[ Page 3625 ]

CONTENTS

Routine proceedings

Public Officials and Employees Conflict of Interest Act (Bill M 214) Mr. Gibson.

Introduction and first reading –– 3625

Tabling documents

Ministry of Health annual report, 1976. Hon. Mr. McClelland –– 3625

Oral questions

Functions of Dianne Hartwick. Mrs. Dailly –– 3625

Cost of government aircraft. Mr. Wallace –– 3626

MEL Paving case. Mr. Macdonald –– 3626

Joint committee on housing. Mr. Gibson –– 3626

Loan to Queen Charlotte Fisheries. Mr. Lea –– 3626

Investigation into Pacific North Coast Native Co-op. Hon. Mr. Wolfe –– 3627

Management review of B.C. Development Corporation. Mr. Lauk –– 3628

Environmental study of Cowichan Bay. Mrs. Wallace –– 3628

Committee of Supply: Ministry of Health estimates.

On vote 169.

Hon. Mr. McClelland –– 3629

Mr. D'Arcy –– 3632

Hon. Mr. McClelland –– 3637

Mr. Wallace –– 3643

Hon. Mr. McClelland –– 3646

Mr. Cocke –– 3647

Hon. Mr. McClelland –– 3650

Mr. D'Arcy 3651

Mr. Cocke .. –– 3654

Hon. Mr. McClelland –– 3655

The House met at 2 p.m.

Prayers.

HON. W.N. VANDER ZALM (Minister of Human Resources): I just noticed friends from the constituency in the gallery. It gives me pleasure to introduce Mr. Ted Van Zanten from Surrey and their friends from Holland.

MRS. P.J. JORDAN (North Okanagan): I'm very pleased to draw to your attention that in the gallery today from the great constituency of North Okanagan we have two very fine families: Mr. and Mrs. Hamish Robertson, with their two children, Bruce and Jane; and Mr. and Mrs. George Richardson, with their two children, Gareth and Sian. I hope the members will not only be on their best behaviour but that they will give them a warm welcome.

MR. G. MUSSALLEM (Dewdney): I'm going to introduce to you, sir, Mayor and Mrs. D.R. Power and alderman Sigrid Ritter, all from the municipality of Harrison Hot Springs. I would ask the House to bid them welcome.

HON. K.R. MAIR (Minister of Consumer and Corporate Affairs): Thank you very much, Mr. Speaker. In the members' gallery today are two distinguished visitors: Dr. Joseph Pellar, who is the president of the Canadian Wine Institute, and I pause to point out that he is a medical doctor, specializing in internal medicine, which is a living testimonial to British Columbia wines; and Mr. Peter Green, the president of Andres Wines. I would ask the House to make them welcome.

HON. D.M. PHILLIPS (Minister of Economic Development): Thank you, Mr. Speaker. It is not too often that I have the opportunity to introduce to the House visitors from the great Peace River country, so today I'm certainly honoured, Mr. Speaker, on behalf of yourself and myself, to introduce - they're up behind the glass cage - the chairman of the Peace River-Liard Regional District, Mr. Eli Framst; alderman Joanne Mucci, who is an alderman of the city of Fort St. John and a director of the Peace River-Liard Regional District; Mrs. Dolores Foster, the administrator of the Peace River-Liard district; and last, but certainly by no means least, our great planner, the adviser-planner to the regional district, Mr. Dietger Hollmann. I'm sure the House will join me in giving them a very warm welcome.

MR. C.M. SHELFORD (Skeena): Mr. Speaker, I would like the members of the House to welcome this afternoon Mr. and Mrs. Peter Crowder from Terrace.

HON. J.R. CHABOT (Columbia River): I'd like the House to join me in welcoming to the Legislature today my niece and her husband, Mr. and Mrs. Joe Arbuckle from Red Deer, Alberta.

Introduction of bills.

PUBLIC OFFICIALS AND EMPLOYEES

CONFLICT OF INTEREST ACT

On a motion by Mr. Gibson, Bill M 214, Public Officials and Employees Conflict of Interest Act, introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

HON. R.H. McCLELLAND (Minister of Health): Mr. Speaker, I'd like to ask leave of the House to table the annual report of the Ministry of Health for 1976.

Leave granted.

Oral questions.

FUNCTIONS OF

DIANNE HARTWICK

MRS. E.E. DAILLY (Burnaby North): To the hon. Provincial Secretary, this is with reference to the Provincial Secretary's executive assistant, Miss Hartwick, who works in the Human Resources ministry. Could the Provincial Secretary tell us if any of the work done by her executive assistant in the Ministry of Human Resources involves the making of grants to various associations named by the Provincial Secretary?

HON. G.M. McCARTHY (Provincial Secretary): In answer to the HON. member from Burnaby North, if we had sought advice from the executive assistant to give us an overview of a programme, to that extent she would be involved. But she is not involved in the actual granting of grants, only in obtaining information,

MRS. DAILLY: On a supplementary, we do understand then that part of her work would have something to do with grants. Would those grants be the ones that are issued under the name of the Provincial Secretary?

HON. MRS. McCARTHY: It could be. I haven't a specific but that could happen, yes.

[ Page 3626 ]

COST OF GOVERNMENT AIRCRAFT

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, this question is to the Minister of Energy and Transport with regard to government aircraft. Has the minister recently been using the services of an aviation consultant to review the services and costs of government aircraft? Has the minister received a report of that consultant's work?

HON. J. DAVIS (Minister of Energy, Transport and Communications): Yes, Mr. Speaker.

MR. WALLACE: Did the report include a suggestion that many of the existing services provided by government aircraft are costly and that economies could be made without serious impairment to air travel services for minister and government employees?

HON. MR. DAVIS: No, not in those terms.

MR. WALLACE: On a supplementary, with regard to the fact that the minister has taken questions as notice on the same subject, and because of the cost factors, in particular, that have been involved, can the minister tell us when he would be likely to report to the House either by tabling the consultant's report or by making a statement to the House?

HON. MR. DAVIS: Mr. Speaker, I've drafted an answer to questions asked by the hon. member in the last day or two about the costing of the use of government aircraft. As soon as it's finalized, I'll make it available.

MEL PAVING CASE

MR. A.B. MACDONALD (Vancouver East): I have a question for the Minister of Economic Development. On February 24, which was about 19 weeks ago - and I hope the minister can recall the question - I asked him about the full legal costs of the MEL Paving case. That was 19 weeks ago. I think the minister has been taking milk of amnesia. (Laughter.) That's why he makes such strong Social Credit speeches! Will the minister give us that information after 19 weeks?

MR. D. BARRETT (Leader of the Opposition): He can't recall!

HON. D.M. PHILLIPS (Minister of Economic Development): Yes, Mr. Speaker, I'll endeavour to obtain the answer for the member in due course.

MR. MACDONALD: You're really efficient in your i b, aren't you? Right on top of it!

JOINT COMMITTEE ON HOUSING

MR. G.F. GIBSON (North Vancouver-Capilano): Mr. Speaker, I have a question for the Premier. At the time of the announcement of the joint committee on housing - the so-called Bawlf committee - which was in early May, 1976, 1 asked the Premier if he was aware of its make-up, which was some government officials, some municipal, and three MLAs, all of whom were of the government persuasion.

HON. W.R. BENNETT (Premier): No.

MR. GIBSON: Mr. Speaker, a supplementary question. If that announcement was made without the Premier's knowledge - and now, of course, that he does know about the composition of that committee - does he approve of it?

HON. MR. BENNETT: As the member knows, Mr. Speaker, ministers can appoint boards to carry out certain studies on their behalf.

SOME HON. MEMBERS: Boards? Oh, oh!

MR. GIBSON: I have a supplementary question, Mr. Speaker - the exact same supplemental I asked before. I didn't ask what ministerial powers were; I asked if the Premier approved of the composition of that committee in the sense that it had government MLAs on it and no opposition MLAs. Did he approve of that?

MR. SPEAKER: I recognize the hon. member for Prince Rupert.

SOME HON. MEMBERS: Oh, oh! Shame!

LOAN TO QUEEN CHARLOTTE FISHERIES

MR. G.R. LEA (Prince Rupert): I have a question for the Minister of Economic Development. The minister recently traveled to Ottawa. One of his endeavours on that trip was to get some money from the federal government in order to loan money to the Queen Charlotte Fisheries. Prior to the minister leaving for Ottawa, had the board of directors of BCDC informed the minister as to why they thought it would be good business to make that loan to Queen Charlotte Fisheries?

HON. MR. PHILLIPS: Mr. Speaker, for the member's information, you know that I had a meeting with some of the directors and the president and our chief financial officer in the airport just prior to stepping on the plane for Ottawa. At that time I was informed about the tremendous amount of work the board had done in trying to put together a

[ Page 3627 ]

package. At that time they reiterated, of course, to me that their decision was made basically on sound financial principles, the same as loans are made by any other lending institution.

The board full well realized that they are basically dealing with the taxpayers' money. Certainly they have a tremendous responsibility to the taxpayers of this province, and indeed to carry out the recommendations of this ministry to see that those tax dollars are well looked after, and not to make loans that are not in the public interest. Mr. Speaker, that decision was made on the basis of good, sound principles and in the public interest.

SOME HON. MEMBERS: Oh, oh!

MR. LEA: On a supplementary, did the minister agree with the recommendations from the directors that it would be good economics to make the loan?

HON. MR. PHILLIPS: Mr. Speaker, as this government said quite some time ago - and we're adhering to that policy - we appointed an independent board of directors to run the affairs of the corporation. Certainly I asked the board to do everything possible to come to the rescue of this particular corporation, because I realize that it is a problem. Certainly you realize that we had very little time in dealing with that problem. I want to thank the board of directors and the financial people for the work done. They worked overtime one night until I I o'clock on that particular problem.

MR. SPEAKER: Order, please. I think the HON. minister is now extending beyond the realm of the question that was asked.

MR. LEA: On a supplementary, I take it from the minister's answer that he did agree with the board of directors. Why then, did the minister, after coming back from Ottawa, decide that because Ottawa wouldn't kick in $1 million... ? Considering the fact that the minister agreed with the board that it would make good economics to make the loan - I assume there's more than $1 million in the BCDC; there must be $2 million there - why did he come back from Ottawa and say the loan wouldn't be made because Ottawa wouldn't put in a million?

HON. MR. PHILLIPS: Mr. Speaker, I haven't the time here this afternoon to explain all the ramifications of good business-lending principles to the member for Prince Rupert, but certainly he knows that in making loans certain risks are shared by certain organizations. As I say, I think the board of directors made a good decision, and they certainly tried. In sharing that risk with Ottawa, certainly Ottawa had some responsibility in that particular case. Certainly that board and business group over there had been dealing with the federal government three months before we were advised of this. At the last moment we came in and we tried to rescue it, Mr. Member. We did everything we could. 1 again think that the board went beyond the....

MR. SPEAKER: Order, please. Please stick to the question and the supplemental.

MR. LEA: On a final supplementary, why did the provincial government not make the loan of the full $2 million after considering that it was economic, a good loan and should be made?

HON. MR. PHILLIPS: Mr. Speaker, as 1 say, I haven't really the time, and I'm sure the House wouldn't want me to take the time this afternoon, to explain all the ramifications of this to the member. 1 don't think he wants to know.

SOME HON. MEMBERS: Order!

HON. MR. PHILLIPS: He knows full well that there is no legislation, unless some are to cram it down the throat of one of the ministers. I wouldn't want to mention Arctic Harvester, and 1 wouldn't want to mention all of the other deals that were crammed down the throat of the previous Minister of Economic Development (Mr. Lauk) by other departments.

AN HON. MEMBER: Answer the question.

HON. MR. PHILLIPS: What we're doing now, Mr. Speaker, is trying to make loans based on good....

MR. SPEAKER: Please answer the supplemental question.

HON. MR. PHILLIPS: Yes, thank you.

Interjections.

INVESTIGATION INTO PACIFIC

NORTH COAST NATIVE CO-OP

HON. E.M. WOLFE (Minister of Finance): Mr. Speaker, I'd like to respond very briefly to a question I took on notice yesterday from the member for Oak Bay (Mr. Wallace) . He directed a question at me asking whether 1 had instructed anyone to conduct an investigation into the Pacific North Coast Native Co-operative. I'd like to reply in this fashion. As minister responsible for that co-operative and the loan that has been issued to it, 1 have recently asked for a financial report, not an investigation, of the Pacific North Coast Native Co-operative. I'm told,

[ Page 3628 ]

incidentally, Mr. Speaker, that their year-end is April 30, and audited statements are not yet available.

MR. WALLACE: Since I'm informed by the minister's own staff that the status report - which is the title your staff used in answering my verbal questions - is being prepared. Can the minister tell the House if in fact his officials are having difficulty acquiring the financial information they are seeking in order to complete the report?

HON. MR. WOLFE: Mr. Speaker, no.

MANAGEMENT REVIEW OF

B.C. DEVELOPMENT CORPORATION

MR. G.V. LAUK (Vancouver Centre): To the Minister of Economic Development: in view of the fact that this year is the first year that the British Columbia Development Corporation has lost money, is the minister reviewing his appointments to the board of directors and has he asked the board of directors to consider reviewing the positions of senior staff with that corporation?

HON. MR. PHILLIPS: Mr. Speaker, I don't want to embarrass the member for Vancouver Centre by answering his question. However, he has forced me to do so.

I would just like to say when we reviewed the loans that had been made under the NDP government by the board, we were trying to be kind. Evidently we were overly kind and we should have written off more than we did. So this year we're just backing up and coming to grips with some of those bad loans that were made while that member was Minister of Economic Development and in charge of the B.C. Development Corporation.

MR. LAUK: According to the annual report, that's not the nature of the loss. The nature of the loss is that no revenue has come into the corporation. The bad debt write-off, although small in the first year, was increased in the second year, and I understand that. The bad-debt ratio is not terribly bad, considering the recession.

MR. SPEAKER: Could we get to the supplementary, hon. member?

MR. LAUK: The supplementary question is this: the loss does not relate to the write-off portion of the budget, because I've looked at the annual report. The loss is directly due to bad management. Is the minister going to review the board and the management to see if any changes could be made to recover?

MR. SPEAKER: Order, please,

MR. LAUK: The first year the corporation made $1 million, This year they had a loss. Are you going to review senior management?

MR. SPEAKER: The question is - "Are you going to review senior management?" - as I understood it.

HON. MR. PHILLIPS: Mr. Speaker, as you know, we took a good look at the Development Corporation and we made the necessary changes so that the situation we encountered won't be developed again.

MR. LAUK: You mean you made the changes and we now have a loss?

MR. SPEAKER: Order, please.

ENVIRONMENTAL STUDY

OF COWICHAN BAY

MRS. B.B. WALLACE (Cowichan-Malahat): Mr. Speaker, I have another question to the Minister of the Environment regarding Cowichan Bay. I understand that Island Shake & Shingle have undertaken an environmental study of the Cowichan Bay situation. I understand, too, that the minister has had this information furnished to him. I'm wondering whether or not he intends to instigate any review of that study by qualified personnel in the secretariat.

HON. J.A. NIELSEN (Minister of the Environment): The member for Cowichan-Malahat understands Island Shake & Shingle has undertaken an environmental impact study of some kind, If they have, I haven't seen it. Presumably, if they have, they've either done it on their own or at the instruction of someone. I will endeavour to determine if, indeed, the secretariat has instructed them. If they have, they have not made the committee aware of this. If Island Shake & Shingle is doing this on their own, we'd be very pleased to receive a copy of it. Island Shake & Shingle may be indeed responding to some desire of the local government; I wouldn't be aware of that. But I haven't seen such a report, and if you have a copy of it, we would appreciate receiving it.

Orders of the day.

MR. BARRETT: I ask leave of the House to call Motion 13 standing in my name on the order paper.

Leave not granted.

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

[ Page 3629 ]

ESTIMATES: MINISTRY OF HEALTH

On vote 169: minister's office, $107,670.

HON. MR. McCLELLAND: Well, Mr. Chairman, at the risk of being accused of perhaps filibustering my

, estimates, 1 would like to take a few moments to outline some of the things that have happened in our ministry this year. It's been a most interesting year and one which has seen some dramatic changes for the better for the health of the people of British Columbia. One of the things that happened, of course, was the changes in the cost-sharing arrangements between the provinces and the federal government.

Traditionally, Canada shared roughly 50 per cent of the cost of our hospital insurance and medicare programmes. This has now been abandoned. Federal funding no longer is directly related to programme cost. Under the new arrangement, block funds are made up of 50 per cent cash and 50 per cent tax revenue potential which is transferred to the provinces.

The new funding arrangement, Mr. Chairman, extends a lot more flexibility to the provinces to enable them to better plan and administer programmes in the province. 1 will admit that it transfers some risk as well, should medicare and hospital costs rise more rapidly than the growth of the economy. We must be aware of that at all times.

In addition, Mr. Chairman, the federal offer regarding cost sharing includes a proposal to provide lump sums that would be used to sponsor lower cost alternatives to present programmes. This funding is based on a formula of $20 per capita. On this basis, B.C. will receive approximately $50 million. Our intention, of course, is to use it for the long-term comprehensive-care programme that was recently announced and about which I'll deal a little more later on,

The control and detection of communicable diseases continues to be a central service of our health system. British Columbia remains part, unfortunately, of a world-wide epidemic of gonorrhea, which is now increasing at a rate of some 5 per cent per year. It's a problem which is causing serious consternation among all of the officials in the ministry.

Safety and protection of public health remains a large part of our ministry, and we are finding serious problems there as well, Mr. Chairman, because of the involvement with the issuing of permits for private sewage disposal systems, particularly in those areas which are growing very rapidly in the lower mainland, Vancouver Island, the Okanagan and some other areas. The pressure, of course, arises from the demand for housing.

Mr. Chairman, our speech and hearing division continues to expand and provide programmes for treatment and identification and prevention. At the present time, the speech services are available in 16 health units. Audiology services are available in five throughout the province and Treasury Board has recently given approval for us to expand that service into 10 new centres around British Columbia.

One of the most important events in the field of vision care, I believe, is the establishment late last year of a vision task force which will make recommendations to me this fall, perhaps in September, for a co-ordinated vision care system for people in British Columbia, with the potential, we hope, to improve quality, accessibility, efficiency and economy of the entire system.

A preventive programme in dental health services is reaching out to more and more people each year, Mr. Chairman. There are tens of thousands of children in this province who have been visited, and their families, in the past year. We have a limited treatment Programme now which involves some 33 communities which don't have resident dentists. Dentists are specially recruited and last year they saw some 4,000 children and adults who were treated as private patients. Six of these dentists now operate in six motor vans which are equipped as modern, two-chair dental clinics. We've recently announced, as well, a new programme which will see dental students dispatched to those hard-to-service areas of the province this summer.

Mercy flights to transport seriously ill or injured persons to hospital are arranged by the ministry. A large programme, Mr. Chairman, directed at alcohol and narcotic abusers, is being established by the Alcohol and Drug Commission, which is now under the Ministry of Health, on a regional basis. Systems of care for problem drinkers now include detoxification facilities, out-patient counselling and referral clinics, residential treatment centres, and support facilities such as halfway houses and recovery homes.

Action B.C. is now jointly sponsored by this ministry and the Ministry of Recreation and Conservation. This project continues to promote awareness of good health through activity and sound nutrition. We also give, of course, financial support to a wide range of voluntary agencies.

We now have some 103 public hospitals, diagnostic and treatment centres, outpost hospitals and other extended-care facilities, which are going to require a budget just for day-to-day operating purposes this year of almost $600 million.

We also, of course, directly operate and finance, on a 100 per cent basis, a number of institutions, the largest of which is Riverview, which has now some 1,200 patients. Historically, Riverview has been the object of some public criticism on the issue of both facilities and staffing. We are moving very rapidly to correct any deficiencies in that institution. This year we aim to have the institution accredited by the

[ Page 3630 ]

Canadian Council of Hospital Accreditation, which is a national standard-setting organization.

Valleyview Hospital, which adjoins River-view, has over 600 patient beds, and it's the province's largest facility for the treatment of persons with mental disorders that arise from the process of ageing. Still, some of the diseases can be arrested or reversed among that category of patient and attempts are ongoing to discharge such patients into more appropriate facilities.

I think it should be obvious, Mr. Chairman, to any member of the Legislature that while we think it necessary to repeat that health-care costs in British Columbia are a major contributor to the growth requirements of public revenue, there is concern that they are distorting other government programmes. For that reason, we need all be concerned with the escalation of these costs during the coming fiscal year. In the estimates which are to be approved during this debate, our Health ministry will spend very close to $1 billion. It's the largest single item in all of the estimates before the Legislature.

At this time in our history, Mr. Chairman, a large number of authorities are questioning the value of expanding expenditures on personal health services. Often we have statements from medical scientists that say therapeutic medicine is probably now entering a phase of medically diminishing returns. Economists are raising questions about the usefulness and kind of investments that we are making. "Perhaps, " they say, "society should use its resources where there may be a more positive and visible impact on health, such as for purposes of better nutrition, improved housing, cleaner environment." Those of us who have been in public life for a while don't find it shocking any more, I guess, to be reminded that health-care costs in this province have tripled during the past five-year period. The question I guess we need to ask now is whether or not there has been a parallel improvement in the state of our healthfulness - an improvement by a factor of three. I think the answer probably is: not really.

So, Mr. Chairman, at the present time we find in our ministry that we have a couple of issues that obviously will affect cost control which we have to face very squarely, and that's the organization of the health system and perhaps incentive structures that affect the behaviour of the citizens' major participants. The distribution of both physicians and hospitals are areas in which the ministry is taking aggressive action - action that very likely have some reflex effects that all of us will notice.

It's quite possible in B.C. today that the oversupply and maldistribution of appropriate hospital facilities is a worse problem than the oversupply and maldistribution of physicians. It's argued, with good effect, that we now have perhaps too many acute-care beds in British Columbia, and the fact that there is a surplus does nothing more than generate an incentive to fill them, whether necessary or not.

The result is that in some parts of this province, particularly in greater Vancouver, we are in the process of making major adjustments to the hospital sector of the health system by reducing the number of acute-care beds per 1,000 of population, decongesting the large institutions, and as quickly as possible eliminating those facilities which are not only antiquated and outdated, but in some cases are recognized as being dangerous to good patient care, and replacing those beds with facilities that will provide - in some cases, particularly - less intensive and therefore less costly levels of care.

It was for that reason, Mr. Chairman, that 1 was indeed proud when the Premier of the province, not long ago - on April 29 - made the announcement that there will be a new programme of long-term comprehensive care effective in British Columbia January 1,1978. This new scheme will give any British Columbia resident requiring intermediate or personal care in an institution the same type of coverage as hospital patients, based on a per diem charge. These will also include care outside of the institutions in terms of homemaker services. I'm happy to say that we have approval in the first year of this programme to quadruple the budget available for homemaker services in order to make sure that those people who require, need or want care in their own homes will be able to get that care at a cost they'll be able to afford. It's one of the most positive steps, 1 believe, of any government in m-any years.

So the citizens of B.C. will get the service they need and the service that is most appropriate to them, not necessarily through the reduction in the number of beds, but through provision of a much more balanced system. It's a balance that has been absent for many years.

The topic of alcohol and narcotic addiction is of great interest to this province and obviously needs much more attention than it has received in the past. We are intensifying an assault on the problem of alcohol particularly. You have noticed some of the s t e p s which have been taken by the Attorney-General's ministry. The Alcohol and Drug Commission will play a large role in this programme in developing both treatment and training facilities throughout British Columbia, The ministry's activities also will be co-ordinated with several other ministries, such as Consumer and Corporate Affairs, Labour and Education. 1 mention Labour particularly because 1 think we have pretty hard evidence today that the assault on alcoholism will be won at the labour level, if we can convince industry and labour to work with us - as we have to a good degree so far - in attempting to reach out and counsel those people with alcohol problems before they get to the so-called

[ Page 3631 ]

skid-row result and while they still have something to lose, Mr. Chairman, like jobs, or their self-respect, or family. There are encouraging results coming out of those occupational health programmes which are now going in co-operation with both my ministry and the Ministry of Labour.

We hear a lot these days, Mr. Chairman, particularly about prevention and the need for greater emphasis on prevention of disease, health promotion and health education. We're extremely serious about this issue, not only because there is a potential for cost-saving, but also because of the tremendous social benefits if we could reduce some of the needless disease and disability. We have, therefore, given much greater emphasis to our health education and information division and placed it among the ministry's support services. This means that every programme now has access to the specialists and is expected to use them. An example of the division's activity is the smoking pamphlet that all of you received recently. 1 strongly recommend to all of the members of this assembly that they distribute that smoking pamphlet wherever they possibly can - in their constituency offices and other places - and also encourage community agencies in their constituencies to help us distribute it. It has had a tremendous success. 1 think we're into our third or fourth printing now. The demand has not stopped.

The issue of prevention often will lead us into some philosophical questions. As we've heard in this House in some of the debates, what business does government have interfering with people's lifestyles in order to provide benefits to what they say is a relatively small portion of the population? 1 think it's pretty reasonable today to have government involvement in the behaviour of individuals if the consequences are likely to devolve on other individuals.

We're committed to preventive programmes but we're a little worried about what prevention means in some instances. We could find ourselves with a plethora of well-intentioned and expensive programmes that will evolve without an evaluation or objectivity. I'm a little worried - and I've expressed this in public statements before - by the thought of a preventive system which will be on the scale of the existing curative system and will simply move the costs around without really getting at the problem. 1 think that through co-ordination of existing programmes we can do a lot more than we have in the past.

In the area of children's services, it is the hope of our ministry to expand services for children in co-operation with the Ministries of Education, Human Resources and the Attorney-General. The studies into the ways in which we can best bring this about are now underway and are before committees of cabinet.

Health research is not being neglected by this government. You will recall that funds have now been allotted from the Western Express Lottery for medical research. A foundation has now been set up that will take over the function of the British Columbia Medical Centre regarding health research, both in the funding and in the project approval. The board has now been appointed. It consists of three ministers and their deputies, and we will have, of course, a peer review committee which will be responsible for vetting all applications for funding.

Mr. Chairman, I hope that I've covered some of the broad objectives of our ministry and I look forward in anticipation to some of the questions from the opposition. Before I do, Mr. Chairman, I would like very much to pay tribute to a couple of people who have served this province very well in the Ministry of Health. One of them, unfortunately, is not on the floor of the House this year, and that's a rarity during Health estimates because he has been on the floor for many years. Dr. George Robert Elliot retired as Deputy Minister of Community Health Programmes a few months ago. I might say that this province, and the Ministry of Health particularly, has lost one of its real characters. Dr. Elliot was born and raised in British Columbia. After graduating from Queen's University, Kingston, with a medical degree in 1935, he established a practice in Creston. He then proceeded to further his education at the University of Toronto' , obtaining his diploma in public health in 1939. The following year, he served as quarantine officer for the Department of National Health and Welfare at William Head. In 1942, he joined the RCAF, served in Canada and overseas until 1945, and attained the rank of wing commander.

When he returned to Canada in 1946, he became director of the Central Vancouver Island Health Unit at Nanaimo. He then went to the same position in the North Okanagan Health Unit at Vernon. In 1947, he was appointed director of the division of venereal disease control. Two years later, lie became assistant provincial health officer in charge of the Vancouver district office, a position he held until March, 1962. At that time, he was appointed Assistant Deputy Minister of Health, serving at the same time as deputy provincial health officer and director of Special Health Services. In 1972, he became Deputy Minister of Community Health Programmes and was able to apply his varied experience in the field to keeping many people, in and out of the health field, on their toes and in line at the same time.

Beneath Dr. Elliot's gruff exterior, as the former Minister of Health (Mr. Cocke) will know, there lurks a great and sometimes outrageous sense of humour, All of us at the Ministry of Health wish him well in retirement, He told me once that he had served seven Ministers of Health, both federal and provincial, and that has to be a great tribute to a person whom I

[ Page 3632 ]

consider a great civil servant. I think that's all I need to say about Dr. Elliot.

There is one other person I would like to pay tribute to before I take my place, Mr. Chairman. Fortunately, that person is on the floor of the House today. One of the first things anybody ever told me about Bill Lyle, who is the Deputy Minister of Medical and Hospital Programmes, was that at the very tender age of 10 he was a page boy in this Legislature. I can tell you that I approached him with a great deal of caution from that time on. I wasn't sure whether he would finally want to get even with an MLA. It hasn't turned out that way. I didn't need to worry.

Bill became a government employee in 1929, after having served as a page boy, as a junior clerk in the Department of Finance. In March, 1942, he enlisted in the armed forces, got a leave of absence, and served overseas as an artillery officer. In August, 1946, he rejoined service as a senior clerk in the accounting branch of Public Works.

Reading over some of Bill's history, I was interested to note that it says in 1927 he was employed as a page boy at a salary of $7.50 a week. The next year he was appointed to a full page, but they still paid him $7.50 a week. In those days, you got promoted but you never got raises. The same thing happened when he was transferred around in some of the departments. He served in the Department of Agriculture. A year after that, shortly after he returned from service, he was assistant executive director of the Hospital Insurance Service. Bill stayed with the hospital service until now, the Ministry of Health - becoming successively supervisor of hospital rates, supervisor of the hospital finance division, and up through assistant deputy minister, acting deputy minister and now deputy minister.

Those of us who have daily dealings with Bill Lyle know him to be something of a philosopher with a keen sense of values. I guess this comes from his years in the financial end. His memory for detail is truly amazing. I find myself still in awe, after having worked with Bill for a year and a half. The only fear we have, I guess, is when he decides to retire we will have trouble finding a computer with a memory bank large enough to replace what he has in his head,

Bill retires this fall and I would like this House to pay tribute to one who is a good public servant.

MR. C. D'ARCY (Rossland-Trail): Mr. Chairman, I appreciate the Minister of Health's remarks, particularly with regard to Dr. Elliot , because I got to know him rather well. He was the kind of guy I got to know through some heavy arguments - and he usually won. He was a chap who was very businesslike and hard-nosed. He could accept well-taken arguments and well-researched positions, and usually did. I found I had to get up rather early in the morning and articulate my points rather well before he would concede that they were well-taken points.

MR. Chairman, initially I want to discuss the situation in greater Victoria, where the Ministry of Health proposes to spend some $40 million, at least initially, for a new hospital in what is known as the western community. Experience tells me that the $40 million will probably be substantially more than that by the time all the accounts are in. I'm not going to enter into the argument as to whether or not that is the correct location for a new hospital, Mr. Chairman. I think that position has been well articulated by the municipal officials and the regional hospital board.

However, I do wish to make some moot points, first of all, as to whether or not more acute beds are needed at all. The minister has said there seems to be an oversupply of acute beds in this province. I would be inclined to agree. If, in fact, there is an oversupply of acute beds and an undersupply of extended- and intermediate-care beds, why on earth is he spending $40 million at a time of austerity in all parts of government? And certainly, as he has said, particularly in view of what appears to have been a runaway growth in health costs in all provinces and all jurisdictions over the past five years, why is he spending $40 million? If we were thinking of wasting $40,000 or $400,000 or $4 million in another ministry I'm sure there would be a hue and cry. Somehow, when it comes to health, we can toss figures of $40 million - or even $100 million or $200 million - around with gay abandon and say: "Yes, it's for health, you know. It's for acute-care beds. Isn't it terrible that they have people in the hallways in the Jubilee and the Victoria General?"

I suggest, Mr. Chairman, that that's a rather emotional argument. The General and the Jubilee, by the statements of both their administration and their medical staff, both say that their patient load varies from 20 to 30 per cent, and sometimes even higher, of patients who should not even be in acute-care beds. They should be at a different level of care -what is usually called a lower level of care, although it may be a more appropriate level for those particular patients - i.e., extended, intermediate or, in some cases, even home care. Those levels of care are a good deal less costly in terms of capital outlay and a good deal less costly in an ongoing way in terms of operating costs.

There is absolutely no question that right here in the city of Victoria we could immediately use up to 400 extended- and intermediate-care beds, which, even at today's costs, can and could well be built at from $25,000 to $50,000 each with support facilities, whether or not they are attached to existing institutions. To provide those beds in the greater Victoria area could probably be done for not much more than $15 million, Mr. Chairman, and that's a

[ Page 3633 ]

good deal less than the $40 million that the minister is proposing.

I'd also like to raise the point that the use of the term "third hospital" at Helmcken Road or McKenzie Road or wherever it is going to be is a kind of misnomer, Mr. Chairman, because when you examine the situation, the minister really does not intend to provide a third hospital in greater Victoria. He intends to provide a replacement for the second hospital. If he is going to supply 300 new beds at Helmcken Road and shut down 260 at the Victoria General, we are, in effect, seeing 40 new beds. That's at a cost of $40 million for a net increase of only 40 beds, Mr. Chairman - 40 new acute beds, which may well not be needed, at a cost of $1 million each. That's what we're looking at, when we usually think....

Interjection.

MR. D'ARCY: Yes, Mr. Member and Mr. Chairman, if we are going to spend $40 million to supply 300 new beds and at the same time close out 260 old ones, that means that we are spending $40 million for 40 beds. That's $1 million a bed. I think a grade I student could understand that arithmetic.

This is at a time, as I said, of general austerity all through the government and particularly in the Ministry of Health. I'm not necessarily opposed to that austerity, Mr. Chairman. I think that the people of British Columbia and their productive capacity are greatly overtaxed at this time. Anything the government can do to put itself in the position of flexibility to lower taxes is commendable. Unfortunately, they have hurt the economy so badly that even at the higher tax rates we are not seeing the kind of revenue that we should have to provide the kinds of services which the people of British Columbia could rightly expect.

Mr. Chairman, apart from the question of the economics, I mentioned that we could be saving something like $25 million right off the top in capital cost because these types of beds are not needed. If we were going to put in the kind of beds that were needed, then we get down to the operating costs. We find that acute beds in this province, particularly if they don't have the averaging factor of having an untoward number of extended-care patients in them, probably cost the hospital and eventually the taxpayer at either the provincial or local or federal level some $150 a day. We know very well that extended- and intermediate-care beds can be operated at a good deal less money than that - $50 a day in many cases.

So not only are we committing ourselves to a lump-sum payment of $25 million, which is not necessary, but we are incurring an ongoing commitment each and every year that we and our children will have to pay. As I said earlier, the costs begin to boggle the mind. We are only looking at greater Victoria; we're not looking at the present moment at the costs of hospital care in greater Vancouver or in other parts of the province, particularly those areas which are very rapidly growing, such as Kamloops, Kelowna and Prince George.

I would have to express grave reservations about the plan to phase out the Victoria General Hospital as an acute-care facility. The minister may be going to claim that he has no such plans. The fact is that if you're going to make the drastic reduction of acute-care beds in that facility, it's absolutely inevitable that it will eventually be phased out.

I would note that the administration and the directors of that hospital indicate that 60 to 80 per cent of all their patients come from within one mile of the Victoria General Hospital. Obviously they're not forcing people to any terrible inconvenience to drive in from long distances such as from Metchosin or Central Saanich when 60 to 80 per cent are coming from within one mile. A significant proportion of the remaining patients, Mr. Chairman, are referrals from other hospitals on Vancouver Island or in the rest of the province.

I think there is a good case to be made, as the local doctors have made, that it's very important to have support facilities for patients. Again, it's perhaps an emotional issue but I think it has been pointed out very graphically by a number of doctors, writing as individuals as well as in some elected capacity, that there is some danger to patients who are considered as medical cases suddenly needing surgery and having to be suddenly moved either across town to the Jubilee or out to another hospital in what is known as the western community, View Royal or at McKenzie Road. Really, from a medical point of view, medical cases should be near support and surgical facilities.

I know of nowhere in Canada - possibly the minister or his advisers do - where there are any split facilities like this, even considering that the locations and facilities of many of our old hospitals in many degrees grew like Topsy as the result of local hospital board initiative and as a result, all too often, of political decisions, Even though I don't know of any split facilities like this, here we have a proposal to go even further down the road of an inefficient hospital administration.

I would note that in Victoria there has been no real significant increase in bed capacity in the last 20 years. In fact, possibly the number of acute beds has gone down. I'm not opposed to this. You have to get quite a bit sicker to get into an acute bed these days than you used to have to get, I think that's a healthy move-1 I think that's a move as a result of a new philosophy among the medical profession. I think it's

[ Page 3634 ]

a new philosophy among hospital administration as well. They don't admit people quite as easily as they used to for what we would now consider to be frivolous reasons, although they were not considered so at the time. Styles have changed; tastes have changed. Certainly people are up and walking around and out-patients in a far greater order, and I think this is a healthy move.

I would note, too, that in the greater Victoria area, the Victoria General Hospital initially, as the minister well knows, was a Roman Catholic hospital. In the later years of the sisters' tenure there was a great deal of government operating money that went in; government no doubt had a great deal of equity in that hospital. When it was sold, it was sold for $1 to the provincial government under the former Social Credit administration. Shortly thereafter that administration acquired most of the land and buildings of the St. Ann's Academy across Humboldt Street at a reduced market price, $1.7 million, specifically for the purpose of expanding that hospital when the time came.

I realize that this minister is the second minister since that time. While he can say that he is perhaps not responsible for decisions made by earlier ministers, I think a case can be made that there is a bit of a breach of trust here, a breach of faith with the Sisters of St. Ann in that they sold both the hospital and the land and the property at amounts substantially below market value for the purposes of expanding the hospital.

I suppose the minister is quite familiar with the details but it's certainly the proposal. Closing out is not just in the closure of beds. Sometimes, Mr. Chairman, I think we get hung up on the numbers of beds. What we're really talking about is services, and health services come in many forms.

I gather from the statements made by the ministry that in the new, amended Victoria General Hospital there is going to be no surgery, no anesthesiology, no urology, no obstetrics. In fact, all surgical services will be closed down completely, including the emergency department.

I would suggest that the operating costs of a hospital with these services closed down are going to be extremely high. Unless there is some flexibility put into the funding of hospitals - I know the minister has made some comments indicating that he intends to introduce some flexibility - the projected new hospital could be put into a deficit position.

I would note that when we think about building new hospitals, whether they be extended-care or acute-care or a combination of the two, we have to think in terms of the total tax dollar, not just the tax dollar from the Ministry of Health and not just the provincial tax dollar that we may be concerned about in this particular chamber. I make the assumption -I think it's a safe assumption - that the city of

Victoria has all of the adequate infrastructure services already in place in the present Victoria General-St. Ann's complex. We know that these services are definitely not in place at the other locations, particularly the Helmcken Road one. I'm not saying this is a specific argument for not putting a unit there. However, I would hope that the minister is considering the costs which are going to be placed on the municipal taxpayer and the Ministry of Municipal Affairs in order to put these services - primarily sewage, water, improved highways and parking areas - in place.

Certainly they have to be considered a cost to the taxpayer. Simply to say, "Oh, that's some other level of government's responsibility or some other department's responsibility, " I don't think concerns the taxpayer out there. The taxpayers know, as everyone in this chamber knows, that they have to pay a certain amount of their disposable income in taxes every year, Most people are not too concerned with the niceties - whether they're federal, provincial or municipal. It's what comes out of your total income at the end of a year. I would hope that the minister has considered these things. If he hasn't, I would think he has made a very grave error.

What is the capital cost of new operating theatres and new emergency services to replace those that already exist? After all, we don't have portable modules in the VGH; we can't just sort of pick them up and transport them to some other location that is deemed more appropriate. In effect, we tear down what we have and replace them with entirely new ones. I appreciate that there are some aspects of the building which might be considered obsolete. However, I don't think the equipment is obsolete, In terms of the health care services that are being put out, certainly there aren't any complaints in that regard.

Mr. Chairman, if there are new services needed in greater Victoria, I would ask the minister if he has considered what is popularly called in the field a "module" on the St. Ann's property that would supply the extra services which are needed in the Victoria General Hospital, and could make use of the heating system, the laundry system and such things as the x-ray facilities, radiology and nuclear medicine facilities without having to build entirely new ones.

It's interesting, Mr. Chairman, that I might have to make these points to this minister. I recall that when he was in opposition he was constantly critical of the former government and governments before that for splitting facilities. He said that particularly in the area of intermediate care and extended care, these must not be built as separate facilities; they must be built in conjunction with existing acute facilities in order that economies of scale a , and operating economies could be made by using jointly shared facilities. Now we see the minister, both in the Helmcken Road site

[ Page 3635 ]

and the UBC hospital, going away out into left field, putting in the kinds of beds which may not even be required, at great capital cost, at great operating cost, with, to my knowledge, no shared facilities, Indeed, he's moving away from the concept of shared facilities.

1 might ask, at least as far as this ministry is concerned, Mr. Chairman, what happened to the bottom line that this government is so fond of talking about. It would seem that the former minister over there was far more of a Scrooge and a bottom-liner than either this minister or his predecessor. 1 know in some cases, to a certain degree of chagrin, just how concerned he was with both capital costs and operating costs when I went to his ministry. If he wasn't getting the best possible deal and the best possible dollar value, we simply couldn't get the approvals. This does not seem to be the case now.

Mr. Chairman, to carry on, 1 would be the first to agree, coming from a small-town area, that there is considerable social value in having smaller hospitals. I certainly would never advocate the closing down of cottage hospitals in some of the smaller communities in my area or in other parts of the province.

From that point of view, 1 suppose there is some value in building small community hospitals. However, it hardly squares again with the stated philosophy of the government to build small hospitals such as the one which is being built at Keating X Road or the small hospitals which are being built in Delta and Coquitlam. 1 do not quite accept the philosophy that you cannot have an efficient operation unless it's 400 to 600 beds.

However, while 1 certainly endorse the idea that we put hospitals where people are and provide the acute- and extended-care beds and intermediate-care beds where the greatest centres of population growth are, 1 would really question the philosophy at this time of building acute-care hospitals and adding beds in areas where the minister has stated. Certainly the bed matrix survey put out by the Greater Vancouver Regional Hospital Board would indicate that we're closing down hundreds of beds and in some cases over 1,000 beds that already exist in an area. It seems to be most false economy.

1 have one other item regarding the Victoria General split. I'm sure the minister is aware, as the federal Health minister has pointed out, that the leading cause of death among men or perhaps among anybody over the age of 40 is heart failure. Most of us in this chamber are men and most of us are over 40; if we're not we're approaching that point rather rapidly. We see what seems to be the ultimate absurdity where chronic cardiological care is going to remain at the Victoria General whereas acute care is going to be going out to Helmcken Road.

As we all know, if we've had anybody in our family with cardiac problems, the difference, even to a professional, between what is an acute problem and what is a chronic problem is very, very thin indeed. It's a very, very grey area, even among the specialists. Yet here we see five or six miles separating the facilities, by design. I can understand if that had happened because of growth like Topsy out of anybody's control; in fact we see here what is a designed programme in 1977, when everyone in the field has been saying: "Please, for God's sake, let's do some planning in these things and not do just what seems to be politically expedient or what seems to be the desire of an individual who happens to have a particularly persuasive point of view."

Mr. Chairman, moving across to the lower mainland, we see what I believe to be an even greater misuse of public funds. We note that we are going to have a commitment at the University of British Columbia for approximately $50 million of public money. I suggest that for a 240-bed hospital this may cost as much as $20 million to run. The implication is that we need a teaching hospital. Nothing is ever said about the existing teaching hospitals. It's kind of a slap in the face. I'm sure the general public is not even very much aware that Shaughnessy, the Royal Columbian, Vancouver General and St. Paul's are all teaching hospitals now. They've been functioning very well over the last 40 or 50 years and working very well with the University of B.C. Yet here we are told that if we are going to expand the opportunities to reduce doctors in British Columbia, we're going to need 240 acute beds at UBC for a teaching hospital.

I happen to believe that the facilities are already in place now and could continue to be used. Again, we see the kind of capital expenditures that absolutely boggle the mind. In the lower mainland, it's not as firm a figure as we have in Victoria, Mr. Chairman, but I think it's fair to say that we could use at least 800 new extended- and intermediate-care beds. Those could be built for, at the very most, even if they were new institutions, some $32 million. This is again about $18 million less than the proposed hospital at UBC. We also see that in the lower mainland the ministry intends to force the deletion of some 1,157 beds in the lower mainland area over the next few years, plus the closing down of Grace Hospital.

As I said earlier, these deletions may indeed be in order due to changing styles. I'm, not critical of that. What I am critical of is this: if, we're in a position where we do have the option of closing down over 1,100 beds in the lower mainland, why in heaven's name are we spending $50 million to add 240 more acute beds, particularly since they are as far away from the population growth as you can possibly get without falling into the Strait of Georgia?

I think it's fairly obvious to anyone in British Columbia that the population growth in the lower mainland is not going out to sea. It can't go that way. It's not going up tile North Shore mountains and it's

[ Page 3636 ]

not going over the U.S. border. It's only going eastward up the valley. Yet we see where we already have a plethora of hospital beds in Vancouver, and particularly west of Main Street. We see the ministry going as far west as you can go, as I said, without falling over the cliffs and down on to Wreck Beach. This is the kind of planning which can only be considered as being no planning at all.

The minister made an interesting statement last December in perhaps an unguarded moment. I don't like to go back that far because he's maybe had time to think about it since then. He said: "Well, it just so happened that I was convinced that that was the best place to put it." I would hope the minister would tell us, first of all, who convinced him and how; why he was convinced we needed more acute beds at all in the lower mainland when he's intending to close out 1,200; and how he came to be convinced that that was the right location for those particular beds.

AN HON. MEMBER: The Minister of Education (Hon. Mr. McGeer) told him.

MR. D'ARCY: Well, perhaps we will get to that. I'm primarily concerned with this minister.

As I pointed out earlier, Mr. Chairman, this minister either inadvertently does not connect his rhetoric with his policies - I quite agree with a great many of his public statements, but he doesn't seem to connect them with his policies - because they don't go along with his public statements, or he finds himself out muscled and outgunned in cabinet by other ministers. I'm not terribly concerned with the particular details of the case. What I am concerned with is the responsible use of public money, particularly the responsible use of the Health budget in British Columbia.

The minister made some remarks about the extent of the importance of his particular portfolio, I would agree completely with that. This particular ministry consumes 26 per cent of the provincial budget -that's 26 cents on every dollar. Of that, 17 per cent of the provincial budget goes for hospitals and 6 per cent to pay doctors. A total of about 85 per cent of that 26 per cent on the dollar goes for hospitals and for medical care, and that's an incredible amount of money.

Mr. Chairman, in getting down to the details of the deletions in the lower mainland, I mentioned a few minutes ago that most of the beds in the greater Vancouver area are located not only in the city of Vancouver, where most of the people do not live any more, if you take into account all of the North Shore, Burnaby, Coquitlam, Port Moody, Delta, Surrey and so on....

MR. CHAIRMAN: One minute.

MR. D'ARCY: Thank you, Mr. Chairman.

If we take that into account, we find out that not only are these beds being closed down but a great many of them are being closed down in those surrounding communities which now are under-supplied with beds. We see 14 beds being closed out at Peace Arch District Hospital in White Rock. We see the Burnaby General having 80 temporary beds closed down; the Royal Columbian, 5 1 beds; the Lions Gate, 25; and so forth.

Again, it makes absolutely no rational sense from a business point of view, from an administrative point of view or from a taxpayer's point of view, apart from all the humanitarian aspects. Mr. Chairman, I think a great case could be made from the humanitarian aspect, but it simply makes no sense from the bottom-line point of view either. We're dealing with such vast amounts of money that one hardly knows what particular point to stress. The more I have looked into this, the more I have found out that really, there has been a decided lack of planning not only under this ministry, but it appears that we could go back practically during my entire lifetime. Decisions on hospital growth and health care have been made, it would seem, more on personal expediency and temporary political advantage - or what appeared to be temporary political advantage -rather than on a commonsense, businesslike point of view. One could even argue that perhaps aspects of health care are too important to be left to the politicians - these ones or any other ones, Certainly our record as politicians in this area has not been a good one.

Mr. Chairman, getting back to the Victoria situation, I would like to bring to the attention of the committee at this point - and I'll be speaking again on this - the aspect of staffing; particularly in view of waiting lists. I know we've had statements made in the press on the long waiting lists for surgery at the Royal Inland Hospital in Kamloops. One can say, okay, eventually these things are caught up with. I would note that many of the people who are waiting for surgery are out of the work force while they're waiting. That means that they're not being productive. They are not in the mainstream of society; they are not adding to the productive capacity of British Columbia, not by their own choice, In many cases they find themselves receiving unemployment insurance or social assistance on the public payroll. This is an absolutely considerable economic loss to B.C., which perhaps doesn't show up in the Health budget, but does show up in the total tax revenue and tax expenditure for British Columbia.

Mr. Chairman, you'd like me to interrupt my remarks and carry on at a later date. Is that your intent?

MR. CHAIRMAN: That's what the standing orders

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say, hon. member.

HON. MR. McCLELLAND: I'd like to answer, if I may, some of the questions at least raised by the hon. member, Mr. Chairman.

I take issue with the comment that there is no planning going on in terms of providing for hospital ~services in British Columbia. On the contrary, I think that for the first time we really do have a rational plan, based over a five-year period, which has been presented to the Greater Vancouver Regional Hospital District and also will be presented in terms of the cash flow available to develop hospital services for the rest of the province as well.

On the UBC hospital, we went all around that road during my estimates last time. I haven't changed any of the statements I made there, but I would like to correct the member. There isn't $50 million available for the UBC acute-care hospital. A great proportion of that $50 million - over $20 million of it - is to be spent on the upgrading of the existing teaching hospitals in downtown Vancouver. That is an important part of this whole programme. So the acute-care hospital is only one part of this proposal. It is too often forgotten, I think, that a lot of that money - almost half of it - will go directly into the facilities downtown - at the Vancouver General, at St. Paul's, at Shaughnessy, at Children's and at those other hospitals.

The member talked at length about Victoria General. It's a problem that has been concerning all of us. Several past ministers - four or five of them, I think - have dealt with this situation. The member says: "Let's do some planning." We've got planning studies coming out of our ears in terms of what's happening at Victoria General Hospital. This goes back to the first master plan in 1965 for what was then St. Joseph's. We've been planning and studying and committee-ing and whatever else you do ever since then without a hospital being built. There was a proposal at one time to rebuild Victoria General on the site and it was shot down very forcefully, mainly because of the medical specialists who said, at that time, that Victoria General was completely obsolete. There is another report up in my office - the Agnew Peckham report of 1967 for the capital region. That was titled the "Obsolescence Report for Victoria General Hospital."

HON. H.A. CURTIS (Minister of Municipal Affairs and Housing): That was 10 years ago.

HON. MR. McCLELLAND: That's right - 10 years ago.

At that time, we were told that that hospital could not be rebuilt safely because of its terrible condition. I don't know whether the member, Mr. Chairman, has been in that hospital and through it, but it's a mess.

Again, 1 say that here are some facilities that are dangerous to patient care and which we want to replace as quickly as we possibly can. There has been lots of planning. As a matter of fact, the original report, which recommended that the hospital be split and the new hospital be located somewhere in the western sector - the report at that time didn't choose a site - suggested that patient care could be handled well with a split site. We've got quite a few examples of split facilities in terms of satellites for hospitals, not necessarily full splits. But there hasn't been any decision made as to what will be in those two hospital sites. That is still a matter of discussion among the capital region planners and the planning team which has been set up. But 1 go back again all of the time to the original report which recommended that split and the new hospital being built had full medical representation on it. It was a unanimous recommendation to the capital region and to the minister at that time that this be the way that this new facility should be developed.

I can perhaps jump around in the same way the member did because I've got the notes in order of the way he presented them to me. You can't have it both ways. The member has said there is a social value of having smaller hospitals close to the people. 1 agree. But then to criticize and say that we shouldn't be putting smaller hospitals in Delta or Coquitlam or any place else is a kind of contradiction. The Coquitlam hospital, at 15 0 beds, has been approved for a long time. It was approved in 1973 by the previous minister with a confirmation to the board there. So that has been going on a long time as well.

Interjection.

HON. MR. McCLELLAND: No, it's September 27,1973. 1 have your letter.

Mr. Chairman, there had to be some decision made and some rationalization of the size of that hospital. Don't forget again, Mr. Chairman, that there will also be extended-care beds on that site as well. I'm not saying we'll have the full services or the full capacity of a larger acute-care hospital. It does mitigate, somewhat, some of the objections that you have made. Nevertheless, the doctors and everyone else in Delta, including almost the entire medical profession who have been in my office to see me, if you talk to them, agree that we can provide good medical care in a small acute-care hospital of the size that is proposed, particularly since it is appended to an existing extended-care facility, without an additional burden on the taxpayers. Those are the decisions we made and the reasons for which we made them.

1 don't know whether 1 should comment on your comment about the former minister being a bottom-liner. 1 don't know whether that was a compliment to him or not. 1 could deal perhaps some more with Victoria General and some of the specific

[ Page 3638 ]

questions you raised. They are valid questions dealing with the cost of additional services which are needed to provide care at the Helmcken site. Yes, there will be additional services. First of all there was a highway needed in that area, whether or not the hospital ever went, and you'll notice that the extension of the Trans-Canada Highway is now well underway. That highway will be four lanes before our hospital is ever in place.

There is good water protection there. There is, I think, about a 48-in. watermain that goes right through that Helmcken property - Esquimalt district or View Royal or whatever it is.

Sewerage will cost a little extra but we've agreed that we'll take a look at some of those off-service costs so that we can meet our share, if necessary, to provide some upgraded sewer facilities, which we hope, incidentally, will ultimately help the community because they'll be able to make some of their plans.

There's no doubt, Mr. Chairman, that that western community is growing faster than any part of this region and that sooner or later there would need to be an acute-care hospital somewhere out in that area. Again, in terms of spending $40 million to provide what you have said is a small increase in acute-care beds, I just have to say that that's not what the government is doing. The government is replacing beds which are very badly outdated and which must be replaced, one way or the other. That expenditure will have to be made. We would not be fulfilling our responsibility if we didn't replace those beds, and I'm sure, Mr. Chairman, the member would agree with me on that point.

Yes, there are patients who are in our acute-care hospitals who should not be there, who should be in some other kind of facility. One of the reasons, again, that we announced the long-term care comprehensive programme is so that we will be able to take some of these people away from those facilities and put them in facilities which are more appropriate to the kind of health care they need. I have great hopes that that programme, along with the development of new intermediate-care facilities, a number of which have been announced recently in all areas of the province for construction starts as quickly as possible, will make that programme possible.

Just generally, Mr. Chairman, on the whole bed matrix situation in greater Vancouver, there's no possibility that will work. It's a desirable objective. It's one which the federal government has been pressing all of the provinces to get on with - the desirable objective of reducing the number of acute-care beds per thousands of population. But it won't work unless we do develop alternative facilities, because in order to empty some of those acute beds, we've got to have someplace else to put patients and have them in the kind of care that they require, given the state of their condition.

So all of the programmes have to coincide with each other or our objective just simply can't be achieved. We hope that we're on the right track in order to make that objective achievable.

Again, in greater Vancouver, I must remind the member that while we talk about new hospital beds, we also have to remember that in the large majority those new hospital beds are replacement beds. If Victoria General Hospital is in tough shape, then I would say that Vancouver General Hospital is in far worse shape. There are some parts of that hospital that I wouldn't want a relative of mine to be cared for in. I'm anxious to see that we get rid of those obsolescent parts of Vancouver General as quickly as possible and bring Vancouver General down to a more manageable size in terms of the total size of that hospital, which now is the largest, I'm told, in the Commonwealth. We have to bring it down to a more manageable size and get rid of those obsolescent beds, which I think are not a good credit to this province of British Columbia. That's our objective and we hope to reach it as fast as we can.

MR. D’ARCY: Like many politicians, the minister has selective note-making ability. I enjoyed the points he made. However, I'd like to make it clear once again that in my remarks regarding the Victoria General situation I was not questioning whether or not a new hospital with new acute facilities may be needed in greater Victoria. I don't believe that the medical association locally is questioning that, nor am I getting into the controversy of whether or not the new facility should be built at Helmcken Road or McKenzie Road or on the VGH site or on the top of Mount Tolmie or anywhere else ...

HON. MR. McCLELLAND: What are you asking?

MR. D'ARCY: ... that the minister, hopefully in consultation with local authorities, although there's some question that he ever consulted with anybody, might decide to put it.

What I'm coming down about, Mr. Chairman, is why in heaven's name they are splitting existing facilities when there seems to be absolutely no technical or professional recommendation that they should go that way. I notice that in January of this year, the Victoria Times noted: "Five hundred doctors come out against hospital split." Now for 500 doctors to take time out from their professional duties and their families and whatever else they do in their private lives is, on an issue in a community like Victoria, which is rather staid, quite significant. This was before most of the real information on this topic had become available. So obviously there is strong feeling about this. I must reiterate, Mr. Chairman, that it's the split of facilities rather than the location

[ Page 3639 ]

of the facilities that is the real point to which I would hope the minister would apply himself.

I'm happy about the announcement that all of the private institutions are going to be put on the system as far as the per them goes for extended and intermediate care, Mr. Chairman. I note, however, that we're back to the old thing of last year. The minister made an attempt to raise the per them for chronic care from $1 to $7. Due to public objection it was put back to $4. We find another nice, convenient way of putting it back to something very close to the $7, saying that we're going to put the private operations on the system too and charge everybody $6.50.

Both the minister today and the Premier when he made the announcement.... I can't understand why the Premier would be making announcements for the Minister of Health, but he did. In any event they said: this is going to help to increase the supply of intermediate- and chronic-care beds. I would like the minister to perhaps tell the committee the mechanics of how raising the per them to $6.50 is going to by itself increase the supply of intermediate- and chronic-care beds. Has it in fact increased it? What are the projections both in the private and the public sector?

It's my note that since the transfer of the responsibility of intermediate care from the Ministry of Housing to the Ministry of Health in the spring of 1976, there have been precious few approvals for construction of any of these types of facilities. Indeed, CMHC recently has said that they are going into a phase-down period in terms of funding because of the lack of activity on the part of the provincial government. I know that the minister is going to say: "Well, we've been re-negotiating the funding with the federal government." I appreciate that need and that desire. However, I still question the mechanics as to whatever has been negotiated. The cost-sharing thing is an improvement over what we had. But the minister is going to have to go to some distance to show me that there has been any improvement or is likely to be any improvement in the supply of beds unless there are some separate initiatives taken by the government. Certainly I haven't been able to discover it in my personal investigations.

Mr. Chairman, getting back to the teaching hospital situation in the lower mainland, I would really question the need for acute beds, wherever they may be built. Just in passing, Mr. Chairman, I would note that I was not suggesting that small hospitals not be built; I was only pointing out that Delta is not Nakusp and Coquitlam is not Spences Bridge. These are communities of 150,000 people plus, probably serving greater areas than that. Certainly if the ministry has capital expenditures to throw around, they should not be considering operations which are hardly greater than cottage hospitals.

Going back to recalling yesterday's discussions in committee, Mr. Chairman, the member for North Vancouver-Capilano (Mr. Gibson) said that 50-cent dollars are always more attractive to the province than 100-cent dollars. I can't help but feel that one of the reasons for going ahead with this facility is the availability of federal money for it, or partly federal money in any event.

First of all, I wonder whether the ministry has attempted to negotiate with Mr. Lalonde at the federal level -- my information is that he hasn't -either for an extension of the period that this money may be available or for the use of the money in some other area of his ministry. I think the minister could ably demonstrate to the federal government that we're oversupplied with doctors not only in Canada but in British Columbia today. In fact I determined that the immigration branch of the federal government is discouraging, if not outright preventing, the immigration of foreign doctors to Canada at this time because they say we have too many doctors in Canada and in British Columbia. It hardly squares with the intention to supply new and expanded teaching facilities in British Columbia for a profession in which we already may be oversupplied.

A great deal has been made in recent years over the fact that we apparently have too many teachers and are graduating too many teachers, and that we have an oversupply of lawyers. Now we find out that we may well have an oversupply of MDs. What is the provincial government doing but spending large amounts of capital and committing the taxpayers of this province to large amounts of operating expenses to graduate people in a field where we may be oversupplied?

In fact when the CMA head, the Irishman, was speaking in Victoria at the Empress Hotel fairly recently, the main thrust of his remarks was that we had too many medical doctors now. Mr. Lalonde has made the point on many occasions that if you have too many doctors you probably not only pay too much for their services but you may well at the same time get a lower level of health care costs.

This article does not have a byline. However, in The Medical Post, the writer - I presume this is an editorial - says some things about the ministry and provincial government which are in rather strong language, even if it were written by a member of opposition in this particular chamber, Mr. Chairman. He said:

"The doctors in British Columbia are upset.

"Recently a number of political decisions have been made which directly concern their future, yet they were either not consulted or their advice was ignored. The decisions made should have been, first and foremost, decisions with a high medical profession input.

[ Page 3640 ]

" Instead, they were made by politicians whose priorities are mainly staying in office rather than the welfare of the taxpayers.

"In the past few years, British Columbia has become an over-doctored province. The doctor-patient ratio in Vancouver and Victoria is hovering around one doctor for every 500 population. The competition is becoming frenetic and it is leading to abuse of the medicare system.

"Yet the government is proceeding with its plans to double the output of the University of British Columbia medical school. The present output of 60 medical graduates a year will move up to 120 as quickly as possible. In the light of the present surplus population of physicians, general practitioners as well as specialists, the decision by Education minister Dr. Patrick McGeer makes no sense at all. We understand that the Minister of Health, Robert McClelland, thinks the enlargement of the medical school is folly, but he gets constantly outgunned by Dr. McGeer when the matter comes up in cabinet.

"The British Columbia Medical Association has officially stopped opposing the enlargement of the medical school, apparently because its officers feel that rape is inevitable. Dr. McGeer, who is also head of the neurological sciences department of the UBC medical school, is clearly empire building. He uses the fallacious but politically appealing argument that the bright young men and women of B.C. must have the opportunity to attend medical school if they wish.

"Dr. McGeer chooses not to see that if these same bright young men and women get out of medical school and cannot find jobs within the province, they will head south, and thereby be lost permanently to the province. When one considers that each medical graduate costs the taxpayers $75,000. . . ."

Mr. Chairman, I think that that is a very conservative estimate; I think the figure is probably more like $100,000, and when you consider the cost to their parents, since many of these people are receiving some support from their homes, it becomes even higher than that.

". . . the loss to the taxpayers of B.C. could be damaging.

"Nor does Dr. McGeer seem to know that most provinces of Canada are reaching a surplus position in doctors;" - so the situation is not unique, Mr. Chairman, to British Columbia -"that the 16 medical schools in this country are now turning out adequate replacement numbers."

It has recently come to my attention that some of the medical schools in Canada are either going to reduce their enrolment or they are seriously considering reducing it; hence the number of their graduates will be in controlled amounts over the next few years. Yet here in British Columbia we're spending millions of dollars to expand the number of people enrolled.

The editorial goes on to suggest:

"The B.C. doctors are equally upset about the political decisions being made concerning hospital construction. Right now the power shovels are scooping out the basement for a 300-bed acute-care hospital on the University of British Columbia campus.

"The hospital is being built not because anyone has a clear idea how it is to be integrated into the hospital system in the province. . . ."

The minister was just getting up saying how a great deal of planning was going on. Yet here it says that nobody has a clue as to how this is going to be integrated into the present hospital system, Certainly my discussions with the Greater Vancouver Regional Hospital District don't indicate that they have a clue as to how it's going to be integrated. It appears that it's only being constructed because, as the member for North Vancouver-Capilano (Mr. Gibson) said, it appears, apparently, that there is a deadline on federal funding and 50-cent dollars are more attractive than 1 00-cent dollars. Well, I would suggest that if somebody's going to sell you a pig in a poke and you pay half the price, it's hardly a bargain if you get stuck for the other half of it.

Also, as I noted earlier, Mr. Chairman, I'm not aware of any attempt made by the Minister of Health or the government of British Columbia to renegotiate that federal assistance, either for a time extension or for some other aspect of health care or even education care. There has been no indication from the Ministry of Health in Ottawa that overtures in that direction have been made. Also, to the question as to whether they would be open to negotiation on the matter, they said: "Well, how can we tell you whether or not we could be open to negotiation when, in fact, we have yet to be approached?

Mr. Chairman, I think that the case has been very well made here that there is not, in fact, a need for more doctors; there is not, in fact, a need for more acute-care beds, certainly not in the lower mainland. Particularly in the city of Vancouver, and particularly within the greater Victoria area, there may be a need for improved facilities, but there certainly is no need for additions. Yet we see the minister persisting in telling us: "Oh, yes, there's a great deal of planning going in." It would seem, Mr. Chairman, that the evidence is all the other way. Not only is there no planning going in, but what is being done is to provide us- with the wrong type of facility in the

[ Page 3641 ]

wrong place with the wrong sort of costs. Again, at the local level, Mr. Chairman, if the minister is going to claim, "Well, look. The reason we're going all the way with a new hospital, wherever it's going to be built, a replacement for the Victoria General, is because those beds are obsolete there, " 1 would ask the minister what he thinks about the priorities for providing beds where none exist at all. Surely it's better to have an obsolete bed that is still functional than to have a bed which does not exist at all. That is the case with our supply of acute- and extended-care beds.

Hopefully, the minister will tell us something about his plans in the greater Victoria and the greater Vancouver area to see that his ministry, in co-operation with C~ or in co-operation with the private sector, has some kind of adequate plans to provide these secondary and tertiary levels of hospital care. Not only is this going to cut down on our capital commitments; it's certainly going to cut down on our operating commitments as well.

HON. MR. McCLELLAND: I'm getting more confused as the day goes on, Mr. Chairman. 1 don't understand what the member wants. We don't need any more secondary and tertiary levels of hospital care., what we really need is lower levels if we're ever to bring this system into balance.

MR. D'ARCY: That's what 1 meant - extended and intermediate care.

HON. MR. McCLELLAND: We aren't going to have more acute-care beds in either of the regions. We will have less acute-care beds per thousand people by 1981 than we do now, if we can achieve our objectives. 1 don't understand exactly what you're saying about not providing beds where none exist. If you're talking about other acute-care bed needs in other parts of the province.... Is that what you're saying?

MR. D'ARCY: No, the extended- and intermediate-care beds.

HON. MR. McCLELLAND: Well, regarding extended and intermediate care, we officially opened yesterday a 300-bed extended-care facility at UBC. There's planning going on for new facilities all over British Columbia at this very time. There are about another 600 extended-care beds coming on line this year unless there are problems - strikes or something like that - that affect them. Our planning division tells us that in order for us to do the very best job we possibly can in British Columbia we need an additional 1,300 beds all over British Columbia -that's all. We're getting very close to reaching a position in extended, intermediate and personal care - all of that lower level of care. This is happening all over the province.

I'm very surprised that the member says that the Greater Vancouver Regional Hospital District doesn't know how to integrate the UBC hospital into its system of beds in the district. The Greater Vancouver Regional Hospital District is building the hospital! They're the project managers; they've taken on responsibility for the hospital, It doesn't make sense that they build a hospital and don't know what to do with it. It's a vital part of the bed-matrix system, which has been approved with a couple of provisos in terms of making sure that we get full concurrence from Vancouver General Hospital on its matrix. GVRHD is building that UBC hospital; they're responsible for it.

Regarding the enrolment in medical schools, yes, it's a problem. We are over-doctored in Canada to some degree, and in British Columbia more than anywhere else. We recognize that and so do the other provinces recognize that. We have discussions with them. Our deputy ministers have been talking, and most recently at the Health ministers' conference in Ottawa a few weeks ago we discussed the need for British Columbia to graduate more of its own people from its medical school. We've been leaning on the other provinces for years. They've been taking up what was really our responsibility by graduating medical students for us and bearing the cost, and then sending them out to British Columbia.

MR. D'ARCY: They don't send them.

HON. MR. McCLELLAND: Well, of course. They come, don't they? Sure.

We haven't been accepting the responsibility that we owe to our own young men and women to be able to graduate from their own medical school. We are now accepting that responsibility from the other provinces. Sure, some of the other medical schools will reduce their intake because that's been the subject of negotiation. Those schools will reduce their intake as our intake goes up. That makes eminent sense. 1 don't think there is anybody who would argue with the objective to allow our own British Columbians to take more advantage of their own facilities here in the province. That's all we're doing.

At the same time, however, we recognize very clearly the problem of maldistribution and oversupply of physicians is a very serious one and one which could threaten the entire funding system of medical services. For that reason, we've taken some strong initiatives with the British Columbia Medical Association and the College of Physicians and Surgeons and others to get on with some kind of method by which we can attack that problem. 1 hope that we'll have some proposals coming before government very quickly on that, as soon as we can

[ Page 3642 ]

finish our negotiations with those people who are most interested. We don't want any more studies, necessarily; we want some action and we want some ways in which we can do this.

Mr. Chairman, the member will be familiar with the fact that there was an attempt made by the College of Physicians and Surgeons to take some action in this regard. They were unsuccessful because they violated human rights provisions of the human rights branch. We don't quarrel with that, but we now realize that we must attack this problem in some other way. I won't apologize for wanting to make sure that young British Columbians have a better opportunity in this province. I never will apologize for that.

It's not true that we've never had any negotiations with regard to the ways in which we might vary that health resources fund which you talk about that is available from the federal government for teaching purposes. We've been talking with Ottawa. As a matter of fact we've recently, through our deputy ministers, had some agreement that there will be some variance in the way in which that fund will be made available. We don't yet know how, but Ottawa has agreed to vary somewhat in terms of deadlines more than anything, not necessarily in terms of the way the money must be spent.

It isn't necessary for us to spend that money on the UBC hospital; we could spend it on any kind of teaching facilities. We can spend it in the downtown hospitals; we can spend it at Children's Hospital; we can spend it at the new Grace Hospital. We can spend it anywhere we want, as long as it is in fact.... We have already received $5 million for the extended-care unit at UBC now. We don't have to spend that money there, but we think that's a good place to put it. It will be distributed not just at the UBC hospital but among those teaching hospitals in downtown Vancouver as well. So it's not tied to that. There's no real connection, except that we certainly want British Columbia to take advantage of all of the federal dollars that are due to us and we intend to do that. The announcement yesterday by the Minister of Education (Hon. Mr. McGeer) is a good example of the way this government has been able to get dollars which are due to us and which have never come to us before.

It's not true, I don't think - at least I'm certainly not aware of it - that CMHC is winding down in its provision of funds for intermediate-care facilities in this province. We are actively pursuing CMHC funds to continue the supply of intermediate-care units. You might be interested, Mr. Chairman, that just this year so far we have approved 50 beds in Parksville, 50 beds in Port Alberni, 50 beds in Prince Rupert, 78 beds in Campbell River, 40 beds at Louis Brier in Vancouver. They're coming across my desk every day and we intend to meet that supply and need as fast as we can, given those funds that are available. There will be no funds left lying in Ottawa because of inactivity of this government.

I might also add, Mr. Chairman, that in terms of consultation and who is involved in the planning of some of these facilities, I can tell you that the team which is responsible for constructing the new UBC hospital is not only concerned with the actual construction of that hospital, but is also.concerned with the allocation of the teaching funds in the other hospitals and the whole spectrum of teaching needs. All of the teaching hospitals are involved. They are part of the team who are actively planning these needs.

For the first time, I think, in the history of this province, we are approaching some kind of solution to this problem of medical teaching, and it's not in isolation. We're not doing it alone, because I think, perhaps, that's been the problem in the past. We're doing it in full consultation and co-operation with all of those teaching hospitals who are involved and they're vital parts of the planning process at the present time.

On the Victoria General Hospital split, I just go back again to that expert report that came in 1975 during the last government, which was accepted - a role study for the capital region. It points out very clearly that the Victoria General Hospital is antiquated. It suggests very clearly that the hospital not be replaced on its present site. It recommends a split, with 350 beds moved by 1981 -- we're perhaps even ahead of target - and the balance of the beds by 1984 to a site, as I said, somewhere in the western sector. It assumes about 200 beds downtown; you know, we're not very far apart in that report from 1975.

I'd like to read just a bit from that site study. The report says that "we have no doubt about the ability to operate an efficient, economical and high-quality hospital in two locations for at least a number of years." That was in 1975. It was accepted by the previous government and accepted by the capital-region planners as well.

Another study in March of that same year concluded that Victoria General Hospital should be moved and that it should be as far west as possible from the Royal Jubilee Hospital. The report said the disadvantage would be to separate the Victoria General Hospital from its downtown image, but it would still be a community hospital for the approximately 50,000 people living in that area. That role could continue to be developed. The report concluded that the new hospital should be constructed elsewhere as soon as possible and that the total hospital would emerge on the new site before many years have passed. Now we've committed ourselves that there will be a total new hospital of 500 beds on that site just as quickly as we can build

[ Page 3643 ]

it. I would expect that in the next five-year planning period after 1981 that will be an urgent consideration - to have the hospital expanded to its full size at that time.

Mr. Member, I can only say that these decisions were made only after what have been interminable numbers of studies, all of them done by experts in the field and all of them with local people involved. The capital region planning commission and the medical profession as well were a part of the acceptance of this report.

We said that it was probably time to make some decisions and build a hospital. That is what we have done. It certainly wasn't based on any decision I made unilaterally. We had some problems over site. I admit I made some decisions there because I felt it was time that the minister had to make some decisions if we were to get on with this job.

In terms of the planning of this hospital, it has been a long, involved process going back to 1965. The experts have assured us that that split can be made efficiently. We have not yet agreed how that split should take place because, frankly, we have some doubts about some of the things that have been initially recommended - some of them that you've mentioned - in terms of what facilities will be where. We want to assure ourselves beyond all doubt that all of those doubts and concerns that we have will be met before we approve the final plans for that hospital.

MR. WALLACE: First of all, I would like to add my personal welcome to Bill Lyle, who is on the floor of the House, I have known him for some years. He has recently come through an illness. I would like to say, Mr. Chairman, that he is a pillar in the whole system of the ministry. I wish him well and hope that he is fully recovered from his illness.

I was very interested in one of the comments from the member for Rossland-Trail (Mr. D'Arcy) about the added incidence of illness and disease in patients over 40 and the fact that most of us in this chamber are over 40 - myself included.

I just can't resist tying it to a headline, Mr. Chairman, in The Medical Post of April 26,1977. 1 think this headline will be particularly interesting to those of us who sit around in this chamber for long hours, because it reports that 70 per cent of those over 40 have hemorrhoids. That's just a little statistic that I think some people might find interesting.

Interjection.

MR. WALLACE: Yes, 70 per cent of people over 40 have hemorrhoids.

HON. MR. PHILLIPS: How do you know?

MR. WALLACE: Contrary to some of the answers you give, Mr. Minister, this has been researched! (Laughter.)

Mr. Chairman, it's an enormous ministry that we have to discuss and I personally will try to stick to more general matters, with one exception. The phrase that the minister has used today which gives me most hope is that finally some of the very obvious principles that we should have been following for a very long time are coming into being. These principles are being followed in implementing certain very practical policies in the development of health-care services.

The minister used the phrase "balanced system." I personally never felt so optimistic in the years I've been in this House as I do now in this debate because of the fact that at long last it seems not just to be lip service that's being paid to an idea of a balanced system. Everybody who is sick doesn't need an acute bed. Even the federal government has finally stopped criticizing provincial governments for the waste of acute beds, for example, when the federal government, to start with, was responsible for some of the rather unenlightened cost-sharing policies which they thrust down the throats of provincial governments.

I think it is fair to being our discussion of hospital and health-care facilities, Mr. Chairman, by being positive and optimistic for this reason. The federal government set up a task force in 1966 that traveled the length and breadth of Canada and was represented by some of the most eminently qualified and knowledgeable people in the health field. They told every province just what the whole story was. Though we wouldn't agree with every detail, what the task force of 1966 said was: "Let's get some balance into the various types and levels of care that Canadians need." That report, I think, is one of the finest reports that I've read in terms of its clarity and its practical application.

It pointed out in 1966 that we had already built too many acute-care beds. We went on building acute-care beds. One of the reasons we went on building acute-care beds was that the federal government still had the same dumb approach to cost sharing. They made it possible and even attractive for provincial ministries of health to go on building acute-care beds because financially that was the most attractive proposition under the terms of federal-provincial cost sharing. It is just that simple, Mr. Chairman. But you probably find it difficult to believe that it has taken 10 years of talk and protest and dancing and screaming from all quarters to finally have Mr. Lalonde come up with the cost-sharing arrangement.

I just want to go on record as saying I think that is really a monumental step forward towards rationalizing and making more practical and sensible

[ Page 3644 ]

the total spectrum of delivery of health-care services in Canada. It's 10 years overdue, and it's better now than ever.

I suppose I could say, Mr. Chairman, that one of the basic issues that got me into politics - and, heaven knows, I sometimes wonder why - was the issue of intermediate care. As a general practitioner in this city, I could see that the spending of taxpayers' dollars on certain levels of care just made no sense at all. At that time I was stupid enough to assume that perhaps if I got into politics I could persuade some of the politicians they could do a better job with the taxpayers' dollars with regard to health-care facilities. Time and events have shown that wasn't such an easy proposition.

At any rate, Mr. Chairman, I want to say that I think this government is certainly moving in the right direction in realizing the priority attention which should now be given, and should have been given years ago, to this concept that there are various kinds of care which each different patient needs. The whole spectrum, from being completely well to being desperately ill, involves perhaps five or six intensities of need. The corollary to that is that you need five or six levels of care. If you need different types of care, obviously they're provided in different types of facilities. At last we seem to have got this very obvious and wise principle accepted that we are now into all levels of care. 1. hope this is the last time I will bore the members of the House with this same speech, and I notice the House is poorly populated this afternoon.

At any rate, Mr. Chairman, the concept seems to be well articulated now by this government. I'll acknowledge that this government - or the former government, for that matter - could not do much in implementing all levels of care simply because of the federal government's stubborn opposition to a different cost-sharing method. I would only agree with the minister that the new cost-sharing formula, as he well knows, relates to a transfer of 13.5 tax points from the federal government to the provincial government together with a cash payment on a per capita basis which will, in future years, be related to a phrase which is new to me. Mr. Trudeau used it frequently in the statements in Hansard. That is "gross national expenditure" - not gross national product, but gross national expenditure.

Now I have some idea what people mean by "net provincial product" or "gross national product, " which is the value financially of goods and services produced, but in "gross national expenditure" that last word, "expenditure, " puzzles me. I've read Hansard from the House of Commons on this debate very carefully - several times, in fact - and I've got it all right here for reference if anyone wants to go into detail. This phrase "gross national expenditure" to me would mean expenditure by the national government on everything from pens and pencils to Avro aircraft. I'm afraid the provincial governments lost out, in one respect, by having a better assurance that as the years go by and inflation and other costs escalate, and as federal government expenditure varies, particularly if the federal government finally does get around to trimming some of their expenditures.... If in fact the provinces then have a reduction, as the years go by, in this cash payment each year based on this phrase, "gross national expenditure, " then I think we could be in for pretty serious problems.

On the other hand, I know that the ministers of all the provinces made their point very clear that they were uneasy about that part of the agreement. I think I would have to be fair and say that, if I had been in this minister's shoes, I could not possibly have rejected the most attractive part of the agreement, which was the 13.5 tax points minus all the stupid restrictions we've had before that you could only spend the money in certain ways - namely, on acute-care facilities. You finished up with the situation the member for Rossland-Trail (Mr. D'Arcy) very correctly pointed out: you have people in acute beds who don't need to be there. The reason they're there is purely financial.

On that point - and I don't want to belabour it, Mr. Chairman - I have one specific issue which I have talked to the minister about privately and which I feel I must try to mention fairly quickly. It's a situation which arose as a result of the old system whereby people were discriminated against, depending on the diagnosis and depending on where they received the care.

Now the minister knows that the file on this particular issue is thick, and I promise the Chair and the committee members I'll be as brief as I can. It sort of compares, if I may say so, to the famous case in the United States of Karen Quinlan, the young girl who is unconscious and has been so for many months.

Since the people concerned, Mr. Chairman, are desperate, they've given me permission to use their names. I'm referring to Mrs. Samson, who was admitted to the Victoria General Hospital, which was then St. Joseph's Hospital, on October 8,1970, with viral -encephalitis, which is a condition which produced almost total unconsciousness and a great degree of paralysis, to the extent that she had to be fed by a nasogastric tube. This lady, I might say, was born in 1905. Apart from the first six months of her life she's lived all her life in British Columbia. She has never been in a hospital prior to this illness.

Her two daughters - and I'm speaking on their behalf; they're both constituents of mine - were told in January of 1971 that their mother was no longer an acute-care patient and that she should be in an extended-care facility. I want to be fair and accurate

[ Page 3645 ]

and acknowledge that there is a difference of opinion as to what the daughters were told at the time they were asked to remove their mother from Victoria General Hospital, but there is no question that they were told. I have this confirmed by the attending physician at the time.

There was not an extended-care bed available. They inquired of private hospital facilities in the city of Victoria, and the private hospitals immediately held up their hands when they realized that the patient was unconscious or almost unconscious and required nasogastric feeding. Without going into all the details the long and the short of it was that the daughters both gave up their jobs - both of them were earning good money in jobs, one of them in another part of the country - to take their mother home and look after her. They acquired the hospital-type bed and the suction apparatus and all the facilities that were required to look after her at home. That was on January 29,1971.

I was made aware of the problem in 1972. 1 went to the house and discussed the matter with them. I subsequently appealed to the then Minister of Health, the Hon. Dennis Cocke, and from August, 1972, to February, 1973, he did authorize payments to cover the cost of looking after Mrs. Samson in her own home. At this time it pretty well involved having a registered nurse three shifts around the clock for the reasons I've mentioned - the condition of the patient.

At this time there is an area of difference of opinion subsequent to February, 1973, when it is alleged by the officials in the ministry that the daughters refused to accept a bed for their mother in certain facilities when they became available. I'm generalizing, because we needn't go through dates and specific times, but there is a memo from the chairman of the provincial adult-care facilities to the minister dated December 6,1976, which alleges that the daughters did not always respond when a bed did become available. The daughters in turn have been to my office and they've gone over that memo. They, in my opinion, offer some pretty reasonable and substantial explanations as to why all of that memo is not accurate. But we're not going to get into an argument of who said, he said and so on.

I think there is enough evidence here to indicate, first of all, that there was no disagreement whatever by any party in the medical arena but that this unfortunate woman required extended care. That's not in dispute in the memos or the correspondence. What is in dispute is that at a certain time a bed became available, for example, when the daughters were out of town and could not be contacted immediately. There was another occasion when a bed became available and the family physician stated that the patient had a super-added infection and it was not wise to have her transferred and admitted, as much for consideration of the other patients she would then be going to mingle with.

And so, Mr. Chairman, what has happened is that finally Mrs. Samson was admitted to the Royal Jubilee Hospital because of acute complications in October of 1973. She was subsequently transferred to Gorge Road Hospital, the new extended-care facility, in January of 1974. She has been there since that date and is there now in the same condition.

Now in the meantime the two sisters, Mr. Chairman, have incurred debts which I have listed here. Up to the time she was admitted to the Gorge Road Hospital, they have incurred private debts, they have lost their home, their cars, just about everything they possess. One of the sisters has had her own personal wages garnisheed and they still have a debt of $26,000 outstanding to the bank.

All I'm asking the minister, and I'll be as simple and plain as I can.... I and his department could argue for many hours, I suppose, about what motivated the sisters to reject a bed at a certain time when it was offered or delay accepting the bed or whatever. But I just say, really, in a humanitarian sense, that this lady, the mother who has now been all but unconscious for six years, requiring round-the-clock care - that is not disputed - is a crying example of how certain people were discriminated against, depending on the care they needed and the place where that care was provided.

I'm just saying, Mr. Chairman, that regardless of arguing about why certain decisions were taken by the two daughters, they happen to be two people who perhaps represent the other side of the coin that we hear about so often - that young people just dump their parents when they get old and sick or push them off into an institution. I'm talking about two daughters who didn't only go the extra mile, but they went about an extra 1,000 miles.

While the cost they got involved in might have been terminated sooner - and I'm not arguing that because I know there's a difference of opinion on certain of the dates when a bed was offered - surely morally, had these daughters not been of the motivation and loyalty to their mother that they were and had they at the first available opportunity, which was the day they were asked to take her out of Victoria General Hospital....

I have been on this roundabout many times because I've had patients where I as a physician have been told to tell the relatives to get Mother out of this or that hospital because she's not acute-care any more. This is most distressing to relatives, as anyone can imagine. So time and time again relatives have said - "Well, where do we put our mother or our father or grandparent?" - as the case may be. Some people dig in their heels and say: "It is not my fault if there isn't a place for Mother. That's not my responsibility. If she needs care in a hospital facility

[ Page 3646 ]

and the right kind of facility isn't available there, tough luck. She'd just better stay in the acute hospital at a $100 a day, or whatever."

But these two daughters exhibited a degree of concern and loyalty to their mother and they took her out of the hospital. My fundamental point is this, Mr. Chairman: regardless of where she was looked after, she needed round-the-clock care somewhere. Surely the government at that time would have been morally, at least, subject to paying the daily cost of extended care if the facility had been available, and later on, had the facility been accepted on the very first date that it was offered.

All I'm asking, Mr. Chairman, is: would the minister reconsider his earlier refusal in a letter of March 11,1976, to the two daughters, telling them that he did not think any useful purpose would be served by arranging for a meeting to discuss the matter because he felt that he could not provide any reimbursement?

I'm simply saying this: does it not make at least moral and humanitarian sense that for the number of days that Mrs. Samson was treated at home, 99 times out of 100 that type of case would have been in an extended-care facility for which the government would be committed to providing, let us say, $30 a day? I'm just asking if we could not surely see the compassion in providing a reimbursement to these daughters of $30 or whatever the average has been for extended care over that period of time. Let's pick an arbitrary figure of $30 a day times the number of days that Mrs. Samson was treated at home. Whatever that sum is, subtract, of course, the amount that's already been paid over a period of time by the former Minister of Health.

It seems to me that we are all too ready to criticize relatives when they are the least bit slow or hesitant at looking after their elderly parents. Here, surely, Mr. Chairman, is a case where two daughters - I could talk at great length about this because I feel very strongly about it - gave up, in effect, if not their careers, a great part of their own earning capacity to provide the help and care in the house in addition to the nursing care provided by the professionals.

As I say, I simply can't go into all the details, with consideration for time. But I'm sure that anybody who would review all the material in an objective way might well say: "They were offered a bed for their mother at an earlier date than they took it and that's freedom of choice." But let's not forget that these two members of the family were out working, trying to earn a living to meet the costs and to cope with the escalating debts. Surely the underlying decision that led them to their actions was first and foremost their deep concern to try and get for their mother the care that she required. Let's not forget, also, Mr. Chairman, that the medical advice early on when Mrs. Samson became so desperately ill was that the physician in charge couldn't give any kind of approximate idea of how long she might live. Now we find that the illness has dragged on in almost the same state for seven years. We have, as I say, other examples in the United States where this kind of condition can cause enormous financial costs to families.

I think that the fundamental drive behind the federal and provincial legislation in the last 10 or 20 years, even though I've been critical earlier on this afternoon, is to ensure that nobody should suffer a crushing financial burden or ruin because of the illness of a member of the family. Here we now have two daughters - and I don't know their ages but I guess they are in my age group, late 40s - who have worked hard all their lives. Their mother lived in this province all her life and still does. Their father served this province well as a dentist. They now find themselves at this age in life paying $5 a day on the interest on the bank loan. They pay $600 a month to the bank before they start to eat or try to get around or buy shoes. That is the kind of debt they are in today. I know this is rather a unique case. I also know that some of the points are debatable. But I think the fundamental point is not debatable: this was a lady who required extended care and who received it for some time at home at tremendous expense to the family.

MR. CHAIRMAN: One minute, hon. member.

MR. WALLACE: Yes, thank you, Mr. Chairman. All I'm saying by compromise proposal is not that they be reimbursed for every nickel that they have spent on their mother's care at home, which was more expensive than would have been provided in extended care. Surely, could they not be reimbursed for the amount of cost, which in 99 cases out of 100 such as this one would in fact have cost the government the per them rate in extended care?

HON. MR. McCLELLAND: Mr. Chairman, I wasn't Health minister when any of these events took place, but I am familiar with the file. I can only promise that we will take another look at this situation in terms of what the member has said in the House today and the request he has made on behalf of these people.

I must say that he is a medical doctor and I think he would agree that although we're all striving to allow people to have care in their own homes if they wish it, there comes a time with the nature of the disease that a person might have and with the sophistication that is necessary in terms of round-the-clock nursing services, that home care does become completely impractical. That is one of the reasons that we do build extended-care institutions.

This case is not as simple as it might be made out.

[ Page 3647 ]

There were a number of opportunities during the time span that was described by the member for Oak Bay in which the ladies had the opportunity and possibility to have their mother placed in an extended-care institution. Mr. Loffmark offered in 1972 to have Mrs. Samson put at the head of the extended-care waiting list in Victoria, which is most unusual and is not done very lightly, because of the number of people who are waiting for that kind of care. The minister directly before me, Mr. Cocke, did agree at one time to pay, despite the fact that these ladies had for one reason or another apparently refused a bed at an extended-care unit, for special-duty nurses until a bed was available at the Gorge Road Hospital. The department has paid out some $10,000 to these ladies, which I also would say is quite unusual.

I have no hesitation in agreeing with the member for Oak Bay (Mr. Wallace) , Mr. Chairman, that, yes, there was discrimination here, as there has been for many years in this province in terms of those people who are left out of the health-care system. We are attempting now to end that discrimination, and will, beginning with the new programme.

But I see some dangers, Mr. Chairman, in giving this kind of an approval. While I'm in full sympathy, where do we go with all of those people who have expended all of their savings in private hospitals, for one reason or another, just as has happened here? Without getting into all of the details, as the member has said, I don't really want to go over this much more, except to say that two Health ministers have considered this situation very seriously and both have come to the conclusion that the government had been quite fair in its treatment of these two ladies. At this point, I agree with that conclusion by the two previous Ministers of Health, but I promise the member I'll ask my staff to look at it again and see if there's any justification for a different conclusion.

MR. D.G. COCKE (New Westminster): Mr. Chairman, the Minister of Health is starting out his estimates very low key and there is very responsible debate going on in this House, Mr. Chairman. I'm delighted to find that. I certainly feel that I have some empathy with the way a Minister of Health might feel on the first day of his estimates, having had a little bit of experience.

HON. MR. McCLELLAND: First day? Aren't we going to finish today?

MR. COCKE: I had a long meeting with my colleagues just before we got in the House and I suggested that we finish in three or four days. There was a scream and a holler and they said: "No. There's no possibility of any such thing." I said: "Well, what we have to do is see whether we can come up with some sort of middle of the road." The middle of the road seems to be a week and a half or two.

HON. MR. McCLELLAND: I'll send for sandwiches.

MR. LAUK: I like the way he's supported by his colleagues on the front bench.

MR. COCKE: Yes, my colleague for Vancouver Centre also has empathy for the minister -sympathy, really, under the circumstances. He feels that he's not getting the proper support from his cabinet colleagues. Right now they're busy in a special cabinet meeting deciding who his successor might be.

Mr. Chairman, first let me say that when the minister got up on his feet he talked about two personalities in his ministry. One was Dr. Elliot, a long-time member of the ministry who has served the province well. I'd just like to say about Dr. Elliot that he wrote the first Foulkes report in 1948. It wasn't published until 1952, at which time it received loud acclaim, particularly from the medical profession. Incidentally, if you read it today you would say that it wasn't all that progressive a document. It wasn't all that bad, but certainly in that day it was a very progressive document. But I don't think it deserved some of the acclaim that it got from the medical people of British Columbia. As a matter of fact, it was widely known as the Alein Kampf of B.C. - not Mein Kempf but Mein Kampf. As I say, he did serve the province well. We, as a Legislature, are certainly going to miss him, and those of us who can meet him from time to time will continue to enjoy his humour. I was the butt of that humour on occasion, as I'm sure the present minister was in the short time he served with him. I would like to ask the minister to answer the following questions sometime later on in his estimates: when are you going to replace him?

Anyway, getting on to the next personality whom he described, Bill Lyle is the deputy minister of hospital programmes, and medicare, and all those very intricate and involved situations that a Health minister has to cope with. I must say that my relationship with that particular individual was a very fine relationship and I had tremendous support. Certainly he has a tremendous background of experience, going right back to page boy in this House - and certainly nobody would dare suggest when that might have been. But he was that and everything else along the way. I certainly have nothing but great good to say about Bill Lyle because he is what we all consider to be the finest of public servants.

Mr. Chairman, having said all that....

Interjections.

[ Page 3648 ]

MR. COCKE: I kind of resent my colleague from Rossland-Trail calling me a bottom liner. I'm looking across the floor at that present minister, who, I realize, hasn't too much control of his direction, having always to look out of the corner of his eye toward the Minister of Education (Hon. Mr. McGeer) . But some of the things which I think he was responsible for - he and probably the Premier and the Minister of Finance - I consider to be real bottom line.

For example, we in this province broke our backs trying to set up an ambulance service that would be a real provider of health care for people in British Columbia - what we say was a preventive service Some would say it's not a preventive service. Ambulance service is something that occurs if a person is deathly ill or is in an accident and has to be rushed to a hospital. It's far more than that, Mr. Chairman. An ambulance service is something that will provide for a reduced impact of illness if a person receives treatment early, or a reduced impact of an accident or trauma if a person receives immediate attention. The last thing we want to do is provide motivation or people not to use an ambulance service, yet that was one of the first things that that minister did. The first thing he did was triple the rates, but it's much worse than tripling the rates because there's a mileage charge beyond the tripling over a certain number of miles traveled.

So, Mr. Chairman, I can remember when this province under the old Socreds had not even an Ambulance Service Act. When we took over in 197 you could have used an old dray; you could have hitched up old Dobbin to the shay; you could have used a light delivery truck-1 you could have done anything you wanted with respect to providing an ambulance service and it was acceptable under law -under statute. The first thing we did was see to it that that was changed. We brought in an Ambulance Service Act which saw to it that there were standards that had to be met, both in vehicles and in services.

Well, Mr. Chairman, that was a good start, we felt. We also saw an ambulance service that was haphazard in the province. In Omineca there are one or two volunteer groups. I'm not suggesting there's anything terribly bad about it. But, Mr. Chairman, I'm sure you'll agree that you don't leave to chance something that you can care for in terms of provincial responsibility. We decided to take that responsibility. We decided to set up an ambulance service. We called it an emergency service because the concept goes way beyond just providing an ambulance. It goes to the extent that it ties in with the hospitals and with the health-care people in the communities, and to the extent that it will provide good service.

Well, there was a training programme and it was expanding and broadening the service. It was a service that was, to a large extent, preventive. It was a service that would be the envy of the whole country. As a matter of fact, Ontario - which has had its own ambulance service for years, incidentally - was beginning to look at us and to say: "Well, you know, those people are on the right track." We had a good training programme. We had even gone to the extent that we had ambulance attendants who were no longer ambulance attendants; they were real emergency attendants, the like of which were not to be found anywhere else in this country. Those of us who see American television from time to time notice that they use this level of attendant - we had gone even beyond what they suggest on television!

So, Mr. Chairman, we were delighted that we were going in that direction. The new bottom-line government came along and reduced the service in this respect: they cut back in training and in access and they increased costs prohibitively. They increased costs to the extent that we get letters from people like the registered nurses at St. John Hospital. Where's St. John Hospital, Mr. Chairman? Omineca! The member from Vanderhoof, Burns Lake and Houston - the Omineca riding - doesn't seem to know that the people who are directly involved in health care in his constituency are very strong supporters of the ambulance service.

I'm not saying that the present minister isn't. I'm sure that he is. But he saw that there had to be some way that you could reduce usage, and I say that's very wrong. Mr. Chairman, the minister last year said people were using the ambulance service as a taxicab; they were not. I would ask him to prove that. We saw very little of that.

We saw people who needed it using it and not abusing it. There's always going to be some abuse regardless of what you do. So that's really what it's all about.

But, you know, the deterrent doesn't necessarily hit everybody. Let me tell you about a situation that occurred just the other day in New Westminster. Here is a chap, a Mr. X. He was taken by a friend to the Royal Columbian Hospital. He spent the day there in emergency receiving tests.

Late in the day he was told that he would have to be taken to St. Mary's. They didn't phone his friend. They sent him in an ambulance from the Royal Columbian to St. Mary's. It cost $15, and he was not acutely ill. The system decided that he should go by ambulance; it was a lot easier for them. They could have sent him in a taxicab. This isn't what the ambulance service was meant for. So often, I suggest to you, the system tends to abuse itself - it's not necessarily the patient - and so this chap is billed $15.

He's lucky it was close. I have incidents where people have been billed over $100 for little trips back and forth between hospitals, out for this care, that care and the other care.

[ Page 3649 ]

Mr. Chairman, I suggest to you that this bottom-line thinking has a detrimental effect on the delivery of health care. The minister was forced, I'm sure, because he had announced when he first became minister that there would be no increase in cost. That was one of his first pronouncements. But he couldn't stay that attractive forever, because either the Premier or the Minister of Finance (Hon. Mr. Wolfe) got to him and leaned on him. It was the same message that they managed to put over to the Minister of Transport (Hon. Mr. Davis) who increased the ferry rates, and the Minister of Education (Hon. Mr. McGeer) who lambasted us on insurance rates. They had to do it in health care too. But it didn't stop there, and I wish it had. No, it has to go through the whole system.

I said in this House - and I don't know on how many occasions, including last year - that it is an abuse to increase hospital rates, particularly the per them where it affects people to the extent that they just cannot manage. So many people now have been in the hospital for a relatively extended period of time, and paying $4 a day has become a very great hardship. We suggested this in the first place- that's why we didn't raise it from $1. We say ~o the provincial government: what did they gain? They gained very little. I'd like to see the collection of some of those accounts and how they're doing.

Mr. Chairman, when you say that the average hospital patient is there for six days, you're using statistics. Statistics will go on to tell you that a stream averaging six inches in depth can drown a person. That's a practical thing. This stream averaging $4 a day can drown some people and it does, economically.

I think in terms of the middle-aged person who has a heart attack. He's not in there for six days. Do you know who's in there for six days or less? Do you know what brings down the statistic? A child who goes in for a tonsillectomy - they're in today and out tomorrow - or day surgery, and all these kinds of things. But when there is a real serious illness, where there's an extensive period in the hospital, that's when you really affect people where they're at. Not only are they being affected anyway by the fact that they're ill and unable to work, they're then being smashed down by the system, Mr. Chairman.

That's the kind of bottom-line thinking that's crept into the health care field. It didn't even creep in under the old Socreds. The new Socreds are more dangerous because they've got that Liberal and Conservative influence in there that's destroying them and ripping them apart. Look at the Minister of Municipal Affairs (Hon. Mr. Curtis) sitting there like the cat that swallowed the canary because he got through his estimates in record time, Mr. Chairman. I don't know what happened to them when they were sitting in the opposition on all sides of the House and getting together. The only thing that they had in common was: "Well, I guess we have to find a philosophy." The thing in common was the search for a philosophy, and the easiest philosophy, of course, to come by....

Mr. Chairman keeps looking at the vote. He doesn't see how I'm relating this to the vote. Mr. Chairman, I'm talking about the minister's office vote. He's part of this group, which is almost a conspiracy, because they looked at the bottom line and they applied it everywhere they could -ambulances, hospitals, and to every other aspect that had any potential for providing the dollars. I suggest to you that they're not raising that many more dollars; they're just raising Cain with a lot of poor people who need help, not the kind of treatment they're receiving from our present provincial government.

Mr. Chairman, I think that the present government has to either rethink or spend a lot of time in opposition in the future repenting. People are not going to buy, for any length of time, this kind of abuse. There was a universal health-care plan brought in; there was universal access to begin with. But now, Mr. Chairman, it has been decided by this new government - a government that thinks in terms of the middle class having access and the poor not needing access.... Mr. Chairman, this is the kind of government that will go to its just reward in the not-too-distant future, I'm sure.

Mr. Chairman, maybe the new minister - he's not so new any more - will decide that he's going to fight for the ordinary people, fight the way they want him to fight up in Omineca, fight the way they want him to fight in other areas of the province - but, for heaven's sake, fight.

I'm not going to talk about the university hospital today. I want a night to think about what the minister had to say. Poor minister. I know that he is stuck with it whether he likes it or not. In any event, I would like to just think over some of his words and we'll go on with that just a bit later.

One of the things that I would like to bring to the minister's attention, just so we can change pace a little bit, is a situation - not his fault - that I would like to have him think about that can occur in a place like this in our health scheme. I was contacted in May by a young fellow who had left Ontario. He came out here and got as far as Kamloops. He was contacted to stop at Kamloops and get to the hospital. They had found something in a test that had been done on him before he left that was relatively critical and he had to get to a hospital and have some care.

Let me read to you parts of his letter: "I am writing in concern with a matter that happened in Kamloops B.C." He gives his name.

"I arrived in Kamloops on May 4, and on arriving I phoned my parents in Windsor, of

[ Page 3650 ]

which I am a resident. My mother informed me that Grace Hospital in Windsor was trying to get in touch with me as a result of x-rays I had on my lungs. They informed my mother for me to get in touch with the nearest hospital, whereupon I was directed to Inland General Hospital. On arriving there I met a doctor."

I'm not going to name the doctor.

"Explaining the situation to the doctor, he proceeded to give me approximately two minutes of examination. I explained to him about the phone call from Grace Hospital in Windsor and offered to pay for a call back to Windsor. He refused.

"I then asked if there was an ambulance service so that I could go to the nearest hospital, which was located in Ashcroft." -denied access in Kamloops. "He refused this service and I was told to take a taxi, which I proceeded to do. On arriving in Ashcroft, they had already been informed of my coming. I did not receive any medical help. The taxi cost me $41.

"I was informed that I could go to a hospital in Vancouver, which I did in a taxi, which cost me another $160. On arriving in St. Paul's in Burnaby, I was admitted to emergency, where I was examined."

Incidentally, everything that happened after St Paul's was relatively good. Mind you, he took of from the province as quickly as he could get out o here because the feeling was that he wouldn't be covered by our province's health-care plan to the extent that he would be back home.

Mr. Chairman, I would have brought this to the minister's attention except for the fact that it al happened so fast that lie was gone. I'm bringing it to his attention publicly because I think it's important that we all know that this kind of thing can happen in our health programme.

I don't believe anybody - I don't care whether they're transients or not - should be rebuffed from our health system. A responsible medical team a Grace Hospital in Ontario asked that this person be hospitalized. He needed hospital care and still does incidentally; he's seriously ill. He's back home now receiving hospital care. Mr. Chairman, I suggest that these are the kinds of things that we must impress on our health-care teams must not happen.

This particular individual, incidentally, has rea difficulty with another department of government but that's something I can take up with that department. But he was here and gone in very short order and, Mr. Chairman, I'm going to bring to the attention of the minister the sequence of events and the people involved in that sequence.

I did feel that it was important that we discus publicly some of the things that can happen in you health-care system. I'm not suggesting that it couldn't have happened while I've been there. Of course it could have. What I am suggesting is that it's something that we should be very aware of and that we should police to the best of our ability. I don't think that anybody should be rebuffed; I don't think that anybody has the right to rebuff a person from our health-care scheme. Incidentally, it cost this young fellow over $200 in taxi fares to get to Vancouver, which broke him.

So, Mr. Chairman, having said that and having indicated that I will give this information, which, incidentally, is all over.... But the only thing we can use it for is to guard against it happening in the future. I will ask the minister what he thinks about a thing like that happening, Is this a part of a bottom-line philosophy that has even managed to seep into those institutions which we have concern for and into the people providing care?

HON. MR. McCLELLAND: I find it a little difficult to understand. I don't know anything about that case; the letter never came to me. If it had I would have investigated it immediately.

MR. COCKE: Just a minute. I sent you a copy of the letter on June 23,1977, so that it would be nice and handy for you. Anyway, I just sent you the whole copy.

HON. MR. McCLELLAND: Okay. Well, I'm not familiar with the case at the present time. It will be investigated as soon as I become familiar with it. You know, nobody knows whether the facts in that letter are correct or not.

MR. COCKE: I had them checked out.

HON. MR. McCLELLAND: If they are, then there should be some serious investigation done, I agree. It seems strange that someone would take a taxi from Kamloops to Vancouver for $100 or something when you can get to Vancouver from Kamloops by air for $35. You know, that just doesn't make much sense, but nevertheless, I'll certainly look into that the first opportunity I have.

Comments about our hospital rates I'll take as notice, but I do want to make some comments about the ambulance service. I recall going through this I same debate in my estimates last year. The speech today from the member for New Westminster is t almost identical to the speech he made at that time. I would hope that I won't make the same reply exactly, at least, because there have been some changes since that time.

But I would like to remind the House, Mr. Chairman, that the member has his facts wrong again, certainly about training of ambulance personnel.

[ Page 3651 ]

Training of ambulance personnel now is at a higher level than it's ever been before. When the training was stopped because of cost factors.... The training wasn't stopped by the Social Credit government; it was stopped in the summer and fall of 1975 by the former NDP government. There was no training going on when this government came to office except for one small course which was continuing. There was no training going on and the former Minister of Health knows that, Mr. Chairman.

MR. COCKE: That's nonsense!

HON. MR. McCLELLAND: I pointed that out, and if you'll check Hansard from last year you'll see that that was pointed out very clearly at that time.

But today the EMA I programme, an 80-hr. programme, is now being offered in all communities where we have part-time personnel who will make themselves available at weekends. We have more than 30 communities now who've expressed their willingness to do that, Mr. Chairman.

The EMA 2 programme is a six-week programme. It's been restarted and by the end of this summer all full-time Emergency Health Service Commission ambulance crew will have achieved that level of training.

The second paramedic course - EMA 3 - at Royal Columbian is completed; nine persons recently graduated. Arrangements are now being made to run a similar one-year course at the Vancouver General Hospital. The situation with regard to training paramedics and ambulance personnel has never been better in this province, and I'm very proud of that.

Mr. Chairman, in terms of rates, yes there was some adjustment of rates. There was also what the member for New Westminster forgot to mention at that same time - a significant expansion into air ambulance in British Columbia. The small charge which is being made - $15 per ambulance trip on a basic charge - when you relate it to the programme which is now being developed and now has developed in other areas of this province, is a small measure to pay for those people who have short distances to travel by ambulance as compared to those who, of necessity at times, must be transported for hundreds of miles.

The increase in the budget for ambulance services - and I know I shouldn't reflect on votes - is an increase of 90 per cent in two years, Mr. Chairman. That reflects the concern of this government for providing good ambulance service all over this province.

You mentioned Omineca. You should talk to some people from northern British Columbia about ambulance charges - through you, Mr. Chairman -because I can tell you they are very happy with that new air ambulance service. I can give you some examples of the kinds of charges which are being made now as compared with what people had to pay previously - for instance, to transport a patient from Vancouver to Castlegar. I'm talking about stretcher patients, Mr. Chairman. At one time, a patient had to pay for six seats in an airplane; it would cost the patient $374. Today, it costs $56.60. By road ambulance, of course, that charge would be about double. From Fort St. John to Edmonton, it previously cost $470 by air and $893 by road. Today, it costs $59.80. From Kamloops, it previously cost $317 by air and $1,000 by road. Today it costs $42.60. From Prince George, it previously cost $468; it is now $77. From Prince Rupert, it previously was $580 by air and $2,000 by road. It is now $100. From Williams Lake, it was previously $377 by air, it is now $55.80.

1 can tell you, Mr. Chairman, that the people in those communities are pretty happy with the ambulance service and the charges which they are now required to pay. It was a good expansion of services and one of which I am very happy to have been a part.

MR. D'ARCY: Mr. Chairman, before I proceed to some areas I've not been able to get on to as yet, I would like to ask the minister a question, He indicates that we in B.C. do not give the correct opportunities for our young people or people of any age to get into medical school and become medical doctors. I think that is true, but I would ask the minister where he seems to get this idea that B.C. is a sovereign state with its own immigration policy. Does the minister intend to use the power of his ministry or of government to prevent or restrict the movement of other Canadian citizens from the other nine provinces who are qualified medical practitioners from practising their profession in British Columbia? If he is not, then there is absolutely no way that we are not going to have an increasing surplus of medical doctors in this province if we increase the number that we are going to be graduating. If we were a sovereign state and if, in fact, the government is going to assume a separatist policy on this, I think they should let the committee and the public know. Certainly to my knowledge there has never been, nor is there allowable under the British North America Act, restrictions from one province to another regarding any occupation or profession. One of the reasons for having a nation as we have known it is that people can move freely from province to province, and if they find opportunity they can go into business or find work or practise their profession.

Mr. Chairman, dealing briefly once more with the proposed medical school at the University of British Columbia, I think we have covered the areas as to whether or not we in fact need more doctors or

[ Page 3652 ]

whether that is desirable. I would, however, like to go into one other aspect of it and that is: is it possible to expand the medical school in British Columbia at UBC without building a new hospital? In other words, have the ministry and the government examined the possibility that the infrastructure in the other teaching hospitals could be expanded to provide the increased number of enrolment and graduation opportunities that the government seems to desire, whether they're needed or not?

I've noted that most of the work of the first-year students exists completely on the campus without the teaching hospital - it's clinical work. The third- and fourth-year students are already in downtown hospitals - in the other teaching hospitals. Those hospitals say they could expand to include the greater number, not only for doctors but for other professions and occupations in the health-care field. What they really are short of is the clinical and laboratory work for second-year students. I'm really beginning to wonder if we're putting out $30 million or $50 million at UBC to provide facilities for second-year students when these, in fact, could be carried in other teaching hospitals already existing in the lower mainland, admittedly with some increased expenditure and some upgrading, which the minister has conceded, and I commend him for it. However, he has announced that that is going to go on anyway in these hospitals. He announced that that is part of the $50 million. I'm not questioning that aspect of it; I'm questioning the aspect of whether or not we need a new facility where there is not a public demand for it.

I would also note that some time ago there was a note in The Vancouver Sun- last December - where it says:

"Health minister Bob McClelland today had no comment on a provincial government planning report saying that by 1981 Vancouver city would have a surplus of 1,000 acute-care hospital beds while the suburbs are 900 beds short."

The confidential report was obtained by The Vancouver Sun and it quotes the minister. He doesn't deny that the report exists, Mr. Chairman, which is, I think, very significant. He says: "I don't know where The Sun got the report but I have no comment to make." In other words, he didn't deny that the report existed; nor did he comment that the report was wrong.

I would have to agree with the report. I think there will probably be a surplus of 1,000 acute-care beds, and I'm sure that's one of the reasons why the minister wants to phase out 1,000 beds.

However, if you're going to tear something down, you've got to put something in its place. I would ask the minister what he intends to do. In fact, that report tends to corroborate comments I've made earlier in this House this afternoon. In the suburban areas of Vancouver, the parts which are growing the fastest, where most of the people are, are now short of acute-care beds. Is the minister planning to take any initiatives in this area? He has said: "Yes, we're going to build 75 beds in Coquitlam and 75 beds in Delta." That's 150. Part of those gains will be cancelled out by reduction in the number of beds at Peace Arch, Royal Columbian and Lions Gate. In any event, even if that were not so, we're still something like 750 beds short, according to this mythical report which the minister has yet to table in this House but which he does not deny exists. Mr. Chairman, that was some seven months ago.

I would like to talk briefly to the committee about underutilization of some very expensive facilities and underutilization of some very, very capable surgical staff. I'm referring particularly to the open-heart surgical facilities at the Jubilee right here in Victoria. I appreciate the fact that there are some staffing problems in the post-operative care - that is, not staffing problems with existing staff but problems in being able to hire the correct number. I understand there have been advertisements placed, and they simply cannot find sufficient numbers of qualified, experienced staff.

However, I am of the opinion that they are overusing the post-operative facilities. In fact, they are moving open-heart post-operative patients around from the open-heart facilities into the ICU. Hopefully there's not going to be a major disaster demanding immediate use of the ICU. They're managing to handle six to eight patients a week. They claim they could use the ability to handle 12 to 14 in the greater Victoria area. In fact, one report I have indicates that eight or nine patients per week are referred to the Vancouver General Hospital. The waiting list for open-heart surgery in the greater Victoria is eight months long.

Now, one could say that this is very expensive; this is a Cadillac facility. There is a fairly high capital cost, although not as much as for other areas of surgery. Certainly there's a very high cost of post-operative care. Mr. Chairman, again referring to the bottom line, I would suggest that this represents a bit of a strange priority for the government because the facts of the people who go through this rather spectacular means of surgery certainly bear out the economic value as well as the human value of this kind of surgical work.

I note that some 75 per cent of the patients who are treated go back to work in a functional, producing job. Of the 25 per cent who don't, in most cases they either prefer not to go back to work because they are of retirement age or because they do not do what our society views as productive work -that is, they may be a house person. So while they may be functioning in a home, they're not in fact

[ Page 3653 ]

earning a wage or salary.

Now if these people, before they became disabled, were in the productive mainstream of society, Mr. Chairman, I suggest that if they're six to eight months on a waiting list, this would mean that a great deal, if not all of that time, they are out of the work force, not performing their professional duties, not minding their businesses. This represents a productive loss to British Columbia. Indeed, in many cases, they end up before their eight-month waiting period is over on unemployment insurance or social assistance - again a double loss to the economy of British Columbia, both in the institutionalized care and the fact that they need to receive money from the public purse. At the same time, they could be and would desire to be productive citizens,

I would hope that the minister and his senior advisers would move very quickly to see that the adequate physical facilities are placed in the greater Victoria area - I presume at the Jubilee, since this seems to be the hospital that does this sort of work in greater Victoria - in order that not only can this human suffering be alleviated but that this tremendous economic loss to British Columbia could be averted.

My information is that the surgical capacity is there; the main problem is the post-operative care and the number of beds and the facilities in the ICU.

Mr. Chairman, I would also like to make a plea. I'm sure the minister has had this plea from hospital boards all around the province that there could be some speed-up in the process by which applications are approved for capital improvements by two hospitals. It seems as though a submission will take months and months to get approved, or months and months to get rejected, or it may come back amended with very little information as to why the ministry is unhappy with the nature of the proposal as it was submitted by the regional district or hospital board. I know this is an ongoing problem; it's not something that suddenly arose with this minister. However, I would note that at the local level the general public do not frivolously or spuriously approve massive hospital spending bylaws or referenda, When they do so, they do so because there's an obvious gross need in a certain area. To have to wait two, three, four or five years for action does seem to be a bit much.

Mr. Chairman, I'd like to raise the question of the reports I have had that some public hospitals in British Columbia, and many private ones, are in fact taking advantage of the funding provided by the Ministry of Labour to hire students during the summer. I see no reason why these shouldn't be made available but, in fact, this is a travesty of the intent of this particular funding. I gather recently the Labour Relations Board has ruled against the Burnaby General Hospital because the Burnaby General Hospital was in effect laying off regular employees and hiring students under the student employment programme in their place. If this is happening in the public hospitals, we can be assured it's happening in private nursing-care homes in all parts of the province. My information is that it is happening. I appreciate this may not be immediately under the control of the Health minister; however, the hospitals are arguing that it is the budgetary restrictions they have been placed under by this minister that are forcing them into this situation.

I would also like the minister to tell the committee whether he is going to be taking action on the Hall report, particularly relative to practical nurses and orderlies in the province of B.C. Certainly one thing I thought that we were all in favour of in this House, including the minister, was on-the-job training and on-the-job improvement in an ongoing way for all occupations and in a great many fields, whether it be in health or any other area.

Certainly a significant amount of the operating costs of such programmes are going to be covered by the federal government Department of Manpower. The minister has already said that the name of the game as far as he is concerned is to get as much assistance out of the federal government as possible. Here's an area where there has been general approval; I gather the industry committee has approved the programme in principle.

Can the minister tell the committee whether he is going to earmark the relatively modest amount of provincial funds 'hat will be necessary to take advantage of the federal funds? I believe, and I think most people would agree, they are going to give us better s service, greater efficiency and better dollar-for-dollar health care in our public institutions. It seems as though approval has been given in principle but it's one of those things that simply gets lost in the global budget. I hope that the minister, as I said, is going to earmark funds for this particular purpose to take advantage of the federal money. I think it's a very good investment.

Finally, Mr. Chairman, in this particular series of remarks I would like to ask if the minister could possibly indicate whether or not he is pleased with the expenditures that the Hospital Labour Relations Association is encountering in fighting a continuing number of arbitrations. It seems to me in my experience on both sides of the table that when somebody had to go to arbitration it was a desperate last-chance move. We have seen some 20 arbitrations taken to the LRB by the HEW in the last eight months. Most of them have been won by the union and there is in excess of 100 arbitrations to be heard.

Now these are extremely expensive to the HLRA. Arbitrators these days run anywhere from $500 to $1,500 a day. They're extremely expensive to the union. I'm quite sure that they would not be using the funds of their members unless they felt they had

[ Page 3654 ]

no other course. It would seem to me that there's something very irregular here. As I said, in my experience on both sides of the table, if something had to go to arbitration, it was either a test case for the entire industry or else there had been a very serious breakdown on one side or the other. It would seem to me that with this colossal number of arbitrations - 20 in eight months and over 100 yet to be heard - with the ongoing costs, as I say, there must be some irregularities here.

MR. COCKE: Mr. Chairman, I would yield to the minister if he wants to answer those questions. I'm going to change the subject a little bit.

HON. MR. McCLELLAND: Go ahead.

MR. COCKE: I'll change the subject. Mr. Chairman, one of the old critics of the old government - the past government.... It wasn't so old; it never did get old. It didn't grow a long beard.

In any event, one of the great critics of that government was the now Minister of Health. I used to laugh at the way he used to stand here and lambast our different ministers, accusing them off all sorts of misdeeds. So I'd just like to develop something here for the minister to cogitate upon, and just for the edification of those of us who are around who have a long memory.

Mr. Chairman, The British Columbia Gazette lists, as of July 1, Mrs. C. Gran as executive assistant to the minister. In asking around, I find that Mrs. C. Gran who's listed in the Gazette - Carol M. Gran, executive assistant to the Minister of Health - is not here. She's located in Langley, I'm told. Yes, and if you phone at the right time you could get her, probably, at 534-5975. It's a Langley number, Mr. Chairman.

The Premier should smile, you know; that Premier has more political hacks than any Premier in the history of the country, let alone the province.

Mr. Chairman, order-in-council 1299 appointed Pat Rogers as administrative assistant to the minister at the usual executive assistant salary of $19,500, effective April 1,1977. He's also listed in the Gazette. However, look at vote 169, if you would, the vote we're discussing at the present time. Vote 169 only provides $19,500 for an executive assistant. Therefore, we must assume that the executive assistant is Mrs. Gran, as she is listed as an EA.

My first question, Mr. Chairman, is: what's she doing in Langley? If she's a minister's executive assistant, what's she doing in his constituency? I don't really think that we have the ministerial office extended out to Langley. Where is the salary for Pat Rogers, the other executive or administrative assistant? He's not in Langley I'm told, Mr. Chairman. Where's the salary for Pat Rogers? He's supposed to be an administrative assistant, yet it doesn't appear under 169 although his salary is also $19,500.

1 know where to find him, however. He's in the minister's office. As I suggested, his salary isn't in vote 169 if, in fact, Mrs. Gran is his executive assistant. As I say, the Gazette, if one reads it from time to time, can become quite helpful.

MR. WALLACE: It's often dull, though.

MR. COCKE: It's dull reading at times but, once in a while, you can get something out of the Gazette, Mr. Member for Oak Bay.

I would like the minister to suggest to us what is going on. What is going on in political hackery over there? I can recall that minister, when he was a member of the opposition, standing up and lashing away, talking about hacks and talking about flacks. Mr. Chairman, the minister has even hidden one,

HON. MR. McCLELLAND: Where?

MR. COCKE: You can't hide it further away than Langley, when that is as far as your constituency stretches.

MR. WALLACE: The case of the hidden hack.

MR. COCKE: That's right. Mr. Chairman, I would like the minister to stand up, tell us what it is all about, and then apologize for his abusive ways in the old days when he used to scream and rant and rave at one executive assistant who might be found in a ministerial office - with justification. Certainly you can find an executive assistant in any ministerial office. There is nothing wrong with that. But when you start finding them out in the constituency, then one begins to get a little bit suspicious that something is going on,

Mr. Chairman, if necessary, I'll ask him to read the quarterly supplement to The British Columbia Gazette. He'll find under Ministry of Health, on page 8, Caroline M. Gran, executive assistant. He'll also find Patrick James Roger, administrative assistant. One of them is found under his vote and the other not. One is found in his office and the other is found in his constituency. It's political hackery from that minister who once was so profoundly critical of any thought of an appointment that could be of assistance to the minister. Repent and resolve to walk on a higher ground in the future. -

HON. MR. PHILLIPS: Sin no more!

MR. COCKE: Of all the people who could say, "Sin no more, " guess who said it?

MR. CHAIRMAN: Order, please.

[ Page 3655 ]

MR. COCKE: The Minister of Economic Development! Well, it was good advice, even from that minister. But I'll tell you, it's reciprocal. I'm sure the Minister of Health could reciprocate, and I'm sure he will, when they get into the cabinet room behind closed doors.

Mr. Chairman, 1 will be interested to hear what the minister has to say about all his helpmates out in the field and in his office.

HON. MR. McCLELLAND: Mr. Chairman, I'd like to deal with some of the questions raised by the member for Rossland-Trail (Mr. D'Arcy) .

On the HRLA question that he raised with regard to the number of arbitrations, I'm concerned not necessarily only about HRLA but about the stance that is being taken between the union and that bargaining agent for the hospitals. It seems very arbitrary on both sides to me. In the conversations we've had in my office, I've suggested on a number of occasions that surely there's a way that that hard ground can be made a little easier. The only way that can be done is with full co-operation between both sides.

That is of some concern to me, but I'm not directly responsible for HRLA. The hospitals are, although we fund it. So we've got some concern there, and I'll accept the remarks that were made by the member, Mr. Chairman. That's part of ongoing discussions and negotiations with us. 1 hope that we can solve some of those pretty rigid stances that are being taken on behalf of both sides.

The Hall report will be subject of a meeting very shortly between the three ministers who are directly involved - Education, Labour and myself - for discussion on whether it will be implemented and, if so, how. That decision has not been made at this present time. 1 am not aware of the problem that you brought up with summer students. I'm sorry, I'll cheek into it and bring back a report if 1 can. Perhaps we can get together privately if my estimates are over by 6 o'clock and talk about it later.

We had reached a pretty good agreement with HEU in terms of summer students in hospital projects - probably one of the better agreements that was reached among some of the other areas that are employing summer students. HEU was very co-operative in this regard. So I'm surprised if there's some problem. 1 haven't received any direct complaints in my office, but if you have some 1 would certainly like to have them.

Interjection.

HON. MR. McCLELLAND: That often doesn't get to me. Again, it's a specific hospital problem. I'll look into that for the member.

The matter of speed of approvals for hospital projects I guess has been vexing people for years. It takes quite a long time to thoroughly plan and develop a very sophisticated hospital. What happens, of course, is that at this end there's a certain amount of money being made available by Treasury Board and that money has to be made to go around to all of the projects which come over the minister's desk, whether it's this minister or previous ones. I'm not laying any blame here, by any means, but quite often when a hospital board has been told it can go ahead, it comes back to us far in excess of the amount of money which was allocated for that specific project.

MR. D'ARCY: Years may have gone by.

HON. MR. McCLELLAND: No, but years haven't generally gone by. There's just been a lack of consideration for the amount of money available. That's understandable in many ways, because those people out in the community want to get the best service and the best facility they possibly can. Nevertheless, Treasury Board has a responsibility to allocate that money, and we have a responsibility at this end to make sure that it's allocated correctly.

There are a lot of things that can happen between the time someone has a dream of a hospital facility and the time that facility is opened. I think I can safely say that we're looking into the possibilities of speeding up those approvals as much as we possibly can. There has been some red tape cut in terms of the project management concept.

The client-team concept of building the hospitals is proving to be very successful, not only in speeding up those kinds of approvals but speeding up the project itself once it gets underway, and also saving money. A lot of the contracts that are being completed now are coming in well under the estimates, and in some cases as much as $1 million under estimates. The UBC extended-care facility was such a case. So things are moving in the right direction, I think, and have been over a number of years. I hope that will continue to happen. The heart surgery problem at VGH is one which we've addressed ourselves to to a large measure. We put that problem before the special advisory committee on open-heart surgery which the British Columbia Medical Association has set up and asked for their recommendation. Their recommendations came to us some months ago - I can't recall exactly when - and we acted on those recommendations immediately by giving Victoria Jubilee the approval to go ahead with those renovations in order that they could upgrade their facilities and so do more open-heart surgery.

I'll have to check this - and I will - but I think there is not a general eight-month waiting list for heart surgery at the Jubilee , I'm informed that there isn't a very lengthy waiting list at the present time Some people may wait for eight months for other

[ Page 3656 ]

reasons. There are many reasons why there may be delays - a physician-patient relationship, for one thing. I'm informed that the waiting list is not as lengthy as you've indicated in a general way.

For your information, I'm also informed that the new unit is not yet fully in operation. It should be very quickly. The problem of attracting qualified staff is one that isn't. . , . I don't hire the staff -1 the hospitals hire the staff. We would hope that they can get that underway quickly.

Regarding the whole problem of control of medical students, I don't know of any problem that's more frustrating in this province than that one. You asked if we wanted to set up a balkanized British Columbia or something and set up barriers at the border. No, we don't. Nevertheless, we all would agree in this room, I think, that we've got to come to grips with this problem of overpopulation of physicians, particularly in Vancouver, Victoria, Kelowna - in those attractive places, the places where it's very attractive to practise. Immigration has already controlled the flow of new doctors from out of the country, and I understand that's been cut from 1,200 doctors to 450 in Canada last year. That's pretty significant; that will have a significant impact.

I said earlier, and I will repeat it, that we have been negotiating and talking with other provinces in terms of balance of their teaching facilities when our teaching facilities come on stream. Two provinces have already asked us to keep them fully informed as to the stages and the phases in which our new students will come on stream so that they can adjust. I think that will be a pretty co-operative effort on our parts and will help. But beyond all of that, we have this whole problem of medical manpower.

I wish I could tell you today that we've set up this task force now to bring in recommendations, but we're waiting for a final recommendation from the College of Physicians and Surgeons. They've said they'll have that recommendation into us by the end of this month on the makeup and how that task force should operate, what powers it will have in terms of limiting numbers of doctors, devising incentives and other methods by which doctors can be convinced to go to other parts of British Columbia that need their service much more badly. I would hope that once we get that recommendation from the college, we'll be in good shape to set up a task force that will have a self-destruct time to it. It will bring in recommendations and we'll demand of that task force that those be firm recommendations. We don't want any more studies; we've had enough. We really want to come to grips with this manpower problem.

I have no doubt in my mind that we can accommodate these additional students, providing we 'have nation-wide co-operation, as I believe we are getting now. I don't think I need say anything more a) out that.

1 think I've answered all of those questions you raised in the last go-around, Mr. Member.

In answer to the member for New Westminster (Mr. Cocke) , yes, Carol Gran is my executive assistant. Her usual base is in an office in Langley. She was in this office today. She comes to Victoria on a regular basis and works out of this office as well.

What does she do? She's not hiding, by any means; it's never been any secret. What is she doing in Langley? Well, she's working in Langley. I've just forgotten the date that I appointed Mrs. Gran to this position. I appointed her because she had worked for me in a previous position and had done such an excellent job for me that I felt that she deserved to have a much more responsible position. So I gave her that position. I think it was around the first of the year; I can't remember the date of the order-in-council when she was appointed.

But since the first of January this year, I've kept a file of the cases that Carol Gran has dealt with in the Langley office, and I can tell you that it's a considerable work load. It deals with all kinds of people, you know. It's people in the greater Vancouver area who have problems with my ministry, who have difficulty in getting to Victoria and who have difficulty even getting through on the telephones, as some of you who have tried this telephone system in these buildings will know. So she's in Vancouver where it's very easy to get to her, to report complaints to me and hopefully to find a lot of solutions for people in need, through my ministry, Mr. Chairman.

Here's a case of a man having problems with the emergency programme; he couldn't reach the zone co-ordinator. That was solved successfully. A senior citizen had a problem with a Pharmacare card. I might say, Mr. Chairman, that these people are from all over the lower mainland.

Here's a person who's unhappy about some care that they were getting and wanted us to investigate it. Here's another one that has parents in the Edith Cavell private hospital in Vancouver. They're not happy. They're paying $1,600 a month, and what can we do about it? They got prompt attention because Mrs. Gran was able to give it to them. So that's what she's doing in Langley. She's working, and doing a very good job as well.

Mr. Rogers was appointed as an administrative assistant in my ministry and he's doing some special projects at the present time, He's doing some extensive work on some studies for sewage control programmes - alternate methods of sewage control. It's a big job and it's one I asked him to do. I know it will take him a couple of weeks to do that one job alone. As for the money for Mr. Rogers, the approval to hire him and to pay that salary was given by Treasury Board. The statutory approval, as I understand it, is also quite evident to any member

[ Page 3657 ]

who wishes to look it up. His salary, I assume, will be coming from financial contingencies for the balance of this fiscal year. In the next fiscal year that position could then be added to the estimates.

MR. CHAIRMAN: Hon. members, may we have a little order in committee, please?

MR. COCKE: Mr. Chairman, at this hour in the day you never have order in committee, even with you in the chair.

MR. CHAIRMAN: We try.

MR. COCKE: You try and you try, but I'm sure your frustration is great.

Well, Mr. Chairman, the minister - that ardent critic of political hacks - has stood in the House and admitted that he's got them. He said she's working in Langley. She's working in Langley. Isn't that just a little bit embarrassing to the minister that she's working in Langley? Why haven't you got her in the Health building in Vancouver? You've got offices to spare over there. That's where the population is. They're not out in Langley.

HON. MR.- McCLELLAND: Did you have an executive assistant in the Health office in Vancouver?

MR. COCKE: Incidentally, Mr. Chairman, I wonder which constituency belongs to that minister by right of conquest. It strikes me it's Langley. Mr. Chairman, if the minister came from Omineca, he'd have her in Omineca looking after the needs of all the people in the interior, he would say.

Mr. Chairman, that's the kind of arrogance, the utter, two-faced ridiculousness that we've come to learn to accept but not like.

AN HON. MEMBER: Ridiculi.

MR. COCKE: I would just love to stand here and recount the criticism that came from this far corner over here when that minister, then a member, was sitting there screaming his head off.

HON. MR. McCLELLAND: I wasn't way over there; I was in about the middle there.

MR. COCKE: Oh, I'm sorry, he was over here a little bit. Wherever he was, you sure knew he was there because he was an arch critic of anything that could be suggested as political hackery. I suggest, Mr. Chairman, that there's a very good reason to have executive assistants. But those executive assistants should be up front. He already has, because of our government, a secretary or a representative in his riding, just as everybody else has or has access to. But no, Mr. Chairman, he needs more than that. He needs a sub-office in Langley. Heaven knows he's going to need help. But, Mr. Chairman, why does he stand up and pompously deliver a little thoughtful suggestion that the reason she's in his Langley office is so that she can serve the people in Vancouver?

HON. MR. McCLELLAND: I didn't say that.

MR. COCKE: Serve the people in New Westminster?

HON. MR. McCLELLAND: Yes, that's better.

MR. COCKE: He didn't say that. I'll tell you whom it's to serve, Mr. Chairman; it's to serve the minister.

HON. MR. McCLELLAND: I guess so. That's what an executive is for.

MR. COCKE: If once in a while she trips over a situation where she can help him out - heaven knows he needs help in his ministry - he'll get some help. But, Mr. Chairman, he's buried an executive assistant in his riding to look after his political affairs in the riding. Not only does he have her, he's also got a political representative in the riding in his office. If he doesn't, he has access to one, but not, Mr. Chairman, at $19,500 a year. You see, the representative in the riding is paid something in the order of $800 a month. That would be something in the order of $8,000 a year. Well, I can see that's significantly less than what one of our reps get in our ridings. She's a political appointment to a minister who used to abuse the old government over this very issue. Now he's carried the abuse to the extent that he has an executive assistant in his riding to serve his needs.

Mr. Chairman, that's two-faced and nothing short of pompous arrogance on the part of that minister. I can't say he's a hypocrite because you wouldn't accept that, but it is hypocrisy to pull this kind of situation.

I'm sure the minister would like jump up and tell us why that person is in Langley, why the executive assistant is in his riding. Why isn't she in Vancouver-Burrard at the health centre? If you want somebody over on that side of the water, why isn't she on that side of the water?

Mr. Chairman, I'm going to give that minister overnight to think about it.

The House resumed; Mr. Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

The House adjourned at 5:58 p.m.