[ Page 5837 ]

CONTENTS

Municipal Act Review Committee Act (Bill M206). Mr. Blencoe

Introduction and first reading –– 5837

Women's Career And Employment Opportunity Act (Bill M207). Ms. Brown

Introduction and first reading –– 5837

Oral Questions

Colwood-Langford incorporation. Mr. Mitchell –– 5837

Okanagan bingo operations. Mr. MacWilliam –– 5837

Nautilus club. Mr. Barnes –– 5839

Cottle Hill transmission tower. Hon. Mr. Rogers replies –– 5839

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

On vote 37: minister's office –– 5840

Mrs. Dailly

Mr. Passarell

Mr. Gabelmann

Ms. Brown

Mr. Rose

Mr. Davis

MONDAY, APRIL 29, 1985

The House met at 2:05 p.m.

Prayers.

MR. SKELLY: I ask the House to welcome a group of students who are in the buildings today — I believe they're in the gallery right now — from Ucluelet Secondary School. They are accompanied by a group from Quebec which is taking a tour of the precincts right now. I'd also like the members to welcome Wendy Doubt from Port Alberni, who represents the Alberni District Parents' Association, and Dell Kimoto, also in the gallery, who is the vice-president of the Alberni District Teachers' Association, Ucluelet sublocal.

HON. MR. GARDOM: It's a pleasure that we have in our galleries today Mr. Stuart MacKinnon, who is the secretary to the Canadian Intergovernmental Conference Secretariat. I know that a number of members know Mr. MacKinnon and would like to pay him a very warm welcome today.

MRS. DAILLY: I'd like the House to join me in welcoming three Burnaby friends in the gallery today: Mrs. Strandberg and her two daughters, Diane and Judy.

MR. PARKS: On behalf of my colleague the Minister of Environment (Hon. Mr. Pelton) I'd ask the House to join with me in making welcome a young lad from Mission who has just attained the lofty achievement of graduating in commerce from the University of British Columbia. Would you please welcome with me Mr. Ian Adair.

Introduction of Bills

MUNICIPAL ACT REVIEW COMMITTEE ACT

Mr. Blencoe presented a bill intituled Municipal Act Review Committee Act.

MR. BLENCOE: A very quick description and explanatory note. The purpose of this bill is to establish a committee to regularly review the Municipal Act and recommend changes that may be made to it. The committee is composed of representatives of municipal government from all areas of British Columbia and Members of the Legislature, and it must report at least once every four years. The intention is to establish meaningful consultation with all local government — between this Legislature and local government.

Bill M206 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

WOMEN'S CAREER AND
EMPLOYMENT OPPORTUNITY ACT

Ms. Brown presented a bill intituled Women's Career and Employment Opportunity Act.

MS. BROWN: Mr. Speaker, what this bill basically does is give the government an opportunity to help women who are interested in moving into the small business community and into small business enterprises, to help them secure a six-month, interest-free loan from either the government or one of the lending institutions. It also gives them counselling and assistance, and in that way does two things. It expands the small business community which, as we know, is the most important employment-creating sector of our economy, and it gives women an opportunity to break out of the poverty cycle in which so many of them find themselves.

Bill M207 introduced, read a first time and ordered to be placed on the orders of the day for second reading at the next sitting of the House after today.

Oral Questions

COLWOOD-LANGFORD INCORPORATION

MR. MITCHELL: Mr. Speaker, this would have been to the Minister of Municipal Affairs (Hon. Mr. Ritchie), but he is not here, so it is directed to his backup, the Minister of Lands, Parks and Housing. On November 17, Colwood voted three to one against amalgamation with the district of Langford in my riding. Recently Langford voted on two occasions against incorporation. The Minister of Municipal Affairs has indicated that he is prepared to extend the boundaries of Colwood into the core area of Langford. The question to the minister is: will the minister assure this House that he will not incorporate any area without a vote by the people involved?

HON. MR. BRUMMET: I'll take the member's statement on notice and bring it to the attention of the minister.

MR. MITCHELL: Mr. Speaker, again through the Minister of Lands, Parks and Housing. The minister announced the intention of amalgamating Langford into Colwood, one week after the vote had taken place for the new mayor and aldermen in Colwood. Can the minister assure this House that there will be no incorporation or amalgamation of Langford without those people having the right to vote on any council that will govern them?

HON. MR. BRUMMET: Again, Mr. Speaker, I'll take the member's statement and question on notice and bring it to the attention of the minister.

OKANAGAN BINGO OPERATIONS

MR. MacWILLIAM: Mr. Speaker, in the absence of the Premier I'll direct my questions to the Provincial Secretary.

Would the minister advise why the government has permitted the wholesale shift of bingo operations onto the premises of a few commercial establishments in the Okanagan that are in the process of skimming hundreds of thousands of dollars away from charitable organizations in those communities?

HON. MR. CHABOT: Mr. Speaker, the member leaves the impression that the bingo halls in the Okanagan are other than strictly rent or lease operations. I want to assure the member that all the bingo licences in the Okanagan and elsewhere in British Columbia are held by non-profit societies, who make the profit. That's no different than in what I believe to be the largest bingo hall in British Columbia,

[ Page 5838 ]

which is in Nanaimo and controlled by the Nanaimo Commonwealth Holding Society. It has a seating capacity of 350 on one floor and 350 on the second floor. They collected rent of $155,847 last year. They're doing the same kind of operation, under British Columbia law, as is happening in the Okanagan.

I don't know if you're embarrassed about the NDP and the four organizations that are operating in Nanaimo and raising funds for charities which they favour. Those organizations are: B.C. Tomorrow Benevolent and Education Association, Harewood Community Association....

MR. SPEAKER: Order, please, hon. minister. At this point the Chair would have to advise that the answer is now going well beyond the scope of the question.

HON. MR. CHABOT: Mr. Speaker, on a point of order, the member raised concern about bingo operations in the Okanagan, and I related to him that the bingo operations in the Okanagan are no different than the bingo operations in Nanaimo that are operated by the NDP. They're strictly space to rent in the Okanagan, just like there is at the Nanaimo Commonwealth Holding Society.

[2:15]

MR. MacWILLIAM: Unlike Mr. Capozzi's operation, the NDP Nanaimo Commonwealth Holding Society is not a private institution.

However, a supplementary to the minister. Would the minister advise why the government has terminated four of the six inspectors in the province, just prior to the opening of the new bingo palace in the Bennett hardware store in Vernon?

HON. MR. CHABOT: Mr. Speaker, it had no relationship whatsoever to the bingo parlour in Kelowna, and it would have no relationship to the bingo parlour operated in Nanaimo. I found that the role of the inspector was one that primarily duplicated that of the police force in British Columbia. I found that the inspectors were not properly trained and informed as to what their rightful role was, and therefore their positions were terminated. They were terminated shortly after the new regulations came into force.

That decision, of course, with the expansion and the large size of bingo halls, such as the one in Nanaimo, is probably of concern to us. In view of the proliferation of bingo halls in British Columbia, and their size, I think I will be reviewing the possible need of inspectors of bingo operations in British Columbia. I'm awaiting a report at this time from officials in my ministry on information that they have secured from a visit they made to Edmonton, Alberta, and to Prince George as well. As soon as I have that report, then I'll be in a better position, my friend, to determine whether there's a need for these inspectors to be re-established in different locations in British Columbia.

MR. MacWILLIAM: A supplementary to the minister. The big losers in the commercial takeover of bingo operations are the B.C. Heart Foundation, the cancer society, Salvation Army, United Appeal, the CNIB, the handicapped bus service and Timmy's Christmas telethon. What study has the minister made of the impact of inviting a few private operators in to take over the bingo operations in the Okanagan? The charitable societies are the big losers.

HON. MR. CHABOT: The member, Mr. Speaker, is under a false premise. No one was invited to come in and operate or to open up bingo parlours or bingo barns or bingo halls in British Columbia. It's a matter of their enticing nonprofit societies to come and operate in their premises. I don't know if the member is suggesting that the non-profit societies operating in these larger, cleaner bingo halls in British Columbia are not worthy of support. I don't know how many people operate out of these. I know that about 20 or 25 operate out of Nanaimo. I don't know if the member is suggesting that those non-profit societies, which make money from operating in leased space owned by other people who have no direct involvement whatsoever in the bingo activity, are not worthy of support. But I think that the people who operate out of some of these bingo establishments like the one in Kelowna and the one in Nanaimo, and I believe there's one in Prince George.... I don't know if he's attacking them or not.

I want to say that each and every non-profit society has the opportunity of operating in the hall they desire. I'm not about to tell anyone where they should operate a bingo. It's their free choice, whether they want to operate a bingo in a church basement or in the Dabbers or wherever. I'll leave that up to the non-profits.

MR. MacWILLIAM: Another supplementary to the minister. Is the minister aware that certain commercial bingo operations are billing charitable organizations for staff, which under the regulations are supposed to be provided by volunteers? I cite sections 1(a) and 1(d) in the revised regulations of November.

HON. MR. CHABOT: I'd ask the member to bring his evidence forward.

MR. MacWILLIAM: Another supplementary. Is the minister aware that commercial bingo operators are selling and renting bingo supplies and equipment, contrary to these revised regulations? I cite section 1(c).

HON. MR. CHABOT: That would be deemed to be illegal, and if the member has any evidence of that taking place.... We don't want to operate the way they do in the province of Manitoba, where supplies were sold to the bingo operators by those who had space to rent. We don't want that activity to take place in British Columbia. If the member has some information or evidence to that effect, I'm prepared to take action forthwith.

MR. MacWILLIAM: I believe that's what the six inspectors were for. However, you fired four of them and there are only two left.

Is the minister also aware that commercial bingo operations in the Okanagan are handing out lottery branch application forms and receiving those forms for processing from potential licensees?

HON. MR. CHABOT: The answer is no.

MR. MacWILLIAM: As I said, the minister fired four out of the six bingo inspectors in February 1985, at the same time allowing private operators to move into the bingo field. What action has the minister now decided to take in order to

[ Page 5839 ]

police these activities, which are obviously occurring without the knowledge of this House?

HON. MR. CHABOT: I asked the member who made some allegations a few moments ago to bring forward evidence if he has it, and he hasn't brought it forward. I indicated to him my views on the inspectors and what action I proposed to take on additional inspectors. I know that you have a set format of asking the questions, and maybe that question shouldn't have been asked because of the fact that I answered it a little earlier.

MR. MacWILLIAM: The point of the questions, of course, was to highlight these individual concerns, and I can bring evidence of those concerns to the minister. In light of the knowledge that the minister now has been enlightened with, has he decided to establish a non-partisan inquiry into the establishment of commercial bingo operations in the province since the first of this year, before the service clubs and charitable organizations are hurt any further?

HON. MR. CHABOT: No, Mr. Speaker, I don't think that there is a need for a public inquiry, or a non-partisan inquiry, or an inquiry of any sort.

MR. MacWILLIAM: This is my last question to the minister. Under the policies of the government, it seems that commercial gambling and lotteries are the only growth industries in the Okanagan today. What action has the minister taken to ensure that the regulations will preserve the nonprofit charitable purpose that the bingo operations have historically enjoyed?

HON. MR. CHABOT: We make sure that charitable and non-profit organizations that operate bingos.... We make sure that the percentage of funds that must go to non-charity does go to non-charity functions. That's what happens. There's no change, be it in Nanaimo or in the Okanagan.

NAUTILUS CLUB

MR. BARNES: In the absence of the Minister of Consumer and Corporate Affairs (Hon. Mr. Hewitt), I wonder if the Minister of Education and MLA for Prince George would respond to this question respecting the Nautilus athletic club. Could the minister advise the House what action he has taken in respect to more than a thousand Prince George residents who bought lifetime memberships in the Nautilus athletic club, which has been purchased by an Alberta company and subsequently sold?

HON. MR. HEINRICH: Mr. Speaker, as can be expected, I'll take the question as notice on behalf of the Minister of Consumer and Corporate Affairs and ask him to report back to the House as soon as possible.

COTTLE HILL TRANSMISSION TOWER

HON. MR. ROGERS: On Friday the member for Cowichan-Malahat (Mrs. Wallace) inquired about a radio transmitter located on Cottle Hill. The radio transmitter on Cottle Hill is being constructed by a Canadian company under contract with the United States Navy. They have leased a parcel of private land on which to construct the repeater station. It is not on land owned by either B.C. Hydro or B.C. Telephone Co. It is my understanding that the station is being built as part of the communications network which supports the joint United States–Canada naval test activities in the Strait of Georgia. The commanding officer of the Canadian Forces maritime experimental and test ranges in Nanaimo has responsibility for overall operations and the security of this system.

Orders of the Day

HON. MR. GARDOM: Before calling supply, Mr. Speaker, I first want to move that leave be given to the Select Standing Committee on Standing Orders, Private Bills and Members' Services to meet this afternoon at 3 o'clock to deal with business of which notice has been given.

MR. HOWARD: Very regrettably, leave cannot be made available at this time.

MR. SPEAKER: Hon. members, this is one of those times when leave has two different meanings. Leave does not in essence mean leave; leave means permission to go ahead on a motion of a vote. Therefore unanimous leave is not required under standing order 48, and also the fact that the motion is.... So it would be on division in that case. Hon. members, it would be incumbent upon me at that time, therefore, to put the motion through division.

MR. HOWARD: On a point of order, are you saying, Mr. Speaker, that standing order 48 does not require leave for making a particular motion sought to be moved by the government House Leader?

MR. SPEAKER: Hon. members, again, for the edification of the opposition House Leader, the motion appeared — as a matter of fact, was filed — on Tuesday of last week, appearing on the notice of business on Thursday. Therefore the two days would have been met under that criterion.

MR. HOWARD: I draw Your Honour's attention to Thursday last, April 25, where a similar request was made with respect to the Select Standing Committee on Health, Education and Human Resources. That motion was proceeded with by leave only. The government House Leader asked leave on that occasion to do exactly what is sought to be done now. I submit to you that standing order 25 should be looked at as well, which points out that in routine proceedings the items of business and the daily routine before we get to the orders of the day identify a variety of things; included therein are motions on notice.

There was no notice given of the motion to permit the standing orders and private bills committee to meet while the House is meeting. All notice was given of was notice by the Chairman that the committee was going to meet, without taking the requisite respectful course of seeking the approval of the House for that event to take place. I submit to you that it should not be permissible to proceed in this fashion, that we are constrained and shouldn't function simply because the Chairman of a committee thinks it's wise or convenient to proceed to call the meeting of a committee, when, for the specific purposes of committee meetings, we set aside Wednesdays, when the House would not be meeting, for those events to take place so that they could take place when

[ Page 5840 ]

the House was not meeting. I submit to you that we should not be allowed to proceed today with this motion.

[2:30]

MR. SPEAKER: Hon. members, prior to hearing the point of the member for Nelson-Creston, I would again advise members, as stated on page 20 of our Standing Orders: "...but this rule shall not apply to bills after their introduction, or to private bills or to the times of the meeting or adjournment of the House, or to a motion to proceed to the orders of the day. Such notice to be laid on the Table before adjournment and to be printed in the Votes and Proceedings of that day."

MR. NICOLSON: On a point of order, I've read standing order 48 just recently, Mr. Speaker, and in its entire context it says: "Two days' notice shall be given of a motion to present a bill, resolution or address, for the appointment of any committee, for the putting of a written question, and for the suspension of standing orders" — which is really what we are discussing, the suspension of standing orders — "but this rule shall not apply to bills after their introduction...." That means, of course, that after you've introduced the bill, you can move that the bill be now read a second time; you can move that the bill be referred to a Committee of the Whole House for consideration at the next sitting of the House after today. It also says the rule doesn't apply to private bills, which, again, means moving third reading and second readings, etc., of private bills, but not private bills in Standing Orders Committee. That's what we're talking about, Mr. Speaker. So what we're talking about is the suspension of standing orders which say that a committee of the House cannot sit while the House is sitting.

MR. SPEAKER: Hon. member, on that point, the order of business of that committee is for private bills.

MR. HOWARD: If Your Honour would permit it, I intended also to make a suggestion to you with respect to the comment you made just a moment ago about standing order 48 –– I suggest to Your Honour that the 48-hour rule shall not apply to private bills, meaning that two days' notice is not required for their introduction because private bills enter the House by an entirely different process than public bills. There is a petition involved, and notice of that nature is given. That is what that applies to.

I think the member for Nelson-Creston quite properly pointed out that we are suspending the standing orders, because standing order 1 prevails. If there's no specific rule in our standing orders, we look to the practices and customs in the United Kingdom. The practice there, as Sir Erskine May points out quite clearly, is that committees cannot meet while the House is meeting, except by permission of the House. You have to suspend that. In order to suspend that, you need the two days' notice, which is one part of it.

The other, I think — and most important to remember, Mr. Speaker — is that the Committee on Standing Orders and Private Bills, which went over these rules and reported just at the conclusion of the last session that they would come into effect at this session, specifically identified the opportunity for committees of the House to meet on Wednesdays. That was the reason for the rule that says the House shall not meet on Wednesdays unless a specific action is taken. The House shall not meet on Wednesdays in order to give committees the opportunity to meet and not to conflict with the House.

Surely it should be fundamental that the committees are agents of the House and not the other way around. The notice given by the chairman of the committee was just that it was going to meet at 3 o'clock today, without regard to the rules and without regard to two days' notice or 48 hours' notice for that, which is what should prevail. If the committee wants to meet, I submit that Wednesday is the appropriate day for it to meet.

MR. ROSE: I won't repeat the comments made by the member for Skeena about the nature of Wednesday or comment on them further than to remind the House that for the last two Wednesdays, when we had an opportunity to meet and discuss private bills, we didn't meet. It was absolutely a free day at the government's discretion for calling cabinet meetings or whatever they decided to do.

But I have another point, and it has to do again with standing order 25, and it discusses routine business. It says the order of precedence on Monday and Tuesday, the government days, are public bills and orders, private bills and public bills in the hands of private members. Well, I point out to the House, and to you, Mr. Speaker, to assist you in making your decision, that if this bill had been through the committee, I think the government would have every right to call it for discussion in the House. But it hasn't. We're talking about having a committee absent itself from the House to meet before it has gone through the procedure that a bill of this nature needs to endure before it comes to this House.

MR. SPEAKER: Hon. members, the Chair has listened to opinions on this particular matter, and I am going to reserve on this matter until, hopefully, approximately 3 o'clock, when I will have an opportunity to present a broader opinion to the House and will do so.

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: Last week when we were discussing Health the minister replied to one of my questions on where he felt his responsibility as minister and his ministry should be going in future planning, etc. I have the Blues in front of me, and he said something that I found a little disconcerting. He emphasized that the primary role of the minister and the ministry was as a health provider meeting the problems of today. He did go on to say that there were some committees structured within his ministry, however, which were looking at alternative models. I found it far from satisfactory, Mr. Chairman, and I want to deal with that for a moment. I'm concerned that the minister, if he really believes that his primary and main concern is strictly heal the-provision, which certainly is important.... I'm concerned that this province will not be ready to meet all the new critical needs in health that are going to be facing us now and at the turn of the century.

I want to say to the minister that I hope that he feels his mandate as minister goes beyond that. I hope that he is

[ Page 5841 ]

constantly trying to get his ministry to involve themselves in looking at other jurisdictions which are dealing with restructuring of health care, with a view to curtailing rising costs but at the same time providing perhaps unique, quality care.

In line with that, I want to ask the minister if his officials have had an opportunity to study the structure of health in Finland, which follows along in a restructuring and a handling of primary-care health centres, the sort of thing which we on this side have been asking the minister to look at, and which many other groups in the province have also been interested in. For the minister's information, I would like to briefly give him a rundown on how it's organized in Finland, where they completely reorganized their health delivery based on primary care in health centres, They introduced a whole new kind of health planning. The health centre is the basic primary-care unit, providing the general practitioner, the occupational health, the maternal and child health, school health, child dental care and physiotherapy services. They now have their whole country organized on this basis.

My basic question to the minister — I asked you this in the last session — is: will you not give serious consideration to at least evaluating and studying the system of community health centres instead of moving in the direction, which I'm concerned about, of closing down what we have? That's my first question today.

My next question to the minister is to do with the whole area of rationalizing the regional delivery of health services. I know this is difficult for any minister when he tries to restructure community groups into new ways of delivery. I believe we've talked about it before, but you still have a problem in British Columbia where the school districts — I know the minister knows what I'm talking about — do not coincide with the regional health districts; public health is done in isolation. I think that for the delivery, so that we can involve a community better, so that it can be coordinated, so it could perhaps even case the costs to our Health ministry.... Has the minister had an opportunity to look into that restructuring so that we can get those boundaries correlating with each other more?

I'll just leave him with those two questions for now.

HON. MR. NIELSEN: The Ministry of Health is responsible for the administration of approximately $9 million a day in expenditures for today's purposes, so obviously the overwhelming function of the ministry is going to be in providing the health care which is being consumed by the citizens of our province daily. There are literally dozens of people who spend a considerable amount of time reviewing programs and operations in other jurisdictions. They also spend a considerable amount of time reviewing, on behalf of other jurisdictions, our process of delivering health care.

I don't believe we've sent officials to Finland recently, but we have done exhaustive studies in Sweden, Denmark, the United Kingdom, Germany, the U.S. and other countries. The Finland concept is the Finland concept; whether it would have any bearing on British Columbia, I don't know. It's probably contrary to the Charter anyway, no matter what we do, We would look at it, sure. Our people do study the journals and the reports from the World Health Organization. We met with some of the Canadian members of the World Health Organization who are constantly reviewing — I don't know for what purpose — certain programs in countries which have far less capability than we would have in Canada. But yes, we would be vaguely familiar with Finland, perhaps more specifically familiar with some of the countries we have reviewed extensively. The clinic concept of Finland could be reviewed: it's not a problem. Whether it could be incorporated into our system is quite different. Their system of government is somewhat different, and their attitudes are somewhat different.

The boundary problem with health districts is not confined to the delivery of health. We still have some archaic remnants of older systems. The other day the member for North Vancouver–Seymour (Mr. Davis) questioned whether union boards of health were still useful or whether they perhaps had outlived their purpose. That's a question that could perhaps be considered at some time. Mr. Chairman, I think it is a problem throughout the province to have different boundaries for different functions. I think there are about 19 separate boundaries for different functions. We have school districts, regional districts. health districts, water districts, forestry and parks, and it does make it a bit difficult to coordinate, Perhaps there would be good cause to see if we could not develop common boundaries, particularly in areas of social services. We are speaking to basically the same people over a number of issues.

Regional districts may be the place to begin. Perhaps that's where the boundaries should be for purposes of schools, health and that which associates itself with services to people, rather than to industry or the environment. It doesn't really create as many problems as one might think, because the boundaries for many of these areas are historic and the people seem to have been able to operate within them for some time. But that's always subject to change.

[2:45]

MRS. DAILLY: Just to comment on those answers before the member for Atlin (Mr. Passarell) takes his place, I want to say, to the minister that I'm glad he has a more open mind on the problems we're dealing with on lack of coordination and boundaries in the province than he seems to have in the whole area of community health clinics. Whether Finland's government is different, whether they are different people, I think they have the same problems that we do in delivering health care. Every year this comes up and the minister says, "Yes, we study it; yes, we look at it," but he still seems to give the impression of a closed mind on this alternative way of providing health care. I just say to the minister that I hope when we talk about this again you can at least say you're going to try to expand the pilot studies on this, instead of closing them.

HON. MR. NIELSEN: Mr. Chairman, to the member, I will go to Finland and visit their clinics, and report back.

MR. PASSARELL: Mr. Chairman, it's a slice being back. A couple of questions regarding the constituency. My experience with the minister has always been helpful. We've always been able to have good meetings together.

The first issue I'd like to discuss is the Nishga diagnostic centre. When we met in the minister's office last year, funding was given by the federal government and a commitment was made by the hon. minister. What I'd like to know is, where's the funding in regard to those meetings that we held last year in the minister's office? What stage is the commitment at by the province in regard to this extremely worthwhile centre in the Nass Valley that will be servicing five, six different communities?

[ Page 5842 ]

The second question I would like to direct to the minister is regarding the Atlin Red Cross outpost. In the community of Atlin where I live, presently it's a small Red Cross outpost. If I'm not mistaken, I think the provincial government funds the major part of that. There are very few Red Cross outposts left that serve the medical problems of a local community in this province, and I doubt that are left across this country. In rural isolated areas it's usually the Department of Indian Affairs who put on a program. Since that one does not fall into that category, I'm wondering when the provincial government is going to put some kind of an inner structure in the community of Atlin that conforms to other communities in the far north of British Columbia, such as the excellent program that the minister brought in three years ago in Dease Lake, which is a fine facility.

I'm not faulting the Red Cross. I think the Red Cross provides an extremely important aspect in the medical facilities, but I think we're in the twentieth century, and it's about time the community of Atlin had a proper inner structure medical outpost similar to the one in Dease Lake.

Those are two questions. Firstly, one regarding the Nishga diagnostic centre, that worthwhile program, and, secondly, the Atlin Red Cross outpost. When are we going to get something in Atlin similar to the community of Dease Lake?

HON. MR. NIELSEN: The question of the services available at Atlin. Red Cross outposts, I believe, have now been reduced to a handful throughout the province. There are five or six, I believe; I'm not quite sure. There would be no difficulty in doing a review of Atlin to determine how effective that Red Cross outpost is and what the requirements of the community might be.

The Dease Lake situation was unique. It responded to a very real problem in Dease Lake and seems to function very well. We would have no difficulty in reviewing the requirements of Atlin to have an evaluation made as to what future planning may be required or what structures, staffing and so on, to meet the needs of the people there. So that's just a matter of pushing the button and getting someone to review it.

The New Aiyansh diagnostic and treatment centre: I'm trying to find some specific material on it. As far as I know, it is going along fine. We committed ourselves to the planning stage. The federal government, I believe, agreed to accept their responsibility, as we had asked. There was some confusion and a bit of foot-dragging for a period of time, because it was a matter of trying to mesh a number of component authorities in some sequence so authority could be granted under certain understandings. As far as I know, it has been resolved.

I'll get more information perhaps in a few minutes time. But my understanding is that the New Aiyansh diagnostic and treatment centre is proceeding as was planned. I'll get more specific times and dates once that file comes down from the office. As far as I know, there is no difficulty that was not foreseen.

MR. GABELMANN: I have three specific issues that I want to raise with the minister. The first is the Campbell River and District General Hospital construction. My understanding is that the five-year construction budget includes a provision for that proposal to come onstream in 1988-89. I don't know whether I need to spend much time detailing the problems in that particular hospital, Mr. Chairman.

Again, last week I did a tour with the administrator and the director of nursing, looking at the totally inadequate situation in the operating room, intensive care and in several other parts of the hospital. It confirmed very much the kind of thing that was said back in 1979 by one of the minister's predecessors, Rafe Mair, who said at that time: "My staff has advised me that the update of the surgical suite, X-ray, emergency and central supply areas is of immediate concern to everyone." Those concerns are more so now than they were then. The use of the hospital has increased; certainly surgical procedures have increased over the years. It is, frankly, quite appalling to spend any time in that particular facility. It's hard to believe that operations can take place. It's hard to believe that appropriate nursing can take place in terms of the recovery room. The intensive care facility, as well, is quite inadequate.

The construction proposal calls not only for redressing these particular issues but also calls for shelling in a future 40-bed unit. The hospital now has 100 beds, 90 of which are operating. This would be an additional 40 for probable use sometime in the mid-'90s, based on likely needs at that time.

I'd like to get some idea from the minister whether or not the 1988-89 target is likely to be met, and where that particular facility sits in relation to other priorities in the province. One of the things that I try to convey to hospital people and to doctors and to others in the community is that there are other facilities in the province that are also in need of fixing. They can't believe there is any place worse in British Columbia than their facility, and I would appreciate it if the minister could give us some idea as to where his staff feel the Campbell River hospital fits into the scheme of things. That's the first issue.

The second is that two and a half years ago a special review team was sent into the northern part of Vancouver Island — the Port McNeill, Port Hardy, Port Alice areas — to do an evaluation of the various hospital facilities in that part of my riding. The review did not include the Alert Bay hospital — for a variety of reasons, I suspect. In any event, no action has been taken on that particular review. I wonder what its status is now and what the minister's thinking is regarding the development and use of those particular hospitals, particularly in Port McNeill, Port Hardy and Port Alice — and even those outside the review, such as St. George's Hospital in Alert Bay. There is still a fair amount of concern up there as to what plans there might be for future policy in that area.

The third concern that I have is very much not a constituency issue — it's one that so far affects a very small proportion of our population — and that's the whole question of AIDS. It's not a subject that has, to my knowledge, been talked about in the Legislature before. I think that the kind of disease it is warrants that there be some discussion. If I can serve some purpose in raising the topic and getting it on the table for discussion, I think that purpose alone would be sufficient, because of the kind of emphasis placed on the disease and people who might have contacted it.

The minister was kind enough to give me some information a few weeks ago as to what the ministry knows about the disease — what programs are in place in Vancouver, particularly at St. Paul's — and indicated that in terms of research there was a $67,500 grant to assist in a study of AIDS in male homosexuals. Now AIDS is clearly — if American information is to be believed and if worldwide information and what's

[ Page 5843 ]

coming out of the Atlanta centre is any indication — a disease that, while starting in the homosexual community, is beginning now to spread into the entire community. The numbers so far are small, but certainly evidence is available that it's a disease that is not restricted to that particular community.

In any event, even if it were, it's of epidemic proportion among some segments of our society and great concern is being felt about it. Fortunately, I think, there is increasing public discussion of it, and the Vancouver Sun ran an excellent series of articles just recently on the problem. I raise it not to ask for anything specific, except perhaps another look at additional research money that might be made available to assist in some of the work that's going on in St. Paul's. Perhaps also, some of the work that could be done might be integrated into the new biochemistry research facility at UBC. I'm not sure I have the right name for that facility, but it's the one that was announced the other day by the Minister of Universities, Science and Communications (Hon. Mr. McGeer). It seems to me that $67,000 out of, I believe, lottery money is not much for a disease of this proportion, and some further assistance might be considered by the government.

I repeat, I raise the topic not for immediate response in terms of promises to do this, that or the other, but because I believe there are some issues that don't get raised for a variety of reasons. Sometimes being the first to raise an issue of this kind in this kind of forum is a useful exercise in and of itself. I wanted to do that. That's all I want to say on that particular topic; I would await the minister's answers.

[3:00]

HON. MR. NIELSEN: Mr. Chairman, the member discussed this question with me some time back and, as he mentioned, I supplied him with the information as we had it. The concern in the community over this particular difficulty — the AID syndrome — is very sincere. It is alarming from a statistical point of view: 7,000 cases of AIDS have been reported in the United States, 183 in Canada and 33 in British Columbia. Fourteen of the 33 in British Columbia resulted in death; that's a 42 percent fatality rate. The virus that appears to be implicated in AIDS has been discovered, and scientists are attempting to learn more. There is a blood test available, apparently only at the Laboratory Centre for Disease Control in Ottawa. The B.C. Health Care Research Foundation awarded a grant of $40,000 to a team of researchers at St. Paul's Hospital and later added an additional $27,500. The B.C. Health Care Research Foundation reviews all applications for research money and makes recommendations to the foundation for approval.

I share with the member for North Island the very serious concern that people in the research world have over this alarming problem, and I can assure that a great deal of effort is being made to try to find out more and assist those who are in research.

[Mr. Ree in the chair.]

The member asked about the special review team which traveled up-Island a couple of years back. Our review teams are primarily involved in financial audits or operational audits. I believe the member may have been speaking of a report which began on the northern Island about the amalgamation of a number of facilities. That may have been what people were speaking of when a team went up. There's been no action on that. There was a very brief report — perhaps only a comment — about the viability and wisdom of amalgamating some of the smaller hospitals on the north Island. There was a fair amount of local opposition to the idea, although from an administrative point of view frequently it is quite useful to share administration, because of the difficulties sometimes of finding the necessary people to administer the smaller hospitals. But no action has been taken on the north Island cluster of hospitals, and I don't believe the subject has had a great deal of attention over the past short while at least. I think the amalgamation question was the key.

We met with representatives from the Campbell River hospital a few weeks back and reviewed their request for capital construction in the amount of about $16 million to $17 million. We have a five-year construction program in the Ministry of Health. Because of the restraint program and the recession, much of that five-year program was unable to commence when we would have preferred it to commence. The entire program has been shifted forward.

The Campbell River and District General Hospital representatives wanted a couple of points. They wanted reassurance that indeed their program would go ahead at some time, and of course, as every delegation from every hospital requests, could we perhaps speed it up. We had an extensive discussion with them. I believe most of their concerns were met. They genuinely believe that if there were any opportunity to modify the priority list. please let it be in favour of the Campbell River hospital. They wish to upgrade their surgical suite, X-ray, emergency, CST, physio, the laundry, dietary stores, renovations to the reception and the outpatients and, as the member said, 40 acute beds in shell.

We were unable to advise the Campbell River folks that they were going to be changed in a priority list or given a leg up over other people. The Campbell River hospital is functioning reasonably well. It's an older facility and in need of certain renovations or changes, and we hope we can move on that within the schedule we originally considered. There would be the planning phases first. and then the actual construction. We hope that the economy will be in a position where we can release that kind of commitment.

I mentioned the other day, Mr. Chairman, that I believe the requests for capital construction in the province total approximately S900 million, so there has to be a lot of thought about the priority. But the Campbell River hospital is certainly on the list. We would like to be able to move as quickly as possible. but hopefully it will be within the original time-frame, subject to the availability of funding.

MS. BROWN: I raised a couple of questions last week, and I know that the minister has got a lot of answers for me. But I was in Kamloops this weekend, and a special case was brought to my attention of a person who was unemployed and stopped paying the medical premium for himself and his family, because, as you know, when you're on income assistance you don't get health coverage unless you're unemployable or a single parent or disabled. So this person stopped paying the health premiums, and with the result of that now is owing something in the neighbourhood of $7,000 to $8,000 in hospital bills.

That made me kind of curious. I was wondering whether the minister ever pulls off the computer these people who are not covered by health insurance and takes a look at the kinds of bills that they have run up, and if anything is done about

[ Page 5844 ]

helping them to meet those financial responsibilities. I'd be interested in knowing whether that's done.

HON. MR. NIELSEN: I'd have to get some information, because a person who is unemployed can apply for premium assistance. I'm not trying to trap you on something, but you said it was a hospital cost, which would not relate to a premium at all. The hospital would be under a different program. They should be eligible for hospital costs if the person is a resident of British Columbia. But perhaps on that one specifically we might get the information. I'd be pleased to look into it.

We have reinstated many people to the program who have simply, on their own initiative, dropped out. But if it's hospital expenses, I don't understand why the person would not have been eligible, because it is not part of the Medical Services Plan, which is only the medical side. But maybe we could get details on that.

The person should have been, as far as I can see, eligible for premium assistance. We pay up to 90 percent. It can be made retroactive in certain instances, so we'll look at that one specifically.

May I just respond to the member for Atlin (Mr. Passarell), who is going out for a cigarette in a moment.

AN HON. MEMBER: Withdraw.

HON. MR. NIELSEN: Sorry, no offence.

New Aiyansh. The planning will be finished this summer for the D and T centre. The construction is to start immediately. Hopefully it will be closed in before winter, and it's expected that the centre should open next spring — 1986. Next spring in Atlin is what — July? 

Just a footnote on Campbell River. After the meeting we had with officials, there was a promise made by the ministry to upgrade critical areas with minor capital projects. But the entire $16.5 million project is still scheduled for the later date.

The member for Burnaby-Edmonds (Ms. Brown) asked several questions last week. In response to them, I believe the first was on the question of midwifery. The computer has produced a considerable response, but it may be of general interest to members. The topic of midwifery has been around for a great deal of time. We receive very little communication with respect to it. Over the last decade, the government opened new obstetrical services based on the LDR concept: labour, delivery and recovery, all provided in a specially designed room in a setting that is as home-like as possible without sacrificing any of the potential for high-tech intervention, should that be necessary.

Some hospital procedures in the past — in fact most, I suppose — were more geared for the convenience of the staff than for the mother or father. You would find that that is seldom the case today. Family-oriented maternity care does involve good prenatal classes, maternal and nutritional counselling, involvement of the father right through to delivery, and frequently rooming-in, where mother and child never need be separated.

Most of the time having a child is a natural, normal process, but there is always the risk, especially to the baby, even in so-called normal deliveries. For that reason we believe the prospective parents deserve the best possible backup during this important event. It means the best physical environment and attendants with the best possible qualifications.

Officials in the ministry have followed the question of home delivery and midwifery with great interest. It appears that countries which used to do a lot of home midwifery are now moving in a very similar direction as ourselves. Of interest, 30 years ago one-third of the deliveries in Great Britain were at home; the figures now are about 1 percent, and many of those were not scheduled.

Mr. Chairman, you'll be glad to hear that the perinatal and neonatal mortality rates are still improving in our province to the point that early neonatal deaths in 1983, including even high-risk cases, was down to 4.2 per thousand live births. Similarly, total perinatal mortality for 1983 was down to 8.7 per thousand live births, which compares favourably with any jurisdiction. It also compares favourably to a rate of 12.3 back in 1973. Most important, the sad cases of brain damage are almost now a rarity.

In B.C. only physicians are registered to do midwifery. There has been an ongoing push by a number of lay and nursing individuals that they be registered to practise. A number of years ago there was a considerable amount of enthusiasm. It seems to have calmed down considerably. We have not taken a firm stand on that question because it really hasn't come before us in any forceful way. There have been inquiries on occasion, but there doesn't seem to be an organized push the way there was some time back. People within the ministry and the medical world have advised us that they believe that a less clinical environment in a hospital provides the best opportunity for the mother and child and the best opportunity to produce the healthiest child.

The member asked a question with respect to abortions. The number of hospitals accredited or approved to perform abortions in British Columbia is 67. The number of hospitals which during the period October 1984 to March 1985 have performed abortions is 47.

The member asked about a couple of grants — for the Vancouver Women's Health Collective and the Reach Centre Association. The Vancouver Women's Health Collective has on occasion requested funding. The Ministry of Health did not respond in the positive with respect to their last request. It is the opinion of the branch which is responsible for grants in conjunction with the minister's office that the services provided by the Vancouver Women's Health Collective duplicated information and direct services provided through our public health units, family physicians and obstetricians. We felt that it was not an essential service from that point of view, and that the information was readily available from alternate sources.

[3:15]

The Reach Centre Association had a grant of $326,000 in 1983-84. It was reduced to $239,000 for 1984-85, and $239,000 for 1985-86. Originally the Reach clinic was established to provide care to the immigrant and transient population in the east end of Vancouver. There has been a shift in demographic makeup that has resulted in the clinic evolving primarily into a family practice clinic. There has definitely been a changing role in the centre. It is now more of a family practice clinic than its original purpose for the immigrant and transient population. We believe the grant is adequate for the quality and level of services provided. I might add that the grant was $239,000, but the Medical Services Commission also paid $330,000 on a fee-for-service basis.

[ Page 5845 ]

The member asked a question with respect to what she referred to as "granny-bashing, " which is the name given by the media today to the abuse to the elderly. It is a very serious problem that has been identified in many jurisdictions. It has been raised in a number of media reports. Instances of what we refer to as elder abuse are becoming more visible at a community level, with increasing care in the home, with day hospitals and day work centres. Staff employed in these types of facilities report cases of financial abuse or neglect and, less frequently, physical or sexual abuse. The Seniors Serving Seniors association of B.C. has provided a brief to the ministry asking for the province to adopt legislation defining abuse, providing for mandatory reporting of suspected cases and establishing protection for the informants. The brief also asks that procedures be set up to facilitate the reporting and investigation of complaints.

In addition, Mr. Chairman, the Victoria Institute of Gerontology is sponsoring a study of elder abuse in order to develop a broader scientific base of data on the types and causes of incidents. We have not yet been able to gather a great deal of objective information on the incidence and causes of this phenomenon. At the moment no province in Canada has moved to establish extensive regulations. We are encouraging research on the subject. We are monitoring the relative incidence of abuses reported to our local health authorities. Also, we are reviewing a report which has been submitted by the Seniors Serving Seniors association which asks for legislative action.

Mr. Chairman, while we have not reached the point where we have produced what we consider to be the role we are to play, we are certainly highly involved in the investigation side, and we are reviewing the report to us which requests legislation. We have not yet completed that inquiry, but we certainly have it uppermost in our minds and intend to pursue it.

MR. COCKE: Mr. Chairman, at this moment I have just one question for the minister. I wonder if the minister would identify his officials.

HON. MR. NIELSEN: The people present in the House today? Mr. Chairman, for the first time as deputy minister, Mr. Stan Dubas is with us in the House. Mr. Dubas took over from Peter Bazowski on April 1. This is the member for Atlin (Mr. Passarell). [Laughter.] Mr. Eric Denhoff was employed by our ministry as an information officer but is now with.... We just call him a public relations consultant. Rob Munro is the man who takes care of all our books — he is our comptroller.

MR. COCKE: Mr. Chairman, by long precedence of the House I contend that ministry officials are not deemed to be strangers in the House. But I draw your attention to standing order 23, and that there is an official who is not an official, who is a private consultant — as identified by the minister.

HON. MR. NIELSEN: Mr. Chairman, I wonder if we could maybe ask of the Clerks later to perhaps offer us a definition of "official" and whether that would include a person under contract. Perhaps that might resolve it.

Interjection.

HON. MR. NIELSEN: Yes, it is a custom of the House, but....

Interjections.

MR. HOWARD: Mr. Chairman, sometimes I can be helpful to the Chair: I hope this is one of those occasions.

I think the standard for acceptance in the chamber during committee is that people who are full-time employees in the public service and are assigned functions and duties as such, such as deputy ministers, assistant deputy ministers and the like, are accepted — and have been so for years —as advisers to a minister with respect to either a bill or estimates, as is the case here. But when we extend beyond that to people identified — as the minister did — as somebody who is in private practice but happens to be under contract at the moment to the ministry for a certain specific purpose.... I don't think we can extend that acceptance and understanding of what is a stranger. and exempt from that categorization the gentleman identified as being on contract to the minister. That is not a public servant, in my view.

If the Chair were to express a thought to that effect, in a very gentle way, perhaps the gentleman in question would, with ministerial approval and endorsement, feel obliged to sit in the gallery.

HON. MR. GARDOM: Mr. Chairman, concerning the point that has been taken, I gather the premise is that a stranger is not a stranger if that individual happens to be a public official, and that has been.... There has been a custom of the House — it's a custom, not a rule — that officials are entitled to be in the House to assist ministers during estimates. I cannot recall if the specific issue has ever been raised before; certainly not during the 19-odd years that I've been here. I think it would be a good point for the Clerks to consider at some point in time. But the distinction never having been raised up to this juncture, I think we should just carry on as we are, subject to a ruling coming down at a later stage.

MR. ROSE: On a similar point of order, it's been my experience that the ministers are always ably assisted by members of their own departments. They are, in fact, government officials. I guess this is right and proper and a custom of this House.

A custom of another House with which I have certain familiarity indicates a quite different practice during committee. Members of the opposition who are cross-examining the minister during committee stage are similarly entitled to have certain kinds of assistance at their disposal and sitting behind them. It seems to me that what happens here is that the minister comes in with his army and an opposition member sits over here armed with a pea-shooter. I would like the Chairman to take up this particular matter as well, because it seems to me only democratic that in the committee stage the opposition should have immediate access to the same kind of expertise — statistics and the like — that are available to the minister.

MR. NICOLSON: On a point of order, I don't know how long the memories of Clerks might be, but I remember having the very distinct advice that it was just not done to bring in a private consultant. When I brought in the Strata Titles Act in about 1974, I had a great deal of the work prepared by a

[ Page 5846 ]

private consultant, and would very much have liked to have had the consultant on the floor of the House to assist. It certainly was not customary at that time. Somehow it has come about. I think the matter could be resolved in part.... Or maybe it has; I don't know if the person has absented himself or not. I certainly recall getting some advice, and it was deputy ministers and senior departmental people, but not outside private consultants. So I don't know where this....

This is just another little testing. I don't think anybody's asked us if we would object. I don't know if we were consulted as an opposition. It certainly isn't cooperation and it certainly isn't partnership.

[3:30]

MR. CHAIRMAN: I think as Chairman I have to take extreme cognizance, particularly, of the comments of the member for Skeena (Mr. Howard), in which he has stated that in the past it has been recognized as practice that advisers to the ministers have been available in the House to advise the ministers. Using the term "advisers, " because certainly section 23 doesn't make reference to.... They're talking about strangers. But we've had advisers. It's not the first time that this committee has had a minister served by an adviser who is not an employee of the ministry. Maybe they have not been identified to the committee as being a consultant from outside of the committee, but by the recognition of the person that was here, members of the committee would have known he was not an employee of the committee. I think that unless the House wishes to take the position that ministers should not have any advisers, the Chair certainly would see no objection to a senior consultant to the minister being in the same category as a ministry employee.

MR. HOWARD: As you said, Mr. Chairman, if I could, standing order 23 makes no recognition whatever of individuals, other than members themselves, as to what their function or capacity might be. Some come as guests on the floor of the chamber; some come as advisers. If your ruling and opinion is that people who are identified as advisers, by whatever categorization, so long as the member who is listening to that advice says, "This person is an adviser to me, " whether a public servant, or on contract, or just freely obtained advice, without contract — just expert opinion.... If that's your ruling, I think that's very worthwhile. Later this afternoon I'll bring an adviser along.

HON. MR. NIELSEN: Mr. Chairman, I don't know what the purpose of all this is, however.... Mr. Denhoff has been working in certain areas, and he is able to produce information far more quickly than some others. Nonetheless, standing order 23 says "the Chairman may, whenever he thinks proper, order the withdrawal of strangers." The Chairman, therefore, is the person who makes any decision. If it is brought to his attention that strangers are present, it is the Chairman's decision: he may, when he thinks proper, order such withdrawal. Other than that, there is no other action.

MR. COCKE: Mr. Chairman, the practice is that ministers can bring in public servants who work within their ministry. What we have just done now is indicated that people other than public servants who will report to a minister can be brought into the House. I contend now, with this new position, that the opposition can bring in private consultants, by virtue of the fact that they are not working for the ministry. We could not conceivably bring in a public servant, because they're working for the ministry. But now with this new concept of standing order 23, we have put ourselves in a position as a committee, which is fine by me, that the opposition can do exactly the same as the minister, as long as it's an outside consultant.

MR. CHAIRMAN: The Chair has made comments that the practice has been for advisers to ministers in answering questions and providing information to the committee and, I guess, particularly to the opposition, at the time of estimates or in committee with respect to bills. The meat of the Chair's position is that it is advisers to ministers that have historically been permitted in the House, and not advisers to other members of the committee, regardless of what side of the House they are on.

Interjection.

MR. CHAIRMAN: Well, with respect to the member's specific question on other members being allowed to bring advisers, the Chair will take that under reservation, but the practice has been that ministers have been historically allowed to have advisers on the floor when their ministries have been subject to examination under estimates, or for a particular bill.

Shall we continue on vote 37?

MS. BROWN: Yes. I want to thank the minister for the answers to those questions. I'd like to ask him to reopen the decision on the Women's Health Collective for a couple of reasons. The first reason that I am putting forward to him is that the Women's Health Collective acquires and places at the disposal of the community information which is used by people who traditionally would not go to the public health units or even to their doctors.

Interjection.

MS. BROWN: Oh, you want to make a ruling? Okay.

The House resumed; Mr. Speaker in the chair.

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

MR. SPEAKER: Hon. members, in putting forth an opinion on the matter that the Chair undertook to resolve, the Chair must express its grave concern that a matter of this kind is not capable of being resolved by the ordinary mechanisms available to both the House leaders and the party Whips. Forcing the Chair to intervene in what is ordinarily considered routine House business is a situation which brings little credit to the parliamentary process, and is a situation not to be encouraged.

The purpose of requiring notice under standing orders is to alert members as to the business of the day, thus preventing surprise or lack of preparation and allowing a member to be present, together with necessary witnesses, in the case of a committee meeting. The members have drawn to the Chair's attention the provisions of standing orders 25 and 48. Having

[ Page 5847 ]

examined both standing orders, it emerges from the examination of standing order 48 that notice is not required to fix the time of a meeting of the House.

A committee is a creature of the House and an extension thereof, and accordingly it seems to the Chair that if two days' notice is not required for a motion relating to a meeting of the House, it would normally not be required for a motion relating to a meeting of a committee of the House. Bearing in mind that notice of this particular meeting was printed on the order paper of Tuesday, April 23, and daily thereafter up to and including today, it would appear that no one in the House was taken by surprise in relation to the proposed meeting at 3 o'clock today.

In the absence of the notice of the meeting appearing in the Orders of the Day, the Chair, mindful of the rights of the members, and, in particular, the rights of the minority, might well view the situation differently. Today, however, the Chair is of the opinion that the matter should be determined by the House by the putting of the motion moved by the government House Leader, which is a motion that the committee have leave to sit at 3 o'clock today while the House is sitting.

Hon. members, we are now faced with a motion before us. The member for Skeena seeks the floor?

MR. HOWARD: Yes, to discuss the motion — as to whether or not leave should be given to the committee to meet while the House is meeting.

MR. SPEAKER: One moment, hon. member. Hon. members will appreciate that the debate allowable here is somewhat limited in scope.

MR. NICOLSON: On a point of order, Mr. Speaker, I agree that, as you say, leave is not required to set the time of a meeting outside the House. However, I thought the question under consideration was suspension of standing orders and whether one needs to have a motion on the order paper for suspension of standing orders. While the time is not really at issue, it is a fact that.... The time could have been changed to sit this morning at 10 o'clock and that would have been probably quite adequate notice. But what we're talking about is the sitting of a committee while the House is sitting. That, I submit with respect, is not answered by the ruling. I agree with everything said in the ruling, but it doesn't rule upon the simultaneous sitting of the House and a committee. The committee sitting could have been changed to 9 o'clock tonight or 10 o'clock this morning, and it may coincidentally have been appointed to sit at 3 o'clock this afternoon.

The time is not at issue. It is the simultaneity of the two sittings. That's what I would expect a ruling on, Mr. Speaker, before we proceed to debate such a motion — that we need notice of this motion. Had notice been given last Thursday, it would have been perfectly in order to order that the House and the committee sit at the same time — but not without notice.

Interjection.

MR. NICOLSON: Mr. Speaker might find this a laughing matter. I think it's very serious.

MR. SPEAKER: Order, please.

MR. NICOLSON: When we tamper with the rules of the House....

MR. SPEAKER: Order, please.

MR. NICOLSON: We had a committee, of which I....

MR. SPEAKER: Order, please, hon. member.

MR. NICOLSON: With respect, Mr. Speaker....

MR. SPEAKER: Be seated, please, hon. member.

MR. NICOLSON: Well, then the Speaker should....

MR. SPEAKER: The member will come to order.

Interjection.

MR. SPEAKER: Order, please, hon. member. The member should listen to the ruling of the Chair before he makes such comments.

The member for Skeena was seeking the floor.

MR. HOWARD: I thought it was an opinion, not a ruling, Mr. Speaker.

MR. SPEAKER: It is an opinion, hon. member, which I was about to....

MR. HOWARD: With respect, you just used the word "ruling."

MR. SPEAKER: The opinion is the one that was mentioned earlier, hon. member.

MR. HOWARD: I think the opinion expressed will become a ruling very quickly. That's what happens to those things.

This makes a mockery of the long, hard work that the committee did with respect to these rules during the previous session of the Legislature. That committee spent many hours trying to develop rules of procedure that would serve the public interest. That was its primary goal and objective.

Standing order 2(2), if I could draw it to the attention of the House, reflected what the committee was trying to do with respect to the conduct of public business by making it an extraordinary action on the part of the government to exempt Wednesday from the sittings of the House. It says: "The House shall meet on Wednesday if the government shall have so advised the House prior to the adjournment of Tuesday's afternoon sitting; otherwise the House shall stand adjourned...." The implication of that is that the House would not meet on Wednesdays unless the government took the deliberate action of saying by motion prior to adjournment on Tuesday that it would in fact sit on Wednesday. It's carried even further with the lost Wednesday question period being carried forward to Friday to make sure it is still available. The purpose of the committee in providing the opportunity for the House not to meet on Wednesdays was specifically that committees of the House could meet on Wednesdays without conflict. Whether the hour is established as 3 o'clock or 3:30 or 4, or whatever the time is — and

[ Page 5848 ]

that's part of what we're talking about here — any time for a Monday sitting between the hours of 2 o'clock and 6 o'clock would have been inappropriate to the sense of what the committee was trying to do.

[3:45]

Let's take an example. When Your Honour took the course in your opening remarks of making reference to the fact that this should have been resolved at another level, those discussions did take place, yes. They were unable to be resolved. I'm not going to go into the discussion that did take place; I don't think that's germane to this. But those discussions did take place. There was an attempt and a desirability to try to accommodate the meeting of the Standing Committee on Standing Orders, Private Bills and Members' Services. I'll touch on that a little bit later by referring to another notice of a meeting of this same committee, which was subsequently cancelled.

We have the Health estimates before the committee today. The Minister of Health is a member of the Private Bills, Standing Orders and Members' Services Committee. He obviously cannot be in two places at once, if the committee is going to meet. That's one member of the committee who is disadvantaged by not being able to be in both places at once. The Deputy Speaker may be disadvantaged too. If the House is in committee, the Deputy Speaker is in the chair from time to time. He also is a member of the Private Bills, Standing Orders and Members' Services Committee. I myself and the member for Nelson-Creston (Mr. Nicolson), when we found out that Health estimates would be the first item up today.... And I should tell you that we were advised at about 10 minutes before 2 o'clock this afternoon, or something of that sort, through the government Whip's office that this would be the first item of public business. The member for Nelson-Creston and I are both desirous of participating in the Health estimates today and find ourselves unable to do that. We have three members from the opposition side on that committee.

AN HON. MEMBER: And all three want to take part.

MR. HOWARD: Well, that's for each member to say for himself, regarding that. I only know because the member for Nelson-Creston and I talked about it. My colleague from Maillardville-Coquitlam says he would like to....

Interjection.

MR. HOWARD: Well, wherever he's from. He also indicates to me as an aside that he would like to participate in the Health estimates as well.

So there is disadvantage accruing. That's the point that the committee last year wanted to overcome and prevent. The first instance of that.... We find that there's a demand by the Chairman of the Standing Orders, Private Bills and Members' Services Committee that the House and the committee have conflict with each other, and that members in it be placed in the impossible situation of having to be, if they so desire, in two places at the same time — an impossibility, no matter how agile we are and how desirous we might be. We cannot serve both things.

When it comes down to the crunch, Mr. Speaker, I find myself obliged to attempt to serve what I perceive to be the public interest, and I consider that to be the Health estimates over a private bill. That is my public conscience that says that. The committee really had high hopes of working together to serve that public interest, and I think now that it's up in smoke.

The Committee on Standing Orders, Private Bills and Members' Services, upon due notice — the same as the notice which is referred to in the order paper today — met on April 17 at 1:00 p. m., which is a Wednesday. The House was not meeting. It met for organizational purposes to elect a chairman and secretary, and to examine the subject matters that may be coming before that committee, namely notices of private bills. And it made some tentative arrangements about that.

On the order paper of Friday, April 19 — it's important, I think, to look at this — the following notice appeared: "Select Standing Committee on Standing Orders, Private Bills and Members' Services. The committee will meet at 1 o'clock p.m. on Wednesday, April 24, in the Oak Room. Business: Bill PR404...." And then it identifies the bill; it's the same bills as are identified in the notice of meeting for this afternoon.

Why didn't the committee meet on Wednesday? Because the cabinet was meeting. That was the information that was given to me by the chairman of the standing orders committee. We're going to cancel the committee meeting on Wednesday — April 24 last — because the cabinet is meeting in Vancouver. Note that there are four members of the cabinet on this committee who don't mind being disadvantaged now, but couldn't be disadvantaged then, on April 24.

Why can't the committee meet the day after tomorrow a Wednesday? Because, once again, I'm told that cabinet is meeting in Vancouver or someplace, and therefore the committee can't meet. That makes a mockery of the whole process of attempting to conduct public business in a rational, sensible way. And it really prostitutes the position of the committee of last year, that was unanimous in its view that if Wednesdays are to be set aside for committee purposes, that will serve the public interest because there won't be that conflict between the two. Mr. Speaker, I submit to you that the whole process really is injurious to the public interest.

There would have been, and there was in prior discussions, every attempt made by me to accommodate the fact that the cabinet was meeting last Wednesday and therefore the committee had to be cancelled, and therefore the witnesses with respect to the Chilliwack Foundation and the Trinity Western College Act were told not to come because cabinet was meeting. I did try, in discussions, to find a common area of time, particularly outside the meetings of the House. We talked about Friday mornings, Monday mornings and different times. Then lo and behold, we get a notice that says 3 o'clock Monday, without regard to what the business of the House is.

I find myself in no other position than to be able to express dissatisfaction with the process, dissatisfaction with the fact that the cabinet and the government, dictators that they are, are now dictating to the Chairman of the Standing Orders, Private Bills and Members' Services Committee and telling him what to do, when it should be the other way around. He chaired that standing orders committee last year when we met to study the rules, an able person as chairman who did a good job. He was on that committee, and he knew what we were trying to do and went along with it; and at the first test between him and the cabinet, who buckles under?

The public interest loses in all of this, Mr. Speaker. I think it's a very sad and difficult day when we see public business

[ Page 5849 ]

put to one side because of the whims or idiosyncrasies of this group opposite.

MR. NICOLSON: Mr. Speaker, I too would like to speak against this motion. You know, this is a little bit of a watershed in terms of what might have been. When one thinks about all the time that was spent in trying to enhance the image of parliament.... It is under attack throughout the democratic world, and one does have to look at ways in which we should seek to enhance and preserve parliament. Then we took at this kind of action, and it is certainly injurious to the very essence of a democracy. We have a chance for some change in this House, and instead of the government's showing that there was going to be a change — referring some bills to committees and having some of the other committees besides Standing Orders, Private Bills and Members' Services and Public Accounts sitting and working to bring people in, to allow people to have more direct access and input into the legislation that affects them — we take the absolute opposite approach.

Now I take the point of view that it would have been within the powers, I guess of the Chairman.... If the committee meeting is at the call of the Chair, it would have been within his powers to call a meeting at 9 o'clock tonight; that would not interfere with the cabinet meeting on Wednesday or with what is going on in the House today. But what would it interfere with? It would interfere with some of those cabinet ministers, who in spite of the money they make are probably too damn cheap to maintain two homes, one here and one over there. They find it cheaper to travel back and forth on government aircraft and commute, when other less remunerated members of this House maintain two residences. If that's what it's coming down to and that's what this motion is all about, sitting here when it's convenient for the cabinet commuters, then I say that this is one of the most antidemocratic acts and most callous things being done around here.

I don't expect much to be said publicly over there, but I hope there are a few people on the other side of the House who are going to raise hell among themselves about this kind of thing going on. When we have left this House, when our day has come and gone and we're no longer here, I think you should want to be able to look back and say that you did something to elevate the level of debate, something to elevate the workings of this Legislature, that you left it a better place than you found it in some respect. But if we are going to do this sort of thing in a cavalier manner — changing rules around and changing schedules simply to convenience these cabinet commuters.... I want to say, Mr. Speaker, that I'm ready to work at 9:00 tonight if that's when the Speaker wants to call this meeting. I'm ready to work in the mornings. I was here to work this morning. But if this is the way that it's going to be run, I say that we're doing a real disservice to people who are coming over here as witnesses to the committee. People must have an ear on what's going on in the House as well as having an ear to what's going on in committee. To think that the minister whose estimates are up for debate is a member of that committee, and we're proposing that the two things should go on at the same time, is just absolutely callous. It does a disservice.

When you think that it was just less than 150 years ago that the Chartist movement in Great Britain tried to reform the House there, and tried to bring about annual meetings of Parliament and tried to bring about universal suffrage and things like that.... It looks like we're trying to go back to those dark, dark days of privilege, where the House is just a rubber stamp and something that only the privileged can participate in. It is a real sad and backwards step.

I would hope that the House Leader would withdraw this motion. Let's not paint ourselves into a corner any further than we already have. I'm not going to use any strong language. Let's just back off, cool off and forget it. Let's get together and think about ways in which we can make that Wednesday work for the Legislature and make it work for the people of British Columbia.

[4:00]

MR. VEITCH: As the chairman of this committee, I certainly don't want to see any undue conflict; I certainly want to see the thing move along in as harmonious a manner as it possibly can. Responding to the member for Nelson-Creston (Mr. Nicolson), I don't think that any member of that committee has ever been a rubber stamp for anything. I think they act in a very independent and very straightforward way. He and the member for Skeena (Mr. Howard) and also the member for Coquitlam-Moody (Mr. Rose) are very able and very competent members of that committee.

We don't really know, Mr. Chairman, whether the estimates of the Ministry of Health will be up, or whose estimates will be up. We don't know at this point in time what the business of the House will be once the Committee of the Whole House resumes. The statement that I made to the hon. opposition House Leader last week was that there were not sufficient members here to conduct a meeting, and if you don't have sufficient members, obviously a quorum would not be in evidence, and you couldn't hold the meeting anyway.

In answer to the hon. member for Nelson-Creston, we did have some discussion about a possible meeting this evening, but I believe the opposition House Leader felt that wasn't an appropriate time for it.

Interjection.

MR. VEITCH: If that is not the case, I'm sorry. I withdraw that.

It appears to me, Mr. Speaker, that the business of the private bills committee is also the business of this House. In lots of our discussions during the time we contemplated the new rules, we talked about the way things were done in other jurisdictions, and we noted — and the member for Coquitlam-Moody noted on several occasions — that the committees of the House of Commons in Ottawa meet continuously during the time the House is in session. So this is not establishing any precedent or really breaking any rules. I think the people are here. I think the interveners and the proponents of these bills are here, and it would be better if the committee did meet with them and gave them their hearing while they've come a long distance to the capital to talk with us.

MR. ROSE: I concur with your sentiments, Mr. Speaker, that it might better have been handled at another level. However, I think that it was probably ordered from an even higher level, and that's why we're facing the particular debate that we are today. I think that the decision to be off for last Wednesday and the previous Wednesday and probably this

[ Page 5850 ]

next Wednesday has everything to do with what the objectives and the motivations and the priorities of the government are. I don't think the Legislature really is considered.

I spent a lot of hours with this committee — hundreds of hours — and I'd like to say that we got along well. What we were trying to do, among other things, was to make our Legislature both understandable to the people at large — the public — and also predictable so that they would know when things were going to happen. We never really know. Last Thursday I was excoriated in the media by a member of this august body because I failed to show up for the organizational meeting of a committee. Well, excoriated might be too strong a word; I was mildly chastised on the grounds that I hadn't shown up for a meeting. Well, I had another meeting of my own caucus committee at that time, and that delegation had spent a long time and done a lot of preparation and given a lot of notice about coming here to meet with us. So those are probably reasonably good, practical ideas for not juggling around the days of committees.

Wednesday is not a day off. Wednesday is not in the rules as a cabinet day. Wednesday is a day designated for work in the committees; that's what it was for. The moment we depart from that kind of procedure we become unpredictable again and start doing things that I found appalling when I first came here — the way we treated one another. If we come to a point where we can attempt in some way to have a little bit more civility in here, I think all of us, as we did on the committee.... I think all of us gained a great deal from that experience. It looked to me like a turning point, from a time when rancour reigned supreme to a time when we had a situation where we regarded one another as "the genial member from Point Grey" and the member for Richmond. We all got along swimmingly on that committee, and I think we did pretty good work; but it isn't going to take very long to destroy the kind of mutual confidence and trust built up in the committee.

I want to be at two committees. I want to be at the Health committee and at the Private Bills committee. Which committee do I absent myself from? I thought my job was to be here since I'm up next on the Health estimates. Therefore I found it difficult to accept the kind of motion that the House sit when the committee sits.

One final point, and this is a little bit of a rebuttal to the member for Burnaby-Willingdon (Mr. Veitch). Scholarly as he is, he will know that the House of Commons has 284 members. Right? And we have 57 — more to come though, as long as they're the right kind. So if 10 members toddle off to the committee, we've got roughly what? A quarter of the House? A fifth? Approaching a fifth of the House is gone from the House, so it might be difficult even to have a quorum in here. We go off to this committee while the House is sitting, and then this House grinds to a halt because of a lack of quorum — potentially. The other thing is that it's much easier with a 10-member committee of a 284-man House — person House; excuse me. It's much more easily covered.

So I think the whole thing is bad procedurally, it's bad for the Legislature, and I think it's bad manners. Therefore I'm going to vote against it.

HON. MR. GARDOM: Mr. Speaker, I'd like to volunteer a couple of observations here, if I may. First of all, I think all members of the House are addressing this debate and this discussion in good spirit, and they're to be commended for that. The rules of the House, Mr. Speaker, are the servants of the House, not the masters, and we're the first to agree with that. I'm sure that's the general trend of thinking by all hon. members.

Quite frankly, I would not even have called this today, but for one reason. I think there was a misunderstanding — no doubt a genuine misunderstanding — between two people. I'm not a party to that misunderstanding. But in view of accommodating the members of the general public, the people who were requested to come did indeed come to Victoria today. There seems to be a great deal of opposition to the committee meeting this afternoon, and in view of that fact, I give, on behalf of the government and indeed on behalf of the opposition, our apologies and regret to them. But, Mr. Speaker, in view of the sentiments that have been expressed by members of the opposition and indeed by the hon. Chairman of the committee, the member for Burnaby-Willingdon (Mr. Veitch), I think the best resolution of this, in order to get on with the business of the people and stop dealing with technicalities this afternoon, is to, with leave, withdraw the motion. I would ask leave of the House so to do.

But before requesting that leave, I would like to formally give notice to all members of the House, and certainly the proponents of Bill PR404 and the proponents of Bill PR406, that it will be contemplated that this committee indeed will be meeting on the afternoon of Wednesday, May 8. I trust I've got the right day. Would you mind looking that up, Mr. Member for New Westminster (Mr. Cocke)? It is May 8. On that basis, Mr. Speaker, I ask leave of the House to withdraw the motion.

Leave granted.

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

ESTIMATES: MINISTRY OF HEALTH
(continued)

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

MS. BROWN: I was putting in a plea for the Vancouver Women's Health Collective to the Minister of Health, on the grounds that the information which they provide goes to people who are really using a lot of alternative health resources. If the minister were to visit the health collective office, he would notice, for example, that a number of young prostitutes — teenagers, some of them — walk in off the street and use the material that's there. They won't go to the public health office; they certainly won't go to their doctors. In addition, because the information collected deals specifically with disease and things which affect women, it's all there and it's very easily accessible to women who need specific information immediately.

In addition, they're doing a good job in terms of printing material, doing some very minor research, talking to schools, running workshops and those kinds of things. So I would like to ask the minister to reconsider his decision about funding for the Women's Health Collective. In addition, I would like to suggest that they would be really pleased to have a visit. If he'd like me to arrange that for him, I would be very happy to do it, but I think if he just walked in off the street, they would be quite thrilled to see him, to show him some of what they're doing and to explain the importance of their work.

[ Page 5851 ]

I got the case of the man with the $7,000 to $8,000 medical bill from an advocacy counselling service in Kamloops. I will certainly contact them and ask them to make direct contact with the minister, because they pointed out the lack of his welfare coverage as well.

I want to talk about the Community Care Facility Act and regulations. I'm not sure whether anyone else has raised it or not.

Interjection.

MS. BROWN: You haven't? Okay. In a letter, dated March 5, to Mrs. Connie Clarke of the Mentally Handicapped People, the then deputy minister, Mr. Peter Bazowski, indicated that the Ministry of Health had initiated a total review of this particular piece of legislation and its regulations. I want to start out by saying thank goodness for that, because it really did need that review. I want to know if the minister would share the information with me on the status of that review at this time. What I need, Mr. Chairman, is the status of the review. I have some questions which will probably be answered when he starts to talk about the review.

Also, has Glendale applied for hospital status? I'd like to have an answer to that too.

I'm told by the B.C. mentally handicapped association that the current interpretation of the community care licensing regulations for adults prevents adults with multiple disabilities from living in licensed group homes if they are unable to transfer themselves from their wheelchair to their bed. And that seems to be the stumbling block. It doesn't matter how well they are able to take care of themselves in every other regard. Simply by virtue of the fact that they can't get from their bed to their wheelchair or from the wheelchair to the bed without help, they are deprived of staying in a group home. There is a very tragic case which I know the member for Rossland-Trail (Mr. D'Arcy) brought to the minister's attention and to that of the Minister of Human Resources (Hon. Mrs. McCarthy). Gail Salewski is a person who is very content to be in a group home. However, she has been deemed to have to be in a medical institution simply because she can't get from her bed to her wheelchair. What this does, of course, is undermine and eliminate a number of opportunities for community living for a number of adults who are capable of living independently, except for this one fact of not being able to transfer from their wheelchair to their bed.

[4:15]

The other issue which I want to raise has to do with a coroner's inquest: the case of Lyle Lulu, who was asphyxiated by drowning. The Royal Inland Hospital in Kamloops.... The inquest made four recommendations directed specifically to the Ministry of Health. One has to do with constant supervision in the pool; one is about lifesaving aids being easily accessible with knowledge of same by supervising staff, and a permanent licensing officer with a suitable client-resident ratio to provide adequate visitations, etc.; the third is the fencing required around the perimeter of the property as well as around the immediate pool area, and so forth and so on. Maybe the minister could explain whether anything has been done about those very specific recommendations. It goes on to say that, "While I concur with the jury's recommendations, I wish to add the following to the Ministry of Health, " and I just listed those things. So maybe he can respond to that at this time.

Also, about the wheelchair-to-the-bed thing, Janine Senft is another story which showed up in the November 27 issue of the Times-Colonist. This is another instance of a young person who feels she can live on her own and would very much like to live on her own in a group home, but can't as a result of the decision.

The other issue has to do with the decrease in contributions to municipalities in terms of funding for health care. I think the minister might appreciate some feedback as to the impact that that decrease in funding is having on some municipalities. The senior labour relations officer for the B.C. Nurses' Union appeared before Burnaby council and indicated that the laying off of community health nurses would not be trimming frills, but rather would cut to the core, leaving little room for an effective program of prevention. The council agreed with her that they certainly did not want to have to lay off any of their nurses, but found that they had difficulties as a direct result of the reduction in the funding contribution from the ministry. As a matter of fact, I should probably tell the minister that by eliminating a full-time nurse in Burnaby the following would be lost: meeting the needs of 619 children at two Burnaby schools; 16 prenatal classes over a six-month period, with 18 couples per class; health teaching; support and counselling to a weekly average of 14 mothers and their young children; twice-monthly child health care sessions, each with between 10 and 12 small children; service to 47 children in day care and 18 in preschool; postnatal care to 219 babies and counselling to their mothers — simply by eliminating one nurse,

That gives you an idea of the incredible workload that those full-time nurses in the school system handle, and also the real negative impact on the delivery of preventive health care and community health care if this happens.

Burnaby is not the only municipality that I can give some feedback on. The Vancouver School Board has decided that a cutback of $134,000 this year in health services led to the removal of 2.5 full-time community positions, used as sick and vacation relief of school nursing. This elimination means relief of the school program is obtained through reduction in the nurses' other areas of responsibility, the individual and family program. They go on to list a large number of services that would also not be dealt with as a result of this, including nutrition deficiencies in children, ulcers, obesity, anorexia and attempted and successful suicides. It seems that West Vancouver also has some such concerns as voiced through the North Shore union board of health.

So maybe the minister could respond to what appears to be a 20 percent decrease. Now I'm never going to go to war to defend my arithmetic, but it seems to me that the decrease to the municipalities is in the neighbourhood of 20 percent, and the impact of that is already being felt. I hope that in the minister's response he will give some indication that he's thought about this and that there is going to be some restoration.

Also, how is it possible to decrease the funding for TB control at a time when it appears to be on the increase? When I visited the North Shore board of health, I was given a statistic which indicated that the diagnosed cases in that area had gone from one to 12; and those were just the ones that were diagnosed. They indicated that although there was access to immunization, there was no clinical followup, no way of finding out whether the compulsory immunization was being enforced, especially among immigrants and students from other provinces. So to decrease the funding for TB

[ Page 5852 ]

control by 7 percent at this time doesn't really make very much sense.

The other point that I wanted to raise was this. I attended a conference of immigrant families and health and social services. It was very well attended and very well represented by Dr. Bill Meekison of the Ministry of Health and some representatives from the Vancouver health department. I really believe that the immigrant women — they were all women at the conference — were very pleased with the responses which they got to their questions. They made a recommendation to Dr. Meekison, which he promised to carry to the ministry, about the business of nutrition guides taking into account the cultural food biases. They say that, for example, when they go in for pregnancy counselling they are handed a nutrition guide that says they should eat lots of apples and — I forget the other thing that they don't like — meat. This doesn't take into account that a number of them are vegetarians by religion and so forth and so on, or that the whole question of poverty also makes it impossible for them to meet the requirements outlined in the food guide. As a matter of fact, the United Way brought to the attention of the Ministry of Human Resources and presumably Health that people living on income assistance can't meet the food guide. That will be dealt with under another ministry, but I wonder whether the Ministry of Health has taken these cultural differences into account and whether the ministry is preparing nutrition guides that reflect cultural differences.

HON. MR. NIELSEN: The Women's Health Collective grants have been designated for this year, and the allocation of grants has been consumed. I think we did advise them that we would keep their request on file for further consideration. At the moment, the grants have been allocated.

The Community Care Facility Act is under review at this time. There has been no resolution as yet. As the member would know, Mr. Chairman, there have been a number of incidents which have led to the review, and those problems and those recommendations and advice which has been offered certainly will be taken into consideration. Actually, there have been relatively few difficulties with the facilities when you consider the number of facilities we have in the province, but they have been somewhat high-profile. It's under review at this time.

The Glendale, to the best of my knowledge, has not applied for hospital status. I'm not familiar with that particular coroner's inquest. I've asked staff if they would see if we've received a letter from the coroner — the one the member referred to. I just don't have that information. I'm not familiar with that, but I shall see if there have been communications.

The difficulties we have in allocating space to people who have multi-handicaps, or certain handicaps, is one of attempting to develop criteria for care. Because of that a person who requires a certain facility must undergo some type of investigation as to which facility is best suited for their needs. I think the member mentioned a Gail Salewski case, which was at the Endicott Centre. The Ministry of Human Resources wanted to move this young lady out of the Endicott Centre to an extended-care bed. The Ministry of Health was required to assess the needs of this patient to determine if the person was eligible for extended-care facilities. The Ministry of Health advised the Ministry of Human Resources that they considered this patient to be extended-care eligible since she required professional nursing care, continual medical supervision and other types of care which can be and are provided in an extended-care unit. The young lady in question is a client of the Ministry of Human Resources, and therefore it is a responsibility of the ministry to determine if there should be a placement. The Endicott Centre is not licensed for this type of client; it is not an extended-care facility. The ministry assessed the patient and determined that she was indeed eligible as an extended-care patient.

The wheelchair-to-bed issue is, I think, one of the issues being considered. That is a measure, I suppose, that was adopted at some time to determine the appropriateness of certain locations for individual patients or clients. There is the flexibility and the ability to review an individual case. Frequently it is literally impossible to write regulations, because the circumstances of an individual may be unique to that person, and it's very difficult to draft regulations that would cover all such cases. So we can and do take it upon ourselves to review an individual's case to see if alternate accommodation or care can be available. That's happened on a number of occasions.

The Burnaby municipality made the decision to lay off one nurse. It is not a provincial health unit, and it was their decision, In the more broad sense of funding with these municipalities on the lower mainland, and within the GVRHD — a couple of them at least — the Burnaby school district contributes part of the cost of the preventive nursing staff hired by the municipality of Burnaby. The Ministry of Health makes up the balance of the costs by way of a grant to Burnaby. The school district proposed a reduction in the grant for 1985 of 6.5 percent. The grant from education was approximately 1.5 percent. Prior to 1983 the Burnaby and Richmond school districts hired all the nurses working for the Burnaby and Richmond health departments respectively. In 1983, as an example, Richmond school district threatened to terminate all of the nursing positions. The Ministry of Health negotiated, or at least worked to negotiate, a solution whereby the municipality of Richmond took over the nurses on the understanding that the school district and the Ministry of Health would meet the full costs. A similar arrangement was offered and implemented in Burnaby, because the circumstances were very similar.

As a result of the wage settlements, the budget for 1985 has increased 6.6 percent over 1984. Burnaby school district has advised that their grant will be $486,000 for 1985, compared with $515,000 for 1984, a reduction of almost 6 percent. So the net impact is a shortfall of $63,000. The Ministry advised Burnaby health department that it's not in a position to pick up the shortfall; they must take steps to reduce their budget by that amount. That is why there has been some change in the nursing population. It's not a reduction in the grant from the Ministry of Health, but rather a reduction in the contribution from the Burnaby school district.

[4:30]

The member made a point that I would hope nutritionists would take into consideration when they are dispensing their services, including their advice — that is, understanding their client, understanding what the client's traditions and diet has been. It would seem to be perhaps inadvertent, and rather surprising, that a nutritionist would not be aware of the peculiar customs or habits of an individual, or a group of people, with respect to advice. You are not going to have much success in advising a person who has never in their life

[ Page 5853 ]

had a type of diet to suddenly adopt a new diet for purposes of maintaining their health during a pregnancy, as an example. It would be far better, I presume — and I'll certainly speak to the person responsible for working with nutritionists — to understand the alternative foods which would supply the same nutrition. I'm a bit surprised that there have been occasions where this has happened, but I think that could relatively easily be corrected, because it seems to be common sense.

The ministry has made some materials available to specific ethnic groups, in revised versions, to try to take into account cultural differences. As part of the new pilot project in prenatal health, the ministry has begun a project to raise the birth weight of babies. As part of the project, material specifically designed for our native Indian population has been prepared. These are being distributed alongside our regular publications. So someone has taken into consideration differences in culture. We are also preparing other methods of bringing similar information to other major ethnic groups, with that same thought in mind: recognizing the differences in the culture. Perhaps we'll achieve that objective within a reasonable period of time.

The tuberculosis problem. I think it's a case of cycles occurring in health. For a period of time it was felt that the tuberculosis problem in the province was really becoming a major thing of the past, and then we had a couple of flare-ups, most specifically in the city of Vancouver, which caused a considerable amount of investigation. There was a case finding survey for tuberculosis in the east end of Vancouver in March of this year. A total of 1,276 individuals attended special clinics in the area. Of those, 11 are under treatment for active TB and another 11 are under investigation for possible TB. The transient population in that area of Vancouver is at greater risk. The problem is fairly stable and ongoing, requiring the continuing attention of our TB control division.

There was an allegation that a Ministry of Human Resources caseworker was a carrier. This resulted in a thorough review of at-risk employees during the past winter. This concern about tuberculosis was shared by the TB control division, the Vancouver health department, the B.C. Lung Association and other social agencies, and they all cooperated in a neighbourhood blitz, which resulted in about 20 percent of the target population being screened. We are very much concerned about any flare-ups in tuberculosis. I can assure the member that there will always be adequate funding to respond. We try to estimate what the incidence of TB will be in the upcoming year, and we try to estimate what our requirements are to control it, or to test for it. But I can assure you that there will never be a shortage when it comes to actually responding to a situation that was not anticipated.

MS. BROWN: I just want to wrap up my comments on this section, Mr. Chairman, by pointing out to the minister my concern about the fact that, with a $2.6 billion budget in Health, something in the neighbourhood of 2 percent — or less maybe — is being spent on preventive and community health care.

I want to make a couple of philosophical statements, if that is permitted, about my belief that a health minister should be more concerned with the prevention of illness than with the treatment, not only because it's cost-effective but because in the long run that should be his ultimate mandate: to keep us healthy. It would seem therefore that a larger proportion of our budget should be going into those programs which keep us healthy, prevent us from being ill, keep us out of acute-care wards and generally enhance and improve the quality of our lives all around.

I do not get any indication, from the small size of the budget on preventive and community health care, that there is a recognition of this on the minister's part. I have been told by the health units — and I've visited quite a few of them and spoken to a number of people in the community health system — that they are unable to introduce new programs; they are having difficulties maintaining existing programs and in fact are even having to cut some programs. They believe — and I agree with them — that preventive health affects every risk factor associated with any disease, and there is a lot more that we could be doing in the way of educating, even to setting an example when it comes to things like smoking. They would love nothing better than to have a Minister of Health who doesn't drink and doesn't smoke. No, I think they wouldn't like a Minister of Health who doesn't drink and doesn't smoke.

AN HON. MEMBER: What has this to do with the health estimates?

MS. BROWN: Everything. It has everything to do with the health estimates.

Seriously, Mr. Speaker — and I'm going to be very brief there has to be a better and an increased financial commitment in future budgets for prevention and community health care. I hope the minister agrees with me, because if not, I may have to stand again. I know you wouldn't want me to do that.

HON. MR. NIELSEN: Mr. Chairman, I suppose the percentage for preventive health and community health care services is relatively small compared to the entire budget because of the size of the budget and the tremendous amount that is being spent on non-preventive health care. The preventive services total approximately $47 million this year, which is an increase of 4.5 from last year. Nonetheless, a fair amount of money is spent through our Medical Services Plan and our hospitals, which really is consumed by what one could refer to as preventive service as well, but is not identified as such.

Our culture, our society and our history seems to be that in the area of health care the lion's share has always been to treat illness rather than to promote health. There are those who even argue that our medical profession has been trained in that way, and that there are the beginnings of some change in the philosophy. I agree that there are areas in public health that could be and should be improved. When the money is available, I'm sure they will be.

We have had great success over the years with respect to preventive health care. In fact, many of the programs that we now take for granted, and which are not necessarily any longer identified as being preventive health, have improved the well-being of our population immensely. An example I could offer would be the various immunization programs introduced over the years, which have to a very large degree controlled some communicable diseases and other conditions. Such people as might now contract those ailments would be treated under our regular health system, whereas at one time it was a major effort on the part of prevention — the outbreaks of childhood communicable diseases and some of

[ Page 5854 ]

the other diseases which affect the population in general. So those are no longer as high profile as they once were, but certainly I think they are an indication of how successful prevention can be.

Mr. Chairman, we do pay a great deal of attention to our preventive side. We offer quite a variety of programs throughout the province. We have increased the budget slightly, to $47,268,000 for this year. I sincerely believe that if we are going to be able to expand preventive health care programs in the future to the point where you would reach agreement with those in that area as to how much money should be spent and how important those programs are, we truly must gain control over these incredible expenditures at the other end, at the medical side and on the hospital side, because it is very difficult to have the two continue with the incredible increase we've seen over the last number of years on the acute care side, with moneys being available for preventive services. We've expanded our health care programs in the province considerably. Over the last number of years the budgets have been increasing rapidly. We have not, as I said in my earlier statement, had the success we wish we had had with respect to medical services costs.

Mr. Chairman, the budget is over $2.5 billion, most of that consumed by our hospitals and Medical Services Plan. It doesn't leave a great deal by way of percentage for programs other than those two. I believe if we are going to be able to dedicate more of our funding to preventive care, we must, from a management point of view, gain further and better control over the expenditures in the medical services and hospital side. So we don't disagree philosophically; it's a matter of finding the money and seeing that it is properly utilized throughout the program.

Mr. Chairman, in the last while there has been, I think, a far greater awareness in our community generally with respect to prevention. We have worked with the CNIB, the Western Institute for the Deaf and other organizations concerned about the difficulties primarily to children with respect to ailments which could be prevented. We have worked very hard with organizations and professionals with respect to prenatal, trying to bring up the weight of these children, and air ambulance service to bring the youngsters down to Vancouver Children's Hospital. So we are working on prevention of future difficulties. Our thrust is to try to produce the healthiest possible child at birth to give that child the greatest opportunity of health for the balance of life.

[4:45]

There are some communities where we have some difficulty in filling positions in the preventive side simply because of the difficulty of recruiting. Unfortunately, when after a great deal of recruitment we are able to find a person suitable to take on a position, frequently they leave soon after because a vacancy becomes available in what they believe is a more attractive area of the province. So it's an ongoing problem in B.C. and other provinces as well.

MR. ROSE: I guess, Mr. Chairman, after all the fuss we raised about the committee meeting while the House is sitting, I pretty well have to say something about the Health estimates. I don't see my two colleagues here, but really it was kind of dirty of me to call attention to that. They'll forgive me.

Mr. Chairman, I've got only one particular topic that I wish to deal with, partly an educational one and partly a health one. It is the issue of the medical lab technologists. I'm just giving you that in case you need to get some information from someone.

Before I get into that, though, I would like to echo the things that my colleague the member for Burnaby-Edmonds (Ms. Brown) said about lifestyle and cultural habits and prevention, which is very important. I think that your culture and your history can actually be a tremendous load to carry — and I say that with no pun intended — as far as your eating habits are concerned. Regardless of how much you know about what is so-called good for you, it's what you like and have learned to eat that really is the determinant, until you get sick, and then you can't do those things any longer.

As a personal example, which will be of interest to no one, perhaps, my own cultural eating habits, because one of my parents grew up in Prince Edward Island and I was born there, lean to fish, lots of salt — and we know what that does in terms of the Newfoundlander and heart attacks and high blood pressure — meat, potatoes, butter and eggs. My wife, who grew up on the Prairies, eats all kinds of yukky stuff like yoghurt and cereals and bean sprouts, you know, so she can be lean and mean. Consequently, even though I know intellectually that I'm digging my own grave with my teeth, even by following Canada's food rules.... According to some nutritionists they're dead wrong in terms of the best diet today for individuals in this high-stress, highly refined food, fast lifestyle that most of us lead. So I think there are some things such as smoking.... That monkey is now off my back after 30 years of being a sinner. I was a colleague of the minister in that — and seatbelt legislation. All those sorts of things combined, I think, will bring down costs.

Nutrition. Children learning to eat better and to take better care of themselves is going to ultimately bring costs down, and probably nothing else. As long as we allow ourselves to keep a polluted environment, we run that kind of risk of increasing the costs of health care. If we just look at, say, user fees or deterrent fees as our way out of spiralling health costs, we're looking absolutely in the wrong place. So I think the whole environment, not only the social but the physical environment, all the exhaust fumes and that sort of thing, is certainly the thing that will probably in the long run — if we have a long run — be far more important as a reducer of health costs, and an improver of general health.

Let's get back to the lab technologists. The lab technologists are assisting paraprofessionals who have had anywhere from two years to four years, perhaps, of university training, and they work in the labs at hospitals and other places. They analyze blood tests, test for infections, germs, mould, yeasts, and all types of things that the ministry probably knows far more about than I. Nevertheless, there was a letter to the British Columbia Institute of Technology that quotes the Minister of Health. I'd like to ask him a few questions about that letter — not that he wrote the letter. First of all, I must say that the problem of gaining clinical placements for those in training now.... I understand that problem has been solved for this current year. It meant infusing extra moneys and then twisting a few arms to get the number of placements — notably, from Royal Columbian that were needed.

This letter is from their executive director, Lorne Thompson, of the program services division of the Education ministry, with copies to Fisher and Newbury. It was written on November 9, 1984. I could go into all the other things about the fact that it never did even go to the board of the

[ Page 5855 ]

BCIT, but I won't get trapped on that one. I had another shot at that in a previous moment. But it says here:

"The Ministry of Health has been deeply concerned by the apparent overproduction of med-lab technologists, and had requested that Education reduce overall enrolments to produce a target of approximately 65 graduates per year. This information was relayed to most of the concerned deans in a meeting with me on September 18."

I have the mobility cross-Canada from 1970 to 1980. In 1970 we lost four that we trained, and went to importing 35 in 1971, importing 51 in 1972, importing 27 in 1973, and so on down the line. In 1982 we imported 103, and I understand that last year we imported 148. I'd like to ask the minister where the overproduction is.

HON. MR. NIELSEN: We don't want to offend our dear Charter of Rights. People come into B.C. looking for a job, and if they are otherwise qualified, you don't dare even suggest they can't have a job that minute.

Over the last three years, approximately 65 clinical positions a year have been provided by our hospitals for medical technology students. If some of these other folks are coming in and working in private labs or otherwise, we really have no control over that. In the hospitals, the need is about 65.

The reference the member made with respect to that letter was to ask the BCIT to try to gear themselves to provide the approximate number of placements available, rather than producing a surplus of students in that course, who then say: "Where are the jobs?" We can't provide the jobs within our hospital system simply because a number of students have been produced. We can't deny other Canadians the opportunity to make application for that type of position in B.C. You certainly can't discriminate against other Canadians for it, so you have to try to control your end. Our end is the production of students.

It seems that at one point in time there were too many funnelling into the system, and there was no availability at the conclusion. We've had some quiet discussion with hospitals to see if they could make positions available, but in some instances, because of the global nature of their budgets, not only do they have the authority to make their own decisions.... To place a couple of students, it may require the layoff of a fully qualified medical lab technologist in order to allow placements for them. But the Ministry of Education, BCIT, the parent colleges and the other people from across the country who are trained are going to converge upon our hospitals looking for positions, and there is no way we can instruct the hospitals, nor is there any way the hospitals can simply create positions because the number is different than required.

It's a bit of a complicated problem, but it follows the same rationale, I suppose: just because a person trains, that does not necessarily mean they're guaranteed a position. We have tried to encourage the education side to produce the approximate requirements in our hospitals. But we certainly can't do anything about the in-migration to the province, and we do not have authority or control over education or the BCIT. We cannot instruct them as to how many students they put through the course. All we can do is continue to fund the hospitals, who will do their best to accommodate the technologists required to do the work.

The hospitals are not a continuation of the school program. It's a continuing opportunity for the person to develop expertise, but it's not in that sense, a teaching situation; it's a working situation. The hospitals would be irresponsible, I think, to simply hire technologist graduates simply because there was a surplus on the market.

MR. ROSE: I am as aware as the minister of the provision of mobility rights in the Charter. I am not arguing that point with him at all. But if there are in fact 148 more positions than we trained our own people for last year.... The minister sounds to me like he would almost prefer jobs for others, or for others outside the province to get the jobs, rather than our own young people. It also reminds me a little bit of a marketing board. It sounds like a supply management proposition. You sound like the leader of the Chicken Marketing Board or the Egg Marketing Board or, more appropriately, the Turkey Marketing Board.

What the minister is saying is that we can only place so many of these kids in the hospitals — 65 — so train 65 and that's all. That's what he's saying, and that's supply management. As a matter of fact, if you want to take it all the way across Canada, you can have the Natural Products Marketing Act, which does that, and the member for North Vancouver–Seymour (Mr. Davis) was probably in the House when that was passed. This is precisely what the minister is suggesting here today.

So sure, there have to be people that are employed in the private labs. But if we don't train more than our hospitals can use, on the proposition that, well, after all, we can't give them clinical spaces because that costs money, then the private part of that industry, if you want to call medicine an industry, which it is — a big one — will be forced to take people from outside the province. So I think his argument there, although he is genuinely a very pleasant man, is somewhat spurious on that particular issue.

I wanted to know also, since the ministry wants to limit overproduction or go into supply management like the Turkey Marketing Board, why the ministry wanted the course cut from three years to two years.

Interjection.

MR. ROSE: Well, I would, but I talked to him for a week and a half and I got nothing out of him. I was hoping for a little bit more here.

It says here in this letter from the ministry.... I realize that I'm throwing a little bit of a curve here, but it's all right; he's used to that.

"Besides the overproduction issue, the ministry would like to bring the British Columbia program more in line with medical laboratory programs in other provinces. Therefore a decision has now been reached to reduce the program to one-year didactic and one-year clinical training, thereby eliminating the first-year transfer program."

So that means that the kids in Cariboo College, in Camosun and in Capilano College — the one in Prince George is slightly different — won't have that opportunity, which I think is really not the most enlightened approach to solving a problem. It sounds like if a person's got a hangnail, you're going to amputate his arm.

So I'd like to ask him how he can reconcile the overproduction on one hand, and therefore limiting enrolment, and then at the same time cutting that training program from three years to two years.

[ Page 5856 ]

[5:00]

HON. MR. NIELSEN: Mr. Chairman, the medical lab-tech program consisted of two years of academic course work, followed by a one-year clinical placement. It is those clinical placements that limit the number of positions in British Columbia.

[Mr. Ree in the chair.]

It was found that a number of the courses given in the first year were designed simply to provide a grade 12 equivalency in subjects such as math, chemistry and biology. With the support and approval of both the Canadian and British Columbia laboratory technology associations, it was decided to eliminate the first year entirely and require a 70 percent grade in grade 12 academic subjects, including math, biology and chemistry. Therefore the students who would then enrol in the course would not be required to take that one year which was to bring up their grade 12 equivalency; they would already have achieved that. They therefore could move into the course in what was previously the second year, followed by a one-year clinical placement. It should improve the quality, because the students who would then qualify for the program have already qualified at that grade 12 level. I don't see that it's really in conflict with what we are attempting to achieve.

MR. ROSE: I have some figures here, Mr. Chairman, on the number of hours of equivalent courses, but maybe it's enough to say this: the situation is viewed with a certain amount of concern, if not alarm, by their organization. B.C. joins the happy number of minorities in Canada that offer a two-year program. Seven places offer a two-year program: that is, the institutional — like the institute — such as the didactic part of it, or the course work, and the hospital, the intern work. Two programs are two years and hospital trained only. That's a total of nine two-year programs. Nineteen of the programs are three-year programs, which is what B.C. had part institute and part hospital; two and one in that case and there are two programs offering a four-year university and hospital Bachelor of Science degree.

So it seems to me that we're watering down the program. We're not only providing fewer opportunities, but we're actually diluting the quality of the program. As I say, I could go through the number of hours. Is the minister aware, for instance, that the entrance standard to two-year programs is traditionally about 60 percent, with the three-year programs at 70 percent? That is a little comment on the academic prerequisites required in some of those programs. Is he aware also that Hamilton and London in Ontario have just moved to three years from two years?

HON. MR. NIELSEN: I can't really add any more than I've already said with respect to this subject. We are primarily responsible for funding the hospitals who provide the clinical placements for such students. The hospitals are responsible for their budget. They're also responsible for determining how many clinical placements are suitable for their operation. We do not have direct control over the production of such students. Presumably, theoretically the BCIT or the Ministry of Education could double the number of students at any time, and then what would we do with them when they're in the market for clinical placements? We really cannot force the hospitals to create more positions if they legitimately advise us they simply do not require that many students. So it's a matter of coordination, which we attempted to assist by offering advice to BCIT as to what we could actually consume.

The other technologists who, I believe, the member was speaking of are people who I presume have completed their courses and moved to British Columbia to take on a position of some kind. We're not talking about the clinical placements, which is really the only role we're involved in. I'm rather shocked and surprised, Mr. Chairman, that the member would even suggest vaguely that the mobility section of the Charter be considered for a moment as improper, with respect to allowing our fellow Canadian lab technicians to come to beautiful British Columbia and be employed in our province. I am surprised that you would consider that for a moment. I will talk to my lawyer about that.

MR. ROSE: I'm looking forward to the day in the next election when our glorious Premier goes out on the hustings calling for jobs for Canadians and not talking about jobs for British Columbians. However, I am quite sure that if there were any jobs here, people would come and we would welcome them with open arms.

I still think that it is a mild cop-out to say that we can only train the numbers that the hospitals here are prepared to use, that we have no responsibility to assist people in the private sector to acquire qualified people to work in their labs without importing them. Pretty soon we'll have the Minister of International Trade and Investment (Hon. Mr. Phillips) going across Asia or wherever else he goes, importing a few more of them. Thirty percent more instruction in Alberta and in Ontario, even in their two-year program.

So I would close by saying this, and offering this advice — and I could ask a question and try to put the minister on the spot, but I don't intend to do that: it is my impression that certain hospitals are much more cooperative with this program than others, and that if we really do need these people in the numbers that have been suggested.... One of the recommendations that I've got here from their group is that we expand enrolment in the current program by 20 students to a total of 145. That's precisely the number that came in last year. That's a recommendation from the profession. Anyway, I wonder if the minister in closing could give me any kind of an indication.... I know he said he can't order the hospitals. I don't know why he can't. I mean, after all, they are all appointed boards, aren't they? It is possible to maybe.... A nudge and a wink, and say: "Well, this is a program that we really need for British Columbia, and there is a great need to produce more here because the private sector in British Columbia needs these people." Does the minister see any way around the limiting factor of clinical placements?

HON. MR. NIELSEN: I could speak to some of the hospital boards — appointed and non-appointed — and I could have someone do a pretty thorough inquiry as to how cooperative they have been. But, Mr. Member, it is a matter of determining, first of all, who should have the responsibility for providing the dollars necessary for these placements. If we could work something out whereby money was made available in addition to a hospital's regular budget for training purposes, I am sure they would be much more cooperative. We, of course, would be in the position of training people who would not necessarily serve in B.C....

[ Page 5857 ]

MR. ROSE: Or in the hospitals.

HON. MR. NIELSEN: Or in the hospitals at all, yes. We can certainly talk to those folks at the hospitals about cooperating. I don't believe I have received the material you have, unless it has recently arrived.

But sure, we can look at that, although I still think we are somewhat limited in what we can impose on the hospitals without responding to their demands for greater funding to accommodate that need. Maybe we can work it out with the Minister of Education, BCIT and the association in the hospitals to see what can be done. However, I am concerned about the Ministry of Health responding to a stimulus which is beyond our control, and that is the educational side, and to an association which represents their members, because we have to be cautious that we are not simply providing opportunities and placements for people produced by a different system or a different element of government. We have a responsibility to spend the amount of dollars we spend legitimately for health care purposes. Education and training, I think, has some responsibility there — Education or Universities or those really responsible for producing the graduates. But we can work together on it and try to work it out.

MR. ROSE: May I say in closing that I appreciate the minister's words and cooperation. May I say two things. First of all, it appears from my correspondence that the Ministry of Health started this and then directed its concerns to the Ministry of Education. So perhaps your diffidence about interfering with another ministry here is not too critical.

Another thing. He can have all my documents. I know he hasn't got enough documents to read. He needs a few more documents. He's quite entitled to all my documents.

The final thing is that there are a number of people who are working in this business privately — and I've met them — who aren't qualified. They are doing the work because they can't get the qualified people. They've got a major in biology or something like that. I don't know what they've got. They've done a little bit of work with slides and stuff like that. So I think you're not going to get the same quality of service from people who are not well trained, and that's why I regret the sort of retreat into the two-year program.

MR. DAVIS: Mr. Chairman, we have in Canada and in British Columbia a shadow community comprised of illegal aliens. There have been several studies done at the national level in recent years, and the numbers for Canada vary all the way from 50,000 to 200,000. The numbers for British Columbia are of the order of 20,000. I'd be curious to know how those people, many of them wives and children, get by when they encounter health problems. I know that Immigration Canada, under the department of Manpower and Immigration, keeps some records, but their records really are only head counts. They deal only with numbers and countries of origins, and not with names or individuals. The Auditor-General for Canada, several years in a row now, has chastised that particular department for its lack of organization, its inadequate records.

I'd like to know whether there's any liaison whatsoever between our provincial Health ministry and federal Manpower and Immigration; more particularly, how these people get by. They're here illegally. They keep their heads down. They don't take out memberships in well-reported organizations. They don't buy motor vehicle licences. They try to avoid our courts and so on. But there is a significant number of people in British Columbia, particularly in the lower mainland, who are not covered by health care; yet when they encounter serious difficulties on the health side of things they must be admitted — many of them anyway — to our hospitals. They must be under a doctor's care.

[5:15]

In Canada we've had successive amnesties declared. Approximately every 10 years the federal government decides to forgive all those who've entered the country illegally up to a certain date and to give them full Canadian citizenship status. That has tended to encourage the illegal immigrant. Nevertheless, many of them, in their lack of understanding of our society, have been reluctant to come forward. Indeed, there have been several attempts in the last 18 months to arrange amnesties for those who've been here more than five years. If they would come forward with proper legal representation or with a letter of recommendation from a prominent person or persons in the community, the chances of their being granted at least immigrant status are high, but a surprisingly small number have come forward.

Has the minister anything he can say about this problem? How are these people covered? What treatment do they receive? There must be a sizable number of them receiving treatment through our medicare or medical health plan, and yet they are without legal citizenship status in this country. I wonder if he'd comment on that problem area.

HON. MR. NIELSEN: There is no simple way to relate to that problem, because we can only respond to the information which is supplied to a hospital, a doctor's office or a clinic. Now there is no question that a number of illegal aliens would avail themselves of the lowest-profile health care method available. Many of them perhaps make use of, depending on their difficulty, a clinic of some kind where there is less formality or maybe even not a need to register. Some of them wind up in our hospitals. Residency is attempted to be determined in all cases. If it's brought to our attention that the person is not eligible for hospital care and yet is in the hospital, an attempt is made to recover the cost.

Mr. Chairman, we have had incidents in the past few years where we have had illegal aliens in the country who have cost the system several hundreds of thousands of dollars each. We have a very difficult time in trying to resolve that matter. We have two natives of Fiji in the province, one with a kidney problem where he is on dialysis. I believe the cost now is about $400,000. We had a number of others who found themselves in Canada initially as visitors, developed ailments of some kind, wound up in a facility and are running up a bill. We have very little choice in the matter if we wish to pursue it. Were we to ask these people to leave the country and go back, as an example, to Fiji, it's almost certain death for them. We offered the government of Fiji a dialysis unit, offered to send technicians along to instruct in the use of the unit, and we were advised that they simply did not wish to have the unit. We tried to arrange transportation of this particular patient to New Zealand, where we understood there could be some type of reciprocal arrangement with the government of Fiji, That was not successful. We tried to encourage the individual himself to have a kidney transplant, which he refused.

We've had a number of incidents brought to our attention. The number of illegal aliens is very difficult to determine, and how many come in contact with our health care system is

[ Page 5858 ]

unknown. But we certainly have had some high-profile cases where people have come to the country, usually as a visitor. We suspect that many of them were held together by adhesive tape and arrived as a visitor and suddenly became ill. We believe the illness was well diagnosed prior to their arrival in Canada.

We work through the federal government with respect to eligibility of such people for treatment. Each case winds up as a major controversy; it matters not which side we take. If we choose not to seek deportation or expulsion of the person from Canada, then we are criticized for spending money on aliens that should be going to Canadians and British Columbians. If we do ask for their expulsion, we're heartless people denying a person an operation which will save their sight, as an example. In that particular instance, we had an absolute guarantee that if a certain person arrived in this country, they would be transported to Seattle for the necessary cataract operation. The operation took place at Vancouver General Hospital, I believe, completely contrary to the understanding. That has happened several times, and it's extremely frustrating because there is no possible way of winning.

The cost associated with it, Mr. Member — I simply could not give you a number at this time. We do not deny people treatment, particularly in an emergency. We try to recover the costs later, with very limited success. I don't know the number of illegal aliens in the country. I don't know where they're being treated, how they're being treated, whether there is a massive amount of fraud involved, whether there is use of someone else's identification, whatever it might be. I suppose all those methods are employed.

We have asked the federal government on more than one occasion. If a person is in Canada illegally, or if their visitor's visa has expired or whatever the circumstances may be, we believe that if the person is either a guest of Canada or is in the country despite the federal government's capacity to remove the person, then the federal government should be responsible for the medical costs of that person. We do not believe that a province should bear costs of several hundreds of thousands of dollars when the person receiving the treatment is here with the authority of the federal government or despite the authority of the federal government. We've asked them to please submit within 30 days the amount mentioned on invoice.

Interjection.

HON. MR. NIELSEN: Yes, we may. We've had some rather peculiar responses, but we certainly hope to recover some of that money sometime. The member for Skeena (Mr. Howard) suggests we sue them. But my time in other lawsuits right now is overtaxing me, so we may have to wait.

It is a problem. We have difficulty in tracking it all down because we don't really come in personal contact with that many people. But the hospitals have problems, and a lot of doctors have bad debts because of it, where people will show up. But I agree, it is an area of interest. It's something we perhaps should look at a little more carefully, but I really do wish we could have far more cooperation with the federal government in matters of these high-profile people, because it has cost the people of British Columbia a considerable amount of money for patients who, I believe, would otherwise simply not be admitted to the country. They're far from being in the category of political refugees or others who may be granted admission to the country on humanitarian purposes.

MR. DAVIS: Mr. Chairman, I think it's fairly obvious that the provincial Ministry of Health has to look after these people when they're in difficulties. I agree with the minister that under ideal circumstances, where people are either traveling through the country on a proper passport, visa or whatever, or are illegal immigrants, the federal taxpayer, not the provincial taxpayer, should pay for their care.

One other area, and it's an area where perhaps numbers would be more readily available, relates to the birth of sons and daughters of people who declare themselves to be foreign nationals in Canada. Some may not, but there are a considerable number. They may run into the hundreds. Some figures I've seen suggest quite a few hundred children are born in British Columbia annually whose mothers come to Canada — in this case to British Columbia — deliberately to have their children here. The reason is that when that child reaches maturity, he is a Canadian citizen and can then bring his parents into Canada, as a matter of right, and has high priority in bringing in any younger brothers and sisters.

The cases I know best involve the parents deliberately arriving, and I think in all instances which I could document, they pay the full shot. They don't claim to be Canadian nationals or British Columbians under any health plan at all. They pay average costs, so it's not a matter of cost; it is a matter of deliberately creating Canadian citizenship. Canadian law is explicit in this area. If you are born in Canada — even in Canadian air space, as I understand it — you're a Canadian, at least in your working and adult senior years, and you have all the rights of a Canadian citizen to bring in close relatives, including parents and younger brothers and sisters.

My only question, really, to the minister concerns this. In hospitals like the Grace Hospital, where there's a significant number of these people, how do they establish priority between pregnant women who are under the B.C. health plan, others who are under other health plans from other provinces or private plans and, finally, these foreign nationals who come — and there are a significant number — deliberately to have their children born here?

HON. MR. NIELSEN: I'm trying to get some specific numbers. I know we had a number of births to foreign nationals at Grace Hospital this past year, and I'm trying to recall what those numbers were. I think perhaps we may have them.

There is no question that there is a method or a scheme whereby expectant mothers arrive in Canada as visitors, knowing full well that they intend to stay to give birth to the child for the purposes the member mentioned; that is, to provide citizenship for that child and perhaps at some later time in life to take advantage of that as the law permits. We also have a number of American women who come to Canada to give birth to children, for financial consideration. Even though they pay the full rate it is still, in many instances, considerably less than they would pay elsewhere. They still have the opportunity of registering the child as an American citizen, so they don't lose what they might otherwise wish to have. I might mention that the foreign nationals do pay the per them rate, which they feel is quite reasonable when they consider what the future benefits may be.

We do not prioritize the patients because of their nationality, in that it is the doctor who arranges for the patient

[ Page 5859 ]

placement at the hospital. My understanding is that the Grace Hospital particularly, which seems to be the favourite of most people, is not experiencing difficulties in scheduling or placement because of any such numbers. Numbers are relatively small overall, but significant just as an individual statistic.

I might add, Mr. Member, that Grace Hospital is perhaps one of the finest tertiary maternity hospitals in Canada. Unfortunately it is not used for that purpose as extensively as one would want. The public relations people at Grace Hospital did too good a job, and now it is very common for expectant mothers in the greater Vancouver area to request of their doctor that they be delivered at Grace Hospital. Frequently it requires that they go to a doctor with privileges at the hospital to get in. But it was designed for tertiary treatment — for difficult births. Unfortunately.... Not unfortunately, but there is a large number of very normal births taking place at Grace, coming from the suburbs and other hospitals. We have to consider the need for maternity wards in some.

Of 7,603 births at Grace Hospital between January 1 and December 31, 1984, 5,710 had B.C. coverage; non-Canadians, 101; out of province, 70. So 101 non-Canadians is not a large percentage of the total number, which is 7,603 births, of which 101 were non-Canadians, of which 47 were from Hong Kong. That's to the best of our knowledge, at least. That was the information and the statistics we had. It's not illegal. Apparently it's understood, accepted, and it's happening, but we're not losing money. It's not really causing difficulties at Grace Hospital.

[5:30]

MR. DAVIS: I guess I just have one comment. The numbers which the minister read out re the Grace Hospital left a big gap of 1,500. I did receive a letter in reply to one of mine on this subject, and I couldn't determine where the 1,500 originated. There's a big gap, in other words, between roughly 7,600 and some 5,800. How many are non-traceable in there? I wondered about that. I wondered largely because in reply to a letter a year previous the number of overseas pregnant mothers ran into the hundreds; but, still, it illustrates the principle.

HON. MR. NIELSEN: Mr. Chairman, I'm sorry if I misled the member. The discrepancy is because the 5,710 was for a period between April and December. They had not kept that type of statistic for the early part of the year; that's why there's a discrepancy. But the 101 is apparently correct.

MRS. DAILLY: Mr. Chairman, I'm going to move from babies now to the other end of the spectrum, Just for a moment, I'd like to go back to Shaughnessy, because I want to bring the minister's figures up to date. My latest check shows that your figures for staffing did not include the fact that 57 nurse's aides have been laid off. I don't think the figures you gave me included that. Generally what I want to say about Shaughnessy — and I regret to say it- — is that since the province took it over, I don't think the standards have been maintained quite as high. That's the general reporting that I receive, anyway. I would hope that the minister could perhaps do a little more.

I'm not blaming the staff or the administrators. It's probably the same old problem as everywhere else; it's probably the results of restraint. But I think for the sake of our old veterans who are there that everything should be done to keep up the once high standards. I know that in the George Derby hospital in Burnaby they no longer have a hydrotherapy pool; they don't have a physiotherapist and many things which they enjoyed before. I just hope that the minister's plans for the future will include a continual upgrading of Shaughnessy for the veterans. That was the point on Shaughnessy.

The other point I want to discuss with the minister today is something that really concerns me. It's long-term care. I know you spoke earlier and replied to the member for Burnaby-Edmonds (Ms. Brown) that you're going to have some recommendations coming out, because you also — I'm glad to know — realize that our long-term care hospitals, whether private or not, have to be brought in under regular and certain standards. Some of the recommendations made by a number of groups have shown that we need it. I'll get into that again.

My other concern is about the financing of long-term care. I understand that you have produced a new funding formula. The thing that disturbs me about this funding formula is that — and I'd like the minister to explain this — there has been a shift in money from the non-profit to the profit. No more money is going in, but there's been a shift. Part of that shift in giving more money to the private sector includes part-payment of their mortgages.

I find it really ironic that here we are.... Many taxpayers in British Columbia today are losing their homes because they can't pay their mortgages, yet their tax money apparently is now going to pay the mortgages of owners of private hospitals. I ask the minister: what sense of justice and fairness, and what rationale, is there in that? Also, these people can turn around, sell any time and walk away, and we've helped give them that equity. I find it a little hard to understand. I have some more questions on that. Would the minister explain to the House this new funding formula that includes the payment of mortgages for private hospital owners?

HON. MR. NIELSEN: Mr. Chairman, I wouldn't attempt to explain that formula without a team of accountants beside me. But we are asking people to provide service for long-term care patients, be they in non-profit facilities or private. We pay them so much for that service. There are component parts of what that amount will be. There are some long-term care facilities which are older and have very little by way of mortgage, unless they've remortgaged. There are some which are brand-new and have mortgage payments to make, as the non-profit have mortgage payments to make. We are asking them to provide a certain standard of service for people in various categories in need of long-term care. The fact of the matter is, Mr. Chairman, the non-profit societies cost approximately one-third more than the profit facilities. On average the cost per patient-day is about a third more.

We have encouraged the private sector to produce units for us. I might add, they are under a very significant handicap, which I have brought to the attention of the federal minister. The non-profit can be subsidized down to 2 percent in their mortgage, where the others of course pay the going rate for mortgages. Despite that, they can still produce not only a building but the service for a considerable amount less on average than many of the others. I think we should encourage that and make use of those facilities.

[Mr. Strachan in the chair.]

[ Page 5860 ]

Mr. Chairman, the per them rate worked out with the long-term care facilities is used to cover their costs. One of the very real costs of either a non-profit or a profit facility is the cost of their mortgage. I believe we permit up to $6.50 a day with respect to the mortgage. We're getting the service for the money we pay. That's what we're contracting for. If we can get the same level of service at a slightly lower cost because of perhaps better management, we're certainly going to try to get it. We recognize there have to be safeguards.

Interjection.

HON. MR. NIELSEN: There's nothing wrong with someone selling tomorrow. It's like somebody with a neighbourhood pub, I guess, selling it and making a profit, letting someone else operate it.

Interjection.

HON. MR. NIELSEN: Well, we're subsidizing every mortgage.... At the moment we're subsidizing the non-profits down to 2 percent. Someone's paying for it.

AN HON. MEMBER: Non-profit.

HON. MR. NIELSEN: Non-profit! It's taxpayers' dollars. Just because it's a non-profit association doesn't mean it costs us less. Goodness gracious!

The reason I become frustrated.... I think we've had a new method of funding every year for the last ten years. This is the latest — April 1, 1984.

We introduced a new system for reimbursing the operators of long-term care. We're dealing with about 17,000 beds. The system replaced the previous arrangement, in which private facilities were funded on a different basis by the Ministry of Health than were non-profit facilities. We have 135 facilities operated by non-profit societies, and they provide 10,800 beds; 300 facilities are operated privately, and they provide about 6,200 beds. In the past, Mr. Chairman, private facilities were reimbursed on a fixed per them basis according to a residence level of care. Non-profit facilities received an operating grant from the Ministry of Health covering their approved budget. This resulted in a unique per them being established for each non-profit facility. They were on a global budget system. The new system now reimburses all facilities for their staffing costs according to a guideline and the average staffing cost in a particular facility. The staffing guideline has been in place since long-term care started, and was last revised in 1979. Other operating costs, such as administrative expenses and supplies, are reimbursed at a fixed daily rate based on a provincial average.

The most contentious component has been the capital component. As the revised system was implemented without additional funding and with severe time constraints, the program was limited in the options that could be considered with respect to capital costs. As I mentioned, as a result, private operators are being reimbursed for capital at a standard rate of $6.50 per day. The rate was based on the medium capital cost. The private facility operators have expressed serious concern that this rate of funding is both inadequate and inequitable. However, there is always next year. The program is in the midst of a major review of capital funding, and it is something we have not yet been able to resolve.

Nonetheless, the 17,000 people are receiving a high standard of treatment. The system is working. We are encouraging more private facilities. We are encouraging the federal government to perhaps allow private facilities the same opportunity of subsidized mortgages, provided they're providing long-term care. We know they can build the facilities cheaper, we know they can operate them at a lower rate, and we know we can require the same level of care. So it isn't quite as ominous as the member would suggest. They provide a very good service, and I think we're fortunate that we do have that many operators in the province. Otherwise we'd have to build that many more facilities without increasing our number of beds.

MRS. DAILLY: Well, it's ominous to people who happen to have a different philosophy than you and your government, for one thing. We find great difficulty in this whole business of making profit out of health care, and particularly this whole area of your new financing formula. You didn't mention that this new formula means that the non-profit are having to cut back on staff. That's true. They're cutting back on staff to enable the taxpayers to pay for the mortgages of the private owners. Let me quote from the director of the B.C. Association of Private Care Facilities: "Nursing homes are a reasonable business to go into now, because virtually every place is full right now, and the business is recession-proof. All census data proves that we are going to increase our aging population, so it's guaranteed for the next 40 years to continue to be profitable." Under this government it's going to be more profitable. That's true.

Interjection.

MRS. DAILLY: I know. We have a complete difference in philosophy here, and I regret it that you have said to this House that you intend to encourage more of the profit-making out of health care. I think that is very sad. I do not agree with the minister when he says that the private hospitals are more efficient and more cost-conscious. You agree? You really say that?

HON. MR. NIELSEN: Less costly.

MRS. DAILLY: Less costly, are they? Have you got figures to back all that up for us? I'd be most interested in seeing them. I think many members of the public would be, too. From everything we can see, that may be so, but at the same time are they providing the same quality of care that we need?

Interjection.

MRS. DAILLY: Well, we have some pretty sad stories. I know the minister knows. I don't want to stay here tonight and read through some long emotional letters that I've received, but the care in some of the nursing homes seems to leave something to be desired. I know that the minister must also receive some of those letters. You may say that private homes can cut costs, but I say: at what cost to the patient in the hospital? That's our concern.

HON. MR. NIELSEN: I'd be pleased to see that correspondence. We do, of course, respond to each complaint we have, no matter which facility may be in question.

[ Page 5861 ]

[5:45]

Just a very brief comment. It was an interesting point the member made about anyone making a profit in health care, because doctors make profits. They'd better. Pharmaceutical companies make profits; they'd better. And those who develop technology make profits. That's what they're in the business for. So we'd better not wipe out the profit motive or we'll wind up with the health system in some of the east European countries.

The House resumed; Mr. Strachan in the chair.

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

Hon. Mr. Nielsen moved adjournment of the House.

Motion approved.

The House adjourned at 5:46 p.m.