CONTENTS

Committee of Supply: Department of Health estimates.

On vote 74. Mr. Wallace — 2807

On vote 75. Mr. Wallace — 2807

On vote 76. Mr. McClelland — 2807

On vote 77. Mr. Wallace — 2812

On vote 78. Mr. Rolston — 2814

On vote 79. Mr. Wallace — 2815

On vote 8 1. Mr. McClelland — 2816

On vote 82. Mr. Wallace — 2816

On vote 83. Mr. Wallace — 2818

On vote 85. Mr. Wallace — 2818

On vote 86. Mr. Chabot — 2821

On vote 87. Mr. McGeer — 2821

On vote 88. Mr. McClelland — 2822

On vote 89. Mr. Phillips — 2823

THURSDAY, MAY 29, 1975

The House met at 10 a.m.

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

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

On vote 74: grants for health agencies, $2,600,000.

MR. G.S. WALLACE (Oak Bay): Mr. Chairman, I wonder if the Minister could give us a very brief breakdown on the $2.6 million which is a very substantial increase. Where is the increase mainly going?

HON. D.G. COCKE (Minister of Health): Mr. Chairman, a lot of the grants to health agencies have actually been put together in a much more presentable way. As you recall, the department used to be sort of a four-pronged department; different departments were providing for different agencies. Now the only ones we are separating out are the mental health agencies. We are still giving grants from that area.

Let me give you a quick rundown of some of them. Cancer control is $95,000. Under consultative clinics: Canadian Arthritis and Rheumatism Society $170,000, up $10,000; cystic fibrosis is up $5,000; hemophilia is up; cerebral palsy is up from $475,000 to $650,000. What this government has really said, in effect, is that innovative services should certainly be part of the voluntary contribution, but real direct health services should be supported by government as much as possible. We are working in cooperation with the voluntary agencies.

For instance, last year the summer programme at the faculty of dentistry was $104,000. That was free dental service for children. This year it is up to $160,000. The Downtown Community Health Society, which works with the poverty-stricken in the downtown area of Vancouver, is up from $100,000 to $140,000, and so on down the list.

You remember that some time ago we had a commitment to improve family planning counselling. Family planning is up this year from $20,000 to $100,000. I think that is representative of what we are trying to do in the whole area.

Last year a LIP programme looked after one of the quite important St. John's Ambulance educational programmes. This year the LIP people have withdrawn and we are providing $21,000 to take up that vacuum.

I have given you the tone of why and where and so on, and that is it, generally speaking,

Vote 74 approved.

On vote 75: community health services development, $391,900.

MR. WALLACE: Again, this sum has increased three-fold. Could we just have a very brief outline of where the increase is mainly going?

HON. MR. COCKE: As you know we are now in the development stage of the pilot projects that we talked about — the ones on the Queen Charlotte Islands, Houston, Granisle, Grand Forks and James Bay. They have to have a budget, and now that they are underway, that is it. Naturally, there wasn't as much money required before as there is now, but since they have to be budgeted for, that is what you are looking at.

Vote 75 approved.

On vote 76: local health services, $21,931,994.

MR. R.H. McCLELLAND (Langley): Just a brief question about the salaries under this vote. It relates to some other votes as well.

On the medical officer grades there was some negotiation between Mr. Perry and the British Columbia Medical Association. It seems that some of the salary increases were quite a lot lower than what was originally talked about. Is there still some dispute about salaries for medical officers?

HON. MR. COCKE: Mr. Chairman, as the Member knows, there wasn't too much negotiation around the doctors because they wanted to be out of the unit. I would suggest that those negotiations will take place over the next few months. I think we can provide the vehicle in which those negotiations on giving recognition can take place. Generally speaking, local health services has been an area that had to be improved; this is the community health service in all of your constituencies, in all of your towns and municipalities, with the exception of some of the major ones like Vancouver.

Generally, the medical officers and so on will be properly taken care of.

MR. McCLELLAND: Just a brief follow-up, Mr. Chairman. If this was canvassed last evening I apologize, but unfortunately I had to be out of the House. Are you saying that you think that in a matter of weeks or months this situation with these professional employees will be settled?

HON. MR. COCKE: Days.

MR. McCLELLAND: A matter of days?

[ Page 2808 ]

HON. MR. COCKE: Yes.

MR. McCLELLAND: Thank you, Mr. Chairman. If the salary increases provided for in the budget differ substantially from what might eventually be negotiated do you expect this will be taken up through salary contingencies?

HON. MR. COCKE: It would have to be, Mr., Member.

MR. WALLACE: I would just like to ask the Minister just to comment, particularly, on the part of this vote 76 dealing with speech and hearing. I know the Minister can't produce speech therapists out of a hat, but there is a very serious lack of speech therapists in this province. I have encountered cases where citizens who have had a stroke and have subsequent speech impairment have great difficulty in obtaining the services of a speech therapist once they have left the confines of a hospital. As the Minister knows, depending on which side of the brain your stroke occurs, you may or may not have a speech problem. So there is really a discriminatory situation here inasmuch as those persons who are unfortunate enough to have a stroke which affects their speech really don't get as complete recovery as the other person.

I have had some correspondence with the Minister's Deputy, who has been very helpful in describing and discussing the situation, and he mentioned that the Minister had set up a task force for people with impaired communicative abilities. I wonder if the Minister would comment on that. Who is on the task force and what exactly is it doing and when can we expect some result?

I have just one or two quick other questions. Shall I ask them all at once? That's one point. Under this vote also I notice there is a new item, "speech and hearing aide" — I presume that's personnel — listed as eight positions. I would be very interested to know just what level of training that person has who is described as aide and particularly what role the Minister envisions that particular employee would fulfil.

I would also like to know about the one item under "allowances" and the word "et cetera." It always worries a politician when you are talking about money, and you describe it as "et cetera" — it goes from $20,000 to $80,000.

HON. MR. COCKE: Sorry, but could you repeat that question?

MR. WALLACE: It's under the word "allowances" almost at the bottom of the page, about two-thirds of the way down. The item right below that is "temporary assistance, including home care." Now it's quoted at $2.2 million. The Minister had said yesterday, in exchange across the floor, that there was $6 million in the budget for home care and I wonder if he could tell us what segment of the total of home care financing is included under this $2.2 million.

Would the Minister comment on these points, please?

HON. MR. COCKE: Yes, the task force for speech and hearing, Mr. Chairman, is a task force under Dr. John Gilbert, who is the head of the speech and hearing department at UBC. That task force has been working in both areas, speech and hearing, and has produced a report. That report has been discussed in the community, and out of that report we are setting up certain programmes. One of the programmes, really, that comes as a result of that is the programme that we discussed yesterday with the Member for North Okanagan (Mrs. Jordan).

The aide would be one of the members of the team which is in these audiometric pilot test areas and will be working in that development group. The allowance is also for that area.

The medical component of the home care is this. When I talked about $6 million, which is a global figure, I was thinking in terms of the Minister of Human Resources (Hon. Mr. Levi) and the Minister of Health (Hon. Mr. Cocke). But this is the actual medical nursing aspect of the home care programme.

MR. P.C. ROLSTON (Dewdney): A quick question to the Minister. I think we should acknowledge that there are 144 more health workers in this vote. By George, this is something we really should compliment him on. But I want to ask him, first of all, at the start of the vote, if there is $34,000 for a medical officer 3, presumably that is an increase. How easy is it now to attract people to get into this? That's maybe halfway up as far as net income for doctors is concerned. It's not a lot but it's take-home income compared to the big operating costs and the other risks that a person in private practice would have. How easy has it been to induce these people to go into the public service?

I want to ask a question. I thought you said you had 18 speech therapists; yet there are only 10 in my vote. Is it not 18 rather than 10, or maybe there's some speech therapist...? We have a new speech therapist in Maple Ridge, for instance, which we certainly appreciate.

Again, what's the real projected expansion next year for speech therapists? I note too that there are 44 more public health nurses. I think there are about two more in my riding.

But I want to ask some questions about public health inspectors. We use the word "grace" theologically to describe, I guess, a case of discretion.

[ Page 2809 ]

This is a very difficult job, Mr. Chairman. A public health inspector needs grace and wisdom and a very flexible approach. Often my experience is that they look at things very clinically, strictly on hygiene, when they're inspecting homes and day cares and nursing homes. I just wonder if the Minister could comment on this very difficult policing job of being a public health inspector today where so many public facilities, really, can be held up for a while due to his discretionary powers. Yet it's a very vital role.

Maybe you could comment something on the training of these people. We are very short of these people. They are in a tremendously influential position in the community.

AN HON. MEMBER: Time!

MR. ROLSTON: Okay, I'll sit down and hear what the Minister has to say. But how many new inspectors do we have here?

HON. MR. COCKE: In the first place, you talked about the number of speech therapists. You count 18; I could 27 speech therapists I and 2. And you're looking in the wrong column if you're looking elsewhere.

Mr. Chairman, the second thing is: how do you attract doctors? I think I answered that question when I answered the Member for Langley (Mr. McClelland) when we discussed the whole question of the doctor situation. So really if you take that as your answer.... I would be making a value judgment beyond saying how attractive this income is and that income is and so on, and I think I mentioned that.

So far as the public health inspectors are concerned, Mr. Chairman, they do have a very tough job and we appreciate the work they do. Beyond that I really can't do much other than to discuss the matter in question.

MR. WALLACE: Mr. Chairman. There are just one or two other points in this vote I wanted to canvass.

I'm very interested in the item in the light of what we talked about yesterday — hearing programmes — under code 041: hearing aid and equipment, $600,000. That's a substantial sum, and I presume it's the equipment used in various areas to do the testing. But since we did talk about hearing aids yesterday, I wondered to what degree this would not come under this vote, providing hearing aids for people on social assistance, presumably. Or would it? I have one or two very quick items I want to ask as well.

Physiotherapists were mentioned, and I've just had an inquiry in my own riding about why service is being cut back. I have a lady who is seriously disabled as a result of polio years ago and who is self-sustaining She teaches music in her home but she's becoming less and less able to cope with the physical problems. Apparently, whether this is a local decision or provincial decision, the service is being cut in half. She can only have it half as often. This is, in my view, very unfortunate. I wonder if the Minister could comment on the question of physiotherapy services. Is there any central policy, either for financial reasons or personnel reasons, that's led to a reduction in the service?

There is another item there I just want to ask about, because it wasn't in the budget last year and it's $435,000 this year: operation and maintenance of motor vehicles. Where was that expense shown last year? Also, since there's a very substantial increase in grants and subsidies from $2.1 million to $5.2 million — code 0.19 in the vote — I wonder if the Minister could comment. That's $2.1 million up to $5.2 million under grants and subsidies. Could we just have a brief outline of the increase?

MR. McCLELLAND: Mr. Chairman, just a brief follow-up perhaps on the question the Member for Oak Bay (Mr. Wallace) asked about the hearing aids — $600,000. There seems to be a problem with some elderly people particularly who need hearing aids, since the government did some time ago make a public proposal that it would supply — or at least it was considering supplying — hearing aids at manufacturer's costs, similar to the programme in Saskatchewan. The question I'd like to ask is whether or not the government will actively pursue that programme. I don't think that was answered — looking at Hansard — last night.

Certainly there is a problem with the hearing aid dealers. They don't know where they stand at the moment. They'd like to have some answers from the Minister. But I think the problem with the uncertainty about where the government is going in this programme is that there are a lot of elderly people who perhaps need service or need new hearing aids now who are not getting that service and are not going to get their hearing aid, because they are sort of waiting to find out what the government is going to do. So they are perhaps going without and perhaps suffering from a health point of view because of it.

I think that in fairness to those people the government should make its position clear and let them know whether it is going into this programme quickly, or whether it will be come time.

HON. MR. COCKE: Mr. Chairman, I think I made the case very clear that the only places we are providing hearing aids at cost are in the four or five pilot project areas, period. That's it. We want to see how it works.

Just to answer the Member for Oak Bay's (Mr. Wallace's) question at the same time on that, the $600,000 is that very amount you were talking

[ Page 2810 ]

about, vote 041. That's a returnable sum. In other words, we have invested or are investing $600,000 in hearing aids just for those pilot areas, and then of course they will buy them at cost and that will be returned to the Crown, but it won't come back to the Department of Health. It goes to the Minister of Finance under those circumstances. So that really answers both those questions.

The physio reduction is something we had to contemplate because we've actually expanded physio, Mr. Member. We have a great deal more physio. We have physio in the home-care programme, physio in the out-patient programme in the hospitals. So what has really happened is that people are taking greater advantage of physiotherapy. Now it is a matter of manpower. It really is. That will be expanded as it can be.

The operation of motor vehicles, Mr. Member. I will have to take that part as notice because I believe — and I can't give you an absolutely definitive answer — that there was a question that that was in another area altogether of government and now is charged to the Department of Health.

MR. WALLACE: Just one last point. If we're cutting back on physio, I would hope the Minister would give this top priority in seeking a solution. It's the same old story: if we can't give the kind of lady I'm talking about in Oak Bay the proper kind of physiotherapy, she is going to be shoved in an institution, and we are back on the old merry-go-round of having to build beds when people could be looked after in their own home, and so on, and at less cost.

As I said about speech therapists, I know you can't produce them out of a hat. But I would hope that the very significant diminishing of the seriousness of a person's disability by physio is fully recognized by his department.

The last question: There is very little increase in the preventive dental programme budget. It goes from $300,000 to $330,000. The Minister did make a statement a week or two ago that he was in the process of developing a dental-care programme for children aged three to 17. He said there would be a research report costing $150,000 by his department and the dental college which was to be released around May 1.

Now I may have missed that or it may not have been released, but I wonder if he could comment briefly on the whole item in this budget called preventive dental programme, vote 034, and also comment on the dental-care plans for the children aged three to 17.

Finally, how are we doing in the province in the very difficult problem of getting an adequate number of dentists beyond the metropolitan area? A dental-care programme isn't much use if we can't provide the number of dentists.

The Minister said this in debate before when he announced that there would be a programme within the next couple of years, I think the Minister said. I wonder if he could tell us the projected figure of costs he had in mind and the question of getting an adequate number of dentists.

MR. McCLELLAND: I know that public health inspectors have enough to do now without asking them to do more. However, there is a problem that has come to my attention. It has to do with TB x-rays and inspection for typhoid carriers for employment in cafes and private hospitals, private institutions. Those inspections are required for government institutions like Woodlands, I understand, but in these other areas they aren't required at all. The health inspectors in the valley tell me that TB x-rays are recommended, but there is no requirement that they take them in order to get employment in these places. I think there could be a case here for some uniformity in the health laws in this regard, Mr. Chairman.

The second thing I would like to ask: last fall the Minister came down pretty hard on the eyeglass manufacturers and sort of threatened at that time that if they didn't clean up their act, the government was going to go into competition with them and start manufacturing eyeglasses.

Interjection.

MR. McCLELLAND: That's right — move in on the scene. At that time the Minister said that he was looking at the matter, I think his word was, "superficially." I wonder if he had got any further beyond that superficiality and whether we are going into the eyeglass business in British Columbia.

HON. MR. COCKE: Mr. Chairman, first I'll deal with the dental report that the Member for Oak Bay (Mr. Wallace) discussed. That report is now being finished — unfortunately it wasn't quite ready. We have an 890-odd-page draft but it's being condensed into a 500-page readable report. I'm meeting on June 9 with the College of Dental Surgeons to discuss further the report and its ramifications.

Yes, we do propose a dental programme for children; yes, that programme will cost money. I project that it will cost something in the order of maybe $30 million to $35 million ultimately. But that would be just a rough guess so I'm not going to tie myself down — that's judging from some of the statistics that I have to date.

Mr. Chairman, to the Member for Langley (Mr. McClelland), the TB X-ray is a question that I'll certainly look into. I think it's a good idea. Although I am told by my medical officials that the incidence

[ Page 2811 ]

of TB in this province now is very, very, very low indeed, it's certainly something that I'll discuss with my officials.

The last thing — the eyeglasses. One of the things that I had anticipated and that has now happened, and one of the reasons that I threw that warning out and I am discussing the whole question — two reasons. One, I wanted the federal government to continue on with their royal commission on optometrics — they haven't to date. Remember, it was going full tilt until that election; then when the federal election was over we heard nothing more from that royal commission. So what has happened as a result?

Interjection.

HON. MR. COCKE: I don't know, Mr. Member, but you can't tell. My voice was a voice in the wilderness because now I understand that Imperial Optical has circulated a 20 per cent increase in the last few days — you can imagine what that's going to do to the cost of glasses. All I'm trying to do as Minister of Health in this province is to warn people that there has to be a better way.

Think in terms of a child or a family with five myopic children — oftentimes this runs in families — where there is a change of glasses, say, every six or seven months. That often happens with each child. It becomes an oppressive sort of situation economically and, frankly, needless under certain circumstances to the extent that it is.

Anyway I'm just going to continue to soldier on in this area and try to keep the costs down. I'm not going to say how. Maybe it would be an idea if we maybe helped somebody in the private sector to get into the actual base manufacturing. This is the kind of question that I've discussed with the Minister of Economic Development (Hon. Mr. Lauk) and will continue to do so.

MRS. P.J. JORDAN (North Okanagan): To arms, to arms, as that Minister soldiers on! I can see the headline tomorrow: "Cocke Soldiers Forth Battling The Optometric Profession." I'd be with him; I think there are real problems there. But while he's soldiering in this massive area of health and he is taking up arms against everybody, would he please take up arms against ICBC? There is a serious situation arising. I have two examples — I haven't got them with me this morning. They have been taken up with the department with some considerable confusion.

It revolves around people who are involved in accidents, have injuries that require physiotherapy and wish to make a claim for this compensation through ICBC. ICBC, when it involves physiotherapy, orders them to take the treatment and it is billed to B.C. Medical. What happens in frequent cases is that there is a limitation on the number of treatments — I think it is 12 treatments a year. I stand to be corrected on that. But there is a limit on the number of treatments people can have of physiotherapy under the medical plan. So if they have their accident in January, February or even later in the year, they have their treatment and are supposedly cured — this is charged to B.C. Medical, not ICBC. Then later in the year if they have other problems perhaps not related to the accident they have to pay for physiotherapy treatment themselves.

The point here is that ICBC has a responsibility to meet that commitments that it makes to individuals in this province through their policies; one is medical treatment in the case of claimable accidents. It just seems ridiculous that they should be able to shunt people back and forth between ICBC and the Health department. The Health department also has a contract with people through the payment of their fees for their medical service, and that is to provide so many medical treatments in various areas, including physiotherapy, if required every year.

I would ask the Minister to straighten this matter up immediately, rise to arms on behalf of those who have been inconvenienced by ICBC in this area and take the Minister of Transport and Communications (Hon. Mr. Strachan) aside and tell him to assume his own responsibilities and let the Minister of Health assume his responsibilities so that we don't have people being bounced around like yo-yos between these two departments, This is a problem at the best of times; it's a very serious problem when people have been involved in accidents and have, as most people do, shock reactions and emotional problems. These last often for many months and then they get into a hassle like this that's not of their making. I would ask the Minister for a commitment to take up these arms.

The other question I wanted to ask him was in relation to mobile dental units. As the Minister is no doubt aware, in the North Okanagan the previous administration pioneered this programme. Dr. Grey, the public health dental officer in Kelowna, and his staff were among the initiators. It was an excellent programme. Up until recently, I know, it has been running to capacity.

Then I believe there was a second programme started in the province. I think that this type of programme is quite apart from any dental-care programme for children. This meets the needs of those in the rural areas who simply can't get in to dentists and who don't have dentists in their area.

Although it was subsidized initially there was a thought that certainly the administrative costs of it could be self-supporting. It was essentially staffed by young dentists who were eager and didn't want to limit themselves to eight or 10 hours a day but were willing to work many long hours a day imparting

[ Page 2812 ]

community service and also, I'm sure, to get a basic start in their dental careers.

I would hate to see this programme shunted aside. To my knowledge there has been no major expansion. I would urge the Minister to expand this mobile dental-care programme into all the remote areas of the province. There is certainly a need in the East Kootenays area. There is a need in the northern parts of Vancouver Island; the Member for Comox (Ms. Sanford) most certainly has the need for such a unit in her area. There is a need in the northern part of the province, just to mention a few areas.

I hope that the Minister will give a commitment this morning that this excellent programme will go ahead at a faster rate than it appears to be at the moment.

HON. MR. COCKE: I think the Member for North Okanagan (Mrs. Jordan) has brought up two good ideas. As far as the physio thing with ICBC I will certainly be discussing that. That was the way with the old insurance companies and I will certainly look into it with ICBC. We got ripped off for years, as you know, with medicare by picking up the tab. In any event, I will certainly see to it that that is what....

MRS. JORDAN: You know that "the NDP does better."

HON. MR. COCKE: On the mobile unit, it is quite correct: that programme has to be expanded. We hope that with our new dental programme we can develop that kind of mobility. You are quite right that you have to have dental care in the more isolated areas; otherwise you've accomplished nothing.

In B.C., for instance, 48 per cent of the people get to see a dentist. But those people are not in the north or more isolated areas. They are in the lower mainland and the lower end of Vancouver Island.

MRS. JORDAN: Just one more question. Are there still no more than the two units operational in the province?

HON. MR. COCKE: I believe that is all there are.

MRS. JORDAN: Would the Minister care to give me a time limit on when he will get some more on the road? Hustle and bustle the dental units, please, right away.

HON. MR. COCKE: I think that there are more in the offing.

MRS. JORDAN: Tomorrow? Next week? September?

HON. MR. COCKE: Yes.

MRS. JORDAN: September. Two more units will be hustled and bustled on the road by next September? You don't want to be snowed in the whole winter.

MR. McCLELLAND: Mr. Chairman, I hope that this is the correct vote under which to bring this up. I've just received a letter from some people in Osoyoos who are concerned about the closure of an x-ray lab in Osoyoos. If I could just bring the Minister up to date, the lab was apparently to have closed on April 30. The letter doesn't indicate to me whether or not it actually closed on April 20.

HON. MR. COCKE: Could I bring you up to date on that question? I granted them an appeal. They were in my office about a week ago. I gave them a further extension. They were not living up to the standards that were set by their own peers in their own profession. Their beef is not with the government; it is with their own profession. It was the Advisory Council of Labs — all doctors — that brought in that report. I had both parties in my office in a proper appeal. We were not party to anything that happened in Osoyoos.

I have given them a further five or six weeks, well into June. I hope that they bring their laboratory up to the standards that are necessary in order to protect the people in B.C.

Vote 76 approved.

On vote 77: division of laboratories, $1,861,270.

MR. WALLACE: Mr. Chairman, I think we have to spend a few moments of this vote for a variety of reasons but mainly the fact that this issue was discussed in question period the other day, emanating from some statements that had been made from the Consumers' Association of Canada with specific reference to coliform contamination of milkshakes. I don't think we should zero in and make a big song and dance just about milkshakes. The subject is much wider than that. It is the whole question of public safety in relation to food outlets — milkshakes, meats, other goods and food. I've talked the matter over with people who are concerned and professionals in this field.

I wonder if the Minister could perhaps just respond to one or two points that I would like to make. Again, the number of personnel required to do a complete and thorough job, I recognize, is different if they are not available. The cost of salaries is considerable. I want to recognize that the staff under this vote has been increased by 25 per cent and there is a dollar increase of 67 per cent. I recognize that.

The point I'd like to make is that, as the Minister well remembers, there was a tendency to be too many

[ Page 2813 ]

laboratories developing in the province. In the last annual report of the medical services commission, on page 8, it recalls the setting up of the advisory board on laboratories. This commission was asked to be responsible for ensuring the availability of quality services, and controlling the expansion of facilities or provision of new facilities until there was reasonable utilization of existing facilities. That makes good sense.

So I'm wondering whether the government itself, in this particular area of food supervision and inspection, is making the maximum possible use of existing laboratories, whether they're private labs or public labs, or whether they are the two mentioned, the provincial government lab in Vancouver, for example.

In discussing this matter with pathologists — and I don't say this to be miserable towards the civil service — but the fact is that the government lab works civil service hours, basically — 8:30 to 4:30 Monday to Friday. A lot of this kind of laboratory testing.... I don't want to transgress on other votes, but talking about venereal disease, for example — when doctors want to take specimens or submit material for tests, the restrictive nature of 8:30 to 4:30 Monday to Friday ... it's like suggesting that maybe doctors could provide that kind of service. We know very well that a lot of the need for testing just can't fit in to that kind of time schedule.

Therefore I'm wondering, first of all, if the Minister would like to comment on expanding food testing by utilizing more widely the services of pathologists and technicians in the existing laboratories in the province, not necessarily provincial health laboratories.

As the Minister knows, in a variety of towns and cities the hospital lab in the particular town or city provides services to the government. When the Minister responded to my question the other day by saying that laboratory services were inadequate, I don't really think he quite meant that. Maybe he did, but only in relation to the provincial government labs.

I get the impression, both from practising myself and from discussing the matter with other pathologists in other parts of the province, that, basically, they are very pleased with the progress that is being made in laboratory service generally in this province.

As the Minister knows — he mentioned the x-ray lab in Osoyoos being judged by its peers — the very same happens in the laboratory field, and the pathologists quite eagerly have taken on a self-disciplinary role in accreditation of laboratories to ensure quality control in their work. Again, this is mentioned in the annual report of the medical services commission, pointing out that they recognize this responsibility, and they think they are making good progress, Now if that is the case, if we have the potential to use these private and public labs more widely for the specific supervision of safety in food distribution, I wonder if the Minister could tell us to what degree he is consulting with the pathologists across the province to bring this about.

The second point in that regard is that one lab that I talked to have certain food retail centres voluntarily asking for advice from the pathologists as to how often they should test their meat, their hamburgers or what-have-you. On a private basis, on a fee-for-service basis, some of these food centres submit samples on a regular basis to this lab. I think that shows real responsibility as well as some initiative on the parts of the parts of the outlets.

Again, I have to ask: what about the other stores or the other outlets who just plan to spend as little time and as little money as possible checking on their products? I wonder if the Minister could give us some general idea of how often some of these outlets are being checked by his inspectors. He did mention that you can't have an inspector in every store once a week, that sort of thing. I'm not asking that. But it would appear, from the investigations I've done, that a great deal is left up to the feeling of responsibility which the food retailer himself or herself has. Some of them are taking this initiative privately, having a regular check on their products, but there is not a sufficiently frequent check by government on other outlets who choose to just carry on in their own way without really having adequate or frequent checks on their product.

I notice that in this vote the Minister has increased lab technicians from 27 to 39, and laboratory aids from 18 to 26. That's all a step in the right direction.

As I mentioned the other day, with the warmer weather coming, hopefully, and an influx of tourists and the tremendous pressure on some of these fast-food places in the months of July and August, I would wonder if there are any immediate steps we should be taking in the light of some of these findings to at least have even temporary increased regulations during the summer months, perhaps utilizing some of the other labs other than present government labs to bring this about.

It seems to me that there is a real potential for an outbreak one of these times. Then we'll all be saying that we should have done something about it. I just feel that, under the circumstances that have been described in the tests done by the Canadian Consumers' Association, and in the light of my information that there is potential for more people to do more testing, providing we can set up some programme in consultation with these labs I have mentioned, maybe we could prevent a serious outbreak.

HON. MR. COCKE: Well, Mr. Chairman, I quite

[ Page 2814 ]

agree with the Member that everything has to be done that can be done. We are in the process at the present time of discussing with the laboratories and with our own public lab expansion of programme, and we're doing everything we can do. The one thing I want to make very clear is that for restaurants like Dairy Queens, McDonalds and all the rest of them, if you were to try to keep up with inspections at the rate of inspecting everything that goes by, it's impossible. For instance, in Vancouver these places are inspected twice a month. Basically, you have to see to it that there are sanitary conditions prevailing. That really is the responsibility of our department.

For instance, in B.C. It's the federal government and the Department of Agriculture that do the milk; it's not done in the Department of Health at all. But we are presently formulating new ways and means of making sure that people are eating pure foods. But I just don't want people to get the feeling that every time they go into a restaurant they are in jeopardy. They are not. Most of our restaurants come up very good.

Vote 77 approved.

On vote 78: division of vital statistics, $1,208,660.

MR. ROLSTON: As you know, in British Columbia there are really two forms of marriage ceremonies. One is by a clergyman and is commonly called a religious service, and, of course, there is also solemnization of marriage by a district registrar or an appointee which is known as a civil service. Over many years, of course, there have been some very substantial changes in this province and in society regarding the attitudes about religious marriage service, not so much on a basis of conviction, Mr. Chairman, but more on the fact that it's convenient and it's suitable to be married by a clergyman in a church.

I am not going to ask the Minister, because he has been canvassed, certainly by the United Church quite recently and also by other churches, about the fact that the churches, in a sense, don't really like being used the way they are as a convenience because of the 24-hour-a-day operations they run. I would hope that the Minister could give us some indication as to the time when we can see some kind of expansion in the hours of marriage commissioners so that they can be much more convenient. In Mission it's from 12 until 2 on Monday, Wednesday and Friday — hardly convenient, Mr. Chairman. Most people get married, on a weekend, and at night.

I just feel that the time needs to come, and this House needs to recognize that we now.... I understand that 21 per cent of the people are married by a commissioner in this province, and that is gradually increasing. Most of the churches encourage that increase, because the church really doesn't like to be used by people who really have not even the slightest commitment to the Christian value system in marriage.

Can we see some kind of a change? Can we advertise, first of all, way more money? You virtually offer very little at all for somebody to conduct a marriage in this province. Advertise for the many people, Mr. Chairman, who do have the aptitude and who do have the training. Often they are retired people — and I am thinking of where I live in my riding — people who would gladly perform weddings on a Saturday out in a park or at a person's home. But by law they are not allowed to.

I don't see you setting up some great bureaucracy, Mr. Minister. But, my goodness, I would hope, as our government and our Premier says that there is wisdom in age, that there are people who do have the time and the flexibility and they certainly have the sensitivity and the wisdom to be hired by the department of vital statistics for an enlarged and far more sensitive and, time-wise more appropriate — you know, beyond 5 o'clock on a Friday.... I would encourage it. I assure you that the United Church of Canada would encourage this.

Quite frankly, the Department of Vital Statistics, even to a clergyman, is often a very secretive part of your department. We wonder if there is simply a memory system, a repository of a lot of vital statistics, not really an agency that is, in a sense, trying to respond to what is really happening out there in the community.

We, as the government, and, I think, as Members of this House, are sometimes pretty concerned about what is happening in Communities. I don't want to single out any particular community, but we are desperately concerned about the fact that there is a 26.5 per cent ratio between the number of weddings and the number of divorces in this province. That is considerably higher than the next province.

This has some bearing — I don't want to make too much of it — but it does say something, I think, about the attitude our community has about marriage. It also might say something about this vote and this particular division of your department, of your Ministry, which after all, does do the regulating and even maybe could posture more deliberately about what is happening in the tragedy of marriage breakdown in this province.

HON. MR. COCKE: Mr. Chairman, we have had briefs on this subject, and we are looking into them. The whole question of diversifying the opportunity for marriage is certainly one that we are concerned about.

As far as the division of vital statistics monitoring people's morals and so on, or anything like that...what we are really doing, and all the division

[ Page 2815 ]

of vital statistics is there for, basically, is to provide the record keeping that is necessary for the province.

Vote 78 approved.

On vote 79: division of venereal disease control, $462,712.

MR. WALLACE: I just wanted to comment briefly again and ask the Minister on this point of the availability of laboratory service, and the point I mentioned about 8:30 to 4:30 Monday to Friday. People get problems at other times of the day in the week. This again is a point that pathologists have made to me, that doctors, generally, just use the laboratory service in the local hospital rather than the facility that may well be available at other times during the week under government financing. This in turn leads to less than complete notification of cases, which the Minister quite rightly stresses.

I noticed in a report on April 17, in The Vancouver Sun, that the rate of increase in venereal disease in British Columbia is much less than the national average. It is reported to have increased by 4 per cent last year, compared to an average annual rate of 15 per cent.

On the other hand, I also noticed a report from the Central Vancouver Island Health Unit area where Dr. Peter Reynolds, back in February of this year, reported what he considered almost an epidemic proportion in the increase in cases of gonorrhea, from 375 to 435.

I wonder if the Minister would comment as to whether it might be possible to make the services of the government laboratories more readily available, more frequently, on a more accessible basis, so that in fact we can be sure that if there is some urgent need for immediate laboratory investigation of a possible case of venereal disease, at least the service is there and available.

The other point I mention in passing is that we have heard a lot in this House, earlier on this session, about the education of our children in the schools regarding the whole question of sexuality which so often seems to zero-in only on VD. I think it is pathetic that when people think about educating our children about their sexual role in society, the first thing people seem to think about is VD. It's really a small part of the problem if the facts are looked at objectively. There has been some tremendous resistance in certain municipalities, I notice, to this kind of effort by, perhaps, more the Minister of Education (Hon. Mrs. Dailly) than the Minister of Health.

I wonder to what degree the Minister of Health is involved with the Minister of Education in formulating the kinds of programmes that are quite feasible and practical and not going to do any harm at all. We have two first-rate people, a lady and a gentleman, teachers in Oak Bay — not only in Oak Bay, they travel around the schools in School District 61, and just do an excellent job. How anyone could take offence at the basic factual, mature way in which these two teachers talk about venereal disease and other related subjects.... I think it is just something that we in this area have to go on record as praising in the highest terms.

I've been to the school to listen. They go over the programme with the parents, and the parents have the choice of having their children take the programme or not. Complete freedom of choice. I wonder to what degree the Minister and his department is furthering this worthy goal in combination with the Minister of Education.

HON. MR. COCKE: Mr. Chairman, firstly, to my knowledge the division of labs is not behind in VD testing. I agree we're not offering tests at 12 o'clock at night, or something along that line. That's not to suggest that isn't an idea we are looking at at the present time — the better utilization. As a matter of fact, the Premier has indicated on one or two occasions, I believe in the House, that not only the division of labs but universities and so on should better utilize their space, and that's precisely what we're doing now.

Going beyond that to the school programme for VD or on that subject, we make available to the schools personnel, films or whatever. I must confess that because there seem to be so many inhibitions out there — that is, when people are dealing with children — that it does sort of mitigate the work that we can do. But the work is going on and there has been, as a result of hard work over the last couple of years, a reduction of VD, despite one particular isolated area. There has been an actual reduction in the tendency to increase.

MR. WALLACE: Mr. Chairman, just one last point. I notice a surprising reduction of one item on this vote. Strangely enough it's entitled "medical services" and they're down from $20,000 to $ 10,000. Does this reduction show up somewhere else?

HON. MR. COCKE: What number?

MR. WALLACE: Code 008, halfway down the vote. It was $20,000 last year and it's shown as $10,000 this year. Strangely enough the item is entitled "medical services." I wonder if this money shows up somewhere else other than in this vote.

HON. MR. COCKE: Mr. Chairman, we have a full-time assistant director instead and so some of the money is taken out of that. Therefore it's a salaried situation.

[ Page 2816 ]

Vote 79 approved.

Vote 80: division of tuberculosis control, $1,220,985 — approved.

On vote 81: division of in-patient care, $4,942,000.

MR. McCLELLAND: Mr. Chairman, I'd just like the Minister, if he would, to bring the House up to date.

On a number of occasions in the House I've asked questions about the staff problems at Pearson Hospital. I know that's it an ongoing problem there and one in which we wouldn't want to see the patients suffering from lack of services. I'd just like the Minister to bring us up to date on how those problems are being met and whether the situation is improving at Pearson.

HON. MR. COCKE: Mr. Chairman, each time the Member for Langley (Mr. McClelland) has brought up the question of staffing we've looking into it; at least I have from my office. The reports have been, as you know, on one or two occasions that there has been a shortage of specific personnel. Generally, as far as I know, the staffing is okay at the present time. We are, as you know, putting all our hospitals into sort of a different stream under reorganization and I hope that because of their closer touch at the rest of the hospitals it will work out better and there will be better interchanging.

Vote 81 approved.

On vote 82: Medical Services Plan, $123 million.

MR. WALLACE: Mr. Chairman, we can't just pass a vote of $123 million. I mean, things may be very good.... The Minister's smiling.

HON. MR. COCKE: How do you avoid it?

MR. WALLACE: I think he has a great deal to be happy about on this vote, but $123 million is a lot of dough and there are just one or two points I'd like to clarify.

The cost is going up from $105 million to $123 million but I wonder if the Minister could give us the projected breakdown, or at least perhaps a breakdown for the $105 million in terms of federal money, provincial money and premium money. I tried to check this out myself but the last annual report is for 1974 which is dated December 16, 1974, and I presume that the report for 1975 isn't available. If it is perhaps the Minister could tell us.

I think everybody talks about the rising cost of medical care, and that has to rise along with everything else in inflationary times, but I think it would be useful to have the breakdown. As the Minister knows, some of the costs are shared 50-50 with the federal government, exclusive of things such as chiropractic and naturopathic and so on. I wonder if he could give us that breakdown.

The other point I would like to ask is that my understanding is that premium structure for those who pay the full premium themselves was set in 1965. This is 1975. If government wasn't dedicated to paying the whole shot in 1965, obviously it set these premium rates in keeping with general economic factors — wages, prices, et cetera.

Here we are 10 years later where costs have certainly doubled or maybe even tripled and the premiums stay the same. I just ask the question again: since we don't have endless amounts of money for laboratories or intermediate care of prosthetic devices and all the other benefits which I have suggested in this debate to the Minister should be available to some of our handicapped and our senior citizens and so on, is it not logical that maybe some of the figures contributed by the recipient of the service might be raised simply because it would create more money to be used in some of these other areas of service which are being completely uncovered by the government? I am particularly thinking of the ones that I mentioned, such as the nursing homes, the cost of drugs to the handicapped person, the child with cystic fibrosis, the hearing aids, the lenses and all the other devices, prostheses and appliances which make life just a little bit easier for the person who has to suffer the disability.

On the same basis I might suggest that there is some relief of 50 per cent of the premium for individuals with a taxable income less than $1,000. Once again, would it not be timely to consider raising that $1,000 allowance? When that rate was set the $1,000 was probably quite reasonable. But again, with inflation and changing economic factors would it not...? Or is the Minister considering raising the level to $1,500 or $2,000?

HON. MR. COCKE: Let me explain it to you.

MR. WALLACE: That's good.

One or two other points I just want to mention. We have had some discussion recently about the so-called blacklist. I think the Minister has answered that fairly adequately. But I think that in keeping with getting all the facts out on the table, this annual report also mentions the question of professional review committees. I think this House and the people of British Columbia should know that a pattern-of-practice committee exists. That just simply means that in the computerized age the pattern of every doctor's practice can quickly be inspected and, indeed, those physicians whose pattern of practice is

[ Page 2817 ]

far from the middle 80 per cent or whatever of the total are subject to scrutiny.

The Medical Services Commission report takes cognizance of the fact that the Minister and his department act cooperatively to provide the various statistics and other data which help the peer review committees to function. I think too often people get the impression that physicians can play fast and loose with whatever they charge and how they charge for medical services. I think it's only fair to point out that the profession seems to be in very considerable harmony under medicare at the present time. Everything isn't perfect I'm sure, but this government has recently negotiated increases on the level of rates that can be charged on a fee-for-service basis. The fact that the patterns-of-practice committee is functioning as well as it is in cooperation with the government is probably why the Minister smiled when I said we couldn't pass over this item. But I think he should be glad that at least I'm standing here and acknowledging some of the good things instead of raising a whole lot of dust about some other points that probably could be discussed.

The last point: I was just wondering about the projected figure of $123 million. Does the Minister expect the same proportionate sharing of costs in the coming year or does he anticipate any expansion of services provided under medicare which will not be cost-shared by the federal government. Or, alternatively, has he any hope that some of these services like physiotherapy and so on, which, again, help to keep people out of hospital, which is very costly...is there any evidence that the federal government might start to share in some of the medicare services which presently they don't share?

HON. MR. COCKE: Mr. Chairman, there is no evidence that would indicate that. I have discussed the question with the Minister, Marc Lalonde.

However, let me first answer your question about the breakdown. We're talking here not about $123 million; we're talking about $235 million in the estimates. What you really have in this is a vehicle for recording revenue — Ottawa, the premium, subsidy and so on. So let me give it to you in a broken down situation. The premium subsidy we have proposed will be about $23 million, premiums will be $94,500,000, investment interest will be $14.9 million for the premium subsidy. Wait a minute...that's not premium subsidy. The federal is $84,081,000. So it works out to $235 million.

You ask if we will raise the premium. What we have actually done is say that the government will pay a greater proportion. In other words, we know that the premiums were set in 1965. What we are really doing now as a government is paying a greater proportion of the total that is going into Medicare. We have no change of policy in that regard at the present time one way or the other. I think that just about answers the question.

As far as the professionals go, yes, as a matter of fact there are one or two people being referred to the review committee of the profession. That is the way we work. We work with the profession.

MR. WALLACE: I think the Minister, along with the Minister of Human Resources (Hon. Mr. Levi), has often used the phrase about moving the money around. I won't be tedious and repetitious but we have talked about the dollar a day in extended care, et cetera, and patients accumulating assets while they are in extended-care hospitals. The Minister has made a very flat, categorical statement that the premiums were set in 1965 and that in the last 10 years the government's policy has been progressively to pay a larger and larger part of the total costs. Do I take that as a flat rejection of the fact that health care is a bottomless pit, that you can't possibly get all the money you could spend, and that therefore the challenge is to give equitable assistance to anybody who is sick and who needs it?

I'm sorry that I have to get on to this again and again and again, but we have people who are going broke in this province paying for their own health care. Yet every single person under Medicare is paying the same fee he paid in 1965. Is that justice?

I just think that that is not fair. It isn't right that people finish up in a nursing home and pay $600 or $700 a month until they finish up on social assistance with the government looking after them. In the meantime, people like ourselves in this chamber who are well paid, pay a premium for medical services which is the same as it was in 1965. We don't buy a single thing in life these days that costs what it cost in 1965.

I agree with the Minister that if we had all the money we needed to provide these other services, there would be no reason to take a look at this question of raising the premiums. Any government that raises any fee knows that it is politically unpalatable. I'm quite aware of that fact. I just say to the Minister that there is surely some logic in the argument I am making that the money could be moved around so that everybody who needs some measure of assistance gets it.

I just feel that we are doing more than we need do in financial assistance to certain income groups like ourselves. Yet we are doing very little for others who are in really bad need of it.

MR. McCLELLAND: Mr. Chairman, I would like a brief follow-up. I would hope that the solution to the problem of those people who are really being cut out of the health services system — those people who are spending their life savings, in many instances, in nursing care homes — will not be simply to raise the

[ Page 2818 ]

fees for people in other parts of the health care system. That won't help the people in nursing homes and it won't help the people who are presently in need of other kinds of health care, I hope that the Minister will continue the commitment of the Province of British Columbia to pick up an ever-larger share of the premiums in health care. I think we have already accepted as a premise that the province will make sure that the people who are in need of health care will be able to get it. The only thing that we haven't done so far goes back to the committee that toured the province, which found out so clearly that the one major concern to people all over this province was that grey area of health care that isn't being met. I think we have accepted the premise in this province that the Minister has outlined. Now we have to accept the premise that health care is health care, regardless of what level it happens to be at, and that everybody deserves fair and equal treatment in this province in that concern.

Vote 82 approved.

On vote 83: Action British Columbia, $275,000.

MR. WALLACE: A quick question to the Minister. I notice that the budget is up by more than 100 per cent. I think that is probably good. Could you just give us a brief outline of what you project for the future under this programme?

HON. MR. COCKE: This is probably one of the best-spent pieces of Health department money that there has ever been. Action B.C. is a continuing programme. Last year it was at the PNE. It will be there again this year. It is going around doing preventive work for very few dollars. Frankly, I'm very proud of that programme.

AN HON. MEMBER: Hear, hear!

Vote 83 approved.

Vote 84: training in the expanded role of nurses, $75,000 — approved.

On vote 85: emergency health services, $11,000,000.

MR. WALLACE: Mr. Chairman, this is a programme which I would certainly commend. All I am asking is some general information about the breakdown on the $11 million in terms of how much is for ambulances and how much is for personnel. Dr. Ransford has given some very useful information, just within the last week or so, about the tremendous progress that is being made in providing facilities for the training of paramedical personnel who travel with the ambulances. This is a service which has really been overdue in the province.

On the same subject of emergency health services, I wonder if the Minister could bring us up to date on the other element that isn't quite so encouraging — the dispute which seems to exist with the federal government over air-sea rescue services which, I gather, have been provided to the tune of $260,000 or some figure in that neighbourhood. I believe the Minister has received the bill. He said that he doesn't believe the provincial government should be obligated to pay that bill.

I would like to ask some very specific questions on the emergency service of this nature. Again we are approaching the tourist season, and the boating season is upon us. In fact, around these waters it's never anything else but a lot of boating. However, in the summer the incidence of accidents and emergencies increases. Again, I am not suggesting that the Minister can have a boat half a mile away from wherever a tragedy might occur, but, on the other hand, the people are using the waters just as they are using the highways in the summer time and we have an increase in accidents — drowning and so on. I just wonder exactly where this government is at in regard to what it is prepared to provide in the way of financing, facilities and personnel. Are we at loggerheads with the federal government? How are we making out in an attempt to come to an understanding of the best integrated use of all the services, personnel and ships available?

Perhaps the Minister could mention whether he has a meeting planned with the federal government or the federal authority responsible. I think it's really a pity if we have to be in any real dispute about this particular service. Quite obviously, lives are involved and every summer we do have people drowning who might otherwise be saved. I don't really see there should be tending to be such a differing attitude to deaths on the waters and of deaths on the highways. We pay a great deal of respect and concern, and rightfully so, about the accidents and deaths on the highways, I am not suggesting we shouldn't. But it seems to me that the attitude to people on the waters.... Certainly the kind of terrible tragedy of the herring fishermen in the last few months is nothing short of staggering when you realize the families that must have been left without a breadwinner as a result of these 12 or 13 sinkings. So I am not impressed to be told that it seems to be a jurisdictional dispute. I think that somehow or other....

HON. MR. COCKE: No. I think you are getting it all.... I'll explain it, anyway.

MR. WALLACE: Okay. Well, maybe it isn't a jurisdictional dispute. That may be too technical a

[ Page 2819 ]

description. But there seems to be some doubt on the part of this Minister as to what our obligations are. And I am not sure that the federal government knows what its obligations are. I wrote a letter to the federal Minister concerned and I received about a five-page reply, but I am not sure that at the end of the five pages I was any further forward than I was when I first wrote to him.

I won't bore the House with reading out the whole perambulatory kind of answer I got, with big words and long sentences, which really just added up to the fact that they don't seem prepared to do much more than they are doing, and they are not even sure that they are going to do that. So I say that here is an area of responsibility which has to be met. I would like to know from the Minister where we are at the present time in relation to the federal government.

HON. MR. COCKE: The air-sea rescue service is a federal government responsibility, and they are carrying out their responsibility well. My complaint is that when I ask for an air evacuation, which is an entirely different proposition.... For example, if some person is acutely ill in a northern community or in a coast community, or whatever, and I ask the federal government to use their air-sea rescue service to bring that person to a hospital, and then they begin to bill us — that's where I say foul. But that's a dispute that we have.

As far as the fishing fleet this year is concerned, we have carried the programme which we started last year with the doctors out there on the fishing grounds.

The breakdown of the emergency health services — it will be about $1.1 million for ambulances, the balance will be on training and manpower.

MR. McCLELLAND: Just a couple of questions to the Minister on this vote. I would like to ask whether it is the practice of the department to call tenders on all new facilities and vehicles for the ambulance service. I would like to know where the service is going to go in the future with regard to emergency centres in communities, whether the service plans to develop its own series of emergency centres on a regional basis or whether they will be localized in individual communities.

I know in my area, for instance, the emergency centre is set up in a local motel. I don't know whether that would be the most prudent use of government money or not. Perhaps it should be somewhere else, maybe in an existing government building. I don't know. I just want to ask the Minister where it is going in the future.

I wonder if the Minister has done any surveys or whether it is too early yet to find out whether or not the ambulance service, the emergency service, is being used to any significantly greater degree than the service was used previously, and whether or not the department or the service has attempted to find any causative reasons for any difference in use.

Referring back to the budget speech, Mr. Chairman, in which it was indicated that the $6 million figure was an actual cost for the current year for the emergency service, the $11 million budgeted this year will cover air ambulance services as well. Is that a realistic figure in the Minister's mind? Does it allow for any inflationary increases in the cost of providing the ground service? Would that $11 million, in fact, cover the increased use of both the ground service and the air service? It seems like a fairly modest increase to me to expand it into a new service altogether.

Just a technical question to sort of bring me up to date: I'd like to ask the Minister whether all of the aircraft in the government fleet are capable of being used as emergency air service vehicles. Having been in one of the jets on a very brief occasion when one of the Ministers was kind enough to take me for a ride, — the whole government has been taking us for a ride, but this was a rather pleasant arrangement — I found it difficult to envision those new jets being used for emergency air ambulance service. Are they all capable of being used for that utility?

HON. MR. COCKE: Going back to the motel, that's just a temporary thing. I've heard all about it. I'm not particularly satisfied, but I am informed that they had no other place to go for the moment. It will be part of the metropolitan area, and certainly we'll have some headquarters. It will be based within the communities at the most appropriate area as far as dispatching is concerned.

Utilization: we've found that in the areas where they kept good records prior utilization has not gone up to that extent. Other areas tell us they have gone way up, but they haven't got previous records. So we think that since in metropolitan Vancouver and the Saanich area where they had kept excellent records the utilization hasn't gone up to that great an extent in those two areas, I don't really think it has gone up that much anywhere. Naturally it is being utilized a bit more.

Air ambulance: the only air ambulance work that we are doing, of course, is some special work and also with our own aircraft.

You asked about the Citation 500. It is only good for children, and we use it a great deal for children. It's okay as long as an adult.... If an adult is prone, then we have to use the Beech 200, which is also pressurized. So the combination of the two gives us fair.... Frankly, I am pushing for the day when we can provide air ambulance throughout this province, but it isn't here at this point. We certainly have used our government aircraft miraculously. I can't tell you the number of lives saved. There have been 40 or 50

[ Page 2820 ]

lives actually, definitely saved, and a great many more that have been peripheral and may or may not have been saved.

The crews out there and the work they have been doing.... They're callable any time of the day or night. If they are in the middle of another flight somewhere and they're told about an air evacuation, it is cancelled and they land their passengers and on with the.... We use them for ferrying civil servants around the province. But it is just tremendous the cooperation we have had from our air crews. I just want to make sure that everybody knows it.

MR. McCLELLAND: Mr. Chairman, just a brief follow-up. I assume then that the Minister is saying that he hopes to see the day that the air ambulance service will have its own fleet.

HON. MR. COCKE: That's correct.

MR. McCLELLAND: Secondly, I asked about tenders for ambulances.

HON. MR. COCKE: Tenders for ambulances: now we can't tender. I went to the purchasing commission and asked the purchasing commission to let us buy the present ambulances without going to tenders. How can you go to tenders when you promised to pick up all the ambulances that the communities have? So you can't go to tender on it.

MR. McCLELLAND: For new ones.

HON. MR. COCKE: Oh, for new ones? Certainly they will go to tender.

MR. WALLACE: I just want a little more detail on the $11 million. I think the Minister perhaps overlooked my first questions.

HON. MR. COCKE: That's $1.1 million for ambulances. Unfortunately I don't have it broken down but I will do it from memory: $1.1 million for ambulances.... Really, the balance is for training and paying personnel.

MR. WALLACE: Out of the $11 million? Would the Minister consider a breakdown in future? With a bald figure of $11 million, we can't really scrutinize that. Could we have a breakdown in future estimates, please?

HON. MR. COCKE: Yes.

MR. D.E. SMITH (North Peace River): Just a couple of quick questions to the Minister. I don't know any other vote I can bring this up under. Really it is a matter that relates to all of the more rural areas of the province where health service is not immediately available through the facilities that are located there.

Quite often we find people involved in tremendous amounts of expense other than just the care and hospitalization of either themselves or members of their family. It's not the $1 a day, Mr. Chairman, that concerns people when they go into the hospital; it's the extra expense of travel and communication and visits from members of the family and so on that become involved.

Without taking the time of the committee I'd like to refer very briefly to a letter that I forwarded to the Minister on May 12 concerning a terminal cancer patient from Fort Nelson. The young lad was 17 or 18 years of age. He contracted terminal cancer. He had to come to Vancouver for cobalt treatment at the cancer institute. Unfortunately it was not successful and the treatment terminated, of course, and the young fellow died.

His father and mother, in trying to provide some comfort for him in the last few months of his life, incurred a tremendous amount of expense, including, for instance, such an item as over $400 in long-distance phone calls, mainly at the time prior to his arrival in Vancouver for treatment, and at the suggestions of his attending physician at that time. The doctor in Fort Nelson, now knowing exactly what he had, or what the boy's problem was and what treatment should be recommended, was in constant contact with specialists in Vancouver.

To wrap it up, the family incurred what they considered to be over $6,000 in expense. Now that wasn't all directly related to the treatment of the boy but it was related to treatment and getting members of the family into Vancouver to see him in the last months of his life.

The chap that's involved has a good-paying job, but he had to mortgage his home, he had to borrow money from a finance company and he had to sell property to pay for it. Is there any fund that would help offset at least a portion of that sort of expense?

HON. MR. COCKE: Mr. Chairman, it certainly isn't under emergency health, but it is being looked into right now, I'll tell the Member. We have to assess, under alternate care, whether or not the need is sufficient and so on. It is being looked at at the present time.

MR. SMITH: Mr. Minister, through you, Mr. Chairman, the one thing that this gentleman brought to my attention the last time we were talking was this particular problem with telephone bills that he incurred at the suggestions of the medical doctors involved on that case — well over $400 worth of bills in a period of about a month, I believe it was.

[ Page 2821 ]

Vote 85 approved.

On vote 86: salary contingencies, $4,771,513.

MR. J.R. CHABOT (Columbia River): I'm wondering whether the salary contingencies when we're looking at that $4 million.... Will the Minister be contributing anything financially for the training of medical students at the University of Calgary from this vote? We certainly are lacking facilities for the training ....

HON. MR. COCKE: It's under Education.

MR. CHABOT: It's under Education. There won't be any contribution from your department to subsidize the training of medical students because of the lack of proper facilities at the University of British Columbia.

MR. CHAIRMAN: Order, please!

MR. CHABOT: It's under Education, Mr. Minister, you say? Thank you very much.

MR. McCLELLAND: Mr. Chairman, the Minister indicated earlier that any negotiated agreement which is reached with the salaried doctors and the department will be covered under this vote. I wonder if he could give us an indication of what other contingencies he sees that might be necessary to be covered under this vote?

HON. MR. COCKE: Well, Mr. Chairman, I have a $712 million budget and thousands and thousands of employees in the department. Naturally we no longer have salary contingencies....

Interjections.

HON. MR. COCKE: Instead of having it under the Minister of Finance we now have it departmentally, as you know, and so this is not a particularly large item when you consider the nature of the budget.

Vote 86 approved.

On vote 87: mental health services, general administration, $7,489,327.

MR. P.L. McGEER (Vancouver–Point Grey): I'd like to speak very briefly about just one tiny part of this.

I see that there is a grant to the University of British Columbia for research.

AN HON. MEMBER: Oh, oh! Conflict of interest.

MR. McGEER: I notice that it's the same this year as last year, and I look at all the big increases. For example, here there's one on development of new programmes — almost double there. Of course, all research is new programmes. I know just a little bit about some of that research that's been done with this $30,000 grant and I can tell you that money is extremely well spent.

Interjection.

MR. McGEER: No, I didn't say there was too much money spent on education. I said that it might be a little better spent. I want to say that this money is extremely well spent — many papers published and that sort of thing.

HON. MR. COCKE: Mr. Chairman, I knew that the Member for Vancouver–Point Grey would bring this up.

Under the B.C. Medical Centre we are going to set up a committee on research. That committee will be responsible for providing funds to certain research projects. We weren't quite sure what to put in here or there. There is money going to the B.C. Medical Centre for research of the sort that you are talking about. I'm quite sure that with your status in the field and so on you won't have any trouble at all looking after the research that you want to do by guaranteeing full-time participation in your basic occupation.

MR. WALLACE: Since the field of mental health is a much more frequent cause of disability perhaps than some of the more obvious cases that finish up in an acute-care hospital, I think that we should spend a few moments on the budget for mental health.

Interjection.

MR. WALLACE: Well, administration. Okay. The Premier is in a great hurry today. I don't know what all the rush is. We are spending $712 million.

I just wonder, under administration, if we are going into competition with Safeway. I see an interesting item there under the heading "central stores: store employees, including stockmen, meat cutters, et cetera." I just wondered under the administration of mental health who these meat cutters are. It is just an interesting little question that strikes one very strangely when you are going through the estimates at 2 a.m. It is the kind of important item that really hits you. I want an answer to the question about the meat cutters, but it isn't....

Interjections.

MR. WALLACE: I wonder if the Minister could

[ Page 2822 ]

give us a general quick rundown on the vote for development of new programmes. In very broad terms what are they, where are they and so on?

The other item is under 042. I am particularly concerned about this because it is entitled "assistance for retarded." A vote of $400,000 last year is not showing up at all on this year's budget. I assume that that $400,000 for assistance for the retarded is somewhere else in the budget. I can't imagine that we would be reducing money for assistance to the retarded.

It's going into Human Resources? Okay.

The other question I find is under 045, "forensic services, $1.3 million." I was one of the strong supporters of the Minister when he set up the forensic psychiatric services commission Act. Could he tell us if that $1.3 million is all destined to be spent providing the medical services under the forensic psychiatric services commission Act? As we all recall, that was set up to provide adequate psychiatric examination and treatment of people who fell foul of the law and particularly to ensure that patients with mental disorders who finished up in Riverview would have periodic reassessment of their condition so that they didn't just disappear from society for 20 years.

I wonder, first of all, if that $1.3 million is all related to that service. If not, what part of the $1.3 million is created through certain other services?

HON. MR. COCKE: Mr. Chairman, the central stores — that's to provide the different facilities. I'm not sure why they put meat cutters there. I suppose they could just have left it at "stockmen, et cetera." I think some knave put that "meat cutters" in there. It could have been a number of other things or occupations as well.

MR. McGEER: Just pressure from George Johnson.

HON. MR. COCKE: I think so. George had a hand in that.

As far as the new programme is concerned, the new programmes are mainly that big project in Vancouver, the adult psychotic programme and other community programmes that are going on at the present time. We are quite happy with those programmes.

The forensic $1.3 million does not include the running of Riverside. We will transfer the budget from our institutions to the forensic commission. They will also take that responsibility but they will have that in addition to the $1.3 million.

Vote 87 approved.

On vote 88: division of nursing education $380,348.

MR. McCLELLAND: I would like to question the Minister about the absence of the $300,000 for the student nurses, the $250-a-month bursaries. Has that been shifted or has that programme come to a stop?

Interjection.

MR. McCLELLAND: Bursaries, Mr. Minister — 100 student nurses at $250 a month. There was $300,000 in the budget previously, nothing listed this time around. There is another $120,000 later on for psychiatric nurses at BCIT, which wasn't in the budget last year.

HON. MR. COCKE: Mr. Chairman, those bursaries are transferred to expenses, according to my records.

MR. McCLELLAND: Mr. Minister, will the programme be continuing on the same basis as it was before?

HON. MR. COCKE: Yes.

MR. McCLELLAND: The same kind of repayment arrangements with the student nurses as well?

HON. MR. COCKE: Just for the 200. They get $150 basic because we're giving bursaries to all nurses at that rate, so anything over and above that which the psychiatric nurse is given would be repayable, but not the basic $ 150.

MR. McCLELLAND: Okay.

MR. WALLACE: Mr. Chairman, since we're dealing with nursing education, particularly in the mental health field, I just want to bring to the Minister's attention the kind of situation which exists due to the lack of instructors and programmes in psychiatric nursing.

While to some extent the Minister may feel this is essentially an educational problem, it's of very great importance. I've had an enquiry, for example, from a lady — an RN trained in the United Kingdom — who in order to become registered in this province requires upgrading of her psychiatric nursing training. She has just had — I was going to say, the very difficult job — in fact the impossible job of finding a place where she can get the upgrading training. She has communicated with the Registered Nurses Association, and she has communicated with BCIT. I'll read quickly the kind of information she got from RNABC: "At the present time the only course offered in psychiatric nursing is the evening programme offered by the B.C. Institute of Technology from September to April two evenings a week."

For someone not living in Vancouver this is a very impractical way in which to take any upgrading

[ Page 2823 ]

training — two evenings a week. With family commitments, travelling expenses and the very interrupted nature of the training, it makes it very difficult.

I have pursued the matter further with the RNABC. The president wrote a very thorough letter back to me, just saying the same thing:

"The only place where an approved course is offered is at the British Columbia Institute of Technology. We have encouraged full-time courses of study, and the B.C. Institute of Technology are willing to cooperate. But at the moment they are not able to move because we cannot find an instructor to teach the course."

It seems incredible to me, Mr. Minister, that while we're supposed to be enlightened as to the tremendous impact of emotional disease in our midst and the tremendous capacity for preventive medicine by treating emotional disorders first, here we have personnel trying to get training to upgrade their pre-existing training, and there just doesn't seem to be a single instructor who can teach psychiatric nursing.

In fairness, and to tell the whole picture, the president goes on to say:

"There is a drastic lack of people prepared to teach psychiatric nursing in the province, a situation which has taken several years to develop and about which the Registered Nurses Association have raised their concern many times. The Association proposed a course in post-basic psychiatric nursing at the University of Victoria last July, and suggested that the B.C. hospital insurance programme fund this in order to prepare people to teach psychiatric nursing. This course was approved by the B.C. Medical Centre provincial council in February of this year and to my knowledge there has been no word as to the funding."

I don't know if it's the funding that's the main problem or the personnel willing to do the teaching, but perhaps the Minister would care to comment on that. I also had a reply from the principal of BCIT. He acknowledges that this lady has been waiting a long time for the course, and he mentions that the waiting list, as of March 26 this year, included 64 names. There are 64 nurses seeking to upgrade their training, and they can't even get a course at BCIT.

He goes on again, so that I don't just read part of the story:

"The course has been tentatively redesigned to be available in a concentrated block of not more than eight weeks in order to serve the needs of clients outside the power mainland. Unfortunately, the delay in implementing the programme has been aggravated by factors such as the unavailability of an instruction.

"Responses to advertisements have not been encouraging, particularly in terms of qualifications, experience and familiarity with the required and desirable approach to the province's mental health-care needs with emphasis on community-based resources and personnel. Shortages of high-quality instructors for nursing programmes of all types are not uncommon."

This has come to my notice specifically in terms of psychiatric nursing. I don't know if the same serious problem exists with other types of nursing, but I know the prevention that can be carried out by good counselling and psychiatric nursing and care which physicians don't have the time to carry out, nor should they when it can be done by other personnel. Has the Minister decided, first of all, to make the funding available that I referred to in the letter from the RNABC and, secondly, what can be done to find instructors?

HON. MR. COCKE: It's a personnel problem, Mr. Member, and I can't answer it. But I will say that I will look into it. I can't give you a definitive answer either way.

Vote 88 approved.

On vote 89: community services, $4,375,734.

MR. PHILLIPS: Just a short question with regard to the psychiatric personnel in the Peace River district that I spoke to the Minister about. Evidently there is a shortage of qualified psychiatric people all over the province. What efforts are being made to solve the problem?

HON. MR. COCKE: We are short in areas and, Mr. Member, I agree that in your area we are really short of people in that particular occupation or that expertise. We are considering a number of different alternatives. You and I could talk about it, but we haven't been all that effective in being able to recruit for the more northerly areas. That's just unfortunate, but it's a fact of life. We are working on it.

MR. PHILLIPS: Well, you said that you weren't aware that the budget had been cut back. The budget applied for in the area was $137,000. The budget approved was only $72,000. Maybe you cut back in the budget because you knew that we couldn't hire those people. This is what concerns me. Why was the requested budget cut back when we are in such desperate need for psychiatric...?

HON. MR. COCKE: It has been over-budgeted for years. What we will do is increase the budget if we can get the staff. There is no point in keeping....

[ Page 2824 ]

MR. PHILLIPS: Will you stand up and say that?

HON. MR. COCKE: There is no point in keeping a figure out there that's not realistic. If you have two staff and you are budgeting for $115,000, and you know perfectly well you are only going to spend $70,000, why not say you are only going to spend $70,000? As a matter of fact, we probably won't spend $70,000 unless we can get another staff person.

We want more and I have some ideas that I want to try on people, but there is no point in just glibly whipping out a couple of ideas here and there. We are suffering in some of the more isolated areas. I'd like the profession to give a little bit of leadership in getting out there, and I am talking in terms of the psychiatric profession. If you were to get psychiatric service, then you would get the ancillary service.

MR. PHILLIPS: Well, Mr. Chairman, I don't wish to prolong this but I am glad the Minister assured me. The information I have says that the actual budget approved was for $72,896; so all extra personnel requested were denied, Mr. Minister. Did you hear what I said? This is the information that was supplied to me.

HON. MR. COCKE: Yes.

MR. PHILLIPS: It says that the extra personnel required were denied. This is what they are concerned about. They put in a request for these people, but the budget was cut back. I would be happy to inform them, if you assure me that this is the reason the budget was cut back — because you didn't think you were going to be able to get the people — that if you can get them, then the budget will be increased. Now if I have that assurance, then I can alleviate the worries these people are having.

HON. MR. COCKE: If you are raising a specific case about a specific area, I will have to look into it and I will look into it with you, but I am not going to give any particular undertaking at this time.

MR. WALLACE: On that same general area, Mr. Chairman, the people in Kitimat have contacted me because they feel that they have reached a serious point in their community in the breakdown of service, particularly in the need for psychiatric services. I recognize the point the Minister has made. But the community itself in Kitimat, from the correspondence which I am sure the Minister received — and I recently wrote to the Minister to find out where we are at — points out that they themselves are desperately willing, through a variety of people in different roles in the community, to help themselves. They are not just asking for a government to provide some instant solution or a whole bunch of experts.

They, as a community, are very concerned at the fact that all kinds of social problems and emotional and mental problems are going untreated. As a result, the general situation in the Kitimat community appears to be deteriorating.

I wonder if the Minister has any specific hope that he can give to the people in Kitimat as to some fairly immediate plan, or some plan in the near future, or is he planning to go up there. You know, I sensed a real note of urgency in their correspondence, if not despair. When there are so many different people in that community willing to take time to put together a committee of their own and to research the matter .... The Minister would agree, I think, that they presented an excellent brief in outlining what the problem is. At least if you can do that, that's step No. 1. I just hoped that maybe the Minister could suggest that there's something in the near future by which he hopes to alleviate their problem.

HON. MR. COCKE: We've been in touch with them, and they did present a very fine brief. I hope to be going up there in the not too distant future. I haven't formalized it yet, but we are in touch with the Kitimat area.

The House resumed; Mr. Speaker in the chair.

MR. CHAIRMAN: Mr. Speaker, the committee reports resolutions.

Hon. Mr. Barrett moves adjournment of the House.

Motion approved.

The House adjourned at 12 p.m.