[ Page 3659 ]

CONTENTS

Routine proceedings

Oral questions

Alleged MLA intervention in ICBC. Mr. Macdonald –– 3659

Increased MLA pensions. Mr. Wallace I –– 3660

Details on executive assistant to Minister of Transport. Mr. Lank –– 3660

Appointment of electoral reform commission. Mr. Gibson –– 3660

Environmental review of Cowichan Bay. Hon. Mr. Nielsen replies –– 3661

Competence of Minister of Economic Development. Mr. Lauk –– 3661

Functions of Dianne Hartwick. Mrs. Dailly –– 3661

ICBC claims. Hon. Mr. McGeer replies –– 3662

Committee of Supply: Ministry of Health estimates.

On vote 169.

Mr. Wallace –– 3663

Hon. Mr. McClelland –– 3667

Mr. Barber –– 3668

Hon. Mr. McClelland –– 3670

Mr. Gibson –– 3671

Mr. Mussallem –– 3674

Hon. Mr. McClelland –– 3674

Mr. D'Arcy –– 3676

Hon. Mr. McClelland –– 3679

Mr.Loewen –– 3682

Mr. Wallace –– 3682

Hon. Mr. McClelland –– 3684

Mr. Cocke –– 3685

Hon. Mr. McClelland –– 3688

Mr. Cocke –– 3689

Mr. Rogers –– 3690

Mr. Gibson –– 3692

Mr. Lank –– 3694

Mr. Cocke –– 3695

Statement

Letter to Bill Funk regarding VRB closure. Mr. Davidson –– 3696

The House met at 2 p.m.

Prayers.

HON. G.M. McCARTHY (Provincial Secretary): Mr. Speaker, this afternoon in the gallery we have two couples from Salem, Virginia: Mr. and Mrs. T.A. Carter, and Mr. and Mrs. C. Brand. They are accompanied this afternoon to the House by Mrs. Newell Morrison and Newell Morrison, a distinguished past member of this House. I would like to ask the House to welcome them.

HON. K.R. MAIR (Minister of Consumer and Corporate Affairs): I would ask the House to join me in welcoming a constituent of mine in the Speaker's gallery today, Mrs. Jean McAlpine.

MR. G. HADDAD (Kootenay): It's not too often that I have the pleasure of welcoming a guest and a friend from the constituency of Kootenay. But this afternoon in the gallery I have Mr. Henry Nelson who ~is the president of Galloway Lumber Company. He's a very good friend of mine and I would ask the House to welcome him.

MR. G.R. LEA (Prince Rupert): Well, Mr. Speaker, it's becoming more and more often that I have an opportunity to introduce to the House people from my riding. Today I'd like to ask the House to welcome with me, to Victoria and to the gallery, Dan Miller and Gail Ballard, from Prince Rupert.

Oral questions.

ALLEGED MLA

INTERVENTION IN ICBC

MR. A.B. MACDONALD (Vancouver East): MR. Speaker, I have a question for the Premier. In view of the Premier's statement yesterday that the hon. member for Coquitlam (Mr. Kerster) was only doing his job as an MLA when he intervened in claims against ICBC, does the Premier consider it proper for an MLA to intervene personally in a claim for a company, Surrey Dodge Ltd., when the MLA was president of that company at the time the claim arose and the damage was sustained?

HON. W.R. BENNETT (Premier): Mr. Speaker, a question was asked of me yesterday. My statement related that MLAs ... whether it was not the position of an MLA to make representation on behalf of constituents would not, of course, be doing one of the jobs he was elected to do and that is to be a representative for individuals against the power of big government, whether it's a Crown corporation or government itself.

MR. G.V. LAUK (Vancouver Centre): I thought you'd say that.

MR. MACDONALD: Supplementary, Mr. Speaker: does the Premier consider it proper for an MLA to intervene with ICBC on behalf of a company in which the brother of the MLA was a director?

HON. MR. BENNETT: Mr. Speaker, I think every MLA should, without bias, represent their constituents, and as such, have the responsibility to forward any request that comes to them as an MLA. They have the right to pass the question along to ICBC, to B.C. Hydro - to any Crown Corporation. An MLA can only be derelict in his duty if he does not pass along the request. If there was any concern about propriety it would be that the person receiving the request did not handle the request properly -that is, an employee of ICBC or an employee of B.C. Hydro.

MR. MACDONALD: Does the Premier consider it proper for an MLA to intervene personally with ICBC on behalf of a company, Surrey Dodge Ltd., when the MLA had and still has a personal financial interest in that company, namely as personal guarantor of its outstanding obligations to IAC Ltd. for advances made to the company under a debenture dated August 5,1975, which I have in my hand?

Interjections.

MR. MACDONALD: As a supplementary, I ask the Premier, in the light of these facts, what action he will take with respect to the hon. member for Coquitlam (Mr. Kerster)

MR. W. DAVIDSON (Delta): Nothing, clown!

MR. MACDONALD: I'm not asking for a withdrawal, Mr. Speaker.

MR. SPEAKER: Order, please.

MR. MACDONALD: My question to the Premier is: what action will he take with respect to the hon. member for Coquitlam in the light of these facts, with a view to showing moral leadership to his own caucus?

HON. MR. BENNETT: Mr. Speaker, the member for Vancouver East (Mr. Macdonald) alleges facts and puts motive on them that I do not agree with. The only time there can be impropriety from an MLA in making representations on behalf of a constituent or

[ Page 3660 ]

a member of the public of British Columbia to a Crown corporation of government ...

MR. MACDONALD: Himself!

MR. SPEAKER: Order, please. The hon. Premier has the floor.

HON. MR. BENNETT: ... is if in the request there were threats made.

Mr. Speaker, I would suggest that if the member for Vancouver East is suggesting impropriety in the dealing of claims in ICBC, he make a charge against the person who has the power to deal with a claim improperly, and that would be a member of ICBC. As such, if he has such information and is making such a charge, I ask him to give the name of such person he's making the charge against.

MR. MACDONALD: The question is directed to you.

MR. D. BARRETT (Leader of the Opposition): You're the Premier.

INCREASED MLA PENSIONS

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, I just want to say, if I may, that although I made a decision of sorts today, I wonder if the member for Burnaby-Edmonds (Mr. Loewen) would put away his tape measure. (Laughter.)

AN HON. MEMBER: He charges too much anyway.

MR. WALLACE: On the same theme, Mr. Speaker, I wonder if I could ask the Provincial Secretary if she has held any recent discussions to consider raising pensions for MLAs. (Laughter.)

HON. MRS. McCARTHY: Well, Mr. Speaker, I shall take that question as notice and I shall not take it as being undue pressure on the Provincial Secretary.

MR. WALLACE: Right on!

DETAILS ON EXECUTIVE

ASSISTANT TO MINISTER OF TRANSPORT

MR. LAUK: This question is to the hon. Minister of Energy, Transport and Communications: is the minister's executive assistant named Miss Joan France?

HON. J. DAVIS (Minister of Energy, Transport and Communications): No, Miss Joan France ceased to be my executive assistant some months ago,

MR. LAUK: A supplementary: would the minister indicate the name of his executive assistant at this date?

HON. MR. DAVIS: Mr. Speaker, the name of my executive assistant, for a term ending August 31, is Mr. Michael McKelvey,

MR. LAUK: Will the minister indicate why Mr. McKelvey was appointed only until August 31 this year?

HON. MR. DAVIS: Because Mr. McKelvey is returning to law school at Queen's University at that time.

MR. LAUK: A further supplementary: is the executive assistant to the minister, Michael McKelvey, who's appointed from April 14 to August 31,1977, a person related in any way to the minister?

SOME HON. MEMBERS: Oh, oh!

HON. MR. DAVIS: Mr. Speaker, Mr. McKelvey was appointed from May 1,1977, to August 31,1977. Mr. McKelvey is my son-in-law.

APPOINTMENT OF

ELECTORAL REFORM COMMISSION

MR. G.F. GIBSON (North Vancouver-Capilano): Mr. Speaker, this is a question for the Premier. When will the Premier be appointing his long-promised commission into electoral reform?

HON. MR. BENNETT: Very soon.

MR. WALLACE: Can you elaborate on that?

MR. GIBSON: Mr. Speaker, could the Premier tell us if he has yet reached a decision whether it will be a single-member commission or a multi-member commission?

HON. MR. BENNETT: It would be one or the other. (Laughter.)

MR. GIBSON: The Premier has often pledged, Mr. Speaker, that as a result of this commission, some electoral reform will be in place before the next election. Does he still hold to that pledge at this time?

HON. MR. BENNETT: Hopefully.

MR. GIBSON: But not definitely?

HON. MR. BENNETT: Well, I can't preclude a

[ Page 3661 ]

disaster. But if there is a planned election, yes, it will be in place.

MR. WALLACE: But not an unplanned election?

MR. GIBSON: That's what I want to ask the Premier. Might there be an unplanned election?

HON. MR. BENNETT: Yes, it's always possible in the British parliamentary system that the government should take an issue of major importance to the people. When such an issue arises, such a case should be put before the people. I can't determine whether such an event would take place.

It is my intention, as I've often stated, within the terms of our mandate, which is five years, that the electoral reform commission shall sit and the recommendations and the government response to it will be dealt with in this Legislature before we go to an election.

ENVIRONMENTAL REVIEW

OF COWICHAN BAY

HON. J.A. NIELSEN (Minister of the Environment): Mr. Speaker, I advised the member for Cowichan-Malahat (Mrs. Wallace) yesterday that I would endeavour to find out some information for her in response to a question by the member yesterday.

The member asked if I was aware that Island Shake & Shingle had undertaken an environmental study of the Cowichan Bay situation. The member said:

I understand, too, that the minister has had this information furnished to him.

She was wondering whether we intend to instigate a review of the study by qualified personnel in the secretariat.

The member is in error that the minister had this information furnished to him. Whoever advised you of that, hon. member, is in error. Island Shake & Shingle presented a statement on environmental issues to a member of our secretariat staff in September, 1976. The gentleman who presented it to the member of the secretariat was asked if they wanted the report sent to other departments or to the Environment and Land Use Committee. He was advised that no, that was not the intent. The intent was for the member of the secretariat to have the opportunity of reviewing it and offering an opinion, presumably.,

The document, I understand, was presented to North Cowichan council by none other than Rooke and Rodenbush in January of this year. But the Environment and Land Use Committee has not seen the report nor has the minister seen the report. Indeed, you asked if any review of that would be undertaken. It's already been done by a person I believe to be well qualified for it.

COMPETENCE OF

MINISTER OF ECONOMIC DEVELOPMENT

MR. LAUK: This question is to the Premier. Last week the Minister of Economic Development (Hon. Mr. Phillips) told the House how he had arranged to salt the Railwest bids after discussions with the federal government. The CPR, the CNR and now the federal government have repudiated this approach, as expected. As this is one more example of the minister's complete ignorance of elementary business methods, will the Premier consider bringing back Waldo Skillings to take his place?

MR. SPEAKER: Order, please! That's an improper question, hon. member.

MR. LAUK: Mr. Speaker, I'm serious. I think the Premier should consider removing that person as totally incompetent. Waldo is available. I have a phone call in to him right now. (Laughter.)

HON. MR. BENNETT: Mr. Speaker, there are greater examples. We could bring back Gary Lauk! (Laughter.)

MR. LAUK: I accept! I accept!

FUNCTIONS OF

DIANNE HARTWICK

MRS. E.E. DAILLY (Burnaby North): This question is to the hon. Provincial Secretary. As the Minister of Human Resources (Hon. Mr. Vander Zalm) does not appear to know what her executive assistant is doing in his ministry, and as yesterday the Provincial Secretary stated that it's possible and that her executive assistant, Miss Dianne Hartwick, could be involved in the dispensing of grants in the Provincial Secretary's name, could she inform the House what those grants are and why the Provincial Secretary's executive assistant would be dispensing grants in the Human Resources ministry in her name?

HON. MRS. McCARTHY: Mr. Speaker, as I recall, my response to the hon. member for Burnaby North yesterday was not to confirm.... I know the question was asked this way: was she dispensing funds? My answer was that Miss Hartwick could be involved in giving information to the ministry on grants which were requested or any information that was requested of government. If I also recall, I said that I did not have in mind at that time an example of such a grant that would have been applied for and that we would have asked for information from her. I

[ Page 3662 ]

could try to find that information out but at the present moment I don't have knowledge of that.

MRS. DAILLY: A supplementary, Mr. Speaker. Would the Provincial Secretary answer yes or no: is Miss Dianne Hartwick, her executive assistant, working in Human Resources and involved in dispensing grants?

HON. MRS. McCARTHY: No.

ICBC CLAIMS

HON. P.L. McGEER (Minister of Education): Mr. Speaker, on Tuesday last, the Premier took as notice a question on my behalf posed by the first member for Vancouver East (Mr. Macdonald) with regard to claim 1961075, asking if it were the practice of the corporation to pay claims which, as he put it, were statute-barred.

The answer to the question, Mr. Speaker, is no, but as I explained in answer to a question posed to me on Monday, a number of claims which were incurred during the period of the ICBC strike were treated because of the confusion at that time with waiving of this particular regulation, and, of course, by section 19 (c) of the Automobile Insurance Act, which is chapter 6 of the 1973 statutes.

MR. C. BARBER (Victoria): How many claims?

HON. MR. McGEER: Well, I can cite some precedents and you can examine these from your roster of ICBC files. I know the member for Vancouver East has a list of these. Perhaps if he doesn't, I could explain the contents or he could check his own sources to get fuller material: claim 2000104, claim 0002254, claim 2402421, claim 1161684, claim 1162402, claim 115 760 1.

MR. LEA: You missed one.

HON. MR. McGEER: Mr. Speaker, in addition to that there was one court case which ICBC faced as a result of the confusion that surrounded the strike and the entering of claims during that period. We lost the case in court. There was another instance where ICBC was ticked off by a judge for leaning on technicalities of the law in its own defence, and this was really not a consideration in deciding on the merits of the particular claim when it was paid.

MR. SPEAKER: For what purpose is the member on his feet?

MR. MACDONALD: I want to make a short statement in answer to the minister's statement.

MR. SPEAKER: Order, please! There is no short statement. Unfortunately, the question period is over, hon. member. If you wish to pursue the issue further it will be at the next question period in this House.

MR. MACDONALD: Well, we really are at a disadvantage when that information is given and some of the other facts are not stated.

Interjections.

MR. SPEAKER: The rules of question period are that if a member or a minister answers the questions that have been asked him outside of the question period, the matter can then be pursued at the next question period which comes to the House.

MR. G.H. KERSTER (Coquitlam): Mr. Speaker, on a point of clarification on a statement made during the question period...

MR. SPEAKER: Order, please!

MR. KERSTER: ... I'd like to correct a statement made by the hon. first member for Vancouver East (Mr. Macdonald) .

MR. SPEAKER: Hon. member, there is no provision to correct statements made by hon. members in question period. The only way that that can happen is by leave of the House. The hon. member would have to ask leave to make a statement.

MR. KERSTER: I would ask leave, then, Mr. Speaker.

Leave granted.

MR. KERSTER: Mr. Speaker, in his questions to the Premier, the first member for Vancouver East alleged that I held a financial interest in a company, and he led this committee to believe that in fact a debenture outstanding by that company was not repaid. He is aware and it is a matter of record that I have not held an interest in Surrey Dodge Ltd., since December 23,1975. That member was told by the manager of the finance company involved that the debenture funds advanced to Surrey Dodge when I was in fact the president and general manager, have been repaid, even though there are at present some outstandings due to the nature of the windup of that type of a business. This was also explained to that member this morning - the contingent liabilities, et cetera, through the financing of automobiles - that those obligations were being satisfactorily met.

What feeble attempt at dragging another member of this House through the muck with innuendo....

[ Page 3663 ]

AN HON. MEMBER: Your muck!

MR. SPEAKER: The hon. member is entitled to make an explanation, but not to engage in a debate.

MR. KERSTER: Well, I'm clarifying my statement; I'm not engaging in a debate, Mr. Speaker, with all due respect.

When I sold my interest in the company, my personal guarantee, however, was not released.

AN HON. MEMBER: That's right.

MR. KERSTER: The personal guarantee has nothing to do with holding a financial interest in a company. (Laughter.)

MR. SPEAKER: Order, please!

MR. KERSTER: It's a fact, as that member knows and all the laughing lawyers across this House know. It's a fact that it is a liability to me that I cannot resign when I sell my interest in a business.

AN HON. MEMBER: How much did you pay for your car?

MR. KERSTER: He failed to state that. He further asked what amount the finance company was owed. He was told - and should have known - that was personal credit information and it was confidential. Nevertheless, he pressed for that information. As for his allegation of representing my brother, well, consider the source. It is inane. If my brother lived in Coquitlam, or in British Columbia, I'd have every right to represent him - he has as much right to representation as any person in this province - but he now lives in Alberta. I'm not a member of that Legislature, and that man knows it.

MR. SPEAKER: The hon. member has clarified his statement.

MR. MACDONALD: Mr. Speaker, I ask leave to make a short statement.

Leave granted.

MR. MACDONALD: Mr. Speaker, I think the member is correct in almost everything he said, The personal guarantee is still outstanding and owed by the hon. member, which gives him a very substantial and concerning interest in the firm. The original advance of $65,000 was repaid in 1977, but there are still outstanding balances under the debenture for which the hon. member is still liable at this time.

MR. KERSTER: You're wrong again. Why don't you tell the truth?

MR. BARRETT: Mr. Speaker, I ask leave of the House to suspend the rules and permit the House to call Motion 13 standing in my name on the order paper.

Leave not granted.

MR. BARRETT: There are some impolite members, Mr. Speaker. I'm shocked!

Orders of the day.

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

continued.

MR. WALLACE: Mr. Chairman, yesterday I didn't have an opportunity to comment on the question of the hospital situation in the greater Victoria area and I would like to do so now. I'd like to emphasize that the tremendous problems facing all governments in relation to finding dollars to provide the modern range of services which technology has provided means there simply has to be a regionalization of health services. It is no good to pay lip service to accepting regional concepts as the only way to go in coping with costs and then, when you put that regionalization plan into effect, to in fact try to maintain the same amount of local service to local populations. That is not to say, that I am satisfied with the way matters have developed in this area, but I think it is only fair to say that for many years - at least eight or nine - the situation has been planned to death in the greater Victoria area without the kind of action that was required a long time ago.

Mr. Chairman, yesterday comments were made about building new acute beds when we're all agreed that there is an urgent need for intermediate-care beds. I just want to place on record the fact that all the studies in recent years have shown that many of the obsolete beds in this area have to be replaced. I won't repeat a lot of the minister's comments, but he was perfectly correct in making the point that it isn't just a question of building new acute beds at Helmcken Road; it's a question of maintaining the total complement that are required by building new ones to replace the obsolete ones. I thought the Agnew Peckham report made that painfully clear. I don't think that's debatable any longer. We've got to replace the obsolete facilities.

In terms of the large amounts of dollars that are

[ Page 3664 ]

involved, we have to try and provide regionalized services, whether it relates to acute beds, or laboratory services, or whatever. I would say, Mr. Chairman, that if there has been any unfortunate development in planning Victoria's hospital facilities it was in the choice of site for the replacement hospital.

I've no intention of giving the same speech I gave on May 25 in this House last year - it's all in the record - and it isn't even that I'm unhappy because I think the wrong site was chosen. But I think it was the manner in which the regional hospital commission - or at least the planning and advisory commission and the regional hospital board - went so diligently about the job of surveying the available sites, coming up with a very considered recommendation and then having a very different choice, in effect, imposed by the minister.

As I say, in the interest of time, Mr. Chairman, I don't want to go into all the investigations that were done and the studies that were carried out at the regional level, but if we're going to have regional planning and regional experts spending time and money doing a diligent, professional job of trying to assess where a hospital should go, and then the government of the day - whether it's this government or any other government - turns around and says: "Well, you may think that sites No. 1, 2 or 3 are the top three, but we're going to take site No. 7. . . ." In this particular instance, Mr. Chairman, it ran completely counter to regional planning, never mind just regional hospital planning. It ran completely in the face of regional planning for that area.

But anyway, that's history and the decision's been made. What I want to develop in my remarks, as briefly as possible, is that having made that decision two problems have arisen, in my view. One is that the minister does not have the capital funds to replace Victoria General Hospital in one move. In other words, it will first of all be 300 beds with a capacity to expand to 500. The problem which quite rightly is disturbing the medical profession in Victoria is the transitional phase, during which there appears to be at the moment either uncertainty or confusion as to what will continue to be provided at Victoria General between the time that the new hospital goes from 300 to 500 beds.

Now I think the community well recognizes from many of the statements that have been made by the Victoria Medical Society, and more specifically by Dr. Banks, that there is some real concern over the transitional phase. I'm not even sure - and I say this with respect to my medical colleagues - that they have accepted the political reality of life that the minister has chosen that particular site on Helmcken Road. The question of debating whether the hospital should be rebuilt on the St. Ann's Academy site, I think is just unfortunate. We may disagree with the minister's choice of Helmcken Road - I certainly do, and have done, and I still do - but the decision's been made and I think the minister at least deserves some credit for the fact that he made a decision when for the last seven or eight years all we've done is argue about whether a road should go through the middle of St. George's site, and all kinds of peripheral matters that should have been capable of solution long ago.

I can understand the minister's frustration when he finally said: "For goodness sake, let's pick a site and get on with it!" I think it's unfortunate, and I respectfully disagree with the choice he made, but that is not the important thing two years later. I think it's really unfortunate if this community is to remain divided, arguing about why the hospital isn't going to be rebuilt on the St. Ann's Academy site. That's history; that's past. Whatever wrong decisions have been made, I would appeal to everybody in this community who has anything to put positively into this whole hospital controversy, to now sit down and try and pull together to get the best possible planning, based on these decisions that have been made, even if some of us are not happy with these earlier decisions.

So the nub of the problem is what is to happen when we have 300 beds built on the Helmcken Road site and Victoria General then is to fill a lesser role in the total spectrum of hospital services in the greater Victoria area. That's the question.

I was somewhat reassured by the minister's answer to the member for Rossland-Trail (Mr. D'Arcy) yesterday to the effect that no final decisions have been made as to the range of services that will be provided at the Victoria General Hospital during that phase when the new hospital is at the 300-bed level but awaiting expansion to the 500-bed level.

I think Dr. Banks made some excellent points in the letter that he wrote to the local press. The one I happen to have here is the Colonist of July 1. His letter, in many respects, is so accurate that I think it is important to quote it. The letter says:

"But what you should also realize is that the present plans mean there will be no more emergency department, no surgery, no obstetrics, no pediatrics, no urology, at the present Victoria General Hospital. Without these departments it will be quite useless as a hospital serving the high-density population of elderly people that surrounds it. Should they be unfortunate enough to be admitted to the 170 medical beds unsupported by the proper spectrum of care that the hospital now provides, they will be in danger of unnecessary medical disaster."

Now I think that statement by Dr. Banks deserves the minister's closest attention. As I mentioned

[ Page 3665 ]

yesterday, the minister seems to be aware of the fact that final decisions have not been made as to whether 170 medical patients are to be unsupported by the kinds of services that are needed in an emergency situation. It's obviously understandable to any lay person that you can be in a hospital with what appears to be a relatively non-urgent medical condition which can quite rapidly become an emergency situation, and quite possibly a surgical emergency situation requiring a surgeon, an anaesthetist and backup facilities.

1 would just plead with the minister that although in the short run my suggestion will lead to additional expenditures to ensure that the regional hospital planners consult very closely with the local medical profession on that very specific and valid and reasonable point.... Quite apart from arguments about where the hospital should be or should have been or all these other matters where the decision has been made, what we're looking for now is the safety of the patient during this transitional phase when in fact the Victoria General Hospital is in the process of being replaced by the new hospital at Helmcken Road.

Again the member for Rossland-Trail (Mr. D'Arcy) was absolutely right to emphasize that it's a replacement hospital. It's not a third, new, additional 500 acute beds because we don't need an additional 500 acute beds in the greater Victoria area. 1 think it would be very reassuring if the minister could tell the House today that he will indeed take cognizance of the very valid point that Dr. Banks raises as to backup services for emergency situations once Victoria General Hospital has only 170 medical beds.

Without going into all the details, Mr. Chairman, the whole question of admission of patients to these 170 beds will have to be very clearly understood also. In other words, in the absence of backup emergency services, it would obviously mean that those 170 patients would have to be fairly carefully selected by the admitting physician, with the emphasis being on those patients less likely ever to get into an emergency situation.

While I'm not trying to be facetious, Mr. Chairman, I would have to differ with Mr. Banks on one point where he expresses concern about transferring laboratory specimens from one location to another. I couldn't help but laugh when 1 read in yesterday's Colonist, July 13, a headline which said: "Medical Services For The Birds." This is from Plymouth, England; 1 guess this could only happen in England. Dr. Banks is a native of that heath. The article says:

"Builders at Plymouth General Hospital are hammering away this summer on a curious addition to the medical centre - a pigeon loft.

By August, health officials hope a flying squad of 12 carrier pigeons will be using the landing pad after racing over Plymouth rooftops with medical specimens.

"The pigeon delivery scheme was devised by an efficiency officer of the Plymouth and District Health Authority to cut down costs and speed up laboratory work."

HON. R.H. McCLELLAND (Minister of Health): He just transferred to our ministry.

MR. GIBSON: Is that a seagull, Scotty?

MR. WALLACE: No, it's not a seagull. He says:

" 'It's true some people think we have gone cuckoo, and most of the comments are unprintable, but this is no fly-by-night idea. It is a serious experiment, ' said health authority administrator Terry Stark.

" 'For a start, we have been told by pigeon fanciers that there's only a one-in-a-million chance of a bird going astray, far less the risk of a taxi being in an accident.' "

I won't go on, but the article points out that these birds are pretty reliable.

MR. GIBSON: That's better than the government.

MR. WALLACE: I'm just briefly making the point that regionalization of services means that. I've done some checking. Ottawa, for example, I believe, has one central laboratory. The apparent complication or inconvenience of transferring specimens is more apparent than real in the total context of trying to give the maximum best service for the region with the most economic and sensible use of dollars. After all, that's what the government of the day is always going to be faced with.

So I would just say that I can well understand and support some of the points that Dr. Banks and the Victoria Medical Society have raised. I hope the minister will be able to make some comment on how he is about to ensure that the proper consultation and meetings take place.

Another question I'd like to ask the minister on somewhat the same theme - namely the best integrated use both of personnel, facilities and brains - is whether or not we're any closer to having a health planning council set up in the province. By that I don't know the exact structure or numbers of people involved; I'm just talking in very general terms about the fact that apparently a different arm of the total range of services isn't aware of what another arm is doing when very often their work is inter-related.

I'm wondering if it wouldn't make a lot of sense to put together representatives of the B.C. Health Association, the B.C. Medical Association, the

[ Page 3666 ]

university and the ministry in some kind of ongoing body which clearly would ensure that there's at least knowledge and awareness of each by the other as to not only thinking in the planning of facilities but some real input into the kind of controversy, for example, which needlessly has dragged on for years in the redevelopment of hospital facilities in greater Victoria. It's a typical example, I think, of how an integrated health planning council could have perhaps shortened and simplified just that kind of unpleasant community controversy that's going on for so long and which today leads us to the situation mentioned by the minister. We have patients in some facilities in Victoria which are definitely unsafe. There's just no question about that. The minister used the word "unsafe" yesterday and I don't think that's any exaggeration.

So I wonder if the minister is any closer to taking some initiative to set up a health planning council.

I have another area I want to touch on very quickly. I've got so many files on health matters it's sometimes difficult to put one's finger right on the one. But it's the numerous issues that have been brought to my attention by members of the Mental Patients Association - patients who have been in hospital or who are closely involved with the problems of patients' rights and the degree to which the freedom of the patient is jeopardized, particularly within a facility providing treatment for people with emotional and mental problems.

I've had a great deal of communication from Jackie Hooper, who is one of the very active members. I haven't the time, Mr. Chairman, nor does the House need to go into all the details, but I particularly want to ask the minister what investigation, if any, he has carried out as a result of at least two of the deaths which have recently occurred under tragic circumstances in Riverview. I don't wish to mention names, but I'm sure the minister is well aware of one patient who was given a bath at a temperature which was too hot. The patient was badly burned and subsequently died. Again, I wish to protect the people concerned, but there's the whole question of suicide of a patient very shortly after being discharged from active treatment in a mental-health facility.

I'm not going to make a whole argument out of one or two cases, but I've had a great deal of correspondence from people who have at different times received treatment in mental hospitals or mental-health facilities who feel that the staffing in many respects is inadequate, that the patient's basic rights - the right to communicate and the freedom to function like any other patient in a general hospital -are endangered, and the degree to which the patient feels cut off from the general society to a degree which doesn't usually happen when a patient is in a general hospital.

Mr. Chairman, it's a big issue in itself, this whole question of the rights and freedoms of a patient in any hospital. But since, of course, the very essence of mental health often leaves the impression that -a patient can be less than fully responsible for their own affairs, there's a real danger that the authorities and the staff go too far in assuming that, because the disease is of a mental nature, the patient all too readily should be dictated to and not given information which usually would be given to a patient with a broken leg or a heart attack. There is still this degree of stigma and different attitude by treating authorities in the area of mental illness.

I'm not suggesting that is the general picture all the time. I'm just saying that there are enough patients who seem concerned enough about this issue that they are asking that I raise this matter in the Legislature and try to find out if the minister is taking any particular steps or has taken any steps to investigate the matter.

Of course, the other matter which the Mental Patients Association has asked for assistance in relates to follow-up facilities when they leave the mental hospital. I have letters dating back to April of last year where they point out again how dollars can be put to better use if there is a greater degree of transitional help when the patient leaves the hospital and returns to society. Many of them cannot immediately return home or may not, in fact, have a domicile to go to. Therefore, they require intermediate-care facilities of various kinds, together with counselling and support services, either from psychiatric social workers or psychiatric nurses.

I know that the Mental Patients Association has put forward many positive proposals in this regard and I also know that sometime last fall their LEAP grant ran out. I know they were in touch with the minister seeking assistance for funding on the drop-in centre which had been very successful, together with their residence programme. They point out to me very clearly that they find the work very frustrating because they feel that they are providing a valuable service and many of them are either volunteers or working at very low~salaries.

I just raise the matter, Mr. Chairman, in the hope that the minister can give us some follow-up news, because I confess that I haven't been able to keep in touch with this particular issue in detail over recent weeks. There may have been developments of which I'm unaware.

I The last thing I just want to mention quickly before my time.... How is my time, Mr. Chairman?

MR. CHAIRMAN: You have three minutes.

MR. WALLACE: Three minutes. I'll take up the whole question of the _UBC hospital and the question of manpower and doctors and so on at a later time,

[ Page 3667 ]

Mr. Chairman.

HON. MR. McCLELLAND: Mr. Chairman, I'd like to thank the member for the comments he has made about hospital services and other aspects of our ministry.

Dealing with the Riverview situation first of all, we are endeavouring to fund many of those follow-up services from our ministry as well as we can, either on our own or through the Vancouver health department which operates many of those services. Also, there is some overlapping there, of course, between our ministry and the Ministry of Human Resources as well.

Mr. Chairman, the assistance to mental health programmes in that regard is now up to about $4 million per year. That includes payments through the City of Vancouver, the Canadian Mental Health Association, the general hospital and the department of psychiatry. We are attempting to upgrade those programmes as much as we can within the budget that we have.

The staffing at Riverview as compared with acute general hospitals is high. The problems of Riverview are many and I won't argue with that. I said yesterday in my opening comments that Riverview has been the subject of criticism over many years and that we are attempting to overcome that situation, first of all, by reducing the number of people in Riverview and making those facilities available for those people to be cared for in their communities. It is folly to think that you can just embark on that programme before you have all the backup services in the communities to look after them. That is one of the problems that we have at the present time.

From time to time there will be incidents in a hospital like Riverview. I think we would be foolish if we thought that there never would be, We would hope that we can keep them to a minimum but that when they happen, we will get them out in the open as quickly as possible, have them fully investigated, and have methods by which there can be full participation in the investigation of any incidents which do happen, . Errors in judgment sometimes among staff members, particularly staff members who may have been on a particular ward for a long time or, on the other hand, someone who may be brand new, will never be completely avoided. The two recent deaths to which the member referred, Mr. Chairman, have both been very fully investigated. They have been the subjects of inquests and in one case particularly, the person who was judged responsible for that death was discharged from the .hospital service. There are other complicating factors in terms of the suicide which the member talked about with drug use which is very difficult, as that member knows, to control.

We would like to respond as quickly as we can to those concerns that the Mental Patients Association has, and we are, I think. I said yesterday that we planned to have Riverview Hospital accredited the same as any other hospital in British Columbia and have it fully answerable to an independent body for its conduct as an institution. In the long run, and perhaps even in the short run if we can straighten out a few things, we hope to have Riverview taken out of being a government institution and more like any other hospital with a full board of directors elected from a community society. If it hadn't been for some difficulties that we've had with hospital board societies recently - particularly Vancouver General Hospital that threw a few curves at us - that might have happened already. But I intend that to happen, Mr. Member.

MR. WALLACE: A great idea!

HON. MR. McCLELLAND: And also, Mr. Chairman, beside the accreditation, we've taken some very serious steps toward making the process easier for in-house investigations to take place and to ensure that they do take place. Those moves have been taken this year and they're not all completed yet, but we hope to continue with those. We want to make Riverview responsible to the people it serves, and it's as simple as that. We're doing all that we can to do that.

The matter of the health planning council: I'm not considering that at the present time. We have, I think, improved our relationships with some of the health professional organizations: the British Columbia Medical Association, the Registered Nurses' Association of B.C., the British Columbia Health Association. All now have regular meeting dates with me in my office. Hopefully through that end, we can do some of the things that the member has complained about, Mr. Chairman, in terms of co-ordination.

We have in the two major centres of the province - the capital region and the Greater Vancouver Regional Districts - both pretty sophisticated planning bodies. In terms of whether or not a new planning council would hasten the development of services, I rather have my doubts about that. I think instead of hastening it, it may tend to delay it even further. If we can streamline what we already have, I would like to try that first.

The member knows that a lot of the difficulties which were apparent in hospital planning in the Capital Regional District were because of internal disputes among the medical profession and internal disputes among the municipalities involved. That went on for many years until the region got permission from the government to establish a health planning commission within the region. It seems, Mr. Chairman, that that was effective in stopping a lot of

[ Page 3668 ]

those internal difficulties which were apparent in the capital region. Again, I wouldn't like to put another body over them at this time.

The Greater Vancouver Regional District has just done about the same thing in developing a hospital committee within its region, a political committee which can report to the region alongside the advisory committee. So I believe that those things might help to end the problems that have been mentioned.

The whole problem of the replacement of Victoria General Hospital: the member has stated the facts quite clearly. I really don't need to comment except to answer a couple of the questions he asks specifically. I would think the major one is the uncertainty of the transition period between the 300 beds and the 500 beds in the new hospital. That's an urgent concern of ours as well, Mr. Chairman.

There was a preliminary functional programme which was prepared by Dr. Peter Hart of Agnew Peckham and it was presented to the capital regional planning commission. It was a programme which saw the division of patients into two general categories, with the acutely ill at the northern site and the less acute at the existing site, generally. The proposal placed the major treatment and diagnostic facilities at the new hospital, leaving minimal facilities at the southern site. There was to be no emergency department, intensive-care unit, surgical or day care. That proposal was for the immediate and dramatic reduction in the role of the existing hospital.

I must say again, as I said yesterday, Mr. Chairman, that that proposal is far from final. It's a proposal by a group of, consultants and it was made to the capital planning commission. I can tell you today, without, I hope, influencing any decisions, that that proposal is in conflict with the philosophy of our ministry. We believe the existing hospital should remain, at least in the early stages, as a satellite of the Victoria General complex, retaining a lot of those components, such as diagnostic facilities, out-patient services and physical medicine. I agree with the member that it may cost a few more dollars - but not very much is our information - and it's worth it in terms of patient care.

Interjection.

HON. MR. McCLELLAND: Well, you see, the problem with us saying that is that I'm not in a position, Mr. Chairman, to tell you what that plan will be without getting in trouble from the member for Oak Bay (Mr. Wallace) again for overruling the regional district.

MR. WALLACE: You just can't win, Bob.

HON. MR. McCLELLAND: So I don't know, but I can only say, in answer to all of the questions, that the plan is not final and it is the subject of discussion. What we want to do is retain good patient care in that area. The phased-in development approach is the one that we favour as a ministry to allow the orderly expansion of the new hospital to 500 beds.

I might say again that our commitment to 500 beds for that new hospital as early as possible is firm. The proposal to place all surgical facilities at the new site is certainly also contrary to the beliefs of Dr. Banks and Dr. Friesen, both of whom have expressed their public dismay at these suggestions. We agree, in hospital programmes, that it makes a good deal of sense to allow some surgery to remain to complement the role of the downtown hospital.

I must say that this is a most major and complex matter, involving a lot of disciplines, and we must allow them to do their job as best they can, That functional programme has been the subject of intense scrutiny over the past few weeks and it will take some time yet before it's approved.

I must also make one comment, Mr. Chairman, and that is that in all of the criticism about the need for that split, and we've agreed that it will take place and that we need to maintain good patient care in both areas, we seem to forget that we do have another major hospital pretty well in downtown Victoria. That's the Royal Jubilee Hospital. It's an excellent facility and it's one which is available to all of the people of Victoria in a matter of minutes. It isn't necessary, as some of the critics of this plan have said, that everybody who is acutely ill in the Victoria area will need to be transported to Helmcken Road. That's just nonsense, because we do have a major and top-notch hospital at Royal Jubilee.

We're also, Mr. Member, looking into the problem of the back-up facilities that will be necessary. I think I can say, too, in answer to some of the members' questions and certainly in answer to those people who have been involved with Victoria General - St. Joseph's, as it was known before - that as far as I'm concerned, and as far as the ministry is concerned at this point, there will always be some health-care facilities on that site. Now what they'll be will be a matter for future discussion and future planning, but it is not our intention ever to allow that site to be used for anything other than health-care facilities for the people, particularly the elderly people of the James Bay area,

MR. BARBER: I appreciate the candour of the minister's remarks regarding the state in which present planning has found itself.

No doubt he's received, even to a greater extent than I have, a lot of correspondence from doctors in Victoria concerned about that particular planning. As it happens, I live in James Bay myself and have done so since shortly after the election. Walking in that neighbourhood, and in Fairfield, and meeting with

[ Page 3669 ]

people, I'm particularly well aware that elderly people in my riding, especially in Fairfield and most certainly in James Bay, are extremely worried about what happens, as they view it, when the inevitable stroke or heart attack comes along and the hospital that they have always expected would be available to them round-the-clock, Victoria General - still called by most of them St. Joe's - is not available for emergency-ward purposes.

The minister said that we do have Royal Jubilee. I agree it's an excellent hospital. On the occasions when I've had to be in hospital, and I've been there, I've been absolutely pleased and delighted with the service, but as the minister must be aware, I'm sure, the demands on the emergency-ward services at Royal Jubilee have only increased in the last several years. The intent was to have opened by June 1 of this year the new ambulatory-care ward at Royal Jubilee and to have expanded the emergency-care services at that hospital.

Mr. Chairman, what the minister may also know is that a number of veterans concerned with Memorial Pavilion have also been complaining that the emergency and out-patient services which they previously enjoyed exclusively at the old Vets' Hospital - now the Memorial Pavilion - are being moved over, in site and programme, to the present site of the emergency-ward facilities at Royal Jubilee.

The demands on the Royal Jubilee facilities, Mr. Chairman, have only increased in the last few years. They have increased because of population increase; they have increased because of a peculiar circumstance we have in Victoria of a disproportionate number of older people using those facilities; and they've increased because the Memorial Pavilion has shut down those previously separate services. Now in regard to out-patient, to the eye, ear, nose and throat clinic, to the emergency services previously available to veterans over at the Vets' Hospital - now known as the Memorial Pavilion -they are in fact taking place at the present site of the emergency ward of Royal Jubilee.

All of this suggests, Mr. Chairman, that if we have done nothing but increase the workload, and very lately the facilities, at Royal Jubilee, then some further kind of reassurance is necessary for the elderly people who live in James Bay and Fairfield in my riding. Many of them are the wives of vets and they know what has been going on at Royal Jubilee. They are aware of the additional demands on the present facilities of the emergency-care unit, and shortly the ambulatory-care unit, at Royal Jubilee. They are not at the moment convinced, Mr. Chairman, by anything they have read that when -and forgive me for saying it - the stroke or the heart attack come along, they're going to be able to get in and get the service they need within time in order to save their own lives.

1 appreciate that there are important economic arguments, once the minister is committed to 500 beds at Helmcken Road, to discontinue a great number of services at the present Victoria General site. It makes good sense - you're going to do one or the other; you can't afford to do both. That's perfectly reasonable and I don't dispute that.

Though I think, Mr. Chairman, the minister would be well advised to take some very special special steps, very quickly, through the seniors organizations in Victoria - Silver Threads, New Horizons, James Bay Golden Age Club, the Old Age Pensioners Association, the Legion, the vets and the rest of it -to let them know very directly and very personally that the kind of ambulance service they need, the facilities they will expect, and the emergency and intensive care programmes which they have a right to, will continue to be available without interruption and without delay at Royal Jubilee after such and such a date.

You and 1, Mr. Chairman, may hear in this Legislature - and I accept personally the assurance of the minister - that there will be, in effect, a period of overlap when those new programmes are being settled or re-settled. That's reasonable; that's fair. Hardly ever does that message get through in anything like a competent or persuasive way, especially to senior citizens in my own riding. I think the minister would be well advised, by letter or by meeting - or by however he could choose to do it - to give some special care and attention to the fears and the anxieties, to the raw fear and the raw anxiety, that many of these seniors feel. Their hospital, Mr. Chairman, when in James Bay and Fairfield, has been St. Joseph's. Many of them were born there; they've always thought of it as their hospital. Their kids were born there too. They've an emotional, sentimental tie to that facility that's very powerful.

I congratulate the minister for saying that that particular site will always remain the site of some form of health care or another. Because there's another group of people in my riding, the Sisters of St. Ann, who have been here for, I think, almost a century; who have made an important moral, religious and personal commitment to this city for years and years; and, indeed, who sold their property on the condition that it would continue to be used for a health facility, for a hospital, for public service. There are many people, within the church and without the church, in my riding who would be happy to hear of that assurance and any the more public the minister cares to make it would be all the more welcome.

The Sisters of St. Ann have made an extraordinary contribution to this area over many, many years. I count as personal friends a number of sisters working, previously in that hospital and in the school, St. Ann's Academy. I congratulate the minister on that

[ Page 3670 ]

particular concern, and that particular representation he's willing to make - that St. Joseph's remains the site of some health care facility or another.

- As well as commending to the minister some special attention to seniors and some special way of obviating their fear that the emergency treatment they need some night at 2 a.m. might not be there, and as well as congratulating him on his commitment to maintaining the promise to the Sisters of St. Ann about that particular site, there's a third matter. I congratulate him on his willingness to maintain one of the most successful programmes in community health and social service that we've ever seen in this province and I'm referring to the James Bay health and human resources centre. The minister, to his enduring credit, was willing to be bound not by ideology but by competent review and audit of that programme. The minister appointed his own reviewers and his own auditors. They weren't our guys; they were his. The minister was willing, with an open mind, to take a look at a programme which required a great deal of work to establish because it was very new and very different. The Minister, and indeed his deputy Mr. Mainguy, who I congratulate in the same regard, have made representations to the board of the James Bay health and human resources centre that they will be allowed to continue. Hopefully, Mr. Chairman, the Minister of Human Resources (Hon. Mr. Vander Zalm) will be defeated by the Minister of Health in regard to the continuing existence of that site.

Interjections.

MR. BARBER: And in all other things. I very much hope that what. is happening to the Vancouver Resources Board will never happen to the Community Resources Board in James Bay. Again, as it happens, I live in James Bay and many of my friends are active in these programmes. Many of my older friends have benefited from those programmes. The work of Derek Carroll and Anne Boldt, the doctor and the nurse-practitioner at James Bay, and the work of the new doctor and the work of that board, have allowed a department of government previously removed from and insensitive to the very particular, very special, very uncommon health and social needs, especially of the elderly population of James Bay . is just fine. The minister's willingness to allow them to continue is just excellent. It's just first rate and he deserves full marks for that. I'm glad he's done that.

I would ask, Mr. Chairman, that the minister tell us whether or not, having now been willing to recognize the experience and the documented success of the James Bay health and human resources centre, lie is willing to consider establishing in any other community in the province some similar forum for change and experimentation, for sensitivity and improvement, for sound administration, and for good health service. What we've~ already demonstrated in James Bay works. It works well. It works economically. It works efficiently. It works with sensitivity and kindness and it works around the clock. The people who work there work around the clock; they're available and they're on call. 1 wonder if the minister, realizing the worth and the reward of the tremendous success that this programme has enjoyed in James Bay, might tell us whether or not similar success might be enjoyed by other communities elsewhere in the province at some time in the future. If it is in the future, Mr. Chairman, hopefully it's in the near future, because people elsewhere deserve at least the same chance as the people in Victoria, particularly in James Bay, have enjoyed with this project.

So all in all, at this point, I have nothing but good words to say to the minister and I'm sure he's surprised. There may be some other stuff later I'm going to ask about but for the moment I'd be happy for his comments on these.

HON. MR. McCLELLAND: No, I'm not surprised.

AN HON. MEMBER: A vicious attack! (Laughter.)

HON. MR. McCLELLAND: Well, first of all, dealing with the James Bay Centre: you know, the decision to keep that facility operating was not mine alone. It was a joint decision made by both myself and the Minister of Human Resources.

MR. BARBER: We prefer to give you the credit.

HON. MR. McCLELLAND: The audit committee was appointed not by my ministry alone, but it was a joint audit committee of the two ministries. It was a joint decision that was made and we accept it.

MR. BARBER: We think you're the good guy.

HON. MR. McCLELLAND: It's not to say, however, that that kind of approach to delivering health care won't be under review and evaluation on an ongoing basis, and also, just because we have an evaluation which says that kind of centre is doing a good job, that we don't experiment with other innovative ideas in terms of delivering health care. We wouldn't want to be locked into the kind of position where we wouldn't be able to do that.

So that brings us to the other communities. We do have three other communities which have this similar kind of centre in the Charlottes and Houston-Granisle. So we do have that experiment to be looked at, not only on an urban model, but also on a rural and remote model as well.

[ Page 3671 ]

We also have moved into some other experiments in ways of bringing a total array of services to people. We now have those kinds of health centres directly attached to the department - not removed from the department but doing the same kind of job in places like Lumby and Madeira Park. We're putting one up in Valemont and we're also attempting to do a number of others. Besides that we've funded agencies such as the Downtown Community Health Centre in Vancouver, which is doing an excellent job, and REACH in Vancouver. So we're still in the infancy in this kind of delivery of health care in this country, and particularly in this province. I think we should leave all our options open and try as many different kinds of innovations as we possibly can.

The member may have been reading my mind - I don't know - in terms of the situation with regard to Victoria General Hospital, but I've given instructions a week or 10 days ago for our education information department to put together a letter to be sent to all the seniors in the James Bay area and probably Fairfield as well. We're exploring the possibility now of going to the Silver Threads community centre and talking with them. I'll make myself available to speak to the seniors on this very important question that they have, as soon as we have all of our answers together for them. So that will be done, Mr. Member, quickly.

Interjection.

HON. MR. McCLELLAND: Oh, I see. I thought I didn't have any leaks in my department.

I might remind the member as well that the emergency department at Royal Jubilee has been expanded recently in order to take on a greater load. The demands at Royal Jubilee have also increased because of the tremendous pressures as well as the growth in the western sector and other parts. I would hope that when that hospital is in place in the western sector, some of those demands will be lessened. But I agree with everything the member said about the needs to reassure the senior citizens. I'm going to attempt to do that as quickly as I can.

Also, in terms of the sisters, you're right. They did sell that property on the understanding that it would be used for health care. As far as I'm concerned, it always will be. I think that answers all the member's questions.

MR. GIBSON: Mr. Chairman, this is my first intervention in this particular debate, so, like other members, I want to wish the minister well as he grapples with his huge and complex department. He's grappling quite well.

Interjection.

MR. GIBSON: We'll talk about that later.

He's grappling quite well with it in very good faith, I would say. I want to congratulate him too. He's in the right ministry; he's looking healthier than he was a year ago.

HON. MR. McCLELLAND: I've taken off 15 pounds.

MR. GIBSON: Well, it shows, Mr. Minister, and 1 congratulate you. You're taking you own fitness programmes and your own preventative programmes seriously. 1 congratulate you and I'm sure you're personally very happy about it.

1 want to follow on to this question that was raised a little bit ago about community human resource and health centres. 1 was glad to hear the sort of approval the minister was indicating today. When the report came in there was a story a little bit later in the Victoria Times. As a matter of fact, the Times of July 4 indicated that he wasn't as satisfied as he stated a few minutes ago.

"Asked about this particular report, Health Minister Bob McClelland said he's not satisfied with the report because the study group did not take a close enough look at the disadvantages of, the centre concept, nor did it look carefully enough at alternatives." That was the quote in the Victoria Times.

Perhaps the minister can tell us that that's not his real feeling. 1 hope he will because I've studied this report of the audit committee very closely, Mr. Chairman. It contained on it two medical doctors, one from the university and one from the BCMA. It contained a representative from Human Resources, a representative from Health, a representative from the B.C. Association of Social Workers and from the RNABC, As far as 1 can see, it was a well-constituted group and a good report.

It's worthwhile describing some of their major findings. They evaluated the four community human resources and health centres. They visited each one of them twice. They came up with the conclusion that those centres provide the following:

"They provide a major potential for reducing the escalation of health care costs by reduction of hospital and nursing home costs, transfer of moneys to an integrated health care system including social services, and evolving more economic health systems for total communities."

That's the first finding and that has to be tremendously important for the minister and this Legislature because, as he said yesterday, health costs have tripled in the last five years. It's not evident that we're getting all that extra value for the dollar.

The minister is in the difficult position of having to squeeze more money out of the health dollar, and

[ Page 3672 ]

that's a difficult task. These health centres look like one of the ways of doing it and providing better service at the same time.

The second finding was that these centres have a potential as change agents, to shift from an emphasis on sickness to an emphasis on health - in other words, health promotion and prevention of sickness. That is a very significant finding too, and one that is in line with what the minister has been preaching in this House, and very properly.

The next finding was that these centres provide for the evolution of an effective partnership between health-care professionals and citizens in determining a focus and priorities and methods of delivering health services. In essence, that is the community approach. That too is terribly important.

The study found that these community centres provide for greater volunteerism than is normally seen in the delivery of health services. They found that the communities concerned believe that they now have better health services.

They found, finally, that to bring about the necessary change in setting up these centres, a task force that they call a development group, which is a particularly structured group, is required to bring that about.

When the minister replies, I would like him to indicate that the Victoria Times somehow hadn't got the story quite right, that he was well impressed with the report of this audit group. It looks like a very competent report to me. 1 agree with the minister that we must maintain flexibility - there are all kinds of different experiments to try - but this sounds like a good one and one that should be expanded.

I want to go on from there to talk about what many, particularly the minister, have referred to as our No. 1 health problem in British Columbia, and that's alcohol. 1 won't go into a long elaboration of the problems of alcohol; they're well known to this House. One of the recent publications of the Ministry of National Health and Welfare gave a short listing.

It talked, first of all, about physical health problems: liver disease, heart disease, cancer, respiratory diseases. All of these are directly and seriously related to alcohol abuse.

It then talked about mental-health problems. There are very few families, blocks or communities that don't know a great deal about that. They talk about social health problems: problems of crime, problems of family disruption, alcohol in the workplace, accidents.

They talk about particularly high-risk groups such as native peoples and young people. They talk about consumption trends, which in Canada have been going up from a point of under two gallons per capita of absolute alcohol equivalent in 1966-67 to something around two-and-a-half gallons less than 10 years later - quite a quick rate of increase.

The problem is an extraordinarily serious one. I know that the minister shares that view, Mr. Chairman. I want to put to him today a particular suggestion. I compliment him for the work that he is doing in work-related alcohol problems, working with companies and working with the Ministry of Labour. I compliment him on the detox centres and all these kinds of things. But there is a basis problem that must be addressed, and that is the problem of the glamour of alcohol in our culture. That problem, Mr. Chairman, is brought about by the tremendous volume of alcohol advertising in all of our communications media, except where prohibited by law in a few areas, by the people who make and sell alcohol. Now that's a normal commercial thing to do, you might say, but the upshot of it causes tremendous social and personal grief.

I have worried a great deal myself as to what is the best way to handle this. Is the proper answer more restriction of advertising? There are problems with that, both in terms of freedom and in terms of the economic impact on the publishing industry of our country. But somehow it has to be counteracted.

I want to suggest to the minister that out of the alcohol profits that are made by this government, there has to be a massive, massive advertising programme launched to defeat this aura of glamour. In every magazine where there are 10 pages of pro-alcohol advertising, there should be 10 pages of anti-alcohol advertising. For every picture of somebody out on a sailboat with their hair blowing in the breeze and a bottle of beer in their hand, there should be another picture in that magazine of somebody slumped over their desk with a bottle by their hand and with their hand getting caught in a piece of machinery because they're drunk. For every suave looking man of distinction standing in a club by a roaring fireplace with a drink of scotch in his hand, there should be a child and a mother eating at a table with an empty chair and the child saying, "When's Daddy coming home?" For every romantic couple snuggling over a scotch or a Bacardi or something, as they sit around that nice picnic table under the sun umbrella, there should be a dead couple in a smashed car.

That kind of strong, shocking anti-alcohol advertising should be massively funded by the provincial government out of its alcohol profits. Until that kind of thing is done, until there is a change in our cultural value about the wisdom or not of abusing alcohol, then....

HON. G.B. GARDOM (Attorney-General): Public attitude.

MR. GIBSON: "Public attitude, " exactly, Mr. Attorney-General. Until that's done, all of the other things, while they're helpful, are not going to get at

[ Page 3673 ]

the basic, No. I health problem in this province, in this country, and the No. I problem of drug abuse.

I commend that to the minister. I also ask him to produce through his department something on alcohol as was done in that excellent smoking pamphlet. Mr. Minister, I don't normally recommend this to the government because I'm always worried about government propaganda, but send that to every home in this province. Put it through the mail system to every home in this province and to every school so that we fight this terribly strong, cultural, glamour image of alcohol consumption.

I want to go on to speak for a moment about dental care.

MR. G. MUSSALLEM (Dewdney): Why don't you speak about banning advertising?

MR. GIBSON: Mr. Member, I did talk about the possibility of banning advertising. I said that made me uncomfortable in terms of restricting freedoms and so on. I mentioned that already and I thought this was a better way of doing it.

On the question of dental care for young people, I would like to ask the minister where it stands. The Evans report, which I think was pretty well endorsed by SPARC, put forward a programme of school delivery which would have cost something in the neighbourhood of $30 million a year, I believe. That may have to be escalated because a couple of years have passed since then. I want to ask the minister where that stands in his scale of priorities now.

Moving to another very different subject, the minister is responsible for the Change of Name Act. When we last debated that Act there was a question as to the restriction that is still placed on women in that Act. They are not able to change their name to any name but simply back to their maiden name or the name of a previous spouse - I think that was the other option. But they cannot change it to any name, which privilege is currently given to the husband. I want to ask the minister if he has received representation on the fact that women are still not in an equal position under that Act. Is he giving some reassessment to it or does he want more representations? I would be glad to try to see what I can arrange in that regard.

I want to ask the minister about the current status of acupuncture as it is practised in this province.

HON. MR. McCLELLAND: Are you giving me the needle?

MR. GIBSON: "Are you giving me the needle?" the minister says. There have been some good one-liners in this House this afternoon.

There was a report in the newspaper on June 2, Mr. Chairman. It starts out this way: "What was to be a conciliatory meeting between an acupuncturist and the B.C. College of Physicians and Surgeons on Wednesday ended in an uproar."

What had happened apparently was that the acupuncturists' association was trying to get together with the college and make arrangements for referral treatment under the supervision of doctors. That just flew apart. The acupuncturists were referred to, reportedly, by the registrar of the college, Dr. McClure, as a cult group. He was quoted as saying: "I don't want any more cult groups."

I had always thought that the previous Minister of Health, and I understood this Minister of Health, had some regard for the possibilities of acupuncture in certain situations.

Interjection.

MR. GIBSON: It depends how pompous what needs to be punctured is, too, Mr. Attorney-General.

I want to ask the minister if he would give us a status report on that. He has a committee that has been studying it, particularly in regard to the alleviation of pain. Could he give us a report on that? Also, what does he think of it as a medical tool and how it should be controlled?

My next question, at this point, relates to the Psychologists Act for which the minister is also responsible.

HON. MR. McCLELLAND: We're not supposed to talk about bills, are we?

MR. GIBSON: I know that there have been certain representations received since that Act was passed earlier on this year. Of course I won't recanvass the debate, but there were serious questions raised about definitions as to who a psychologist is and exactly what this Act is controlling.

HON. MR. McCLELLAND: That's all been done in the debate on the bill.

MR. GIBSON: I know that, but what I'm asking you, Mr. Minister, through you, Mr. Chairman, is: how many representations and what kind of representations have you received since then? Have you not received considerable evidence of concern over this bill?

HON. MR. McCLELLAND: Twenty-one.

MR. GIBSON: That's all I want to know because certainly I've been receiving that in my office and I want to know what the minister has and what his reaction has been. At that stage I will sit down.

MR. CHAIRMAN: If it's a matter of a bill before

[ Page 3674 ]

the Legislature it's not proper for discussion.

HON. MR. McCLELLAND: It's passed.

MR. GIBSON: It's a matter of a bill that has been passed, Mr. Chairman. I'm just asking how it is operating.

MR. MUSSALLEM: Mr. Chairman, with apologies, may I quote?

"The time has come, " the walrus said,
"To talk of many things:
"Of shoes - and ships - and sealing wax -
"Of cabbages and kings."

I wish to confine my remarks to cabbages.

I'd like to ask the hon. Minister of Health why it is that such an excellent farm as the Colony Farm adjacent to Riverview Hospital is not being utilized for the purpose that it was intended. A great farm, a great success producing nutritious food is now confined to the production of milk only. I'd like to know what, I've asked the Minister of Agriculture this question: I was promised an answer and didn't receive it.

I think the Minister of Health should insist that this farm become productive for the benefit of the residents of Riverview and for the benefit of the areas as a whole. Something is wrong in that place and I'd like to know the reason. I don't want to know a fancy reason; I want to know the actual reason. It's a very important question. The farm was productive at another time; it is no longer productive.

I would like to ask the minister and I would like to wait upon your question, whenever you're ready to give it. I haven't been able to get it from the Minister of Health, but no doubt it will be found somewhere.

I'm concerned, Mr. Minister, that the medical profession is not sufficiently concerned with nutrition. For example, we find that our government taxes candy bars that consist mostly of sugar, which any doctor will tell us is very injurious to health. Yet there is no tax on candy bars and yet there is tax on vitamins. I'd like to know the reason for that. I think we must be consistent.

Is the problem that we're not knowledgeable on nutrition? Is our medical profession not concerned with nutrition? Well, my answer is: they cannot be. Why do we have so much junk food in our hospitals? For example, Rice Krispies, Corn Flakes, white bread. I think these matters are important.

After all, the reason we are all here and living is because we fuel the machine that we are. If we put the same junk fuel in an automobile that we put in our bodies, it would stop dead on any highway on any day. We must be careful with our cars, with our animals, but we're not careful with ourselves.

I would like to suggest to the hon. minister that it would be a guidepost and a direction for society and for our people to say that the hospitals do not supply junk foods anymore and that you cannot obtain these junk foods in the hospital. And this is the way to start. I urge the minister to take this under consideration.

HON. MR. McCLELLAND: My ministry is concerned about nutrition and junk food. I think we made that quite clear. We're looking all the time at the kinds of foods that are provided in hospitals and ensuring that they are nutritionally prepared whenever we can. I'll continue to do that and continue to have discussions with both the medical profession and the hospitals themselves about that very matter.

The matter of taxes on vitamins: I would suggest that we'll have to ask the Minister of Finance (Hon. Mr. Wolfe) about that one. I'll help if you like.

I'm sorry I can't answer your questions about Colony Farm. I was under the impression that it was a productive farm. I visited there just 10 days ago and it certainly looks like a working farm. I know that the patients from the forensic institute at the Riverview site work on a regular basis on Colony Farm. I wasn't aware that was a problem, but I'll certainly take it up with the Minister of Agriculture and see if there is some kind of a problem, what it is, and if we can make that.

I know that farm was the pride of British Columbia at one time. Certainly some of the dairy animals are - and I understand they still are - among champions in this province and take away a lot of honours at Pacific National Exhibition time and also at the Royal Winter Fair in Toronto. I believe that still is a fact. That's all I'm talking about. I don't know what other production they were in before, but I'll certainly check it out and talk to the Minister of Agriculture about that. As you are aware, the farm is under the control of the Ministry of Agriculture.

To the member from North Vancouver-Capilano (Mr. Gibson) in terms of many of the questions he raised. Acupuncture: we still have an active committee monitoring the two acupuncture clinics in Victoria and Vancouver. We are getting some extremely good research data from those two clinics. Recently, as a result of some of the recommendations made because of the preliminary reports of those studies that are being done into acupuncture, the College of Physicians and Surgeons have opened the opportunity for acupuncture to be practised as a part of the medical practice in British Columbia.

It is not at the present time covered by the medical plan. Nevertheless, for certain kinds of pain, it's become apparent that acupuncture works. Hopefully we'll be able to expand those committees into other areas of the province, and clinics as well, when funds allow us to and when the research indicates that we should as well. We want to move

[ Page 3675 ]

reasonably carefully in this area because we know now that a lot of the claims for acupuncture that came generally to us were not based on fact. There is a limited use for acupuncture. So we'd like to be very sure of our ground before we move any further in that regard.

I've had no representations regarding the Change of Name Act whatsoever and not one letter.

Dental care really is in the same position as it was when we were elected. It was our pledge at that time that when the resources permitted, we would embark upon a denticare programme of some kind. That hasn't changed. The government doesn't consider at this point that we're in the position to be able to embark on that programme yet.

However, I might advise the member, Mr. Chairman, that the latest indications are that well over 60 per cent of all young people under the age of 16 are now covered by some form of dental plan and it's going up on an ongoing basis. We'd want to be a little careful, I think, in implementing a government plan to make sure that pretty major investment on the part of industry doesn't get lost to the government of British Columbia. I agree with the comments, Mr. Chairman, that there are still a lot of people who aren't covered and have some financial hardship, but I can't give the member a date or a priority on this matter.

[Mr. Veitch in the chair.]

In terms of alcoholism, I can't do anything more but agree wholeheartedly with the member for North Vancouver-Capilano (Mr. Gibson) . Acute alcoholism is increasing at over twice the growth rate of the population while acute drug dependency as well is growing at about 20 per cent a year. Alcoholic cirrhosis of the liver was up over 220 per cent in a five-year test period. It's a shocking situation with which we're faced and it is the most serious health problem that we have in our society today.

And yes, a lot of the problem is linked to advertising. We don't have as much problem here with the glamour of alcohol advertising as we do with the publications coming in from the United States. I think that it's rather difficult for us to control that. Perhaps one should ask for a show of hands among members in this House who would agree to a total ban of advertising of alcohol.

MR. GIBSON: That wasn't my point, Bob.

HON. MR. McCLELLAND: No, but I wonder whether we would. How many would? Nobody? Everybody? I don't know. George Mussallem would, I know that. I think we should consider that. At our last health ministers' conference 10 days ago or so we talked about that. it's my position, if we don't ban alcohol advertising, that we certainly don't expand it any further.

Interjection.

HON. MR. McCLELLAND: Well, yes, I'll get to that in a moment. But 1 wanted to make the comment that there is a pretty heavy lobby right now on government, and there was on the previous government as well, to have advertising of alcoholic beverages expanded into radio and TV in British Columbia. In representations I've had from the Canadian Association of Broadcasters I've rejected that completely. 1 feel that would be totally irresponsible of us to expand into any other areas of advertising for alcoholic beverages. I'm not speaking for the government at this point this is a personal approach that I've made to them on behalf of my ministry.

The federal government is taking some initiatives in terms of de-glamourizing all alcohol ads, and that will be the subject of some regulations which we hope will be coming forward relatively soon.

In terms of our advertising to counteract the other advertising, that's before government at the present time. There is an inter-ministry committee now dealing with the ways in which we can launch a very extensive advertising campaign based, as you've suggested, Mr. Member, on the profits that the government makes from alcohol.

That's in addition to anything that the Alcohol and Drug Commission is doing, particularly in demonstration projects that we've been setting up on the last few months with the funds from - and I'll goof the name on this - the alcohol, tobacco and drug education fund. It was set up some time ago, and I was, at the first of this year, fortunate enough to have it transferred over to my ministry. We're now setting up demonstration projects from that fund in terms of education in the schools as well.

The programme we have in mind - and it's an inter-ministry programme involving Labour, Education, Health and Consumer Affairs - will be an all-encompassing advertising campaign based not only on media ads but also on the kinds of brochures that you've mentioned that will go out to the homeowner. We hope it will be as dramatic as you stated it in your speech. That is a ways off because we're in the preliminary stages of it now, but it's a commitment of government and it will be done as soon as we can.

The only comment I could make on the report of the audit committee is that there were a lot of specific criticisms which appeared in the British Columbia Medical Association Journal, the BCMA News, and the Canadian Medical Journal, 1 believe, and in the provincial media, that were very critical of those health and human resources centres. 1 had

[ Page 3676 ]

asked specifically that that committee deal with those criticisms. All of those criticisms and any responses to them were left completely out of the report. 1 felt that was a fault of the report in that it should have dealt with those.

I also asked - and 1 think probably the problem here was lack of time - they also look at some of the alternatives 1 had mentioned like REACH in Vancouver and the Downtown Community Health Centre in Lumby and some of those. That was left out of the report as well. From that point of view, I felt that the report failed to do all it could have done to be a completely comprehensive report.

If 1 could further have the attention of the House for a moment, I would like to announce that seated in the gallery today is the new president of the British Columbia Medical Association, Dr. Bill Tysoe, and his executive director, Dr. Norman Rigby. We welcome them today.

MR. D'ARCY: Mr. Chairman, 1 would like to question the minister somewhat more closely on the way in which he relates the new comprehensive-care programme to increasing the number of intermediate-care facilities in the province of British Columbia. Just to recapitulate, the change in programme.... We had an announcement earlier this spring, made by the Premier, which indicated that the cost for care was going to increase from $120 a month to $195 a month or from $4 to $6.50 per day, but that all private facilities were now going to go on the system, whereas only public facilities were on the system before.

HON. MR. McCLELLAND: No facilities were on the system before.

MR. D'ARCY: There are some aspects of this that are commendable and welcome. However, I would really like to question the minister as to what is really new or different in this. In one of the later pages of the release there was a caveat that the public funding was going to be based on an assessment for need. In plain English, Mr. Chairman, I suggest....

HON. MR. McCLELLAND: That's not true. No, you know better than that.

MR. D'ARCY: Well, it said that, Mr. Minister, in the Premier's press release.

HON. MR. McCLELLAND: It does not.

MR. D'ARCY: Maybe you've altered that since then. I've not seen a subsequent release. I only have to go on....

HON. MR. McCLELLAND: Read the release.

MR. CHAIRMAN: Order, please.

MR. D'ARCY: Mr. Chairman, the copy of the release I had, and it's the release everyone else had and the press had, said it was going to be subject to an assessment for need. Mr. Chairman, this was the same way as it has always been done and is still being done under the Ministry of Human Resources, where they do what they call "an ascertaining of circumstances" before they provide the additional funding through the Ministry of Human Resources. I would hope the minister can show there's been some change in this, but it would seem as though the method of funding is still very much the same except that it's now based on $6.50 a day instead of $4 a day and the mechanics of the funding have moved down the hall. They've moved down the hall from the Ministry of Human Resources to the Ministry of Health. The minister seems to be a bit exercised about this; perhaps he's going to assure us that something has changed, that something is different.

HON. MR. McCLELLAND: You don't know what you're talking about.

MR. D'ARCY: Mr. Chairman, he gave us a short compendium yesterday about what he would have the committee believe were new approvals for new projects for intermediate care in the province of B.C. I did some investigation about it last evening. I found out that these were all old applications and old approvals. They were not new; in fact many of them were pending at the change of government, let alone when this ministry assumed responsibility for intermediate care last spring.

HON. MR. McCLELLAND: Nonsense!

MR. D'ARCY: I commend the minister for finally pulling these out of the drawer, after sitting on them for nearly a year, and piloting their approval through the Treasury Board. I commend the minister for doing that. But can the minister tell us what really new projects, new applications and new programmes he has for intermediate care that have been received since his ministry took responsibility for intermediate care in the spring of last year? That's what we'd really like to know. Some projects went ahead in the early spring of 1976, when intermediate care was still under the Ministry of Housing. When they were transferred to this ministry, as I said, they all went into the drawer. The minister sat on them, for reasons best known to himself. He then started to release the projects and to get them going; I commend him for that, but what really is new? Can he tell us what really is new?

Mr. Chairman, yesterday afternoon I questioned the minister. I urged him to see what he could do to

[ Page 3677 ]

expand the cardiac surgery, post-operative care and intensive-care units at the Jubilee Hospital because they were able to handle less than half of the potential caseload on a weekly basis and because they had a waiting list of up to eight months. The minister denied this was true. I've had my information subsequently confirmed. I'm wondering if the minister can tell us. Once again it's true that there are some post-op beds that have not been opened out 'there. I'm told, though, that these were additions not to increase the surgical capacity, but really only to bring the post-operative care facilities up to what they should have been under the present surgical load. Because they were only keeping their patients for two or three days in the open-heart post-op care and then either moving them out into the ICU or into an acute-care ward, they were really running at greater than 100 per cent efficiency. The new beds were designed to rationalize the surgical facilities that they already have.

I appreciate, Mr. Chairman, that there may be some physical limitations in terms of the space allotted the design engineering of the particular area of the Jubilee that is used for this. However, I do believe that some expansion should be made. I would also like to impress upon the minister what I feel is the need for some kind of high-density care for post-operative cases. There is an inflexibility here where the hospitals are required to have no more than one nurse for two patients. In some cases this is adequate or even more than adequate. In some cases one patient needs one nurse or maybe even more intensive care than that. I would suggest that there could perhaps be a better use of facilities and a better use of staffing that would allow the administration of that hospital and the other hospitals, VGH and St. Pauls, that do this sort of work greater flexibility and better staff use.

Mr. Chairman, I would like to reiterate what I said yesterday that 75 per cent of these patients re-enter the work force. Those that don't are either past retirement age or choose for other reasons not to seek employment and that the productivity loss to the economy of B.C. and the use - of benefits to sustain them while they're on the waiting list, apart from the obvious humanitarian question, would far outweigh the extra public expense here of speeding up the process. I am totally convinced that the surgical care ability is there already. It's the matter of post-operative care that is the bottleneck.

Just briefly, rather than recycling the business of the replacement hospital in greater Victoria, the minister implied, perhaps inadvertently, earlier that there was room in the Jubilee Hospital to handle the patient load and service load and emergency-care load that would be abandoned by the closure of some of these facilities at Victoria General. It is my opinion, and I think this is borne out by the administration, that the facilities at the Jubilee are already overutilized. Just out of curiosity I have dropped by the emergency department there at I o'clock in the morning and found they were falling over themselves there, not through any fault of the staff, but they had young children with medical and accident problems, they had older people with sudden crises, they had extremely ill people. The same is true at 3 o'clock on a Sunday afternoon.

Again, the minister implied that they were in fact from the western community; most of them were in fact from within a few miles of that particular hospital. So it's quite true that the 60 to 80 per cent of the caseload at the Victoria General that are within one mile of that hospital could, in fact, without a great deal of difficulty be served through the Jubilee facility were the VGH not there. I would wonder how the minister thinks that the Jubilee facility can handle those people considering that it is already overtaxed from people living within its immediate sphere.

Mr. Chairman, the minister has talked about planning; he has assured the committee that he is doing a great deal of cost analysis and long-term planning. I don't see evidence to that effect, but we will initially, at least, hope that we can take him at his word. I'm wondering if he's done an analysis of the cost effectiveness in terms of student services and teaching services of the UBC teaching facility. Let's assume for a minute that we need that added enrolment in British Columbia and Canada, of which I'm not convinced.

However, abandoning that argument for a minute, can the minister tell the committee if he's done an analysis of the cost effectiveness of training those extra students and extra other people in the medical field on the UBC site versus the question of expanding and intensifying the facilities in the existing teaching hospitals in the lower mainland? We haven't heard mention of that.

Earlier in the discussion this afternoon, the second member for Victoria (Mr. Barber) noted that, functionally speaking, one of the real values of the James Bay Health Centre was the fact that they'd had nurse practitioners on duty. I normally think of nurse practitioners as people who work in rural areas and semi-rural areas which are perhaps under-doctored or have doctors only at some distance. I would wonder if the minister could tell the committee how he feels about the programme of training more nurse practitioners in British Columbia and using them to greater effectiveness,

I feel that there is a fair consensus in the medical profession that this would be desirable, and perhaps the minister could tell us some exciting things in this area.

A small item about difficulties of hospital administration, Mr. Chairman, is that it has come to

[ Page 3678 ]

my attention that hospitals bill people, actually send out bills, for amounts as small as $1. 1 think that for things like physiotherapy there's a charge for each patient visit to the hospital of $1. 1 don't know whether this applies to other things such as people using ophthamology labs and so forth. However, at 12 cents a mailing just for postage and 12 cents to send the money in, plus clerks working at $5 or $6 an hour and the cost of stationery, I would suggest that the hospital be instructed to either drop these small forms of billing completely or else charge cash on the barrelhead, as do you pay for emergency services.

People who go to emergency in a hospital pay $2 cash out of their pocket. I think this is a good system. If there is to be a fee at all, let's pay cash right there, but the question of chasing people around the province for amounts of $1 or $2 just doesn't make any sense at all in 1977.

1 was very appreciative of the remarks of the member for North Vancouver-Capilano (Mr. Gibson) , Mr. Chairman, regarding alcohol in British Columbia. I would wonder, though, if the Minister could tell the committee what he's doing to assist those public organizations, such as AA, who have been running their own treatment services, partly through government grants; who have been operating halfway houses; who have been working quietly, but very effectively, in British Columbia for some years to assist people who have realized they have an alcohol problem, wish to resolve that problem, keep it resolved, and get back and continue to be productive citizens in B.C. There has been some indication that government support for these organizations has not been what it could have been. I think every member of the House will agree that self-help and self-starting out there is far more valuable than anything a government can do directly. Perhaps the minister can tell us something in that regard.

Mr. Chairman, briefly, again I'd like to make a plea that there be some kind of rationalization of the method of funding for hospitals. I know the minister has mentioned sympathy for this cause; that he has intended to do something about it. The very fact that most of the funding for hospitals is simply tied to patient-days is bound to lead - hospital administrations being only human - to different abuses.

For instance, it obviously costs a great deal more to keep someone in intensive care than it does to keep a chronic-care patient in a hospital. They wouldn't be human if they did not, in fact, try and rationalize their cost if you get the same fee regardless of the type of patient. There are going to be some people kept in acute-care beds who could be at another level of service because the amount the hospital is going to get is going to be the same. I would hope there would be some rationalizing so that a hospital would recover from the government the actual costs for the services given rather than some arbitrary figure about how long a patient stays in bed regardless of the type of care that patient did need.

I would also like to point out that there's hardly any incentive for the hospital establishment - and I don't use that word critically, but for want of a better term - to press for more extended- and intermediate-care services as long as this situation remains in effect. I'm not suggesting that they're opposed to this kind of care; I'm just saying that there is perhaps a large and influential lobby which is perhaps backing off a little bit because, quite frankly, under the present method of funding it's hardly in their interest, in many cases, to lose the patients they have in their care for a few extra days that could be at a lower level of care.

Mr. Chairman, I'm wondering if the minister could let us know if he is going to proceed with the suggestions that have come from many agencies for a health advisory council for British Columbia.

HON. MR. McCLELLAND: I just answered that. The member for North Vancouver-Capilano (Mr. Gibson) asked that and I answered it.

MR. D'ARCY: Perhaps he used a different form of rhetoric, or a different set of words, when he was answering that. However, I would like to know the details of it and just how far it's going to go, particularly in the coming year.

I would also like to make a plea that we're now in July this year. This is the seventh month of this year. Hospital budgeting really can't finalize anything until after these estimates have been passed. This budget was brought in in the latter part of January. These estimates were called just this week. I'm not blaming the minister for that; I'm just pointing out that perhaps we could have a more definite system and a more flexible system.

There have been pleas, as well, from out of the ministry that hospitals lack information that would assist management effectiveness, and I make a quote here: "But the system militates against the considerable benefits that would arise from a more participatory form of decision-making." I realize that the ministry cannot involve all of the major hospital administrations in its decision-making all the time; however, I do believe there could be greater communication and greater participation by the major hospitals, particularly in the decision-making which affects them as individuals and is particularly relative to them.

Mr. Chairman, in closing my remarks, I would like to note some remarks made by the federal Minister of Health (Hon. Mr. Lalonde) regarding what he considers to be the oversupply of doctors in British Columbia and in Canada and how these costs affect us in British Columbia. He notes in some of his

[ Page 3679 ]

remarks here that for reasons of climate and landscape, the elderly are attracted to British Columbia, seeking a retirement place. He also says that so are physicians. He says:

"The result is that your province now has a very generous supply of physicians, although their distribution geographically may be less than desirable with a concentration in Vancouver and Victoria. In addition, the mix of specialist physicians in any given locality may be inappropriate for the needs of citizens for medical care."

In terms of the numbers of physicians and cost, what does this really mean? He says that at the end of 1974, the province had a total of 4,150 physicians, representing a population ratio of 1 to 588. If the rate of increase in numbers continue, there will be 5,700 by 1980, creating a ratio of 1 to 5 10. He notes that these compare with the figure of 1 to 650 which the WHO considers as representative of an adequate supply.

"More physicians obviously mean more cost but not necessarily better quality of care or improved health status on the part of the population. In fact, there may be minimal improvement if an increasing supply fails to resolve the continuing problem of functional and geographic maldistribution.

"Needless to say, the larger number of physicians practising in the province in turn is reflected in the fact that British Columbia has the highest per capita cost for physicians' services in all of Canada, about $72 in 1974-75 compared to a national average of approximately $65."

That's even higher than the province of Ontario, Mr. Chairman.

I would really wonder. I know that the minister has had negotiations with the federal government on this. I don't know whether he is satisfied that they have been resolved to the interests of the province. I know he's going to tell us they have been. However, the minister knows that the federal legislation, in the past at least, has only provided for 50 per cent sharing on a national basis. If you have higher costs than that, you can still only recover your share prorated over the entire country, and this is meant in B.C. that traditionally we have picked up from $5 to $10 million difference above the federal contribution. Mr. Chairman, I was also interested in the concept of the responsibility of the individual to their own health. In B.C. and in other parts of Canada, there's absolutely no question that we have need to expect from the individual a far greater responsibility in preserving -their own health. If we think of illness and disease as acts of God that happen to fall on people from time to time, there's certainly plenty of evidence to indicate that the kinds of things that make us seriously ill and cause premature death are in fact self-caused, self-imposed hazards, accidents which in many cases could be prevented. They're caused by such things as lifestyle, lack of exercise, too much smoking and drinking, as has already been indicated by the member for Capilano (Mr. Gibson) . Indeed there are many things which the individual can and should have a great deal more responsibility for.

I'm not suggesting that some kind of Draconian measures be taken by the ministry regarding people's lifestyle but I do think that the Ministry of Health in this province and in other provinces could show a great deal more initiative - the Ministry of Education as well, Mr. Chairman - in alerting people to the responsibility to their own health and the grave risks which they take to premature illness and premature death that we have in B.C.

Again, looking at some work produced by Mr. Lalonde, we can see that there is no question that over the age of 40 the rate of or the risk of death due to coronary disease or all cardiovascular ailments is so high that it becomes really frightening, particularly if one is a male. There's absolutely no doubt, as he says, that obesity, stress, high-fat diets in combination all make a tremendous contribution to this,

I must commend the minister in his initiatives regarding smoking. Beyond the age of 50, if we look at all deaths from cancer of the larynx, trachea, bronchial area or lung, as well as those deaths caused by bronchitis, emphysema and asthma, we have again a tremendous number of deaths which could be prevented by individuals taking better care of themselves.

In fact, if we look at the five major causes of death between persons of I and 70, we see that each and every one of them relates to factors which are within the control of many individuals - motor-vehicle accidents, coronary disease, all other accidents, respiratory diseases and suicides. These in all cases are due to lifestyle; they are due to reckless behaviour, either by a one-shot thing or over a long period of time,

Mr. Chairman, I would like to return to some other things in a few minutes, and give the minister a chance to respond to some of the comments that have been made here,

HON. MR. McCLELLAND: Mr. Chairman, I'd like to thank the member for reading one of my old speeches about lifestyle into the-record again. I'll try and answer as many of the questions as I can.

The problem with physician supply I went over in quite great detail yesterday. I don't think I need to deal with the initiatives we are taking in that regard.

The hospital advisory committee - as I answered the member for North Vancouver-Capilano (Mr. Gibson) , we're not considering that at the present

[ Page 3680 ]

time. Hospital funding is a matter which is of ongoing concern to the ministry. If there are better ways in which to provide funding for hospitals, we want to know about them. To that end I some time ago asked the British Columbia Health Association if they would put together an economics committee, which they did. I've asked them if they have suggestions. If they can come up with new ideas for hospital funding through their deliberations then by all means we should have them.

The budgeting problem is age-old in terms of hospitals not getting their budgets as quickly as they should be. This year we hope to have budgets out this month or early next, I believe, at the latest and I think that's one of the fastest times that we've had in a long time. Sometimes hospitals have waited until September for their budget.

However, we've taken further steps in the legislation which has been passed now to ensure that as of next year hospital budgets will be in the same fiscal year as the minister's budget, rather than calendar versus fiscal. I believe that will go a long way, Mr. Chairman, towards ending some of those problems that have been faced in the past.

The matter of alcohol grants - we're expanding our grants to community agencies all of the time. We now fund approximately 50 community agencies around the province. We've developed an evaluation programme control mechanism, which for the first time, I think, asks those agencies to demonstrate that they're doing a good job with the alcoholics in their community. On a couple of occasions - not very many - we've had to say: "We can't continue to grant you money, because you're not doing a job." In those instances - and I think of Prince George, for instance, where we've had some problems - we've gone in and developed a programme as an alternate to turn over to the community which we think will work. As you might expect, there are more requests for grants than we have money available, and that will always be as well. But hopefully we can evaluate those requests and make sure that the ones that we do fund are the ones that deliver the best service to the communities.

Incidentally, I stand to be corrected, but as far as I know Alcoholics Anonymous has never ever asked for government funding. I believe that their philosophy is that they stay away from government funding. They've held to that much more firmly than a lot of other community groups have done, and I think they should be commended for that.

MR. D'ARCY: I simply grouped them in as a group having a great track record.

HON. MR. McCLELLAND: In addition to those 50 agencies which we are now funding -approximately 50 around B.C. - we have a number of new programmes that are now at the implementation stage. I'd like to outline some of them for the member, Mr. Chairman.

In terms of direct services provided by our Alcohol and Drug Commission, there's the Maple Cottage Detoxification Centre, which will service the South Burnaby, New Westminster, Surrey, Coquitlam, Richmond and the Delta areas. It's to be built at Maple Cottage at Woodlands. It's in the renovation and construction stage now. Its initial capacity will be 20 beds and we hope to later establish another 15 or 20 beds there. The first floor of Maple Cottage is now being renovated and if necessary we could use the second floor and expand up to about 50 patients. That completion date is set for around September 15 or 30. That will be another new detox centre on the lower mainland.

There is a residential treatment centre designed by the commission which will be a model for all of British Columbia, and we now have approval. We had some problems with that one. We had it all set to go into a place called Seton Villa, which you may be familiar with, in Burnaby and we had some problems with Burnaby council. We couldn't get a rezoning, so we had to scrap our plans and move somewhere else. Fortunately we were able to get an approval from New Westminster city council to allow us to use the facilities of the New Westminster YMCA, which was having trouble filling their residence. So 1 think we came to a very good mutual agreement where we got some facilities we needed and the Y got some revenue that they needed and that they were losing.

That centre will be a treatment resource for the lower mainland. It will also be a model for developing programmes throughout the province and a training centre for professionals both within the service and in the funded agencies in the community. We hope by having these model treatment centres we will be able to train those people to do a better job in the community than they're doing now. That facility should be ready either this month or early next month.

I'm sure every member in this House heard particularly from the Vancouver police that there's an urgent need for an alternative to the drunk tank for non-violent people who are picked up for having had too much to drink. The commission is now in negotiation with the Ministry of the Attorney-General to bring such a unit into operation. That will be a compulsory detox centre, which will take the place, we hope, of the drunk tank in the Vancouver city jail, which is a terrible mess. It will be used primarily by the police, and one of its advantages is that it will be able to be used for longer periods than can that city jail. In other words, they just won't be dropped in at midnight on Friday night and dumped out on the street on Saturday morning. They'll be able to get some real detoxification when

[ Page 3681 ]

that facility is built. I'm sorry I don't have a date for that facility at the present time.

We are now in the planning stages of a more comprehensive out-patient service in northern B.C. It will be centred in either Prince Rupert or Terrace. In the West Kootenays, there is an out-patient counselling service planned for this area which has been without any service, as I understand it, with this kind of facility. In the upper Fraser Valley there is another comprehensive out-patient counselling service for the problem drinker in the Mission, Abbotsford and Clearbrook area.

One of the priorities of the Alcohol and Drug Commission has been the buildup of its research division. That is going full speed ahead and we expect that that will result in better treatment for the alcoholics, particularly in this province. There are quite a few things happening, Mr. Member. I'm pleased, first of all, that the Alcohol and Drug Commission was transferred over to the Ministry of Health because I believe that is where it should have been all of the time to deal with this problem.

I just don't know how to answer the question of the waiting list at Royal Jubilee because your information is completely different from mine. The hospital informs me that there is no general eight-month waiting list, that they are doing six operations a week now, and they are as up to date as they could be. Certainly there are some people who will wait eight months, but that's usually a combination of factors that may be predicted by the doctor or by the patients themselves who may have some trepidation, for instance, about having the operation and wait until they can be confident that they are able to go through with the operation. There are a lot of different reasons. But I'm told that there are perhaps 85 people on the waiting list and that there just is not a real waiting period for that facility at the present time. Obviously we're getting our information from different places, but that is what the hospital tells me.

I'd like to deal with the first issue you raised and that is the question of our new comprehensive long-term care programme. Obviously, Mr. Chairman, the member does not understand that programme and what was announced. If he does, he is completely misrepresenting it. What is different in that programme? For the first time in this province's history, we will have met the commitment to provide a universally subsidized coverage at the intermediate and personal-care levels. What is really new about this programme? In excess of 10,000 people in this province will now be getting intermediate and personal care at $6.50 a day who were not covered before. That's what is new about this programme, Mr. Member. More than 10,000 people will now be covered who may have had to spend their life savings to get that.

MR. D'ARCY: Are they covered by Human Resources?

MR. CHAIRMAN: Order, please, Hon. member.

HON. MR. McCLELLAND: No, they were not covered by anyone at this point. They were paying out of their own pockets, some of them as much as $1,000 a month for this kind of nursing-home service. Now they will be covered for $6.50 a day. There is no income or asset testing whatsoever in order to achieve this coverage - none whatsoever. The only criterion upon which this programme will be based will be medical need. If they are assessed as having that medical need they will receive that service for $6.50 a day. That is what is new and different.

Mr. Chairman, as well as the programme of institutionalized care, there will be a homemaker service which will, in all likelihood, be transferred over to the Ministry of Health from the Ministry of Human Resources. In that programme we will see persons receiving that service, based again on their medical need, but paying for it on the basis of their income and only for that portion of the programme. 1 can tell you that the vast majority of the people who are involved in needing homemaker service will get that service for nothing or for a very minimal charge. Mr. Chairman, I outlined many of the kinds 'of charges that would be made for the homemaker programme in the press conference we had when the Premier made this announcement. Somebody - 1 believe it was the member for Rossland-Trail (Mr. D'Arcy) - asked why the Premier made the announcement,

MR. WALLACE: He announces all the good news.

HON. MR. McCLELLAND: The reason the Premier made the announcement is that this is one of the most important new steps forward in British Columbia's history and no one should make that announcement but the Premier. 1 don't find anything unusual in that. The full cost of that programme in its first year will be about $138 million. The budget for homemaker services will be quadrupled in the first year from what is now being spent for homemaker services. 1 must emphasize just once more that under the new programme the homemaker services will be based first of all on medical need. The charges will be based on an income test only and not an assets test, which is a very important distinction.

MR. D'ARCY: There will be an income test?

HON. MR. McCLELLAND: There will be an income test for the homemaker services - I wish you would listen - but not for anything else. Institutional care will be covered on medical need only at $6.50 a

[ Page 3682 ]

day for everybody who needs that care.

For the homemaker part of the service there will be an income test - it was announced by the Premier on that day. There will no longer, however, be any assets test. If you just mull that over in your mind for a moment, you'll realize what an important distinction that is. The example 1 gave was that for a single person with an income of $8,000 a year there will be absolutely no charge for the homemaker service. For a couple making up to $12,000 a year there will be absolutely no charge for the homemaker service. It will be graduated up above $8,000 a year for a single person, up to a maximum of what will probably be around $150 a month. But that would be for someone who was making a pretty substantial income. There'll be no assets test, only an income test and only for homemaker services.

MR. R.L. LOEWEN (Burnaby-Edmonds): First of all, I'd like to express my appreciation to the minister for the many programmes that he has been responsible for introducing that have a real concern for people. I have expressed my concern a number of times with respect to detoxification centres. I'm just sorry and in fact extremely disappointed that his plans in respect to the Seton Villa in Burnaby North did not materialize. 1 suppose 1 don't have the right to apologize for the municipality of Burnaby but 1 must express my disappointment, because the Seton Villa would have been a beautiful location.

I'm also somewhat sorry that the member for Burnaby North (Mrs. Dailly) wasn't in a position or wasn't willing to do her part to try to encourage the establishment of the detoxification centre at the Seton Villa.

Secondly, I'd like to express my appreciation for assisting and making use of the facilities of the YMCA in New Westminster. As a member of the board of directors of the YMCA in New Westminster and struggling with the economics of their residential programme of the YMCA in New Westminster for some years to combine the detoxification needs together with the needs of the YMCA, 1 think it is certainly a very honourable and commendable move.

I also appreciate his concern regarding intermediate and personal care which has been way overdue in British Columbia. Finally we have moved into that field which has been so very important.

Most of you know that 1 was honoured to be a guest of the Chinese people in China in October of last year. One of the outstanding happenings and occasions in our trip to China took place in Shanghai. So I'm happy to hear the minister's comments in respect to acupuncture. For those in this House who have doubts concerning acupuncture, or who simply have concerns or are simply interested, I would like to tell you at this time that we were privileged in the hospital in Shanghai to witness acupuncture used for many different reasons: from coronary problems to ear problems, stroke patients, ulcer problems, nervous problems, pain problems, even bedwetting. We also saw acupuncture used in a very, very major and very serious operation, a cancerous hysterectomy operation where acupuncture was used as the anaesthesia.

MR. WALLACE: A hysterectomy for cancer!

MR. LOEWEN: A cancerous tumour - a hysterectomy operation in which the cancerous tumour was removed, doctor. We witnessed the operation and we witnessed the patient communicating with her doctors throughout the operation.

I have several concerns in this respect. One is that I asked the doctor who was explaining the operation to us whether or not western physicians or western medical colleges were making a sincere and honest effort at understanding acupuncture as practised in eastern countries, particularly in China.

1 can only pass his expression on to you: there was not a real, concerted effort at truly understanding the merits and the benefits of acupuncture. My concern, which I would like to pass on to the minister, is simply this: 1 appreciate the move that we have made, that he has made, that the British Columbia College of Physicians has made in recognizing the benefits of acupuncture, up to a point. My concern is that the public - the western people, particularly in British Columbia - have the confidence in our medical profession, that they in fact are making every effort to find the very best possible treatment for our people here in the west and particularly in British Columbia. I believe the people of British Columbia need to be assured, both by the minister and by the College of Physicians, that this is in fact taking place. 1 can't help but think, hearing the member for Oak Bay's memorable announcement, that possibly he should lead a committee to look into the possibilities of acupuncture, seeing he will have all this spare time.

MR. WALLACE: Mr. Chairman, 1 appreciate the member for New Westminster (Mr. Cocke) deferring to me. 1 have to be elsewhere in a little while.

I thank the member for Burnaby-Edmonds (Mr. Loewen) for his bright idea, but the answer is, no thank you. I won't have all the spare time that he seems to imagine.

I just want to talk very briefly on the question of physician manpower and the problems that relate to that, particularly the decisions that have been made regarding the UBC campus hospital. 1 think this question has not been well canvassed as yet.

1 want to quickly read into the record, Mr. Chairman, figures for immigrant medical doctors to Canada: in 1969 - 1,347; 1973 - 1,170; 1975 -

[ Page 3683 ]

800; 1976 - 401. For example, in 1976 we've had one-third of the medical immigrants that we had in 1969, and for the first quarter in 1977 there has been a 20 per cent reduction over 1976.

I also want to read into the record that between September 1,1975, and August 31,1976,329 doctors were registered in British Columbia, of whom 220 were Canadian graduates and 66 were from UBC. Sixty were from the United Kingdom, four from the United States, seven from South Africa, five from Australia and New Zealand, and 33 were from other countries.

I have no wish, nor have I the time, Mr. Chairman, to go into a long discourse about the details. All I'm saying is that federal immigration policy has made a very dramatic dent in the number of doctors coming to Canada from other countries. If the trend continues throughout the rest of 1977 we will have about 300 immigrant doctors to Canada compared to 1,300 in 1969, for example.

The point I'm making, Mr. Chairman, is that in some ways I think the argument about medical manpower is like politics in B.C. It's on a pendulum. We're either going to have too many doctors or we're going to get upset about that and within another five or ten years we'll be wondering where we're going to get enough doctors. I know it's a difficult problem. I'm not suggesting that the answers are easy or that there's any one particular body of opinion - doctors, politicians, or anyone - who can come up with completely reliable figures. But there is no doubt at all that national policy has greatly and quite abruptly reduced the inflow of doctors to Canada from other countries.

I think that should not be overlooked when we suggest, for example, that we should not be expanding the medical school at UBC. I happen to believe that the medical school should be expanded. I think that there are many first-class students who have great difficulty obtaining access to medical education. Little countries like Scotland provide a very substantial output of doctors. Many of them leave Scotland for reasons we needn't go into in this debate. Nevertheless, on a per capita basis a country like Scotland with five million people produces a very substantial number of doctors annually, many of whom leave Scotland, and the Scottish people don't seem to be upset about the fact that they're making a contribution by providing these professional people. Similarly, I feel that British Columbia should and could do better at providing a medical education for a larger number of B.C.'s sons and daughters.

What I do feel is very regrettable and something with which I totally disagree is the building of an acute-care hospital on the campus at UBC. I've looked at this matter as carefully as I can, and I've listened to many points of view, and I've had a meeting with the president and other members of the university.

I find that very much in conflict with the espoused policy of this government. It recognizes the community importance of medical services, namely that w e should de-emphasize institutional hospitalized care to the maximum possible degree and provide the greatest possible emphasis for community care at the very local level, whether it be between patient and general practitioner or social worker or nurse or whatever.

[Mr. Schroeder in the chair.]

The reason I find this decision to build a UBC campus hospital additionally puzzling, Mr. Chairman, is that this minister, as recently as May of this year, wrote an article for the Canadian Medical Association Journal. While there is a great degree of the minister's article with which I am in agreement, there is just an amazing statement, for the minister's benefit, on page 1047 of the Canadian Medical Association Journal, May 7,1977, in which the minister says:

"The fact is that our entire system of medical education is largely hospital-oriented. The medical graduate who is the product of a large hospital with sophisticated equipment and a wealth of medical and nursing staff can be forgiven for feeling uneasy when plunged into a small community with a minimum of facilities. Apart from increasing demand for ever more sophisticated facilities, this syndrome has another unfortunate effect. It discourages many young physicians from practising in rural areas."

Now it would seem to me that by expanding the medical school, which is a good idea, through a hospital on the UBC campus which is convenient to teachers and students and faculty and everybody else, when it isn't suitable to the patient who has to travel to that rather ivory world or some relatively isolated hospital.... I thought all the thrust in the training of doctors nowadays was to emphasize a much more localized, community-based type of service and relationship between patient and the person providing the medical service. I just see that we're going in exactly the opposite direction by having a new hospital built on the university campus which, as I say, is suitable for everybody but the patient by and large.

And on top of that, to be told that 90 of the beds are basically for research work.... I'm not saying that we shouldn't be involved in research. But we have already debated at great length the difficulty in deciding how many acute beds are needed in the province and in the urban areas, I just see two blatant contradictions here. On one issue we're talking about teaching doctors to be good community-oriented physicians. I don't see how they can become such

[ Page 3684 ]

when the most important years of their training will be in a very sophisticated hospital located on a university campus. I'm disappointed that that decision was made, although I strongly support the thinking that we do need more places for young British Columbians to receive their medical education.

Once again, it's like the decision on the Helmcken Road Hospital - that's going in the wrong place too. The decision has been made. This decision on the UBC campus hospital has been made. I wonder if the minister can tell us what steps will be taken to ensure that the young doctor coming out of that UBC campus hospital will not in fact be the very kind of person who is blinded by the number of lab tests he can order and all this sophisticated, expensive equipment that can be used and all the very things that the minister expresses concern about in the Canadian Medical Association Journal on May 7.

That is one point. The other question I would like to ask the minister relates to the extended-care hospital on the UBC campus for which they're having all the difficulty in obtaining nursing staff. Now once again, manpower - or womanpower, I suppose, if we're talking about nurses - is always something that's hard to predict. I know that many nurses choose to quit for the summer and decide to take time off with their family. These are problems the former Minister of Health (Mr. Cocke) talked about. But would the minister care to tell us what light there is at the end of the tunnel in solving this problem of spending, quite justifiably, large amounts of capital money to build facilities and then, at a time when unemployment in the province is said to be 8 per cent, we can't find nursing staff? This seems a major puzzle to me, let alone to lay people who are wondering where the truth really lies in regard to not only providing the facilities but coming up with the staff.

The last quick point I wanted to make was to ask the minister with specific regard to a situation in a rest home in Burnaby. I don't want to mention names, but the minister has on file letters from a lady who doesn't mind being identified, a Miss Marcia Harris, who was reassured back in April that the matter had been given over to Mr. Bainbridge to investigate this particular rest home. I don't want to appear to be picking out one particular facility, but there's no doubt that this lady went to visit patients in that particular home and was very distressed by some of the things she saw, and the poor standard of care.

She wrote to the Minister of Human Resources (Hon. Mr. Vander Zalm) and to the Minister of Health, who I believe in turn arranged for Mr. Bainbridge to carry out an investigation and report back. I'm wondering if we could know, first of all, if that investigation has been done, and what more general investigation is being done to ensure that the standard of care in these facilities is maintained.

Related to that question, of course, is the one following the minister's answer to the member for Rossland-Trail (Mr. D'Arcy) about the intermediate-care programme at $6, 50 a day. I'm very puzzled to know what plans are underway to create new facilities that are very much required. It's all very well to say they'll be covered at $6.50 a day in intermediate care, but the B.C. Health Association wrote a letter of which I'm sure the minister got a copy.

It's from the B.C. Health Association. I can't remember the exact figures - they were on the order of 1,500 intermediate-care beds being available - but there was a real need within the greater Vancouver area, I think it was, for something on the order of 3,500 beds. Now I'm quoting from memory. Therefore the question is very simply this: as the programme the Premier announced was certainly the good news, who's going to announce the bad news that there aren't enough beds or facilities to provide the intermediate care? I think that's a very valid question, and the evidence is there from authorities like the B.C. Health Association that even if the care were to be provided free, it doesn't make much sense if there are no facilities in which to provide that care. Could the minister tell me what construction plans or what other modifications of existing facilities he plans in order to ensure that when medical need is there and a person requires intermediate care, that the actual facility will be available come January 1,1978?

Not only would this be reassuring to many of these elderly patients, but surely if we could get into a construction programme in the summer and fall months, that would be particularly valuable in trying to create some of the jobs which the Premier well knows are desperately needed in the province.

HON. MR. McCLELLAND: I would like to answer the member's questions because he said he must leave.

The problem of new facilities is one which is ongoing and, regardless of what the member for Rossland-Trail said about those new facilities for which we've given approval, six of them got their approval from this government now. They never had any approvals before.

As for those new beds, we have decided, Mr. Chairman - and it has been announced publicly -that we are not going into a construction programme that the government will sponsor, but that we intend to continue the practice of having locally based societies develop intermediate-care facilities. That's going on now. As the applications for those societies come in, we're processing them as rapidly as we possibly can.

[ Page 3685 ]

We've got applications underway, or about to come in, from all over the province. As soon as we get them we'll process them. We're planning to have a number of others finalized late this summer and we'll be making announcements on them as well.

The nursing home problem that the member raised - the specific one - I'll have to get the staff to look into that one again because I just don't recall it off the top of my head.

MR. WALLACE: I'll send you the address.

HON. MR. McCLELLAND: Yes, please do. On a general basis, I would like to say that the Queen's Printer now has the new regulations for personal, intermediate and nursing homes which considerably tighten up the need for the operators of those homes to provide upgraded service for the patients, and also, perhaps more importantly, spell out in good detail the need for the operators of those facilities to provide activation projects for those patients who are in their care. So they don't only provide a bed for a person who's in an intermediate-care facility, but they provide some programmes as well to make that environment more pleasant for those people, some of whom will have to be there the rest of their lives.

Those regulations, as soon as they're finished at the Queen's Printer, will be circulated to the operators and to all our health units so that nursing-home co-ordinators can begin operating under the new regulations as quickly as we can get them out.

I can't answer the member's questions on the UBC extended-care situation except to say that it's very distressing when we have 200 nurses on our unemployment insurance rolls in the greater Vancouver area and we can't get 60 nurses to go to work in a new hospital.

You can't force the nurses to work, and certainly some of them have said that they would be happy to come to work in August. They want their summer off, I guess. I would hope, however, if a job is offered to someone on UIC, that they don't continue to get paid from the government if they don't want to work. But that's out of my jurisdiction entirely.

One thing I can say in speaking to the administrator of the Health Sciences Centre is that the media campaign which went over those two or three days before the opening was very helpful, and he now has far more applications than he had before. So I think it's coming along. I think he did about eight interviews yesterday or the day before. He's doing interviews every day and I think that the complement will be filled.

Rather than get into the whole question of the UBC hospital again, I think the member just wished to express his opinion. I don't think there's too much of a contradiction in the things that I've said before.

We are still committed to the kind of medical education in this province that will help to prepare a student for service in areas which don't have all of the facilities of Vancouver or Victoria.

As you say, the decision has been made. It wasn't made lightly, and it was made on the recommendation of a task force committee which was unanimous at that time in its recommendation. Certainly there's still a difference of opinion, both among the medical profession and among the teaching profession, and certainly among politicians. I recognize that difference of opinion and respect it, and I think that's all I can say.

MR. D.G. COCKE (New Westminster): Mr. Chairman, the minister brushes that one aside lightly. He says there's a difference of opinion. Yes, there's been a difference of opinion. The only trouble is that yourself and the Minister of Education and two or three other people in the province who are in favour of a university hospital, a monument to the member for Point Grey, a monument to the Minister of Education.... As a matter of fact, I would suspect that you're even opposed to it because your party bought that member by giving him the university hospital - nothing more, nothing less. I think it's absolutely a travesty and it's tragic because, Mr. Chairman, let's have a look. Let's sort out who supports what. The B.C. Health Association, what do they say about it? "In general, we're concerned that this project, intended to benefit the province, may well be more potential liability than benefit." That's the B.C. Health Association.

The B.C. Medical Association.... Now, mind you, they roar like mice, but I don't believe that the B.C. Medical Association supports it. I really don't. I've talked to enough of them that I suspect right now that the vote would be very, very strongly in support of getting that hospital back down where it belongs, in the hospital corridor. It's purely and simply a means of looking after the academics. They don't want to go too far; they don't want to take a taxi; they don't want to drive their cars downtown. Let the people come out there. But, Mr. Chairman, if they haven't learned on one occasion - McMaster -which has been 40 per cent occupied since it was built.... It's a university hospital in Hamilton; it's away from the people. Sherbrooke - exactly the same thing, Mr. Chairman. What's the matter with us? We take the hospitals away from the people instead of putting the hospitals down where they belong. It's an absolute travesty. It's tragic. But anyway, we've gone all over this material and I'm going to go over some of it again just a little bit.

I would like to suggest, Mr. Chairman, that the BCMA hospitals committee reported: "This would appear on the surface to be extremely costly and in the best utilization of existing resources ... would

[ Page 3686 ]

create problems in the future."

Mr. Chairman, this is from the B.C. Medical Journal, Volume 18, No. 11: "When one adds the impact of the political decision to build an unnecessary, expensive university hospital at a time of impossible financial constraint, one can only conclude that our problems with hospital financing in this province are just beginning." I think the whole thing smacks of, having made a promise to that research-oriented Minister of Education, they had to carry out the promise. That's it. He announced it. The Minister of Education announced it. The Minister of Health didn't even announce it.

Mr. Chairman, we do have hospitals in the corridor in Vancouver badly in need of repair, badly in need of services. Instead of that we're diverting the funds that could be very well used in the VGH-Shaughnessy-St. Paul's corridor. We're diverting those funds out to UBC to satisfy the academics.

Mr. Chairman, I think that's just preposterous. I can't believe that the minister continually gets up and tries to defend that decision made by his colleague, a decision that I'm sure he had very little part in because I'm not sure where he would get any advice that would take him along in that direction,

Mr. Chairman, I think that the Minister of Education (Hon. Mr. McGeer) has a conflict of interest in this situation. I'll bet you that President Kenney's job out at the university isn't all that secure. I believe that that Minister of Education wants to build that whole university into a magnificent monument for himself and then he's going to go out there and be installed as the next president. You wait and see. That's my prediction as to where we're going in this province and that's my prediction as to where that Minister of Education is going. The Attorney-General smiles because he knows there's a lot of truth in that.

Interjection.

MR. COCKE: Mr. Chairman, they've been trying to make me go for a long time, but you know, you can't quite make it. You've got to offer New Westminster something better than a courthouse.

HON. MR. GARDOM: We're not allowed to bet.

MR. COCKE: I wouldn't mind a little bet. We'll set it out in the hall.

Mr. Chairman, I don't even believe that the Attorney-General's going to be here at the next election, let alone the Minister of Education. He's still looking for that judgeship, despite the glory of being Attorney-General.

Interjection.

MR. CHAIRMAN: Order, please. May I ask the Attorney- General not to interrupt the man who has the floor?

MR. COCKE: Mr. Chairman, the Attorney-General is making light of the Leader of the Opposition (Mr. Barrett) , who received the highest percentage of votes that this province has ever seen in the last election.

HON. MR. GARDOM: He won't be the leader at the next election and you know it.

MR. COCKE: He certainly will. I'll give you one good reason, Mr. Chairman. Under vote 169 I'm going to tell you why the Leader of the Opposition is going to be our leader: because I support him. That's one of the reasons he'll continue to be the leader.

HON. MR. GARDOM: Four-time loser.

MR. COCKE: Four-time nothing! You're on your way down the grade.

Mr. Chairman, I'm going to just deal with another situation. I don't want to deal too much with the university hospital under this minister because he had nothing to do with it.

I want to talk about Dr. Clarke, 2, 4-D and milfoil. Mr. Chairman, the one thing that I think identifies this minister better than anything else is his ability to fight back at those who can't fight for themselves. We saw it last year. We've seen it two or three times in his ministry where he's taken on civil servants - people who couldn't care for themselves, people who couldn't protect themselves - and then he's done it with Dr. Clarke, a respected medical health officer in the interior. He's told that doctor to keep his mouth shut, you know, and whatever he might say.... That's no suggestion, Mr. Chairman; he's proven it.

We asked him. We asked the Premier and we asked the minister to table the documents. Has he tabled the documents? No. Of course he hasn't tabled the documents because if he tables the documents, particularly the memo from the Minister of the Environment (Hon. Mr. Nielsen) that indicates that the seas are getting a little bit rough because of what Dr. Clarke is saying.... That, I think, would be very interesting for us to see.

But I believe the chairman of the Union Board of Health in the Okanagan Valley, who said in no uncertain terms that Dr. Clarke was muzzled. Now he doesn't have to worry about the minister - I guess the minister might go gunning for him - because he's a volunteer.

Interjection.

MR. COCKE: That member for Omineca (Mr.

[ Page 3687 ]

Kempf) is getting upset again, Mr. Chairman. Unfortunately he's not one of the millionaires, but he's an upward striver.

Mr. Chairman, the minister says that he supports the 2, 4-1) programme. He said everything was fine; he said they had lots of scientific advice on it. 1 read some of that scientific advice. Did they tell you to do it? Did they tell you to use the 2, 4-1) in beach areas and areas that are adjacent to irrigation outflows?

Mr. Chairman, the very recommendations of their commission - the pesticide committee, really, who they are using - were not followed. Dr. Powrie, as soon as he found out where they were spraying, suggested that that wasn't what he was supporting, and I'm sure that the other members of the committee felt exactly the same way. They did not have the scientific recommendations to spray where they sprayed.

But, Mr. Chairman, I think the most serious thing is that the minister interfered. The minister muzzled his civil servant and I think that that's just a little bit much. 1 think the minister should somehow or other, some day or other, justify his behaviour.

HON. MR. McCLELLAND: Sit down and 1 will.

MR. COCKE: I'm not going to sit down until I'm ready to sit down. You sit down.

HON. MR. McCLELLAND: Well, you want me to justify my behaviour. Good gracious! I'm going to try.

AN HON. MEMBER: He's stretching.

MR. COCKE: Yes, he's stretching. You'll get your chance in just a moment or two.

Mr. Chairman, last year it was a member of the hospital programmes division - a finance person, as 1 recall - demoted to protect the minister's face, to protect the minister's political life and, 1 presume, give him a little more clout in the cabinet. He did not have enough clout, however, to go against the Minister of Education (Hon. Mr. McGeer) on the university hospital, but just enough clout to survive. Now he's done the same to Dr. Clarke and 1 know it's been very quiet in the Okanagan.

HON. MR. McCLELLAND: 1 can read all this stuff in Hansard, Dennis; you don't have to take the time of the committee up.

MR. COCKE: Mr. Chairman, that's the way we see it.

1 just want to go back to a little discussion we had last evening.

HON. MR. McCLELLAND: Hansard of last year.

MR. COCKE: Are you through? You can have all the time in the world, particularly to explain this.

You had a constituency representative, I understand, who was being paid $800 a month like the rest of our representatives. A constituency secretary, some people call them. All of a sudden that constituency secretary, Mrs. Gran, became an executive assistant. The minister was quoted last night as having said that she's working in the Langley area doing work for the Minister of Health.

HON. MR. McCLELLAND: For the Minister of Health.

MR. COCKE: Minister of Health.

HON. MR. McCLELLAND: What do you think an executive assistant does if he doesn't work for the minister?

MR. COCKE: Mr. Chairman, he replied that: "Gran takes care of health-related queries from people from all over the lower mainland." I asked the minister last night and I ask him again today why he hasn't got her in the Vancouver office. He's got seven floors there, with lots of office space available and you could very easily put an executive assistant in there. I'm suggesting, Mr. Chairman, that we phoned the office today to find out what kind of an answer we'd get on the telephone call. It's MR. McClelland's office, that's what they say on the line.

HON. MR. McCLELLAND: That's exactly right.

MR. COCKE: It's misuse of public funds and he knows it. It's an abuse of public funds and he knows it.

HON. MR. McCLELLAND: What nonsense!

MR. COCKE: Mr. Chairman, the minister looks after himself very nicely, doesn't he? He's got a constituency representative at $19,800. The rest of us have to have a constituency representative or secretary at $800 a month. That's a significant increase. The only reason the minister has her in Langley is because of the fact that it's his constituency and she's to do his constituency work out there. I'd like to ask some questions about that office. Who pays the rent? Where is it?

HON. MR. McCLELLAND: You know where it is because you read out the address yesterday. You also read out the phone number.

MR. COCKE: I read out the phone number; I didn't read out the address, as I recall.

[ Page 3688 ]

HON. MR. McCLELLAND: Well, you know where it is. Why do you ask me?

MR. COCKE: I just would like to know. We'd like to drive by it some time and see whether or not you've got a bunch of advertising there.

HON. MR. McCLELLAND: You're welcome any time.

MR. COCKE: Mr. Chairman, the minister naturally is embarrassed. I don't blame him for being embarrassed. I would yip, yip, yip, too, if somebody caught me with my fingers in the cookie jar like we found him out there. Yes, Mr. Chairman, they answer the telephone and say, "Bob McClelland's office."

HON. MR. McCLELLAND: That's right.

MR. COCKE: In that office we'll find an executive assistant. That executive assistant should either be upstairs in his office here or that executive assistant should be in the Vancouver public health office, but not out in Langley. He's burying her in Langley so she can do his constituency work. The business about saying that she's available to the people on the lower mainland, health-related queries....

Mr. Chairman, I suggest that the Minister of Health doesn't really require too much debate around his estimates - not at all. He doesn't run the office. He runs a political office. I think we're going to talk in terms of many of the health-related things with respect to education under the Education estimates. But I don't see any use in trying to get an answer out of him on some of these very important questions that he can't really answer.

HON. MR. McCLELLAND: Mr. Chairman, that member is the one who should be embarrassed for the stupidity of his arguments this afternoon and last night. He should have even listened to his own leader the other evening when he was talking about executive assistants. What the devil is so strange or unusual about an executive assistant serving the minister? That's what an executive assistant is for.

MR. COCKE: You've got two of them, and you've got one in your constituency.

HON. MR. McCLELLAND: I have one executive assistant and you try to prove any different. At least I don't plant my executive assistants in a position where they were in the position of trying to undermine the deputy ministers of departments as that government did for three and a half years. Stupid, stupid, stupid! If that's all you've got to offer to this debate, you'd better go out and get another bag of marshmallows.

MR. CHAIRMAN: Please address the Chair, hon. minister,

MR. LEA: He knows what it takes to kill a crocodile.

HON. MR. McCLELLAND: Mr. Chairman, that member says that I ordered one of our health officers to keep his mouth shut, and that's a damned lie.

MR. MACDONALD: Table the documents!

MR. COCKE: He either withdraws or withdraws himself.

MR. CHAIRMAN: I would like to remind all hon. members that in Committee of Supply, where we have debate in which we can ask questions and have immediate replies, it is very desirable that we use tempered language if at all possible. I would like to suggest the same to the hon. minister.

HON. MR. McCLELLAND: Mr. Chairman, I apologize and I withdraw that. But it is not true.

Interjection.

HON. MR. McCLELLAND: Well then, it's a lie!

SOME HON. MEMBERS: Withdraw!

HON. MR. McCLELLAND: No!

MR. CHAIRMAN: Order, please, hon. members.

MR. MACDONALD: Table the document. What are you hiding?

MR. CHAIRMAN: The first member for Vancouver Centre on a point of order.

MR. LAUK: He should withdraw the charge against the hon. member for New Westminster, and, further, it's only within the minister's power to prove what is true in this instance. He steadfastly refuses to prove it, he stands in his place instead and charges the member for New Westminster with a lie, He should withdraw it.

MR. CHAIRMAN: There's a request for a withdrawal?

MR. LAUK: Yes.

MR. CHAIRMAN: I ask the hon. minister to withdraw the words: "It is a lie."

HON. MR. McCLELLAND: Yes, Mr. Chairman, I

[ Page 3689 ]

withdraw.

MR. CHAIRMAN: Let's proceed on vote 169.

HON. MR. McCLELLAND: Mr. Chairman, the comment that I asked any health officer in this province to keep his mouth shut is not true.

MR. LEA: Then table the documents.

HON. MR. McCLELLAND: Will you wait for a moment? It's not true. I have never asked any health officer in this province to do anything else but his job, and I've asked them to do anything necessary in order to do that job. I received, as I said in a statement in this House some time ago, a number of queries and complaints from a number of different municipal bodies, citizens and my own colleagues about public statements that were made with regard to a very emotional subject in the Okanagan area. I have a duty as a minister to respond, when those queries are made to my office. If I didn't respond I wouldn~t be doing my duty.

I did respond, particularly to one note which was sent to me by the Minister of the Environment (Hon. Mr. Nielsen) . I'll tell you right now that I cannot table the letter from the Minister of the Environment because it isn't my letter to table. If you want it tabled, you ask the Minister of the Environment to table it. It was a note between two ministers and I think this House will respect that.

But I will table the answer that I gave to that request from that minister, as I said before, and I'd like to read it. I would like to read it, Mr. Chairman, and then I'll table it.

MR. LEA: The question is more important.

HON. MR. McCLELLAND: No, the answer is what's important because I'm the minister that's in question here. So my answer and my support of a health officer is what's important here.

"Reference is made to your memorandum, the date of which you bring to my attention, that the director appears to be too vocal in regard to weed problems in the Okanagan."

And there was a copy of the Vancouver newspaper attached.

"The matter has now been checked out, and it's pointed out that the director has made no public statement relative to the problem under discussion since October 20, when there was a meeting of the South Okanagan Union Board of Health, at which time 55 letters were received supporting the opinion of the South Okanagan Health Unit,

"The article you referred to would appear to be a review of previous statements made by the director, since there has been no recent contact with any radio, television or press."

MR. MACDONALD: Why?

HON. MR. McCLELLAND: Well, I'll tell you why. In my conversations and in staff conversations with the previous deputy minister of health, Dr. Elliot, and Dr. Clarke in the Okanagan, Dr. Clarke decided that it would be best of him to await the outcome of the committee which was studying this matter before taking any further action. And at that time he certainly did take further action.

"It has also been brought to my attention that there has been a large amount of material appearing in the papers in the South Okanagan area opposing the viewpoint of the South Okanagan Health Unit and the Union Board of Health, as well as the Kelowna Medical Society.

"I have never in my life ever asked any health minister to either not attend the meeting or to keep silent in any issue, and I never will, because any health unit director worth his salt has to have that opportunity to deal with health matters without that kind of Problem." I'd like to table this with another letter, Mr. Chairman, which was just received today. It's addressed to me. It's from the North Okanagan Health Unit. It says:

"Dear Mr. Minister:

In view of events of the past week I feel it necessary to state to you the philosophy of Health Officers' Council concerning the MacKenzie report on the control of Eurasian milfoil. The majority of members of council supported the MacKenzie report and the controlled use of 2, 4-D. No formal vote was taken. However, I can assure you a significant majority of health officers agreed with the content of the report.

"It is my wish as chairman of Health Officers Council to assist you and your staff in promoting the best relationships possible between the public and the ministry and to emphasize that all health officers act in a dignified, ethical manner at all times."

It's signed: M.R. Smart, MD, chairman of the Health Officers Council.

Mr. Chairman, I just want to say once more that there is absolutely no truth to the statement that at any time I have asked a health officer to shut up, that I have muzzled a health officer, or that I will ever do so in the future.

MR. COCKE: Mr. Chairman, I would just like to think in terms of what the minister is talking about. For instance the minister gets up and accuses me of lying. I want to recall for the minister when he got up

[ Page 3690 ]

and apologized in the House the other day after a question that I asked about his statement when he said that Dr. Clarke had been censured by his colleagues. I didn't then jump up, Mr. Chairman, and indicate that he was a liar or anything along that line. Yet his words were in Hansard and we knew it to be certainly not a fact.

Mr. Chairman, I would wonder why that minister doesn't act in a little bit more minister-like manner in this House.

Mr. Chairman, Dr. Clarke was not censured, and today we find out that there wasn't even a vote taken at that meeting of the health officers' council before they passed the resolution. Today we find out in the minister's own words, quoting a document from Dr. Smart, that there wasn't even a vote taken.

Things change. Mr. Chairman, the more they change the more they stay the same with that minister. Be proud of that Minister of Health that has difficulty understanding what's going on around him. Either that or he tries to make it difficult for us to understand what's going on around him.

Mr. Chairman, I suggest that the kind of support that a health officer needs is hardly a copy of a letter to the Minister of the Environment. If that letter doesn't say, "Shut up!" I don't know what it says.

HON. MR. McCLELLAND: Oh, stupid!

MR. COCKE: It says, "Shut up." Almost in those words. And read Fotheringharn tonight, member for Delta (Mr. Davidson) . I suggested to you the other day that you might regret your Funk letter.

Mr. Chairman, just one more word before I defer to the member for. Vancouver South (Mr. Rogers) . I would like that Minister of Health to stand up and show us any place where an executive assistant interfered with deputy ministers when we were government. He gets up and makes the most irresponsible statements in this House - continually making statements that are not true.

Mr. Chairman, I don't even know why we debate his estimates. I wish the Premier would get rid of him and get somebody who has enough strength and determination to stand up for his own portfolio.

MR. C.S. ROGERS (Vancouver South): About four months ago the minister embarked on a campaign of making people aware of tobacco in an effort to get people who are already hooked on this marvellous drug to quit. I'd done a little investigation as one of those people who is a strong believer in non-smoking. So I'll change the tone of the debate a little bit. I'd like to discuss tobacco. One of the reasons I want to is because liquor has been with us a long time and we know quite a lot about it. The effects of liquor have been noted by man since the first distilleries were built in Bushmills in Ireland many centuries ago. Tobacco, and especially the cigarette is something we know very little about.

When Sir Walter Raleigh came back from the Carolinas with some seeds in his pocket during the reign of Queen Elizabeth 1, he didn't bring a carton of Camels with him. In fact, he introduced tobacco to Europe ... and its use was extremely closely contained, mainly by the members of the royal courts. Tobacco was billed as a cure-all and mostly used by royalty.

MR. LAUK: Are you giving a quiz later?

MR. ROGERS: No, I'm not, but you might find this interesting because I know you personally have a habit you would like to stop. (Laughter.)

MR. LAUK: Withdraw!

MR. ROGERS: No, I won't withdraw, and you know that's true.

MR. CHAIRMAN: Order, please.

MR. ROGERS: If the member would listen to my address on smoking, he would appreciate that it's his tobacco habit that I know he wants to get away from. However, the history of tobacco is....

Interjections.

MR. CHAIRMAN: Order, please.

MR. ROGERS: Anyway it's interesting to note that tobacco doesn't come into wide public use until the Crimean War. In fact, wars really have been the best thing for tobacco sales, as I will demonstrate a little later on. But at that point the officers of the Royal Navy and British officers of the army, when they were in Crimea, were not able to get their cigars. It was at that time that the western nations were first introduced to a thing called a cigarette, hand-rolled, as a substitute for cigars. When they returned from the Crimean War they brought tobacco back to England with them. At about the same time tobacco, as a cigarette, was reintroduced into the United States. And in this post-Crimea, pre-World War I period, the most significant change in tobacco was the invention of a machine that made cigarettes, the cigarette-rolling machine, because at that time if you wanted to buy cigarettes you had to buy them ready rolled.

MR. GIBSON: Are you going to table a smoke signal?

MR. ROGERS: Listen, this research is terrific. I wish you'd listen to it. Anyway, World War I is really

[ Page 3691 ]

significant here because during World War I the YMCA was the number one distributor of tobacco in Europe....

MR. LAUK: The YMCA?

MR. ROGERS: That's right, and that's significant. You've got one in your riding and I've got one coming in mine. The per capita consumption of tobacco and cigarettes in 19 11 is 108 but by 1919 it becomes 426. So, much as a lot of other things expanded rapidly, like taxation during the war, that's when the great first boom of tobacco comes along.

Now at the end of World War I you have some very important changes. You have the first tobacco advertising, which took place actually in 1914. But after the war you have the introduction of the first national periodicals called Life magazine, Fortune, Time, all of which were introduced in the period directly after the first world war. During the 1920s the first of the national radio broadcasts, the NBC and CBS and what they called the "blue network, " which has nothing to do with movies - it's now ABC. Tobacco advertising at that time got its first national shot and distribution. Now $3 billion was the budget in 1919. It's $85 billion today. But you'll remember that they don't want anybody to start smoking; they just want to change your brand. And for $85 billion, it's quite effective.

Interjection.

MR. ROGERS: No, pardon me, 85 billion cigarettes. Let me see; let's get the numbers right on the thing, Hang on, it comes a little later on.

It's 85 billion cigarettes that are smoked annually in Canada now, and it was three billion in 1920.

Interjection.

MR. ROGERS: I might filibuster this thing right to 6 if you like.

MR. LAUK: You're doing very well; keep it up. Keep it up.

MR. ROGERS: However, you remember that Camel cigarettes in those days had a big ad and it was: "Not a Cough in a Carload." Chesterfield had the big thing that you weren't even ever going to make it anywhere in life if you didn't learn how to smoke. Arid during that time, all of the tobacco advertising -now it would be almost illegal to reprint it - was geared toward tobacco and health. World War I I came along and this was a really tremendous boom because at that point the tobacco distribution was made a priority in the logistics department in the United States military, and everywhere the American military went, tobacco was in excellent supply.

The post-World War 11 period, between 1945 and 1965, was their greatest boom. In that period, we had really effective mass television advertising with the lifestyle advertising. My friend there, who is the Marlboro cowboy in disguise.... Anyway, it wasn't until the early '60s that there was any kind of recognition at all that tobacco might be a health factor, Tobacco companies recognized this as the world started to say: "Maybe this stuff isn't so good for us." So they diversified and invested in other things, such as the wine industry. Only coincidentally did they not need to because tobacco sales continued to boom.

Interjection.

MR. ROGERS: Well, those and many others.

The introduction of the filter, which was a little device which came along after the war, was sort of interesting too, but it has since been proven that filters are of questionable value, if they are of any value at all. In fact, they may be even more harmful, because once addicted to tobacco, the person on tobacco is going to continue smoking until such time as he has the correct amount of nicotine.

Interjection.

MR. ROGERS: That's right; they could be dead as well.

One of the things about the filter cigarette and the mild cigarette is that they make it much easier to start. While the cigarette companies, with their great pious attitudes, can tell us that they are now making low-tar cigarettes and they are going to make it healthier for, everyone, that is really not what happens. What happens is that it makes it easier for the kids to get started and those who have graduated to Export A can stay there. In 1973, there were 27,000 fires in Canada caused by smoking for an $85 million loss. Mr. Chips, in the corner, it was $10 million caused directly by smokers. But I know you don't have that problem because we know that your problem is solved there.

In 1975, advertising and promotion by the tobacco industry in Canada - the last figures I could get - was $40 million. That is interesting because it was never designed to intend to get anyone to start; they just wanted to change. At the same time as they spent $40 million on advertising, they spent $128,000 on research. Canadians are the third heaviest smokers in the world and the Canadian cigarette production is 58 billion per year. The tobacco companies get about one per cent per cigarette. One of the major increases in the last 10 years has been in the tragic group of teenagers between 15 and 19. The major increase has been with

[ Page 3692 ]

young women. There are some interesting little bits of trivia there, Mr. Minister. I know you put out some nice pamphlets on getting people to stop. I think if we really realized that the cigarette as we know it has only been in common distribution since the mid-1920s as opposed to, say, Gordon's Gin which has been around since before your father or before my father or longer than that. Tobacco has been around a long time but the cigarette hasn't. The beauty of the cigarette is that it's convenient - it's easy to pack around, it slips into your pocket -compared to all of the other devices like pipes, which need to be stored in various places, and cigars, which take 20 minutes to smoke.

The cigarette is just perfect. It's excellent for having a quick break out of this House, which is why there are so many members in here today. You don't have to look far to see the members outside having a quick one.

MR. LEA: Ban smoking! (Laughter.)

MR. ROGERS: I can only ask you, hon. minister, through you, Mr. Chairman, to continue in your very zealous drive. I think you're on the right campaign. I think you're doing very well. A little explanation, along with the rest of the evil that tobacco is, would help. I know that if the member for Dewdney (Mr. Mussallem) gave this speech then we'd all really be laughing, instead of just a few of us,

Mr. Chairman, I know that the member for North Vancouver-Capilano is very anxious to spring to his feet in my defence, so I will yield to him.

MR. GIBSON: Mr. Chairman, I very much enjoyed that discussion. As a matter of fact, I'd just add a little tag onto the end of it. My uncle used to have a special kind of filter cigarette holder. I recall one day he was bragging to my father about it and explained that it used to spin the smoke around sideways and the tar would stick to the edge of the holder or something. He said to my father: "You know, it spins the smoke around at 250 m.p.h." My father said: "Good thing it spins it sideways, or it could blow a hole in the back of your head." That's all I know about cigarette smoking. (Laughter.)

MR. LAUK: That's it, eh? Okay....

MR. GIBSON: Sit down, Lauk! That was my introduction. (Laughter.)

Mr. Chairman, I want to talk about this university hospital and the 240 beds. It's not too late.

MR. LAUK: It has nothing to do with him.

MR. GIBSON: He has nominal responsibility for it.

MR. CHAIRMAN: Hon. members, I appreciate the good humour of the House, but let's try to remember standing order 17, which simply says if a member is making a speech, no other member has the right to interrupt him, except to raise a point of order. The member for North Vancouver-Capilano has the floor.

MR. GIBSON: I'm willing to give them leave, Mr. Chairman.

It's not too late to stop the university hospital. That's the point I want to make to this House. Mr. Minister, what are we in for so far - $1 million or so? One of the doctors from the university was telling me about the progress so far. There's a few steel girders up, and so on. Maybe in some cases you're better to write a bad mistake off and walk away from it. You'd be millions and millions ahead in the end, in my opinion, and give better service to the people of Vancouver. Call it a mistake, put it a plaque on it, call it the "Pat McGeer Memorial Mistake, " because that's what that hospital is going to be.

MR. LAUK: And he knows it.

MR. GIBSON: I think that minister knows it, Mr. Chairman. This has been a situation that has just developed in an absolutely appalling fashion. The doctors on this issue have been confused and gutless. They've not done the job they should have for the people of British Columbia. Their representative on that planning group did not act in the way that he was directed to by the Medical Association, so in the end they just backed off and forgot it.

The university's been gutless too. They have accepted a hospital package on terms that are going to cost them dearly down the line. They've been given some kind of assurance, I guess, that they're going to get the necessary money to pay the operating costs, but they'd better understand that there's only so much money in the educational budget, and what goes into that hospital is going to come out of their other operating abilities. The university's been sold a bill of goods on this, and it's all because of the ego of one man who's not even in that department.

It is a type of hospital that has a low occupancy. The minister knows that research hospitals on this continent tend to run something like 60 per cent occupancy as opposed to a regular acute hospital running much closer to somewhere between 90 per cent and 100 per cent. It's going to be a poor experience for the students.

These aren't my opinions. I'm not a medical person. I very frankly admit that, but I put some study into this. Surely the minister can't easily pass over the kind of criticisms that were made by the B.C. Health Association in November, 1976. They finally got so upset about the whole thing that they

[ Page 3693 ]

released it. Let me just read a few things out of this:

"The proposed university hospital offers students a questionable quality of medical experience and education and in fact is intended to provide only clinical research education to second-year students."

There's one quote. Another quote:

"The proposed hospital will add acute-care beds in an area that already has enough, if not too many. Expenditures in this area will surely reduce the moneys available to fund the development of other forms of patient care -extended, intermediate, personal and home care. "

It can't be questioned, Mr. Chairman; it's just plain true.

Later on in their brief:

"Mr. Alan Kelly, consultant to the Ministry of Health, was asked in October if building 240 acute-care beds at UBC would mean the elimination of some 240 beds in other hospitals. He replied:'l would say in the end it will work out that way.' "

That's a quote from Mr. Kelly.

"If moneys were spent therefore on upgrading existing acute-care beds rather than constructing a new physical plant, it would appear that the same objectives could be met at a lower overall cost."

Well, there are some very serious charges. Let's go a little bit into the detail of these charges. What about the quality of the medical experience and the education, because that ostensibly is what this $30 million white elephant is being built for? I'm quoting again from that brief.

"When the original plan was being developed for a UBC hospital, a 440-bed teaching hospital was proposed. This was regarded by many at the time as being too small to be a viable teaching unit. The current proposal, as noted, is for 240 beds. The proposed bed allocation at UBC is 90 for clinical investigation special-interest studies, 20 for family practice" - that's some community hospital - 60 medical and 50 surgery.

"One of the flaws in the proposed hospital is that it has a limited community to serve. It may well find itself well supplied with everything but the patients appropriate for teaching family medicine. The UBC campus is not the centre of a typical urban community and is inaccessible to many densely populated parts of the greater Vancouver area."

West Point Grey of course is not a densely populated area; that is a cleverly populated area. I guess that's why the hospital is out there.

"Medical educators have been telling us that they need 10 acute-care beds for each space in an entering medical school class. In Vancouver, there are now some 3,200 acute-care beds. Even if it were desirable to increase the class of medical students to 160 from the present 80, it would only take 1,600 acute-care beds. The best education of medical students is through good patient-care activity. What that surely means is that we need more effective organization and use of existing acute-care beds to ensure good medical education through the patient care already provided in these beds."

This is the British Columbia Health Association speaking, Mr. Chairman.

Then there has been a concern about oversupply of doctors. The minister himself has been concerned about an oversupply of doctors. He has been quoted in the newspaper several times on that, How, in that regard, he comes down for this hospital, I can't imagine. But here's the health association, and I'm now quoting Dr. Jory, president of the BCMA:

"I firmly believe that an oversupply of doctors leads to a deterioration in professional standards because of a reduction in clinical practice appropriate to the physician's training. It could also be that oversupply could lead to physicians performing - work which can be properly performed at less cost by paramedical and paraprofessional personnel."

That is a very important consideration, Mr. Chairman. Paraprofessionals are one of the keys....

MR. BARBER: Nurse practitioners.

MR. GIBSON: Nurse practitioners - exactly, Mr. Member - and other paraprofessionals are one of the keys to reducing health costs in this province. That's what the minister wants to do but is working against with this development.

AN HON. MEMBER: It's not his fault.

MR. GIBSON: Well, he must take responsibility for it, Mr. Member.

They say again, speaking of themselves:

"The association cannot fight for equitable treatment in the funding of health-care facilities and, at the same time, remain silent on such a major issue as the development of the proposed university hospital. There are too many unanswered questions, too little evidence that this proposed hospital fits into the everyday realities of the health-care industry in British Columbia."

I say amen, Mr. Chairman. I'm glad that one group in this province that is knowledgeable in the health field had the guts and the timeliness to speak up in this regard. I say that British Columbia has not had the service it deserves out of its medical community

[ Page 3694 ]

in terms of voices being raised against this monstrosity of a programme.

The profession had some spokesmen at a meeting organized by the Vancouver Board of Trade in their health committee on March 2,1977. Here's what Dr. Graham Clay, himself of the University of British Columbia, had to say about this:

"Many clinical teachers are alarmed and convinced that the money to be spent at UBC could be put to better use by providing beds elsewhere. The original decision to provide hospital facilities at UBC was not made on the basis of it being a right decision but rather on the basis of making the hospital.work. McGill, University of Toronto and Harvard do not have hospitals on campus."

Now that's an interesting fact, isn't it, Mr. Chairman? McGill, the University of Toronto and Harvard have a reasonable reputation as medical schools, and somehow they manage to get away without this kind of white elephant we're being asked to build out at UBC. Not that we're being asked; the construction is actually underway now. And further, Dr. Clay said:

"The proposed 240-bed community hospital at UBC cannot teach 160 students and will not begin to meet the need. Each student needs 10 beds in order to gain experience. It would be more justifiable to put 160 students to work in the city where the clinical action exists and where the beds are located."

And what is the consequence of putting these beds out there? The minister has provided a copy of this bed matrix plan of the Greater Vancouver Regional Hospital District. As we go down there and we look at the 1981 revised capacity that it's proposed for the various communities around the GVRD, when we look at the needs in those particular communities in this official document, we see that in the Surrey area we have a shortfall of 185 beds; in the Delta area we have a shortfall of 120 beds; in Coquitlam we have a shortfall of 200 beds. At least two of these shortfalls could have been substantially remedied by the money that is being spent on this particular hospital.

I'm not for 10 seconds going to buy any kind of an argument that the federal money could not have been used in other ways than building that university hospital. It could have been used exactly the same way in building teaching facilities at the downtown hospitals and then using the other improvement money at the downtown hospitals and in the outlying areas of the greater Vancouver hospital district. The minister said as much yesterday; Ottawa would have been flexible in negotiating. He said that there had been negotiating going on, although they were related mostly to time.

AN HON. MEMBER: What's the member for Delta (Mr. Davidson) doing about this shortage?

MR. GIBSON: I don't know what the member for Delta is doing. I don't know why he isn't taking part in this debate. Is it large enough for you?

MR. LAUK: You're the kind of person we don't need in this community.

MR. GIBSON: But I do hope that the member for Delta will stand up and explain why his community got a smaller hospital than it should have, than it needs, in part because of this 240-bed white elephant out at the University of British Columbia.

Mr. Chairman, I say to you that this is a major, disgraceful misallocation of health funds in this province. I say it is not too late yet to do something about it, and I call on the health community in this province and the educational community to finally have the guts to stand up and say to this minister: "Stop this project. Put this money where it should go. Have no fear of the Minister of Education - we will protect you from him." Mr. Chairman, that's why it's there. We all know that. We don't expect the executive council to admit that, but we all know that that hospital's there because the Minister of Education wanted it there. It was the Minister of Education who announced the money and who had the gall to say with the announcement: "and make a decision within 60 days that we're going to spend this money in Victoria." That's the kind of arrogance and that's the kind of complete appropriation of that money that that Minister of Education took.

Mr. Chairman, I say it's a very, very sad thing. I don't expect any response out of the minister. If I were him I'd just sit there kind of looking at the floor, I'd be so embarrassed. I don't really expect any response because we all know what the real situation is.

MR. LAUK: With respect to the university hospital, I agree entirely with the hon. Liberal leader (Mr. Gibson) . Petulant gets his way. He's the man who runs the government in this province. I understand he's the only one that refers to the Premier as "Bill." He can overrule the Premier at any given opportunity. Who could conceive that this man could spend so much money on a personal ego trip out at UBC, this academic elitist who can overrule a once-powerful opposition member like the member for Langley (Hon. Mr. McClelland) ? The old crocodile of the back bench is now stomped on, made a puppet by Alfred E. Newman, once leader of the Liberal party. Who could conceive that such a situation could develop? Sitting there he's embarrassed. Of course he's embarrassed! Could you blame the man? He's flesh and blood. Isn't he human? You want me to withdraw that? I withdraw that.

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MR. KEMPF: And that was once Minister of Economic Development - unreal!

MR. LAUK: Did someone hear the plumbing corner over there?

Mr. Chairman, I can do no better than to support the remarks of the hon. Liberal leader and the remarks of the hon. member for New Westminster in condemning this extravagant and egotistical action on the part of the Minister of Education and in condemning the lack of responsibility and complete abdication of responsibility by this Minister of Health.

MR. COCKE: Mr. Chairman, I'm sure that the minister is now beginning to feel the weight of opinion. The weight of opinion, as I expressed some time ago, is something that that minister hasn't taken into account.

Mr. Chairman, I think that the minister, when he said that a very thoughtful study had been done, was begging the question. How long does it take to make a thoughtful study? They were hardly government. They had had the reins of power for but a few weeks when that announcement was made. The announcement was not made by the Minister of Health; it was made by the Minister of Education, according to the papers.

MR. LEA: It's in his book, Politics in Paradise.

MR. COCKE: I tend to believe from time to time what I read in the media. He very definitely made that decision.

Mr. Chairman, I just would like to give you a little bit of history. Where did we go for advice? Incidentally, we took a long time to make that decision.

I had heard debate in this House over whether there should be a university hospital, whether that hospital should be at Shaughnessy, whether it should be a medical centre, and I heard debate across this country. I'll never forget that one night I met for two hours with Claude Castonguay. Claude Castonguay at that time was the Minister of Health for the province of Quebec - la belle province. In our two-hour private meeting I asked him how he felt about a university hospital. He said: "We made that disastrous mistake in Sherbrooke, and I hope we don't make that mistake again." He said: "As a matter of fact Lavalle University was putting together a tie-in with the six hospitals in Quebec City, working much better than the Sherbrooke situation." Sherbrooke was another university hospital - a mistake.

Now you can justify a logical mistake, but you don't keep repeating those mistakes. You don't defend those mistakes. The Minister of Education got his advice from the same people who I was trying ...

He was part of it actually. He got his advice from the same people who tried to advise me - with very little to substantiate their direction. The people who were giving some real hard advice were people who could point to McMaster University Hospital.

What do we find there? We find an occupancy such that the Minister of Health in the province of Ontario was closing down beds to force them out into the peripheral area - that is the patients - into that hospital that wasn't being used properly, and still to this day is not being used properly. Where do we find the university hospitals? Not where the patients are. We find them right out on the periphery.

AN HON. MEMBER: Out where Pat McGeer is.

MR. COCKE: Out where Pat McGeer is. Sorry, the Minister of Education. Right out there by Wreck Beach. As a matter of fact, if they build it high enough they'll be able to look out the windows and see the nudies down on the beach, and Mrs. Gerard will have something else to holler about.

Interjections.

MR. COCKE: Mr. Chairman, that is not the location for a hospital. Even the Minister of Mines (Hon. Mr. Chabot) agrees. How did you let that happen? No, it happened before you got into the cabinet, unfortunately.

AN HON. MEMBER: He's still not in the cabinet. He's wandering around the halls looking for the cabinet.

MR. COCKE: Mr. Chairman, let's, for Heaven's sake, ask the Minister of Health to kindly go to the rest of his colleagues. For once, circumvent the Minister of Education who's made so many disastrous mistakes since that group has been in government. Circumvent the Minister of Education. Go to the cabinet and suggest that reconsideration is the way to go. If they reconsider the university hospital, I would suggest, Mr. Chairman, now, with all of the thoughtful health people making their position clear, that surely this government will do something about it and change their direction. Mr. Chairman, having said that, does the minister want to suggest that he's going to change his direction?

The House resumed -I Mr. Speaker in the chair.

MR. DAVIDSON: With leave, Mr. Speaker, I'd like to make a very brief statement.

Leave granted.

MR. DAVIDSON: This is in response to Mr.

[ Page 3696 ]

Fotheringham's column today in The Vancouver Sun. I received a letter from Mr. Bill Funk, the chairman of the Renfrew Collingwood Citizens Association, a letter which I took strong exception to in that it indicated that the future of the underprivileged, aged, handicapped and children would be put back into the times of the Dirty Thirties if the Vancouver Resources Board were to be abolished.

I was genuinely upset with this type of rhetoric, which has all too often been used by members of the opposition to cloud the real issues before the people. It was in this light that I wrote my response to Mr. Funk.

At no time was it my intent to in any way, publicly or privately, demean Mr. Funk, his family or his associates. If that in any way has happened, then I publicly apologize to Mr. Funk in every respect.

I have in addition, Mr. Speaker, sent a telegram to Mr. Funk on this very matter, expressing my private apology for any misunderstandings in the intent of my reply.

MR. KING: I just wish to respond briefly to the member for Delta's statement, Mr. Speaker.

Interjections.

MR. KING: It's a tradition that the opposition has an opportunity to respond to statements.

MR. SPEAKER: Only if you receive the leave of the House. Shall leave be granted?

SOME HON. MEMBERS: Aye!

SOME HON. MEMBERS: No!

MR. SPEAKER: Sorry, hon. member.

HON. MR. McCLELLAND: Mr. Speaker, I ask leave of the House to table two letters.

Leave granted.

Hon. Mr. McClelland moves adjournment of the House.

Motion approved.

The House adjourned at 6:01 p.m.