[ Page 7667 ]

CONTENTS

Tabling Documents –– 7667

Ministry Of Post-Secondary Education Act (Bill 15). Hon. R. Fraser

Introduction and first reading –– 7667

Education (Interim) Finance Amendment Act, 1986 (Bill 12). Hon. Mr. Hewitt

Introduction and first reading –– 7667

Oral Questions

Premier's principal secretary. Mr. Stupich –– 7667

Northeast coal. Mr. Williams –– 7668

Government advertising. Mr. Macdonald –– 7668

Expo 86. Mr. MacWilliam 7669

Food bank operations. Mr. Williams –– 7670

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

On vote 37: minister's office –– 7670

Mrs. Dailly

Mr. MacWilliam

Mr. Howard

Mr. Davis

Mr. Lockstead

Mr. Stupich

Mr. Cocke

THURSDAY, APRIL 10, 1986

The House met at 2:05 p.m.

HON. MR. GARDOM: At considerable sacrifice in coming over the waters from that great riding of Vancouver–Point Grey today, and missing a day in classroom, are 22 grade 7 pupils from St. Augustine's School. They are in company with their teacher, Mrs. Gladys Brown, and I would like to inform all members that St. Augustine's and its church will be celebrating their seventy-fifth anniversary this year on May 31 and June 1. Much welcome to Victoria. Glad to have you here.

HON. MR. CURTIS: Among those in the gallery at the start of our afternoon sitting are Deanna Mulvihill, the Victoria chapter president of the RNABC, accompanied by Ruth Ditchburn, who is a constituent in Saanich and the Islands and director of nursing at Sunset Lodge. Would the House make them welcome.

HON. MR. RITCHIE: I would like the House to welcome very good friends of the Ritchie family, Mr. and Mrs. Gordon, visiting us today.

HON. MR. SMITH: Also in the gallery as part of the delegation of registered nurses is Mrs. Wendy Underhill, registered nurse from my constituency. Would the House welcome her.

MR. PARKS: Very early yesterday morning we had a serious apartment fire in Coquitlam. Luckily there were two RCMP members on routine patrol and they spotted it. Not only did they turn in the alarm, but at great risk to their own lives they went into that building and ensured that every resident got out safely. Both of them unfortunately were overcome by smoke, and I understand that they are recovering. I would ask the House to join me and acknowledge our RCMP throughout the province where they are continually doing a very fine job and often not given recognition. I would ask the House to join with me in acknowledging the efforts of Const. Randy Marquardt and Const. Reg Steward.

HON. MR. WATERLAND: In the precincts today and meeting in Victoria are members of a very important industry in British Columbia, managers of the various mines in our province. I ask the House to join me and welcome these gentlemen to Fantasy Island.

Hon. Mr. Curtis tabled the report of the auditor-general for the year ending March 31, 1985 and the 1985 annual report of the commissioner of critical industries.

Introduction of Bills

MINISTRY OF POST-SECONDARY
EDUCATION ACT

Hon. R. Fraser presented a message from His Honour the Lieutenant-Governor: a bill intituled Ministry of Post-Secondary Education Act.

HON. R. FRASER: Mr. Speaker, after much consultation with the education industry, the government, as you know, has moved to combine post-secondary education into one ministry. This has met with great approval around the province. I would therefore move that the bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 15 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.

EDUCATION (INTERIM)
FINANCE AMENDMENT ACT, 1986

Hon. Mr. Hewitt presented a message from His Honour the Lieutenant-Governor: a bill intituled Education (Interim) Finance Amendment Act, 1986.

HON. MR. HEWITT: Mr. Speaker, I move that the bill be introduced and read a first time now. In making that motion. I would like to take a few moments to explain the principle of the bill.

These amendments basically give school trustees the right to raise additional revenue through residential taxation to provide programs identified as those which meet local community preferences. With these amendments, there will be a three-tiered system of educational funding in British Columbia: first, a fair and equitable allocation of funds per student throughout British Columbia, paid for by the provincial taxpayer via the Ministry of Education fiscal framework formula; second, the local school board's ability, because of these amendments, to tax residential property owners to cover expenses in excess of the provincial funding allocation, in order to provide services which may be unique to that particular school district; finally, the opportunity for local school boards to now apply to the Excellence in Education fund for funding of innovative projects.

In introducing these changes, I can say there is strong support for greater local autonomy in decision-making, and this is a move towards that goal. Secondly, fiscal controls introduced in the education system in recent years have been in keeping with the economic conditions of the times. School boards must continue to be cautious in increasing the tax load on homeowners in a district. I would like to remind them that along with the ability to tax goes the corresponding responsibility and accountability. Therefore school boards should ensure that program enhancements have the support of their local taxpayers.

Bill 12 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.

Oral Questions

PREMIER'S PRINCIPAL SECRETARY

MR. STUPICH: Mr. Speaker, my question is for the Minister of Finance in his capacity as chairman of Treasury Board. Will the minister advise whether the government's contract with Jerry Lampert in the Premier's office entitles him to use the private government aircraft fleet in connection with his duties and responsibilities?

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HON. MR. CURTIS: Mr. Speaker, did the member say the private government aircraft fleet? What was his phrase? I didn't hear the last part of it, I'm sorry.

MR. STUPICH: ...fleet.

HON. MR. CURTIS: Mr. Speaker, I don't know. I have indicated this is the third day of questioning with respect to the person who is taking up the position as principal secretary in the office of the Premier, replacing someone who has served as principal secretary. I would refer the member to the opportunity, which will be as long as members of the opposition wish, to examine the Premier regarding the expenses of his office and policies in his office at the time....

SOME HON. MEMBERS: He's not here.

HON. MR. CURTIS: I understand, Mr. Speaker, the Premier will be here quite soon — if not tomorrow, then the beginning of the week. I also wonder if the question meets the test of urgency as in question period.

MR. STUPICH: Mr. Speaker, I would just like to remind the Minister of Finance that for the last two years the Premier has not been here for his estimates. It used to be that we had someone who took his place as deputy Premier, but that post has been done away with.

However, another question to the chairman of Treasury Board. I'd expect the Treasury Board to have some answers to some of these questions. Can the minister advise us whether or not the hard-pressed taxpayers of B.C., in addition to providing a $77,000-a-year salary for this person, will be supplying him with a government automobile in connection with his duties and responsibilities prior to and during the election campaign, which we have been told will be sometime within the next two years?

HON. MR. CURTIS: Mr. Speaker, the question asks of future government policy.

MR. STUPICH: Mr. Speaker, on the contrary; it asks whether or not the contract provides him with an automobile. Is the minister saying that it's future because it does not at this point?

[2:15]

HON. MR. CURTIS: I do not know of a "contract" — the NDP might like to put one out on him — which has been signed by the future principal secretary to the Premier. If such exists, then I will admit the same to the House, but I do not know of the existence of contractual arrangements or a contract between the office of the Premier and the soon-to-be incumbent of that position.

MR. STUPICH: Mr. Speaker, again I'm a bit puzzled. Is there nothing more between Mr. Lampert and the government other than a golden handshake? I do have another question and it's along the same lines. Maybe I should let him answer that one.

Apart from the automobile, on which we will have to wait for an answer, I wonder if the Treasury Board chairman knows whether or not the taxpayers will be reimbursing Mr. Lampert for his travel expenses within B.C., again during the period prior to the election — during the election campaign.

HON. MR. CURTIS: Mr. Speaker, I clearly heard the phrase "will be," and if that does not relate to future government action, then I don't know what does. The member has tried valiantly. I am confident that the Premier of this province will stand in this House before Committee of Supply to answer questions. He enjoys debate on his estimates.

Interjections.

HON. MR. CURTIS: You have difficulty thinking up some questions for him, but as it turns out, Mr. Speaker, I'm sure that opportunity will present itself. As soon as I see the Premier of this province — in a day or two or three — I shall indicate to him the interest shown by the member for Nanaimo, and urge the Premier to call his own estimates relatively soon. Then we can have the full discussion which that member wishes. I hope he doesn't, however, run out of questions, as often happens.

MR. STUPICH: Just one more question to the Minister of Finance.

AN HON. MEMBER: Don't stop!

MR. STUPICH: Just one more for today.

Does the Minister of Finance recall the most recent occasion on which the Premier stood in this House and answered questions in connection with his estimates?

MR. SPEAKER: Out of order.

HON. MR. CURTIS: That's clearly out of order, and that would be a matter of record in this chamber.

NORTHEAST COAL

MR. WILLIAMS: Mr. Speaker, a noted economist and Rhodes Scholar, the member for North Vancouver–Seymour (Mr. Davis), stated on February 5 that there was to be a discount in the first five years in terms of the surcharge on the Tumbler Ridge line. Could the Minister of Finance advise me whether that is the case or what the revenues have been from surcharge on that line?

HON. MR. CURTIS: Mr. Speaker, a question very similar to that has been taken as notice, and I will return to this House very quickly with the full answer. The question today has slightly different shading, but I shall examine that and take it as notice as well.

MR. WILLIAMS: Could the minister advise the House how the $501 million extension to the northeast coal fields will be paid?

HON. MR. CURTIS: Mr. Speaker, I think actually that that matter has been explained in this chamber before, but I restate for the member's interest, in terms of northeast coal and financial obligations associated with it, that I will bring that information back to the House.

GOVERNMENT ADVERTISING

MR. MACDONALD: To the Minister of Finance. A citizen sitting and watching his television, not doing anybody

[ Page 7669 ]

any harm, saw the minister on an ad. It began with.... There was even a picture of Bob Hope — you know, government with and without hope over there. It talked about the film industry, and I think the minister knows the one I'm talking about. Then it said how great that we were putting people to work, and then the minister was behind his desk. The citizen wanted to know whether that was paid for by him, in part. Is it being paid for by the taxpayers?

HON. MR. CURTIS: Mr. Speaker, I think we have again encountered a circumstance where, if you choose, almost any question can be directed to the Minister of Finance of the day in terms....

MR. BLENCOE: You don't like the heat, eh?

HON. MR. CURTIS: Why don't you get a question of your own and then you can ask it, Mr. Member?

Mr. Speaker, I think that there is a more appropriate minister for that question to be directed to. It is certainly not....

Interjection.

HON. MR. CURTIS: I've never met Bob Hope.

MR. SPEAKER: Order, please.

HON. MR. CURTIS: I tried once, and he declined, and I don't blame him.

But, Mr. Speaker, the activity to which the member's question refers — i.e. television announcements, if you wish to use that term — are not under the jurisdiction of the Ministry of Finance.

MR. MACDONALD: Mr. Speaker, I ask the Minister of Finance again: did the public pay for that ad? Are you really going to fudge that question? Are you really?

MR. SPEAKER: Order, please.

HON. MR. CURTIS: Will the member sit, Mr. Speaker?

MR. SPEAKER: Order, please. The Minister of Finance.

HON. MR. CURTIS: Mr. Speaker, the member is occasionally here for question period, but not always. I would suggest that he determine, with the assistance of his research department, the minister who is responsible for a question such as that and direct the question to that member of the executive council.

MR. MACDONALD: Mr. Speaker, would I have the approval of the Hon. Minister of Finance to reply to this citizen that the Minister of Finance would not answer my question...

MR. SPEAKER: Order, please.

MR.MACDONALD: ...and that what to the citizen was obviously outrageous political advertising at the expense of the taxpayer is something this government is so guilty of that they won't answer the simplest questions about it'?

Interjections.

MR. SPEAKER: Order, please.

MR. MACDONALD: You know that that is larceny of public funds.

[Mr. Speaker rose.]

MR. SPEAKER: Hon. members, it's question period; it's not expressions of debate or interest. May we continue with question period, please. There was no question there, hon. minister.

I Mr. Speaker resumed his seat.]

EXPO 86

MR. MacWILLIAM: Mr. Speaker, in the absence of the Minister of Tourism (Hon. Mr. Richmond), and the Provincial Secretary (Hon. Mrs. McCarthy), I'll direct my question to the Minister of Education, who is the backup for Tourism, I understand. Expo 86 Corporation requires approximately 15,000 temporary employees, I understand, to operate the world's fair. I wonder if the minister would advise how many of these positions have now been filled'?

HON. MR. HEWITT: Mr. Speaker, in order to be accurate, I'll take that question as notice and have the Minister of Tourism report back to the House.

MR. MacWILLIAM: Thank you. Mr. Speaker, I'll inform the minister that it's 9,000. which leaves about 6,000.

A new question to the minister: Mr. Bob Griffiths, who is the director in charge of hiring, is among the small contingent of Expo executives— I think somewhere in the number of 42 — who have recently been dismissed by this government. According to the Minister of Tourism's earlier statement, these people were dismissed because their job has run out. Obviously with the 6,000 people remaining, his job has not expired.

My question to tile minister is: in view of the fact that Mr. Griffiths was dismissed before his job was complete, is the minister prepared to reveal the total value of the severance package?

HON. MR. HEWITT: Mr. Speaker, in the form of a correction to the member, the employees — I think you mentioned some 42 or 43 of them — were dismissed by government.... The member made an error. It is not "dismissed by government," but released — or if their contract was up or their job was finished, they would be released by, or in some cases maybe fired, Mr. Member — by the Expo corporation, not by this government.

Mr. Speaker. I for one find it that good management would dictate that when a job is complete, then there is no further need to pay or have an employee on staff. If this gentleman that the member refers to is one that has been released, and there is a severance package available to him, I would advise the Minister of Tourism of the member's question, and the Minister of Tourism will respond when he gets back as to whether or not he is prepared to release that information.

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MR. MacWILLIAM: Another question to the same minister. The government has failed to comply with the provisions established in the Financial Information Act with respect to Expo corporation. The financial disclosure report was, I remind the member, due on October 1, 1985. Expo spokesman George Madden says that the government has been given a specific list of the fired executives and a complete list of their severance arrangements.

My question to the minister is: why does the Minister of Tourism refuse to make this information, which is available to him, available to this House and available to the public?

HON. MR. HEWITT: Mr. Speaker, I am not aware of any material that has been passed to the Minister of Tourism. As a result, of course, I will again take that question as notice so that the Minister of Tourism is aware of the member's concern about Expo and its employees as opposed to being concerned about some of the areas of the economy in this province.

FOOD BANK OPERATIONS

MR. WILLIAMS: To the Minister of Human Resources. The executive director of the food bank in Vancouver yesterday announced that one week a month she would be discontinuing food bank operations for people in need. Is the new minister willing to meet with the director of the food bank, and is he prepared to go there and see the problems that they currently face in these very difficult times?

HON. MR. NIELSEN: Mr. Speaker, I don't know whether I've heard from the executive director of that particular food bank, but I'm sure if she wanted to get in touch with me she could contact me— unless that member is booking appointments for her.

MR. WILLIAMS: It's a simple question. Will he or won't he meet?

MR. SPEAKER: The bell terminates question period, hon. members.

Hon. A. Fraser tabled answers to questions from the member for Mackenzie (Mr. Lockstead) on Wednesday, March 26, 1986.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $207,950.

MR. HOWARD: I'll defer to the member for Burnaby North.

MRS. DAILLY: Thank you to my colleague from Terrace.

Would the minister respond on the hospitals'? I gave you some statistics, and I know you and your deputy were writing down the answers — if you would.

[2:30]

HON. MR. NIELSEN: I apologize for the break in continuity of the questions which the member was discussing prior to the adjournment.

We were discussing hospitals, and the member was mentioning various situations with respect to hospitals' budget and surplus situations, and with respect to the comparison between the number of beds available today and in 1982, and whether in 1982 the action was taken with respect to closures because we were over-serviced, and perhaps what the situation may be today.

I don't know whether the member would want the precise financial position of all hospitals at this time. We some time back developed a program where all hospital budgets are subject to a quarterly review. In many instances we make adjustments to budgets to reflect their actual caseload. Those changes in budgets could be up or down. Then there is the year-end reconciliation, once again, to determine precisely what the caseload of the hospital was that year.

Some hospitals could be in positions, at certain times of the year, which would indicate that they could be headed for a deficit. The quarterly adjustment could recognize their caseload increase, and their budget could be modified accordingly, or vice versa. I'm not sure at this time.... In fact, the fiscal year having just concluded, I would think that the ministry is just now receiving actual figures from some hospitals to see what their situation is.

We told the hospitals some years back that we would no longer pick up deficits, that we felt it was their responsibility to manage their facilities, and the deficits would have to be worked out in future budgets. They would have to carry some over. Most of them have been able to comply with that, but we do look at increases in cost as they relate to the workload, and we make corrections.

With respect to the number of beds, there's been a change over the last number of years with respect to beds. There's been a conversion of beds from acute to various forms of long-term. There's been added interest in day-surgery beds, newborn beds and other categories, and there has been some conversion. In fact, we were rewarding some hospitals with grants when they converted from acute to extended, because the patients in the acute beds were actually extended-care patients.

Mr. Chairman, I got the figures between the two sessions today with respect to the acute-care bed vacancy situation in the province. At the present time we have 11,084 acute-care beds, what they refer to as "approved" beds. As of April 7, 1986, 9,505 were occupied. The beds which were reported available for acute-care patients but not utilized as of that date: 1,451. The 1,451 beds which were available April 7 are, of course, staffed and available for patients. It is spread all over the province, of course, and you're going to get different situations at different hospitals, some of which operate at very close to 100 percent occupancy almost always because of the nature of their facility. Those were the numbers as of April 7. I don't have the reports going back to the other weeks, but we do have this done on a weekly basis. The number is usually in the 1,100 to 1,400 range.

We do have, if you like, provincewide a 10 percent factor or so of beds available for acute-care needs. Obviously a person who requires a bed in one town is not going to be able to take advantage of a bed available elsewhere unless it's a highly specialized need. But on balance we're usually sitting in about a 10 percent factor of available beds which, at the

[ Page 7671 ]

moment, are not being utilized. I think that was part of the question that the member had asked.

I'll wait and see if there are further questions, but I think basically that's what you were speaking of.

MRS. DAILLY: While we're on hospitals — and there will be some other questions coming up from my colleagues which will point out to the minister that there are still concerns in some of the areas in the province about the shortage of beds, but I'm going to let some of my colleagues report from their own areas later.

There's one point I want to bring up before the member for Okanagan North (Mr. MacWilliam) speaks: that is, that when I was discussing with you.... I know we cannot come to any meeting of the minds on the matter of user fees, but I do want to point this out for your consideration, to get your reaction. Mr. Minister, 19 of the hospitals that we surveyed in the province reported either an increase in the number of bad debts at the hospital or an increase in the number of people entering the hospital without MSP coverage. So apparently more people are letting their coverage lapse, particularly young people; this has occurred more often than not— being able to pay for the emergency fee, which some people going to the emergency manage to scrape together, even if they're in great difficulties, although I consider that can be a burden for some also.

My question to the minister is this: many people today, now that your government has seen fit to increase the premiums to a point where a single person now has to come up with over $200, are not paying for that coverage — young people particularly. They're out of work; they can't come up with that amount of money.

You may say yes, but if they go to the hospital we won't let them suffer. The point is: this breaks the universality of medicare. I'm wondering if the minister is not concerned that more and more people are turning up at hospitals today without coverage because of this policy. We're also having an increase in the number of bad debts at some hospitals. Would you comment on those two problems?

HON. MR. NIELSEN: The member is aware that if a person is on income assistance, then the Ministry of Human Resources takes care of their premiums. If a person is on low income but not in need of income assistance, there is a subsidy program of up to 90 percent. I would suggest that very few people, young or otherwise, could not pay a couple of dollars a month for premiums. So there is no excuse for not being covered under MSP in the province. There's no excuse, in my opinion.

Increase in bad debts, I don't know. I'd have to verify that. We probably have numbers somewhere in the system. One of the reasons could be because we do not pursue relatively small amounts of debt owing with great vigour. We certainly ask people to pay. But we do write off some, yes.

The Medical Services Plan, of course, is not the hospital. The hospital is available to the person. They don't have to have MSP; that's to do with the medical service they may receive from the doctor, or otherwise. There are really very few reasons for a person not to have coverage. There are many occasions where a young person has been covered by a family plan and is no longer and never applies for medical service. In some instances, they believe they'll never be sick. But they should apply for it. There is a subsidy program if they are in a position of having a very low income. So I don't see that as a major factor. I don't see why it should be.

Mr. Chairman. I might also mention that there are people in the province who sometimes get into some medical difficulty and then complain that they're not covered, or that they're not eligible to be covered, even though they did have an opportunity at some time to acquire forms of insurance to cover it: and we get these from the different people. It's almost as though they want to buy fire insurance after the fire. We do cover people in a retroactive way: if a person's insurance has lapsed, and a couple of months go by and they're in need of care, we will permit them to retroactively pay the premium. I've never met a person who has been involved in expensive medical coverage who was not delighted to be able to get the coverage simply by paying the premiums. But in the instances of some young people, medical premiums, probably, are not one of their highest priorities until there's the need. But they should be aware that they can have the coverage, and should have that coverage.

I don't think it's widespread as perhaps some of your surveys indicated — I think you said 19 of the 97 hospitals. I would have to try to confirm that with some. But bad debts have always been a fact of life; and that's why they try to get people to pay up front for a portion of the period of time they are expected to be in hospital.

According to the Greater Victoria Hospital Society, bad debts have decreased from $404,000 in 1982-83 to $234,000 for the current fiscal year; that represents less than I percent of the non-grant revenue generated by the hospital. The provincewide basis: the industry — we refer to it as the hospital industry — in 1982-83 reported bad debts of $4,465,000. During the current fiscal year it is projected the expenses will not exceed S4 million, so there seems to be a downward trend on bad debts.

MR. MacWILLIAM: To the minister, last year when we were discussing previous estimates — and I know it comes under previous estimates, but it comes under these estimates too — I had talked to the minister at great length in regard to the speech therapy program, specifically as it relates to the North Okanagan area. Perhaps I can just quote from a letter that I wrote subsequent to that regarding that program, and the minister may recall the details. But I will, if you permit me, refresh his memory.

"Pursuant to my recent statement in the Legislature regarding speech and hearing therapy, I am writing to supply specific details....

"Discussions with Dr. Roland Katagi, ministry speech consultant, verified that there are 170 people awaiting speech therapy in the North Okanagan Health Unit. The average length of wait is approximately one year, depending upon the severity of the cases."

Now that was written in July of 1985, and the minister may recall that he responded to that letter with the following:

"At present the Ministries of Health and Education are reviewing the distribution of speech and language services in the province. If rationalization of services is accomplished, there would be a significant increase in speech pathology services to the preschool and adult populations of the North Okanagan region."

Perhaps I would ask the minister at this point whether such a rationalization of services has now been completed and what the results of that study have shown.

[ Page 7672 ]

HON. MR. NIELSEN: I am advised that that study has not been completed. It is still being worked on, apparently. Mr. Chairman, with respect to that subject the member raised, the question of speech therapy is quite difficult without knowing — as you mentioned, 170 — what type of therapy is required. There are various types, as you know. One of the more common is the effects of a stroke and various other difficulties for adults. There are separate problems for children who have some form of a handicap that frequently affects their capacity to speak. But just as quick general information, there were 1,800 clients who received direct intensive speech and language therapy in the '85-'86 year. There was a success rate— although I wouldn't attempt to suggest how they determine the success rate — in their program in excess of 50 percent. That's the speech and language therapy. The companion to that of course is audiology, which is often the problem. There are 47,000 children screened for possible hearing impairment through the high hearing program and the school hearing conservation program. So the combined speech, language and audiology program is an extensive program. But specifically, no, we have not yet concluded that rationale. I am advised that the report has not been finalized.

[2:45]

MR. MacWILLIAM: I certainly have no disagreement with the minister that the program is very successful, if in fact a person can get onto the therapy program. The cases I cited and supplied to the minister last year were largely cases of children, preschool children specifically, that could not get access to the program without undergoing lengthy waits, up to two years. Sometimes by the time the person finally got a chance for the therapy program for initial screening, they were already of school age and a lot of the effectiveness of the program had been compromised by the wait.

Anyway, to make my point, I have received further correspondence in regard to this problem, and when I checked with the North Okanagan health unit, I was advised — and this is just recently — that the waiting list is still about 156 to 160 long and the length of time for initial screening and assessment is still an excessively long period of time. I guess what I am trying to say is that not much has happened in the last year, and I would suggest to the minister that there are a number of preschool children up in that area who are anxious to get onto the program. It seems that after a year in process, I would have hoped that this rationalization program could have been finalized and some recommendations for rectification made at this point.

Moving on to another area with regard to a number of letters I have had from chiropractors in the North Okanagan area — and I will submit these letters directly to the minister at this time, if you would like to take them over — the letters do outline a number of concerns, but I will break them down into just a few.

Firstly, fee schedules for chiropractors. Just a little background information. In 1985 there were 355 chiropractors treating approximately 322,000 B.C. residents. The information that I received from them is that about 80 percent of the general populace experiences periodic back pain at some point in their lives, but about 30 to 40 percent suffer from daily spinal problems. They may be minimal or they may be very serious. About six years ago the value of insured services with chiropractors was fairly much on a par with that of physicians in the province, but the difference has grown quite dramatically over the years. In 1977 the average income of a chiropractor was $40,700 before expenses — about $23,500 in expenses, leaving a net salary of approximately $17,300. The 1985 figures I have indicate that income is now at $69,000, expenses at approximately $44,000, with a net income — I am told — of approximately $20,000 to $25,000. It seems that for the years of training and the responsibility that these professionals have, their remuneration has fallen far behind remuneration in other areas of the health care system. That information, by the way, has been supplied both by a survey of the practitioners in British Columbia and from Ministry of Health files.

Now apparently — and the minister might address this point — the budget for chiropractic care under the Medical Services Plan has increased fairly significantly since 1981; but the records indicate that the increase is due to an increase in the number of practitioners, a significant increase in the number of patients and a small increase with regard to fees for service. Comparing it to the medical profession, an increase of 74 percent in the MSP budget since 1981 has been mainly and largely, I guess, due to an increase in fees for service. B.C. chiropractors, according to information available to me, are the lowest paid in Canada. After initial visits they receive $11 per visit. I just want to compare this with other provinces. Apparently Alberta is $15 per visit; Manitoba, $16; Ontario, $19; Quebec and the Maritimes, approximately $18. So it seems that B.C. chiropractors are financially quite behind the rest of the country. I would suggest that the minister consider the fact that these professionals, who have a very important part to play in an integrated scheme of health care delivery.... I don't think they're getting their fair share of reasonable remuneration.

The second point I'd like to make is in regard to visitation rights for chiropractors in hospitals. If the minister cares to peruse the letters that I have received from chiropractors in the greater Vernon area, he will find that a number of them are proceeding to attempt to get visitation rights with patients they have in Vernon Jubilee Hospital. I guess I and my colleagues come from a philosophical point of view that these professionals are a part of the total health care scheme, an important part of any integrated scheme of health care delivery, and should have access to their patients, after consultation with the physician and if it's in the patient's obvious best interests. I wonder if the minister would care to comment both on the present remuneration received by chiropractors and on the area of chiropractors' hospital visitation rights, and shed some light upon the direction he'd like to take in the ministry.

HON. MR. NIELSEN: The last question first — the visitation rights in hospitals. The B.C. Chiropractic Association and I are in complete accord with respect to what they're asking for and what they should have. As a matter of fact, I was speaking — I believe it was yesterday — with the president of the Chiropractic Association. I told him I was quite prepared to encourage all hospitals in the province to permit the chiropractor to attend a patient in hospital, provided the person responsible for the admission of the patient concurred — that's the medical practitioner who puts the patient in the hospital. Mr. Chairman, I might mention that the medical practitioner who admits the patient has the responsibility of that patient while the patient is in hospital and must be responsible for all treatment of the patient. So I said if the medical doctor who admits the patient agrees to

[ Page 7673 ]

permit the chiropractor to work on that patient, I would encourage the hospitals to agree. The chiropractors said that is precisely what they're asking for. They don't wish to admit patients to the hospital; they simply want to be permitted to work on a patient with the concurrence of the medical practitioner. I have no objection at all to that. It is the hospitals who must make the decision in that they are running those facilities. Why they would object to it I do not know, but I certainly intend once again to send a general statement to all hospital administrations and boards to let them know what I think the situation should be and recommend that they cooperate.

Just staying with the chiropractors for a minute, Mr. Chairman, it was recently that we advised the hospitals to make available to chiropractors copies of x-rays of their patients, rather than submitting the patient to a separate x-ray where one had already been taken. I think now every hospital has agreed to do that. There was reluctance on the part of some. There was some concern about releasing documents or files that they deemed to be confidential, but we eventually.... I think it was changing the regulations that permitted this to occur. So they now have that, and it's working reasonably well. There are still a few bugs in the system.

So the chiropractors have been able to achieve that, and I know they appreciate that, and it's probably to the benefit of the patient. The availability to patients in hospital I agree with. I will encourage all of the hospitals go along with that at least to see what the problems, real or imagined, may be. I think we'll have a handle on that.

I was just waiting to see if information came down with respect to the fee schedule. Chiropractors have been excellent over the last number of years in cooperating with the provincial government when it comes to fee schedules and costs. They were the first of the health professionals who agreed to a capping system — not necessarily implemented but agreed to the concept. They were the first to roll back the fees of a few years back. They've been very cooperative. We've discussed many ways in which we could improve the situation. A few years back the chiropractors were concerned because a global amount of money was allocated per patient for that service, and as their fee schedule 1ncreased the number of visits declined, so what we said was no, we will keep it at a fixed number of visits, rather than a total amount of money. That also assisted.

The chiropractors can quote fee schedules from different provinces, but they haven't said whether they're covered in those provinces. Chiropractors are not an insured service in some of the provinces in Canada. They are in British Columbia up to that limit, but in some provinces it is not an insured service at all, so in effect they can charge whatever they want and get paid that. We do cover it. They also have private patients who pay their full fee schedule. They also do work for the Workers' Compensation Board, ICBC and others, so they are not limited to what would appear in our blue book, paid from the Medical Service Plan. Chiropractors do have a lot of private patients, and they also have services to people who are insured by other methods.

The $11 is low by comparison to other fee schedules across the country. We recognize that. Chiropractors have been very good about not making excessive demands. The amount has increased substantially, because the utilization has increased substantially. It is most interesting, because there are those who have been critical of the Medical Services Plan, which limits the number of chiropractic visits per patient per year as an insured benefit — a dozen at the moment and 15 for seniors — and many people have said that it's unfair, and it should be open-ended. But just as an aside, the investigation into utilization for chiropractic adjustments shows a remarkable number of people who utilize 10 to 11 per year and stop there. Only about 9 percent of the patients actually exceed the limit. It's argued that if there were 15 a year, that would be the number; if there were 20, that would be the number. But it has worked.

I can't give you the list of provinces who cover chiropractors, but not all of them do. So some of their figures may be interesting but really not part of what we would offer in B.C.

Chiropractors do deserve some consideration for modification in their rates. I think they provide an excellent service to the people in British Columbia. They're an important adjunct to the medical system, and I regret the traditional animosity that seems to continue between chiropractors and medical doctors.

The information, I'm told, is that Quebec and the maritime provinces do not cover chiropractic as part of their services. But I've been in constant contact with the chiropractors, and we've had good discussions. We are in negotiations with them right now for fee modifications. I don't negotiate with them directly, probably because I've been a patient of chiropractors for many years and perhaps they might take advantage of that. But your message is well received, and I have great respect for that branch of the health sciences.

[3:00]

[Mr. Ree in the chair]

MR. HOWARD: First I want, out of my ordinary, normal, compassionate nature and friendliness, to express my understanding and concern about the mental health condition of the cabinet when it was revealed that its national leader is Jim Keegstra. I can see how much you....

Interjections.

MR. HOWARD: I have full concern about your feelings that this has suddenly been revealed to the general public.

Anyway, I want to deal also.... This is under the estimates. So was the other. Mental health is under this minister's jurisdiction, and I'm sure he's concerned about the mental health of his colleagues, as well as he is about the general citizenry. But there were two or three items, if I might, one of which relates to user fees, which had been raised by my colleague from Burnaby North (Mrs. Dailly) earlier, and to which the minister replied that in his view the member's opinion about user fees was in error.

Interjection.

MR. HOWARD: That her view was in error. You said that it was a good view. Her opinion about user fees was correct and supportable. I want to talk about user fees and tell the minister that at the annual general meeting of the Mills Memorial Hospital Society in Terrace, a motion was passed stating that the society opposes user fees in general and in particular in the emergency department. At Mills Memorial Hospital, no one is refused service because of inability to pay, and I'm sure Mills Memorial is not unique in that regard. That can be demonstrated by the patients who never seem to be able to pay according to their account card but who

[ Page 7674 ]

continue to receive the necessary health services. That's a commendable approach for all hospitals. As I said, I'm sure Mills Memorial is not unique in that regard.

For the hospital's fiscal period ending March 31, 1985, the total visits by insured residents to their emergency department was 13,959, and that generated a total revenue of $83,369, which is 1.2 percent of their total hospital budget.

"Our in-patient and out-patient user fee (excluding MSP rejects) write-off accounts total $24,297, whereas total revenue for in-patient and out-patient user fees was $229,394. Terrace and the area served by Mills Memorial Hospital has been no exception in feeling the effects of the recession" — and of restraint.

I'm reading now from the letter from Mills Memorial Hospital.

"In discussion of 'user fees,' we support the new Canada Health Act, Bill C3, and its intent to ensure that the fundamental principles of medicare are protected. If not the immediate abolition of user fees, planning for a more cost-effective health care system should include phasing out user fees.

"A comparison of specific hospitals over a two-year period shows that while other income increased by 23 percent in hospitals' revenue totals, the bad debt expense for these same hospitals for the same period rose by 31 percent. The bad debt experience of hospitals is increasing, indicating that the ability of hospitals to realize the income generated by increased user fees is diminished.

"User fees only deter the poor, the elderly or the chronically ill. User charges are a breach of accessibility, because people who can afford the fees are not deterred, but people on minimal or fixed incomes are deterred" — or may feel deterred. "User fees may deter persons from seeking help in what may or could be an emergency situation. Although mechanisms can be created whereby Human Resources clients are exempt from user charges, studies have shown that it is the 'working poor' who are the lowest beneficiaries of health services...."

They refer there to a study by the Ontario Economic Council, identified as "Income Classes and Hospital Use in Ontario.

"The parliamentary task force on federal-provincial fiscal arrangements agreed that, for reasons of both principle and practicality, user charges for hospital services should be discouraged.

"One could understand and possibly support user fees as a means of increasing revenues in times of budgetary constraints, if retention of these revenues could be negotiated with the Ministry of Health. As it now stands, any revenues raised by the hospital are deducted from the portion payable by the B.C. hospital programs; in effect, the responsibility for funding merely shifts from the society as a whole to the sick, the elderly and the infirm. This is contrary to the spirit of medicare and the national health program which was legislated into being by the Medical Care Act of 1966.

"From time to time there have been incentives, offered by the Ministry of Health, to hospitals who were prepared to introduce programs that would generate cost savings" — and they enumerate two or three of them there.

They go on to say, in the final representation made by Mills Memorial Hospital, that "from the patient's viewpoint, user charges amount to extra charges that an individual must pay after he or she has already paid for health care through federal and provincial taxes. The society is requesting that legislation be drafted for the next sitting of the Legislature abolishing all user fees and, in particular, emergency outpatient fees." That letter was written at the end of January, incidentally, and submitted and signed by Mrs. Linda Hamilton, president of the board of trustees of Mills Memorial Hospital.

As I understood the minister to say earlier, this is not a matter that anybody seems to clamour about consistently and persistently enough to get the ear of government with respect to it. But the fact of the matter is that the highly respected board of trustees of one hospital have made a deliberate and conscious effort to this effect — abolishing user fees. They approved a motion at their annual meeting, prepared a letter in support thereof and transmitted that for consideration. I wrote to the minister's immediate past predecessor about this, and got a terse reply back which said that user fees have been in existence as long as the program has been in existence — period. That was the end of the reply — no comment as to whether it was agreeable or disagreeable.

I think we need to take into account, in dealing with user fees, the facts of the matter that many of us know, as stated in this particular letter from Mills Memorial Hospital. Let me just sort of reiterate them. It is basically the elderly, the infirm and the working poor who are taxed an excessive amount, through both user fees and general taxation, and can least afford it; and those are the ones who receive the least amount of health care services, when compared with other groups in society or with those in a much higher income bracket.

I also want to discuss a question of sexual abuse. Some psychological opinion, in a very broad sense, says that sexually attacking women, children or other relatively defenceless people is an exhibition of a power trip on the part of the abuser, that there is an element of insecurity involved in that person's makeup, so that ordinary, regular, normal, healthy sexual relationships are not participated in, and they have to have this aberrant view and approach to sex and exhibit that power by attacking children and women. In this regard, I wonder whether the minister can advise whether his ministry has any knowledge of or information on, or has conducted any inquiry into, the subject matter of sexual abuse of patients in mental hospitals and of elderly residents in intermediate- or extended-care facilities — whether there is any indication that the power trip that people with aberrant sexual behaviour go on is visited upon people in those groups. I have heard that it occurs. I don't know of specific instances and so on, but I have heard from different sources that it does take place, and I think it is worthwhile examining — or hearing from the minister as to what knowledge may exist about that and how it's being approached.

I want to deal with the question of alcohol abuse or booze or whatever name is used to identify it. While it might be an exaggeration to say that this is a government that is in partnership with alcoholism, I think that it's necessary to declare that they are partners in alcoholism for the purposes of making the point. Being partners in alcoholism results in the budget that was presented to us, showing that there's an expectation of an income from the liquor distribution branch this year of $420 million, or $185 for every person in the province of whatever age.

[ Page 7675 ]

AN HON. MEMBER: Is that profit?

MR. HOWARD: That's the income to the provincial treasury. It's in the budget as an income, and that would be from the liquor distribution branch into the province's hands, down the gullet of the treasury branch — $420 million. In these estimates, for the community services side, the alcohol and drug portion of it is some $22 million — $22.3 million, I believe from memory — or something in the neighbourhood of $9 to $10 per capita; $185 per person income, a $9 to $10 expenditure, and that is an expenditure after the fact. It's an expenditure supposedly treating alcoholism. It's an expenditure after the damage is done. It's an expenditure for detoxification centres and for treatment in facilities, both public and private, of people who have problems with alcohol and need, therefore, to be treated for it.

The income is about 19 times the expenditure, and the expenditure is after the damage, not before. The expenditure is not in the area of prevention, not in the area of education. It's in the area of trying to clean up the mess for the individual afterwards. It's after the misery, and it's after the family breakup takes place, and it's after the child abuse takes place, and it's after the wife-battering or woman-battering takes place. It's after the accidents, it's after the physical damage. It's after everything that takes place that's damaging with respect to the abuse of alcohol that the government then steps in and says: "We're going to put out some money here for treatment." It's a paltry, insignificant, piddling amount of money compared to the income. I don't think anybody who looks at it could justify raking in $420 million on the one hand and paying out $22 million on the other to deal with the effects that the $420 million created in the first place.

I've no idea what the costs to the health scheme are.

I see my time has expired. I'll leave it at that and maybe come back in a moment to the same theme.

[3:15]

HON. MR. NIELSEN: I'd like to just respond to the member's questions with respect to the abuse of those people who may be in mental institutions or intermediate care, and frequently we're dealing with elderly people.

There have been a fair amount of inquiries into what is known as elder abuse. It is a problem. There was a provincial conference on abuse and neglect of the elderly in November 1985. The report indicated that the instances of abuse of the elderly are becoming more visible and are more frequently reported. The growing number of the elderly receiving care in the home and in institutions has heightened the instance of abuse. Staff employed in the community and institutions report cases of financial abuse, emotional or psychological abuse, and, less frequently, physical abuse. There was no mention in that one report with respect to sexual abuse. This is primarily the elderly; this is not necessarily all mental institutions.

Mr. Chairman, if I could just, in a very general way.... It is a very serious problem, the matter of abuse and the matter of sexual abuse, particularly in instances where the victim is, in effect, in the custody of the abuser, or the person who is the abuser has some form of authority or opportunity because of the nature of their employment. We've had some specific instances which have led to reaction. I'm not going into precise detail, but in one instance a person employed in an institution was believed to have been abusing some patients sexually. It was brought to the attention of the administration and the person was suspended for, I believe. three or four days. Immediately there was an appeal to the suspension, and the matter carried on for a period of time. We found out about this and asked questions as to: is that all? It then turned into something a bit more; the RCMP were brought in and criminal charges were laid. I was astonished that an incident such as that would be dealt with by way of a relatively light suspension from duties. If the person were not responsible for the abuse, then why suspend them at all? If they were, then what is a suspension?

Nonetheless, it has become far more understood that it's not to be swept under the carpet. We have had reports of some incidents where a person, again engaged in an institution of some kind, has been the subject of accusations of that type of thing and charges have been laid. I would think the incidence of abuse is far less in our medical or our health institutions than in others. In most of these areas there is generally a reasonably large number of staff around at all times. There are times when the staff is minimal — overnight and so on. We have had very few reports of sexual abuse in these institutions. I am very concerned about that possibility and we have instructed a number of the institutions to provide us with information, including what procedures they follow, but we have not had large numbers of cases reported to us.

Mr. Chairman, again in general, a national report — I forget the name of it — which spoke about sexual abuse suggested that there should be a specific criminal act, rather than a general act that applies to all, for a person in a position of trust who abuses victims. It also suggested — which I very much support — not permitting people found guilty of that conduct to return to that line of endeavour. It suggested they be disbarred from that particular vocation once found guilty of breaking that trust. I truly believe we are going to have to consider that form of legislation across the country and in provinces because we seem to be in the centre of an epidemic because of the vast number of reports which are beginning to show up. We could be in two positions: more of this being reported now than previously, or more of it occurring now than previously. But it's a very, very serious matter. I agree completely.

Basically, Mr. Chairman, a person in a position of trust with people in his or her custody has an extreme responsibility, and when a patient is in a hospital or a child is in a school, or a citizen is in any form of institution where people are responsible for their care, they and their relatives must be assured that they are not about to be abused. So we're working toward that end. As you know, we have legislation specifically with respect to the protection of children which requires people to report suspected cases of abuse. It leads to all types of fun and games, but nonetheless it's an attempt to try to bring that matter to the attention of the proper authorities.

On the alcohol and drug abuse, I don't think there's a direct relationship to how much money people in B.C. spend on liquor. The amount the member quotes is from the sales of our liquor in the liquor stores to citizens, restaurants and licensed premises. The S420 million is the profit, which is, I suppose, about half of what they actually receive, because the markup is about half. But then, of course, much of that liquor is purchased by licensed premises, who then dispense it to their customers at a far greater cost. So I would think you might be looking at $1.5 billion — a huge amount of money spent on alcohol in the province.

[ Page 7676 ]

I don't think it would be reasonable to suggest that that amount should be used to rehabilitate people, because not all people who consume it of course are going to be in need of rehabilitation. The member mentioned, and he didn't complete his statement but I think I caught part of what he was saying, that the prevention is far more practical. Of course it is, just as it is in all matters of health care. We have introduced various programs by way of education. We've tried to warn young people, particularly. The Ministries of Attorney-General, Education, Health, Human Resources and the Insurance Corporation of B.C. have cooperated with respect to alcohol and driving. There have been many programs. We do offer counselling. We do have, as the member said, detox centres and others dealing with the results of the problem. And we do fund a number of agencies which specialize in treatment of those suffering from alcoholism.

[Mr. Strachan in the chair.]

There are also a tremendous number of people who are being treated for the effects of alcoholism in our hospital system by medical doctors, and so on — after the fact. How you prevent abuse of alcohol is a problem facing all of society. We have entered into agreements with various agencies to try to assist those who are suffering from the difficulties. It is perhaps the greatest contributing factor to our social services budgets, be it health, human resources, corrections or whatever. If someone has an answer as to how you avoid that, it would be most welcome. But I know tremendous efforts have been made everywhere. The problem does not seem to be abating. Perhaps the member might have more on that issue, Mr. Chairman.

MR. HOWARD: I had just earlier reached that phase of the comments that we're dealing with.

I think we need to look at who benefits from the consumption of alcohol, in a very broad, general sense. The minister referred to the $420 million as being profit. He touched his pocket when he did that. That's money in the pocket. That's profit. That's what it is in terms of liquor sales. There's another profit as well. That's the profit that accrues to the producers, to the beer, wine and hard liquor producers in this land who sell the product, and who promote and advertise it in the slickest way possible at all possible levels to entice people to consume it.

I've looked at a number of ads in household magazines, newspapers and the like, and in not one ad promoted by a liquor company — that I have seen in any event, although there may be exceptions to this — has any advertising by a liquor company tried to talk about the damage that would accrue from alcohol. It's always beautiful, glorious and sexually attractive, youthful, virile, gay and happiness that's exuded in these advertisements. If you'll just drink the booze, you'll realize all those attainments of contentment and happiness and lifestyle and pretty women or pretty men — whatever you're looking for. The liquor industry is selling anticipation of something better, and that's what adds to a great deal of the misery. The profits go to the government — $420 million of them — and to the liquor industry and its distribution elements. The misery and the suffering come to individuals in society, but to society generally. The misery and the pain and the cost are borne by the taxpayers. It's the taxpayers who put up the money to keep and treat in hospitals those people who are impaired or injured by the ravages of alcohol. The industry does not suffer. Hiram Walker doesn't suffer in that way; Calona Wines, to name just one in the wine field, doesn't suffer by that. They are the beneficiaries. They receive the benefits in the form of profits from the sale of their product.

[3:30]

And the government receives the benefit in the form of profits, as the minister said. He called them profits and touched his pocket — a $420 million profit. I submit that this government is looking at liquor no differently than does the liquor industry. They're both bottom-liners. "What profit can we reap out of this in dollars and cents that we can stick into the budget and show that it's there?" You can't stick in the budget family misery and pain and battered children and broken homes and broken bones. You can't stick in the budget the common plea of the person who gets drunk and appears in court on some charge or another, or as a witness, and says: "Your Honour, I don't remember. I was drunk." You can't put in the budget here the pictures of people murdered by drunken drivers who end up in court and plead, "Your Honour, I don't remember. I was drunk," and somebody's life is snuffed out or they're injured for life as a result of that.

Yes, many examinations have been made of this. I don't think the government is trying hard enough. I don't think they're recognizing the fundamental question of who benefits and who suffers in alcohol. Industry and government benefit; people are the ones who suffer. I've advanced the idea on a number of occasions and I put it forward again. I put it forward in this House a few years ago and the response I got from the Minister of Health was a simple one: "Oh, if I carried out that idea, all it would do is to raise the price of liquor." I didn't think that was of any consequence. The government doesn't look at that when it comes to taxation. It says: "Let's raise the price. What's the difference?" They exploit the frailties of human beings who have an affinity for alcohol or who want to buy it regardless of the cost.

I suggested — and I suggest again — that we deal with the liquor industry on the basis of its advertising program, and that for every buck spent on advertising and promoting its product, the liquor, wine and beer industry set aside another dollar in a fund. It doesn't really matter to me whether it's a government fund or an independent group fund. Dollar for dollar advertising — that extra dollar can be used to advertise and educate and promote and give the balance factor. The liquor industry's sole interest is in selling its product; it doesn't give a damn about the results on society or people. Individuals in the industry probably would. The individual president of a corporation may have that feeling about the damage that accrues, but the industry per se is an inanimate object and the corporation per se doesn't have compassion or a soul. It only has a bottom-line approach: how can we expand our profits today?

I'm saying that the beneficiary, he who reaps the benefit in dollars and cents from the sale of liquor, should also put up money to deal with the misery part of it. It shouldn't be all one-sided. I urge the minister to look at that as a possibility, and perhaps find a sufficient amount of money that we can engage in an educational and promotional campaign to talk about moderation in alcohol use. All the general public is getting now, with the full endorsement of this government, is advertising that says liquor is glorious and beautiful, it's the way to go, and no damage will ever accrue to you if you drink this brand of gin or that brand of scotch or this kind of wine, or

[ Page 7677 ]

whatever it is that they're promoting. If we don't do something of that nature, we'll be having this same debate next year and the year after and I don't know how long into the future — if we don't take a dramatically different view of it and ask the people who are reaping the profits to also share in some of the misery on the dollar side.

MR. DAVIS: Mr. Chairman, I want to make several points and ask one or two questions. The first point I would like to make is that not only do we appear to have kept our health care in this province under control, but that our health care costs, relative to the total income of the province, are quite low. I don't really understand what the reasons are, but in the United States more than 10 percent of the gross national product goes to pay health care costs. In this province the figure is somewhere around 7.5 percent. It is around 7.5 percent across Canada. While our health care costs have risen substantially over the last decade, they have, by and large and especially in the last few years, mounted more or less in line with the ability to pay of Canadians and in our case British Columbians.

So I think that the minister and certainly the government and indeed a succession of ministers should be complimented for the containment of health care costs relative to other countries. Even in the United Kingdom, where per capita incomes are much lower than in the United States, the health care cost proportion is more in the order of 8 or 9 percent. So we have in this country and in British Columbia a remarkable record in this regard. I would like to hear from the minister why he thinks we in Canada and we in British Columbia in particular have been able to contain costs to this extent, particularly because the quality of health care service here is so good and because it compares favourably with those services delivered in other countries.

I would in this connection like to quote a recent report on health care funding in B.C. The quote is from the B.C. Economic Policy Institute, which, while critical of some aspects of health care administration in the province, has this to say:

"Restraint is no new phenomenon in the health care area. Despite periodic claims of cost explosions by various political figures, the Canadian medicare program has achieved a degree of stability. Health care costs in Canada have run between 7 percent and 7.5 percent of GNP since the early 1970s. B.C.'s health care costs have risen somewhat faster than the national average, Between 1970 and 1981 they increased their share of provincial output from 6.8 percent to 7.5 percent. But the key point of these figures is that the Canadian form of funding universal, comprehensive and public insurance has made cost control possible, at least thus far."

So a pat on the back from a left-leaning institution which otherwise was critical of health care. Certainly they were saying that performance in terms of cost containment was reasonable and compared favourably with other administrations.

I would like the minister to tell us, if he can, the extent to which we have been able to contain our costs by treating people at home, treating them outside of expensive institutions like modern hospitals. That has to be a contributing factor, and I know that the ministry has further plans in that connection.

Doctors' fees, more particularly billing numbers. I understand from several people in the medical profession here in B.C. that no new billing numbers have been issued for some time. We had legislation last year which empowered the government to deal directly and forthrightly with the numbers of doctors in the province. I gather that by 1983 some 400 new billing numbers were issued; in 1984 some 260; in 1985, how many? In the last six or eight months, how many? My impression is that zero or very few if any new billing numbers have been issued. And in the face of the fact that taxpayers are paying for and graduating a hundred or so new MDs a year from our centres of higher learning, what are the longer-term intentions or plans of the ministry? We've had a bulge in admissions. We are overdoctored in this province. The doctors themselves agree about that. There has to be some way, if not immediately, of rationalizing our expenditure on the education of young doctors, and the fact that for the time being at least, we are not admitting more of them or any additional doctors to practice via billing numbers in the province.

There is an attrition of a hundred or so doctors a year. Could we have a policy where we were educating of that order of young doctors and they have some priority in entering the medicare system in this province — in other words, in obtaining billing numbers?

I realize this is a problem. It is not a problem unique to British Columbia, although we have a unique way of dealing with it. The profession across Canada — certainly the health ministers — agree that we have too many doctors. We also appear to have too many doctors in our major metropolitan areas and, in some instances anyway, not enough doctor care in the outlying areas of Canada and of the province. Ontario has a financial incentive for doctors to serve in smaller communities in northern and western Ontario. I gather that the incentive for a family practitioner in northern Ontario is currently of the order of $40,000 and is income-tax-free. It's certainly income-tax-free from a provincial point of view, and it is paid quarterly — $10,000 a quarter — to doctors practising for a period of time in those outlying areas.

What do we have? What do we intend to have in order to give an incentive for doctors, young and old, and particularly our new young doctors, to serve in those under-doctored areas of the province? Have we a longer-term objective? Have we a plan other than simply limiting billing numbers in the greater Vancouver area drastically and perhaps, over time, issuing billing numbers in some of the under-doctored regions? Do we intend, in other words, to introduce an incentive plan, as opposed to one which is directly administered by a committee largely of doctors, who determine where the regional requirements are in the province?

Last year — on August 1, I believe — the Health ministry decided not to extend publicly financed health care coverage to foreign students. I'm not talking about landed immigrants or Canadians whose parents — or, indeed, they themselves — came to Canada in the not-too-distant past; I'm talking about people who have visas, who are foreigners. As of August I last year they ceased to receive tax-supported health care coverage and had to go, if they wished coverage at all, to the private market. I agree with that policy; I think it makes good sense. But there are several cases I currently know of in which people who have obtained Canadian citizenship have returned to their country of origin because of financial and other problems here, and are now sending their children back for various reasons: one is the low cost of education here;

[ Page 7678 ]

another is to escape the draft in Iran — or whatever. I would hope that the minister would continue that policy of not giving them any more financial incentive to come here.

[3:45]

Finally, a serious problem area — the rising cost of no-fault insurance carried by doctors. Plans of that nature are being discussed in the United States, especially where the annual cost to a doctor of covering the likelihood of lawsuits is now running at $10,000 a year, and in some instances $50,000 and $100,000 a year per doctor. There is some increase in settlements here, and there certainly is concern about this. I've been told by doctors practising in the province that not only are they concerned about exceptional settlements which might go against them, but also, because of the fault system that we have, the adversarial system in the courts, that they can be sued for not having carried out all conceivable tests in a given set of circumstances. In order to cover themselves, they are calling for all kinds of tests at great expense to the taxpayer, when common sense tells them that only a few tests would do, would focus in on the problem as they see it developing with their patient, and that this problem of insurance is therefore adding materially to the costs of delivering health care here, because it's adding immensely to the testing, to the laboratory expenses of our health care program. I wonder if the minister might care to comment on any or all of those points.

HON. MR. NIELSEN: ML Chairman, the health care costs.... I'm not convinced that a percentage of the gross national product is the only way to measure, although it's a consistent factor you can reflect on.

One of the features, I guess, of the system in Canada is that we do not have practitioners engaged in the financial obligations of the facilities. There is no advantage to a practitioner having a patient in hospital with respect to profit, whereas if you are an owner of the facility you may be also interested in maintaining maximum use of the facility by patients. That could be one reason.

But it's interesting, the dilemma country to country, by comparison, because in some countries the utilization of hospital space is grossly inefficient compared to Canada, and yet our utilization appears to be grossly inefficient compared to many institutions in the United States. The average length of stay for an acute-care patient in B.C. Is about 7.6 days, down from about eight a few years back, when we asked them if they could speed up the admission and release programs to get people in quicker or out quicker, and thus reduce the average length of stay. So it's down to about 7.6. In Washington state the average stay for acute-care patients is about 4.3 days. The obvious reasons for it: there's a tremendous financial incentive to get out.

I was in Los Angeles last year at the Cedars of Sinai Hospital, where I was advised that their per diem rate is $1,600 a day. Patients who in our system would be admitted to hospital the previous day for, let's say, bypass surgery arrive at that hospital frequently the day of the surgery to avoid that extra charge and are released much quicker than our patients might be. So there seem to be inconsistencies, where their system seems to have certain efficiencies from a turnaround point of view, but the costs are extraordinarily high.

Our institutions are quite different than many of theirs, where they have private facilities that really look like headquarters of international banking corporations, with tremendous duplication of equipment. The hospital I was speaking of was designed in such a way that each floor is a self-contained hospital with laboratories, radiology, operating theatres and so on. So the patient never has to leave the floor. It's awfully expensive to operate that way — and four and five nurses per patient in the intensive-care ward.

[Mr. Ree in the chair.]

So we have developed tremendous efficiencies, I think, in the health care system across Canada, probably in B.C. as well, because we have far more direct control in the big spending areas, and we've had some success. We've also put on the pressure. B.C. at one time was leading the way across Canada in health care costs. We still have the highest fee schedule by about 30 percent, but in all aspects of our health care system B.C. was leading the way, and we were subject to a tremendous amount of criticism from the other provinces for excessive settlements for health care workers and doctors.

That has been reversed considerably, and now we are the only province that I'm aware of — perhaps Quebec has a similar system — where we have introduced a partial capping method for the medical doctors. I'm advised that the CMA has expressed very strong opposition to that concept with the BCMA people, but we've had some success.

The savings for patients outside of hospitals is only measurable with respect to what we pay per day compared to what we would pay in a hospital. The saving to the system, however, is not the same, because while the patient is relieved from the hospital care and sent home, someone else takes their place in the hospital, so the cost is still there, with an additional cost for the patient at home. The cost for the individual patient, of course, is considerably lower. I think the big saving we're seeing is coming about by substitution — by way of day surgery rather than in-patient surgery — where patients are using minimum facilities in a hospital for the surgical procedure and then being released and going home that day rather than utilizing the full bed.

I mentioned earlier, Mr. Chairman, the use of high technology such as the lithotripter. That's an absolutely amazing comparison. The lithotripter for kidney stone disintegration permits a patient to be released the same day rather than stay in for eight days at a cost of several hundred dollars a day, so that is a tremendous saving, and more will be coming.

The question of billing numbers is before the courts, isn't it? It is always before the courts. I think we've had four or five cases. Mr. Chairman, you may recall that the government lost a case in court, and our Medical Services Commission was ordered by the court to issue numbers, in effect. We had been doing very well trying to contain the numbers. In 1984 there were 258 numbers issued. We got into the glue in 1985, and by way of court instruction had to issue certain numbers. In 1985, 455 numbers were issued, 281 permanent, 174 locum; 258 the year previous and 455 last year. We do have too many doctors in B.C.; the doctors acknowledge that. We tried to do something about it, and we've been challenged in court repeatedly. So we will continue to pursue that.

The question of medical coverage for foreigners. Last August, as the member mentioned, changes were made with respect to the definition and eligibility of people in Canada for the Medical Services Plan. It centres around the definition

[ Page 7679 ]

of "residence" and also "visitor." The people the member spoke of would be regarded by the definition as visitors to Canada. One of the reasons it was changed was a matter of consistency and equality for all non-residents in Canada. If a person visits us from Seattle as a visitor, they are not eligible to be covered by our plan. If a person visits us from another country by way of some other method of coming to Canada, they are not eligible for the plan.

We have a large number of problems and a continuing argument with the federal government about ownership — we'll be here until Monday, anyway — of these people. Our argument is that if the federal government permits a person into Canada as a refugee, a visitor or whatever other status, they should be responsible for that person's costs, rather than the provinces.

We've had a poor fellow in the hospital now for two or three years with a kidney disorder, and I think he owes the hospital about $800,000 or somewhere near that. The costs are just incredible. The man is not eligible for the coverage. Of course he hasn't paid it, but we've asked the federal government to please send a cheque forthwith for our costs in taking care of their patient, and they have said no. We've tried to encourage these patients to return to their homeland, and we would also assist them medically. But that's been turned down as well.

But I think it is improper for Canada to permit a person into the country who then requires extensive medical care and then to say to the provinces: "Pick up the tab." We did not permit the person in. They're here, and I think we have to say that our program is paid for by the citizens of Canada for the citizens of Canada and those who are eligible for that status, including landed immigrants and others. We've had some flack about it, but we're not doing too badly, I think.

The member asked about the liability insurance. Mr. Member, I have some specific numbers which may be of interest. The liability premiums have risen in Canada from $50 annually in 1973 to $500 by 1983. In 1984 a differential fee structure set higher fees for hire of specialists up to $2,900 per annum. The Chair may be interested that a second-year gynaecologist in New York state is required to pay about $90,000 in premiums yearly. The doctors are very concerned, as we are, because the money does come from the taxpayer by way of a portion of the fees. The hospitals are also faced with this liability insurance problem, as are municipalities and so many others. I think there is going to be some resolution to it. We have suggested that it is worth considering with the doctors that rather than the coverage, the traditional method of insurance, perhaps there could be a fund established, jointly funded in some way — basically self-insurance. I think perhaps that is the only way to go.

MR. DAVIS: I just have one specific question in one area, really, relating to children born at Grace Hospital. I wrote to the minister last year and asked how many children had been born in the Grace Hospital, and in the calendar year it was about 7,600. Of that figure, some 5,700 were covered by the B.C. hospital plan. Therefore some 1,900 were not; and there were 70 out of province. So there was a substantial remainder in the order of 1,600 to 1,700 babies born.

They are, generally speaking, born to foreign people who either come here and by accident had a baby here but more likely come here by design. They first, I believe, pay average cost. They are not subsidized in any way. I'd like the minister to confirm that. My comment really is that a child born here, in the fullness of time and certainly at reaching maturity, is a Canadian citizen. Not only can that Canadian citizen, having been born here, come to Canada as a Canadian citizen at any time, but that person can also bring younger brothers and sisters and parents to Canada upon reaching majority.

[4:00]

Has the provincial ministry expressed any concern whatever about this particular category of coverage. Obviously facilities are being used in the province by outsiders, and I think a good many of them for the purposes of obtaining Canadian citizenship. Does the minister think this presents a problem of priorities in getting into Grace Hospital and other hospitals in the province when outsiders are tending to use our system as a way of obtaining Canadian citizenship?

HON. MR. NIELSEN: The utilization of Grace Hospital is of major concern. It is not the foreign visitors who have arrived who are the major contributing factor; it is the tremendous success of the Grace Hospital as a tertiary centre for maternity cases, and the popularity of the facility to the point where people who would otherwise go to their community hospital are booking into Grace Hospital, and it is being overutilized.

There is an element of births resulting from intentional visits to Vancouver by people from other countries. I believe the member is probably quite correct that it is primarily for the purposes of Canadian citizenship. There are distinct advantages to having Canadian citizenship, and in certain areas of the world where there is tremendous political unrest, parents are considering having children born in Canada so that child will have the right to Canadian citizenship in the future. Thus, having that, they would be in the position to sponsor relatives as well to the country. So there is no question that part of that is occurring.

I don't think it's causing an overcrowding at Grace Hospital. Grace Hospital has worked with all of the other hospitals in the metropolitan area to try to get them to make better use of their own facilities rather than automatically sending patients to Grace. It was designed for 6,500 to 6,700 deliveries annually; in 1984, there were 7,474, so it is being overutilized at the moment and we are trying to do something about it.

The member is correct. The people who are not covered by our plan do pay the actuarial price, which is still pretty cheap for them compared to some international standards, and they don't spend that much time in the hospital. I don't think it's the major element, but it's part of it.

MR. LOCKSTEAD: I want to thank the member for deferring to me because I have to be somewhere in a short while.

Firstly, I want to say that I don't want to break up the thread and trend of this current debate, and I want to associate myself with the remarks from our caucus spokesperson, the member for Burnaby North (Mrs. Dailly), but I have two specific matters to bring to the minister's attention involving my constituency and I welcome the opportunity to do so now.

The first is the construction of a new hospital in the Powell River regional area. For some years, as long as I have been an elected member of this House, this matter has been under discussion with various ministers of health, particularly over the last eight to ten years. That hospital board and regional board has, over the years, slowly been building a construction reserve fund for this purpose and has acquired

[ Page 7680 ]

the property near the populated area of the community. What I am asking the minister in terms of that is if the ministry has any plans to work with the hospital board in the Powell River regional area to start construction of that Powell River regional hospital.

In all fairness I should tell you that I did pose this question to a recently former Minister of Health, and he was very obliging. I hope the minister is listening, because this is quite important; it's the reason I'm on my feet here today. The then Minister of Health of a few weeks ago did respond to my correspondence, and did imply in that correspondence that that this matter would be a priority item within the five-year hospital plan of the ministry. But I'm suggesting to you that a more specific date or answer would be appreciated.

I rarely invite cabinet ministers to the riding. However, on this occasion, if the Minister of Health would like to visit the Powell River area, and perhaps do a little politicking for his party on the side — yes, you're welcome — and visit the hospital and look at the equipment, and meet with the administrator and members of the board, that would be appreciated. So you've got an invitation — might even get you a salmon or something.

Interjection.

MR. LOCKSTEAD: Well, the local Socred will look after that.

We have, Mr. Chairman, a matter that is just as serious. This is St. Mary's Hospital in the Sechelt area — the one hospital, aside from the clinic at Pender Harbour, that serves that whole Sunshine Coast. They urgently require a new wing for extended care. That area has a large proportion of senior citizens. It's a great retirement area. People are moving in all the time for retirement purposes. Once again, I'm requesting firmly in this House, and for the record — because you have all of this in your correspondence, I know — that that particular very much needed project be undertaken just as soon as possible. It's my understanding that people who require extended care in that area from time to time actually have to go to Vancouver, Powell River, Courtenay or other hospitals, as I understand it. That's secondhand information. Nonetheless, perhaps the minister could give us some idea where this matter is on his priority list or on the ministry's list. While you're in Powell River, you may as well take the ferry and go down the Sunshine Coast and visit St. Mary's as well.

HON. MR. NIELSEN: To the member for Mackenzie, Mr. Chairman, there were two projects being considered for Powell River General Hospital. One is a 75-bed extended-care unit. Then there's planning for a new acute-care hospital. The planning for the extended-care unit is much further advanced than for the acute-care one. Both are in the pre-planning process — although I think the extended-care unit is in the planning process now. I couldn't offer a date. It is, as you were advised, within the five-year capital program. I wouldn't know precisely where. We have never attempted to provide a date, other than when we are assured it will be within the fiscal year. We've always tried to wait until we know which fiscal year it will be in, and then made that known during that fiscal year, or just prior to it, so that they can then begin the process. You could tell them it might be in a couple of years and then, for whatever other reasons, it can't happen. Sure, I'll go up there.

Interjection.

HON. MR. NIELSEN: Is there any doubt? I'd be pleased to go up to Powell River with you, visit the hospital and look around a bit. Work out a time, and we'll go up and see it. But I'll have to do some digging to see precisely where they are at the moment. I'd be pleased to accompany you up the coast, and we'll have a look at these facilities as soon as we can. How about tomorrow?

[Mr. Rogers in the chair.]

St. Mary's. The planning for a 50-bed extended-care unit, expansion of associated support areas, planning for.... This is just on St. Mary's. There's an extensive request from them — about $6 million. At the present time the action is the planning for the 50-bed extended-care unit. I believe I will be meeting with these people very soon. I think they've made an appointment to come down and talk about it. They do have a request before us, and it's still being considered. But I can't give a specific date.

MR. STUPICH: I have a specific complaint to raise on behalf of a constituent, and then a more general concern in connection with the same thing. It's from a letter — a file of correspondence, actually — from a constituent of mine, a Mr. Walter Ward. He wrote to the then and current Minister of Health on November 19, 1985. I talked to him as recently as today, and he was a bit upset that I couldn't raise this matter with the Minister of Health, who was also then Minister of Health. And I said: "Well, things have changed. By tomorrow maybe not, but the Minister of Health today is the Minister of Health who was in office on November 19."

"Dear Mr. Minister:

"I receive handicap assistance. My lower jawbone has shrunk to such an extent that it will no longer hold a denture. My gums are constantly irritated and my speech is affected. Since I am unable to properly chew solid foods, I have constant indigestion and stomach pain."

He sent a copy of that letter to the Minister of Health and to the Minister of Human Resources. I was able to tell him that it is one and the same person today, although he was Minister of Human Resources yesterday for the purposes of estimates. He has received a reply from the Minister of Human Resources telling him that there was nothing that that ministry could do for him. What his specialist wanted was financing for a special material — durapatite. The Minister of Human Resources, in expressing concern for him and saying that her ministry could do nothing, did say in her letter:

"I have taken the liberty of sharing your letter with my colleague the Hon. James Nielsen, Minister of Health, as hospital programs fall under his jurisdiction. The Minister of Health may be able to assist you.

His concern was that he wrote the letter to both of them on November 19, 1985. He has yet to have any response from the Minister of Health, which surprises me. I think it must be an oversight. Knowing this minister's record in that regard, I think something has gone astray.

He wrote again on January 23 to the Minister of Health, and mentioned the letter that he had written to the Minister of Health on November 19, saying that he had written to two ministers and had had a reply from one, and had still not

[ Page 7681 ]

heard from the Minister of Health. He had a date for surgery approved, and in this letter says: "Since you did not answer my letter, my surgery, after several months' wait, had to be cancelled. You know very well hospital beds are very hard to come by."

[4:15]

Along with the correspondence he includes a letter from the oral and maxillofacial surgeon. The surgeon said that there are three possible ways of dealing with this situation. The most inexpensive would be through day-care surgery, which could be done locally, but which involved the use of this durapatite. That was the most inexpensive from the point of view of care or lost time: it would take just day care, whereas the other two possibilities would both involve travelling to some other community to see an orthopaedic surgeon as well as an oral surgeon. Yet it would seem that the rules of the game would provide for that kind of operation to be done in Vancouver for him, but would not provide for it to be done locally since he's on handicapped assistance and couldn't afford to provide the durapatite material himself.

But really, he would like to have some response from the minister. I'll make a copy of this file available just so that.... I can appreciate that. But my more general concern is with respect to.... I talked to the oral surgeon, and he said it's not really just a matter of this durapatite, but a matter of prosthetic devices that are surgically implanted. Generally they're just not provided for under the medical health plan, I understand. I understand that that's the case, but I don't understand why it works that way. I believe, from what he told me, that even in the event that he has patients — which he has — who are quite able to pay for this on their own, the hospital just can't have that material on hand that the surgeon can then implant and have the patient reimburse someone for. That surprises me. I just don't know that the system works that way, but that's what the oral surgeon, as I took the conversation on the telephone, told me. He believes, from his letter, that this is much the best procedure. I'll make a copy of his letter available to the minister as well, although he didn't want his name used in this discussion. My constituent had no concern.

Apart from that, I have had other correspondence. Every one of us on both sides of the House, I suppose, could complain about this. There are stories.... I had a letter from someone who was in the hospital who had nothing but good things to say about the attention the staff gave, but was concerned about the fact that the staff were just hard-pressed — they weren't able to provide the level of service that this patient felt would help her recover from the condition for which she was hospitalized. There's a story here that was in one of the local papers, the Nanaimo Times — "Heavy Hospital Workload." I have a photocopy here and the original elsewhere.

"My wife spent ten days in Nanaimo Regional General Hospital recently with a serious infection. We were both impressed by the care given by the doctors and nurses, especially during the critical phase of her illness. However, we could not fail to notice the extreme pressure the nurses were under to maintain the required level of care, given their heavy workload. This became even more evident as my wife's condition improved and the nurses' attention shifted to newly admitted critical patients."

I notice the minister, in responding to a comment from the hon. member for North Vancouver–Seymour (Mr. Davis), said that where people had to pay the whole shot themselves for a hospital bed in the U.S. A., their time in hospital is much less. I don't know of any patients in British Columbia, or anywhere in Canada, for that matter, who decide themselves when they can get into a hospital and how soon they should leave. It seems to me that that decision is made by the doctors. If the system is being overutilized — if the hospitals are being overutilized — then it's something that should be taken up with the doctors. It's not the patients who should be suffering, and unfortunately that's what's happening, because of the workload and because of the fact that there are limited funds and because some people are taking advantage of the situation — and not the patients; it's the doctors.

Now I'd appreciate the minister's comment maybe on that. I don't know what he can do about it, but it would seem to me that it's nothing to do with the patients. They just don't make the decision.

HON. MR. NIELSEN: Mr. Chairman, I usually can recall all the correspondence, and I do not seem to be familiar with this. Now perhaps the gentleman.... If he's tried twice, I'm not wishing to pass the buck to him — perhaps the address has been wrong or something, because I just don't recall it. The deputy does not recall having seen it either, so there's maybe something wrong somewhere, but I would be pleased to get the information.

The last comment with respect to length of stay in hospital: the patient has a certain amount to do with it. They could do a little lobbying with the doctor to stay in a day or two longer. We get this frequently in maternity situations where the mother may want to stay in for a day or two just to rest. It seems to be inappropriate to have a hospital setting for that, but we do get that. The doctors basically are responsible for the ins and outs.

One of the reasons why sometimes the staff appears to be overworked.... And they do work hard — I'm not suggesting they don't — but the 12-hour shifts certainly take their toll. A 12-hour shift is a very long time, particularly in nursing, if you are in an intensive area. A 12-hour day is a long work day, and some of them get pretty ragged before that day is over.

Nanaimo hospital is a burgeoning hospital; it has been. Its location has just been that way, and as the member would know we have approved, I think, a 150-bed extended care which will offer some relief to the hospital.

Interjection.

HON. MR. NIELSEN: Yes. Well, Nanaimo is growing very rapidly too.

AN HON. MEMBER: Not right now, but....

HON. MR. NIELSEN: It has been.

But the figures indicate that by provincial standards they have more nurses per patient on average than the others — not a huge amount more, but an identifiable percentage more.

The rule of thumb for devices is — let's see now — if you can take it out, it's not paid for, but if it stays in as part of a procedure in a hospital, it is. I'm not that familiar with this procedure, but if as an example the implantation for a lens is in the eye, then it's covered, but contact lenses that would go on the outside are not. But I will respond directly to that letter, and if you're talking to the gentleman, I'd appreciate you

[ Page 7682 ]

saying that I just don't recall having seen it, but we'll certainly look into that.

MRS. DAILLY: Mr. Chairman, I want to turn to the topic of abortion, birth control, and I must say that I find it necessary to take to task you as one of the former Ministers of Health, as acting minister — and also the... I guess the former Minister of Health, the member for Vancouver South (Mr. Rogers).

To the present Minister of Health, I believe it was in 1983 that you were responsible for cutting off the grant to the Planned Parenthood Federation. I think that was a tremendously backward step which has had some bad effects on a number of people in this province since that move was taken. I consider it, to put it quite bluntly, a step based obviously on ignorance, because I can't understand the Minister of Health, who certainly is an intelligent person and who has shown so throughout all our debates.... I just cannot understand with his background how he could possibly cut back a grant in 1983 to Planned Parenthood.

What is even more astounding is that the former Minister of Health, the member for Vancouver South, actually made statements on the matter of the government's decision to cut preventive programs, such as the aid to Planned Parenthood — actually spoke in terms, Mr. Chairman; I've been waiting for you to be in the chair; you can't get back to me right now.... Anyway, Mr. Chairman, I found the terms in which it was couched.... His reasons for supporting the '83 move to eliminate the Planned Parenthood grant were based on statements that would have fit in more with 1846 than 1986 — again, I feel, based on complete ignorance. I find it astounding that any ministers of the Crown in 1986 could have made such statements as were made by that minister re this matter.

To make my point, if I may just quote from the Province, March 30, 1986: "Rogers defended the government's decision to cut preventive-program funds for groups such as Planned Parenthood in the 1983 restraint budget, saying that most people, including teenagers, are aware of birth control methods. It is not the state's job to ensure everybody take care of themselves, and the problem is one of attitude, not ignorance, he added." As I have said before, I'm afraid that the problem is the ignorance of the Social Credit ministers who actually believe that nonsense.

Mr. Chairman, for the edification of the Chair and the other members on the Social Credit side who obviously support this, may I point out to you, first of all, that each day in B.C. — and these are figures for a couple of years ago — 18 teenagers become pregnant. On the average, ten of the girls, little more than children themselves, decide to bear their babies and nine of them choose to raise them for adoption. That's just some figures that we have from a few years ago. The point I want to make is that it is known all across Canada and the United States, through many studies, that the rate of teenage pregnancy in Canada drops when sex education takes place in the schools and public birth control clinics are funded. Those are statistics, and this government.... We have cabinet ministers who make statements that fly completely in the face of the facts. I find it incredible. Let me say this again. The rate of pregnancy in teenagers drops. After a study it was found that it drops because of sex education in schools and public birth clinics.

So here we have the Social Credit government, through the voices of Ministers of Health, the ones who are in control of this, saying that it's all a matter of attitude, that women.... Actually, and may I quote again from the Province of March 30, Mr. Rogers went on to say: "Women are either blase (about birth control) or whatever. They don't think about it." Asked if women are using abortion as a form of birth control Rogers said: "You know it's true. I know it's true. Of course they are." Of course, a man has never had to have an abortion and never will, but I can assure you that for any woman I've talked to who's had an abortion or any woman who has to be faced with it, it is a dreaded thing that women do not look forward to. To suggest out of ignorance that women would want to use this as birth control is, as they say, completely based on ignorance, shocking ignorance.

To suggest that all women, teenagers included, in this province of British Columbia know all about how to prevent pregnancy is utter nonsense. Teenagers today may appear very sophisticated and very blase, but let me assure you that if you talk to many teenagers today and you start asking them specific questions about birth control and about how the child is created, how you become pregnant, I would suggest to the Ministers of Health that you would get a shock. They're making statements — one, particularly — presuming, out of ignorance, that all teenagers are right up to date on all this, that are absolutely false, particularly in the province of British Columbia.

Ever since the Social Credit government came into power back in 1975, it has very carefully refused to move on this area of sex education in our schools. I know the present Minister of Health will stand up and say: "Yes, there are programs going on." But they've only been dragged in without any leadership or help from Ministers of Education or of Health. There has been no real cooperation or leadership given by the Social Credit government to this matter.

At the same time that we have these Ministers of Health not doing anything to encourage and do away with ignorance, which is not their fault, in our teenagers by encouraging good sex education in our schools — and, may I say, of course, funding birth control clinics — they are decrying the fact of high abortions and the high number of teenage pregnancies. That wasn't stated by either of the ministers, but I have the figures here for that.

The member for Vancouver South, the former Minister of Health, has certainly decried the fact of abortions. I must simply get this on the record: I think that the Ministers of Health of the Social Credit government are doing an extreme disservice by turning their backs on real support for sex education in our schools and turning their backs on helping Planned Parenthood to do their job. I find it absolutely unbelievable.

[4:30]

All the costs that arise — not only the social costs and the emotional anxieties from young girls becoming pregnant, but the cost to society at large.... Let me give you an example. Do you know, Mr. Chairman, that $1 spent on prevention of teen-age pregnancies will save $10 in social services. Even though you may be reluctant, on a matter of principle or philosophy, or whatever it is, to endorse birth control clinics and sex education, you still have a responsibility to look after the taxpayers' money, and you're not doing that when I can give you these figures that $1 in prevention saves $10 in social services.

Here is another example. In the United States, do you know how much money is now spent on support services because of teen-age pregnancies?

[ Page 7683 ]

I do hope the Chairman doesn't have to leave — not that I don't care to see the new Chairman, but.... However, you can read it in Hansard.

(Mr. Strachan in the chair.]

Mr. Chairman, do you know that in the United States, $17 billion has had to be provided for support services in health care, etc., because of the teen-age pregnancies that take place in the United States. Yet we have the president and other groups who are doing nothing there — in fact, they're doing the opposite — when it comes to preventing these pregnancies.

I really feel that any government in 1986 that comes out with these kinds of statements.... I find it abhorrent and I find it tragic, because of the tragic victims of those policies. I don't want to appear to be lecturing to the ministers; I simply want to say to you that I believe you have a responsibility in this area. I would like to hear from the present Minister of Health and know his reasons for cutting back on the grant to the Planned Parenthood Association. I would like to know if he will reconsider reinstating that grant. I would like to know if he endorses the statements on abortion made by the former Minister of Health. I think we simply owe it to the many people who have been upset by those statements, and by the government's policy, to have an answer. I would like to hear from the minister on those.

HON. MR. NIELSEN: Mr. Chairman, I'm trying to remember all the details associated with the Planned Parenthood Association, which is a private organization. I mean, they have an attitude and a product to sell, and we....

Interjection.

HON. MR. NIELSEN: Well, sure. We decide whether we're going to contract their services. We decided not to.

As I said, for a number of reasons, one of which was that the services they offer are available elsewhere. We're not obliged to continue contracts with one organization when there may be a similar service available from others or in some of our other clinics or through different forms of counselling. The Planned Parenthood Association is just one of many available and we're not obliged to continue grants to these organizations indefinitely. We do make decisions and make modifications as to whom we fund.

They had 17 birth control/VD clinics across the province. The grant portion of the funding was terminated. The Medical Services Plan continued to provide payments to the association for their physicians. The member may be interested that in 1982-83 they received $115,000. In 1983, as of September, they received $50,550. In 1985-86 they received $115,000. The payments made to them in 1985-86 were $115,000 from the Medical Services Plan, so they are still receiving moneys, but not the grant portion. We provide free space to the association in our health units and, as I said, payments from the Medical Services Plan totalling $114,500, so their physicians may continue their service. So we are still supporting them.

I'm trying to get some vital statistics for the last year, and I know the book is on its way, because I don't know what the numbers were for the last year. The book has just been produced, I believe. In fact, I don't think I've tabled it in the House as yet.

Interjection.

HON. MR. NIELSEN: Far too many, I believe. Sex education does take place in our schools. There are programs available. I think we're looking at the age 11 and 12.

Interjection.

HON. MR. NIELSEN: It may be. But it does take place. It may not be the best program. I recall the great furor over sex education in schools. I also recall some of what I consider to be the errors made by some of the proponents, and the extreme reaction by those who oppose it.

Mr. Chairman, I think it's absolutely essential that young people have access to information that would be useful to them to avoid unwanted pregnancies. The alternative is unnecessary agony for our society. I'm not speaking about the costs; I'm speaking about the individual difficulties.

We receive a tremendous amount of correspondence on abortions. We receive perhaps an equal amount from the two sides of the question: those who are opposed to abortion, and those who are in favour of wide-open laws permitting abortion; those who identify themselves as the right to life, and those who identify themselves as the right to choice. I'm not taking either side. The government of British Columbia is obliged to follow the laws of Canada. The laws of Canada permit therapeutic abortions. The Criminal Code of Canada permits therapeutic abortions where a hospital board establishes a therapeutic abortion committee and each application for an abortion is reviewed.

MR. COCKE: They're supposed to be obliged to do that.

HON. MR. NIELSEN: It's optional, Mr. Member. They must establish a committee before they can consider abortion. When an application is made for an abortion, the committee must approve the application before the abortion can take place; that is the law of the country. There is an option by a hospital board to determine if such a committee should be established. It's certainly an issue that is not going to go away. It's revived rather regularly, and the same opinions are offered each time.

One of the alarming figures — and I don't have the information immediately before me — is not just in teen-age pregnancies; it's also quite alarming to see the number of older women who are having abortions. You wonder if indeed education is the only factor. You will see in the statistics the various categories in age only. It's rather surprising to me that abortions involving people of more mature years are still showing up. So it's not a matter of just education; there's another element as well.

It's a problem that I hope some day we can resolve. I agree with those members who talk about the need for education. Unfortunately, parental responsibility is part of that education program. I don't think parents can simply say it's up to the schools to teach certain things; parents have a very real obligation as well. Perhaps better information could be made available to them.

I think that pretty much covers it. If I get those statistics later, I might make mention of them.

MRS. DAILLY: Mr. Chairman, I find it most interesting when the rationale given by the minister for not funding Planned Parenthood is: "Well, you know, we contract it out.

[ Page 7684 ]

It's a private institution." This is the very government, since they came into office, that has talked about less government involvement and assisting the private sector more and private groups. It shows that this can be just used.... Mainly underneath it is what you really believe in and what you don't believe in philosophically. As far as I'm concerned, to continue the funding of Planned Parenthood, which is a prestigious, well-recognized organization, is an act of faith in the work that those kinds of groups are doing.

Interjection.

MRS. DAILLY: Did they get that? But you did cut back on them.

So you have shown them that you do accept the fact they have some responsibility. But when you start....

HON. MR. NIELSEN: No more than any other.

MRS. DAILLY: Oh, no more than any other. The point is that leadership from the government is all-important in this area.

When the minister mentioned the area of abortion, I did not get into that discussion of abortion at this time from that point of view; I got into it to bring up the point that we actually had a Minister of Health who considers it used by women for birth control; that was my point, and that was not addressed. But I don't mind saying it right here on the floor — and I always have — that I'm pro-choice. I do not believe that the state should be involved at all in that area. This again is the government that is always saying: "Keep the state out of people." The Minister of Highways (Hon. A. Fraser) is known for saying: "Keep the government off the backs of the people." Yet when it comes to an area like this, the other line is brought up. I say the state should not be involved in this, and that's why I'm pro-choice. Many people, even people who have strong religious convictions, feel this is a decision for the woman and her doctor, and government should not be involved in it. Of course, I realize that it's federal at this time, but it certainly would be a great help if some provincial governments would speak out on behalf of the majority of women. And they are the majority; the majority of men and women, whenever a vote is taken, are in favour — some of them of the present procedure, of course, others who are also pro-choice.

I just want to say to the minister that yes, I realize there are sex education programs in the schools. I realize parents have a certain responsibility, but the facts are that many parents cannot or will not talk to their children about sex education. That is why it's absolutely essential that governments take leadership in this, and the Social Credit government has not given encouragement. The programs we have have mainly been done through the school boards and demands by parents themselves. Times are changing. If the Social Credit government is afraid they might be subjected to some of the scenes that I was subjected to as minister when I endorsed sex education, I think you'd find it somewhat different today. I used to be followed around to meetings, as the Minister of Health knows, by a loud, vocal minority screaming about what I was doing by trying to endorse sex education. I won't go into all that again. You'll still have a vocal minority shrieking against bringing sex education into our schools; you always will have. But I do think you have to look at what is best for the young people, the adults and society, and ignorance is never the best way to go. It's always interesting that people are usually against this based on no facts whatsoever; basic ignorance.

So I'm still concerned, Mr. Speaker, that no great leadership is taken by this government in supporting more birth control clinics and in the matter of sex education in the schools.

[4:45]

To make one final comment on this, the minister did state that it is not just teenagers who get pregnant. He was concerned with the increase, I think he said, in abortions in adults. Perhaps the minister should look at what is going on in our society today — the economic problems. Often women, because of economic necessity, have to face this problem. Social stresses are much greater. All these things come in. If the minister asked someone to give him some background on the reasons for an increase in abortions in adults, I think he would find that much has to do with the stresses and strains, the economic and social conditions that women and families face today because of our economic situation. There is nothing simplistic about the answer for it, I am quite aware. I just hope this government will repudiate the kind of statements that came from the former Minister of Health from Vancouver South. I would like to see that repudiated openly for the whole province to hear. We haven't really heard that.

Another area which I wish to discuss with the minister, if I can find my file here, is AIDS. I know that the minister has expressed concern over this. He and his ministry have definitely taken some steps in this area and I commend you for steps taken so far. I would like to ask you specifically if you are giving any consideration to requests which I know you have received from people with AIDS who feel there should be some form.... I may not be expressing exactly what they want, but I know the provincial Health ministry has said they would examine it, and that's a long-term care area for the victims of AIDS. I don't think any of us felt at all happy when we read about the AIDS victim who was turned away from the UBC hospital. I know that was discussed. I'm not sure; I think the minister did comment on it.

The very fact that a situation like that could arise, the very fact that other hospitals are wondering if they are going to be in a position to cope with it, the very fact of the tragic scene for those victims of AIDS who should be given all the encouragement they can and the best surroundings during this crisis they face.... I think that the suggestion of having a special facility would be terribly important today. I wonder if the minister would comment on that, because I understand that a while back the Ministry of Health was considering looking at this and examining it. Have they?

Also, I know that when the AIDS people were here, their request, I believe, was for more support for research. I do think it's tragic that not enough research has been taken on by the federal government in this whole area. I know that at that time the former Minister of Health did make a statement on it. I think we've got to be constantly aware of how important it is to give support for research into this dread disease. I wonder if the minister — because I haven't had a chance to talk to him about it — could tell us what his feelings are and what is being done about assisting research in his own area and putting pressure on the federal government.

The other point to do with AIDS that is very important has to do with the position of the schools and the school districts. I think that most of us saw that terrible scene on television — I forget where it was; I know it was in the United

[ Page 7685 ]

States somewhere — of the young boy who was not allowed to go to school because of fear of contagion. He had contracted it through blood transference — a completely innocent victim, of course. Most top medical people — and I've been trying to follow this and read something on it — seem to point out, and pointed out in this particular case, that a young person could go to school without causing infection. That's what we heard about in listening to this tragic case in the United States. At the same time, may I say that I can easily understand the fears of parents. So a school board has to deal with the normal, natural fears of the parent. But they also have to deal with the facts.

The minister has a vote in the Ministry of Health estimates which shows that.... I forget the number. It's vote 40, I believe — community health services. I want to ask a specific question, and I'll show how it ties in with the AIDS thing in a moment. I would like to know how much of that vote is earmarked for school health services, as is required by the School Act. I want to remind the minister that this is to be provided — it states so in the School Act. How much was provided last year? The next question is — and I don't expect to get an answer on this one immediately — how does this compare with ten years ago?

I think it's important to bring to the attention of the minister the responsibility of the Minister of Health for community health services under the School Act. I want to move from that into section 110 of the School Act. I hope I have the right section, to assist you here. It requires the Minister of Health to outline policies and procedures for the operation of school health services. That's in the School Act. Therefore if it's up to the ministry to outline these procedures — and section 100 provides the minister with responsibility when it comes to a student with a communicable disease.... Actually, I think it says they must be excluded from classes. But in addition, section 107 requires that any school board employee — which, of course, could be a teacher — could also be suspended. I know this may sound a bit convoluted, but I'm trying to pull together the fact that the Minister of Health definitely has a responsibility to give some guidance to the school districts of this province when it comes to, for example, a situation like having an AIDS patient. I think that at this time it puts the school boards in a rather difficult spot, unless some guidance is given to them by the Minister of Health. Have you given any thought to that?

MR. LAUK: I thank the hon. minister for deferring. I ask leave to make an introduction.

Leave granted.

MR. LAUK: I would like the committee to welcome Alex and Ann Waterton from the city of Vancouver. Mr. Waterton has been a longtime employee of the Attorney-General service. He was a police officer and a court officer, and is a friend of long standing. I ask that Hansard record his presence today, and I ask the committee to welcome them both.

HON. MR. NIELSEN: Mr. Chairman, fortunately we have no AIDS victims who are children at the moment in British Columbia. The ministry does have the responsibility of outlining procedures for such things, as you mentioned. I have no doubt that this matter would be dealt with in that way. Yes, there has been a considerable amount of consideration given.

The AIDS problem. As we know it's a fatal viral disease. There is a tremendous amount of research underway internationally. This matter has been discussed by so many people and a tremendous amount of money is being spent on research. We're advised by some of the scientists that it's not a matter of shortage of money; it's a matter of progress in the research and the time that it takes to examine. One of the tragic difficulties with AIDS is the period of time from identifying the problem and the life expectancy of the patient from then. It is relatively short, and the research is very difficult, but a lot is being done. We have taken certain measures in the province. In fact I think we were perhaps one of the lead provinces working with other provinces as well to try to get things going.

Some of the people who are suffering from the disease met with the previous minister with a request that there be a viral lab established in British Columbia. They wanted a certain level of lab. We don't object to the idea if indeed there is the need and we have the capacity, because that level of laboratory would be valuable in British Columbia not just for the purposes of AIDS but for other ailments. So if it's a viable thing, we certainly don't object to it. This was one of the requests these patients had, and we're certainly discussing that. It's under very, very active consideration. We should have an answer very soon as to whether we can go ahead with it.

There's been some comment made by people who have assumed spokesmen roles for people suffering from the ailment that they would like to see a form of hospice for AIDS patients. We have not received a proposal as such. There has been discussion, but there's been no proposal made. What they suggested is perhaps a hospice so patients who have the disease and are expected to expire could do so in a different setting. It's a terribly tragic ailment, Mr. Chairman, and very seriously being considered internationally with respect to research and treatment and care. We do receive reports constantly on any new development in research.

I'm just repeating that I certainly don't object to the viral lab idea philosophically. If it seems we can institute such a lab, if we have the people who could maintain the laboratory, then we might very well look at establishing one. A hospice is a very real possibility.

The St. Paul's Hospital has specialized, if you like, in the treatment of these people, because it's far better to have one area of excellence than spread around where your staff would have to be dispersed.

That UBC Hospital foofaraw about the admission of a person was unfortunate. I think to some degree there was some misunderstanding, but it was unfortunate. Obviously we all hope that a breakthrough will occur and some form of treatment and cure or immunization will be developed soon. It's a scary, scary problem, because it is said by some that we can expect a doubling of the caseload each year. Just for your information, AIDS has been reported in 111 residents in B.C. to date. Fifty-five have died. About 20 percent of all cases reported in Canada occur in B.C. There have been 5 29 cases reported in Canada, and approximately 20,000 reported in the United States. So it is a situation that really does have the attention of the medical research people. It's a very frightening situation, and it is not being ignored by anyone.

[5:00]

MR. COCKE: Mr. Chairman, I have a number of things I'd like to discuss with the minister over the next week or so.

[ Page 7686 ]

I'd like to start out with a problem that we have in Westminster respecting the Royal Columbian Hospital. I don't know whether the minister has visited there recently, but a lot of the facility — and I am talking about the facility, not the people that work there — is an absolute, utter disgrace. Compliments of Mr. Loffmark years ago, we had modular units that were temporary additions to take care of the needs of the hospital. Those modular units are still being used today. Not only are they being used for short-term acute care — as a matter of fact, I don't think there is very much of that going on there any more — but they are being used for long-term care, extended-care patients. People have to live in that mess. They were moved from upstairs in the modular units to downstairs in the modular units. They were having trouble with access, egress, three or four doors, and people could just wander in off the streets, Here we're talking about people who are totally defenceless, people that are non-ambulatory. Mr. Chairman, I think it is about time that we got some kind of commitment out of this government respecting getting rid of the modular units, building the next tower. The sooner that gets off the ground and running, the better we are all going to be.

Now I recognize that there is some discussion about this. The present board seems to be optimistic that something will happen. The present board, Mr. Chairman, would be optimistic about anything, because if they are not optimistic they can be fired. In the old days we had a democratically elected board at the Royal Columbian, some elected by a small society, others appointed by the different municipalities involved. All of a sudden, with the wave of a pen and a cooperative gang in cabinet, down the tube that went.

The Royal Columbian Hospital has served this province and served it well. And what did the incumbent directors get for all of their trouble at that time? They got canned. Not one person who lives in New Westminster is on the board of the Fraser-Burrard Hospital Society, which now runs the Royal Columbian Hospital.

Interjection.

MR. COCKE: The member from that little riding up in the interior, I think it is called Columbia River or something like that, is saying: "Tell us why." I'll tell you why. It was politics, member from Columbia River: pure unadulterated politics, stupid politics. You were part of the cabinet when it happened.

MR. CHABOT: The board was playing politics.

MR. COCKE: The board was playing no politics at all. What the board was asking for on behalf of the people in our community and on behalf of the people that that hospital serves — which is a major part of the Fraser Valley, Burnaby, Coquitlam and New Westminster — was fair play. The word is out and has been out for years that the reason the Royal Columbian Hospital gets very little attention from this government is that the people in New Westminster have had the audacity to elect and re-elect CCF and NDP members since 1952.

Interjection.

MR. COCKE: It just shows brains. The member for Boundary-Similkameen (Hon. Mr. Hewitt), who is in real jeopardy next time, says: "Not next time." How many times have I heard that in this House? I've heard it five times. I've heard it from W.A.C. Bennett, who used to do the flying fish, from Phil Gaglardi, from the member for Columbia River and now the poor, pathetic member for Boundary Similkameen.

MR. CHAIRMAN: Let's avoid personal references, please.

MR. COCKE: Yes, Mr. Chairman, I'm sorry. I just get blown away sometimes when I think about the way they've treated our hospital.

HON. MR. HEWITT: You're my constituent.

MR. COCKE: No, I'm not any longer. I gave that property to my children. Now they're your constituents. The member for Boundary-Similkameen says I am his constituent because I had some property on Skaha Lake. No, I don't own it any longer. I gave it to them, and said: "Now you can live with that member up there for the short time that he is going to be there."

[Mr. Ree in the chair.]

But anyway, getting back to the RCH. My first squawk about the whole question is the fact that there should have been a building program that continued on with the program that we started in 1974 and which was completed in 1976 or thereabouts, on time, on track and within budget — as a matter of fact, $3 million below budget.

Now, Mr. Chairman, I would like to hear from the Minister of Health whether or not they are going to pay some real attention to that hospital. Let me outline one or two of the reasons why you should. It is becoming increasingly important in the whole delivery of health services in the lower mainland, Vancouver cannot grow any farther west. Vancouver cannot grow any farther south — well, it can, I suppose, annex Burnaby. It can't go any farther north.

AN HON. MEMBER: Why?

MR. COCKE: Because there's water in the way. However, the population expansion is moving, of course, toward Coquitlam, the Fraser Valley and all around the environs of the Royal Columbian Hospital. The reason that hospital has been so important is because of its accessibility. Geographically it is the best-located health care centre in the province, as far as I'm concerned, in terms of access to large numbers of people. To neglect that hospital now is neglecting the people in this province. I'm absolutely amazed that that marvellous staff there have been able to do as well as they have done, given the facility in which they've had to work.

All right, Mr. Chairman, what's my next problem with the Royal Columbian Hospital? Suddenly this new board.... Incidentally, the board is absolutely, totally at the beck and call of the Minister of Health and the cabinet. They are all appointed. There's no representation from the various municipalities, only representation from the office of the minister. What do we hear in this new planning program that they've got for the RCH? Well, we see all sorts of paper. We read this paper, and we see that they have decided in the Fraser-Burrard Hospital Society that now they have to justify

[ Page 7687 ]

the existence of a hospital built way out on the periphery, the Eagle Ridge Hospital. The Eagle Ridge Hospital is absolutely on the periphery of our area. So what do you want to do with a hospital on the periphery that you can't get anybody to attend? You take all of the services of various aspects of health care out of the Royal Columbian, and everywhere else in that environment, and move it out there so that people have no choice but to go out there.

Now guess what they plan to do or would like to do. Hopefully they're going to be stopped in their tracks. They're justifying moving maternity, pediatrics, gynecology and neonatology all out to the periphery. They justify that by giving us some births in the area. The way they do the birthing thing is they take the school districts, and they say: "Well now, in School District 40 there are only 436 births; New Westminster, all stable.... Then they tell us about Port Coquitlam and Coquitlam, and so on and so forth, part of School District 43. They tell us all about the 787 in Port Moody, 560 in Port Coquitlam, and 648 in Coquitlam. I venture to say that most of the people in those numbers are more accessible to the Royal Columbian Hospital than they are to Eagle Ridge. I'm not saying don't set up maternity or this or that at the Eagle Ridge Hospital. Go ahead; you've got to use it for something. You've got to justify its existence. But for heaven's sake, don't put people through that kind of nonsense and move them all out to the periphery. I believe it would be a tragic mistake.

Certainly the medical care.... It's all very well and good to say: "Well, let the damn doctors move." The doctors are in the area of the Royal Columbian right now. By far the majority are clustered around, because, you know, it has carried the weight. We, the folks in New Westminster, have carried the load for years, prior to all of this health insurance and all the rest of it. We have actually carried the load. Then to be told that we lose that entire aspect of health care is just crazy. Regardless of what this tame-duck board says, my suggestion to the minister is to get them off this track. They can plan, they can become more efficient and all of those very nice things, but to break up that particular hospital that way I think would be very injurious to the health system in Westminster.

There's no question that one thing you're not going to move is trauma, although I've had some criticism of some of the ways you've handled that trauma situation with respect to a very fine neurosurgeon who got burnped out of there. Aside from that, I believe that naturally you're going to have to go along with the trauma situation because of the fact it's so accessible. Ask an ambulance driver in that area what the easiest hospital is to get to. The Royal Columbian. As a matter of fact, we've been carrying the load of trauma all the way from Hope to the PNE. Anybody hurt along the 401 highway — and it's been a disaster at times — finds their way into the Royal Columbian Hospital because it's the most accessible.

No, trauma is not going to be moved, but, Mr. Chairman, we shouldn't denude that hospital of a very important service. I'd like to hear a word or two about that from the minister before I proceed.

[5:15]

HON. MR. NIELSEN: Mr. Chairman, the board of the hospitals is still considering the roles of the two facilities, Royal Columbian and Eagle Ridge. Speaking of Eagle Ridge, I remember that the former member for... I'm not sure what the riding was, whether it was Coquitlam-Moody, but he's now on the bench. Mr. Leggatt really pushed for Eagle Ridge Hospital and it's doing very well. I believe the latest statistics are that it's functioning at capacity.

Royal Columbian Hospital is, as the member for New Westminster says, situated in such a way that it has attracted a tremendous amount of traffic over the years, and I don't mean vehicle traffic. It has provided excellent service for many years. It's one of the three hospitals that come to mind that have tried to provide a high level of two types of hospital care — community as well as trauma or emergency, or very difficult specialties. It's done it with great difficulty, not the least of which is, as the member said, the physical plant. The hospital is all over the place. At the present time at Royal Columbian Hospital, work is proceeding on renovation of the emergency ward. The second request from the hospital is for a new tower. That's a major construction project. The emergency ward is being renovated, modified, and I gather the work will begin very soon. I believe the planning has been completed.

I think the board at the Fraser-Burrard Hospital Society is a good board. I think they've done a good job at both Royal Columbian and Eagle Ridge. Technically they may be at my beck and call, I suppose, but I certainly don't manipulate them in any way. I've had many meetings with them. I've been to the hospital many times, and I believe they are functioning quite well. The hospital does attract patients who require intensive care, and that itself makes it somewhat more difficult to function; their emergency ward services a vast area of the province and frequently is heavily utilized.

In Victoria, when we had the opening of the new Helmcken Hospital, there was a similar discussion taking place as to what to retain at Royal Jubilee and what to specialize in at Helmcken. The same two areas of specialty were under discussion between the medical staffs of the hospitals — that is, pediatrics and obstetrics or maternity. And it was requested that there be a ward of some kind retained at Royal Jubilee in those two specialty areas. The countervailing argument was that it should become a specialty at Helmcken. Eventually the decision made by the board was that Helmcken would be the location for the obstetrics and pediatrics, and it would be phased out of Royal Jubilee. The same argument, if you like, or the same discussion is taking place with respect to the Royal Columbian and Eagle Ridge Hospitals.

The Royal Columbian Hospital cannot be all things to all people. It cannot continue to play its historic role as a community hospital in all areas, and continue to evolve in the trauma area as almost a specialty hospital for that. The hospital itself cannot be all things to all people. I believe that they are looking very seriously at utilizing Eagle Ridge Hospital for care of patients in a far less intense way, and seeing Royal Columbian Hospital perhaps evolving into a specialty facility in many areas, while at the same time phasing out certain specialties.

Royal Columbian has done a good job. There's no question of that. There are some serious physical problems with the hospital, some of which are being addressed at the present time, particularly with respect to the emergency ward. But the board, I think, has done a good job. It's a difficult hospital to operate and run. The staff has done a good job — the doctors and medical staff as well. But the emergency renovation is about to take place. The next consideration is the request for a new patient tower, and the ongoing resolution of

[ Page 7688 ]

Eagle Ridge Hospital versus Royal Columbian Hospital and what will take place in each and, to a very lesser degree, St. Mary's Hospital as well, but to a far less degree.

So I know what the member for New Westminster is speaking of when he speaks of the Royal Columbian Hospital. But I'm not directing the board as to their decisions with respect to what utilization will be made of Eagle Ridge. I do know that some of the previous medical critics of Eagle Ridge are utilizing that hospital very, very much now. So traditions may change, but we certainly have not ignored the Royal Columbian Hospital. The member, I think, was speaking somewhat with tongue in cheek when he said that the CCF and NDP being representatives for New Westminster since 1952 would be the reason. I don't think Royal Columbian Hospital is regarded as a political thing. It's an important hospital and I think it's been treated reasonably well. It certainly has not been ignored nor will it be ignored in the future.

MR. COCKE: Whose tongue is in whose cheek? Come on. You're talking to me, old-timer.

SOME HON. MEMBERS: Oh, oh.

MR. CHAIRMAN: Order, please. The comment may be reflective of others.

MR. COCKE: Oh, I see.

Mr. Chairman, look, he says it's a good board. I'm not arguing that it's not a good board. I'm not going to dissect the board and say individually or collectively they are good or bad or indifferent. Frankly, I don't agree with some of the premises that they're working on at the present time. But I am saying it's not a representative board. It's an insult to the city of New Westminster, an absolute utter insult. How they put up with the Socreds in that town is beyond me. What we should do is just build a wall and say we're isolating ourselves, and from here on in we're a nation unto ourselves, and the blazes to you. Except that we're going to defeat you.

AN HON. MEMBER: Socreds?

MR. COCKE: The Socreds are going to be defeated. One of the reasons that I know that is because now that I've announced that I'm not going to run again, I get all the people telling me that they're going to do something they've never done before: that is, they're going to vote NDP and knock off the Socreds. It's trauma. Yes, make the Royal Columbian Hospital a specialty for trauma.

There are other specialties. It is a specialty hospital, not necessarily because of anything other than the fact that with its geographical location it has to be a trauma hospital. But to therefore take other specialties and shunt them aside in an area as large as ours.... As a matter of fact, I recall the knock 'em down fight that there was between the Victoria General and the new Victoria General and the Jubilee. But, you know, we're not talking about a hospital on the periphery when we're talking about the new Victoria General; we're talking about a hospital that's right in the middle of a new growth area. As a matter of fact, my colleague from Esquimalt.... Most of his people are probably beyond the new Victoria General.

AN HON. MEMBER: We could get a bed in the Oak Bay wing.

MR. COCKE: Yes. Had you, for example, on the other hand, built a hospital down at Sidney and said, "Now that's going to be the maternity, pediatrics, etc., for the whole area," then people would have a beef. That's the consideration that I'm putting forward here.

Anyway, I'm not going to press that any further. I think the minister knows exactly how I feel. No, a hospital probably can't be all things to all people, but certainly it should offer the services that are required in the particular area.

I'd just like to go on a bit with something else. I notice that my colleague from Vancouver Centre, who's often in a big hurry and I'm not, wants to have a few minutes with the minister, and I'm going to afford him that time.

Interjection.

MR. COCKE: Turned on him? My goodness.

I just would like to say a couple of words, however, about the whole question of our health financing. I hate to stand here and say: "I told you so." In 1972, 1973, 1974 and 1975 I was part of the negotiations with the feds. They tried every kind of ruse that they could possibly pull off to tie the cost-sharing with the growth of the gross national product. We said: "Not on your life. Health care costs are growing at probably 13 percent; the gross national product is growing at maybe 5 or 6 percent, 7 percent at the outside."

Then brilliant Alberta and Ontario, those Conservative sanctuaries, came up with an idea that they thought would be really something else — transferring tax points and grants. Now, you know, in those days things were going along pretty nicely. Taxation bases were good and strong, and in little old B.C. a bunch of neophytes came in. Big business people though — you know, they make a lot of good sense, these business-oriented Socreds.

MR. LAUK: Financial wizards.

MR. COCKE: Financial lizards.

In any event, they made a decision that they were going to go along with Alberta, and they were going to go along with Ontario, and they were going to go with this new system. "Hell, we can get our own tax points, and we can do all sorts of things. Freedom at last." You know, great stuff. Well, I'll tell you what that freedom is costing us. We are going to lose, by 1990, something in the order of 36 percent of that share. The federal government is going to become a decreasing participant in this whole area of health sharing. Look, I know it was Tommy Douglas who started the whole thing. But the fact of the matter is the feds embraced the idea of hospital insurance, and ultimately medicare, and then went to the provinces to persuade them to participate in a national plan. Then they said the plan was getting a little expensive: "We can't seem to control it, so we'll plump it right back in their laps."

[5:30]

This tame bunch over here — this marvellous bunch of negotiators called Socreds — have sold us out on our health sharing plan. Mr. Chairman, I worry about the future of medicare. I worry about the future of prepaid health care generally. Not that I think we haven't got a relatively efficient system. Nothing is perfect by any stretch of the imagination.

[ Page 7689 ]

But when you consider that in Canada our health costs per capita, or based on a percentage of gross national product, are so much more efficient than in the United States, it's not even funny. I think we're probably running something in the order.... I know we've gone up quite a bit in the last two or three years. It was 7.2 and 9.3 — or 9.1 or something. I think it has probably gone up to around the twelfth percentile mark in the United States, and it's something in the order of 8.5 or 9 here. But there's still that disparity, and we are more efficient than they are. What purse it comes from is a different proposition. Here a great part of it comes largely from the public purse; there, of course, a lot of it comes from other insurance or private funds. It can be ruination for a family that hasn't got proper coverage or hasn't proper coverage available.

So there's no question: our plan has to be protected. And we've got to start fighting back with these federal people, and see to it that they participate.

I just think that we're sending to Ottawa continually a bunch of marshmallows. They can't fight, they can't negotiate. Once they've got themselves into a bind, they've lost the whole thing. Mr. Chairman, I'd like to hear just a little bit of assurance to the people in British Columbia that the government is going to put up a real fight. Just for fun, just tell us that you're going to go down there and put those people in their place. Maybe take the Minister of Intergovernmental Relations (Hon. Mr. Gardom) with you. It would be an endurance test for him. I know that flight to Ottawa is a tough one.

Interjection.

MR. COCKE: Providing you don't smoke. Anyway, my suggestion is that you get these people down there and start fighting back. We haven't got Monique Begin down there any more. She and our present Minister of Health were very fond of each other. I have heard her speak very highly of him, and he of her. In any event, now we've got a new one, Jake Epp. Almost sounds like like hiccup. You're more closely related, I would think, because of his Conservative stripe, and he won't believe that your leader is really going to be that fellow from Eckville.

MR. HOWARD: Who's that? What's his name?

MR. COCKE: Oh, it escapes me for a minute.

MR. HOWARD: "Keegstra."

MR. COCKE: Anyway, all that stuff aside. I just do hope that we can do some negotiating, tell the feds that health care, as far as the people in this country are concerned, is one of the most important priorities on people's minds. You go out now and find me ten people within a radius of a mile that don't believe in the health care system that we have at the present time. You can't find them.

Years ago when poor old Tommy Douglas and Lloyd were fighting that thing out in Saskatchewan, sure, there was blood all over the streets. But the fact of the matter is, now all of a sudden people have discovered it, and they think it is an invention of the Conservatives. It's not, but in any event let's protect what we've got.

HON. MR. NIELSEN: I'm going to go down there and put those people in their place, and I'll take the Minister of Intergovernmental Relations with me.

The federal government does have a role to play in this program. I become very concerned with what I consider to be a bit of a tradition in Ottawa of not fully understanding how it works. I don't think they pay enough attention to the provinces with respect to the medicare program in the country. The feds are partners, diminishing partners from a cost-sharing point of view. Although the early concept was a fifty-fifty cost-sharing program, it's been diminishing since that time. They have not relinquished, however, their legal authorities associated with it. They like to retain the authority but not necessarily participate financially.

In fact, we will be meeting with the federal minister very soon about a number of issues. We will point out to them the importance of the system and their lack of participation in it. We've done that before. The provinces have not won the battle, but they've certainly put up a good fight. We'll do that: we'll go back there as soon as the weather breaks.

MR. LAUK: I want to ask a couple of quick questions. There is a shortage of physiotherapists in the province that has been brought to the minister's attention, both private practice physiotherapists and institutional physiotherapists. This shortage is costing us a lot of money in health dollars. I've seen it firsthand. I've been visiting a relative of mine in the hospital recently who is undergoing physiotherapy and extended physiotherapy. They just don't have enough trained physiotherapists to do the job and get people out of the hospital and back home so we can save money on these people. I think it's costing us a lot more than.... Is there some program that the minister is thinking about or has decided about to increase the number of physiotherapists, and are hospital budgets for physiotherapy adequate?

Second, what are the psychologists doing? I understand the psychologists are going to have an act that would make them into more of a self-governing professional group. That's been on back burners and front burners for almost 20 years now. As much as I like my friends who are psychiatrists — and I need at least six of them every day when I leave this place — they really dominate an area of health that I think maybe psychologists could provide more cost-efficient and more specific service in.

One of the things that appears to me, as a layman, to be holding back this service that psychologists can provide is the public's and our health institutions' reliance on the profession as a whole. That would include a self-governing profession, perhaps even with examination boards and licence-granters and so on to weed out the person calling himself a psychologist who believes in psychosurgery or some other freak-out type of thing. Although I'm broad-minded, I don't foresee B.C. Medical allowing an item on its tariff for psychosurgery. If we had a professional act that would give us some reliance on people so licensed, I think B.C. Medical would be well served — as far as cost efficiency is concerned — by expanding its coverage to psychologists.

[Mr. Strachan in the chair, ]

Those are the two specific questions that I have; then I want to make a remark about recent complaints from the medical profession about malpractice liability insurance.

[ Page 7690 ]

Interjection.

MR. LAUK: Yes, it's a four-minute tirade that I've got planned here. I would like you to pretend that you're the subject of the tirade.

I am really astounded that doctors are complaining that they're paying $500 and $700 a year in liability insurance. Some specialties are paying more; maybe $1,500 a year. My honourable and learned friend the Minister of Intergovernmental Relations knows that with extended insurance coverage, the average lawyer is now paying $4,000 and $5,000 a year, and that's in a profession where our mistakes can be corrected in the Court of Appeal. With medicine they bury their mistakes to some extent, or it costs the public a lot of money for them.

I don't think that the judgments of courts are any higher. I agree with the Trial Lawyers' Association that the judgments of 1980, when inflation is taken into consideration, are not much higher, and probably in some cases in some areas are a bit lower, than they were in the 1960s and 1970s. Eastern courts through Ontario, and now the Supreme Court of Canada, have expanded the law of malpractice, and that's making some doctors here a bit nervous. But it's not seriously expanded to threaten the emotional well-being of the medical profession.

But it seems to me the Minister of Health has a leadership role to play here to tell the truth when these professional groups panic. I know it's getting into a hornet's nest. He doesn't want to get involved in the issue, but a Minister of Health who will provide leadership will make a statement with respect to malpractice, and not a defensive one, but one which embraces the public policy need for such a lawsuit as a watchdog on the profession.

It is the public's perception, and I think not without some evidence, that the medical profession protects its own. My profession — well, we throw each other to the wolves at the first opportunity. That's just one less mouth to feed in the legal profession. But in medicine they seem to be very protective of each other, and that's slowly changing. The good public policy reason for such a lawsuit is that we can weed out the incompetents — incompetents that are in every profession.

I wonder if the Minister of Health is planning to make a comment on these medical doctors, who are being hysterical about these things, and to explain to the public that we don't have to pass legislation that will forever prohibit a lawsuit against a doctor for malpractice, or whatever else they're calling for. I ask the Minister of Health: what is his position on those statements?

HON. MR. NIELSEN: The BCMA has not requested that type of legislation. They've expressed concern about the rising costs of malpractice insurance, but they haven't suggested that there be limitations set for settlements. Others have; as you know, there have been advocacy groups who have.

Just very quickly on the physiotherapists: we have a chronic shortage of physiotherapists throughout the province. We have suggested that the requirements be modified to permit foreign physiotherapists to practice much earlier than the present schedule permits. We have requested UBC to expand their program for physiotherapists — produce fewer lawyers and more physiotherapists — and we also have made some other suggestions where people who are here can begin to practise rather than.... There's a time period they have to wait and so on. So we're trying to work on that. Primarily, shortages are in more remote areas of the province. We also have included physiotherapists in the bursary program, which would try to locate them in remote areas of the province and have a bursary program, which the former minister announced and which the deputy had tried to get me to announce prior to that.

The psychologists do have their own act now, as you know. It is a self-governing organization. I understand that there has been some discussion recently — a request that they would like to get on the Medical Services Plan. I had previously told all interested groups that we did not intend to expand the plan to include any more categories of practitioners.

I shall now move that the committee rise and report progress and ask leave to sit again.

Motion approved.

The House resumed; Mr. Strachan in the chair.

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

Hon. Mr. Gardom moved adjournment of the House.

Motion approved.

The House adjourned at 5:47 p.m.