[ Page 5797 ]

CONTENTS

Oral Questions

Report on forest industry. Mr. Williams –– 5797

Mrs. Wallace

Mr. Lea

B.C. Hydro brain drain. Mr. D'Arcy –– 5799

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)

On vote 37: minister's office –– 5799

Mrs. Dailly

Mr Lauk

Mr. Reynolds

Mr. Cocke

Hon. Mr. Hewitt

Ms. Brown

Royal assent to bill –– 5815

Appendix –– 5816

THURSDAY, APRIL 25, 1985

The House met at 2:04 p.m.

HON. MR. GARDOM: Mr. Speaker, we're honoured today in having in our gallery a Member of Parliament from the great state of Western Australia. It has a population of about 1.8 million people and is comprised of a million square miles, and I'd say there are great similarities between that state and British Columbia both in opportunities and problems. I think this gentleman has probably held more port folios than any individual in this room, certainly in the economic area. I'd like all hon. members to bid a most cordial welcome to the Hon. Andrew Mensaros.

HON. MR. BRUMMET: I'm very pleased to have as guests in the gallery today three gentlemen representing the Haida nation in the Queen Charlottes, Messrs. Yaku, Guujaw and Miles Richardson. We've had some very good meetings with them, and I would like the House to make them very welcome.

HON. MR. PELTON: Mr. Speaker, in your gallery today is a long-time friend and business associate of mine, Mr. Vern Seymour. I would be pleased if the House would make him welcome.

HON. MR. RICHMOND: I would like to introduce to the House a hard-working constituent from Kamloops, Dr. Tony Milobar, who is not only an alderman in the city but also chairman of their task force on employment. I'd like the House to make Dr. Milobar welcome.

If I might beg the indulgence of the House for just a few seconds, I would like to point out to everyone that the third annual Dixieland Jazz Party starts this evening in Victoria. I would like to congratulate everyone who's had anything to do with it, and I would heartily recommend it to the members, as a little jazz is good for the soul.

MRS. JOHNSTON: Mr. Speaker, in your gallery today and in the precincts are a number of people representing the B.C. health professionals' legislative committee. I would like the House to please join me in welcoming Jan Rulon, Marion Wright, Christy Amidon, Tim Roark, Jackie Napier and Harold Janzen.

MS. BROWN: Also in your gallery today are Theresa Kiefer, Janet Shaw and Lynn Gary, who are members of Concerned Citizens for Choice on Abortion. I'd like the House to join me in bidding them welcome.

MR. LEA: Mr. Speaker, I'd like to ask the members to join with me in welcoming two other people who are in the gallery today: Sherry Stewart from Kamloops and Tom t Finkelstein from North Vancouver.

Oral Questions

REPORT ON FOREST INDUSTRY

MR. WILLIAMS: A forestry research project at UBC with respect to our basic industry, headed by Dr. Pearse, has just released the latest in a series of major reports deploring the disastrous state of the British Columbia industry. In previous sessions in the House the Minister of Forests has dismissed statements from Professors Reed and Walters at UBC with respect to this crisis in our number one industry. Now Sten Nilsson has made equally damning reports and has come to similar, maybe even stronger, conclusions. Is the minister willing to admit that he was mistaken in his judgment of Prof. Reed and Prof. Walters?

HON. MR. WATERLAND: Certainly not, Mr. Speaker. I've always had the highest respect for Prof. Reed and Prof. Walters. I just don't agree with them in certain things they have said, particularly when they get outside their area of competence. Many of the things that Prof. Walters said are absolutely right, as is the case with Les Reed, and many of the things in this report are quite accurate and very much in keeping with those things in the report I tabled in this Legislature some weeks ago. There's nothing new in the report. The report states that unless the industry in British Columbia invests in plant modernization, in the latest technology, and addresses its attention more to the marketplace they deal in, the industry is going to be in trouble. The industry is doing that, Mr. Speaker. I have been saying that for years and so have others. I have very little disagreement with it, except perhaps the hysterical conclusions drawn from the report by certain reporters and politicians.

MR. WILLIAMS: Areas of competence that this minister speaks of.... Is the minister saying that they' re not competent to comment, as they've done, with respect to this industry? Did I hear news reporters correctly today when they quoted the minister's response to Prof. Nilsson's report? Did I actually hear that response from the minister on the air? Could he elaborate on his radio response on this report?

HON. MR. WATERLAND: Mr. Speaker, I'm afraid I can't advise the member on what he heard on radio.

MR. WILLIAMS: I think it was a reference, Mr. Speaker, to some kind of animal excrement that was the comment with respect to the study and report. Maybe he could elaborate on his learned review of the professor's study.

HON. MR. WATERLAND: Mr. Speaker, when I was asked if the forest industry in British Columbia is in a state of disaster, yes, my response was in a reference to that particular animal excrement.

MR. WILLIAMS: Vancouver's Alderman Bellamy said that in Spanish it's called el toro poo-poo, or something like hat.

The minister himself has hired these experts, and could he explain the areas of competence that he thinks they have with respect to the forest and range analysis that he just tabled?

HON. MR. WATERLAND: Some of the facts that the member refers to I think are el toro poo-poo,

Mr. Speaker, seriously, I'll respond to that one. When Les Reed, who is an economist — and quite a competent economist — makes a statement that we are practising liquidation of forestry in British Columbia, I say he is mistaken. My opinion is supported by many professional foresters in British Columbia, because we are practising sustained yield forestry. And when Dr. Walters starts making remarks that

[ Page 5798 ]

are probably better in the area of competency of economists, I say — and have said — that some of the things he's said are in error. Many economists support me in that conclusion as well. But I do have a great deal of respect for both gentlemen. In their areas of competence they have contributed a great deal to the forest sector in British Columbia.

MR. WILLIAMS: The minister has reconsidered his earlier comments and I think we should all appreciate that.

Professor Reed says our industry will decline 30 percent if we maintain current practices, which we're doing. Professor Nilsson says they will decline 40 percent. Can the minister indicate what steps he will be taking to deal with this serious problem that we have on our hands?

HON. MR. WATERLAND: Mr. Speaker, the member delights in quoting numbers without any reference to exactly what those numbers and percentages refer to. My analysis that was tabled in this House, which was done by professional staff of the ministry, indicates that over the next 100 years there will be a decline of approximately 14 percent in the timber available to the forest industry, unless certain things happen. Professor Reed has made certain statements that unless certain things are done — and they're different to the conclusions that I have drawn, and in different areas — something else will change by 30 percent. I'm not going to argue with the conclusions he drew, because the things he was talking about are quite different than those I am talking about. The member again is in error, Mr. Speaker. I have not changed my opinions on the remarks that I made in response to some of the things that the two professors stated.

MRS. WALLACE: Another question to the Minister of Forests. We now have the current figures on raw log exports from B.C. They tell us that in December 1984, 269,862 cubic metres of raw logs were exported, and for the entire year of 1984, it was 3,322,242 cubic metres. This is an increase of 44 percent over the preceding year — between 1983 and 1984. What immediate steps — and I stress immediate, because it is an urgent problem — is the minister taking to halt this export of logs and associated jobs which we could be creating here in B.C. by processing those logs here?

HON. MR. WATERLAND: Mr. Speaker, I can't argue with the member's statistics. I don't have those numbers at hand, but I believe last year the export of unmanufactured logs from British Columbia was in the order of 4 percent of the total volume harvested. I would remind you also that there has been a policy in place for a number of years which controls log exports from the province and which is a way of determining what logs should be eligible for export. This policy, these regulations, have been in place for many years, including the time when that party formed the government. The same rules are being complied with now as were being complied with then.

I have said in this House recently and publicly that I think those rules are no longer appropriate, that they're being abused somewhat. Therefore last November I announced a new policy to govern the export of unmanufactured logs from British Columbia — a policy that will assure that if logs are exported, it does have a very definite benefit for the province in many ways. I'm afraid I can't go into the details of that policy here and now. Perhaps a more appropriate time would be during my estimates.

So I have already taken action to correct what I see as parts of that export policy that are not working the way they were intended to work. This government, as was the case with that party when they were in government, and the previous Social Credit government have always tried to discourage the export of unmanufactured logs from British Columbia.

[2:15]

There are some cases when perhaps the export of some types and species of logs is appropriate. We will allow that, and our new policy recognizes that there will be some exceptions to that in the future.

MRS. WALLACE: The minister says, Mr. Speaker, if I read him right, that he's already taken action to correct what he says is a minor difficulty with the regulations. It can't be a very minor difficulty when there's been a 44 percent increase. When he says he's already taken action, does he not realize that it is not yet December 1985, when his action takes place? Can the minister confirm that this policy he is talking about initiating in December 1985 will simply designate green standing forests as eligible for export? That's something that has never before been done in this province, not even during the Depression.

HON. MR. WATERLAND: The word "minor" in terms of problems was the member's word; I didn't use that term at all.

I don't think that you can state in a couple of moments, as you just have, what the effects of the new export policy will be. I've discussed this policy with all sectors of the forest industry in British Columbia. They all agree that if we can make the policy work as it is designed to work, it will be a great improvement, and it will accomplish many of the objectives we have. This agreement to that policy includes the members of the IWA, who have a very specific concern about the export of logs.

MRS. WALLACE: Mr. Speaker, my first question to the minister was: what immediate action would you take? He told us in reply to that that he had taken action. Can he confirm that his action, even action that he is proposing, doesn't begin until December 1985?

HON. MR. WATERLAND: No, I can't confirm that. The committee that will be advising on the eligibility of logs for export has been meeting regularly. It has now just about completed the terms of reference of a method that it will be operating with, and I expect that by the end of this month or early next month they will be beginning to operate under the new system as the old system is phased out.

MR. LEA: Supplementary to the Minister of Forests. Would the minister confirm that because of past export policies of round logs, not only by British Columbia but by the United States and other countries, Japan has had a supply of round logs that has allowed them to put a capital investment into the sawmill industry, and that at this present moment the industry in Japan has available to it approximately a ten-year inventory of round logs ready for their sawmilling industry, and that even if we were to cut round logs off right now, we couldn't sell into that market because we've allowed so many round logs to go to build up that ten-year inventory that they're sinking them in fresh-water lakes. The past policy has

[ Page 5799 ]

almost made it impossible to have a policy now that will solve the problem.

MR. SPEAKER: Hon. Members, the purpose of question period is to ask questions, not simply to bring information in the guise of a question to the floor of the House.

HON. MR. WATERLAND: I can't confirm that fact; in fact, I would think it very unlikely that Japan or any other jurisdiction has a ten-year supply of logs. Even if they do, Mr. Speaker, a very small percentage of the logs which Japan has comes from British Columbia. Logs are available to most jurisdictions in the world from many sources. I can't tell you what the statistics are for the percentage of Japanese logs coming from Canada. But I will certainly make an effort to get that information and bring it back to the member.

I have heard rumours that there are massive stockpiles of logs in Japan. I have asked that question of people in Japan — both people in the Japanese industry and people representing British Columbia in Japan — and no one has ever been able to confirm that fact. In fact, they think such a statement is rather silly.

B.C. HYDRO BRAIN DRAIN

MR. D'ARCY: To the Minister of Energy. B.C. Hydro has terminated 3,000 employees in the recent past. The chairman now says that hundreds more are to go. These new cuts are highly-skilled design engineers who have built the best hydroelectric generation and transmission grid in the world. Has the minister directed Hydro to speedily investigate the validity of new industrial uses of electricity and gas in order to stem this latest brain drain of engineers and highly skilled people from British Columbia to other jurisdictions?

HON. MR. ROGERS: No, Mr. Speaker, we haven't. The question should probably be phrased in this way: is B.C. Hydro going to keep people on staff that it doesn't require? The answer to that is no. Is it going to release people that it does need? The answer is no, we will not release people that we do need. Yes, we are down from the peak of employment that once occurred; that was a peak of employment that occurred during the construction of the last dam. Many of those people were people directly employed with the construction of the Revelstoke project, and as the Revelstoke project nears completion those numbers in terms of natural depletion would occur.

The chairman of B.C. Hydro announced yesterday an internal task force which will deal with the reorganization of B.C. Hydro. Those people will examine the various aspects and disciplines of how that company worked when it was in the construction mode. Now that it is changing to an operating mode with a very minor construction end, there will be some adjustments. As much effort as possible has been made to find other work for those people for whom we will not be having further work in the foreseeable future at Hydro.

Hon. Mr. Curtis tabled the answer to a question on the order paper.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $206,025.

MRS. DAILLY: Mr. Chairman, I listened with great interest to the Minister of Health's dissertation this morning. It was done very well. He too has a beautiful voice, made and born for radio. There's no question about it.

AN HON. MEMBER: He's got lots of charm.

MRS. DAILLY: Well, yes. However, I almost became lulled, actually, into thinking everything was wonderful in the health world. The minister made it appear as if there were no problems whatsoever in our hospitals or with medicare or our whole health system — that everything was under control, that everyone was pretty happy and that the people who criticize were really headline hunters and maybe a few naughty people in the press gallery.

Mr. Chairman, as the debate leader for Health, I want to disabuse the House of the facts that everything is wonderful in the health world. I regret to say it isn't, because as members of the House we would hope that the people of British Columbia would be receiving good quality care in the health system. Because of the government's financial policies, which started in 1982 with heavy restraint on hospitals and were skipped over very lightly by the minister this morning, we are now seeing some very sad and often tragic results.

You cannot eliminate 3,000 staff from the health system and eliminate 1,200 hospital beds and then say everything has continued along and we still have a marvellous system.

Mr. Chairman, I want to say, however, that I am not here only to say that the minister was somewhat erroneous in his facts today; I am here also as a member of the opposition, along with my colleagues who will follow me, to hopefully give some positive approaches to the health situation today in the province.

Following my remarks and questions there will be other speakers particularly interested in health, the member for New Westminster (Mr. Cocke) and the member for Burnaby Edmonds (Ms. Brown). I want to deal first of all with general comments on our approach and our concerns about what's happening, and I hope that the minister will give some positive reflection to it in his replies.

Interjection.

MRS. DAILLY: Yes, I will be short, and then I hope the minister will reply, so we can keep the thing moving that way. I think it's more interesting for all of us, Mr. Chairman.

The basic concern that I have is that it seems to me that your ministry, although smoothly run — there's no question about it — still lurches, as the rest of the government does, from crisis to crisis in health care. You have problems with an overabundance of doctors in certain areas, so in comes some heavy-handed legislation with no consultation.

Interjection.

MRS. DAILLY: Well, maybe consultation. We'll accept you had consultation, but I'm wondering how much of that input was observed and used by the minister.

[ Page 5800 ]

We also find that we have the problem in the hospitals of increased costs. The NDP is quite aware of this, and we are not saying: "Just keep spending and spending." Our problem with the present government is that they do not seem to have any long-term planning. I've yet to hear the minister give us some long-term objectives to lead us up into the next century, because that's obviously the way any minister of health would have to be looking today. I hope that when the minister replies he will perhaps be able to show us that his ministry has been studying changes and alternatives in health care so that the costs of health can be contained to some degree while still maintaining quality care for our citizens, because no one should be denied that right in this province.

My concern is that in this particular area there does not seem to be an overall plan. The NDP has recommended, along with the Health Sciences Association of B.C. and other interested groups, that there should be a health planning council set up under the ministry, where consumers can also take part in helping the government and the ministry in their objectives on dealing with rising costs and providing good quality care.

To date I haven't heard any moves on behalf of that ministry to involve the consumers in this whole area. As one of my first questions, I would like the minister to react to.... What about your long-term objectives, moving into the next century? May I also ask him what his reaction is to establishing a health planning council, with consumers and other interested groups on it? We do hear from the other side of the House a tremendous amount of criticism about the use, and perhaps the abuse sometimes, by the health consumer of the hospital facilities and medical facilities. Why not, on the other hand, involve the consumer in working with the government and dealing with some of these very critical problems? I would hope that would be another area that the minister would react to.

[2:30]

The minister has mentioned — and there will be more dealt with on this later — in past years the area of trying to develop alternatives so people can keep out of the hospital if at all possible. Of course we on this side of the House, along with many other groups, have advocated the establishment of a network of community health clinics. There is no question in my mind, from any studying I have done and from talking to people who have been involved in them here and elsewhere, that this can indeed save money and yet provide an integrated health care system in one's community. I would like to know why the minister is not supporting this, instead of doing the opposite, which is eliminating them. So my next question is: has the minister had second thoughts about the setting up and re-establishment of health clinics across this province?

I think that in the budget, where it particularly made note of the fact that senior citizens.... The population is increasing, and you face a real problem, of which we all agree, in increased health costs because of this in our province. My concern is that the ministry and the budget, as produced by the government, just make that as a flat, bald statement, almost an acceptance that there is nothing we can do: health costs are going to rise; it's inevitable because of the increasing senior citizen population. My next question to the minister is: why do you not — and are you going to — look at alternatives for the care for our senior citizens which could perhaps contain costs and yet give the senior citizens a much more fruitful life and existence?

I am very concerned about the long-term care: we still find acute beds being taken up by people who should be in long-term care. You mentioned a certain amount of increased moneys for long-term care, but would you elaborate and give us some idea of where you're planning to do this? At the same time, would you perhaps give us some specifics on dealing with the care of senior citizens? What worries me is that the senior citizens could perhaps be kept in their home far longer, instead of ending up in a long-term facility, if you and your ministry and your government would provide backup support systems.

I know the minister knows what I'm talking about. I'm talking about increased homemaker services; I'm talking about increased community services, to enable the senior citizen to stay in the community. Will the minister tell us what he is doing about expansion in that area? Actually, in the long run, it should avoid some of these increased costs which the minister is very concerned about.

I have innumerable questions in front of me, but I think it's better if perhaps I sit down now and wait for a response on those ones.

HON. MR. NIELSEN: Mr. Chairman, I think it's terrific that everyone has a philosophy about health care; I suppose, if you are academically inclined, that's probably what you'd spend your time doing. The Ministry of Health provides health care. We are actively providing health care for the three million people in British Columbia. There are divisions within the ministry that work in the area of future needs. It's an ongoing program by those people, who specialize in ongoing needs by developing pilot projects, by reviewing the technology which is coming to us today and which is expected to be with us in the future, by working on committees and with committees of professional medical people, by having consultants within the ministry who work with a particular specialty of medicine to try to determine that which is available today and may be available later — that which may be an alternative to the methods applied today.

The member, in some of the comments, I think was embracing far more than that which is the ministry's mandate — the provision of the health system. As an example, the member was speaking of various alternative forms of caring for seniors, some of which could be more of a housing nature than a health program. We have developed some pilot projects for seniors — activation projects. As a society, the philosophy we have towards senior citizens in British Columbia is far different than it is in many other societies. We have based our treatment for senior citizens primarily on the institutional model — be it in extended care, if that level of care is required, or intermediate care. The intermediate-care facilities we have in the province now — it's very difficult to describe them as institutions — are the ones which have been built over the last few years, and they are extremely attractive areas for seniors to reside.

I agree with the member that it would make good sense to try to keep a person of advanced years in a home setting as long as possible, provided such a setting allowed that person's health to be maintained. We have literally thousands of requests from seniors who want to leave their home to go into a long-term intermediate-care facility. We do have an extensive homemaker or home service program. There are also some very legitimate concerns about the well-being of a senior citizen who may not be under some type of observation

[ Page 5801 ]

or maintenance on a regular basis. Many situations are reported in which a senior citizen suffering from a health problem and attempting to take care of it himself, or perhaps with the help of a friend or relative, is also suffering some serious side-effects from the health problem because of inability to maintain a certain medical regime that has been prescribed; whereas in intermediate-care settings that is taken care of. So there is going to be a blend; there's going to be a change.

Some of the other comments. We are constantly reviewing the health needs of the people of British Columbia — at the medical level, hospital level, public health level and so on. It's constantly changing, of course. We are constantly reviewing institutional care requirements in the province. The results have been seen over the past few years with the new construction at various facilities: Eagle Ridge Hospital, Victoria's Helmcken hospital, Children's Hospital, Grace and a number of others; the intermediate-care facilities which have been put in place and a great deal of other expansion. We are constantly reviewing and trying to stay somewhat ahead of the situation. We are never going to have a static situation where what we have in place will serve us for all time. It's always going to be changing.

I think it's fine to get as much information as we possibly can, but most of the activity of the ministry is activity now. We have committees and review teams who are looking to the future, who are thinking of planning. We are in constant communication with those persons, in whatever discipline, who are responsible for the delivery of health care. We are in constant communication with those who have the academic bent toward future medical requirements. A health planning council might sound all right. In part, that's what the Ministry of Health is — making use of a tremendous resource of experts in the community and elsewhere.

The member said that it is inevitable — I am not quoting her — that there is going to be certain damage to the system if you close beds, and so on. I think that began in 1982. We closed some beds, but we were able to maintain the same level of service — basically the same number of patient-days. We've been building more, we've been opening, we've been remodelling and so on; but even today, as of April 17, in our acute-care system 1,169 acute-care beds are open but not being used –– 1,169 acute-care beds available for patients. That was the survey taken April 17. On March 4 there were 1,288 beds open and not being used. That's not a criticism. There has to be availability of beds. If you were to take the other 1,100 beds, or however many were closed, then you would almost double that figure. In some instances it was the correct thing to do — it had to be done. Even so, we have approximately 11,400 acute-care beds, and as of April 17 we had 1,169, spread throughout the province, available for use. That's not bad at all. I don't know whether we really need another 1,200 sitting there empty — or 1,000 or however many it may have been,

I'm not going to argue that in the Ministry of Health, since you're dealing with individual people who are suffering various problems, you're going to have crisis. But not crisis to crisis. There are certain situations which develop, for whatever reasons, and a crisis develops, and we respond as best we can. That's the nature of the business. My goodness, we're dealing with health, we're dealing with literally every person in the province, and frequently in crisis conditions. We're dealing also with professionals who themselves can undergo a tremendous amount of crisis because of the strain and pressure of their profession, So you're going to get that. We accept that as being part of the Ministry of Health's responsibilities and characteristic of the work that's being done.

There's a tremendous amount of misinformation which is made available on occasion — great exaggeration frequently. There is a desire on the part of some people to accept, upon complaint. statements which later prove to be incorrect. That doesn't prevent the scare from already being felt by the people.

We have a very good health care system in this province. As everyone knows, it's a very difficult province to govern and to service, but we have an excellent system. The problems we have in B.C. are not unlike the problems they have in every province. We offer a far more comprehensive system than other provinces do. We have a good system. We have dedicated people working in the system. We get relatively few complaints when you consider the number of people who come into contact with the system every day. Sure there are going to be individual situations which can be identified. Complaints are going to be made. We deal with the complaints,

[2:45]

I'll give you an example, Mr. Chairman. A very sincere lady in Vancouver wrote a long letter to me complaining about the treatment of a friend of hers in one of our hospitals. The complaints were: the elderly lady's appearance to her friend wasn't what it should be, basically because of her hairdo; the food the woman was being asked to eat was described in some very unattractive terms by the person complaining; the patient's bed was lumpy; there was garbage on the floor: and a couple of other minor complaints.

We spent a lot of time investigating that. We found that the poor soul's hair did not have the appearance this woman wanted because the family insisted on doing her hair in the hospital; they refused to allow a hairdresser. The mattress was lumpy; it was a therapeutic mattress because the woman had a back problem. The food didn't look too good because she was on an absolutely strict diet; that's what she had to have. And the poor old soul had a habit of writing notes and throwing them on the floor. So even though the complainant was well-meaning, the observations were completely in error. I don't know how much money it cost to investigate that, but she was receiving good treatment. Perhaps a person not fully acquainted with her difficulties read it differently.

We get a lot of complaints like that. Frequently they are completely in error: sometimes they are absolutely correct. But, Mr. Chairman, when you consider what we're doing in the field of medicine and health in this province and what's available to our people and the kind of treatment they receive, on balance we have a tremendous system. I am quite prepared to accept individual complaints and try to respond to them, but we have a job to do every day of the year. We're spending almost $10 million a day, and I think the people of the province are extremely well served.

MRS. DAILLY: I regret that the minister has obviously rejected the need for any overall coordinating health agency for this province with consumer involvement. I listened carefully to your words, and it seems to me that you did not react to the kind of council that I and many others who are involved in health in this province want. They want an overall council with consumer involvement. The minister has minor committees here and there.

[ Page 5802 ]

Look, Mr. Chairman, there is too much in the ministry that goes on behind secret doors. The people who consume health have a right to be involved far more in the decisionmaking. That is the whole point of having a planning council with consumers on it. The minister can use rhetoric and keep repeating that we have a great system, it's marvellous, and there are a few things wrong with it. If he keeps saying that long enough, maybe the critics will shut up.

Mr. Chairman, I can also pick out from volumes of letters and so on, people who have written to me.... I agree with the minister: sometimes you check up and there is no validity to the complaint. But I also want to assure you that there are many complaints that are tragic and rather sad. I'm just going to throw one out to you. I'm only going to ask the minister to check the validity of it, because I cannot presume to know if this report that I have is accurate. But I have heard that because of staff cuts at Shaughnessy Hospital.... There are still old veterans out there. For many years that hospital had a great reputation — I know; my own father was there. But in the last few years that great reputation is no longer there, and again I place the blame on restrictive policies by this government.

Now here's the particular case I want to talk about. Because of staff cutbacks I've been told that no longer are some of the old senior patients taken for their baths. I think you would agree that bathing in a hospital can be real therapy when you are there day after day in bed or in a wheelchair. I have been told — and I ask the minister to please check this — that because of staff time being cut, and staff shortages, patients are wheeled in now to the bathroom area, stripped and hosed down. I know that sounds like a dramatic thing to be saying. I cannot validate it, but I would please say that if that is happening, something has to be done about it. I ask the minister to get a report to us about that situation. I was going to bring that up to the minister perhaps at another time, but the minister brings out an example of this poor old lady who wasn't.... You know, the complaint wasn't valid. So in my turn here I want to give you a complaint that we also hope is not valid. It would be a pretty tragic situation if it were.

I want to get back to the financing situation of these hospitals and also ask the minister's deputy — to give him a bit of time, because I'm sure he's got a lot of things to do at this particular moment.... But we keep hearing about the tremendous cost of health and it is; the budget is over $2.6 billion — so I have a question which I know the minister could not answer right at this moment, but his deputy....

Interjection.

MRS. DAILLY: Maybe he could. Yes, the minister could perhaps do it. Okay, here it is; I'll give it to you now, Mr. Minister.

How much of that $2.6 billion is made up of user fees? I want the projection, if you can, for the coming year. How much is made up of premiums which are collected from the people of British Columbia, and how much are federal contributions? That's your non-Trivial Pursuit question for the moment.

HON. MR. NIELSEN: My deputy is looking for the precise numbers of projections. I can offer you some. The $2.66 billion — none of that is premiums; the premiums are in addition to the $2.66 billion. The premiums bring it to over $3 billion. The premiums anticipated for 1985-86 are $346 million. That's in excess of the $2.66 billion, though, not part of it.

MRS. DAILLY: That's a 3 percent increase.

HON. MR. NIELSEN: Yes. Now, the user fees. We have the numbers somewhere, but I believe it represents about $40 million. We may have a more precise.... About $41 million, I think it is. And that portion of the federal grant.... I'll just reserve on that, because as you know it is a combined grant sent through EPF and I'm not sure what precise amount of that grant is in the health side, but I will find out for you.

MRS. DAILLY: I'll give the minister about a C for that quick answer, but I want to ask him.... I forgot one more. Included in that budget.... I wonder if you can tell me how much you estimate will be raised by the new health surtax which has been imposed on the people of British Columbia — the 8 percent surtax? How much do you expect to derive from that tax for 1985-86?

HON. MR. NIELSEN: Well, Mr. Chairman, we do not collect taxes. The Ministry of Finance is responsible for that. It's their tax. I guess we'd just have to phone them and ask them what they believe it will be. We don't see the money. Not really. I would have to find out from the Minister of Finance how much money is anticipated being raised by the surtax.

MRS. DAILLY: He is being literally correct. I can understand what he's saying, but on the other hand I'm quite sure his department must be very interested, when they are drawing up their budget for the year, in knowing how much is coming in.

Interjection.

MRS. DAILLY: You're not, eh? You just go to the treasury and get whatever you want?

HON. MR. NIELSEN: The process we use — I'm not going to give you any secrets — is primarily to determine what we require, and then where it comes from is up to the Minister of Finance.

But I wonder if the member might elaborate on all these decisions that go on behind closed doors that you were referring to. I'd be interested in what you were talking about.

MRS. DAILLY: The first major one that comes to mind is the negotiations with the doctors. That goes on for months and months. Then suddenly out it comes and we're just told: "This is the agreement that has been made." We don't know anything about the discussions that took place. The consumer, who is vitally involved and pays the money, doesn't know how it was reached. We get a few sketchy little details after the fact. So I would say, why, if you had a health planning council, couldn't it be involved with the ministry? Maybe it's a rather sensitive negotiation, but I can't understand why it's always so hush-hush until the final moment. I would say that's one major one.

The other thing that goes on behind closed doors and behind the cabinet doors, which I suppose is your privilege.... I wonder again why the health council members,

[ Page 5803 ]

if you had it, couldn't be involved. That's in where you are going to build a hospital. I'm afraid that governments have a tendency — and I'm sure this happens not only in this province but in others — to make political decisions come first in the building of some hospitals. I'm thinking particularly of the UBC science hospital. We know that it's there now and that it's a beautiful hospital; it's probably going to do much good — we hope — for the province. I don't know if he was Minister of Health at the time, but I want to ask the minister how the decision was made to allow the Minister of Universities (Hon. Mr. McGeer) to get his way in building that hospital, which appeared very affluent, at a time when many people wondered about its location.

I also want to ask the minister: when it comes to making decisions on what money should go into research and technology, which the member for New Westminster (Mr. Cocke) wants to talk about at far greater length, why is all that done in secrecy? Why don't you take the advice of a number of groups of people? The minister himself admitted that he went to Germany and saw some system he liked there, so he put it in. It doesn't seem to me that that's a thing that should be done secretly or behind closed doors. Those are the areas.

HON. MR. NIELSEN: Mr. Chairman, I just don't agree that some committee is going to solve everybody's problems. It's one of the responsibilities of government an the Ministry of Health. We're not going to ask four or five people out there to form a committee and solve all our problems.

The negotiations with the BCMA. They're a trade union and we're an employer; we're negotiating. I don't know of too many labour negotiations that take place in the public or bring in a committee to resolve it. We negotiate with these people; it's straight labour-management negotiations. And they're not too easy to deal with, I can assure you of that.

Where to build a hospital. Madam Member, I can tell you I wasn't Minister of Health when that UBC hospital went in. So that solves that problem. The hospitals that I've been associated with over the last number of years.... The last to open, I guess, was Eagle Ridge in Port Moody. I know the person who applied most pressure to have that built was our esteemed friend on the bench — a former member of your party who pushed very hard for that hospital. Our present member for Maillardville-Coquitlam (Mr. Parks) was chairman of the foundation pushing for the hospital.

[Mr. Ree in the chair.]

The Helmcken hospital decision was made some years back as well, in the Victoria area. That's not a political decision. It's not in a riding represented by a government member. The Grace Hospital was built fairly close to the old facility on a site which was available — the Children's Hospital.

I suppose there are political decisions in giving considerations and making decisions, but I really don't know of any flagrant examples. We haven't approved any hospitals based on political priorities. I think the hospitals which have been built have been built because of need. We've been far more active in the last couple of years in the intermediate-care area, and that's been spread around all of the province. There's always going to be that suspicion.

I'm sure that doctors would have an entirely different attitude as to where hospitals should go — preferably as close to home as possible.

[3:00]

AN. HON. MEMBER: Whose home?

HON. MR. NIELSEN: Doctors' homes. That was one of the big arguments we had about UBC with some of the doctors. They simply didn't want to drive out to UBC. Maybe it's hard to blame them.

Madam Member, I believe you asked a question earlier....

MR. LAUK: Spend a little more time on that one.

HON. MR. NIELSEN: That comes under vote 47,

Mr. Chairman, I did get some information about doctors' numbers and consultation. I know the legislation is before the House, so I'm not going to go into detail. But, Madam Member, we spent a long time with the doctors with respect to manpower, as they refer to it: in fact, that has been discussed for years and years. There have been a number of reports. One was the Black committee report of '79. There was a 1982 study by the joint committee on medical manpower. The manpower question has been a fact of life for years. Nothing was ever resolved.

We finally got together with the BCMA — not only the BCMA, but my other friendly organization known as PARI. We got together with the BCMA, the B.C. Health Association, University of B.C. medical school, the College of Physicians and Surgeons and the Professional Association of Residents and Interns. These were the people who asked to be included on manpower committees. They were all represented, and I think that's a pretty good bit of involvement by their profession. This was the manpower committees; they requested to be on them. It functioned for about a year. Somebody said.... They let it be known that a lawsuit was going to be launched. These folks were told that they would be included in the lawsuit, so they gave us notice that they were pulling out. In fact, they not only gave us notice; they insisted that the notice be delivered in a formal way so that it could be recorded, because they were given legal advice to do so.

So they pulled out. We continued on, and eventually there was a case in court. But boy, I tell you, we consulted. We consulted almost forever to try to resolve it. There was a very wide range of opinion as to how you resolve manpower problems. One of my doctor friends said: "We have to start at the national level, at the training. We're producing too many doctors." And I agree. It's expected we'll have a surplus of about 6,000 by the end of the century. We're producing too many — not we in B.C., but we across Canada. So he said: "That's where we have to start." I said: "Fine, but what do we do about the problem today?"

I couldn't agree more that we have to start where we're producing the doctors — not only producing, but bringing other doctors into the system. We spent a lot of time consulting with them. They weren't surprised that I introduced legislation, because I told them well over a year ago that if legislation were necessary, it would be brought in. So they weren't surprised. They may have been shocked, but they weren't surprised.

MR. WILLIAMS: Mr. Chairman, I ask leave to introduce a noted person in the gallery.

[ Page 5804 ]

Leave granted.

MR. WILLIAMS: I'd like to introduce Mr. Leo Nimsick, a long-time member of the Legislature for Kootenay. Mr. Nimsick was our Whip for many years, and if he saw the attendance today, he would be using his whip indeed. Welcome, Leo.

MR. LAUK: I want to address some remarks to the minister with respect to his role with the doctors, and without referring to any legislation that has been tabled for second reading, I want to inquire why the minister has flouted — or apparently flouted — the decision of the chief justice with respect to the allotment of billing numbers.

The minister, if he received what I would consider adequate legal opinion about the judgment, could not have in any way thought that the judgment could be set aside by any legislature, because it was based on constitutionality. It was based on common law civil rights, as well as on statutory civil rights. Is he not aware that any legislative attempt to thwart the chief justice's opinion is likely to meet with the court's disapproval in a subsequent judgment and be set aside again? The efforts made by the minister indicate a lack of confidence in the courts and a lack of respect for the civil rights issue that was the gravamen, the main portion of the chief justice's decision.

With that in mind, I would ask the minister to outline his attitude and policy vis-a-vis the Ministry of Health in any kind of situation arising out of the charter — that is to say, individual rights — and out of the constitutionality of provincial legislation concerning health.

HON. MR. NIELSEN: Well, I'm not going to enter into a debate with respect to the constitution or the law involved, or the reasons for the judgment of the chief justice. We too have lawyers who reviewed the matter, and they offered certain opinions and developed what they believed to be corrective legislation.

The courts have a role to play in our society. So do parliaments and legislative assemblies. In part, the chief justice.... If you haven't read the decision, I'd be glad to make a copy available to you.

Interjection.

HON. MR. NIELSEN: How many pages was it?

MR. LAUK: Quite a few.

HON. MR. NIELSEN: The chief justice cited certain absence of law and wrote an opinion based on that. The lawyers whom we employ reviewed the opinion and provided explicit authority to cover what the chief justice found to be lacking. Mr. Chairman, we recognize the role of courts. A court must judge a case based on the evidence they receive and the law as it exists. If the law is found to be lacking, and they find that the law is lacking, that's their judgment. But a legislative assembly has the authority and responsibility to write law, to correct law or to amend it; otherwise we should perhaps let the court write law for us, let them take over the role. It happens when you have too many lawyers in your society — at least one too many.

MR. CHAIRMAN: On a point of order, at the moment, Mr. Member, you might be just straying a little bit off from the estimates here, when there is legislation that may be more on the point of the item that was just discussed.

MR. LAUK: That statute, Mr. Chairman, I am sure will be thoroughly debated by others in this chamber. But I'm raising the issue of the chief justice himself and the judgment, not the legislation that was introduced. I know that the Minister of Health says there's one too many; I won't pass that along to the chief justice. I won't let him know that you referred to him as one too many lawyers. It's our secret, right?

Interjections.

MR. LAUK: No one else will report that: that the Minister of Health thought that Allan McEachem is one too many lawyers. I'm not going to repeat that. I'll never repeat it outside of this House, and I'm sure everybody will respect that confidence: that the Minister of Health insulted the chief justice of the Supreme Court of British Columbia. No one is going to mention it, because, after all, it was in the heat of debate.

But there is an outstanding problem: yes, the chief justice did refer to the weaknesses in the legislation, and the minister did allude to the length of the judgment. It was a lengthy judgment; it was a very elegant one, by the way. But it also dealt very eloquently with the mobility rights of Canadian citizens, and that a reasonable interpretation of the charter of our new constitution, on mobility rights, meant within the provincial jurisdiction as well as between provinces. That's consistent. I'm sure that the lawyers who advise you said it's consistent with American jurisprudence and similar laws, and it's consistent with a reasonable interpretation of that section.

That's the issue that I'm sure will be litigated. I certainly hope it will be litigated, to establish that a provincial government does not have absolute power within its jurisdiction to restrict, in a democratic country, mobility rights with respect to employment and residence.

When the minister says: "We're responsible for writing the laws...." The way the British parliamentary system now works is by parties. The party in control virtually dictates what goes on in a legislature. We've got the charter; that's protecting individual rights against the tyranny of the majority, as it was called recently in the Lord's Day Act judgment of the Supreme Court of Canada. There's little doubt in my mind that the Supreme Court of Canada is going to listen very favourably to an argument that mobility and residential rights are protected within provincial jurisdiction as well as between provinces.

MR. CHAIRMAN: Order, Mr. Member. I think we are straying a little bit far from the estimates of the Minister of Health. Possibly you could get back to that. As for constitutionality, we can do that during the Attorney-General's estimates or the Intergovernmental Relations estimates, but not directly on the Minister of Health's estimates.

MR. LAUK: With respect, Mr. Chairman, I don't think we should refine things so precisely, so we can't deal with.... The minister is the one who dealt directly with this mobility issue with respect to the doctors. I grant you it

[ Page 5805 ]

could occur to lawyers as well. Who knows what other legislation will be coming up? Simply because the government view themselves as the employer vis-a-vis the doctors.... This is an issue raised by the minister, Mr. Chairman. He said that....

MR. CHAIRMAN: Be that as it may, Mr. Member, he may have been a little bit outside of his estimates at the time he raised it, but that does not mean that it is proper within the debate on the estimates.

MR. LAUK: Can I talk about the relationship between the minister and the doctors, in the way he did, in terms of trade union and an employer? Or would that be under labour relations?

MR. CHAIRMAN: I think the member is well aware of....

MR. LAUK: That would be under the Ministry of Labour? And mobility rights: that would be under the Ministry of Transportation?

I'll conclude by saying that the attitude that the Minister of Health expresses is a very antidemocratic attitude. I personally was not in favour of a charter in the constitution. I thought that lawyers were being lazy and not using the common law, as the Attorney-General did in the injunction on prostitution in the West End; he used the old nuisance common law very effectively. But now that we have it, it's there to protect individual rights, and I am one who believes in the rule of law.

If the minister wants respect for his government and its power and its ability to govern, he cannot flout the decision of the court when it interprets that vis-a-vis the new constitution of Canada. That would bring the law, the constitution or even the government into disrespect to the extent that any law passed will be considered arbitrary and dictatorial.

[3:15]

HON. MR. NIELSEN: Mr. Chairman, I'm sure that when the member returns to private practice those sitting on the bench will remember his kind words.

Mr. Chairman, unless legislative assemblies or parliaments are prepared to give up their reason for being.... It's fine to say that the way the British parliamentary system works today means the government runs the House. They represent the majority. British parliamentary system is recognized majority rule with respect to legislative assemblies and parliaments. It hasn't changed; it's been identified with the party name.... The system is still basically the same, and legislative assemblies or parliaments have the authority to write laws. Just because a judge or a court may find a law to be inadequate or not explicit, it doesn't mean the process is wrong.

MR. CHAIRMAN: Order, please. Mr. Minister, I think the same comments might be appropriate here, that if we get back to the Ministry of Health estimates and....

HON. MR. NIELSEN: Fine, Mr. Chairman. I'll speak about that when the bill is here for debate.

MR. REYNOLDS: I won't be very long. I want to talk about some alternative therapies, but also say before I get into that area that I just had the pleasure of nominating the member for Maillardville-Coquitlam (Mr. Parks) as chairman of the Health, Education and Human Resources Committee. I find it rather shameful that not one member of the NDP showed up at the initial meeting, and the only one who really had an excuse is the member for Burnaby North (Mrs. Dailly), who as the critic for her party is sitting here asking questions of the Minister of Health, who also had an excuse for not being there. I find it rather strange that not one member of the NDP was concerned about these issues of health and education and human resources, three major areas in this province — couldn't even show up to the first committee meeting.

Mr. Chairman, I really got up here just to congratulate the....

AN HON. MEMBER: Is that member in order?

MR. CHAIRMAN: I believe the member is directing his remarks towards the estimates. Mr. Member, on your point of order where you did not rise, I might comment that the Chair does give a member a little bit of leeway in the commencement of comments, to see the actual direction of the comments.

MR. REYNOLDS: It's a preamble.

I just want to comment and congratulate the minister in the area of the alternative therapies. With respect to chiropractors, we've made advances over the past couple of years, allowing the chiropractors broader scope outside the spine, and also allowing them to use the title of "Doctor." It was long overdue; I think it is a very progressive step that the minister has taken. The fact that they are insured under the medical plan is a very positive step and very progressive. Naturopaths, podiatrists and optometrists: all three of these occupations had their statutes amended to allow the use of the title "Doctor." I think the minister is to be commended for that. I bring these things up, Mr. Chairman, because so often we hear about the things that we're not doing. But this province, if you really want to look at the health care issue very closely, is very progressive and very much ahead of many of the other provinces in Canada.

With regard to naturopaths, podiatrists and optometrists, we are the only province to include naturopathic services under the Medical Services Plan. Alberta does provide limited coverage under their optional Blue Cross plan. We are one of only four provinces to include pediatric services, and I think we are to be commended for that. The minister should be commended, because he's been the minister for a period of time.

Interjection.

MR. REYNOLDS: The second member for Vancouver East (Mr. Lauk) asked who the author is. Well, the author is this member, who asked this department of Health.... I am interested, like the member for Burnaby North, and we've been out attending some meetings around this province on alternative health care services. I've asked the minister what he has done, and these are my notes, not his, but information obviously came from his department as to which services are provided in this province. I think it should be spelled out once in a while, the positive things that are

[ Page 5806 ]

happening in this province. It's so easy to talk about the negative things.

Physiotherapists and massage practitioners: we insure both these services. While most other provinces insure physiotherapy services, we're the only province to insure massage practitioner services on a referral from a medical practitioner. I think that's extremely positive.

The member for New Westminster (Mr. Cocke) put a private member's bill forth with regard to acupuncture, and I would like to state that I've spent many hours over the past couple of years with the acupuncturists who visited my office here; and through the good offices of the minister, who met with the acupuncturists, a committee was set up. The committee includes representation from the Acupuncture Association of British Columbia, as well as the College of Physicians and Surgeons and the ministry itself. I'm hoping and I am sure that some positive things will come out of that committee over the next period of time. I think the minister and his department have shown a very positive attitude — much more positive than other provinces in Canada — toward alternative health care practitioners.

I would also like to talk for just a minute about health foods. We know that the federal government has been raiding some health food stores lately and taking the herbal tea and other things off the shelf because somebody might make a claim somewhere that they cure cancer. I think the federal government is wrong. I know the minister has talked to his federal counterpart, and he might want to explain to this House the attitude of the federal government in that area. With regard to health food stores, I think people have a right to the materials available in those stores. Why should they be taken off the shelf just because they might become popular or because somebody might make a claim that they cure something — if it's a product like a tea that does nobody any harm? Some might say: "Well, it might give some people false hope." I guess, Mr. Chairman, if somebody has a terminal disease anyway, why not let him have false hope or something that may work on that. I just see no rhyme nor reason why the federal government, through its federal health agency, is taking certain things off the shelves of health food stores. I think a lot of people agree with us, and the minister might want to comment on his conversations with the federal Minister of Health.

My main comment is just to congratulate the minister for the fine job he is doing with these alternative care practitioners and to hope that he will continue in that progressive manner, because there are many other things that need to be done in those areas. We can't run at them quickly, because health care is a very important thing. There are many things I know his department is researching, and I hope they will do a thorough job and keep on progressing at the rate they have been for the last couple of years.

HON. MR. NIELSEN: On that area of alternative medical services, for many years the various organizations representing chiropractors, podiatrists, physiotherapists, massage practitioners and naturopaths suffered from the exaggerated claims of some people who identified themselves as being one of those individuals. Even today in certain areas of North America there are outrageous claims made by some people who claim to be such practitioners — but really not in Canada. I think the reason we don't suffer to the same extent in Canada is that there has been a much closer association between governments and those associations. They have a place, they do a job and they provide a service. We have very few complaints; in fact, Mr. Chairman, proportionately no more than we receive from those complaining about medical practitioners.

The federal minister has discussed this question of their rather anxious people removing certain products from health food stores. The last time I met with him I raised that subject, and he quite honestly didn't understand why they were doing it — other than that, as the member suggests, someone may have claimed that a certain product cures a certain disease. Someone may have even put it on the label somewhere. But I think they were reacting rather strangely with respect to some of the materials they removed. The federal minister said he would look into it, and I believe he has responded rather quickly and quite thoroughly in reviewing this matter. I know there has been a lot of discussion about that.

I would just like to say that when you consider the various services which are available to insured members, British Columbia has the most comprehensive health care system. Other provinces have fewer; some have none. I think chiropractors were recognized 20 or 25 years ago, and others have been. I think it was correct, in that we permit people who have achieved an academic qualification through a recognized facility to make use of their academic title. Chiropractors may call themselves doctors of chiropractic; optometrists, similarly of optometry; and podiatry and naturopathy. I think it's reasonable recognition. The reason they were not permitted previously is that.... It simply said that if you were not a medical practitioner, you couldn't call yourself "Doctor" — unless you were a PhD.

The hon. member for Burnaby North (Mrs. Dailly) asked about Shaughnessy Hospital a while back. She asked if it were true — I'm not sure if she suggested it was — that patients at that hospital were being asked to go without baths due to staff cutbacks. I am informed by our hospital programs officials that they have communicated these concerns to the director of nursing at Shaughnessy Hospital and have been assured that standard bathing practices and facilities are in use at the hospital. I'm advised that the allegation by the member that some of our elderly patients — veterans — are being hosed down rather than bathed is without foundation. They say there are instances of the use of shower chairs in some extended-care facilities where residents do not have the physical capability of being bathed in the usual fashion.

It might be of interest as well that the staffing level at Shaughnessy Hospital at March 31, 1984 was 1,798 full-time equivalents; the average for the year to date is 1,782.

MRS. DAILLY: I appreciate the quick response on that Shaughnessy question, because it is something we'd like to have cleared. We certainly are pleased that you were able to give us assurance that what was reported to me apparently is not going on. I think we're all most pleased to hear that.

I would like to move on to another subject with the minister. Before I do, I would like to agree with the member from West Van–Howe Sound who spoke on the whole matter of alternative health care treatment, which of course the NDP is also very interested in developing. As is probably known by many, I believe the member for New Westminster (Mr. Cocke) is working on — and has worked on — a form of umbrella legislation, which he wants to discuss later during the estimates on this matter.

I wanted to discuss with the minister something we've discussed before, but I think it's still current. It's something

[ Page 5807 ]

that really concerns not only the NDP, but many other people: that is, the whole matter of user fees. I understand that there's a difference of philosophy here. The Social Credit government sees absolutely nothing wrong with imposing user fees, and yet the people who are involved — the Canada Health Act, well-respected Judge Emmett Hall, and many other respected health people throughout Canada — reject the imposition of user fees.

I'd like to quote something from the Canadian Press, April 20, 1985 — pretty recent:

"British Columbia had its federal medicare grant trimmed by nearly $2.7 million this month because of hospital user fees. That's up from the original penalties of just over $2.5 million a month. Health Minister Jim Nielsen said: 'The money's technically in the bank at the moment. It's recoverable within a three year period. We lose the use of it at this moment.' Asked if the province would recover it, he said: 'Oh, possibly.' After three years? he was asked. 'I don't know.' He said the province will continue to charge hospital user fees."

The people of British Columbia are having user fees imposed upon them and at the same time it is costing everyone $2.7 million a month. Will the minister now answer this question: are you planning to continue this imposition of user fees? And would you also.... Oh, somebody's already said "yes" for you. Would you also answer how you could possibly expect to recover the money if you're planning to continue to use them?

[3:30]

HON. MR. NIELSEN: Mr. Chairman, the policy of the government at this time is to maintain the user fees in our hospitals. Presently the acute-care charge is $8.50 per day. There is a $ 10 emergency room charge, and there is a charge for day-care surgery of $8 a day. That is the policy of the government.

The Canada Health Act, as the member would know, does not prohibit user fees. It simply says that they will deduct that amount from the transfer, and asks us to cooperate by letting them know how much money is coming in through the user-fee system. It also says, under the Canada Health Act, that if the method is changed to the satisfaction of the federal minister — in fact, it's a very peculiarly worded act at all; it comes down to the opinion of the minister on all these various things — in a three-year period the money is recoverable. We are meeting with the Minister of Health; all the ministers of health will be meeting with him again on May 16 and 17 to try to make some sense out of the Canada Health Act. I'm not convinced that some changes may not occur which would alleviate this particular problem and eliminate the concept of penalty.

So we haven't given up on that. Just because the federal government wishes to be punitive or the former federal government wished to be punitive we don't believe we should necessarily respond in a knee-jerk reaction. We think they're wrong. You think we're wrong. That's the way it goes. The user-fee concept is not new. It's been in British Columbia for 30 years. We welcome the NDP government in Manitoba as part of the family of user-fee people. In April my friend Larry Desjardins in Manitoba announced that the then New Democratic government was introducing user fees for chronic-care patients at $15.25 a day. They have accepted the need. They call it board and room, I think, but only because the federal Canada Health Act does not penalize you for that particular user fee. The Canada Health Act could be amended to permit a portion of acute-care costs to be deemed to be room and board, as they do with long-term care or chronic care. They could do that, and that would alleviate the problem. Technically it's still a user fee, but it would be exempt from penalty under the Canada Health Act.

[Mr. Strachan in the chair.]

As they said in the paper: when is a user fee not a user fee? The answer: when it's imposed by an NDP government. User fees, I think, are legitimate. They do not impose a financial hardship on the patients. If the person is of no means, the user fee is picked up by Human Resources. If the person cannot pay, they're not prosecuted, they're not hounded. Most people can pay, and most people are very pleased to be able to pay what is a relatively small amount.

MRS. DAILLY: Mr. Chairman, we've had this debate, so I don't want to bore you particularly in repeating, all the arguments, but I simply want to say to the minister that we consider it a tax on the sick. The whole principle of medicare is being abrogated when you continue to increase your user fees. We consider the user fee in acute care to be quite different from the one in chronic care, although we're very concerned that your chronic-care costs are continuing to rise.

I wonder if the minister could answer this one question on this subject before we move on to another one. It is this: how can you justify imposing a user fee on the citizens of British Columbia, which works out to what now — over $60 a week — when at the same time you have imposed an 8 percent surtax on the citizens? You are increasing the premiums so that now you are getting over $340 million annually in premiums. Part of the sales tax is to go for health costs. You are getting money from the federal government. Why are you imposing the user fee?

HON. MR. NIELSEN: Mr. Chairman, the user fee has been part of our hospital system for years. The premiums have been part of the medical system for years. The whole system is based on that. As you know, we offer additional services in B.C. We just discussed it with the member for West Vancouver–Howe Sound (Mr. Reynolds): chiropractic, podiatry, optometry, naturopathy, physiotherapy. The money has to come from somewhere. The people are not complaining about the user fees. Only the NDP is complaining about user fees, except in Manitoba.

There is a difference between a user fee in long-term care and in acute care. The difference is that the user fee in long-term care is usually for life — every day of the rest of that person's life. Acute care is an average of 8.8 days. The NDP is the only group of people who can be identified as a group who are complaining about user fees. We're providing the best health care system available. We are providing the most comprehensive health care system in Canada, and we get no complaints from people about paying $8.50 a day for an acute-care setting. That's an average cost of around $380 to $400 a day. Chances are they pay more for the cab to go home when they are discharged from the hospital. It might pay for breakfast, but it doesn't pay for much else.

MRS. DAILLY: I know over on the other side they were agreeing with you and the minister is shaking his head — he

[ Page 5808 ]

can't understand why the NDP doesn't see this. There is somebody else who doesn't agree with it either, and he's a conservative. It's Professor Bob Evans of UBC. Do you know one of the reasons?

Interjection.

MRS. DAILLY: He's certainly not NDP.

I'll tell you one of the reasons that the majority of the people may not be complaining: I don't think you'll find the majority of the people of B.C. have had to face up to it yet. You must admit that a minority are in your hospitals. Secondly, you have done a really good job — I have to give you great credit — with the taxpayers' money of selling a scare to the public: if you don't pay the user fee you're going to lose medicare. Don't deny it. This is what has been going out from the minister and from the Social Credit back-benchers, who are all chortling there and backing him up right at this moment. You have sold the people of British Columbia the idea that we are in such a desperate state with the cost of health that unless they pay these user fees, medicare perhaps will suffer or go down the tube. You've done a great job of scaring them.

Let me quote what came from Prof. Bob Evans in front of the health committee. The minister, knows about this. I think he followed him later...the same one who had the hearings on the Canada Health Act. They were talking about B.C. imposing these user fees. Somebody had said: "Well, I guess they have to, you know, with the deficit and the problems in British Columbia." To quote directly from Prof. Bob Evans:

"First, the deficit is partly contrived by elaborate accounting. Second, to the extent that it is there, it's there as a result of world economic conditions in the downturn. But third, B.C. Railway and B.C. Hydro are building well ahead of demand. Everybody said it was doing so at the time" — but they went ahead. "B.C. Transit commission, the northeast coal problem.... The Japanese have decided that since they're not building cars, maybe they don't need so much coal. We have a whole series of projects which are imposing serious costs on the B.C. government. They are looking around for a way to justify the increased taxes to support earlier economic mistakes — certainly earlier problems — and medicare, being the most popular program in B.C., as in the rest of the country, makes a natural stalking-horse for those taxes."

So what I'm saying to the minister is that this business of imposing user fees is strictly a political strategy. I think it is most unfair. It is not accomplishing anything as far as the government's finances go, because basically that money.... We have no assurance of how much of it is going back into health anyway. The people who are unemployed — yes, they're taken care of. But I wonder if the minister and the other Socred members who are backing up the minister would enjoy going to a hospital today with no money, knowing you're out of work, not being able to pay, and yet being told: "Well, it's okay, we'll take care of you." That's pre-medicare days, when people were made to feel like second-class citizens. That is the issue. The minister and the Social Credit government are destroying the principle of medicare. That is the whole issue which somehow or other we can't seem to get through.

HON. MR. NIELSEN: Even the socialists who drafted the Canada Health Act didn't agree with that. They outlined in the Canada Health Act the five principles of medicare. It didn't say "user fees." User fees are permitted under the Canada Health Act. It's fun to have this discussion....

I believe Bob Evans is an economist, is he not? It's fine for him to have an opinion. My God, we're not prohibiting people from having opinions. It doesn't mean he's correct. The average length of stay for a citizen in an acute-care hospital in B.C. is 8.8 days. For a person who's in a long-term care it's probably for the balance of his life. We are not imposing heavy financial hardship on anyone. If people go to the hospital and can't pay the $8.50 a day, they don't pay it.

The $41 million, or whatever amount it adds up to in a year, is utilized to expand the medical services to citizens. It is the money, in part, that is used to provide additional programs. The people are not complaining. They're not afraid of paying $8.50 a day. In fact, many people write letters and say we should charge a lot more for the service they receive. Many people have sent in donations to hospitals in appreciation of the service. Many people shake their heads; they can't believe.... They leave a hospital such as Children's Hospital, and if a child's been in there for five days they receive a statement that advises them that the cost of treatment on average for that five-day stay is about $3,000; their cost is $40 or $45, whatever it is. They appreciate it. They write letters and say thank God for our system. Don't tell me those people are offended at paying $8.50. They feel privileged to be able to take part in a small way.

We disagree on user fees. You may be the only political group left in Canada who disagree — that is, the B.C. NDP — because my friend in Manitoba, Larry Desjardins, said user fees are only user fees when they are applied to people who can choose whether to avail themselves of a government service, whatever that means.

MRS. DAILLY: Just a final comment on it, because I know the member for North Vancouver–Seymour (Mr. Davis) would like to get up. I just want to say to the minister.... He keeps saying that user fees are not illegal under the Canada Health Act. The point is that the people involved in the Canada Health Act, and even the present Conservative government, impose penalties for governments such as yours which insist on imposing them in acute-care hospitals. So obviously it must be abridging one of the principles — or two of them — of medicare. The minister can say all he wants that it's not illegal and it's not wrong, and yet he has to make the people of British Columbia pay penalties for it. So someone is wrong.

[3:45]

MR. DAVIS: I want to raise two topics. One is the new health care tax, the one that was introduced in last year's budget. Essentially my question is: how much longer will all of us who pay income tax to the provincial treasury have to continue to pay that levy? It amounts to a substantial sum. The other topic relates to the unique problems of the North Shore Union Board of Health. I gather we have several boards of health in British Columbia. The services they perform are funded differently than in the rest of the province. In the rest of the province there are ministry health units, which are not funded through local municipal government or any of local municipal government's agencies.

[ Page 5809 ]

First, back to the special health care tax that we now pay. I gather it's a couple of points on our income tax. It relates to the fact that the federal government no longer pays 50 percent of health care costs in this or any other province. I'm not one of those who bewails the fact that the federal government no longer pays 50 percent of our costs. The hon. minister has said several times that we enjoy the best health care service in Canada. It's certainly the most comprehensive. Its quality is high. And it is more expensive than other health care programs in other provinces, because of its breadth and its quality. I can't see the logic, looked at from a Canadian point of view, of the national government, which incidentally is running a very substantial deficit, automatically putting up half of the health care costs of the wealthier provinces, British Columbia included, which can afford — if one's looking at ability to pay, at least — to pay more for health care.

In order to entice provinces into medicare, the 50-50 formula was invented, and it continued for some years. In the mid 1970s when the federal government began to run increasingly into debt — to run increasing deficits — it naturally looked at its large areas of increasing expenditure, and health care was one of these. Health care costs were rising much more rapidly Canada-wide than other costs. In order to contain that runaway cost item, the federal government switched from a 50-50 formula to essentially a per capita formula, one which paid each province, on the average, the same per person that all other provinces were paid. That way, it managed to put a lid of sorts on its runaway costs. As a result, provinces with the steepest cost increases found that they were no longer getting from the federal government half of every dollar they spent on health care.

Provinces are fond'of claiming-jurisdiction in health, education, municipal affairs, a number of other areas. But when it comes to dollars, provinces feel they should get as many dollars from Ottawa, regardless of jurisdiction. Health, I claim, and.... I think most people looking at our constitution — certainly most people in this province — would say that health is a provincial responsibility. Initially, during the early days of medicare when provinces were joining the national health care scheme — and British Columbia was one of the first in — the 50-50 formula was, I think, a useful device, if not appropriate.

But as health care costs rose, it was, I think, equitable that provinces receive substantially a per capita payment rather than a payment which reflected their wealth. So I personally feel reasonably comfortable with the present formula, which is not 50-50.

The tax that was introduced last year ostensibly was to make up for the fact that Ottawa was in default. Because it had moved some years earlier off the 50-50 formula, Ottawa was in some way in default of certain sums of money that were due to the relatively well-to-do people of British Columbia, and they were due because the 50-50 formula in some people's minds was deemed to continue to exist.

While we made those charges last year, while we invented a tax in order to cover the gap pro tem until the feds came to their senses and paid us the 50-50 basis, is that now a perpetual part of our budget? Is the fact that we're going to have to make up the difference between the old 50-50 formula and the new — and I'll call it a per capita formula...? Is it now a permanent feature of health costs in this province? Is the revenue that's likely to flow to this province under the heading "health" from the central government likely to continue to fall behind our overall expenses divided in half?

In other words, is the 50-50 formula really a thing of the past, or does the province still hope it can be revived? What discussions have been held with the new government in Ottawa in the hopes that the 50-50 formula would be revived? What expectation does the minister have that somehow we'll gain relief from a government that is $30-plus billion in the hole, and from a government that is just as interested in the people in the lower income areas of Canada as it is in the people from the higher income levels?

I'd like a comment on that tax, because it's costing British Columbians a great deal more than user fees, for example. It's a much bigger item in our total budget. Is it a permanent fixture now, or is it not?

Turning to the problems of the North Shore Union Board of Health, if I can capsulize them, they are these. Because the Education budget of the province is not rising as rapidly as the Health budget of the province, the North Shore Union Board of Health, and I'm sure other union boards of health in the lower mainland, are complaining that they're not treated properly. They get their money via the Education budget,

West Vancouver recently, as a result of a motion passed by the school trustees, decided to cut their contribution even more than the formula contribution, and presently the council of West Vancouver is considering whether it will make up the deficit.

But nevertheless, the moneys flowing to the North Shore Union Board of Health for the administration of a number of functions normally carried out by health units is less proportionately than in other areas of the province where the funding is carried out directly by the Ministry of Health. I know that the simple solution would be to do away with these remnants of the past — the continuation in a few areas of local administration of health services — and to put all the areas of the province on the same basis: give them all health units, fund them all proportionately with the increase in the total Health budget of the province, and not treat them — financially anyway now — as second-class citizens who are tied to an Education budget and not to a Health budget.

In essence, there are two questions there, Mr. Chairman. Firstly, how long are we going to continue to pay this additional health tax because of a federal funding formula which is no longer 50-50? Secondly, when are you going to rescue the North Shore Union Board of Health from being a captive of the Minister of Education's budget, rather than your own?

HON. MR. NIELSEN: To the member, thank you for the two areas of discussion. Let me respond first to the union board of health on the North Shore.

I don't believe there is anyone — at least that we've been able to identify — who can truthfully and correctly identify the process that has left us with what we have now vis-a-vis these local suppliers of certain levels of health care, because it's all over the board, all over the province. Not all over the province, but all over the Greater Vancouver Regional District, the Capital Regional District and others. It's been a source of a tremendous amount of consultation over the past couple of years between Vancouver, Burnaby, Richmond, the North Shore, New Westminster, the Capital Regional District and others. It is very different than the rest of the province, and varies a tremendous amount within a district. As an example, Mr. Member, preventive services — and that's what we're dealing with, preventive services — we contribute to the city of Vancouver 23 percent of the costs associated with

[ Page 5810 ]

their preventive services; in Burnaby we contribute 51 percent; Richmond, 35 percent; the North Shore, 45 percent. So as you can see, it doesn't really make any sense.

The one element within these various percentages, however, is that in some instances municipalities have taken it upon, themselves to add a program to their health system, if you like. They add a program on their own. So it modifies the percentages because their list of preventive services may be broader than a neighbouring municipality's. They may be providing a service that another municipality does not provide — as an example, audiology. Some municipalities may provide audiology services; others do not. But it should be far more consistent. Through the GVRHD and others we are attempting to work out a method whereby we can equalize, at least within the region to begin with, and then perhaps see what we could do on a provincewide basis.

It's a big money item. It does involve a considerable amount of money. I believe the estimate for GVRHD was about $9 million or $10 million on a yearly basis. We have been working on that, and the assistant deputy minister responsible has had numerous meetings to see if they can all agree. We don't have consensus yet even among all the municipalities. But I agree with you; I think it is a remnant. As you said, the union boards of health themselves are from an age gone by. Certainly the financing formula is from an age gone by, and it is something we are attempting to resolve. Your suggestion may be the correct one. There is still a lot of local pride in those services and they would like to retain them, but perhaps they do in some instances suggest that they are an anachronism.

Mr. Member, you asked about the tax, which I'll respond to briefly. As you know, the tax was introduced in 1984 as the health care maintenance tax surcharge. The budget stated that the surtax would be removed when federal health care funding is raised to an adequate level. I appreciate that the word "adequate" is very subjective. What does adequate mean? When will it be adequate? The federal contribution toward our health costs is approximately 42 percent — that's medical and hospital, the areas they share in; not our overall budget, but in the areas in which we share medical services and hospital. The chiropractor, the extended benefits and intermediate care are a separate item entirely. So it's 42 percent.

I agree that when the federal government tried to persuade provinces to join a national system, they offered a very generous fifty-fifty — 50-cent dollars. Many provinces took advantage of that and built, and in some cases overbuilt or overextended themselves. The federal government recognized that it was a runaway system and that they had to bring some control. I don't disagree with you that the concept of fifty-fifty is the only answer. That's a very simplistic way, and it's perhaps a good way to introduce a system. We have asked the federal government to consider not only the per capita grant — that's really simplifying how the system works — but also the demographics of the region and the province, along with raw numbers of people. Our argument is that British Columbia attracts a large number of senior citizens, and the cost of delivering health care to seniors is much higher. We'd like them to recognize that senior citizens from the Maritimes, eastern Canada or the Prairies may move to British Columbia — the Vancouver and Victoria area — because of the climate and become an additional burden on the health care system. We support the mobility of Canadians to come here, but we would like the feds to recognize that there is an additional cost; and perhaps, if they did, if the demographics were taken into consideration, it might come up to an acceptable level.

[4:00]

I'm advised that negotiations for the next EPF contract will begin this fall, but the present agreement doesn't expire until 1987. So they are beginning to negotiate next fall. I don't know when the federal government's contribution will be adequate. The Minister of Finance (Hon. Mr. Curtis) could probably offer an opinion on that in his estimates. But, Mr. Member, I think there is a bit of room to negotiate with the federal government with respect to demographics, to see if that would help resolve some of the problems.

Your North Shore Union Board of Health thing is, as I said, under very active review. I agree that it is not equal to all. We've been looking at it very carefully, and we hope to be able to resolve it over a period of time.

[Mr. Ree in the chair. ]

MR. COCKE: Mr. Chairman, I smile just slightly when I hear that discussion. I recall some of the negotiations with the federal government going back to 1971, '72, '73, '74 and so on. Of course, the federal government's first offer — and I'm dealing just for a moment with this whole question of financing — tied their contribution to the gross national product. The gross national product in those lush days was somewhere around 5 to 6 percent. The cost of health care was increasing at a rate of something in the order of 13 percent. So naturally all the provinces were a bit shy of that and resisted it. Then along came Alberta and Ontario with their massive tax bases, and they were talking about tax points and the grants. When the new B.C. government took over in 1976, they fell right in with it, because at that time we were a have province. They thought: well, as long as we're in this great position, the Maritimes can sort of take a back seat and so can the Prairies. We argued at the time that Ontario was pushing this; that it was going to be unfair for people with a lower tax base.

Now I see that we're starting new negotiations. I certainly concur that there should be new negotiations, but these are the kinds of negotiations that should have been happening right from stage one. Ottawa has been able to leave us with this particular heritage. I also think that while there is the provincial responsibility, as long as the feds are participating to the extent that they are, they should be participating in a far more active way — not delivering services, but participating in terms of planning. There's just too little of that being done at the cooperative level — in other words, at the federal-provincial level. Sure, the ministers of health meet and the bureaucrats meet from time to time, but there isn't enough health planning done in this country.

One other word, just before I get on to one subject that I want to deal with, mainly in my first moment or two here, and that's the whole question.... I listened to repartee going on between the Minister of Health and the member for Burnaby North (Mrs. Dailly). She was talking about "behind closed doors," and he was saying: "Show me some of those closed doors." I'll show you a closed door — sitting right in that corner. The kind of closed door that I find absolutely reprehensible is when the Minister of Health tells the member for Maillardville-Coquitlam (Mr. Parks): "Give us the appointments for the Royal Columbian Hospital board, and they'll all be on." Not one of them is living in New Westminster. Mr. Chairman, that's the kind of thing that we see and absolutely abhor. Royal Columbian Hospital and Eagle

[ Page 5811 ]

Ridge, and all the rest of them, will suffer as a result of that kind of decision-making. Those are the kinds of closed doors I see.

Getting back to a much more friendly and affable situation, Mr. Chairman, today the minister and some of his colleagues met with the B.C. health professionals' association, and they made certain suggestions about some kind of title protective legislation. I'm going to ask the minister a few questions vis-a-vis this. I note that in 1980 the then Health minister, Rafe Mair, said that work on proposed legislation had been going on for a long time, but added that he didn't know when it would reach the Legislature. Well, it still hasn't reached the Legislature.

Interjection.

MR. COCKE: The member for Maillardville-Coquitlam (Mr. Parks) may find his tongue so that he can stand up and give a speech in the House, and when he does that maybe we'll listen. Right now, from his chair, he's making no sense whatsoever.

Mr. Chairman, this kind of legislation is required not for those health professionals but for the protection of the people in B.C. Many of them have become far more responsible of late years in terms of their requests, because they have seen, because of past licensers that have occurred, that it's a licence to exclude. It's the kind of thing that is a real moneymaker. But that's not what they're asking for at all. One of the things that I'm very gratified about is the fact that they agree — incidentally, I wish that they would agree exclusively; they say either would be acceptable — on either individual legislation or umbrella legislation. I think the minister knows my feelings about that.

As far as I'm concerned, umbrella legislation is the only way to go with respect to this. We should include.... I'm not talking about the doctors and the nurses and so on; I'm talking about this level of professionalism. People included are the public health inspectors, most of whom probably work for the minister; nutritionists; dietitians; occupational therapists, which is a real irony if I ever saw one — occupational physiotherapists have their own act and occupational therapists don't — respiratory therapists, cardiology technicians and speech and language pathologists. I see no reason that the kind of legislation that they are asking for couldn't be very simply put forward.

Of course the minister can say that there are all sorts of other people that want that. But the way to protect the ministry in this respect is through umbrella legislation, which incidentally leaves the door open sometime in the future for other groups that have attained a level of professionalism and are required by the health system to be enrolled at that time. Other Canadian jurisdictions have gone for this, like Alberta and Ontario. We all know that. The reason that they've gone for it is because of the fact consumers can evaluate. Today, if I want to hang up a shingle and say that I'm a dietitian or a nutritionist or any other kind of ist....

HON. MR. NIELSEN: Insurance agent.

MR. COCKE: Yes, or even that. You know, one of the things about that is the fact that they're doing it. They're doing it right along. People are giving the impression that they have a lot more to offer than they really have. I suggest, let them go through the hoops, go through the courses, be able to meet the standards, and then be recognized. We're not saying we want to get rid of caveat emptor at all. But once you have that, it is buyer beware of anybody else that's trying to elicit their customers in those fields — but they're going to have to use a different name to do it. I think it's important. So at least then consumers can say that the government has given us some kind of leadership with respect to how they, the consumers, can evaluate whether or not they're going to be looking forward to the level of care and service that they want.

Health care, I guess probably, along with many others areas in our complex society, is becoming increasingly specialized. Because health care is so tremendously important and because it's so sensitive in this respect — that many times lives depend on the level of care that's being offered — I think that it's time that we came into the new ages with respect to this very simple, I would say, title protection. It's certainly going to take some decision-making with respect to who comes in and who's excluded, but I believe that it's time that that happened.

Standards are essential in health care. So I ask the minister, as Rafe Mair was asked five years ago and as I was asked ten years ago: when can we look forward to this kind of protection, not of those people but of the public that we serve as legislators?

HON. MR. NIELSEN: I'd be very interested to know what the member said ten years ago. However, we also heard from the association today made up of the organizations the member for New Westminster identified. Mr. Chairman, I think it was a very impressive presentation today. There's been something very important which has been clarified or altered in the last year. I had previously met with many organizations and associations who represent health care areas, and I think probably what caused some of the difficulty was the different attitudes several of the groups had as to what they were after and what they wanted. I think it's been clarified by them joining together as a group — many of them at least — and zeroing in on title protection and some other ability to discipline members or seek certain standards for their own members.

Previously I had talked to some, and they did not necessarily have the authority to speak for their association, but they took it upon themselves to speak. They were seeking exclusive authority in certain areas. They were seeking automatic enrolment in the Medical Services Plan in certain areas. As I told the group today, I think their presentation now has been clarified, and I think it's very supportive. But I made it very clear that there were two points that had to be understood. One was that it does not give them a monopoly or an exclusive right to that area; nor does it mean automatic entry to the Medical Services Plan.

The umbrella concept, I think, is by far the best of the two routes, because it can be expanded. You can incorporate other organizations into it, rather than as it was done in the past when it was strictly ad hockery and whoever happened to lobby hard and long got the legislation. But, Mr. Member, there is also, I think, something very important for the citizens and for the organizations, and that is not to imply, simply because they have some type of legislative protection, that it suggests that they are approved by government. That's a bit of a problem we were considering as well. We don't want people putting out a sign that says "government-approved nutritionist," or whatever the discipline may be.

[ Page 5812 ]

[4:15]

But I agree with what the member was saying in principle: that the umbrella concept, the title protection idea and some of the other attitudes have been well thought out, well planned and well presented. I would think, Mr. Member, since it wouldn't be my bill, I don't believe — not if it's the umbrella.... I don't think it would necessarily be my bill; it might be one of the more legal ministries. I would think there would be every good chance we would see that produced this session — I would hope. I think that the point's been well made, and I would think that it's quite possible we may see it this session — finally.

MR. COCKE: I sure welcome those words, Mr. Chairman. I would, however, suggest that if you want to get it in this session you don't make it outside the Ministry of Health. Why not have ministries take responsibility for their own paraprofessionals, professionals or whatever? Because if you do it the other way, paralegal people, para-this, para-that, before you know it, you're in mire up to your armpits. Let the ministries responsible look after their own particular area.

I think there are significant numbers of people in the health field who require this kind of legislation. I'm not suggesting to the minister for one minute that this is endorsement. What you're doing here by title-protective legislation is seeing to it that the public is served to the extent that when they go to a dietitian they know they're not going to a food faddist; when they go to an occupational therapist they're not going to someone who has no training, nothing really to offer.

Anyway, I'm really delighted that the minister has taken that position, because we will took forward to that kind of legislation. The minister can be assured that within reason we'll certainly support it, because we feel that it is time. The frustration that has happened.... I noticed the minister was somewhat snide about the fact that nothing happened when we were government. Let me tell you what happened. We were three years and four months in government. Social Credit have been in government for 30-some years. We'll be there again, Mr. Minister, and it will be a lot sooner than you think. But that's neither here nor there. The fact of the matter is, we just didn't have time. I'm not suggesting that we didn't have some of the problems that you had until recently. I believe that they have come up with a lot easier question to answer than what we were asked before. Virtually every group that came to my office were asking for the ability to license, the whole comprehensive thing, put them in the same class as the College of Physicians and Surgeons — and heaven help us, we don't need a lot more of those colleges.

That's about the size of it. Anyway, I'm delighted. I don't know whether my colleague wants to pursue the hospital situation, but I think I'll let her pursue that, and then I have a few things that I'd like to say about some of the areas that have come very close to me.

MRS. DAILLY: Yes, back to the hospitals. The minister mentioned earlier in reply to a question that there were over 1,000 empty beds — I can't remember the exact number now; 1,700, whatever it was — in the province. I guess he was making the point that a lot of that press hysteria about not having enough beds was probably not valid. But we didn't get a chance to carry on with that, and I'd like to move into that discussion now.

I wonder how many of those beds are not in use.... When you say beds, do you mean they have the correct staff for the bed? The whole thing? That's what I wanted to know. That's answered that question.

I understand you have a five-year plan for capital projects. The minister is laughing; maybe we can find out why. Oh, he has. Could the minister then give us a list of the capital projects in order of the priority in which you are planning to establish these? Have you got any lists? We were talking before about long-term planning. It would seem to me that if you're embarked on a five-year plan for capital, that's good. Maybe you could give us some idea of your priorities and the list of the projects.

Then I want to carry on and go into some more specific problems in various hospitals around the province, because the minister has said over 1,000 beds are there. There are empty beds, so there's something not quite right here with many of the other materials that many of us in this House have been receiving from different areas of the province who were expressing concern about a shortage of beds. So perhaps we can deal specifically with the minister to try to clear this up.

I'd like to start with the Prince George hospital. I think we all know how important it is, and it's a very busy regional hospital. The figures that I have point to the fact that there is a deficit held over from last year, that they've already cut back beds and staff — as have many, of course — and that they still have a long waiting list. It's grown by 200 to 300, and last year it was 2,000. Can the minister explain that situation in Prince George? Is it accurate? Are you concerned about it? What's going to be done about it? Because the Prince George one still keeps coming up.

I would also like to ask a question about the Surrey hospital. I know that one of the members from Surrey is here. The Surrey hospital, I understand, will have a deficit also from last year, which it will be able to cover from the previous year's surplus; we are aware of that. But apparently in Surrey there are 1,200 on the elective surgery waiting list. As to Surrey, I'd also like to ask whether money is available for their new emergency facilities. Actually, I'd like an update on the Surrey situation, which is another area about which we've had reports of some serious problems. This is another growing municipality, of course, where this hospital situation could cause severe problems, so I wonder if we can have the minister explain and tell us how he feels about that. Has he any update on it.

In my own area of Burnaby we still have 33 beds closed. We understand that there's more stress with staff, and absenteeism due to stress levels and harder workloads. There's a gradual increase in Burnaby Hospital elective surgery waiting list. I know that Burnaby Hospital, similar to the other hospitals in B.C., still.... Maybe you've sent out their information but to my knowledge, from when I last contacted any of them, they didn't know what their grants were. I know that most of them were down to the bone, so they are very concerned about the new grants. Once again I'll ask the minister: have they been informed of their grants to date?

I wonder, therefore, before I go on with further questions which are too specific to give all at once, if you could reply on the five-year plan, on what the situation is with the Surrey hospital and the Prince George hospital, and on anything on the Burnaby Hospital situation.

HON. MR. NIELSEN: Mr. Chairman, we have attempted to have a five-year plan for a number of years. Because of the recession, capital projects came to a grinding halt. The five-year plan was, in effect, in suspension, being

[ Page 5813 ]

retained on a five-year program. We have approximately 50 major projects in various stages — some at only the conceptual stage; some in planning — that have been requested of the ministry from the hospitals in the province. The requests for capital amount, I think, to about $875 million. We have not developed a precise list in priority from 1 to 50, because we recognize that the size of the project may have a bearing on its capacity to be approved, where some are much smaller.

Prince George Regional Hospital. I'm not sure what the member was referring to, precisely. I know I've received a communication from the Prince George Hospital just recently — I don't have it before me — and they advised me that they were doing very well and that they were very pleased. They've had some difficulties, yes. As an example, Madam Member, you mentioned about the vacant beds. On April 17 they had 31 available beds for patients, which is well over 10 percent of their capacity, The Surrey Hospital, on the same day — and Surrey is a growing and busy area — had 23, and Burnaby, a very good hospital, had at the same time 35 available beds, approximately 10 percent.

The Prince George Regional Hospital has claimed that funding restrictions did not recognize the high cost of their operating budget, which resulted in a deficit in 1984-85 and prevented beds being reopened to correspond with their surgical waiting list. The hospital is rated at 350 beds. Because of fiscal reality in 1982-83, the board decided not to open their rehabilitation unit and to operate at 286 beds. Additional acute beds were closed in early 1984-85 without ministerial approval, which left 270 in use.

In February 1984 I approved the hospital's request to reopen 18 surgical beds and one operating room for three months with operating costs covered by their surplus from 1983-84. The hospital was unable to recruit staff so the operating room was open part-time. Thirteen beds were reopened between April 1 and June 30 of that year. Additional funding was also allowed for increased day surgery, but the hospital did not achieve their anticipated workload levels. The hospital opened 12 additional extended-care beds on April 1, 1984, without required pre- authorization. The ministry staff visited the hospital — this is Prince George — and funding was approved for the balance of 1984-85. Combined with a small upward adjustment for increased workloads, lost ultrasound revenue and a reduction for unachieved day surgery, the annual grant was increased by $206,000.

Mr. Chairman, I might add that this procedure, which was introduced a couple of years back, has proved most effective. It is a quarterly review of each hospital's operation by various teams or upon request of the hospitals. This information I just offered you is an example of the frequent results of the quarterly review; that is, an in-depth audit of their operation, and modifications if they're required. In this case the Prince George Regional Hospital picked up an extra $206,000.

[4:30]

In February 1985 the regional team again visited the hospital, and an allowance of $60,000 will be added to the base effective April 1, 1985, to fund 200 additional surgeries a year. In addition the hospital will receive $101,000 for unexpected inflation of medical surgical supply costs in 1984-85, with approximately half of this remaining in the base for 1985-86.

Prince George Regional Hospital is operating at a high occupancy in surgical and medical beds. The surgical waiting time is increasing. However, waiting times are not much out of line with other large hospitals in the province. The additional surgical allowance of $60,000 should ease the situation. The hospital is also one of the most expensive to operate in their peer group. We believe the hospital can operate within their budget for 1985-86.

But, Madam Member, I believe the Prince George situation specifically was responded to by the regional teams, by those who were responsible for investigating, and I think they did a pretty good job in resolving it.

Surrey Memorial Hospital has requested some modest redevelopment. They've also asked for some new extended-care beds and acute-care expansion, so Surrey has a large shopping list, as it is a growing community, although many of the residents of Surrey are well-served by surrounding area hospitals.

Burnaby Hospital does have a request, I think, for extended-care beds. Burnaby Hospital has asked for a 125-bed extended-care unit. That's their present request for capital. They're after extended-care at the moment. But Burnaby Hospital's biggest request right now is for a CAT scanner,

MRS. DAILLY: I thank the minister for that detail. I think the hospitals out there will be pleased to get some.... Maybe you've talked to them anyway; I don't know. But I'm sure that there's some information there that may be helpful to them.

I would like to make a few more points, though, about the Prince George area and the lack of physiotherapists. I'd just like to make a point that the whole thing is very ironic — I'm sure the minister agrees with me — that there was a suggestion of cutting back on physiotherapists at UBC when at the same time they are desperately needed in areas such as Prince George and elsewhere. I think the minister would agree with that. I wonder if you have anything up to date on that. Have you discussed it with the Minister of Universities (Hon. Mr. McGeer)?

The other point I wanted to bring up with the minister is about the Kelowna General Hospital. We understand that your ministry gave an ultimatum to the Kelowna General Hospital to stay within its budget for the fiscal year, or else. The executive director told the board members in early March that it seems inevitable that we'll have to contemplate major cutbacks in beds and services, and that it would be unrealistic to think otherwise. Really, what I want to find out from the minister is whether the situation is as serious as the executive director says. Has it become common practice now for your ministry to deliver these ultimatums, the same as are emanating from the Education ministry?

[Mr. Strachan in the chair.]

HON. MR. NIELSEN: Mr. Chairman, we offer the hospitals options, hardly ultimatums. We offered them a variety of options.

The situation in Kelowna is not as alarming as some people want it to appear, Madam Member. It is also part of the bargaining. When we get near that time of year when budgets are being established, some people make much more noise than they would otherwise.

We have completed a line-by-line analysis of the Kelowna General Hospital. That line-by-line analysis determined that the workload of the facility justified a $400,000 increase in their funding allocation. The line-by-line, which

[ Page 5814 ]

they requested, showed that they were justified in seeking an additional $400,000 increase in their funding allowance. Part of the problem at the Kelowna facility was that they were running a deficit in excess of what we felt was reasonable. We believe they can operate within their funding allocation for 1985-86, as a result of a $403,000 increase in their funding allocation and some additional efficiency measures which are to be implemented by the hospital. We were there recently and advised them. Some changes were already made. I think the Kelowna situation has settled down reasonably well.

Physiotherapy in the Prince George area. I'm told by my deputy that we are actively recruiting to try to fill these positions. I agree with the member, and I've made my point to the minister responsible for universities. I think I said it in the House: physiotherapists, audiologists and some of these other health care people are required in certain areas of the province. We should at least attempt to train enough to fill what we anticipate our need might be. Even though that doesn't guarantee that they will work in those areas, it gives us a better opportunity. I think the universities would be irresponsible to cut back on those courses; if the universities wish to give me the list of courses offered, I'll make other choices than those. We'll start with political scientists: one of the categories of people we really don't need too many of.

AN HON. MEMBER: Lawyers.

HON. MR. NIELSEN: Lawyers. Sorry. No offence.

Mr. Chairman, the physiotherapy. I agree, it's a double problem: we don't train enough, and it's very difficult to recruit these people to remote or northern areas when there is an opportunity for employment elsewhere. It's very tough.

If the member for Prince George were here, I'm sure he would be interested. One of the areas that has been suggested to us to relieve some of the pressure on the Prince George hospital, because it is a regional centre, would be to give very serious consideration to perhaps upgrading and expanding the hospital at Mackenzie. So that has been received from the member responsible for Mackenzie, the other member from the Prince George area. We're looking into that as well. I think that the situation is in reasonably good shape.

Did you wish to ask about a CAT scanner too?

HON. MR. HEWITT: I appreciate the invitation from the minister. He's well aware that there are two proposals in my area. One deals with a mobile CAT-scan vehicle that would provide service throughout the area. With the technology today, I'm told by Dr. Karr and other representatives of the medical profession that the vehicle, the mobile CAT scan, can achieve equal quality to a stationary CAT-scan piece of equipment, and it could serve the interior of the province — the Okanagan Valley and, I would say, through the boundary country and possibly into the Kootenays — providing regular service not only to the hospitals but to the doctors in that area, and certainly to the patients who need that service. I'd just like to support the efforts of the medical association in my area, and the submissions that have been made to the minister, asking him to seriously consider the possibility of placing a mobile unit in the Okanagan.

Secondly, Mr. Minister, since I'm on my feet, I would also like to again indicate my support for the establishment of a cancer clinic in the Penticton area at some point in the future. We have a number of specialists at the Penticton Regional Hospital dealing with cancer patients. The environment of the Okanagan is, in my opinion, second to none. It certainly provides an area where not just the patients, of course, could enjoy the climate while going through some pretty traumatic experience, but their families as well would come to that area. I think it's fair to say that the Okanagan is fairly central and could serve that part of the province through from the Kootenays.

As I say, we have the medical expertise there, with a number of specialists. Also, it's fair to say that statistics prove that cancer strikes the elderly.... And it's fair to say that in my area, the Okanagan, which is basically a retirement area, many people come from other parts of Canada and the province to retire. Therefore I think the incidence of cancer patients, those people needing the service, could certainly justify serious consideration by your ministry and you of the establishment of a cancer clinic in the Okanagan Valley, and particularly in Penticton. Thank you for your consideration, Mr. Minister.

MS. BROWN: First of all, I want to thank the minister for arranging for me to see the computers in the Ministry of Health and for some of his staff to spend some time with me. I really appreciated that and I was very impressed — so impressed that I'm not even going to make speeches. What I'm going to do is give him my questions, and I know that before I sit down somebody will be pushing little buttons and the answers will be here forthwith. So I'm just going to give you a list of headings.

I want to start out by saying that I'm the spokesperson for preventive health, community health and health care as it affects women. I want to look at the issue of midwifery and whether the minister has made any decisions about some changes in the policy around this issue in British Columbia. I also would like to look at the funding — or some funding — for the Women's Health Collective. I know that they are not on the computer, so maybe I should tell the minister just a few things about them as I go along. I also want some response on the whole issue of "granny-bashing" and whether the ministry is...

Interjection.

MS. BROWN: Yes, "granny-bashing."

... looking into that at all. Abortions is the other issue that I'm going to be touching on, and some of the clinics, such as Pine and Reach — and some of the community clinics.

I want to start off by talking about the Women's Health Collective and bringing the minister up to date on some information. The Women's Health Collective has been surviving on a federal grant from Health and Welfare, under the health promotion component of the grant, to provide information to women right across the province so that they can make some choices as to their health care.

What they've done with this money is publish an impressive list of publications of interest and importance to women. I have a bibliography here with me, and it touches on things like DES, which is very important. It also talks about birth control methods and safe and effective means. There is some literature on menopause as a process, as well as a self help approach. It talks about vaginal and cervical health care, abortion, early diagnosis of breast cancer, and it teaches you how to examine yourself for breast cancer. It talks about

[ Page 5815 ]

fibrocystic breast diseases and those kinds of things. It also deals with the menstrual cycle, as well as a number of books on general women's alternatives to psychiatric drugs; a women's guide to bladder infections; and estrogen replacement, obesity, radiation on the job and a number of other issues. It really puts things into pamphlet form and very simple language so that women can understand some of the diseases and some of the health problems that affect us specifically.

They are very worthy of financial support from the Ministry of Health. So I'm starting out by asking the ministry to reconsider its decision not to fund them, because the federal funding is running out. The very good job which they are doing for the women of the province is one which I know this minister would like to continue.

[4:45]

My second question has to do with the whole question of midwifery. I've never been quite clear as to the ministry's reluctance to deal with that particular topic. There have been numbers of letters and briefs and visits by midwifery groups. There have been conferences on this topic. Other parts of the world have been using midwifery successfully over the years. I know that the midwifery task force is in constant consultation with the government. I need to know what their status is now. How does the minister feel about them? Are we going to have any change in policy in this particular area?

The Reach clinic — the whole concept of preventive clinics; Reach, the James Bay project and others — had their funding reduced by 27 percent last year. They are finding that it's almost impossible to maintain quality services to the people in the community. We have to remember that both Reach and the James Bay clinic often reach that part of the community that will not go to the traditional health delivery system, such as teenagers who will go to the clinics for pregnancy counselling and that kind of thing. Even seniors use those clinics for nutrition counselling, but young adults particularly find it much more comfortable to go to the clinic rather than to emergency or a private doctor or whatever. They also give nursing services. These are all very important. As a matter of fact, the demands on these clinics are increasing. So I'm wondering what the ministry is going to.... What kind of explanation can we have as to why, for example, Reach had a decrease of 27 percent last year in their funding?

I think the community health clinics are doing a super job. They're a very important resource in our community, and I know the minister is going to want to do everything he can to support them.

Do you want to respond to me?

HON. MR. NIELSEN: Mr Chairman, I will respond, but I presume the member is aware that the Lieutenant-Governor is due shortly.

I appreciate very much having been given the list of at least five areas. Perhaps we might get the computers working overnight and have some information first thing tomorrow.

I'd like to respond to the Minister of Consumer and Corporate Affairs (Hon. Mr. Hewitt) on the two subjects raised. The technology for a mobile CAT scanner is with us, yes. A number of companies are producing mobile CAT scanners, and there is a good argument, I suppose, that they may serve a very useful function in certain areas of the province. The Penticton area would, I know, like to see a mobile scanner, rather than see Kelowna get a full-body scanner. Kelowna has a head scanner. They're now the only hospital, I believe, with just the head scanner. The request is that they get a full-body scanner. I've never found Penticton, Vernon or Kelowna to agree on anything when they're competing. We've asked the doctors to sit down together and give us a recommendation, and I believe Dr. Karr is one of them. So that's fine.

I will acknowledge your request that the third major cancer treatment centre be located in Penticton. I will acknowledge that, along with requests from Kelowna, Prince George, Cranbrook, Kamloops and several other communities.

MS. BROWN: I appreciate the minister's cooperation. On the abortion question, I wanted to know what hospitals still had active abortion committees and what hospitals were still performing abortions.

HON. MR. NIELSEN: Mr. Chairman, I will find out that information.

The House resumed; Mr. Speaker in the chair.

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

HON. MR. NIELSEN: Mr. Speaker, I am advised that the Lieutenant-Governor will be approaching the chamber in a few moments. Perhaps we could...

MR. SPEAKER: ...have a brief recess. It will not be a long recess, hon. members. Possibly we could remain in our places until the appropriate time.

The House took recess at 4:51 p.m.

The House resumed at 4:59 p.m.

His Honour the Lieutenant-Governor entered the chamber and took his place in the chair.

[5:00]

CLERK-ASSISTANT: Provincial-Municipal Partnership Act.

CLERK OF THE HOUSE: In Her Majesty's name, His Honour the Lieutenant-Governor doth assent to this bill.

His Honour the Lieutenant-Governor retired from the chamber.

Hon. Mr. Nielsen moved adjournment of the House.

Motion approved.

The House adjourned at 5:04 p.m.

[ Page 5816 ]

Appendix

WRITTEN ANSWERS TO QUESTIONS

26 The Hon. J. Davis asked the Hon. the Minister of Finance the following question:

What are the Provincial Government's Estimates of Gross Provincial Product for the calendar years 1980 through 1984 inclusive or, alternatively, for the fiscal years 1979-80 to 1984-85 inclusive?

The Hon. H. A. Curtis replied as follows:

"The Government's estimates of Gross Domestic Product at market prices for British Columbia for the calendar years 1980 to 1984 are:

"Data for 1980 to 1983 are the most recent (March 1985) estimates by Statistics Canada. The figure for 1984 is a preliminary estimate by the Ministry of Finance."