKE: That Sherbrooke was a health-science university hospital on campus, and you know it. Mr. Speaker, what did the Minister of Health in Quebec do after that? He built a new concept at Laval.

AN HON. MEMBER: Right.

HON. MR. COCKE: And he said to the six hospitals, "you are part of the process." So, Mr. Speaker, they talk about….

Interjection.

HON. MR. COCKE: Shortliffe gave me all sorts of reports to the Foulkes committee.

Interjections.

MR. SPEAKER: Order!

HON. MR. COCKE: Mr. Speaker, I don't really think I want to keep you too late tonight. I think that anybody who has read this bill thoroughly, anybody who can see the direction that we are trying to go in concert with all of those other people who are delivering health care, they know they want the children's hospital.

Mr. Speaker, on that basis I move second reading on this bill.

Motion approved on the following division:

YEAS — 36

NAYS — 14

[ Page 1116 ]

SOME HON. MEMBERS: Record it.

Bill 81 read a second time and referred to Committee of the Whole House at the next sitting after today.

Hon. Mr. Barrett moves adjournment of the House.

Motion approved.

The House adjourned at 11: 26 p.m.