[ Page 1655 ]

CONTENTS

Afternoon sitting

Routine proceedings

Committee of Supply: Department of Health estimates

On vote 75.

Mr. Chabot — 1655

Hon. Mr. Cocke — 1655

Mr. Fraser — 1656

Mr. McClelland — 1657

Hon. Mr. Cocke — 1658

Mr. Fraser — 1659

Mrs. Jordan — 1659

Mr. Gibson — 1660

Hon. Mr. Cocke — 1661

Mr. Morrison — 1663

Hon. Mr. Cocke — 1663

Mr. Phillips — 1663

Hon. Mr. Cocke — 1664

Mr. Phillips — 1664

Hon. Mr. Cocke — 1667

Mr. Phillips — 1667

Mr. Wallace — 1668

Hon. Mr. Cocke — 1669

Mr. L.A. Williams — 1670

Hon. Mr. Cocke — 1671

Mr. Gardom — 1672

Hon. Mr. Cocke — 1673

Mr. Gardom — 1673

Mr. Fraser — 1673

Hon. Mr. Cocke — 1673

Mr. Wallace — 1674

Hon. Mr. Cocke — 1678

Mr. D.A. Anderson — 1680

Hon. Mr. Cocke — 1681

Mrs. Jordan — 1682

Hon. Mr. Cocke — 1682

Mr. McGeer — 1682

Hon. Mr. Cocke — 1682

Mr. McGeer — 1683

Hon. Mr. Cocke — 1684

Mr. McGeer — 1684

Mr. Bennett — 1684

Hon. Mr. Cocke — 1684

Mrs. Jordan — 1685

Hon. Mr. Cocke — 1685

On vote 77.

Mr. McClelland — 1685

Hon. Mr. Cocke — 1685

Mr. McGeer — 1685

Hon, Mr. Cocke — 1685

Mr. Morrison — 1685

Hon. Mr. Cocke — 1686

Mr. Fraser — 1686

Hon. Mr. Cocke — 1686

Mrs. Jordan — 1686

Hon. Mr. Cocke — 1687

Mr. McClelland — 1687

Hon. Mr. Cocke — 1687

Mrs. Jordan — 1688

TUESDAY, MARCH 26, 1974

The House met at 2 p.m.

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, we have in the gallery today a group of senior citizens from that illustrious riding of Oak Bay where we're not all millionaires. I'd like the House to welcome them.

HON. N. LEVI (Minister of Human Resources): Mr. Speaker, in the gallery today are a large group of senior citizens from Vancouver — the Golden Age Club of the Jewish Community Centre. Among them is Mrs. Rose Gordon, the Premier's mother.

For Mrs. Gordon's information, your son isn't playing hooky; he's on his way to Ottawa on public business. I would ask the House to make them welcome.

MR. D.M. PHILLIPS (South Peace River): Mr. Speaker, I'd like the House to join in welcoming today a newly appointed judge in the Peace River area, Judge Lundeen, his lovely wife Frances and their daughter Trudy.

Introduction of bills.

Orders of the day.

The House in committee of Supply; Mr. Dent in the chair.

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

On vote 75: Minister's office, $82,898.

MR. J.R. CHABOT (Columbia River): Mr. Chairman, I've listened this morning with great attention to the plea made by the Member for Cariboo (Mr. Fraser), a very reasonable and responsible plea. He asks very civilly that the Minister clear the name of a public health nurse in this province who has been arbitrarily dismissed.

The Member requested that the Minister show some compassion for the fact that this woman's reputation has been damaged by the action of his department.

I'm not going to suggest that the Minister of the government is callous or indifferent to this plea, because I'm sure that the Minister has always attempted to act in a responsible fashion. I'm asking him to show that he's not callous or indifferent to the plea put forward by the Member for Cariboo on behalf of Mrs. Vaness.

I think also that this government has the responsibility to let the people know that they're genuine when they say they care about people.

I want to assure you that Mrs. Vaness is one of those people you talk about. She's not only a number in the civil service as you might assume. All we're asking is that the Minister clear her name. There's been a black mark against her record which will damage her for the rest of her life in seeking gainful employment either in British Columbia or anywhere else in this country. The Member very ably appealed to the Minister to show some compassion in this respect.

The Minister stood in his place here this morning and suggested that he did not have the authority as a Minister of the Crown to reopen this case. Now what a bunch of nonsense from a Minister of the Crown! Certainly that Minister or his cabinet has that authority to reopen this case to make sure that Mrs. Vaness does get justice.

Also, the Minister has suggested that the Member for Cariboo come and see the Minister quietly into his office so that he can soft-soap him and bury the case — bury the case! That's not the way this matter should be handled. This is a public interest matter, and it should see the light of day.

MR. CHAIRMAN: Order, please! I would ask the Hon. Member, since the subject has been quite thoroughly canvassed already this morning, to confine his remarks to any new point he might be wishing to make.

MR. CHABOT: Well, the new point, Mr. Chairman, is that that Minister over there is trying to bury and trying to sweep a public interest situation under the rug; that's exactly what he's trying to do. I don't think that's good enough for a Minister of the Crown.

We're asking for justice on behalf of a wronged former public health nurse in this province. She has a right to have her day in court. She has a right to have a fair hearing. That's all we ask from that Minister: to stand in his place and tell us that there will be justice and that her case will be heard again, because she's been wronged.

The majority of the people in that community who know her best, 1,500 people, know that she's been done wrong by that government. They're asking for justice, and I think that that Minister has the responsibility to stand in his place and say that there will be justice — that that government cares about people.

MR. CHAIRMAN: Order, please! I would caution all Members, including the Minister, that this subject has been quite thoroughly canvassed. I would ask them to keep their remarks brief.

HON. D.G. COCKE (Minister of Health): Mr.

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Chairman, as a Minister I feel that it's up to me to answer the questions that were raised by that Member for Columbia River (Mr. Chabot), up there near the Alberta border where he is away from things from time to time.

Mr. Chairman, in the first place, what did that Member say? He said that she's been done wrong, referring to nurse Vaness, by this government. The issue has never been before this government. It's never been before this government.

MR. CHABOT: You're part of this government.

HON. MR. COCKE: Just a minute. It's been before this Minister, but never before this government. There are two steps that are to be taken, and those steps are as follows — if you wish.... Now I suggested, and I think rightly so, that if we want to deal with every personnel issue that comes up when there are 40,000 people out there employed by the government .... If we want to deal with those individually we might be here beyond July.

I suggested to that Member that we discuss the whole question, because there are two normal courses to go. You as a former government Member and as a former cabinet Minister know what those two are. We know what they are and there are two appeals available — one that nurse Vaness has already taken advantage of in 1971 over a different issue; that's an appeal to the Public Service Commission. That's available to her now.

There's a second appeal if, in fact, that first appeal is of no avail. The second appeal is an appeal to the cabinet in council. And that's where it's at. I really don't see why we're making a public issue over a situation that can be....

Interjection.

HON. MR. COCKE: That's not putting it under the rug, Mr. Chairman, with deference to that Member. That's giving the opportunity to follow the normal procedure that's available to every single solitary public servant in this province.

Mr. Chairman, they voted for that procedure, that group. So it has nothing to do with a case that can't see the light of day. My goodness gracious, this case has seen the light of day. It's seen the light of day for the last number of months — publicity. I think now it's time, Mr. Chairman, to put due process to work as opposed to this method.

What you're asking me to do here is to judge the case. What you're asking me to do is judge the case from this vantage point, and that would be frivolous. And the Member for Langley (Mr. McClelland) that says, "Do your job:" Mr. Member for Langley, I've been trying to do my job despite you. Thank you, Mr. Chairman.

MR. CHAIRMAN: On a point of order. In response to comments that were made I would just point out that this subject has been discussed for something like two hours in committee this morning and the subject has been, as far as the Chair is concerned, fully covered. Therefore, I would request that the Member, unless he has some new point to raise, move to another subject.

MR. CHABOT: On a point of order, Mr. Chairman, I think it's most unfair for you to anticipate what a Member will raise when he stands in his place. I wish you'd refrain from that type of anticipation when a Member stands in his place when another issue has been raised.

One other point I want to make is the fact that you stated this matter had been canvassed for two hours this morning. It's quite obvious to me that you were not in this chamber this morning because your figure of two hours is absolutely wrong. You're not aware of when the debate took place and when this issue was actually brought on to the floor of the House. I want to suggest to you that it was nothing in the neighbourhood of two hours that this matter was discussed. You are in error when you state two hours, Mr. Chairman.

MR. CHAIRMAN: On the point of order I would just state again that the subject has been canvassed at length, and unless there's a new point introduced I would ask the Hon. Member to move to another subject. This is simply a word of caution, but if he has a new point to raise, the Chair will entertain it.

MR. A.V. FRASER (Cariboo): Yes, Mr. Chairman, thank you very much for your warning. I certainly have a new point to raise and it probably leads to another one that concerns you, Sir, regarding this case. Maybe you want to leave the Chair while I discuss what you have had to say about this case.

MR. CHAIRMAN: On your request, the Chairman will remain in his chair. You can discuss the Member for Skeena as if he were a third person. (Laughter.)

MR. FRASER: I'm glad you chose to stay in the Chair in your capacity as Chairman. But your other hat is that you are the MLA for Skeena riding, and I would like to tell this House that you are a long-time resident of 100 Mile House and you are aware of the problems in this case. I will certainly give you credit in having something to say about this case in this Legislature.

I'd just like to inform the House what you did have to say:

"Skeena NDP MLA Hartley Dent, a former 100 Mile House resident, added his voice to those who wished the Vaness matter reopened

[ Page 1657 ]

in a speech to the House earlier in the month."

I might say this is from a local paper of 100 Mile House, the 100 Mile House Free Press. You went on further to say:

" 'This is the very kind of situation which points up to the need for an ombudsman for the province,' Dent said.

"Dent told the House he had many friends in 100 Mile House and had received letters from people concerned about the forced resignation of former 100 Mile House public health nurse, Freda Vaness. 'I'm not going to say who is right and who is wrong in this situation,' Dent said, but he read excerpts from letters he had received."

I'm glad you have had some concern about this also, Mr. Chairman, and I know why, because you know a lot of the people in this area who are concerned about the treatment Mrs. Vaness has had. I would like to take issue with the Minister on the stand he appears to be now taking. He will not announce to the House, apparently, that he'll reopen this case: he has just stood in his place and related the two courses of action available to Mrs. Vaness. He said one of them was an appeal to the public service the other, I believe, was to the cabinet. I imagine that either one will cost her a lot of money to prepare.

I would like to bring another point on the scene on this. When I wrote you, Mr. Chairman, through you to the Minister, in February about this case, and brought it up on the floor of the House, you wrote back and you never mentioned any of these courses in that letter. I think, Mr. Minister, through you, Mr. Chairman, that you were very remiss in not outlining it at that time if you had concern. It seems to me now, you're just grasping for answers to get rid of the case — grasping at straws — and I can't understand your position.

If you were so sure, Mr. Chairman, that Mrs. Vaness had these courses open to her, why didn't you put it in that letter you wrote in reply to me on February 20? — in reply to the letter where I asked you to reopen the case. You didn't say that at that time; you just dwelt on the position that she had up and left.

HON. MR. COCKE: You knew it.

MR. FRASER: I did not know it. I certainly did not. Furthermore on that question, I'll read to you: "...that maybe under the Public Service Act or something she has recourse," but I'd like to put a new dimension on this.

I am again reading from the local newspaper in 100 Mile House, from another article on this case:

"After four years of service at the 100 Mile House health unit, Mrs. Vaness was asked to resign following complaints that she had misused a government vehicle. The passage of Bill 75 prevented the B.C. Government Employees' Union from representing public health nurses, and the RNABC is evidently unable to act for her either, leaving her out in the cold."

Now, what kind of stuff, double-talk, are we getting here? I'm not saying this is authentic and I don't know whether you know what you're talking about. But as a lay person.... Maybe you bright guys here...the Provincial Secretary (Hon. Mr. Hall) can inform me. They are saying in this article here that because she's a professional person, as I understand it, the passage of Bill 75 prevents them from acting on her behalf.

Interjection.

MR. FRASER: Well, this is where all the confusion is created in this case, because this is what the lady thinks.

Interjection.

MR. FRASER: No, Minister of marbles, I don't need you to get into this. (Laughter.) We'll have plenty to say to you shortly.

All in all, I am still of the opinion that we can't resolve this case until the Minister announces in this House that he's going to reopen the case. Whatever course he takes that's his business.

I'm sorry, Mr. Chairman, for repeating, but I feel very strongly about this. There is a wrong being done here, and the Minister can correct it without losing any face at all. What is it to reopen a case — maybe they'll come back with the same findings as before. I doubt it very much, but at least the air will be cleared and this, as I fell, innocent person will get the justice that has been lacking up until now.

I don't suppose the Minister wants to comment any further, but perhaps somebody else will.

MR. G.F. GIBSON (North Vancouver–Capilano): Mr. Chairman, I hesitate to jump into the middle of this particular case if anyone has any more to say on it.

MR. CHAIRMAN: Order! I would suggest to the committee that the subject has now been pretty thoroughly canvassed for two hours. If there is a new point, the Chair will entertain a new point, but I would request that you riot repeat old arguments again.

MR. R.H. McCLELLAND (Langley): Mr. Chairman, I have not been on my feet in this particular debate with regard to this matter so far. I'd like just to remind the Chairman, that during estimates it seems to me that is a time for Members to

[ Page 1658 ]

be allowed to get up and give their opinions about either the philosophy or the handling of the administration of the Minister's office. I would expect the Chairman would be fair enough to allow us to do that.

What we are asking for here is simple justice and nothing more. I don't understand why the Minister of Health wishes so badly to sweep this case under the rug, to refuse to study the case again, to determine once and for all whether or not an injustice has been done.

I don't understand why that Minister who on so many occasions in the past when he was a Member for the opposition, stood in his place and fought and argued and pleaded for individuals. He named individuals on the floor of the House, brought individual cases to the floor of this House, as did so many other Members of that group when they were in opposition.

The Minister of Transport and Communications (Hon. Mr. Strachan), the Premier, the Minister of Mines and Petroleum Resources (Hon. Mr. Nimsick), the Minister of Public Works (Hon. Mr. Harley) — we can name them. Time after time those people who stood in opposition in this House brought forward the names of individual public servants who they thought had been unjustly fired. As long as it was on that side of the House that it was being done, it was a perfectly acceptable procedure.

I still feel that kind of action on behalf of an individual MLA for the people of his constituency is the kind of action that an MLA must carry out or he isn't doing his duty.

This is the highest court of the land. It is the court of last resort as it were. I think that Minister has been derelict in his duty simply by the nature of his reply to the Member for Cariboo (Mr. Fraser) when he refused, or at least for one reason or another, didn't outline the course of action that this public servant had at the time he wrote back to the initial inquiry from the Member for Cariboo. That's dereliction of duty.

I say, Mr. Chairman, that what we want here is some justice. We want that Minister to stand in this House and say that he will reopen this case. The reason we demand that from the Minister is that we can't trust you. We can't trust this government to take action out in the open. We can't trust this government to take action out in the open. You say, "Trust us." Well, we say, "In God we trust, not in socialism."

HON. MR. COCKE: Mr. Chairman, if the Member for Langley (Mr. McClelland) felt a tremendous empathy for me, I would have to re-examine my whole being.

AN HON. MEMBER: Hear, hear!

HON. MR. COCKE: Simple justice that Member calls for. Simple justice is available, Mr. Member. Simple justice is more available outside the court of last resort that you are talking about — far more available than splashing things across the headlines.

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: There are two areas that have not been canvassed yet, and those are the appeal procedures that I was talking about.

AN HON. MEMBER: That you voted for.

HON. MR. COCKE: That you voted for. That Member for Langley also went on to say, "The Minister refuses to study the case again." He wasn't in the House this morning. He was out drinking coffee, or whatever he was doing, when I said that I'd be pleased to look over the transcript and discuss the matter with the Member for Cariboo (Mr. Fraser) who, incidentally, I think, at the time — I must give you my impression — was quite happy with that, until the backbenchers over there started to whisper to him: "Oh, no, don't. No, no, no."

The Member for Columbia River (Mr. Chabot) had to move over and sit beside him, passing him little tidbits, sweet little tidbits. You're a bunch of sweethearts. Take off that mantle that you've got on of this great protector. The fact of the matter is that this woman, if she wishes, can write to the civil service commission, the public service commission, and have an inquiry.

She can have the union, at least the RNABC, to represent her — which is part of the process — and failing any satisfaction at that level, she can go on to a committee. I'm sure that when that Member was a member of cabinet he sat in on cabinet appeals. He knows that they're there, and they're available. If he didn't, well, it is possible that they didn't let him on a cabinet appeal.

But anyway, Mr. Chairman, I think that it's there. Don't ask me to open the case. The case is not closed. How can I open something that isn't closed?

MR. D.M. PHILLIPS (South Peace River): You said in your letter the case was closed.

HON. MR. COCKE: As far as I was concerned.

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: Wait a minute....

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: What you ask of me.... Oh, jump around, Peace River. The daffodils are

[ Page 1659 ]

beginning to bloom up there, so I'm sure that we'll be off that.

But, Mr. Chairman, I was asked to make a decision as to whether I should personally interfere....

AN HON. MEMBER: Not at all.

HON. MR. COCKE: That's a fact — whether I should personally interfere with a decision made by public servants in charge of other public servants...

AN HON. MEMBER: Tell them you had a reason.

HON. MR. COCKE: ...by district deputies and people of that ilk. I don't think that I can go rushing around, as Minister, making intervention after intervention in my department, nor should I expect it from the other cabinet Ministers. The recourse is to the commission. And that's the way to go.

AN HON. MEMBER: And he voted for it.

HON. MR. COCKE: That was what you voted for.

MR. McCLELLAND: If the Minister doesn't mind interfering in labour agreements, why won't he interfere in a case of justice?

MR. FRASER: Mr. Chairman, the Minister here says that about opening and reopening the case. I think he's forgotten what he said in his letter to me of February 20. I'm going to read an excerpt out of it that is relative to what the Minister said. It is dated February 20, addressed to myself:

"With reference to your letter of February 11, 1974, it is not my intention to reopen the case of Mrs. Freda Vaness, since Mrs. Vaness, of her own volition, terminated her employment with the Health Branch on January 18, 1974."

You stated there most emphatically that you wouldn't, and that's what it's all about. Why can't you reopen it? You raised another....

Interjection.

MR. FRASER: I beg your pardon?

AN HON. MEMBER: She resigned.

SOME HON. MEMBERS: No, no!

AN HON. MEMBER: With a little help from her friends, she resigned.

MR. FRASER: You raised the other point, Mr. Minister, in your last answer that a decision had been made by somebody down the ladder. Don't you understand that you're in the position, an elected position, that you can do something to overrule a decision — not of a junior clerk in your department, but an Assistant Deputy Minister and his assistant and the head of the Public Nursing Service of the Province of British Columbia? They weren't two-bit-level civil servants; they were senior people.

But are you saying that that's it? That's final? And you, as the elected person, the Minister, won't interfere? That surprises me, that you won't overrule. Are you going to go along and administer this department that way? I don't think you are, even if you are nodding your head. I don't think you are. You're going to find lots of times in your tenure of office that you're going to have to overrule these people, and rule probably against them.

Again, I think it is a very simple request: you just direct that this case be reopened. I again ask that that happen, and I sincerely mean that should happen in view of the fact that you can do it. You are the elected person. If you want to direct the public service to do it, fine; go ahead. But certainly Mrs. Vaness says that as far as she knows she can't do it, and I quote from that article.

MRS. P.J. JORDAN (North Okanagan): I listened with great care to the Hon. Minister just now and frankly I think that he just wove another thin edge of the wedge that is building the laminated beam that he's trying to use against the professional nurses in this province.

The Minister, through you, Mr. Chairman, is subtly building layer upon layer upon layer of interference, discrimination and public weaving which is working against the professional nurses of this province.

You stood up here and you said that the nurse in question, Mrs. Vaness, resigned. She resigned under the pressure of the subtle schemes that this Minister and his government are weaving for some of the people of this province.

We ask you, Mr. Minister, to stop skating around with sweet talk and sweet smiles in this whole issue of health. It's this Minister's trademark, and I refer back to his own words when he talks about sweethearts. He's trying to be the sweetheart of the health area, doing this through selective moves in his responsibilities and through actually sitting in an area of doing nothing except in the areas of motherhood.

Mr. Minister, you're the Minister of Health. The people who work for you are responsible to you and to the public of British Columbia, and that includes fair treatment for those who work for the government. Surely it is time you came to grips, through you, Mr. Chairman, with your responsibilities.

We've seen one incident where this Minister went in on a political basis to cure what he called a discriminatory situation, and brought about a settlement that cost him $35 million. When the bill

[ Page 1660 ]

came home to roost, the Minister of Finance looked at him and said, "Cockey, baby, your wife was too strong. Back off. You're costing the people of British Columbia too much." That Minister just turned around and closed his eyes to the second discriminatory ripple that was caused by his actions.

Mr. Minister, if you can't come to grips with your own sense of responsibility in so simple an issue as this, where a nurse who has served remote people in this province well and long, who is willing to work nights, weekends, and travel through vast areas of this province alone, or in company with someone, in order to meet the needs of the people who are her responsibility...if you're not willing to stand by this person, what hope do the rest of the people in this province have?

Mr. Minister, there is an acute nursing shortage in this province right now — a matter which I will deal with later in the Minister's estimates. But there is, without a doubt, an acute shortage of professional nurses in this province. There is an acute shortage of public health nurses, and there is a tremendous need for increased health care in remote areas such as 100 Mile House and the district that this nurse serves.

Mr. Minister, in fearing to get your feet wet, you are letting the people of this area suffer. I would urge you to assume your responsibilities — as you felt that you had to in the intervention you made on behalf of the licensed practical nurses in this problem — and open this case, and bring it to light.

If this nurse has been wronged and her professional status and her ability to meet her responsibilities and carry out her job has been impaired, then her name should be cleared.

In light of the long delays that have taken place — the Minister's refusal, which has been quoted by letter in this House, to intervene into the situation and have a hearing...

MR. CHAIRMAN: Order!

MRS. JORDAN: ...into a review of the case has left a professional person whose name is in question....

MR. CHAIRMAN: Order, please! I would ask the Hon. Member to raise a new point. Otherwise, as I said before, the subject has been discussed at length.

MRS. JORDAN: Well, thank you, Mr. Chairman. It's hard to raise a new point when the matter involves one human being, one human being's professional status, and one human being's willingness to serve the people. The Minister who has a closed mind, closed eyes, in fact is trying to build a laminated beam against the registered nurses in this province and he'll use every avenue through which to do it.

MR. GIBSON: Mr. Chairman, I will be brief and mostly ask the Minister general questions because I enter any debate on health with some humility.

There's one topic on which I will pretend to speak as a bit of an expert; that is on the question of the danger of motorcycles. I want to congratulate the Minister on what he said yesterday about that, and endorse his point very strongly.

He brought out the point that people who ride motorcycles are about four times more likely than automobile drivers to be involved in accidents, and that those accidents are likely on the average to keep them in hospital longer.

Mr. Chairman, the accidents on motorcycles, generally, are particularly gruesome things, and particularly unfortunate because they generally happen to people who are younger and who have to go through the rest of their lives maimed in some way or another by the damage done by these particular machines.

MR. CHAIRMAN: Order! I would caution the Hon. Member, and just ask him when he's discussing a subject to relate it to the administrative responsibility of the Minister.

MR. GIBSON: Mr. Chairman, I am relating it precisely to remarks made by the Minister in opening this debate. In any event it's not a subject on which I propose to linger at great length, but I think it's important.

This is one of the jobs of a Minister of Health, to warn people of health dangers. This very clearly is that.

There's this great feeling of freedom, of being out in the open on these marvelous machines. It's fine in good weather; then you get into the bad weather — the heavy traffic, the rain, the poor visibility — and all of a sudden you're smack in some kind of an accident with no protection around you. It's that first six months. I don't know if your figures show this, Mr. Minister, through you, Mr. Chairman, it's that first six months....

Interjection.

MR. GIBSON: It's in the lower age grouping and particularly in that first six months that the riders get into trouble.

In any way I can, I beg every motorcyclist to take a course; to have good crash equipment on their bikes which will give you some protection, not much; to wear the helmet like you're supposed to, and so on. I just want to make a very heartfelt plea in that regard, as one who had an awfully close call. I was in hospital a number of weeks myself.

Now, I'd like to ask the Minister some questions — that's all they are; they're not suggestions at this stage

[ Page 1661 ]

— about people who are healthy, more than people who are sick. I'd very much like to hear his remarks about the concept, which has been kicked around in the medical world for many years, of check-up clinics, diagnostic clinics, doing the same for ordinary people on a routine yearly basis, or even a six-month basis as people get older, that without thinking we do for our automobiles if we care about them, which is: take them in and get them checked over.

Many people follow this valuable practice with their own private physicians, but most people don't. It's not a habit that most people have gotten into. This is the comment I would like from the Minister: would it be a good use of medical manpower? Do we, indeed, have the kind of medical manpower to set up this kind of preventive and checkup centres to become a part of the ordinary life of British Columbia? That's the first question I have.

The second question to the Minister is: what is happening with respect to health in our schools? This, it seems to me, is where good health habits are formed. The background that a person needs for their health all of their lives, and, indeed, for bringing up their children and seeing that they're healthy too: this is where the knowledge and the habits are provided.

I remember my own — I think it was called health and personal development — classes in the school system many years ago. I remember none of us paid very much attention to any of it, but particularly the health part we paid almost no attention to.

I ask the Minister: what is happening in the schools in this regard now? Are there better ways being developed of seizing the attention of students and teaching them about the fundamentals of health?, I appreciate that is in part the responsibility of the Minister of Education, but I expect this is something that the two would liaise about. It's certainly the responsibility of the public health nurses in the schools.

The third question I would ask the Minister, speaking, as I say, still about people who are healthy: What guidance is available to the ordinary person in the choice of a doctor? Many of us have been fortunate enough to find a good doctor because he's been the family doctor, or because you knew a friend — this sort of relationship. But many young families start out without having a doctor. Many new residents come to British Columbia. This is one, or should be one, of the closest and most important relationships at any citizen has with a professional person. Yet the ordinary way of finding a doctor for people who are new to the situation tends to be to look in the Yellow Pages. Now, I have to confess that I don't know of any better way, but I'm asking the Minister if there is a better way — if he'd comment on that.

I'd ask him a fourth question, which as a layman I'm much interested in. Would he give us a brief report on the legal and medical status of acupuncture in British Columbia?

I would make a final representation to him in the matter of the field of research, specifically brain research. We had an excellent talk yesterday from the Hon. First Member for Vancouver–Point Grey (Mr. McGeer) who spoke about medical research in general. He was, I assume, too modest to speak of his own specialty, which is brain research, and the team that is working in this field out at the University of British Columbia.

There's widespread belief, whether it's true or not, that most of us use only 10 per cent of our brains — some perhaps a little less, some a little more. Given that fact, there's a great chance here. In particular, there's a great chance in British Columbia to approach the world frontiers of knowledge in the brain research field, because it's a very low-cost field as medical research, or any kind of research, goes. It doesn't require a lot of equipment, it doesn't require expensive cyclotrons or all of the hardware that's required. All it requires is the first-class minds in the field in the world to be brought together. There's a building block out at the University of British Columbia for that purpose, and $1 million or $2 million a year could get us close to the frontiers of knowledge of brain research in the world.

The importance of this to me is that the next quantum jump in human affairs will probably come about through mankind learning better how to use this basic working instrument he has. The brain researchers are a part of that. Researchers in other fields, parapsychology and so on, are working on other aspects of it.

I think it's a public investment that's a worthwhile one. I would be grateful if the Minister would consider that and use his influence, particularly with his federal counterpart and the activities of the Medical Research Council, to try and have this supported more extensively with the group working at the University of British Columbia — also if the Minister would work in that direction through any financial and other means he has at his disposal.

HON. MR. COCKE: Mr. Chairman, thank you to the Member for North Vancouver–Capilano. I'm glad that you were supportive on that motorcycle situation. No question that the younger people are the ones who are having the problem and that's why I suggest that they be very careful with this whole area.

Just to give you an idea, out of the 1,000 that were admitted to hospital in 1952, there were 404 males and 48 females who were between the ages of 15 and 19. That's virtually half of them. Between the ages of 20 and 29, there were 348 male and 25 female.

That really means the remainder were in the other

[ Page 1662 ]

age groups and, of course, were really not significant in any other age groups. You are quite right; it is the same thing applied to the hospital days — exactly the same situation. It's a very dangerous plaything. I would hope that people would stop regarding it as a plaything and think in terms of the serious consequence of motorcycle accidents.

The Member also brought up the whole question of check-up clinics and diagnostic clinics. I agree that this is a very desirable kind of thing but one that is going to require a great deal of public education. I know people who are fairly close to me who don't go to a doctor for fear of what they might find out. I have a little bit of that in me in a way; I think we all have. You overcome it and you go. I think there has to be some public education on the whole question of preventive medicine in this area.

We had an all-day meeting at UBC on this question that I attended just recently. I also have two consultants who are working in this area, both preventive-medicine doctors, who took their specialty in space centres, as a matter of fact. I am told by both of these groups that we do not have sufficient manpower at the present time to do a thorough job. There would be a requirement for a great deal of paramedical manpower.

All I can say is that we are certainly looking at this. We feel it is much better to stop an illness than to treat an illness if it is at all possible. Our thoughts are in that direction. We have had a tremendous number of discussions as to just exactly which way to go. Plans are being sought and are being made to carry us in the right direction in an area of preventive health care. It's the old "ounce of prevention" idea; it is still as true as it was when that philosophy was first introduced.

We are helping out some cardiac preventive centres. Suffice it to say that we are quite aware of this, Mr. Member, and I appreciate your thoughts on it. We are certainly going to move in that direction.

Health in schools. Naturally, the Minister of Education (Hon. Mrs. Dailly) and I have discussed these questions. We have people in our department who we call health educators. The health educator's job is to move around to help and assist the school teachers and people working in the school system to get more attention paid to public health, prevention and nutrition. We have teams available to schools who deal in all areas of health.

It's very difficult. Some of us would like to say to the schools, for instance, "No more of those hamburgers and chips. How about some good nutritious meals in the schools as a good preventive measure and also a little bit of education along the way?" Unfortunately, where this has been tried, the kids go romping off to McDonald's. It's very difficult.

Interjection.

HON. MR. COCKE: That's right. It is very difficult to make a move in that direction. As a matter of fact, I thought of free apples for school children. I haven't got too many statistics on this, but my understanding is that where this has been tried they have used them for helping one another.

Interjection.

HON. MR. COCKE: We have professionals available in our public health department who make themselves available to the schools to assist in public health education in that area. We also have teams of nurses to work with school children. As you know, they inoculate them, have immunization programmes and so on. They are there and available and those teams are being built up.

The choice of a doctor. I can't give you too much advice other than ask a friend who you trust if he has a physician he trusts.

Interjection.

HON. MR. COCKE: I understand that. Also access to the College of Physicians and Surgeons. If one wants a lawyer and doesn't know a lawyer in town, he can request the name of a lawyer from the bar, I presume. I know the college would certainly afford a list of Doctors available in a particular area. The local health officer would be another choice. You could go to whoever is in charge of the public health unit in your area, wherever that area might be around the province, and he would know doctors in the area. I realize it is a problem for people.

The fourth point you brought up is the legal and medical status of acupuncture. Acupuncture as a technique is not recognized as a medical procedure as far as I know. Our college and our department are working together to try to develop standards for acupuncture treatment in this province mainly where it involves the relief of pain.

We have had a clinic going; Dr. Saita from West Vancouver is working with it. He is a qualified acupuncturist in his own right and he is also licensed under the Medical Act in B.C. He has a pilot project going in Vancouver where we are using medical people as observers and arthritic people and others as people who are taking treatments to find out just exactly what standards we can set and how we can best get acupuncture working in this province.

MR. GIBSON: Is it working well now?

HON. MR. COCKE: As far as I know there will be some results very shortly. From what I see, it's working very well in that they are doing all of the things they set out to do. I can't give you the exact results of the procedure to take but I have an idea we

[ Page 1663 ]

will be seeing moves in the area of acupuncture in the not too distant future.

As far as brain research is concerned, we have discussed this question with Dr. Gibson and his colleague, Dr. McGeer, the Member for Vancouver–Point Grey. Certainly, we're most interested. I think we will be developing even more cooperation in the future than we have given in the past.

We still contend, however, that research with the federal government should be more and more their responsibility. We feel that at the provincial level there is a real chance of duplication of research being done elsewhere. We've called upon the Minister federally to get more involved and we have participated in discussions that have included your Member.

I just hope that we do continue on as a country thinking in terms of the necessity to go after those conditions, those diseases, those illnesses that to date have not been successfully dealt with. That's our position at the present time. We can improve our participation and we hope that our partners down east will improve their participation.

MR. N.R. MORRISON (Victoria): Just before we get off the complete subject of motorcycles, I wonder if the Minister could tell us if these statistics hold pretty well true for Europe also where there are many, many more motorcycles. Perhaps their younger children and young people are better trained in the use of them and the drivers are a little more familiar with what to anticipate. I'm a father who has gone through the motorcycle stage with his boys — I hope; there's only one left in the driveway now. At one time there used to be four. Fortunately, we have had no serious accidents in our family. I do think many of our drivers here are unfamiliar with how to treat a motorcycle on the road and I am sure most of the younger people are not adequately taught or trained how to drive motorcycles and really how dangerous they are.

I would like to ask the Minister if he could tell us what the present status of the Victoria area private hospitals is. How many of them are currently being taken over by the government or are being negotiated with the government? What do you plan in the future, which ones do you plan to acquire and what exactly is that programme here in the Victoria area?

HON. MR. COCKE: I don't have the European figures and I wouldn't even try to second-guess those figures. I know that a lot of the accidents that occur are not necessarily the fault of those driving. They just have to be that much more of a defensive driver than the person who is driving with a piece of steel all around him to protect himself. They have to be much more of a defensive driver.

As the Member for North Vancouver–Capilano (Mr. Gibson) said, they should be very careful about the times that they drive these vehicles. In the rain and when it's hard to see they become even more lethal. But I do know that they have been a problem as far as our health facilities are concerned. I just want people to realize that the consequences might be serious.

Now as far as the private hospital status is concerned, we have bought — negotiated for and bought — two of Victoria's private hospitals. At the present time, naturally, our thrust has been to try to cover the need for extended care. Now according to the projections that we have, we should now have extended care taken care of in the Capital Regional District. The numbers are now equal. In other words, the number of beds we have available is now equal to the need, according to our projections. Now we'll see just how accurate those projections are in the next few weeks and months, I presume.

Of course, the next phase for us is intermediate care, Whether or not the private hospitals will work out for intermediate care and whether or not we will negotiate for a number of them for that purpose, I'm not quite sure. It might be that we're going to have to build a variety of.... We already, as you know, have three or four that are pilot projects to find out what best serves the intermediate-care field. We'll be building smaller ones and larger ones, and so on. But we might very well, and certainly if a private hospital owner wants to sell, then come and see us. We're open to negotiations as long as the hospital can serve a purpose.

MR. MORRISON: Are we going into an expanded outpatient-care programme now in the major areas rather than trying to treat them in the hospitals, where we can just bring them in very briefly and out again? Is that programme being expanded considerably?

HON. MR. COCKE: Yes. In most hospitals, Mr. Chairman, day-care surgery and day-care treatment is on the upswing. I can't give you the exact figures at the moment. I could under the vote, but it's up a good deal. It's up here, it's up at most of the hospitals in the province. Most doctors have been most cooperative in this area, and I think it's going to increase. It's a great saving; and that, combined with a little bit of home care, can sure save you a lot of money.

MR. PHILLIPS: I'd like to ask the Minister of Health what assistance the government is giving to people who are wholly disabled by multiple sclerosis. Is there a hospital where therapy can be administered, where these people can be occupied with crafts, et cetera? Or is it still necessary to keep these people

[ Page 1664 ]

who are chronically ill in the home? What action does the government plan on taking? What facilities are available?

HON. MR. COCKE: Well, we have rehabilitation hospitals, as you know, and rehabilitation wards in hospitals. We have a number of multiple sclerosis patients in Pearson, for an example, in extended care. There are a number of other patients with this illness in a lot of our extended-care hospitals throughout the province.

As far as what we are doing, my colleagues in the Department of Human Resources provide Mincome for those who are handicapped in that regard. Naturally we hope — and that's part of what the Member for North Vancouver–Capilano (Mr. Gibson) was talking about — we hope for a breakthrough in research in this area as well. It is a dread illness and the quicker it can be contended with, the better.

MR. PHILLIPS: There's one other subject I want to discuss. I want to discuss it under the Minister's vote because it doesn't only involve venereal disease control but it involves general education in the public health service. I'd just like to spend a few moments discussing this subject under this vote rather than under vote 86 because it is rather far-reaching. I'd like to dispose of it now, with your indulgence.

In listening to television last night, I must say I was appalled to learn that there are 30,000 cases of venereal disease in British Columbia at the present time. I guess maybe I was under the impression, like a lot of people are, that venereal disease has practically been eradicated and was no longer a problem. But I would say, and as the television programme last night stated, 30,000 cases is of almost epidemic proportion.

So I started doing a little research into the matter between then and now, Mr. Chairman, through you to the Minister. In the 1973 annual report of the Department of Health there is a section on venereal disease control. It states that:

"Venereal diseases are diseases usually contracted through sexual intercourse. Of the five diseases classified as venereal only gonorrhea and syphilis occur to any extent in the province. Gonorrhea is very prevalent with 8,970 cases reported in 1973; syphilis is much less common with 100 cases of infectious syphilis being reported in 1973."

Either this report is wrong or the television broadcast is wrong. I would like to know what the situation is. This is a report of 1973. This is just a year later, and this report stated that there were 30,000 cases in British Columbia.

In doing some research I find that venereal disease in Canada still exacts an appalling toll in human suffering. As. of January 31, 1974, there are 425,000 Canadians a year infected or suffering from this disease. That's nearly a half a million Canadians. That's certainly more than we have troubled with tuberculosis.

I'm not going to go into the origins or the symptoms or the treatment of this disease, but I'd like to discuss with the Minister some of the causes of this crisis and what government action is needed to eradicate this menace.

MR. CHAIRMAN: Order, please! I would point out to the Hon. Member that there is a complete vote, vote No. 86, and I would ask him to keep his remarks relevant to the administrative responsibilities of the Minister.

MR. PHILLIPS: Well, Mr. Chairman, I am. In discussing this, I'm going to be discussing other votes such as the public health service and the nursing and also education. So, please, I am talking. I feel that the treatment and education of this disease certainly comes under the administrative responsibilities of this Minister. Certainly it is known that both of these venereal diseases are curable and preventable. What I want to know from the Minister is what is happening in the Department of Health in British Columbia that would allow this disease to reach such epidemic proportions, Maybe, Mr. Chairman, it's complacency on behalf of the medical staff and on behalf of the Department of Health — and maybe in the public health service, because they are like I am and thought it was licked. Penicillin was discovered for the treatment of venereal disease in 1943. Venereal disease in Canada rapidly fell — the amount of cases rapidly fell. There were 16,475 cases of syphilis in 1944 and this dropped to only 2,038 in 1958. So I guess I'm not the only one that thought that this disease had been eradicated.

MR. CHAIRMAN: Order, please! I would remind the Hon. Member, if the main point of this discussion is venereal disease, that it would seem more appropriate to discuss it under vote 86, entitled "Division of Venereal Disease Control." That is clearly the area where this whole matter should be discussed.

MR. PHILLIPS: Mr. Chairman, as I just pointed out to you, I'm going to be discussing a vote for education and I'm going to be discussing the public health service; and let's get the subject out of the way now. If you'd just allow me to continue, this does come under the administrative responsibilities of the Minister. If you'd quit interrupting me, I'll carry on with my talk. I haven't got much more to say, but if you keep interrupting me....

One of the reasons, it is thought — and this is in the research I have done, Mr. Chairman — one of the

[ Page 1665 ]

reasons it is thought that this disease has reached such proportions is. because of the lack of government funds to control, the lack of government funds to educate; and public interest in this subject has seemed to have dropped.

Even in the medical schools, from the research I have done I understand that emphasis on training general practitioners to detect and to treat venereal diseases has not been dropped but there is not as much emphasis on it today as there has been in the past.

Dr. James Morrison, the director of VD control for the Ontario Ministry of Health, said many family doctors today and in recent years in Ontario are not really doing their job in home treatment or in detecting it as a family physician. Maybe this is why this disease has reached epidemic proportions. He also feels there has been some lax use of chemicals. Particularly the wrong type of penicillin is being used today where it is not eradicating the disease as it has in the past because certain types of venereal disease have developed resistance to penicillin being used.

I suppose the development of oral contraceptives has had an affect on VD's resurgence. Today, with the amount of contraceptives on the market, there is not as much fear of pregnancy. Therefore, probably sexual intercourse is on the increase and this is probably one of the reasons why this disease has reached epidemic proportions. Dr. Ralph Persad, successor to Dr. Morrison at the Ontario Ministry of Health, says many women in Ontario who were taking the pill feel that the pill will protect them from venereal disease. There is a great need for education, both in the schools and through the public health nurses and through all types of medical practitioners. As a matter of fact, he said taking the pill probably makes many women more susceptible to gonorrhea than if they were not taking the pill.

Another reason they in Ontario feel these diseases have reached these proportions is because private physicians who treat these cases in families do not report to the public health service so that the giver of the disease can be traced. One of the reasons I suppose is that the public health service sometimes doesn't treat this disease with the privacy they should.

It seems to be the appalling ignorance and the stigma still attached to venereal disease that keeps it swept under the rug. "It is not a sin or a crime," writes Dr. Ann Keyl, director of the VD clinic at Toronto Women's College Hospital in her book on VD. "They are diseases, and the sooner we recognize them the sooner all infected persons will get proper treatment.

MR. CHAIRMAN: Order, please! Hon. Member, I don't choose to interrupt your speech, however, I'm just afraid that we're going to get into a general discussion of this subject in the wrong vote. Therefore, I just point out to you standing order 61, part 2: "Speeches in Committee of the Whole House must be strictly relevant to the item or clause under consideration." Clearly, all of your remarks are entirely relevant to vote 86 and should be dealt with at that time. It's coming up, I think, fairly soon.

MR. PHILLIPS: In due respect to your ruling, Mr. Chairman, I would find it very difficult to discuss public health education under vote 86, and that's what I'm leading up to. As I've asked you before, if you will just let me continue, how can I discuss education under vote 86?

MR. CHAIRMAN: Order! If the main point of the whole discussion is venereal disease, then clearly it should be brought up under vote 86. The Hon. Member may continue if he is relevant to vote 75.

MR. PHILLIPS: This is, I would say, a very grave problem in the Province of British Columbia. I would like to hear the Minister's remarks as to what he's going to do if this TV programme is true and if this disease has reached epidemic proportions.

Our own Miss Trudy Rudermann, who was a senior nurse with the B.C. Venereal Disease Control Division, says, "Too often VD is covered along with abortion, drugs and all the other no-nos in life." So she has some fairly strong feelings on this.

MR. CHAIRMAN: Order, please. If the Hon. Member is moving on to another point, I would allow him to continue. But I would rule any further discussion on venereal disease at this time out of order. It should be brought up under vote 86.

MR. PHILLIPS: Mr. Chairman, this is the responsibility under the Minister's salary. Under the Minister's salary you can discuss any full responsibility under his jurisdiction. In all due respect, as I told you, I'm going to be talking about education. I wish you would quit interrupting me. You'd think I was committing a sin of the House or something here.

MR. CHAIRMAN: I think the Hon. Member would appreciate that the Chair is concerned we will get into a full discussion with all Hon. Members participating on venereal disease at the wrong time. I would ask the Hon. Member if he wouldn't mind waiting until the vote comes so that we can have the general discussion at that time. It would seem much more appropriate.

MR. PHILLIPS: I want to ask for money, Mr. Chairman. As I pointed out before, I want to ask if the Minister will allot money for education in the

[ Page 1666 ]

public health service. I'm going to talk about money for pills; I'm going to talk about money for television; I'm going to talk about money for billboards; I'm going to talk about going into the schools. That comes under education; it's a separate vote, and it's under the Minister's salary. It's under his jurisdiction.

MR. CHAIRMAN: Order, please. Are all of these things that you are to discuss related to venereal disease?

MR. PHILLIPS: They're related to education in the public health field, yes, but education is a separate vote. Now, are you being stubborn or am I being stubborn? If you would just let me finish I'll be through in about three seconds and the subject will be disposed of, I hope, to my satisfaction.

MR. CHAIRMAN: The Hon. Member may proceed if he's right.

MR. PHILLIPS: Just recently an Ontario task force recommended that information on VD be included in health curriculum by grade 7, through the Department of Education. The Ontario task force proposed a campaign which would include radio and television broadcasts through the Department of Education in conjunction with the Department of Health. This will take money; it may even take money from the Department of Education. Maybe the Minister might have to use his influence with the Department of Education to see that this is brought about.

They recommended advertisements in newspapers; they recommended pamphlets. Maybe I'm not going in the right places, but it's been a long time since I've seen a pamphlet on venereal disease. I remember they used to be lying around in various areas. It has been a long time since I've seen a poster warning against the disaster of contacting venereal disease.

Films in the schools. Here again this may take the expenditure of a fair amount of money. Lectures in the schools.

MR. CHAIRMAN: Order, please! It appears the Hon. Member is continuing on the same discussion on venereal disease. Perhaps it would be helpful to the Hon. Member if we would ask the Hon. Minister if he chooses to discuss the subject at this point or whether he would prefer to wait until vote 86.

MR. PHILLIPS: I have about two minutes more....

MR. CHAIRMAN: Order! The Hon. Minister had indicated he prefers to discuss the subject under this vote. Would the Hon. Member continue, please?

MR. PHILLIPS: Does that have anything to do with your ruling? Either you rule I'm out of order or I'm not in order. But thank you very much, I'll continue.

MR. CHAIRMAN: You're now in order.

MR. PHILLIPS: They even went so far as to recommend that audio-visual kits be distributed in the schools so that each teacher can use them at his own discretion. They could be slide films, pamphlets and all of the other paraphernalia that would go to make up a good presentation in the school. This could be used in all grades from grade 7 up.

What I'd like to know is what we are actually doing in the Province of British Columbia. Under vote 86 we have a sum of $303,913 for the total Division of Venereal Disease Control. This is compared with the Division of Tuberculosis Control, for instance, of $1,025,449.

I would say, listening to this TV broadcast, from the statistics that I have, this epidemic of venereal disease that is in the Province of British Columbia, and not only British Columbia but in all of Canada, would be far more serious at the present time, and a far greater threat, and a far greater epidemic than tuberculosis. Yet on tuberculosis we are spending three times as much money.

When you think, Mr. Chairman, that we spent approximately $200,000 more on the Foulkes report than we are going to spend on venereal disease control, I have to think. The Minister just a few moments ago, when he was responding to the Member for North Vancouver–Capilano (Mr. Gibson) said that it would be better to stop an illness than to treat an illness. So this education, I feel, should receive a great deal of attention from the Department of Health.

Ontario, in the month of December had an hour-long film on venereal disease. It was called "Careless Love" and it ran in December in the Province of Ontario through their educational TV network. After this film ran, Mr. Chairman, the phone lines were busy to have a rerun of it because of the amount of interest from interested students and interested parents.

Maybe we should get that film and run it in British Columbia. Maybe we could get the cooperation of one of the TV networks here to run it here.

In February, 1973, the Canadian Broadcasting Corporation ran a similar film 4.4 million viewers, and it was called "The VD Blues." This is a U.S.-produced film documentary and it received a great deal of attention and a good response from the viewing public.

"Information and education, it would appear, are the best way of eradicating this disease, and today We have diagnostic and therapeutic tools available which

[ Page 1667 ]

are effective in detecting and treating venereal disease." So said Dr. J. Donald Miller of the U.S. Centre for Disease Control at the 1972 International Venereal Disease Symposium in Venice, Italy. "The question is whether or not we can supply these tools sufficiently intensively to interrupt transmission of these diseases."

So I hope, Mr. Chairman, that the Minister will bring his statistics up to date and advise the House that some immediate action is going to be taken. I suppose, with it being a coast port, where there are a lot of visitors coming in, mariners, seamen, I suppose that the disease is brought here from other countries. Maybe we should have some type of a vaccination. I don't know what the answer is, Mr. Chairman, but certainly some drastic action is needed, and I would be very interested in having the Minister's comments.

HON. MR. COCKE: Now, Mr. Chairman, let me first say that there is no such thing as a vaccination or inoculation for venereal disease, so we can dispense with any discussion of that.

The Member talked about seeing a TV programme last night and the TV programme informed him that there were an estimated 30,000 people in this province suffering from gonorrhea.

MR. PHILLIPS: No, I didn't say gonorrhea; I said VD.

HON. MR. COCKE: Well, Mr. Chairman, then he read the annual report of the Health department and found that there were only 9,000, roughly, reported. It's not terribly inconsistent because there are about one-third only that are actually reported, or there have been in the past.

But in B.C. I believe we are making real progress right now. We have met, over the last couple of months, with the B.C. Medical Association, and indicated to them that lab findings have shown us that there are a number of unreported cases in the province. They've agreed, and very happily agreed, to really put this whole thing together. There's real cooperation between the Health department and the medical association, the medical doctors of the province. Ways will be sought to do a better job of the reporting, because reporting is very important.

You talked about Health education, and we'll go into that in a minute. But the reporting is important because you must find out where the carriers are in order to stop the incidence, or reduce the incidence.

Last year's summer programmes: in a number of the areas which you talk about in the province, that we haven't built our VD control bureaucracy any longer, that's quite right. You're talking about a headquarters department, really. However, all local health units are involved, should be involved, will be involved to a greater extent.

Last year's summer programme was, to some extent, involved in VD, our programme. We are now having discussions with the Department of Education as to how we can best go about assisting with health education in this respect.

We have put some material forward for education, because we know, as everybody else knows, that it has now become a real outbreak in the younger age groups. At one time it was, generally speaking, an over-age-21 disease.

AN HON. MEMBER: What's the cost?

HON. MR. COCKE: Now it is an under-age-21 disease. It's in the teens — at least a large section of it is — and so therefore we have given to PTAs and other people educational material to examine, to read. We have access to the films which you are talking about, and we want to make this kind of educational material available. It's a large programme. But certainly we are not lacking any information and nor are we lacking in motivation to try to clear it up. We certainly want to do that, and I think that we will move in the direction of making our service available, so that we can correct some of the flaws that have been in the system. One of the big flaws has been the reporting aspect.

So, in any event, let's hope that we can start to change the trend and go in the direction that the trend went in the 50s.

MR. PHILLIPS: Mr. Chairman, just one other thought here. In the report it says that diagnostic and treatment units are maintained in New Westminster, Victoria, Prince Rupert, Dawson Creek, Prince George and Kamloops only, with others in the lower mainland and the City of Victoria. Now the Minister just said that all public health units were involved. There are public health units in more areas than mentioned in this report. What about in Terrace, or Vanderhoof, or Williams Lake? None of these centres are mentioned in here.

HON. MR. COCKE: They all have public health units, Mr. Chairman.

MR. PHILLIPS: Well, it, doesn't say so in the report. In other words, there are diagnostic and treatment clinics in all public health...?

HON. MR. COCKE: We have special nurses seconded where the incidence is high. But certainly they can get direction in any of those public health units, even where there is just one nurse working, for instance in Enderby, in an afternoon. You can go and find out just exactly how to go about getting correct information or diagnosis or whatever. So that's what public health nurses are all about.

[ Page 1668 ]

MR. PHILLIPS: Are you telling me that there's a higher incidence of venereal disease in Dawson Creek than there is in Fort St. John?

HON. MR. COCKE: Mr. Chairman, that was the Member's suggestion.

MR. PHILLIPS: Well, no. You said these treatment centres are maintained where there's higher incidence than others, and I see Dawson Creek but not Fort St. John.

HON. MR. COCKE: No, that's not necessarily the case. I said there are people seconded in some areas where there's a higher incidence; that would normally be in the lower mainland. Naturally there would be a greater number of....

MR. PHILLIPS: Mr. Chairman, I want to thank the Minister for his rational discussion on this. I'm certainly pleased to hear that something is being done and I hope that next year when we discuss his estimates there won't be 30,000 cases in the Province of British Columbia.

MR. G.S. WALLACE (Oak Bay): I've been sitting back waiting to discuss certain issues under certain votes, and I've just become a little frustrated because everybody's all over the ballpark on this side of the House, and I just find that on some of these subjects I'll lose the thread if I don't take them up at the moment. But I really feel that they should come under specific votes — such as the hospital vote, which I would like to talk about at some length, and some of these other areas.

But I've noticed, Mr. Chairman, in previous estimates that we've debated this session, that if you wait and try and discuss it under the separate vote, we find that the person speaking is somewhat harassed because it seems that the general impression in this House is that once we get to specific votes, you can hurry them along.

I think the consequence is that the Members of this House are trying to cover every part of the waterfront under the Minister's votes so that they won't be restricted when they talk under the specific vote. I wish we could get our guidelines clear because it's thoroughly confusing.

MR. CHAIRMAN: Order! The Chair was endeavouring to do just that, Hon. Member. However, the Chair was a little more tolerant than it should have been, and the point the Member's made is quite correct. The discussion should be brought up at the appropriate place and it should be strictly relevant to the vote. Therefore, we will make the attempt to keep the discussion strictly relevant to the vote under consideration.

There has been a discussion of venereal disease tolerated to this point. The Minister indicated he was prepared to discuss it, but strictly speaking, it's out of order. However, if the Hon. Member feels that the thread would be lost, or that he needs to pursue the matter at this time, the Chair will allow this, but would prefer the Hon. Member wait until the vote comes up.

MR. WALLACE: I certainly will respect your ruling, Mr. Chairman, as long as I can be reasonably certain that the same ruling will be applied to all Members. You had about a five-minute debate with the Member for South Peace River (Mr. Phillips); then finally you let him carry on. Now, if that's the way it's going to be, I've just got a whole sheaf of notes here that I can start on right now and you would have great difficulty ruling me out of order. So just as long as the same ground rules apply for everybody, that's just fine.

MR. CHAIRMAN: The point is well made.

MR. WALLACE: Mr. Chairman, there are one or two points that must come under the Minister's vote. One I have raised already, and I respect the Minister's decision. But I would like him to consider this question of coverage for individuals outside the province which at the present time is extended for the period of one year.

I raised a case with the Minister, and I won't mention names; I'm sure he remembers the gentleman from the University of Victoria. And I respect the answer because you can't stretch the rules for one person and not for another.

I wonder if the Minister would comment on whether he would consider some changes in the present legislation, or look at the somewhat inconsistent situation which exists as a result of order-in-council 492. The Minister answered in the question period one day that he considered this a fringe benefit for government employees. That's a fair enough statement also.

I should say, Mr. Chairman, that I'm talking about order-in-council 492, which applies to employees of the provincial government performing duties in the State of California, who are presently not eligible for hospital insurance and medical benefits after they have been absent from British Columbia for six months.

The order-in-council is rather wordy; I'm not sure I understand exactly what it says. The Minister can correct me if I'm wrong, but my understanding is that for government employees in California, there really is no time limit on which the B.C. Hospital Insurance will cease to pay for that employee's hospital and medical care costs. At least there seems to me to be no time value; it's not just a matter of extending it

[ Page 1669 ]

for six months to a year or 18 months. As I read the order-in-council, it is a perpetual commitment by the government to at least assist in paying the costs of medical care and hospital service for B.C. government employees in California.

The point I'm raising, Mr. Chairman, is, for example, the situation of a member of the teaching staff of the University of Victoria who went on a year's sabbatical to England. When he finished the year's sabbatical, he was offered and accepted a fellowship at the University of Liverpool. In his case it was quite clear, both by his stated intent and by documentation, that he was still a staff member of the University of Victoria. In fact, this extra experience that he had greatly enhanced his value as a teacher at the University of Victoria when he returned. So he was out of the country almost two years. It's interesting that when he re-entered Canada, his passport Was stamped "returning resident."

Anyway, the very sad situation was that his wife became ill soon after their return, and the bill for the hospital care was $1,900. Now here is a resident of British Columbia, under these circumstances, who finds himself committed to pay the bill privately.

I won't belabour the point and I respect the Minister's statement that there has to be some kind of guidelines and some kind of period of time beyond which they cease to be regarded as Canadian residents. But in light of the fact that the Minister has given certain, it seems to me, unlimited coverage to government employees in California, this in itself creates a measure of inconsistency.

It's quite true, as the Minister stated, that his department has chosen to give this as a fringe benefit, for lack of a better phrase. But the fact is that the University of Victoria has no option to provide that kind of fringe benefit for their employees nor, for that matter, has any other business in this province which has employees who are involved in considerable periods of time outside of British Columbia. As far as I'm aware, there is no mechanism under the legislation whereby they could do that even if they wanted.

I suppose one might say they could take out private insurance through a private insurer, but this is still not easy to obtain compared to the ease with which government employees in California are obviously covered under this order-in-council 492. I think it is certainly an area that I'd like the Minister.... I know there's no easy answer.

I'm not suggesting we just make it 5 years or 10 years or some fixed period of time. But I wonder whether we could consider legislation which allows the Minister himself some flexibility which he doesn't have right now.

This was a case of a faculty member who came to Canada in 1961 and he's taught here since 1961. He was granted tenure in 1968. As I say, all the way through here was a man who is a resident of Canada beyond question, and who, for the reasons I've stated, encountered a very substantial financial debt for hospital care when his wife became ill.

I wouldn't even, have raised it were it not that the Minister is obviously aware of problems for government employees who may be out of B.C. for a while. I just wonder whether maybe we shouldn't try and extend something of the same benefit to other people.

HON. MR. COCKE: That's a good, valid question. I think we should just take a look at it. In the first place, if we were to increase the one-year coverage offered by BCHIS or Medicare to, say, five years even, then somebody would be away for six years and it would work a hardship on that person as compared to the person who was only away four-and-a-half years, or something.

I'm not saying that we're set, that one year will always be the case. I'm saying, however, that at this point it's not a high priority to change that situation. Therefore, until we can think of some good basic reason for prolonging the coverage time allowed outside the country, then we'll stay at the one year.

Mr. Chairman, through you to the Member for Oak Bay, I think you misunderstand the order-in-council. What the order-in-council said is that the government will pay — not Hospital Insurance, not Medicare — but the government will pay the medical expenses of its own employees outside the country where they are working for the government. And many of them are outside the country for years and years and years working for this government. Where they're outside the country working for the government, if they're over the year, the government pays. Prior to that, their medical expenses are paid by Medicare and Hospital Insurance.

The reason for that is because we feel that we're asking people to do something. to expose themselves to a situation that their colleagues in other departments or in other positions in government don't have to expose themselves to. Therefore, we decided, as a cabinet, that we would provide them with that fringe benefit. But it is not an insured benefit; it's a fringe benefit. If MacMillan Bloedel or B.C. Telephone, or any other company employing numbers of employees — and I'm sure that some of the lumber companies employ Canadians and send them out of the country for some years — if they wish to do the same kind of thing for their employees, they may do so. But they don't do it through Medicare, nor do they do it through BCHIS, nor do we. So we're really not being inconsistent. We're just saying that if a person is working outside the country and gets to a point in time where he's not covered by our normal Medicare or hospital insurance benefits, then we pick up the slack.

[ Page 1670 ]

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Just dealing with the subject that the Minister mentioned as he took his place, I don't know why government regulations have to be so difficult.

If a person is employed in the Province of British Columbia and their work is going to take them outside the province for a year or 18 months, I don't see why some application can't be made to the medical services commission for them to suspend their coverage for that period of time and at the same time be able to send back to British Columbia, within a fixed period, to resume normal coverage without the waiting period. I just can't believe that it's that difficult.

However, I don't want to discuss that, Mr. Chairman. I would like to pursue with the Minister one step further a matter which we discussed yesterday — the matter of health delivery care in outlying areas. I want to carry it a step further in another direction.

The Member heard from the Member for Cariboo (Mr. Fraser) this morning on the situation that arose in the Chilcotin. I am not concerned about the specific circumstances of that case. Obviously we had the government satisfied that a team of a doctor and a public health nurse was suitable for that area, and the doctor was paid a salary by the government to carry on his practice because a fee-for-service basis couldn't possibly work.

I would like to know from the Minister whether or not his department has made any assessment of other areas in the province which could benefit from the location of a similar doctor-nurse or doctor-paramedic team with appropriate facilities, and if so, how many of such teams are required in the Province of British Columbia, and to what extent the department, in cooperation with the medical fraternity, is being able to fill the need for such teams. This is one way in which we can approach the problem that we discussed yesterday — the absence of health delivery systems in remote areas.

This is something which I would hope the department has under consideration — in fact, is operating on now. As I read the report of Dr. Foulkes, as a result of his lengthy examination, it would seem that if the government is to accept his proposals entirely or in part, the time to be involved in bringing this new health delivery system into British Columbia will be such that outlying areas are going to continue without proper medical facilities for a considerable time yet.

I notice that in the report of Dr. Foulkes he talks about a time frame for implementation of his ideas which, in order to meet it, would oblige us to be considering legislation at this session — and I doubt that we will — plus availability of staff for key positions and so on early this year. So obviously that's delayed. If the government is considering anything like the scheme that Dr. Foulkes is putting forward, I know that it is going to take a long time, and the people of British Columbia should recognize that it will take some years before we will realize the goal. Yet the department and the Minister must recognize that in that interim period we still have got to make some progress.

Now in another section of the Foulkes report he talks about the manpower that will be needed if we are to make these advances that he recommends. He suggests that we will need a number — he doesn't say how many — of highly skilled people, people with broadly based experience in the health care system who can also manage and administer effectively.

He goes on to point out, as a result of his examination of the province and its facilities, that these people are currently in short supply throughout this entire continent. Therefore he recommends that an immediate, full-scale, professional effort be made to locate and hire key people for the task.

I would like to know from the Minister to what extent he and his department might be engaged in that search for personnel who can be used to implement the Foulkes report as well as the extent to which they are searching for personnel to meet the current needs.

That brings me to another aspect of personnel, and that's the training of our young men and women — maybe those not so young — to do the jobs that need to be done in this province. Certainly with the Foulkes concept of health care delivery, we are going to be embracing an expanded medical team. Some are going to be the doctor and the nurse, primarily, or the doctor and the nurse with some other paramedic assistance. It's going to be a much broader team that will be brought to bear upon the health problems in all of our communities.

These people, I suggest, are not available to us today. I would like the Minister to indicate what steps the department is taking, or the government — his department in conjunction with other departments — to expand the training facilities that we must have to provide the required personnel.

Foulkes also deals with this in his report and it is illuminating with regard to medical education: Dr. Foulkes finds it essential to remark that "Medical education has lagged, producing only 60 to 65 physicians a year." This was at the time he was writing the report. It's now being increased to 80 doctors a year. But the number, he says, is still low. "Training to the Canada average would indicate 152 doctors a year with about 200 a year by 1981." That's for this province to come up the Canadian average. He goes on to say:

"We believe that the province should be prepared to train its own medical manpower skilled in the special problems of this province. This should not be done, however, without

[ Page 1671 ]

assurance that the supply of physicians so produced will be absorbed by the demand. In the past the graduates produced in British Columbia have tended to stay in the province, finding their way mainly into family practice while specialists have been recruited from the outside."

That's why I was interested in hearing from the Minister the extent to which his department now may be assessing the demands for medical personnel and the paramedical support group, and to what extent we may see this government moving towards meeting our own medical manpower and womanpower needs. The problem is a difficult one. It's expensive, but it's not going to become less difficult nor will it become less expensive by waiting, because it's not going to go away. If anything, it's going to get worse.

I know the Minister has no doubt had the opportunity to consider the admissions problem with regard to our own medical school at the University of British Columbia. The statistics with regard to admissions are really quite revealing.

In 1973 there were 625 applicants for admission to the 1973 entering class. That's down just a little bit from 1972 when there were 698.

Of those 625 applicants, 302 were Canadians residing in British Columbia or landed immigrants residing in this province; 193 were Canadians residing outside British Columbia or landed immigrants residing outside British Columbia; and 130 fell within the classification of non-Canadians, where their citizenship or their residency wasn't clearly defined.

That's 625. But, as the Minister knows, in 1973 there were only 80 of those who could possibly get into the medical school because there were only 80 places.

This creates a very serious problem, not only for our ability to fill our medical manpower needs, but also for the entitlement of young British Columbians who want to go into the field of medicine — and this applies as well to the ancillary fields — to be able to take their place in this province to be trained and to go out and serve the province which has been their home and which they hope will continue to be their home.

We've had a declining number of applications to our medical school over the last three years. The decline is certainly not significant in number and can be traced only to the number of non-Canadians, and non-British Columbians who are applying for medical school. I can only assume that they recognize that their chances of entering a class at UBC if they're non-resident is a little less than appropriate, We also find, however, that another consequence flows from the low intake into our medical school and that is the tendency on the part of the admissions group to draw from the large number of applicants those who stand in the highest categories, so far as academic qualifications are concerned. They do range down as low as 70 per cent figures, so far as that is a measure of academic qualifications, but generally they are drawn from the higher levels of academic skills.

Also they are drawn from people who have spent many, many years at school and university training before even making an application for medical school. Of the 1973 entering class there were 38 students of the 80 who had three undergraduate years and no degrees. There were four who had four undergraduate years with no degrees. But from then on you find Bachelor degrees, Bachelor plus one, two and three additional years, Masters' degrees plus additional years, and four PhDs.

What concerns me, Mr. Chairman, in light of the discussion that the Minister and I had last evening is that when you draw people with these very high academic skills to our medical school there is, I suggest, little likelihood that when people of that caliber have passed through the medical school they will be the ones who will willingly offer themselves to go into our remoter areas and take up positions that the government and the people of this province recognize must be filled.

Indeed, when you have people of very high academic skills — double doctorates, Masters degrees in other disciplines coupled with medical degrees — those people are more likely to pursue the route towards a medical specialty or perhaps go into medical research, if that field is available to them. So then having taken the positions in our medical school — I'm not denying them their rights in that regard — and having graduated there from, they do not necessarily flow with such ease back into the areas where there is the greatest need.

I'm asking the Minister if he could indicate to the committee what he sees for the immediate and long-range future in British Columbia so far as medical education opportunity is concerned. If you want a young man or young woman with a first-class average, or high second class, who may be just the right person to be a doctor, what chance will such a person have to get into a medical school and complete his or her training. This applies to nurses, to people in rehab medicine, to all of the other paramedic ancillary groups who under a more modern health delivery system will join with the doctor to provide what we require for our community.

It's going to cost a lot of money, as I said. I know the Minister recognizes it. I'd just like to know when we're going to begin. What word do we give to the young men and women of British Columbia today who are looking to medicine for a career? What are their chances? Should they stay in British Columbia or go elsewhere?

HON. MR. COCKE: Mr. Chairman, the Member is

[ Page 1672 ]

quite right. The Member for West Vancouver–Howe Sound (Mr. L.A. Williams) indicated that there has to be some way to develop health care personnel. It's all very well and good to have ideas about the needs; it's okay to write a report indicating that there are those needs; it's okay to have manpower committees, suggesting that you need a much heavier concentration in isolated areas or in rural areas. That's very much a part of the reason that last fall we made the decision to develop the whole British Columbia Medical Centre concept.

This will be the training centre. The focus will be in the Vancouver area but it will have its out groups, as far as paramedical and nursing training is concerned, in the regional colleges and so on. It will be the focus on the clinical aspect of health education in this province, and it will certainly be the clinical aspect of the medical training of this province.

The University of B.C. Is very much a part of the organization and the planning of this B.C. Medical Centre. We feel that within two or three years we can increase our output of doctors — start increasing it in a year or two — to the level of 160, once we're well on the way to getting the B.C. Medical Centre into first-class operation.

Interjections.

HON. MR. COCKE: What I'm talking about is the intake. The intake has to grow from the 80, where it now applies, but it's not only there, Mr. Member. You know, for instance, of the school of rehabilitation medicine, where we're producing 40, and we need so many more, and of the schools of nursing, particularly the school of nursing at the University of B.C. where we're hoping we can develop the Masters and PhD levels so that they can be then free to go out and teach nursing in the regional colleges, et cetera.

So a tremendous job has to be done. We have not carried our load in this province as far as development of our own health personnel goes. I hope that the B.C. Medical Centre will be a great part of the solution to this whole question. It will be the catalyst; it will help put things together. We will probably be putting the council of the B.C. Medical Centre into operation within the next few months. I think probably within two or three months we should have all the appointments on the council. Then, of course, we will have that liaison with the regional aspect of this need. We will have members on the B.C. Medical Centre council from the north, from the eastern end of the province, from education and from some of the hospitals and health districts outside of the lower mainland.

It is a real problem and we know that it's going to take a great deal of work to achieve the kinds of objectives that you're talking about.

As far as qualifications are concerned for entry into medical school, I tend to agree with you. As a matter of fact, I have talked it over with the Dean of Medicine and I've talked it over with others involved. But it is a university decision as to how the standards are set. I think, however, that having a larger programme and the access to the wider setting will give the university an opportunity to really do a job around family practice. I think that's where we need the greatest input now.

We have all sorts of super specialists, but what's getting scarce, Mr. Member, through you, Mr. Chairman, are general practitioners or family practitioners in this province. Therefore we're hoping that that is going to be much more a part of the programme in the future than it has been heretofore. But you raised some excellent ideas.

MR. G.B. GARDOM (Vancouver–Point Grey): A few moments ago I received a telephone request from a public-spirited citizen who has presented a problem very deserving of the Hon. Minister's attention. Would it be possible to incorporate any programmes or make assistance available in the Province of B.C. for mother's milk banks?

Apparently this came to light as a result of a youngster in Arizona who suffers from a very rare genetic disease known as acrodermatitus enderocatheca. I gather he's about the first of eight people to have this in medical history and only one of two do survive. As a result of the disease to the digestive process, the body breaks into the equivalent of second degree burns both internally and externally; the individual can die a very slow and painful death of malnutrition if a supply of mother's milk is not available. I believe this individual has raised through donors up to 500 ounces last week in Vancouver and hopes to have another 1,000 available by this Friday for delivery to the United States.

He drew to my attention that there were apparently six such banks in the United States and some of them have apparently closed. I gather most of them if not all of them were commercial. He very strongly recommends that there be a mother's milk bank in Canada and that it be established free of charge. There's not one in our country as far as he knows. In order to initiate it, he mentioned that for pasteurization processes and freezing procedures there would be an outlay of perhaps $10,000 of capital. He would guesstimate at this juncture an annual operating cost of something in the neighbourhood of $20,000.

He very much impressed me with his talk over the telephone of the great need for such a situation which should be brought very much to light and to a head as the result of the very unfortunate disease that is now being suffered by this youngster in Arizona. I think it's a very worthwhile suggestion; I wonder if the

[ Page 1673 ]

Hon. Minister would like to comment upon it.

HON. MR. COCKE: I only know of this case by way of the news, and all I can say is that we would look into it. I can't say anything further; I don't know what the incidence of the disease is and what the priority would be. But certainly we can look into it.

MR. GARDOM: I'm not relating the request for such a bank to this specific disease, which apparently is a rarity unto itself. But he indicated that there is a need for a milk bank in our country because we don't have one in Canada. Babies do require mother's milk on a temporary basis in all sorts of situations, and this would be a means to establish that very kind of a bank much in the same way as we have blood banks.

MR. McCLELLAND: I just want to take a second to pass on a message to the Health Minister from one of the pages. I won't name names, but one of the pages came to me and just asked if I would ask the Health Minister to bite his lip on the McDonald's hamburger thing. (Laughter.)

MR. FRASER: I want to take as much time as possible here, Mr. Chairman, because I've done quite a bit of talking today and haven't had any answers at all. I've had time to think about the answers I've had and I haven't had any answers. I intend to get some answers. I'm going to have to talk about the weather for awhile.

The Minister is leaving now, but in the absence of the Minister there's something else I would like to know. Maybe it's in this report; I think we just got it. I'd like to know the average daily rate we paid in the Province of British Columbia for an acute-care hospital bed. I would also like to know the highest daily rate we paid in the province in 1973 and also the lowest. I would particularly like the average rate. I am only referring to acute care on that question.

The other question is: what is the average daily rate of the extended care paid in 1973? I think there's a big difference there. Maybe his department people there can get the information.

This morning we reviewed public health problems, specifically in the Cariboo. I'm not satisfied that I got the right answer about the Chilcotin, the Tatla Lake Health Unit — certainly not for the people out there. I gather the Minister is satisfied to leave things the way they are; in other words, locked up. I just wonder if he's had any opportunity to reconsider. As I said before, I think the route is with the doctor: why can't the department get him to cooperate so that the citizens of the Chilcotin can have the use of this public facility which is there but locked up?

The other thing I would like to come back to is the Vaness affair. This is in reply to the answer he gave that he wasn't about to open the case. If he is concerned about not opening the case, why, as a member of the executive council the cabinet, wouldn't he discuss it with them and apparently they could take that action. Quite frankly, it's completely unsatisfactory the way it is. I don't want to have to go back to the Cariboo and tell them what the Minister, where it stands now, just refuses to do anything about it. I've been trying to get these answers but they're hard to come by from this Minister. I can't understand why; they shouldn't be that embarrassing to answer. Everybody's entitled to an error and to a second look.

HON. MR. COCKE: Okay, Alex.

MR. FRASER: Thank you very much for returning. I was just saying that I didn't get the answers. I've asked first for daily rates on acute care and extended care; I'm interested in the differences. Probably your staff might have that now. I'm not after any specific hospital, just the general provincial scene.

I wish you would come up, Mr. Minister, with an answer to the Tatla Lake Health Unit and our friend the doctor. I don't think we should leave it the way it is. The way I see it now, the House prorogues sometime this summer, the, staff will probably leave it the way it is and we'll lose the rest of the year. I don't think that's good enough when the facility is there and everything. I think it's a question, in other words, of negotiating with the doctor.

The last but certainly not the least is the Vaness case. I suggested while you were out that if you won't reopen it, you would consider taking this up with the cabinet. Then you could have the cabinet take the responsibility and order the reopening and review of the case. Thank you.

[Mr. Liden in the chair.]

HON. MR. COCKE: I can't give the Member the specific daily rates at this point in time. I don't think they've been finalized for one thing; they're working on provisional budgets.

MR. FRASER: I meant for last year.

HON. MR. COCKE: Well, in that case I'll get them for you. I can give you an idea what hospitals they are. The more sophisticated the hospital, the higher the rate. In a way it's kind of unfair. Where the sophisticated work is going on, the rate is charged across the board. It could be that a person goes in with a very minor complaint but the rate is charged across the board and not to any individual. In any event, that's the rate the hospital charges BCHIS. I'll certainly have those figures for you.

[ Page 1674 ]

As far as Tatla Lake is concerned, we've tried everything in Tatla Lake. I think you, the Member for that area, know as well as I do that we financed the doctor in the region. Then we sent in a nurse subsequently, hoping that the teamwork would be the natural flow from that situation. But it didn't work. I'm told fairly clearly that it's not likely to work in the future under the present circumstances.

MR. FRASER: But it's worked in other parts of the province.

HON. MR. COCKE: Oh, absolutely. There's no question about that; it works in many instances. It's just a rugged individualist in my view — that's the doctor up there.

I think it would be precipitous of me to suggest that the community should go without a doctor, and have a public health nurse look after the situation. So we are not unmindful of it. As a matter of fact, I might go in there this year if I have time, Mr. Member. I'd like to have a look at....

Interjection.

HON. MR. COCKE: Well, that makes it even more attractive. And the Member for Victoria says only one of us will come out.

As far as the necessity is concerned, I suggest to you she should write a letter to the public service commission; that's the first step. And it will certainly get every attention.

MR. WALLACE: Mr. Chairman, issues keep being raised that I thought were going to be raised under other votes. So once again I will just go on record that I will respond at this time.

I wanted to make some comment on the question the Member for West Vancouver–Howe Sound (Mr. L.A. Williams) raised about medical personnel, and particularly the training of doctors. I'd like the Minister to comment on the recent federal-provincial conference where Marc Lalonde commented on the fact that perhaps one should look at the restriction of inflow of non-Canadian doctors to Canada, and accentuation of more training facilities for native Canadians, or Canadian citizens.

I may have missed part of the debate, and he may have covered that, but I think it's a very important issue because for the first time it may introduce an element of government restriction of professional people coming into this province, or coming into Canada.

I know that in the past the medical profession itself has often been criticized as though it was the medical profession — the College of Physicians and Surgeons — which was restricting access to medical school. I hope, once and for all, that this debate and other debates have made it very clear that there is a very limited number of places for medical students in British Columbia. To provide a much increased number, as the Minister I'm sure knows, involves not only physical plant and facilities but a great increase in the number of teachers. It's exactly the same problem we have in the nursing profession.

It's all very well to say we need more nurses, but you just don't produce them out of a hat or manufacture them like cookies. You have to find not only physical facilities, but well-trained teachers to teach the greater number of nurses. In medical personnel, to take the very quickest, simplest example, to teach anatomy you need cadavers. You need larger rooms to house the cadavers, and you need more people to service the facilities, and you need more teachers in anatomy and physiology and pathology and bacteriology — and so it goes.

I think it would be tragic if this Legislature gave the impression to the public of British Columbia that you just turn out more doctors like you turn out more sausages out of a factory. I know that's a ridiculous analogy. But the concept must be clearly understood that you're spending many years training people in a very highly complicated field. Therefore you need teachers who themselves are well trained. And they are not just that readily available.

In passing, I would say that it is my understanding, too, that some of the problems in setting up the medical centre — and the Minister might wish to comment on this — involve the pension plan. I wonder if it is accurate to say that part of the resistance of the staff is based on their wish to continue in the federal pension plan rather than enter the provincial government plan which would apply when the Veterans Hospital becomes operated by the provincial government. I'm not certain what the strength of that argument is, but I'm sure the Minister will be able to comment.

On that point of integration of service, I would just refer back for a moment to the Foulkes report. I said yesterday that there are many good recommendations in it. I stand by that; there are very many that I can support completely. But my general apprehension is in this word "system." I just get the horrible feeling that the whole report endeavours to set up the most complicated kind of administrative system rather than, as it claims to do, guarantee adequate high-quality service at the periphery, which is where the patient is.

It's perhaps too sweeping a criticism, but it seems to me that if this report were to be adopted by the government — never mind in total, even in part---I think so much time and energy and money would be spent setting up the various administrative layers and structures and community health clinics and advisory councils and disciplinary bodies, and Lord knows what else, that the tendency of the report would be

[ Page 1675 ]

to glorify the system rather than result in very worthwhile improvements in the delivery of service. Now that is too general a statement, but I think it is a feeling that you get from reading this report.

The final pinnacle of my concern is in two lines — recommendation 248 — that the government integrate the Departments of Human Resources and Health and form a new Department of Social Affairs. Now I just boggle when I read a recommendation like that.

Earlier in the report...and again I can't find the page 1n this publication, it's very frustrating. I can't get back to the page, but there's a page earlier in the report where it states that these two departments are already — I think the phrase is — having acute administrative difficulties, or some such phrase meaning the same thing. Similar words to the same effect. (Laughter.)

I really don't think it's much to joke about, but the fact is that somewhere earlier in the report it does admit that already the administration in these two departments presents some very realistic difficulties. Then you get to recommendation 248 and it wants to put the whole works under one Minister. Now this is just ridiculous, Mr. Chairman.

Furthermore, in the same theme, they want to increase the size of regions, or rather diminish the number of actual regions with a larger area covered in each region. All I can say, Mr. Chairman, in this particular capital region is God help us if they're going to enlarge the region looking for more efficiency.

I'm quite willing right now for all the criticism that I'm about to receive. I think the performance of the Capital Regional Hospital Board and in the capital city of this province at the very least, I could say, leaves a very great deal to be desired. And that involves the specifics such as the issue that was dragged out last night about the peninsula hospital and whether it will expand to acute care, et cetera.

The fact is, Mr. Chairman, to quote specifics rather than give blanket condemnation, we had a referendum.... I'm just trying to make the point that this government cannot be held responsible for much of the dilly-dallying which to my mind goes on at the regional level. There are reasons for that and it's not all the fault of the regional municipal politicians either. I'm not saying that. I'm just trying to point out that regionalization in this city is not working well for whatever reason.

In 1968, the people of this area passed a referendum for $12 million-plus for extended care. The Minister mentioned earlier on today that, by and large, the numbers have been met. But let me make it very plain that that was in 1968 and this is 1974; and the only reason we've got the extended-care beds was that just months ago the Minister took over two private hospitals to the tune of 150 beds. So for six years, out of the 600 beds that were financed in this referendum, we sat around in this region of the capital district for at least five years before we got half of the 600 beds.

Now I don't know how anybody trying to study the delivery of health service can look for an even greater extension of regionalization where you have bigger regions and fewer — of them when we've got this dismal record in the capital region.

In 1972 the people in this district of this region voted a referendum for $22.5 million and there hasn't been a penny of that spent. There's nothing to show for a referendum of the people who passed $22.5 million for various facilities, including some acute care.

I know the argument is, "Well, we're waiting to see what happens to the Veterans Hospital." That's the kind of factor which I agree has to be taken into account. But it really bothers me, Mr. Chairman, when I read this Foulkes report and all this emphasis is laid on systems, administrative structures, regionalization, councils, advisory bodies, et cetera, et cetera, et cetera.

All I can say, Mr. Chairman, is that we've had a bellyful — pardon the language. We've had a large amount of that already, and as far as the capital city with 300,000 or 400,000 people in the region is concerned, it's not working.

Their performance is very poor and I gather from reading the Foulkes report that our present Capital Region would be expanded halfway up the Island, and we'd have an upper Island and a lower Island regional district.

It just seems to me that before we start getting into a larger bureaucracy and more emphasis on systems and committees, and departments, and so on and so forth, I think we should take a pretty hard look at what's been achieved up to this point.

I am told by others that fortunately the Capital Region's performance has been bettered by other regions and I'm happy to hear that. But I'm certainly very impatient with the situation in the Capital Region, and when I complain about it publicly, the chairman has the audacity to say that I'm playing politics, and we've taken five years to get half the beds that were voted for in 1968.

Who does he think he's kidding? I know who's playing politics, and it certainly isn't me. If this is the kind of carry on that goes on in the Capital Regional Board for five years, let's not get misled by saying, "If we just enlarge the region, have fewer numbers of regions," that's going to solve anything.

The fact is that regionalization is a very sound and necessary structure in the context of delivery of modern health services, no question about that. But I'm sure that in setting up regions, you have to look at two things. You have to look at the size of the region and you have to look at the political and

[ Page 1676 ]

administrative structure which is going to provide these services through the vehicle of regionalization. That applies whether it's sewers or hospitals or anything else.

I, for the life of me, cannot understand where some of the problems lie. Now I understand in one respect, and I'm told this as a physician, that a great deal of the problem lies with interprofessional rivalries between two hospitals in this community, and that may be.

I know I'm probably not making any more friends by saying that today, but the fact is that what we need is leadership to make decisions. Surely you're not telling me that all this delay in the creation of the necessary facilities is being purely stymied by interprofessional rivalries? If that is the case then again I lay the decision clearly at the door of the Regional Hospital Board who have avoided making decisions which are urgently needed for the development of a general range of hospital facilities in the Capital Region.

I had intended to talk about this under the hospital vote, but since we're on the subject and since there are so many points that must be made, I think I should just finish the remarks I had prepared.

I'm not sure that the province and the people in the hospital field have completely accepted the basic theme of progressive patient care — that you treat a patient in the appropriate kind of facility. You don't give more treatment or more expensive surroundings than are needed, and you don't give them less than they need.

We've got the paradox that we have people in acute hospitals who no more need it than I do, at the moment, and we have other facilities where they are receiving inadequate treatment in. intermediate-care nursing homes.

Until we realize, the Minister better than anyone, and certainly the federal Minister of Health (Mr. Marc Lalonde) knows, that costs are just going up and up by something around 12 to 14 per cent per year, it's all very well to have all this theory in this great pink volume, and I've talked about theorizing about systems and structures and committees and goodness knows what else. But the other point that's wrong with the Foulkes report is its complete failure to deal with the financial problems of providing health services. It skirts around it.

It uses phrases like, "Adequate sums will have to be allocated," and all kinds of very general statements. The Minister knows what kind of sums of money, we're talking about and they are fantastic sums of money. When we're talking about nursing care — and I won't get into this question of the negotiations that are going on — but let's get one figure on record. The base monthly rate for the RN which is being sought is $915 a month. So just dropping that little pearl in there gives some idea. I quoted other figures for nurses aides, and LPNs and orderlies, and so on.

Now I'm not for one moment denying the right of any employee to bargain for the best wages that he or she can achieve. That isn't the point. The point is that the total cost of all health services is just going up on a steady line at a rate which cannot continue. There is just no question that we cannot continue to spend an increasing 14 per cent or thereabouts, annually on these services. So the next most important challenge which we have to face is to utilize what services we do have in the most economic ways.

With respect, Mr. Minister, through you, Mr. Chairman, we still don't have the extended-care beds, for example, that we need. In answer to the Member for Cariboo (Mr. Fraser) the cost of an acute bed in Victoria is around $70 and the cost of an extended-care bed is around $25. So it's $45 a day difference in ballpark figures.

We still have in the Jubilee Hospital and in the Victoria General Hospital somewhere around 20 or 30 extended-care patients. As I say, you cannot look upon any one category of patient in isolation, and when the Minister took over the extended-care hospitals that I mentioned — and I want to touch on that briefly — I think it was a good move.

But the problem is that the Minister has to find accommodation for — I don't know the numbers — 30 or 40 patients who don't qualify for extended care. They've got to go somewhere and there's just nowhere for them to go, and wherever they go they are going to receive a lesser quality of care. There's no question in my mind about that.

We have to look at this business of levels of care and try not to define or to develop one level at the expense of other levels. Simple economics for one thing, is most important. But beyond that, to take the example of the extended-care hospitals which the Minister has acquired, I talked to them just in recent days, and I think it should be on record that the number of staff has been increased. The wages have been increased and we are now operating that kind of facility, in my view, under much better circumstances, which will result in better care for the patient. I credit the Minister with that move.

Now as I say, it bothers me that we talk of isolation about different types of patient. When you're a patient, you're a patient. You're sick. You need health care. you need nursing care, and all these artificial divisions really bug me.

I think it's just incredible that in a supposedly enlightened age with all the medical know-how and technology that we've got patients compartmentalized and in one compartment they get pretty good care and in another, well, they're on their own. I know the Minister is aware of this, but I wonder if he would try and do something at the same time as he's dealing with extended-care facilities and

[ Page 1677 ]

expanding them, to deal also with these other people, and try and find even some interim measure which really right now is unsatisfactory.

Now, to look for a moment at acute care. I was staggered to discover the other day that some of the patients admitted to extended care have bedsores, Wherever they had been, they had been receiving less than adequate care, and I was further staggered to learn that some of them came from acute hospitals.

So I enquired about this situation, as I thought this certainly raised my eyebrows. The answer I get is that it is now so difficult for nurses in acute hospitals to cope with the total volume of work that somebody gets the short end of the stick, to speak in metaphor. Now if somebody gets less than the treatment they require, then Mr. Minister, through you, Mr. Chairman, the person who gets less than fair treatment is the little old lady, or the little old man lying in a bed not very able to vocalize his complaints. Perhaps their needs are less obvious and less acute compared to the surgical cases and the people with strokes, and the more obvious serious pressing needs. As a result some of these elderly patients who are waiting for an extended-care bed are actually receiving less than adequate care prior to their transfer to an extended-care bed.

Now I've just read the Annual Report of the Royal Jubilee Hospital which is a very proficient hospital and I read with particular interest the director of nurses' report because she puts in very clear language some of the problems that will have to be faced and should be faced right now. With this tremendous attempt to use acute beds intelligently, you discharge the patient as soon as possible. The figure that's quoted, I think, in the annual report of the length of stay is somewhere around 8.9, which has been steadily decreasing over the last few years.

In passing, you quoted, Mr. Minister, the day-care facilities. Something of the order of 25 per cent of all surgery is now done on a day-care basis. That's certainly a big improvement over the past and it should continue to improve.

But there is a cut-off point; there is a point at which you just cannot diminish the length of stay in an acute hospital. If you do try to diminish it further, you get two things happening: you are either going to put such a strain on the nursing staff that they will quit in large numbers or they will seek work elsewhere; or you put the patient at risk by decreasing the quality of care. I have talked to many people in the hospital field and, certainly in this city, we are very close to that point if not at that point right now. There is no way that you can stretch the point beyond a certain level.

The hospitals in this city have certainly worked very hard to provide facilities and staff to do day-care surgery and it's at a high percentage of the total. I know the nursing staff works extremely hard. We have reached the point in my view and in the view of many people in the field that you just can't stretch it much more, Mr. Minister. The nurses and the RNs are working to their utmost capacity, and already it looks as though perhaps some of the patients who really require smaller amounts of care as compared to the seriously ill patient are perhaps receiving less than the treatment and supervision they need.

With the very essence of acute hospital care involving more technology and more retraining and more in-service training, the director of nurses points out very clearly how difficult it is to find the time to take the staff temporarily off a ward in order to give them the in-service training or to allow them time off to take courses. But all the time the nurse is not only being challenged but she is being asked in many cases to upgrade her learning in a specialized way in order to provide the service in some of the specialized wards.

Coronary care is an outstanding example. The Minister knows very well I am referring to the degree to which we teach nurses in coronary care units to understand electrocardiograms and some of the technical matters which previously were considered only to be done by the physician. With advances in our knowledge and awareness of some of the fundamentals of coronary artery disease, we have these nurses now filling a very vital role in our hospitals. Renal dialysis is another very good example of this. We have better understanding of pulmonary function. A nurse can play a part in both diagnostic and therapeutic assistance.

And so, at the same time as these nurses are being asked to do more, there is greater difficulty in orientation programmes, in-service training and post-graduate courses. It means that many of the nurses have to be allowed time away from the ward in order to obtain this training. Even those who are not away from the ward either have to take off-duty time to take the courses or have to make it more difficult for the remainder of the staff to meet the demands.

I think it's fair enough also just to mention that in terms of economy and in terms of costs of this very substantial dimension I quoted, I simply have to ask if there will be, in view of salaries likely to be paid to the RN, a transfer of clinical responsibility to, let us say, the licensed practical nurse or to the elderly or to some form of aide. I think we have to face the fact very clearly that one of two things is going to happen: the costs are going to continue to skyrocket or certain of the nursing and medical functions presently carried out by a registered nurse will be carried out by a person with a lesser degree of training. When you start asking people with 10 months of training to carry out responsibilities previously carried out by somebody with three years of training, I don't think you can come to any other conclusion than the quality of care will drop. Patients

[ Page 1678 ]

in this province will be receiving a lesser quality of care.

I know the Minister has never said this will happen. I am just asking the question. Anybody who follows this field of medical services at all closely asks himself that question. The problems in the nursing field are considerable in the summertime when many of the nurses take holidays or choose the summertime to leave one job. They are off in the summer months and they look for employment in the fall. This is another fact of life in the Royal Jubilee Hospital. We closed a surgical ward last summer simply because the nursing staff was not available.

As it was stated so well by the director of nurses, if we have to have full employment in the summertime, we have to accept unemployment of nurses in the wintertime. If you are going to have enough nurses to provide the service in the summer months, there is obviously going to be a surfeit of the nurses available in the winter months.

Unquestionably, many of the areas in hospital care involve a much greater degree of complexity of knowledge and technical know-how than ever occurred before. The citizens of not only British Columbia but North America and everywhere else have come to expect this level of technology and this level of know-how. I'm not sure the people are prepared to pay for it or are aware of what it is going to cost if we continue on the present path.

I'm not suggesting for a moment that we shouldn't use all the technology, information and various drugs and treatments available. But this has all become extremely costly. It would seem to me that until we have seriously provided all the levels of facility and the appropriate kind of personnel looking after the needs of the patient in an appropriate manner, we are not using those large sums of money that are available in the most intelligent way.

Last year the standing committee did learn a great deal as to the judicious integration of all these levels from intensive care right down to home care. I doubt if the conclusions from that committee are being implemented as rapidly as I believe they could be implemented.

Again, I think the people of British Columbia should recognize the depersonalization that's occurring at all levels. Somebody talked earlier on about the emergency service. It seems to me that again one has to make some kind of choice between two alternatives, each of which has its disadvantages.

Again, to quote the hospitals in Victoria, the emergency departments have taken on emergency physicians. Instead of having the patient wait for their own physician to reach the hospital, in the case of an emergency there are salaried "casualty officers," as the Minister said. This means that as soon as the patient reaches emergency, they certainly need immediate attention from the casualty officer. Again, as I say, the patient may or may not see their own physician. I'm not debating whether that's necessary in an emergency or preferable or what; I am saying that the more complicated hospital service becomes and the wider the range of service that can be provided, the further and further away the patient gets from his or her own family physician.

The same applies because of the greater involvement of specialist care. We all expect to have the best and the highest quality care. But many patients used to complain to me that while they might get the best technical and expert help from a specialist, the rapport and the understanding between the patient and the specialist very often left something to be desired.

The Minister has talked about prevention. I couldn't agree more that prevention is the key, particularly in areas like the Member for South Peace River (Mr. Phillips) mentioned when he was talking about VD control. Again, I say to the Minister, why not provide preventive medical examinations and provide coverage under Medicare? Clearly make it plain when a person seeks a routine medical checkup, which might prevent him requiring expensive hospital care later on, that the routine physical examination at least once a year should be covered by the terms of Medicare.

We also have had a lot of emphasis and a lot of talk about dental care and various other examinations of children. We have the same problem with the pre-school medical — parents very often dutifully bring the child to the office prior to going to school, then find they have to pay for the examination. I think this is a disincentive, if that is the word, to the very vital preventive health measure.

I suppose one could also look at the same principle in relation to driver medicals, elderly people who have to have a medical exam before they can drive their car. This prevents accidents and damage to others. So, if we're going to talk about prevention, let's do it in a realistic way which may involve the expenditure of money. As I've said, we're trying to use money intelligently and not look after people in expensive facilities when cheaper care would be quite adequate. The other side of the coin is that maybe people would have routine medical examinations if they were covered under Medicare.

The sum total of these points I've tried to raise is that it seems to me the Foulkes report is much too general and academic, and deals with the system. I think what we need right now in 1974 is an outline by the Minister of a policy which deals with some of these very valid, economic and clinical problems which are here right now and which would not really be solved by just building a bigger bureaucracy.

HON. MR. COCKE: Mr. Chairman, the Member for Oak Bay dealt with a number of areas. First he

[ Page 1679 ]

talked about the immigration of doctors. When we were in Ottawa during the Health Ministers' conference a month-and-a-half or so ago, it seems like yesterday, we did discuss the whole question of immigration of medical manpower.

One of the questions that was raised was the fact of our dependence, not only in B.C. — and we've been dependent here on immigration to fill our medical needs — but also for the rest of Canada. We have been quite dependent on immigration, and having said that, then we'd have to think in terms of what we've done.

We've virtually said to the young people in British Columbia that unless you've got a grade point average of x plus, you have no chance of being a doctor because as long as we only have to fill a small vacuum instead of a much larger vacuum, we don't have to train so many doctors. That's what we're trying to get around now.

The emphasis can be on training of more Canadians for the medical profession, not a bad idea. There will have to be some limitations on immigration, I suspect, in the years to come. I don't know how soon that's going to be imposed, I don't presume to know. I do know that's a point which Ottawa is looking at now, and we in British Columbia are naturally very interested. We want medical manpower, however.

Then the Member for Oak Bay went on to discuss the Shaughnessy acquisition. The pension plan is no longer a problem, Mr. Member. I think we are just next door to agreement on the Shaughnessy vet's hospital and the George Darby wing being transferred. The negotiations have been amicable — naturally the federal government had to be concerned about their employees in those institutions, and so they had to take the necessary steps to see that their rights were protected. But I think we've reached the stage now where I can say that we're very, very close. I don't think there are too many....

AN. HON. MEMBER: How long?

HON. MR. COCKE: Not very long from now, not very long.

Interjection.

HON. MR. COCKE: No, the vets are fine. We've involved the Legion in the negotiations, and they're quite happy. We've been quite open about the whole thing, so I think everybody's quite happy about what's going on. There has to be a few i's dotted, a couple offs crossed, and we'll be moving on ahead.

The cost of health service, Mr. Member: We could stand here for the rest of the afternoon, tomorrow and the next day discussing this terrible escalation, You're right, something has to be done about it. There has to be the different levels of care.

If only we could get our partners, who share the cost of acute care, who share the cost of extended care, who don't share the cost of mental health care, to at least participate with us on other chronic care — then, I think, under those circumstances we could provide the kind of flexibility within the system where you don't have a person.... And I'll answer the Member for Cariboo's (Mr. Fraser) question right now. He asked: what was the highest daily rate in B.C.? Mr. Member, $79.05. The lowest daily rate was $41.85, and the average was $63.90 last year. So, with that flexibility, we wouldn't have that kind of situation where a person occupies a $79 bed, when they could be handled nicely at, say, $15 or $16. Extended care, incidentally was $21, on an average across the province.

Our objective is to give that kind of backup. And home care it has to happen. The Member for Dewdney (Mr. Rolston), sitting right beside you, he's a home-care nut, if you'll excuse the expression. But he's right, you know; he's right. These are the areas we have to really get involved in in order to provide the alternative for the much more expensive level of care. The challenge is here.

I'm not going to comment too much on the Foulkes report at this point. As you know, it's before the public now. It's being criticized; it's being developed. Some areas are being developed while other areas are being negated, but this is the kind of thing that I want to happen. I think that it's best that I don't really get involved in that discussion at this time.

Interjection.

HON. MR. COCKE: No. I made that statement right at the outset. If they want to integrate these two departments, somebody else can worry about it because, I'm telling you right now, I've got enough trouble with Al.

To carry on, Mr. Chairman. You were talking in terms of nurses and the more specialized work they are doing. I sure appreciate that. I've never been so surprised in my life as one day when I talked to a cardiologist who said to me that the girls working in the coronary care unit could read cardiograms more effectively than he could; they watch the monitor and know more quickly than he that something has gone awry.

As a matter of fact I was discussing the whole question about when we get to the stage in emergency service where we have paramedics out with their own remote monitors, who's going to give them directions? He said, "I'll tell you who'll give them the best direction of all, the coronary-care RNs."

Sure it's happening, and we are having a kind of a

[ Page 1680 ]

change of roles for a lot of people in the health care business.

Nurse distribution is a real problem. And I understand what's happening. I'm sure, for instance, that it's similar to the north — how do you keep them down on the farm or whatever? For example, here are some statistics we dredged up: Last year, in September, 1973, remember what kind of a summer we had? — couldn't get RNs. Yet, there were 404 graduate nurses in the Province of British Columbia on unemployment insurance. There were 750 nurses aides and orderlies on unemployment insurance at that time, and we were pulling our hair out. It's a distribution of manpower, and there are so many problems — it's monstrous.

But we are dedicated to improving the nurses training situation in this province. We're working with the university at the present time. I've met with Dr. Uprichard on a number of occasions, discussing that whole question, and there has to be more nursing teachers before you can make more nursing schools available.

I suspect that a lot of people are getting check-ups — going to their doctor with a headache and getting a check-up. But let's say that we get 2.25 million people per year for a check-up, and that the average cost of a check-up was $14. That is $31,000,500 per year. Now that's money well earned if it can be saved; and it is money, I think, well spent. But it has to be done in such a way as to do it in the most economic way possible.

That is why we are having this study at the present time. That is why I've got Dr. Chisholm and Dr. Kulah working in this particular area, to see what we can do to at least cut the costs so that they are reasonable, and to educate people so that they will take the best kind of advantage of this kind of a situation.

I want to thank you for your comments, Mr. Member.

MR. D.A. ANDERSON (Victoria): Mr. Chairman, I would like to thank the Minister, and congratulate him for answering so many questions. It is refreshing change. I have one or two questions which I trust will be answered.

There's another thing I would like to do. I would like to thank him for.... In the publication of the medical income at the end of 1973, he was kind enough and good enough to put in the proviso, the memorandum by Mr. J.A. Stewart, that the doctors' net income is not necessarily gross income. I think that's a constructive, conciliatory approach which the previous government did not do. I would like to congratulate him for that.

The question I would like to ask him — the first one is the question of drug advertising. I understand that the federal Minister is going to throw into the lap of the provinces the whole question of drug advertising, and I personally suspect it is a wrong move.

My view is this: drug advertising will lead to increased use and demand by patients of certain drugs which have caught their fancy. They've seen some great picture or something, and they would like to have the same drug even though their case may not be on all fours with the case of the patient described in the advertisement. I think that if we do have drug advertising to the general public, as opposed to the medical journals, were going to have some real trouble in this regard.

I may be wrong, but from a brief I received from the pharmaceutical association, I understand it may be possible, under Canadian rights of law, to advertise drugs. I would like to know what the Minister's views are. Mr. Lalonde apparently believes that advertising will decrease costs, and it will reduce the price of prescription drugs and will not contribute to increased utilization.

Well, I think that it is quite wrong, and I just wonder whether the Minister might have a comment. If he hasn't thought about it, well, I will appreciate the fact that he is not in a position to answer. But if he has some views, I would like to have a comment on that.

Second point: on January 24 of this year the Minister put out a press release dealing with immunization and the outbreak of diphtheria in the greater Victoria, southern Vancouver Island area. The final three lines of the press release are interesting. He said that, "At the present time universal childhood immunization is the only effective preventive measure available, and Mr. Cocke again urges all parents to see that their children are fully protected.

I wonder whether you have some figures to indicate how many are not protected and how many are, in this particular case of diphtheria in lower Vancouver Island. It worried me that he had to remind parents that immunization is necessary. I wonder what the magnitude of the problem is.

The third question is...and I appreciate, Mr. Chairman, that some of these may come up under line-by-line estimates. But perhaps if they can all be dealt with at once, it may make things easier. The third question is on haemophilia.

I received a letter not so long ago about the problem of haemophilia in the province and attached to that letter was a copy of a letter sent to the Minister in June of 1973. The problem that Mrs. Wayne, the president of the B.C. chapter of the Canadian Haemophilia Society, raised was the tremendous difficulty facing the haemophiliac when dealing with dental problems.

Very few dentists are interested in handling the patient who has such potential for disaster — even from a very slight slip of the drill or anything else.

[ Page 1681 ]

The risk of bleeding in dealing with the teeth of these people is great, and the risk of death coming from even the most simple of scratches or wounds is also great, and dentists are very reluctant to treat them.

She went on to point out that because of the difficulty few of these people receive dental treatment and the result is that when the dental problem becomes acute, they are in big trouble. She pointed out that we have not that many in the province, a little over 50, but they spend about two days at least in hospital a year for care directly attributable to this condition.

With your permission, Mr. Chairman, I'll just read one or two lines of her letter. She goes on to say:

"It may be difficult for you to understand why our particular group is seeking assistance with this programme, the dental programme. Many haemophiliacs are under financial stress due to the demands of the disease. Costly items, such as frequent trips to the hospital, perhaps two or three times a week, outpatient treatment, fees, et cetera, add up greatly over the year making dental care seem like a luxury item.

"Providing the money obstacle is overcome, it is difficult to find a dentist willing to work on a haemophiliac. Freezing cannot be used for even the simplest filling, and even the simplest filling for many reasons could turn into a major haemorrhage. They just do not want to accept the added responsibility. Can you blame them?"

And she goes on to say,

"Wouldn't it be so much better for everyone concerned to have a supervised clinic available to this limited number of people in B.C. where they can be recalled regularly for sustained supervision and care and preventive education?"

I made a number of calls, about a half-dozen calls, earlier today on this subject, Mr. Minister. I was unable to find out whether there had been developments following that letter to you. Perhaps you could get the information from your officials and let me know when you reply to my comments.

One other point — I guess it is point 4 — is the problem of runaways, and the fact that they can now be treated in hospital and the parents never informed. I know this is perhaps a problem more for the Attorney-General than the Minister of Health, but I wonder whether or not he has considered and could let us know his thinking on this point. Should hospitals report runaway cases where children, often quite young children, are treated and sent on their way, and the parents who might be quite frantic about getting in touch with them and trying to encourage them to return home, never know they have received such treatment?

One runaway boy — I'm referring to another letter here — one runaway boy, 15 years old, was treated for injuries in an Interior hospital during the period when his mother and father were unable to locate him, and when the police had been notified of his being missing. Yet apparently, according to this correspondence, the police and his parents were not informed of the fact that he had been treated. I don't know what he was treated for — perhaps a traffic injury or something of that nature.

Perhaps the Minister would like to comment on those questions. I'm sorry if they are out of order. Perhaps line-for-line might have been better, but I couldn't find the exact spot in the line-by-line, and at this stage perhaps he would like to answer them.

HON. MR. COCKE: Mr. Chairman, the drug advertising was the first question that you asked, and I happen to share your views, Mr. Member — as odd as that might sound. On drug advertising I do feel that prescription drug advertising particularly just makes people more conscious of, "Hey, I haven't seen the doc lately; maybe I'd better go and get another prescription" type thing. I think it does tend to motivate.

Now, the Hon. Marc Lalonde has changed his mind. I'm grateful to come back and say that there was pretty well unanimity around that table when we discussed this question on drug advertising. So it is not going to be a factor in Canada, and B.C. In particular. I just could not support it after having looked at both sides of the question.

Going on to diphtheria, I can't give you a count, but basically a child is immunized for diphtheria in the school system, unless the parent objects to it. So there wouldn't be too many that are not immunized. But there is a danger that people don't go back to get boosters as the years go by, and that really was what we were directing ourselves to: young people out of school and so on, with no natural access to immunization.

Fortunately for us, I suspect that one of the reasons the diphtheria outbreak was so mild — it didn't affect people to the extent that it used to in the old days — was because of immunization. While maybe it had been some time since they had last had a shot, at least they were in better condition to fight it off. So that's generally it.

At the present time I haven't really given too much consideration to this haemophiliac problem, other than we do give the society a specific grant. We recognized this specific problem, as far as the dental situation is concerned, very much as we looked at a cleft-lip, cleft-palate last year. I'm thinking, along that line, that that might be one of the next moves to make in that area. But I must confess that I am very distressed about the cleft-lip, cleft-palate thing, because we are having extreme difficulty making

[ Page 1682 ]

deals with the dentists around that question. That is the orthodontists. Anyway, that is a question that will resolve itself.

Now on the last question you talked about — on this business of treating kids, wayfaring kids, away from home in hospitals and not reporting it. They are on the horns of a dilemma, Mr. Member, a real dilemma. They can say to themselves, "Okay, let's wring the name out of this kid and get in touch with his parents." If we do that, he's likely to run away with some condition that may become more serious. The doctors advise me that what we should do is free it up so that there doesn't have to be reporting.

I know that sounds neglectful, but at the same time if it's a case of potentially saving a child's life, then that's the position that the medical people are taking. I just don't know what should be done, but I know that if a child comes to a hospital and is in real need of care, naturally they ask him and they try to get his name, but they certainly, having taken the Hippocratic oath, feel that they have to treat him in any event, even if he happens to withhold his proper name.

MRS. JORDAN: While the Minister has answered a lot of questions today and we appreciate them, while we were deciding that he was the ogre of the nursing profession yesterday, I asked him some questions in regard to cancer surgery of the breast in women. One was: would he consider having cosmetic surgery where it was medically advisable or safe included under B.C. Hospital Insurance Services and the Medical Plan, and would he also include prosthesis in this care under the Medical Plan? This is often a problem. I know there's some coverage under Human Resources, but that doesn't always reach the people who need it. It is quite a delicate adjustment and a great psychological matter, and very costly.

HON. MR. COCKE: I thought I answered it yesterday, but maybe I didn't. In both instances, yes, we are providing prostheses under those circumstances and also will provide for cosmetic surgery under those circumstances.

MR. P.L. McGEER (Vancouver–Point Grey): Mr. Chairman, it's nice to see the Minster and his staff looking so fresh after all of this work — and I feel fresh, too. I'd like to ask the Minister just a couple of brief questions if I may. Could he give us a progress report on the state of negotiations for the land at the Shaughnessy site? Have we got it in the bag? No problems at all?

HON. MR. COCKE: No problems. It's coming. I just announced to the House that there are a few "i's" to dot and "t's" to cross. I suspect that it will be within weeks — very short weeks, too.

MR. McGEER: May I say how pleased I was to hear the announcement that Shaughnessy Hospital would be joining into this grand consortium of hospitals to bring greater service in the health field to the people of British Columbia. I'm less convinced about the research aspect that the Minister talked about, but certainly it will be better. It won't take very much for us to be better.

I'd like to ask the Minister what the construction schedule is going to be. When does this thing go into high gear? How many million dollars a month will the expenditures be? When will the first beds come on stream? When will patients actually be treated at the Shaughnessy site?

HON. MR. COCKE: I would be second guessing the board if I suggested what would be first. I have a hope in my own heart that it will be children first, followed very closely by some of the related specialties. As you notice, in the estimates this year we set aside $10 million. I hope they can spend it. The total expenditure that we anticipate there within that core group is $130 million over the next five or six years. So it's off and running, as far as we're concerned. There's no holds barred. We're going to be providing the training facility that's necessary for this province and that this province so long has wanted.

MR. McGEER: Mr. Chairman, could I carry on with that for a moment or two, please?

The Greater Vancouver Regional Hospital District voted $95 million over a five-year period. If you take that money and the money that was set aside for the health resources fund, which was some $52 million, you're looking at more than the Minister talked about for the next five or six years. That doesn't strike me as being very impressive. So I'd like to ask the Minister just how much will be placed at the Shaughnessy site in the way of beds, and how much of this money that he's implying will be spent at the Shaughnessy site is going to be taken from what otherwise would have been spent at other sites. For example, between $40 million and $50 million is what's been taken away from UBC. How much has been taken away from the General and St. Paul's and the other hospitals to make up this amount of money, which isn't really that great when you add health resources in the five-year plan?

HON. MR. COCKE: I think that the Hon. Member is reading something into this whole situation that doesn't exist in the first place. It's not a case of taking away or adding. It's a case of putting the decision-making of that particular area into the hands of the people who are directly affected — all of the institutions. What was happening before was that nobody could make up their minds because there were conflicting needs.

[ Page 1683 ]

Now it could very well be that the board decides to put more services in St. Paul's than it was originally thought should be put in St. Paul's, et cetera. I'm not going to second guess where those facilities go. We do know that we've got 45 acres at Shaughnessy, of which right now about 30 acres are covered with buildings — such as some of them are. But let's not try to second guess. The task force reports are in now to the board. They will take a look at those reports, find out the directions that they want to go, there'll be discussions with the regional districts and with hospital insurance — and I'm sure with you, Mr. Member — and progress will be made.

MR. CHAIRMAN: Shall vote 75 pass?

MR. McGEER: No.

MR. CHAIRMAN: I hope you'll make your contribution, so the Minister can answer. He's been up three times, and some of it's been dealt with earlier today when you weren't here.

MR. McGEER: Mr. Chairman, I beg your pardon. I think this is entirely new ground....

MR. CHAIRMAN: You raised some questions that have already been dealt with when you haven't been here. That's unfortunate, but it's most unfortunate that we have to go through it again.

MR. McGEER: Mr. Chairman, I don't need to take orders from you as to when I'm in this House and when I'm not, and I can tell you this — we'll get through these estimates a lot quicker if you just don't interfere. We're not covering old ground at all.

MR. CHAIRMAN: Order! I don't want you to be repeating the things that have been going on here earlier today. I've heard questions you've asked that have been dealt with just a little while ago. Proceed, but I'll remind you when you seem repetitious.

MR. McGEER: Mr. Chairman, what you'd better do afterwards is to go through the blues in Hansard and show me exactly. We've heard this argument before when you've been in the chair about new things have been covered when they haven't.

MR. CHAIRMAN: Will you proceed with vote 75?

MR. McGEER: I'd be very pleased to, without your help.

MR. CHAIRMAN: Have you something new to contribute?

MR. McGEER: Mr. Chairman, that's not an appropriate question for the Chair to ask.

MR. CHAIRMAN: I'm reminding you that some of the things you're dealing with have been dealt with already.

MR. McGEER: Name them, in detail.

MR. CHAIRMAN: You may proceed if you've got something new to contribute.

MR. McGEER: Mr. Chairman, you ask that question afterwards, not before, When somebody stands up in this chamber to make a speech, don't interfere with them before they start.

MR. CHAIRMAN: Order! Will you proceed if you've got something to contribute? That's what I'm saying to you. You've got the floor.

MR. McGEER: I'm asking the Minister to explain to us.... It's fine for him to say he's not going to interfere with the superboard's decision. I think that's good, sound common sense from the Minister. On the other hand, it's in his hands as to how much total money is to go into the pot for this thing. That's something which has not been openly stated.

Unfortunately, as I read the amount of money that's to be made available, if one sums up what was voted in the regional district hospital bylaw and adds to it the health resources fund, one comes out with less than what the Minister is talking about for his giant plan in the next five years. We aren't going to be able to satisfy all the needs for teaching and research, plus the service facilities that were voted on by this regional district referendum after a great deal of paring down, unless we're going to be prepared — and that's the Minster's decision, not the superboard's decision — to put additional money in the pot. I don't think $135 million is going to be enough.

I think we're going to have to be in excess of $250 million. If we're going to do the job in a finite period of time, take care of all the chronic hospital facilities that have not been taken care of over all these years, we're going to have to go at considerably more than $2 million a month.

Right now what the Minister needs to do is state an upper figure — a real goal.

HON. MR. COCKE: Are you talking about BCMC (British Columbia Medical Centre) or the whole lower mainland?

MR. McGEER: Well, I'm talking about the Greater Vancouver Regional District. I'm talking about the facilities and services.

HON. MR. COCKE: Can I just answer you in part?

[ Page 1684 ]

MR. CHAIRMAN: Order! I would like to see the Member continue and finish his contribution so the Minister can....

HON. MR. COCKE: I want to answer.

MR. McGEER: I think we'll get there faster, Mr. Chairman, if you just let the Minister answer as he was prepared to do.

MR. CHAIRMAN: I recognize the Minister.

HON. MR. COCKE: Mr. Chairman, the amount going into the BCMC from the Greater Vancouver Regional District will be that original $25 million. Remember, $22 million was set aside for the VGH, $3 million for children's, and then possibly the $8 million set aside for St. Paul's. That will probably increase the $130 million aspect to some degree but it's not in any way going to cut down on the other hospital projects going on. For instance, Lions Gate came in way higher than was set aside; the Royal Columbian came in way higher than was set aside; so did Burnaby hospital. So is everything else that's coming in, unfortunately.

Instead of the Greater Vancouver Regional District going to be $95 million, I suspect it's going to be something in the order of $135 million or thereabouts. Add to that $135 million something around $100 million and you've got the whole amount of money that will be going into the Greater Vancouver Regional District. You've got your $250 million certainly and then some.

You're not wrong, Mr. Member. If you're looking at the whole thing, the $130 million was not for the whole district.

MR. McGEER: The Minister obtained on December 13, I think it was, a $25 million special warrant for the B.C. Medical Centre. As of January 31, when our interim accounts came out, none of that money had been spent.

HON. MR. COCKE: What special warrant?

MR. McGEER: Yes, a special warrant. I think it was No. 70 or something. It was $25 million special warrant for the B.C. Medical Centre. Oh, you got that last December.

HON. MR. COCKE: Not a $25 million special warrant.

MR. McGEER: Yes, it's in our interim accounts. As of January 31, when these statements were made up, none of it had been spent. Look under the Department of Health for special warrants. I don't want to take the time to hunt for it. But you do recall getting a special warrant last December.

HON. MR. COCKE: We got a special warrant for a small amount but certainly not for $25 million.

MR. McGEER: You don't recall getting one for $25 million and you can't explain the expenditure.

MR. W.R. BENNETT (Leader of the Opposition): There was an announcement that the B.C. Medical Plan was going to be amalgamating or taking over the MSA. The takeover date has been adjusted. I wonder if you could just bear with me and let me know if it will solve some of the problems of coverage that I have particularly from one resident of B.C. who is concerned. He had B.C. hospital insurance and also extended health benefits under Medical Services Association, and there was a gap in this coverage. I won't bore you with the letters and the very good reply he received from W.J. Lyle, the Deputy Minister. Will gaps of this nature be covered when these services are brought together?

HON. MR. COCKE: I think that the Hon. Leader of the Opposition is discussing extended health-care benefits. We don't have any authority nor do we sell extended health-care benefits. I'm sure that MSA and CU&C will continue to do so in the future. So we just have no authority over his health.

MR. BENNETT: I had understood there was a chance the B.C. Medical Plan was going to be taking over the function of the Medical Services Association.

HON. MR. COCKE: No. They're providing health insurance for B.C., extended health-care benefits.

MR. McGEER: It's special warrant No. 75, dated December 13, 1973 — Health Sciences Centre Fund — $24,513,866, page P18 of our interim financial statements.

Interjection.

MR. McGEER: He's been consulting with his Deputy there, Mr. Chairman, to try and find out what that....

HON. MR. COCKE: It's probably a bookkeeping entry, Mr. Chairman, and I just can't get to it right now. We decided not to go the route at UBC so there's likely a debit-credit process. I know that Ottawa's got it back now, and then it comes back toward the Health Resources Fund Act money that will go into the Shaughnessy site. But I can't give you definitively exactly what it is or how these book entries are made.

[ Page 1685 ]

MRS. JORDAN: In light of the fact that St. Paul's has agreed to come into the Medical Centre, has the controversial problem of abortion and whether or not this procedure will be carried out within St. Paul's Hospital been settled to their satisfaction?

HON. MR. COCKE: It was never a question, Madam Member, as St. Paul's Hospital has never done them and I suspect will not be doing them in the future. That's nothing to do with B.C. Medical Centre setting that kind of policy, they set their own policy.

MRS. JORDAN: You don't interfere with their policy?

HON. MR. COCKE: Not in any way.

Vote 75 approved.

Vote 76: Accounting Division, $494,656 — approved.

On vote 77: Public Health Services, general services, $2,384,840.

MR. McCLELLAND: Just a question on vote 77 in relation to the Kidney Failure Correction Programme. I wanted to ask the Minister what has happened to the kidney transplant programme, in Vancouver. My information is that two or three years ago the renal transplants were at the rate of 8 to 12 a year in Vancouver General Hospital. Is the thrust now in the direction of renal dialysis instead of transplants?

I also want to ask the Minister if it's true that the transplantation programme is encountering some roadblocks because of lack of cooperation among Vancouver hospitals in providing cadaver donors.

I also want to ask what the Minister is doing to make certain that the interests are maintained in this lack of cooperation. I also wanted to ask the Minister if it isn't more costly to maintain a person on dialysis than to have them receive the kidney transplant.

HON. MR. COCKE: Three major problems in this area: (1) there are not enough kidney donors available; (2) there have been a number of rejections; (3) on the plus side, the artificial kidney machines we have now are working better and more people have the home dialysis units. Under those circumstances, a lot more people are being maintained now than have been heretofore. But we do have the two problems in the area of kidney surgery.

MR. McGEER: Following up on that, one of the very brilliant advances made in the matter of treatment of kidney failure has come from the renal dialysis unit at the Vancouver General Hospital of Dr. John Price, particularly along with his colleagues.

One of the things this team has done is to invent a kidney dialysis machine the size of a deck of cards. It has received preliminary testing but is not at this point being developed commercially, really through lack of capital and imagination in the private sphere. One or two commercial firms, I understand, have looked at this and expressed interest in it.

I know that he can't make this decision himself, but his cabinet is very interested in getting into private industry — they have purchased a dozen corporations. I would like to ask whether the Minister would be prepared to recommend to his cabinet, and I would recommend it if I were in that cabinet, that as a Crown corporation they go into the biomedical engineering business.

It's a growth industry; we have a winner already in British Columbia in an invention which is not being promoted — can you believe it? — because of lack of initiative in the private sphere. Now, that's something that people on this side of the House are not supposed to admit exists, but which people on your side claim is there all the time.

Here's an opportunity for the government to get into a brand new growth field with a brand new invention where the private sphere wouldn't scream because they wouldn't be doing what they have done to date, which is to take over existing businesses, some of which are failing.

I just think this kidney dialysis machine that's been developed by Dr. John Price and his colleagues is a wonderful medical event and it only needs capital and imagination from somebody, possibly the government, to make it a world product.

HON. MR. COCKE: Well, I'll answer the question quickly, Mr. Chairman. Hoffman-LaRoche, the pharmaceutical firm, have backed Dr. Price's work.

MR. McGEER: Twenty thousand bucks.

HON. MR. COCKE: You know, if he wants to talk to us I'm sure he could talk to the Minister of Industrial Development, Trade and Commerce (Hon. Mr. Lauk), but my department has just sent him money to take care of his research at UBC, which UBC cut him out of this year, so I think we're carrying our load in the Health department. We've indicated to him within the last 2 or 3 days, I think, or the last week or two, that we're carrying that part of the freight. As far as the Health department setting up the factory, no, that's the Minister of....

Interjection.

HON. MR. COCKE: You talk to him under his estimates, not me.

MR. MORRISON: Mr. Chairman, I notice in the

[ Page 1686 ]

expense items a one-third increase in travel allowance of $31,000. There is a healthy increase in office furniture and equipment of $23,000 and a very large increase in the health education item of $195,000. Obviously a major change there and probably all tied together. Could you explain it?

HON. MR. COCKE: Mr. Chairman, there has been a real increase in health education — the increase is $195,000. This will be taken up in: some for advertising that we've been asked to do; some for audio-visual work; and just the operation of the division has gone up, naturally — manpower and so on. Generally speaking, we feel there has to be real hard priority set for health education which is really part of the preventive sphere, so that's why more money is going in.

MR. MORRISON: Is that a travelling programme? Is that why those travel allowances are so much higher, and automobile allowances?

HON. MR. COCKE: Yes, a lot of travelling in that programme.

MR, FRASER: In the question of the master, Mr. Chairman, here on vote 77, I think that's going backwards in this budget. There's a few hundred thousand dollar increase overall, which is just about 10 per cent and that won't even look after inflation. So, where do you think we're going? Where are the cutbacks in here? There must be cutbacks in the headquarters of the vote here somewhere because of the fact you haven't got enough increase in here to look after inflation. I don't think we should be doing that with health care in this day and age.

HON. MR. COCKE: The wages haven't been included in some of these areas because of the fact that they are being assigned, and that's the problem. Some of the programmes weren't quite ready when the estimates came up.

MRS. JORDAN: First of all I would like to check, Mr. Minister — I've been looking through and I've missed something or something has been changed around. Is this where you want to discuss regional health offices? I can find them under mental health, but I can't find them under public health.

HON. MR. COCKE: You're talking about the community health centres.

MRS. JORDAN: Yes, not mental health centres. In the meantime, while you're getting some direction, I'd just like to speak for a moment on this matter of public health regulations which certainly have a place in good health care and preventive health care, but at times they're becoming utterly ridiculous.

It's my view that there should be strong confidence and a good deal of latitude placed in the hands of the local health inspector who is in fact subject to the opinions of the local public health officers.

One of the instances I brought up last year were the requirement for camping grounds in more remote areas — where they had to have a 12 ft. roadway, a 16 ft. parking area and a 25 ft. spread for each unit. Families that came to camp together couldn't possibly locate their units on a compatible basis, and there really was no need for this. Maybe one or two days of the year it became an acute problem. But by and large it was an increased cost to those operating the camp grounds who had a very limited income time, and the clients certainly didn't appreciate it. That's one area where I'd like to see some latitude left in the hands of the local inspectors, and I think they'll be conscientious.

I'd like to ask the Minister how far we intend to go with these wicky-wacky packages you get on the ferries and the restaurants of British Columbia, where the salt is in a package, the pepper is in a package, the ketchup is in a package, the cream is in a package and the sugar is in a package. By the time you've finished your dinner you've got nothing but a garbage heap on your plate. It's expensive; it certainly isn't in keeping with utilization of our resources on an economic basis. Furthermore, I have a message for you from our sons: the ketchup doesn't taste as good; they want to have it out of a bottle. I'm quite serious, Mr. Chairman, we're packaging ourselves to death.

MR. CHAIRMAN: Order please! Unless the Hon. Member relates her remarks to the responsibilities of the Minister....

MRS. JORDAN: Well, I'm asking him just how far we're going to go in health regulations in British Columbia because I think this is utterly ridiculous. I don't know anyone who has died as a result of an open ketchup bottle on the table. If you poll the public, I'm sure, Mr. Minister, you'd find that generally people like their salt in a shaker. It's terribly wasteful, and some people tell me it's a public health regulation. Others in the community area say they haven't heard about it.

If it isn't a regulation, I wonder if the Minister would make it known publicly that this type of utilization of paper and packaging is not in the best interest of our resources, and perhaps encourage restaurants to use certainly, salt, pepper and ketchup in bulk packaging.

Just one more thing in terms of training health inspectors. I brought this to your attention last year and I'd like to do so again this year. We're turning out very competent young people from BCIT, after the

[ Page 1687 ]

two year programme. They do have some field experience in the middle of their programme, in the summertime, whether it's with the federal department or the provincial department. They come out after two years, and, Mr. Minister, they're all buttoned up with their diploma, and they're thinking.

It's felt generally in the sector, as I understand it, that there needs to be a six-month apprenticeship or internship programme so that these people, who are trained very well academically and technically, have a greater opportunity to apply this technical knowledge in the field on a practical basis.

I certainly found as an MLA some of my time and some of our health inspector's time is taken up running around after these people repairing the upset they've created and trying to create good will with the department, which was already there but had been upset by some of these people. It's not that they aren't good; it's not that they aren't well intentioned; they're just too technically trained and they need to have the comers rubbed off in terms of diplomacy and the realistic approach to phasing in health changes.

I'd just cite one example in the constituency I represent. We have a small little coffee-wagon service which serves hot dogs, doughnuts, buns, coffee and this sort of thing. It wasn't a big income business. He had four Volkswagen vans and had the milk in the fridge and in the ice packs and everything. The little guy came along fresh out of BCIT, and within a week he would have had him out of business. Fortunately, we have a very responsible health inspector and we all got on the bandwagon.

I think if they could teach them a little bit more of a practical approach and have this internship programme, everyone would benefit.

Interjection.

MRS. JORDAN: I'm not worried about Capozzi, but I'm worried about the workers who want a cup of coffee and a doughnut, and also a little business that was badly hit by ICBC but is still surviving due to the health inspector.

MR. FRASER: Is it right to read a newspaper in the House because the Minister of Public Works (Hon. Mr. Hartley) is reading one. I don't think he's supposed to.

MR. CHAIRMAN: On the point of order, it is permissible to have a newspaper if it relates to the remarks that the Hon. Member will make. Otherwise it should not be used.

Interjections.

HON. MR. COCKE: I'll very quickly try to cover the points the Member raised. I agree there is a tendency to be a little bit tough, particularly if you are a new guy and you've got a book in front of you, and so on and so forth. As a matter of fact, we have the public health inspectors, the medical health officers and the public health nurses in from time to time for meetings. All of these questions are discussed. I just can't stand here and say we ask them to overlook the law, but we want them to be practical just as you do. However, when you get into the area of packaging, this is not a public health demand at all. We ask people keep their restaurant or whatever clean and sterile and, generally speaking, in good health conditions. As far as they meet those conditions, that's fine.

As far as packaging is concerned, my colleague, the Hon. Minister of Consumer Services (Hon. Ms. Young), probably would be most interested. If, on the other hand, however we say they can't use any more paper, then the Minister of Lands, Forests and Water Resources (Hon. R.A. Williams) would be unhappy with not being able to sell enough paper.

Interjection.

MR. McCLELLAND: Mr. Chairman, just two quick questions with relation to the other question I asked earlier. The Minister responded that there weren't enough donors and that they've encountered a number of rejections. I wonder if the Minister could advise the House whether or not there will be an active encouragement of a programme to increase the number of donors or whether the rejection problem is too great to be overcome. Does the department have any plans to actively encourage people to become donors?

The second question: I'd like the Minister to elaborate slightly on the increase in the health education programme. Are there some definite plans for that programme? Have they been laid out? What direction will it take? It's a pretty healthy increase from $75,000 to $270,000. Do you know exactly what the department will be doing in that area?

HON. MR. COCKE: Not a line-by-line, Mr. Member. What we're doing is increasing health education. That isn't a lot of money when you consider that the problem has been that there hasn't been enough money spent in health education. There will be a lot more film making; there will be a lot more film distribution; there will be a lot more attention paid to the whole area of health education.

Getting down to your other question, I do have a committee on the whole area of renal problems. This committee of. doctors, including some of our own staff, works diligently in seeing to it that people in this province are either afforded the dialysis unit or access to a dialysis unit. We've also done, from time

[ Page 1688 ]

to time, ads and publicity on the whole question of donation of kidneys.

MRS. JORDAN: Just on that point, Mr. Minister, I don't often hand you a bouquet but I'd like to in this instance. I think your response in terms of the home dialysis programme has been very rewarding.

I'd also like to take this opportunity to speak for Dr. Dan Rose in Kamloops who has been a diligent worker and has certainly had a lot of problems from our area where we have a problem with people of different ethnic backgrounds and where the parents are unable to understand what's going on. There has been great difficulty in trying to wean adults onto an independent home dialysis programme. We also have tremendous water problems because we utilize an irrigation system for our water. Dr. Rose has a good deal to contend with because of the area he serves and some of these difficulties. I would just like to mention in the House today that the people in our area are very grateful to him and, as MLA, I'm more than grateful to him.

The House resumed; Mr. Speaker in the chair.

MR. CHAIRMAN: Mr. Speaker, the committee reports resolutions and asks leave to sit again.

Leave granted.

MR. SPEAKER: Before we close I just wanted to give the two citations that I referred to the Hon. Member for North Peace River (Mr. Smith) and for Columbia River (Mr. Chabot). The Hon. Mr. Shantz, Speaker, in Journals 1962, page 24, dealing with the government's right to call government orders under standing order 27 in regard to government motions and the others, private Member's motions, in sequence. The same applied again in March 30, 1973, in the Journals page 198, by this Speaker. Just for the records.

Hon. Mrs. Dailly moves adjournment of the House.

Motion approved.

The House adjourned at 5:55 p.m.