[ Page 7711 ]

CONTENTS

Oral Questions

Expo 86. Mr. MacWilliam –– 7711

Casino gambling. Mr. Cocke –– 7711

Log exports. Mr. Lea –– 7711

Mr. Parks

Casino gambling. Mr. Williams –– 7712

Hotel evictions. Mr. Blencoe –– 7712

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

On vote 37: minister's office –– 7713

Mrs. Dailly

Mr. Williams

Mrs. Wallace

Ms. Sanford

Ms. Brown

Mr. Ree

Mr. Reid

Mr. Cocke

Mr. Blencoe

Mr. Rose

Mr. Nicolson

Committee of Supply: Ministry of Post-Secondary Education estimates. (Hon. R. Fraser)

On vote 62: minister's office –– 7737

Hon. Mr. Nielsen

Tabling Documents –– 7737

MONDAY, APRIL 14, 1986

The House met at 2:08 p.m.

Prayers.

HON. MR. PELTON: Mr. Speaker, in the precincts today are some 90 outstanding British Columbia young men and women, grade 11 students at one of the better high schools in this province — Maple Ridge Senior Secondary School. They are here today in the company of Mr. Gordon Edmonds, director of their class in school. I would ask all those present to make them welcome.

MR. COCKE: I would like to point out that today is the birthday of the Leader of the Opposition, and I would like all members in the House to wish him a happy birthday.

MR. LEA: With us at the Legislature today is a long-time friend of, I would say, all of us, and that's Cyril Shelford, a former member. With Cyril are two of his old friends, Mr. and Mrs. Rehill. Mr. Rehill and Cyril go back a long way; they served together in Italy during the Second World War, and they're here to watch us do it today. I invite you all to welcome them here.

MS. BROWN: Visiting us from Burnaby today are John and Isabel Pihowich. I would like the House to join me in bidding them welcome.

HON. MR. NIELSEN: Mr. Speaker, unless I'm mistaken — unless there's a mixup in dates — is today not the Premier's birthday as well? Is it true that lightning struck twice? I believe it is. And coincidentally we'd wish him the best as well.

Oral Questions

EXPO 86

MR. MacWILLIAM: Mr. Speaker, my question will be addressed to the Minister of Tourism. The Expo opening ceremony, as all members know, features Their Highnesses the Prince and Princess of Wales. We have learned this morning that the Social Credit MLA for Maillardville-Coquitlam (Mr. Parks) is in fact handling all final applications for special invitations to this opening ceremony. Why has the responsibility for allocation of the special invitations been transferred from the office of the Provincial Secretary to the office of the member for Maillardville-Coquitlam?

HON. MR. RICHMOND: Mr. Speaker, the member for Okanagan North obviously is privy to information that I am not.

MR. MacWILLIAM: I am glad that the minister recognizes that.

It has also been determined that the member for Maillardville-Coquitlam will be discussing the issue of invitations with his Social Credit caucus. I would like to ask the Minister of Tourism why the government appears to be playing politics with the official royal visit.

HON. MR. RICHMOND: I know not whereof you speak, Mr. Member, so I suggest that perhaps you address your question to the Provincial Secretary (Hon. Mrs. McCarthy), if that is where you claim....

Interjection.

HON. MR. RICHMOND: Since she is not here, if you like I would be happy to take the question as notice on her behalf.

CASINO GAMBLING

MR. COCKE: Mr. Speaker, I would like to address a question to the Attorney-General. The Vancouver police chief, Bob Stewart, has called for a non-partisan gambling commission to monitor and regulate the explosion of organized casino gambling in B.C. because of the fear of other organized people being involved. Mr. Speaker, this is for profit. Has the Attorney-General decided on behalf of the government to accede to this request of the police chief?

HON. MR. SMITH: No, it is a matter that we are concerned about as well, and Chief Stewart's proposal is one that has a lot of merit. We will be examining that, and I'll be responding to him. I think the fears of all are to ensure that while we have recognized lottery activities and recognized bingo activities, all of these yield money for very good community causes and for amateur athletics. We are all very pleased to have these moneys provided in our areas. Nevertheless, we have a strong duty to safeguard that none of the activities get into the hands of organized gambling and organized crime.

[2:15]

MR. COCKE: Mr. Speaker, this is a happening that has just spontaneously struck the province. The fact that the gates were opened is of great concern to us — and the fact that this industry is noted for its unsavoury characters. We're talking about organized crime. I just ask the Attorney-General: has he decided to take care of regulations for the industry, to take it out of the partisan hands that are now operating it, and to take appropriate action to protect our community immediately?

HON. MR. SMITH: The only thing that is sudden is the fact that this member has heard of the problem. I don't think that it's sudden at all. It has been a concern to the government for many years. I do not accept that it is in partisan hands. It is in conscientious law-enforcement hands, which are not partisan.

LOG EXPORTS

MR. LEA: My question is to the Minister of Forests. Has the government decided, in terms of its export of logs policy, to go back to a system where logs that are surplus to the domestic use will be allowed to be exported?

HON. MR. HEINRICH: Mr. Speaker, I met this morning — and I have for the last two or three weeks, as a matter of fact — with a number of people who are involved in the export of round logs. Those primarily affected now are the market loggers. We had a meeting this morning, which probably lasted the better part of three hours, at which time they provided a great number of details. The request that they

[ Page 7712 ]

made of me was to reconsider the existing rules; they requested that a committee be struck which would involve the market loggers who had not been involved in the past and represented roughly 5 percent of the coastal cut. They have requested that labour be represented on that committee, the independent sawmill operators, a member from the integrated operators as well as a chairman. I have been reviewing a lot of material lately, and I am looking seriously at that request which they made. They also made another request this morning for an extension.

I think in fairness it must be said that this policy was introduced in the fall of 1984, and they were all very much aware of what was going to happen. March 31, 1986, came and passed, and now of course we have seen considerable concern expressed by the market loggers, primarily on the Island. I can't give any commitment with respect to reconsideration at all until I've had an opportunity to examine that which has gone on before and the present status of the position in which they find themselves in.

MR. LEA: Mr. Speaker, supplementary to the same minister. Why would the government not keep these people working while industry, the trade union movement and the government look for value-added jobs, as opposed to putting them out of work while you look for value-added jobs?

HON. MR. HEINRICH: Mr. Speaker, there is no easy solution to this problem, That is recognized by the market loggers, and it's recognized by the IWA. I'm now getting two views that are being expressed by the unions involved. I recognize as well that the member has a valid point: there may be room for resolution, and it's going to take a little while.

MR. LEA: Is the minister aware that if this policy that's in effect now continues, in my constituency alone we're looking at a direct loss of 250 jobs, with the multiplier effect of a further 500 jobs; that we're going to be losing more jobs through this policy than if the pulp mill in Prince Rupert closed down? Is he aware of that?

HON. MR. HEINRICH: I am very much aware of the impact of the existing policy, with the surplus criteria expiring on March 31. I'm very much aware of the impact not only in Prince Rupert but also in North Island and in a number of the communities. As a matter of fact, I don't need to name them, but we all know what they are. I'm very much aware of it.

MR. PARKS: I have a question to the Leader of the Opposition. In light of the fact that he is on record with respect to opposing log exports, and in light of the obvious loss of jobs that has been created by the cessation of log exportation in this province, is the Leader of the Opposition...?

Interjections.

MR. SPEAKER: Order, please. Before a question is ruled in or out of order, the Chair must hear the question. However, hon. members, I would refer members to the policy that suggests that the only possible area for questions to private members would be to such members as chairmen of certain House committees. In any case, questions on policy, even directed to ministers, would not be in order and is one of the areas that is recommended. Therefore I must decline the question put forward by the member for Maillardville-Coquitlam.

MR. PARKS: On a point of order, Mr. Speaker, are you suggesting that the Leader of the Opposition is in fact not the leader of his caucus committee?

SOME HON. MEMBERS: Oh, oh!

MR. SPEAKER: Order, please. Hon. member, a valiant effort, nonetheless....

The second member for Vancouver East.

CASINO GAMBLING

MR. WILLIAMS: Mr. Speaker, to the Attorney-General. The Vancouver police chief said that this enterprise, i.e. casino activity, attracts unsavoury characters. He indicated there is inadequate audit of their activities. He indicates that only 35 percent of the profits go to charity. It is apparent that government policy is to do through the back door what they're unwilling to do through the front door. Is the minister prepared to look seriously at what Alberta has done and not see this gaming going on in our downtown hotels like we've never seen before in British Columbia?

HON. MR. SMITH: Mr. Speaker, I thought for a moment that the member was responding to the question by Mr. Parks. I was trying to find a question in the comments that he addressed towards me, and it would appear that there was a germ of one, but I can tell the member that the policy of the government on lottery funds and the operation of the Lottery Corporation has been to expressly take strong safeguards to ensure that organized crime can't get a foothold in this province. And it hasn't happened here. All over the world where lotteries have been illegal, there have been those dangers and those tendencies. These are not new. The original lottery in Louisiana at the turn of the century was a well-known scandal because of the prevalence of organized crime. All safeguards have been taken here, and it has been run by the Lottery Corporation as a government corporation, and we will not allow organized crime to move into bingo or other operations. We believe that chief Stewart's caveat to us is positive and constructive, and we'll take action on it.

HOTEL EVICTIONS

MR. BLENCOE: I have a question for the minister responsible for housing in the province of British Columbia. The crisis in the downtown east side continues; the evictions continue; the human misery continues; and a lack of action continues on behalf of this government. British Columbians are deeply offended by this heartless policy of evictions. They want action; they want compassion from this government. When is this government and this minister going to take action on behalf of the tenants in the downtown east side?

HON. MR. KEMPF: To that member, the government has already taken action. Unbeknown to that member, there is already a committee made up from government of both the province and the city of Vancouver that's very much involved

[ Page 7713 ]

in that problem, and I would suggest he contact his friends in Vancouver to find that out.

MR. BLENCOE: We know what that committee was set up for. My question to the minister is: how many evictions have to occur before this government will change its policy and start to save lives and save human beings in the downtown east side? How many people have to be on the street, Mr. Minister?

Interjections.

MR. SPEAKER: Any further questions? The member continues.

MR. BLENCOE: There is legislation on the order paper, a private member's bill to deal with this.

MR. SPEAKER: Order, please.

MR. BLENCOE: Will the minister advocate that that legislation come before this House? Let's get some action on behalf of tenants in British Columbia.

MR. SPEAKER: If the member does not have a question, we will be hard-pressed to invent one at the last moment. Hon. members, the bell terminates question period.

HON. MR. NIELSEN: Mr. Speaker, I would ask leave to call Motion 61, which appeared under the name of Mr. Parks in Votes and Proceedings Friday last. I'll read the motion for the members: "That pursuant to the provisions of the Ombudsman Act, this assembly recommends to the Lieutenant-Governor that Mr. Peter Bazowski be reappointed as acting ombudsman upon termination, pursuant to the said act, of his present appointment to the office of ombudsman."

MR. SPEAKER: Hon. members, leave has been requested.

Interjections.

MR. SPEAKER: Order, please. Hon. member, the Chair is aware of the negative voice, and therefore the motion called cannot be put.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

MRS. DAILLY: To pick up where we left off on Friday, we will take our time as usual.

Mr. Chairman, I would like to again deal with the subject which I've brought to the attention of the minister for a number of years now without satisfaction, and will continue to bring to his attention. I already have mentioned it earlier in these debates, but I have a further reason for mentioning it to the minister today. I want to discuss again with the minister the use in this province of user fees. I have contended, along with many other people, that the user fee principle is not only breaking down the universality of medicare but is causing hardship to people in this province today.

I have in front of me in the Blues the answers that the minister gave during last week's debate. Before I refer to those specific answers. I want to read into the record part of material — letters — sent to me as recently as this morning to do with this matter. Because I think it expresses far better to the minister the concerns that many of us feel over this use of the hospital user fees in this province, I thought I would, with the indulgence of the Chairman, just read sections of this correspondence.

[2:30]

The correspondence I've received is from a war veteran. He says:

"Dear Mrs. Dailly:

"I know that you are concerned about persons not able to pay co-insurance from their own resources. I am a war veteran who was injured during service, and receive combined pensions totalling $870 per month, which is just above the poverty level. I have added expenses, because I am an amputee and cannot afford to pay demands from two hospitals for co-insurance, and my medical coverage through DVA only became effective on November 26, 1985.... I am enclosing copies of the correspondence, and hope that you will protest this to the government on my behalf."

And I'm taking this opportunity to do it now, so I can have it put on record, just to back up what I've been saying earlier in the estimates to the minister.

We have a letter here from the Holy Family Hospital, which refers to this bill owed by this particular gentleman. I certainly can have some of the correspondence sent over afterwards. It says:

"We can only suggest that Mr. Isbister pay off his account at a rate of perhaps $25 a month on his own, or with any help he could receive from the Legion."

She is replying to a request, by the way, from the Legion to help out this man.

"Unfortunately, these are trying times for everyone. However, charges for patients" — and this is the line I'm particularly concerned about — "having financial difficulty cannot be waived."

Yet if we look at the Blues, the minister does state that there are cases where he has allowed the waiving of these fees. I have the exact quote from the minister, if I could just find it. I'm reading here: "One of the reasons for bad debts could be because we do not pursue relatively small amounts of debt owing with great vigour." That was one thing. But there is another section of the Blues, where the minister refers to the fact that sometimes these debts are forgotten or written off. Now that certainly doesn't connect at all with the letter which this man received from this hospital.

Then he received a letter from another hospital which he also had to attend. This is from the director of finance of the hospital:

"We regret to advise you that unless the above named account in the amount of $297.50 is paid within 30 days, it will be turned over to a financial collection agency for attention. Because such attention may impair your credit rating, you are urged to contact us immediately."

Attached to it is the bill, and at the bottom is how much it cost Medical Services for his stay there.

[ Page 7714 ]

Mr. Chairman, the point I'm trying to make to the minister here is: here is a man, a war veteran, who cannot.... He couldn't, up to the time when he went to get help from the Legion. He was being plagued by demands to pay these bills from the financial officer of the hospital, threatening him with having a bad name for debt. Knowing this minister, I give him credit for looking into cases — he and his deputy.

Even though this bad debt may, I hope, be looked into by the minister and his department and cancelled, or whatever you can do about it, the main general principle here still remains: people in this province are no longer being given the right of true hospitalization. Once you start putting in user fees for hospitals and once the patient starts receiving those kinds of demands for payment, you have broken down the basic universality principle.

Now I know you might say: "Well, what's $200?" I notice in one of the letters from the hospital it says something about: "I'm sure you can afford the $25 a month." The problem today is that too many people do not realize that if you live on $800 a month and you have all the problems and costs of being an amputee, particularly, and up to the time you got coverage you simply.... That $25 a month means a lot to you.

Anyway, the point I want to make without belabouring this, because there are many other things to bring up this afternoon not only from myself but from other members.... I simply say to the minister: it is all right to say in this House that people don't have to be plagued by these debts, that we don't call them all the time. The point is, Mr. Minister, that some of the hospitals, which are being financed by the public taxpayer, are still putting heavy demands on people who cannot pay. In a way I can't blame the hospital. I have to blame the minister. Either his message isn't getting through.... Even if it is, I still have to blame the minister and his government for adhering to user fees, which I contend break down universality.

Could the minister comment on this particular issue that I've brought up with regard to those letters?

HON. MR. NIELSEN: Rather than relinquish the concept of user fees, minimum as they are, I far prefer to refer to the specific incident and resolve that matter if possible. The incident the member speaks of, and the correspondence, relate to a person in a somewhat difficult position with difficulties. We're more than pleased in those individual situations to review the case and if necessary take direct action.

The user fees have been a fact of life in B.C. for 30-odd years. It does not cause hardship for a person when there is relief for an individual who truly is suffering a great difficulty with finances. To average persons required to pay the $8.50 a day, they are pleased to death that it only costs $8.50 a day, because they've had experiences elsewhere or know others who have had experiences elsewhere, and they recognize that it is a minimum contribution to their cost of stay in the hospital. This gentleman must have been in there for a considerable period of time to have a bill of that size. No problem at all to speak with the hospital administrators and make arrangements to take care of that matter.

I doubt if that one situation, or even a couple, really argue very strongly against the benefit to the balance of our society achieved by the collection of that amount of money. It does provide the opportunity of funding other benefits to people that are not covered by medicare at all. It's a fact of life — $40-odd million or whatever is a lot of money, and it can be used for other purposes in health care. Without it, there would have to be reductions. I don't know whether members on the other side are so opposed to user fees that they would like to see the supplementary benefits and non-medical benefits gone because the money isn't there. But in part, that's what user fees fund, to a very large extent. They fund a significant amount of the non-medical benefits that are found in our medicare plan in British Columbia.

On this specific issue, there's not a problem at all. I'm not aware that I've heard from the gentleman. Had I, I think we probably would have resolved the matter before the member was aware of it.

MRS. DAILLY: I did pay credit to the minister; I know he and his deputy will look into this case. But again, of course, we have a very basic difference here and will continue to have one. I regret very much that the minister still does not see that the principle of user fees is destroying, and will continue to destroy, the principle of medicare, of the hospitalization and medicare in this province.

One final word of debate on this. When the minister says, "Where are you going to get the money from?" let's remember that already he is losing that amount of money from the federal government at the time. And you will get it back. I notice you said: "I've already asked for it back." Was that just being facetious? May I ask this question directly to the minister? You have already asked for the money back. Does that mean that this government intends therefore to abolish user fees? I wonder if you could explain what you meant in Hansard when you stated the other day: "We've already asked for the return of the money."

HON. MR. NIELSEN: To be succinct: in various correspondence from various ministers to various counterparts in Ottawa, we've told them to think rationally and eliminate that nonsense of penalties and send our money back SAP.

MRS. DAILLY: Mr. Chairman, I hope the federal Conservative minister will not follow at all in that request from the point of view that obviously you want the money back and you want to keep user fees. I hope the federal Conservative government feels more strongly about universality than you do, Mr. Minister, and hopefully they will.

Another word on that, though I said it would be the final word. You did refer to "Where are you going to get the $40 million?" Well, this government's always able to pull money out of the hat somewhere for some of their projects. I think that's a red herring. With this government I think it would be more to the point if the minister simply admitted that philosophically he believes in the user fee and obviously cannot therefore believe in universality. I just want to get that out to the minister.

HON. MR. NIELSEN: Why did you as government have user fees?

MRS. DAILLY: I'd be glad to answer that. I believe it was a dollar.

HON. MR. NIELSEN: Why did you have user fees? Never mind the amount.

MRS. DAILLY: At the time we had them, I recall the government saying that their intention was to eliminate user

[ Page 7715 ]

fees. I believe what the minister does not appreciate today is that you have raised the user fee continuously since you've been in office, to a point where it is indeed going to crack universality — and has already with some people. I regret very much that the minister cannot open his mind on this problem. If your government continues to increase them, we have really broken up that fundamental principle, and I regret it.

The other area I'd like to discuss with the minister — there's quite a number of them — is an area that.... The minister was kind enough, Mr. Chairman, to meet with me on this matter. At the time I certainly said to him, "We're not going to make a great big public issue of this matter," but I do think it's worth a debate in this House. It's a matter that I think can be dealt with in a realistic, practical discussion here, and that's methadone treatment.

The minister certainly must have had as many letters and calls as I have had on this matter, and I appreciate the time that was given to me in his office with the people in charge of this new treatment facility. But since leaving the minister's office I have continued to discuss this matter with a great number of people, and I am sincerely of the opinion — and it's not just my opinion, it's the opinion of people who know far more about it than I do, including some doctors — that the arbitrary, almost compulsory way in which these clinics are going to be dealing.... I think the changeover of methadone patients from the physician to the clinics is ultimately not going to be for the benefit of the patient. I am particularly concerned about patients who are now receiving methadone treatment from their private physician. Those people — the majority of those that I've had an opportunity to talk with — have most certainly been able to hold down jobs. As far as criminal records or the like, which some of them quite openly admit they have, they have never been inside a prison from the time of this methadone treatment.

Many of these people are actually becoming, may I say, nervous wrecks over the thought of this change and this upheaval — that they now will have to go to the health clinic. Their concern, as I have stated, is not just their concern; it's also the concern of some physicians. I actually have a letter here from a physician who has been in contact with the ministry. He prepared a number of papers, I believe, and even worked for the government at one time; I'm sure the minister knows who I'm talking about. In the discussion paper which he prepared, I imagine for the ministry, this doctor suggested interim measures — and these are the things I want the minister specifically to comment on — whereby government could offer help to private physicians treating addicts in return for some control, with the object of allowing stable methadone patients the privilege of private treatment while retaining new and poorly behaved patients in government clinics.

[2:45]

Now this is the position that I found myself arriving at before I received a copy of this letter. If people now receiving methadone from their private physician have not posed any problem, have shown a good record of attainment since they've been there, why not leave them with the private physician? I cannot understand why the minister could not concede or.... Has he given consideration to doing that? This does not mean we do not concede that maybe the government clinics have to be there. I know you're already in action with them, but why should the patients with the good record have their lives disrupted? Why should they be arbitrarily moved out and sent to the clinic'? Why can they not be allowed to stay there? I'd like a specific answer to that question from the minister.

Before I sit down on that issue — I think another colleague wishes to speak on this — I'm rather concerned with some of the very strict regulations that may be applying on the matter of mandatory withdrawal. But as I read this part of the letter I think it would be better, for the sake of those involved, if I had this discussion with the minister in private at some future time. So I'd like a specific answer as to why people who are already on methadone with their physician and have a satisfactory record, some of them over ten years, can't be left there.

HON. MR. NIELSEN: Many reasons, Mr. Chairman. This decision was made after extensive consultation with the B.C. College of Physicians and Surgeons, the B.C. College of Pharmacists, B.C. Medical Association and the Federal Bureau of Dangerous Drugs as a joint advisory committee. Some of the reasons which were considered with respect to what was going on in the province of methadone distribution.... It was brought to the attention of the joint advisory committee that there has been poor coordination between private fee-for-service physicians and government clinics due to lack of control, especially with regard to who should be admitted to the program. In June 1985 the subject of methadone was investigated in three separate coroner's inquests, convened as a result of death from overdose of a combination of drugs, including methadone.

The number of methadone users is unknown because many users are known to be involved in double doctoring, using false identification. A significant amount of methadone has been diverted to the street for sale on the black market for $1 a milligram. Most private fee-for-service physicians prescribing methadone do so in an unstructured setting. Authorizations to prescribe are granted by the federal Bureau of Dangerous Drugs in Ottawa. Theoretically a private physician should adhere to federal protocols, but this is almost impossible to enforce.

The private physicians do not have facilities for regular supervised urine collection or supervised methadone dispensing at their disposal. Neither do they have a staff experienced in the field of addiction rehabilitation. Urine collections, if they are carried out at all, are often haphazard and poorly supervised.

The federal protocols are quite specific about the amount of methadone a patient is allowed to take away from the dispensing area in multiples of a maximum of 80 milligrams. The suggested maximum for stabilized patients is a one-week carry, and carries of up to four weeks have been given by private physicians. The treatment requirements have not been followed. Methadone is intended for use as merely one phase in the treatment of heroin. It is used to help addicts stabilize their lives, while at the same time ensuring they have regular contact with the many other services which are acknowledged as essential in the long-term treatment of these patients.

If methadone is used under these circumstances. It is essential that through constant surveillance of urinalysis the treatment team is assured that the patient is indeed free from taking other drugs and that they are taking the methadone rather than diverting it on the street market. Methadone is one treatment available to physicians in the treatment of heroin

[ Page 7716 ]

addiction. The fact that patients are on methadone for many years shows treatment failure rather than success. Statistics on outcome of methadone treatment are difficult to assess, as there is no standardization of follow-up methods.

Mr. Chairman, this question has been before us for a long time. The system that was in place has not proved to be satisfactory. In consultation, as I mentioned, with the College of Physicians and Surgeons, the College of Pharmacists, the federal Bureau of Dangerous Drugs, B.C. Medical Association and the ministry, this new program was brought up. As far as I know, it has unanimous approval of all.

So I am sure some individual addicts may be upset, and I recognize that they do have trepidation, and they may fear that their lifestyle as it has existed for some time will be modified or disrupted. We believe that it is in the interests of society that we have control over the dispensation of methadone. There are too many side effects that have been brought to our attention, and I think it is the Ministry of Health's duty to try to minimize the effects on society in having methadone being dispensed in somewhat of a haphazard way.

Please remember it was not just the ministry but also medical organizations and others that recommended that this system be in place in B.C.

MR. WILLIAMS: Maybe, Mr. Chairman, the minister could advise us how he sees this being delivered, then, and what patients that now get treatment from doctors will face with respect to these clinics. Are they clinics available on a 24-hour basis?

HON. MR. NIELSEN: The two clinics we are speaking of would be open from 6 a.m. until 10 p.m. seven days a week.

MR. WILLIAMS: I met with an addict in my riding who has lived with this problem for a dozen years, treated by a private physician. He has a truck-driving job and since being on methadone has been able to lead a reasonably fulfilling life, if you can call it that, in terms of carrying out his job and carrying on with his family. None of us envy these situations or are happy with them, but this is a person that has dealt with the habit in this way for a dozen years. He happens to be a truck-driver who makes a more than decent living, but he has to be up at 5 a.m. for his truck-driving job. What does he do? He tells me that he gets up and he's sick in the morning. He needs methadone then. Your clinic opens at 6 a.m. He's out of a job; it's as simple as that.

It's this kind of narrow, centralized way of dealing with problems that you birds over on the other side always find as the solution. The irony of ironies; you people are the great centralizers in this province. Where are the two clinics? Aren't they three blocks apart? One of them is on 8th Avenue and one of them is on Broadway. Now isn't that a great service to the greater Vancouver region! You know, it's that kind of narrow bureaucrat's answer and your kind of rubberstamp attitude, instead of seeing these issues in very clear, human terms. This guy clearly and simply is out of a job if you proceed in the manner in which you are planning. Can the minister respond?

HON. MR. NIELSEN: No problem at all. We have other people who are in very isolated areas of the province who cannot possibly get down to the clinic on a regular basis.

Those people are being taken care of on a one-by-one basis. If your truck-driver gets up at 5 o'clock, let me know who he is and we'll make arrangements so the methadone can be available for him. We don't want him out of a job.

MR. WILLIAMS: You know, I presume then that what you are talking about is daily control over these people. Is that what you're talking about? Do you want daily control over the lives of these people? The member for Burnaby North (Mrs. Dailly) has said that it may be one thing if you're going to deal with your new problems on the street, but these are people who are leading reasonably productive lives despite the addiction. It doesn't make sense to me to funnel them into this kind of entrance program.

You know, there are serious academics, I understand, from Simon Fraser who question what you're doing. So all of your bureaucratic agencies can tell you what you like, but there are at least some outside academics who say this doesn't wash and that it doesn't make sense. You've got two clinics three blocks apart? Where?

Interjection.

MR. WILLIAMS: No, but you've got two in Vancouver; isn't that so — one on Broadway and one on 8th Avenue, a few blocks apart?

Interjection.

MR. WILLIAMS: That's the minister, and he was the minister before. He's bringing in the program. Don't you know if you got out of grade 11 or grade 12? You figure it out.

HON. MR. HEWITT: Well, I know that I at least know what I'm talking about. You just told us that you knew.

MR. WILLIAMS: You don't know if you graduated from grade 11 or 12, Mr. Minister of Education. I don't think I need your advice on anything.

MR. CHAIRMAN: Order, please. The member for Vancouver East has been recognized. Would all members when speaking address their comments through the Chair.

MR. WILLIAMS: Isn't it true, Mr. Minister, that the clinics in Vancouver are a few blocks apart?

HON. MR. NIELSEN: The proposed plan would see two clinics, one adjacent to the existing clinic on West 8th Avenue, and the other would be on Willingdon Avenue in Burnaby. Presently it's at 525 West 8th and 307 West Broadway, I believe. The other main one would be in Burnaby, but arrangements are made depending on the individual. We have many now who go to our clinics, and have been for many, many years. They receive their methadone through the existing clinics. As these cases become known to those people working with them, many arrangements are made to assist them in difficulties they may identify individually.

So that type of problem you mention with the truck-driver and his unusual hours probably could be accommodated. As I mentioned, some addicts in remote areas, and they are functioning in these remote areas, know they can't possibly get over to a clinic regularly. In some cases they have a prescription supplied to them on a bi-weekly or whatever — semi-

[ Page 7717 ]

monthly, sometimes — supply. That need not necessarily be changed. It's a matter of investigating the circumstances surrounding each.

But there has been a significant amount of abuse associated with the methadone, and we believe that this is the best way to try to get it in a responsible dispensing manner. We will take into account an individual circumstance, and we will try to tailor some plans to suit those who have legitimate difficulties in attending such a clinic. Many have done this for a number of years. I think it's probably in a ratio of about five-to-one outside to in. We think it will provide a far better handle on the problems associated with dispensation of methadone, as I mentioned earlier.

[3:00]

MR. WILLIAMS: It seems to me that the doctors are either responsible or they are not. If they are not responsible, then there are their own professional agencies, there is your ministry, and so on. If it's the doctors who are being irresponsible, then deal with the ones that you've got a problem with. This is an easier bureaucratic answer, it seems to me, given your perspective. But given the problems of the patient or the addict, it's something else again.

[Mr. Rogers in the chair.]

Again, in the case of my truck-driver example, what about a person who is actually taking two doses a day? That is, he isn't taking it just once every 24 hours, he's taking it twice a day, and he has a job. So there's this problem of getting up at 5 in the morning and being on the job, but also needing further help later in the day. Does that mean he has to go back to the clinic again? Again, it interferes with the job.

HON. MR. NIELSEN: If an individual needed a couple of shots a day of this, and when they returned to the clinic and the urinalysis indicated that they had not consumed the previous dose, I imagine he'd be told: "You better come back for each individual...." But if he's established a pattern of responsibility, I don't see any difficulty in dispensing an additional supply to the individual. But we have to develop some case records on some of them, because we find a lot of methadone on the street. They find, as I mentioned earlier.... Many of the doctors' offices do not have individuals who are trained in a lot of these matters. It's not just the doctor. If a person receives a week's or two weeks' supply, the doctor has no control over what happens to that methadone. This is a major concern to the law enforcement agencies as well. There is no guarantee as to what happens to that methadone once it is in the possession of an individual.

So I believe it's a matter of testing the service, and I think we can work out problems for people who have legitimate concerns and fears and difficulties. It's done now at the clinic, and I don't see why it can't be expanded to most of the responsible persons receiving the treatment.

MR. WILLIAMS: I appreciate the minister responding, but it's disturbing when you hear the minister say: "Well, I imagine blah, blah, blah, that this is what will happen." Well. fair enough. That's clearly the way you see what will follow. But by the lord, any of us who have studied bureaucracies say, "Lots of luck, Charlie, lots of luck," because they often have their own agendas inside these bureaucracies. The guy at the top.... Well, you know, maybe this minister has more impact — or his deputy; that may well be the case. But still these people often have their own agenda. It does seem to me that even if you wanted to monitor it, that would make sense initially, as an interim step.

Say in the case of my truck-driver example, if for two weeks he ended up showing that he had to have this kind of help to deal with his addiction, and you are satisfied about those volumes, then once that's established, what's wrong with it being back in his physician's hands to handle those kinds of volumes? That seems reasonable. You've then satisfied yourself about the volume and the particular patient's problem on a monitoring basis or on a sample basis instead of on a continuing basis, in terms of the Big Brother thing. That's what bothers me. I don't think we need a Big Brother solution here — the "Big Brother is watching you" routine. These people have a miserable enough circumstance without being handled by the state every day of their lives. So what about an interim period where you might simply monitor and review, rather than drawing the line and saying it's over?

HON. MR. NIELSEN: We are starting out somewhere, and indeed we will be monitoring the program. We will be developing policy with respect to individuals as we go along, hopefully to improve it and make it more reasonable and accessible and controllable. But as the member would know, Mr. Chairman, depending on the individual, regular lab samples are necessary to determine if the person is following the medication as prescribed. We've had some pretty bad experiences where that indication is anything but that. We also have had some history recently of private physicians being known to certain addicts and being known to be very liberal with their prescriptions and so on, and there's been action taken. But it has turned into a very major problem of considerable concern. I think it's necessary to get it all together again to get it started, at least, and then if there are recommendations from some of the people who are involved, either at the patient level or the physician level at the clinics, then I'm sure we would consider an individual who may have such a record that there is really no concern or fear that the methadone will find its way improperly elsewhere or that the individual will abuse the program. We want to start at the beginning.

One of the things we wish to do is to identify how many there are, and we would like to avoid duplication. We'd like to avoid a patient perhaps going to several doctors for supply, to try and get a handle on that and find out how many of these people there are. But we don't intend to be overly arbitrary, nor do we intend to be overly bureaucratic when it comes to that. We're going to be very flexible and, I hope, very understanding with respect to the treatment of these people. We want them to be as they were intended to be under controlled methadone consumption in replacement of heroin, to avoid the crime and street life that goes with the acquisition of heroin. I think we're going to give it a very legitimate and honest effort to try to gain a little better control over it, and Mr. Member, I can assure you that we will be taking into consideration the individual's needs as well as the system's needs. I think we can look forward to quite an improved situation over the next period of time. At least we're going to give it our best shot.

MR. WILLIAMS: Mr. Chairman, it does seem to me that if you clearly have problems with specific doctors, then you might deal directly at that base in terms of those obvious problems for starters. That's not what you're doing. Beyond

[ Page 7718 ]

that, it seems to me that if you see this program the way you've just now suggested, then the prospect of these people returning to a doctor-patient relationship is still there. Could we have some assurance from the minister to that effect, Mr. Chairman — that he doesn't dismiss that possibility down the road?

HON. MR. NIELSEN: I'm sorry, Mr. Chairman, was that the possibility of returning to prescription by physicians? I wouldn't dismiss that as never happening. I would not say that there may be patients today who have a good track record and a good history where they could be accommodated by a physician we know to be competent and — I shouldn't use the word trustworthy, because I'm not suggesting others are not — competent in that field. Sure, there's quite a possibility that it could be accommodated in a relatively short period of history for that individual. It's quite possible. I wouldn't dismiss it out of hand, no.

MRS. WALLACE: Mr. Chairman, I wonder whether the minister is aware of the size of the problem in some of the outlying areas, particularly central Vancouver Island — the whole drug cult. It's a very severe problem in central Vancouver Island. I took the occasion not long ago to meet with a person who works as a counsellor in drug and alcohol, and I was extremely upset at some of the things that he brought to my attention.

One of my questions to the minister is: what makes you feel that the people in the clinic will be any more capable of determining whether or not the would-be acquirer of methadone has a urine sample that is in line with what you're looking for? People who are anxious for drugs, either for money or for personal need, are very devious. What are you expecting those people in the clinic to do, actually observe the taking of the urine sample right on site, which is not done by the medical profession?

HON. MR. NIELSEN: Not always.

MRS. WALLACE: Not always. Right. So this is why you feel that the observation in the clinic will be more complete than it is with the medical profession.

What about a clinic in central Vancouver Island? What kind of facility are you going to provide there? That's another question.

I guess a final question: I was interested that you mentioned the side effects. We have methadone users in the valley who have been on methadone for 15 years, and it does have very serious side effects. I'm asking for a policy statement from the minister as to what the purpose of this is. Is there going to be an effort to get people off methadone, or are you just going to continue dishing it out?

HON. MR. NIELSEN: If we did, they'd stay on it for another 15 years.

MRS. WALLACE: What is the policy? Is the clinic to be just a continuing thing of doling out methadone over the years, or is there going to be some definite attempt to encourage people to kick the habit? What about Maple Cottage? What are you doing about that? Is that going to be enlarged? Is it going to be utilized? What is the policy of the minister relative to this? I think that's the question I would really like an answer to.

HON. MR. NIELSEN: Mr. Chairman, I'm sorry the member may not have been here at that time. That is the concept of the clinic. These people are not just dispensers of synthetic drugs, but rather specialists in this area, and they are involved in many of the other treatments that are required to assist people with getting off the habit — counselling and so on. The member mentioned someone on the island with 15 years. That's the worst possible example of an absolute failure of the system, where a person has been on it for 15 years, possibly because he's just picked it up and consumed it, picked it up and consumed it, with probably very little counselling or treatment of any other kind from the person dispensing the methadone.

I don't know what the numbers are on Vancouver Island. That's one of the things we'd like to know. We'd like to know how many methadone addicts there are on Vancouver Island and elsewhere in the province. We have a rough idea of how many there are, but we don't know in precise terms, and we hope to find out if we can. We think there are less than a thousand in the province, but we are not quite sure as to their precise numbers — maybe more than that. It is very difficult to know — maybe 800 outside, I think; about 1,400, I guess, in total.

But the staff at the clinics specialize in this. They are staffed by physicians and rehabilitation staff. Physicians still see all the patients, but they have far more expertise in trying to get these people off. There has been some success in getting some of them off methadone as well, from heroin to methadone to nothing, although there is no reason to suspect that methadone is any less addictive than heroin. But it is a different substance, as you know. It is also permitted, so....

But we think it is going to have a major impact on the negative sides of methadone treatment, and we are going to give it a try to see if indeed it works, according to the beliefs of all those people who are on the committee.

MRS. WALLACE: The clinic facilities for central Vancouver Island — I had asked you about that. What sort of facility are you going to provide, or are we still going to be using doctors there? What is happening in that area?

HON. MR. NIELSEN: We will not have a clinic as such on central Vancouver Island at this time. We are experimenting with the two on the lower mainland first. Whether the numbers would require one on the Island, I am not sure, but we will be looking at the individual cases as they are brought to our attention.

We will continue with the clinics in Prince George, Nanaimo and Campbell River. One of those communities has a fair concentration apparently, but it's Nanaimo, Campbell River and Prince George for the time being.

[3:15]

MRS. WALLACE: So the clinic in Nanaimo is going to continue. Does that mean that people living in Ladysmith, Duncan, Mill Bay and Shawnigan Lake requiring methadone will have to go to Nanaimo to get it, or will they still be able to get it from their doctor in those areas?

HON. MR. NIELSEN: I imagine they will have to go to the clinic. We're trying to get it out of the doctors' offices as much as possible. I don't know what distances may be. It's probably just as close for someone from those spots you

[ Page 7719 ]

mentioned as it is for someone in Richmond or Surrey to get to the clinic. I'm not sure what the actual road miles might be. It may be a little inconvenient; it may also save someone's life. Maybe we won't have three coroner's inquests in February of next year dealing with death from overdose of methadone and mixed drugs. I think it is important to monitor this. We're dealing with a very serious problem. Maybe we can keep some of the stuff off the street as well.

MRS. WALLACE: The problem is that you are going to do exactly the opposite, because with those kinds of distances there is going to be black marketing of methadone like you wouldn't believe in those areas. There is going to be a real pressure put on those people. Rather than going to their doctor in Mill Bay or their doctor in Duncan or their doctor in Ladysmith, they're going to have to get themselves in to Nanaimo once or twice...well, every day, or every week, or at the best every two weeks, from what you're saying. It just isn't going to work.

The whole methadone thing will be abused, and there will be a tendency to return to other hard and illegal drugs, and you will be making criminals out of people as a result. It just isn't going to work in that area if you insist that those people have to get in to Nanaimo to the clinic, rather than letting them use their own doctor. It's going to have exactly the opposite effect to what you are suggesting.

MRS. DAILLY: Mr. Chairman, yes, I endorse what the member for Cowichan-Malahat has said. I have had those concerns expressed to me also, just as she has laid out to the House. That is why we feel that the government, perhaps — maybe with the best of motives, I don't know — has moved upon this thing without really looking at some of the serious ramifications of it.

I noticed that in answer to the member for Vancouver East the minister said — and we were pleased to hear it, of course — that maybe some of these people, after careful monitoring and watching their pattern at the clinics, may be returned to private physicians. It seems to me — and this is my final word on it this time, Mr. Chairman — that we've come right around full circle. The point that we are trying to make today to the minister is that those who have a successful history with their doctor.... And we accept the fact there have been some bad scenes in some cases, but by and large the majority have successful histories.

Why upset their lives? Why upset the life of that truck driver who has been brought to your attention? Why upset the lives of many other people? That's all we are saying, Why can you not follow some very strict monitoring with those people? For example, I know right now they have to be registered with Health and Welfare Canada when they're with a private physician. A suggestion was made that the alcohol and drug programs should also have a form of registration. All we're saying is that we believe it would be better for these people's future and health if they could be left with the private physician. I make one final plea to the minister: kind of pull back, stop and look at that situation with great care before these people have this terrible disruption that we consider will not be for their benefit.

A final question to the minister. I understand that some of the methadone addicts involved have asked for a meeting. They had a meeting set up with the former Minister of Health. Now that you are acting minister.... I phoned your office, and I was wondering if you have been able to work out an opportunity to meet with this group of people who would like to meet with you.

HON. MR. NIELSEN: I haven't seen it on my schedule, but I have no problem in meeting with any of these people. If arrangements have been made, I'll certainly see them.

MS. SANFORD: I certainly support the views that have been expressed on this side of the House with respect to methadone, but I'm going to drop that topic and move to something else.

I'm wondering, Mr. Chairman, if the minister has any information about the hiring of ambulance attendants to work during the period of Expo. I assume there are some that are being hired to work onsite. I would like to know how many are being hired, and how many of them are actually already employed full time. There is some criticism about that.

HON. MR. NIELSEN: Mr. Chairman, I really don't know the numbers. This is an onsite, in-house ambulance service that Expo 86 is putting together. In fact, the deputy minister was investigating this matter today, because it has been brought to my attention that the requirements for qualifying for a position through the Expo Corporation may be such — and I don't know this to be absolutely correct; we're looking into it — that only persons presently employed for the ambulance service may qualify.

MS. SANFORD: Full time?

HON. MR. NIELSEN: No, this would be on a part-time basis.

We don't know yet. Let's see now. Is this today's date? Yes. Expo emergency service. It was determined that they have a total of 151 employees; 77 are EHSC members; the balance are nurses of various skill levels. EHSC employees hired by Expo are EMA-is, EMA-2s and EMA-3s. The shift schedules at Expo are to be six hours in length. It says that Expo and the region 3 management are exchanging shift schedules in order that there be no conflict with employees coming to work in a fatigued condition.

It was suggested — this is only a preliminary response that it would appear, at least from the ambulance point of view, that.... My own conclusion, although it may be modified later, is that only people who work for the emergency health services at this present time qualify under the conditions laid down by Expo. That's what I believe at this time. So they would be, I presume, on a part-time basis. It could be that some will be on vacation; I don't know what arrangements have been made for that. But it would appear that the Expo folks have established a standard of ambulance attendant that is only met by those who are employed for emergency health services at this time.

I've only just started to look in to this. That's just the preliminary information I have.

MS. SANFORD: I thank the minister for his answer. While he's looking into that, Mr. Chairman, I wonder if he would also look into some of the complaints that I've been getting. A number of people currently employed by the emergency health services are part-time employees and do not necessarily live in that lower mainland area. They would like very much to become full-time employees, and, as a result, have made application to be employed so that they can

[ Page 7720 ]

fill out a full-time schedule rather than the part-time schedule they're on now. The hours they are working are currently flexible enough so that they could spend some time working at Expo, as well as fulfilling their obligation in the job in which they're currently employed. These people, I understand, are not being considered, even though they are EMA-is, EMA-2s or EMA-3s. They are being set aside because of the fact that so many of the people who are already full-time drivers in the Vancouver area are the ones who are being hired; so they are, in effect, doing the full-time load for the regular ambulance service, and in addition are being hired to do this extra time at Expo. I think that's grossly unfair, in view of the high unemployment rate in this province, and in view of the fact that there are a number of EMA-is, EMA-2s and EMA-3s too, I guess, who would like to be hired full time. These are people, by the way, who live on the Island and do have accommodation in Vancouver with relatives, and they have made arrangements so they could stay with them. They would like very much to be considered for these positions. I hope it's not too late, because I know that the interviewing has been done, and I hope that the minister will be able to make some adjustments in the interest of fairness.

The other thing that I would like to raise with the minister is one that I was asked to raise under these estimates rather than under the MHR estimates. It relates to the counselling services for sexually abused children. Those children are now to be counselled under the jurisdiction of the Ministry of Health, the mental health services branch, and the information that I have that has been a great deal of worry to me over the last period of time is the fact that these people in the mental health branch do not consider the counselling services for sexually abused children to be a priority. I know that there are people in my constituency who have had trouble getting counselling, and I cited one case under the MHR estimates in which the mother had been waiting since last October to have her two children receive some counselling, and I had to intervene in order to have it happen. I would like the minister to ensure that that counselling is a priority in every branch of his ministry.

HON. MR. NIELSEN: Very briefly, I would agree. I would certainly encourage those responsible for those offices, clinics or whatever, to consider that to be a priority. I would be more than pleased to do an audit as to what kind of delays, if any, have occurred, because I agree with the member. Yes, I believe that type of counselling is essential, and it's essential to have it started early rather than wait for the effects to become so permanent they may not be modified later. I'd be more than pleased to get some information on that and offer them that instruction.

MS. BROWN: I'm going to use this opportunity under the minister's vote to discuss preventive and community health. I have a number of issues under that if the minister would like to prepare himself for this.

The minister has said that prevention is the emphasis that the ministry is going to be taking, that the recognition if we are talking about health is that we should try to prevent people from becoming ill and place our focus on that, rather than waiting until they are sick and in acute care and start spending money on them. That is why I'm kind of puzzled by what's happened to the budget in this ministry for preventive and community health care, because, of course, community health care is much less expensive to deliver than hospital or institutional care. It seems to me that in terms of the fiscal feasibility, one would be better off spending money in community and preventive medicine rather than the other way around. Yet we find under mental health, for example, that there's been a reduction in the budget. We find a reduction in the budget for forensic psychiatric services, and under community health care services there's been a reduction of $2.7 million. As far as preventive services is concerned, there has been a picayune increase of $176,000. So maybe in responding the minister would try to explain how they're going to place emphasis and reduce the sums of money in the budget at the same time.

The reason I'm having to ask this is that the other mystery that's occurred is that the budget supplement has been changed. Whereas in 1985-86 the supplement gave us details of the vote — on the preventive services it was broken down into program management, public health nursing, public health inspection, health education, speech and hearing, nutrition, dental programs, epidemiology, and so on — in 1987 under preventive services we have two things: program management and field operations. So we don't really know what's happened to whom as a result of this redrafting. So I'm going to have to start out by asking the minister to give me a breakdown based on the 1985-86 listing of the services covered by preventive services so that I can have a better understanding of where the money was reduced at the same time that the emphasis was increased.

[3:30]

I want to know, for example, what's happening to public health nursing, public health inspection, health education, speech and hearing, nutrition, the dental program, epidemiology, contributions to municipalities, and so on. I need more details on that.

HON. MR. NIELSEN: Mr. Chairman, we ran over this the other day and there's a number of these.... . I guess we don't call them sub-votes anymore, but specific items where there have been some reductions for a number of reasons. As an example, in the forensic psychiatric services the decrease was a reflection of the reduction in funds needed for the Young Offenders Act, and a salary and benefit reduction equivalent to the actual surplus in the '85-86 budget. In mental health services there was a 1.1 percent decrease due to a salary reduction equivalent to the actual salary surplus in fiscal year '85-86, and also with reference to the Young Offenders Act. The numbers have been changed.

The member did not ask, but as an example, hospital equipment was reduced somewhat because we had increased it for the one-time purchase of the lithotripter at $3.2 million. So the reduction reflects that we're not buying another one. Similarly, there was salary and benefit over-budgeting of 22 percent in community physiotherapy. There was a reduction in employees' benefits due to a salary surplus in home nursing care, so there's a 0.7 percent decrease. In long-term care facilities, a decrease of 2.3 percent due to a program transfer of 119 beds to the mental health boarding home program. The ambulance service decreased 8.5 percent due to the fact that employee benefits were double-budgeted in '85-86, much to the shame of someone; they were caught and then modified.

So the programs that the member is speaking of were modified because of bookkeeping changes from the previous year, and in effect overestimating certain costs of unknown factors at that time — salary and benefits that we did not have

[ Page 7721 ]

a firm handle on, but which have been adjusted for this year. That's what those reductions were about.

[Mr. Strachan in the chair.]

MS. BROWN: Mr. Chairman, I wonder if the minister would reconsider going back to the old format in terms of the supplement and giving us more detail. It makes it easier on him during his estimates because we have the answers and therefore there is no need to ask the questions. This modern new way of putting everything under two headings is proving to be an incredible burden on the minister, because he has to have all of this additional information at his fingertips. We would appreciate it if we could go back to the old 1985-86 way of dealing with the supplement, which would give us all of the information that we need to begin with.

In addition, I'm kind of surprised at the reduction in mental health services at the same time as we're having this wonderful conference here, and I'm not quite sure what this says about us. Maybe in responding to my question there could be more detail about how we can afford a reduction in an area which isn't really adequate. I understand from a newspaper clipping that the minister has a probe in process; somebody is looking at doing a review of B.C.'s mental health services. When will we get the results on this, or are they now ready? And is the minister interested in sharing them with us?

The other thing I was concerned about is the whole area of public health boards. There is a call from around the province for more funds for them. According to this quote, B.C. health boards have served notice to the provincial government that they need more money for public health services. Looking through the annual staffing report of the central Vancouver Island health unit, they talk about a reduction in home nursing care and public health nursing — that has suffered — the clerical support staff is in short supply, and increased illness among clerical staff has created quite a severe problem, with staff having to be juggled between different offices.

The Williams Lake Tribune talks about shortages. The northern interior health unit talks about shortages. Northwest B.C. talks about shortages, At the same time, we're being told that cases of TB are increasing, as are a number of the other illnesses that should be identified quite early and dealt with, while staffing levels are not improving in any of these districts. I wonder whether the minister could indicate.... I think I noticed somewhere here a reduction in the public health vote. Was there a reduction in the public health vote? I think there was a reduction. Anyway, maybe he could explain and tell us whether any of these boards are going to have the increase they are looking for.

Home dialysis. This is another service which, if it's funded and the home monitoring can be done and the care can be done for support at home, would save us dollars in terms of hospital care. Yet we are told that there is an underfunding of nursing support for home dialysis. I can't tell from either the supplement or from the estimate book whether the ministry has moved to deal with this underfunding problem in terms of home dialysis. Maybe the minister in responding can say whether that has been done or not.

Diabetes. There is a need to extend B.C. Medical coverage to cover blood-monitoring supplies. The cost of blood strips, dipsticks, etc., is causing a hardship for many British Columbians, from children to the elderly — because unfortunately diabetes does not respect age; it can strike very young children as well as the elderly. The cost of these supplies creates a hardship for the family. Self-monitoring saves money, and again we've been told that there is not medical coverage for this.

The major question, in addition, that I want to talk about is a study which was conducted by the native community in terms of alcohol and drug abuse among native people. To quote:

"When a group of Indians set out to examine alcohol and drug abuse among native people last year, it opened a door into Dante's Inferno. But, unlike in the Italian poet's Divine Comedy, the travelers were confronted with scenes of the living tormented, not by a vision of souls after death."

It goes on to talk about children 10 and 12 years of age sniffing Liquid Paper, swallowing illegal chemicals, drowning their brains in alcohol to get high enough to deal with their depression. The president of the National Association of Friendship Centres said: "Nobody's doing anything about it." The study also pointed out that many of the victims are as young as five years of age.

The study came up with some recommendations, and that's what I specifically want to ask the minister about. It suggested that the provincial government establish alcohol and drug education programs at school levels, targeting the native students. It also suggested funding agencies to offer graduate fellowships to natives training as alcohol and drug counsellors. Thirdly, it suggested that financial resources be provided for the development of community-based treatment facilities for rural and isolated areas with urban natives.

What I'm specifically asking the minister about, because I realize that there's nothing that he can add to the horror which was outlined in this study, is: I'm wondering what the provincial government has done, if anything, in terms of those three recommendations.

HON. MR. NIELSEN: I'm not familiar with that study. I'm sorry, if it's a recent study or whether it's some time back.... We do have a tremendous amount of discussions with the federal government with respect to the plight of Indian people in Canada and in British Columbia, and a tremendous amount of funding is made available. A tremendous amount of funding is made available in Canada and in British Columbia to Indian people for a variety of needs.

The recommendations by that study should not go unheeded. I can't see why there would be any difficulty in the discussions which I'm sure either have or should take place with respect to that. The conditions among Indians on reserves and elsewhere are not the best in Canada, and never have been, and nothing seems to have been resolved to the point of solving the problems. We spend a tremendous amount of time consulting with the federal government over these issues, and I don't know why those would not have been specifically reviewed. Perhaps they have been and not brought to my attention, but I don't know whether I have that report. I'm sorry. It's not the Alberta report, is it?

MS. BROWN: No.

HON. MR. NIELSEN: Yes, okay, but I could look at that later and see what has been done. A lot has been.

Interjection.

[ Page 7722 ]

HON. MR. NIELSEN: Okay, yes. But those don't seem like unreasonable requests for those. I'd be very pleased to review the matter and see what's been done.

MR. BROWN: What about my other question?

HON. MR. NIELSEN: Oh, I'm sorry. With respect to the mental health funding? Is that part of it?

MS. BROWN: Yes, and the dialysis.

HON. MR. NIELSEN: Yes, I don't know of any underfunding at all in home dialysis. As far as I know, that is not a problem and hasn't been a problem. The union boards of health, most of them, have been reporting shortages of staff, not because of a budgeting problem but because of recruitment problems. I was in Terrace, I think it was; the last time I was there I believe they had about seven positions unfilled, and they were actively recruiting for them. We have a very serious problem when the union boards of health get involved in recruitment of such people as speech pathologists, audiologists and some specialists.

What we have done for this year is to offer a bursary program that will provide up to $5,000 a year for four years for students who go into these subspecialties, or whatever they refer to them as, and are prepared to work in areas where we need the people. It is a tremendous problem trying to recruit people for those areas and to keep them there once they have been recruited, because other areas open up and many of them transfer. But it is common throughout all of the remote areas of the province, where there is a shortage. We are the first to admit that, and we recruit constantly. In some instances we have recruited for a position in excess of a year and a half without success, and we have asked in some instances that certain rules be waived so we may use foreign graduates in those areas as a stopgap if nothing else.

It is a real, ongoing problem. The union boards of health mention that every year, and we recognize it. We haven't been able to resolve it as yet.

[3:45]

MR. REE: Mr. Chairman, I have received a letter from the Lions Gate Hospital in North Vancouver, expressing a concern with respect to their neurological rehabilitation daycare program. They have indicated this program, which was implemented in 1980, is an important part of their ambulatory-care service towards decreasing in-patient stays within the hospital.

Through the program, they have referred many patients to various community organizations on the North Shore, some in North Vancouver, some in West Vancouver, to do followup treatment of the patients at these community centres. Some of these centres are dealing with seniors: Silver Harbour seniors' centre, the Margaret Fulton adult day-care centre, the Stroke Clubs, fitness centres and so on. Their concern, Mr. Minister, is that the handyDART system, which I appreciate is not the responsibility of the ministry, is now implementing some restriction and moving some of these out-patients or these people that have been discharged from the neurological rehabilitation day-care program so that they cannot get to the community program and, as a result, may then have to be readmitted or spend longer time in the hospital. What I am asking is whether the minister could have some staff negotiate with the Provincial Secretary's office to see what can be done to alleviate this shortfall in handyDART services with people that will be taking the benefit of this program at the hospital.

That, Mr. Chairman, is the only thing I would really like to ask the minister. I would like to make some comments, though, with respect to the hospital and medical care in this province. During the past year, unfortunately — I received a great education from it, but I am sorry I had to receive it this way - my family had a great deal of benefit from hospital treatment, hospital care, doctors' care in British Columbia. Last summer my two sons, within a month of each other, were admitted under emergency circumstances to the Lions Gate Hospital, and each spent approximately a week in the hospital. My wife had extensive major surgery at Vancouver General Hospital in January of this year and was there eight or nine days.

I don't think there is any place in the world that could possibly get the care and the treatment, the capability of it, the extent of it, the care of it that we have in this province, particularly in those two hospitals. With my first son, I felt a little bit concerned when I took him to the emergency department, because he was injured in a sporting accident. We sat and waited for quite some time. Others came in — you might say there was a lineup — and got served before us, and people get a little bit annoyed. We're used to standing in lineups at Safeway or for ferries or other things. We sort of think first come, first served.

My second son was involved in a motor vehicle accident when he was riding his bicycle, and he arrived in the ambulance service, which was excellent. They were prompt. He had blood all over the place. I didn't know whether he was going to live or die. The whole emergency service of that hospital was on him in a matter of seconds. They had his serious injuries, which turned out not to be too serious, looked after very quickly and very promptly. In other words, he appeared to be critical, or if he had had critical injuries he would have received the same. My first son's injuries were not critical. The hospital attended those that needed it immediately. The others weren't left waiting just to wait; they were left waiting while others that were more critical were being treated. But I also found with respect to my second son that the emergency service at that hospital had specialists brought in in hardly any time at all. They were communicating with them; they were available. Doctors were available, and this was on a holiday weekend — Labour Day. This sort of medical care is available to us in this province. I think we're the most fortunate people in the world to have it available to us.

But in these three times in hospital that I spent this year I talked to a great number of patients, and since then have talked to other patients. Usually in conversations you come up with.... They usually have something a little bit negative that happened to them in the hospital. You know, Mr. Chairman, I would suggest that 90 percent of the complaints that I received were as a result of lack of communication, and usually — and I'm not knocking the medical profession when I say this — as a result of lack of communication by the doctor toward the patient, in not keeping the patient informed of what was happening to him, what was going to happen to him or what could happen to him. This, Mr. Chairman, is not to take away from the doctors who provide, I think, excellent medical care and excellent treatment to patients in this province, but I think there's maybe a little bit of a lack of bedside manner to a certain extent.

[ Page 7723 ]

I can't help but commend the minister, who has been the minister of this ministry for some time, for the extremely excellent care that we have available in this province, which I think from personal experience in this last year is second to none.

HON. MR. NIELSEN: On the handyDART, certainly we'd be pleased to look into that, because we'd like to maximize the advantage of the community services for these people. I appreciate the member's comments about the overall service, recognizing that indeed we are fortunate to have the health care program we have in British Columbia, but recognizing that there is always going to be room for expansion and improvement. But I appreciate your comments.

MS. BROWN: There are two questions that the minister didn't respond to that maybe he'd like to comment on again, and that's the coverage for diabetes — extending medical coverage to cover blood-monitoring supplies: blood strips, dipsticks, these kinds of things — and also about redesigning or going back to the old way of reporting next year rather than the new method that he's using this year.

I want to talk a little bit about physiotherapists. I don't know whether it was covered before or not, but a survey which was carried out by our interns indicated.... Oh, no, it was a 1986 hospital survey that found that almost 50 percent of the hospitals surveyed were having difficulty recruiting physiotherapists. The health manpower training study for western Canada identified a need as far back as 1982 for additional physiotherapists.

It seems, Mr. Chairman, through you, that there are two reasons for it. One is that the University of British Columbia school of rehabilitative medicine is not graduating a sufficient number of graduates to meet the need; and secondly, there aren't sufficient immigrant physiotherapists coming in either to help us meet the need. The first problem, to do with the school of rehab medicine.... Certainly the number one way to start with it is that in fact there were approximately 480 applicants last year to get into the school of rehab medicine, which only takes 40 students and only graduates 20 students each year in terms of occupational therapists and physiotherapists.

So clearly that is not sufficient, and the first thing I'd like to suggest to the minister is a recommendation which I know he's heard before, and that is that we really need to look at the establishment of a second training centre, possibly attached to a community college in the interior of the province. That's the number one recommendation. That would save, in cost terms, the students themselves having to move down to the lower mainland to study, and it also would relieve the problem which he mentioned earlier of finding graduate physiotherapists or health professionals to go to areas outside of the lower mainland. So I'd like to go with the number one recommendation, which is establishing a second training centre. Graduating 20 physiotherapists a year is just not good enough for the province.

The other one is the requirements placed on immigrant physiotherapists before they can qualify, and these are really quite bizarre, Mr. Chairman. The way in which the Immigration Act operates and the requirements for practising here.... An immigrant has to come to Canada, write the appropriate exam, then leave the country and apply for immigrant status, with the hope that this will be granted. Then by the time the immigrant returns, hopefully the exam results would have been successful, and then the immigrant will be able to embark on a four-month residency under a licensed physiotherapist. This is really a very convoluted way of doing things. I realize that medicine and other professions have difficult criteria too, but I'm wondering whether there isn't a streamlined way in which we could deal with immigrants who have degrees in physiotherapy from other parts of the world, to maybe make it less convoluted than this way of going back and forth with it.

I don't support the recommendation that all physiotherapists should come in and be permitted to practise; I don't. I certainly think that some kind of supervision is called for in testing their credentials to be sure that they measure up to the high quality of physiotherapists who are graduating from UBC school of rehab medicine. But I think there can be a simpler way of dealing with it than the present one.

The other thing, of course, is that there's a lack of funds for in-province training for some of the students who would like to go through the system. I think that the minister could address himself to that. But I think, even more importantly, we really need to be able to graduate more physiotherapists than we're doing at present.

I just have one other small thing I want to touch on before going on to my other major presentation. It's about the optometrists at Woodward's. I only say this because the Woodward's store in New Westminster, which is the one where the optometrists I know are.... I respect their work. A lot of the seniors in Burnaby go there. They can go and have their eyes tested, and then go into the little restaurant downstairs and have a cup of tea and a muffin or something, and come back, and their glasses are made. It just seems so convenient for the seniors. It seems so convenient for everyone.

I find this decision really strange. I realize it's an internal battle between the optometrists themselves, and it's not something that was imposed on them by the minister. But I'm kind of disappointed that the minister went along with the recommendation that Woodward's be forced to phase out this particular service. It was of great convenience to a large number of people. It was a good, reliable service. They are top-flight optometrists. I think it's unfortunate that the minister was forced to take sides and go along with the decision that he did.

I want to talk about a report that was done on the role of women in health. This was done by the Canadian Advisory Council on the Status of Women. The report pointed out that women represent 75 percent of the workers in the health care system, but they hold only 17 percent of the executive positions. The medical profession, mirroring society, projects stereotypes which keep women subordinate and subjects them to unnecessary interventions, such as over-prescribing of tranquilizers, unnecessary mastectomies, hysterectomies, etc.

[Mr. Ree in the chair.]

The reproductive function of women is controlled by medical technology, and primarily male gynecologists and obstetricians. "Attempts by women to reassert their control," this study tells us, "through health collectives have been unsupported by government. Women's use of health services are due mainly to reproduction, ageing, and natural functions which seldom need medical intervention," which brings me to the one issue which I raise every year, and I

[ Page 7724 ]

guess I'm going to continue to raise it every year until the minister comes to understand the importance of women's health collectives to the delivery of community and preventive health services to women.

[4:00]

This is a real opportunity that women have, without going through the traditional health care system, of learning more about taking care of their bodies and about taking care of themselves. In fact, what women's health collectives do is save the government and the community at large a lot of money, if we want to look at it from a financial point of view. But more importantly, it helps women to do a better job of remaining healthy; and it does this on a shoe-string budget.

It seems to me, Mr. Chairman, that a minister who has articulated that he is, and I know that he is, honestly more committed to health than he is to sickness and does really believe more in prevention than in cure, should recognize that the Women's Health Collective is an ally, and not an enemy; that the work that the Women's Health Collective does is important. The Women's Health Collective identifies for women a number of areas in terms of ageing or reproduction in ways in which we can prevent some of the illnesses which would eventually lead to being admitted to hospitals or mental health institutions. Women's health collectives also alert women to ways in which we can deal with depression and other kinds of psychological and emotional problems without having to overuse prescription drugs such as tranquilizers and those kinds of things.

Women's health collectives did not grow out of the traditional health services. Doctors, in particular male doctors, male obstetricians and gynecologists, and people who specialize in geriatric medicine, didn't set up women's health collectives. That is true. It is outside of the traditional medical hierarchy. It grew out of women, a lot of them doctors, recognizing that women can take a lot more responsibility — and consequently a lot more control — over what happens to our bodies as well as our minds, and thereby do two things: live healthier lives and be able to make a more positive contribution to society, and at the same time save the community's hard-earned tax dollars from being put into treating sickness and illness in the health care system. I am baffled, therefore, by the minister's reluctance to fund this very important and viable aspect of the community and preventive health field. Maybe the minister has a genuine explanation to give us on this issue, so I am raising it once again this year.

The Vancouver Women's Health Collective is unique in that it does manage to get some funding - not nearly enough — from the federal government. It does get some assistance from the city, because they've allowed them free office space; but they still need some core funding. I know they have invited the Minister of Health, so maybe I could put this in the form of a question. Has the Minister of Health accepted the invitation, which was issued to him by the Vancouver Women's Health Collective last year, to visit the premises and see what they're doing in the way of counselling and education? The educational component of their work is what's really important. They're not treating people there. They're not treating women or illnesses, they're not delivering babies. What they're doing is an educational job — health education. That's the part of the government's budget that their funding should be coming out of.

They're interested in expanding their services to a broader range. They want to get to women for whom English is a second language. They want to be able to give the same kind of educational information to immigrant women, and move even further than that — into the native communities. So they are ambitious, but their ambition is based on a recognition that the more we know about our body and how it functions, the better care we take of it, and the better able we are to stay healthy and save the community hard-earned tax dollars. So is the minister at this time willing to look with approval on the Vancouver Women's Health Collective in terms of their request for funding?

HON. MR. NIELSEN: I know that no money has been allotted for them this year. We mentioned last year that the reason for termination of their funding was that the services they provided duplicated services and information which were available through our public health units, family physicians, specialists in certain fields. We felt that the services were being provided through the regular programs for those who wanted to receive them and there was no need for specific funding through the ministry for the Vancouver Women's Health Collective, which is one of many groups wishing funding to offer — no offence — their view. There are many groups that would like to have similar funds to offer their views on health care matters and we simply can't fund them.

The member spoke earlier of the blood glucose monitoring test, which is not included. The medical advisory committee of the ministry suggests that there is relatively small proven additional benefit to the patients with this test, and they have not recommended that it be included under Pharmacare at this time. They advise, however, that they do authorize expenditure of almost $2.5 million in needles, syringes, insulin, oral hypoglycemics and other required needs for diabetics for the calendar year 1984 — $2.4 million. But the view of the medical advisory committee was that the glucose test itself had relatively small proven additional benefit to the patients, so they did not recommend it be included.

The method of reporting in the book I will pass on to the Minister of Finance. They prepare it, and we supply the numbers to go into the slots.

On the physiotherapists, I believe the member's comments are in line with what we have been recommending and what we are working on with the association. The ministry has recommended the recruitment of physiotherapists who meet the requirements of part 2 of the act, which does not require the four-month residency. The ministry has requested the association remove any obstacles to the registration of foreign trained physiotherapists. It is a very major problem. We also have advised the Minister of Post-Secondary Education (Hon. R. Fraser) of the shortage, and we have recommended previously that there be an increase in the class sizes, and the ministry has recently announced the bursary program which would award a $5,000 bursary for a one-year return of service to a designated geographical area. We hope that that will have some effect.

But we have been asking the institutions to expand their program, to please produce more physiotherapists, and we are talking to the association about trying to break down some of the obstacles that make it more difficult for a foreign-trained physiotherapist to practise in British Columbia.

The optometrists at Woodward's. I believe this is the case the member is speaking of. The British Columbia Court of Appeal by a two-to-one decision ruled in favor of the B.C. Optometric Association upon the validity of regulation 36,

[ Page 7725 ]

which says a practising optometrist shall maintain a definite place of practice in the province.

"All premises from which an optometrist practises shall be situate in such a fashion as to consist of a self-contained office or suite of offices exclusively used for the practice of optometry, having a separate and distinct entrance from a street or, where within a building, from a common lobby, hallway, or mall; and in no case shall such premises be located within or form part of a commercial retail store."

So their regulation is very specific, and the British Columbia Court of Appeal ruled in favor of the validity of that regulation. Now we really have no choice but to follow court orders, even though sometimes we may not wish to. I believe there is a further appeal to the Supreme Court of Canada. I gather the case has not yet been heard. But the court did rule on the validity of that which would prohibit what you had mentioned.

MS. BROWN: Mr. Chairman, I wish I knew what to do to get the Minister of Health to understand that the Vancouver health collective delivers a different service to a different constituency than the people who go to your traditional public health clinics and to doctors' offices. So I am going to try something new. I am going to invite the Minister of Health to accompany me, the two of us together, to go and visit the health collective on a date of his choice, at a time of his choice. Did the minister say agreed?

Interjection.

MS. BROWN: Oh, I thought he was speaking on your behalf, Mr. Minister.

The women who walk in off the street and go to the Vancouver health collective, a number of them teen-age prostitutes, a number of them adolescents who won't go to their doctors' offices, won't go to a health collective.... A number of women who won't use those traditional services are being served. Their caseload is large. They are delivering a very important service, Mr. Chairman, and I think that the minister has to take that into account. The service may be duplicated, but we are dealing with a different catchment area; we are dealing with a different constituency.

So I am appealing to the Minister of Health again, in terms of the Vancouver health collective, to take another took at their request for funding, and if you want to have a visit with them before doing that, I would be quite willing to accompany you, or if you want to go by yourself, I will give you the address.

I just have a couple of things I want to raise on the business of youth. Because I speak on community and preventive health, I have this potpourri. The drinking age — I don't know if anyone raised that before, but maybe you would like to comment on that — but more specifically, Dr. Blatherwick's recommendation that there be more counselling services for youth, and whether in fact the ministry is looking at the establishment of this and generally what your feeling is about the drinking age and what you are going to be doing about that.

The other thing is the request for tougher regulations in dealing with bulk foods to protect the public from contamination, etc. Maybe the minister would like to comment on that.

My final comment, of course, has to do with smoking.

Interjection.

MS. BROWN: I'm raising this one without the permission of my caucus.

The number of public places that are voluntarily instituting non-smoking areas is wonderful. I don't know whether the minister has any comment to make in terms of beefing up the educational program on the dangers of smoking and generally looking at increasing the number of non-smoking areas in the public place to encourage the community at large to rid themselves of this — to perform a death-defying act, I think the burnper sticker reads.

My final thing is the request about redesigning the supplement. Are we going to get more details next year?

[4:15]

HON. MR. NIELSEN: Last first. I mentioned that I would pass the message on to the Ministry of Finance, who does design the form.

Smoking. There has been tremendous reaction to community requests and also municipal bylaws. I offer you an anecdote, which is rather interesting. Last September the municipality of Richmond passed a bylaw which prohibited smoking in — and they identified all the areas: reception areas, elevators, taxi cabs, a great list — and they passed it and went around to all of the community facilities and required that they post notices with a $500 fine and have all of this posted. As time went by, one gentlemen came by to our constituency office and told my staff that we were in violation of the bylaw because we had not posted their notice in compliance with the bylaw. I was advised, and I said: "Well, I'm not aware of a bylaw." The municipality apparently wasn't aware that under the act the Minister of Health has to validate the bylaw before it's in effect. Oh, boy. Then of course by the time I brought it to their attention, and by the time the deputy Minister of Municipal Affairs reviewed the matter, I was no longer Minister of Health so I couldn't sign their bylaw. But last week I finally signed it.

Now I've told the municipal council of Richmond to resubmit it to make sure it's valid, because I'm getting tired of these people blowing smoke at me in hallways, elevators, back alleys and places like that. We are involved in a pretty active program with respect to smoking. This one that's known as "Decisions" is an attempt of mild peer pressure in the grade 8 and 9 level — but not a stern lecturing style, a quite different style — in conjunction with the federal government. We're hoping it will have some effect; it's basically to try to persuade younger people to make decisions on their own for their own reasons, rather than being persuaded by others. There is a fair amount of that going on, and a provincial awareness program.

The bulk food issue. We've had very few problems recently. We had a large number a couple of years back when there seemed to be an inconsistency at the regulatory level from region to region. We seem to have ironed out many of the problems, and it's working quite well. We've really had very few complaints of late. There was some inconsistency; one municipality or one public health officer would make certain demands and another would not, so I think we've got it going pretty well.

The drinking age. There have been recommendations made that the drinking age be changed back to 21. It has not received that much attention and pressure. I recall a survey taken some years back by the Ministry of Consumer and

[ Page 7726 ]

Corporate Affairs where they analyzed some of the history of those who are either deemed to have or admit to have a serious drinking problem. Almost without exception, most of them began drinking at around the age of 12 or 13. Most of them began drinking at an early age, and most were introduced to alcohol at home.

There has been a lot of information, but I don't know of any pressure or uniform attitude about the drinking age being increased. I really don't. Now I'll make you a deal, partly. I'm going to be tied up for some time with various duties and activities, but to start with I'll have my deputy contact that organization and have him get down there fairly quickly to have a review. I'll have my deputy get down to see them probably within the next couple of weeks.

Interjection.

HON. MR. NIELSEN: Well, sure. Then you and I can have lunch or something and save time.

MR. REID: Mr. Chairman, just a couple of questions to the minister and his deputy minister and his assistant who is sitting on the other side of him there. Mr. Minister, we've talked a couple of times about the question of long-term care, and I can say that in my early activities in political life I got quite involved with the Kinsmen Club and we built a Kinsmen Place Lodge while I was on the board in Whalley. At that time it served the purpose, but since then the facility has attracted, as normal, more attention than they can accommodate. I received on December 18 from the Kinsmen Lodge a letter with some requests that I'd like to refer to you and ask you to respond to if you would. They point out recently some problems with assessments and reassessments of current residents, and the delay in those assessments. They are sometimes five or six months in getting reassessments, which in a five-storey building creates major problems in reallocating the beds in the facility. There's also the ongoing assessment problems with Boundary health unit and the expediting of the requests for the expansion of Kinsmen Place Lodge in order to provide 30 additional beds that have been indicated by Surrey Memorial Hospital, as there is a dire need in that location. So, Mr. Minister, I'd ask you to look into that one first of all.

Secondly is another request, and I'd like to read you the letter from the Ministry of Health. It goes as follows:

"Thanks for your letter of October 11 giving me the numbers of residents in your facility and on your waiting-list and their residence. As we agreed, the matter of approval of an extension of 50 beds as an intermediate-care wing to your facility will be looked at once we have experience of the new long-term care program to start on January 1."

That's dated October 24, 1977, signed by the minister of the day. I have a more current letter — March 7, 1986 — from that same organization, Evergreen Baptist Home, asking if we wouldn't take a look at the program as it refers to long-term care need and the approvals for those facilities which have proven they do have the ability and the facility to provide long-term care for additional residents in a community such as White Rock with its large population of seniors. The job that Evergreen Baptist Home does in that community.... I would encourage long-term care programming to look at providing these people with the permission to expand and add the 50 beds, because they have all the other facilities in that complex to accommodate 50 beds without building the cafeteria/dining facility, the cooking facilities and the activity centre already part of that complex. It's an incredible complex and it should be given whatever assistance is available or could be made available to add these 50 beds to that particular unit.

At the same Evergreen Baptist Home there is another firm or organization in White Rock which also tries to service that large predominantly senior population, and that's the White Rock Come Share Centre, which has a family home support program which operates out of the basement of this Evergreen Home. They currently have had their numbers of day clients reduced rather than increased, even though the numbers of requirements continues to increase by the day.

So, Mr. Minister, I'd ask you to give those serious consideration for assistance. And the announcement for the expansion of the Surrey Memorial Hospital on behalf of the first and second members for Surrey would be certainly appreciated very shortly. We want to commend you, Mr. Minister, for your diligence in your ministry, your vision, and your approval of the much-needed facility in White Rock that you've allowed to proceed. We've had many compliments, because that's been a much-needed facility. But you could announce the one for Surrey Memorial — within hours would be satisfactory to these two members, Mr. Minister — and deal with those other two questions, if you would.

HON. MR. NIELSEN: To the member for Surrey, I'd be pleased to look at the details of those long-term care facilities he mentioned, and I will make a decision very soon on that other matter. There have been a number of announcements made recently with respect to various construction programs. I mentioned earlier that I think it's $150 million in a year or so. Surrey is growing very rapidly. We recognize that, and there's quite a change in the demographics as well, so there's great need. We'll have a look at it.

MRS. WALLACE: I would like to talk to the minister about extra billing.

Interjection.

MRS. WALLACE: Well, yes, theoretically we don't have it, but unfortunately we still do have it. And the minister can cast his mind back to a couple of instances that I have brought to his attention, where the question of tray service has been raised by a doctor in my constituency. I can't imagine that it's an isolated case. I know of two instances where this charge has been made in writing to the B.C. Medical Plan people. I have a letter from Mr. Thorpe, who indicated that tray service charges are not to be billed, that they are considered as part and parcel of the premiums that doctors receive. Yet this doctor continues to bill tray service. It's interesting to note that he has a poster in his office put out by the Medical Services Association which lists sterilized tray service as something that is not covered by the plan.

As I say, it's bad enough to have this situation occur and to have the B.C. Medical Plan people have to write to the doctor and the patient and tell him that he can go and get his money. But what really hurts is when a patient gets a letter that reads like this from his doctor:

"Dear Mr. Low:

"Following our recent conversation, I feel I can no longer be regarded as your family physician."

[ Page 7727 ]

That conversation, Mr. Minister, had to do with the fact that he had been charged $5 for tray service, which should not have been the case.

"I would request that you find alternative medical care. So that your care will not be jeopardized and to allow you time to arrange this, I will continue to provide care as requested for the next two weeks. I will forward your records to the physician of your choice if you would let my office know who this will be."

[Mr. Strachan in the chair.]

Not only was that the physician who looked after Mr. Low, but that physician also looked after Mrs. Low. Mrs. Low is in a position where she just feels she cannot change her physician. Her health is not good. She's under special care. The physician has agreed to treat Mrs. Low, but I can tell you, it has shaken the confidence of that family to have that kind of letter coming to them. How can the medical profession continue to override the law of the land? How can that be allowed to happen? I suggest that the minister has been remiss in not ensuring that the law is obeyed.

I understand that there has been a lot of negotiation going on. There is presently a draft poster to patients in hand that excludes tray service from the list of exclusions. But what assurance do we have that that new poster is going to be posted? What assurance do we have that there is not going to be a continuation of this misuse of power by the doctors concerned? It is misuse. It's flagrant disregard of the law. There is an absolute lack of understanding on the part of the medical profession that that is excluded.

[4:30]

I spoke to my own doctor, who is a personal friend, about this, and he said: "Well, we could do it, but we don't do it because we figure we get enough. But we could do it." That was his feeling. He had been told by the B.C. Medical Association, obviously, that charging for tray service was a permissible thing to do.

Now $5 may seem insignificant. It's not just the fee; it's the principle. And $5 is pretty significant to an old age pensioner or someone who is really faced with living on a very limited income. So I have a lot of concerns about this. I hope that the thing is being looked after, that it is in hand, but if in fact it is not followed up, I'm suggesting there are going to be more and more Mr. Lows who are going to have to continue to face that situation. I guess a doctor has a right to refuse to treat a patient, but that is some flimsy right to refuse to treat a patient because the patient has insisted that the law be followed. That's really what it is all about.

Maybe the minister would just like to deal with that before I go on to the next topic.

HON. MR. NIELSEN: Well, if somebody went by the buildings, say, at 32 miles an hour, but the law says you cannot exceed 30.... If someone wishes to do something, it has to be brought to our attention. We don't sit in doctors' offices and watch everything they do. We expect to hear from the patients. If they feel that they're being inappropriately dealt with, we expect to hear from them, or from their member if their member is advised. We can't sit in all 5,000 doctors' offices and watch what they do with each patient; we'd probably be breaching the confidentiality of the doctor-patient relationship anyway. So I see nothing wrong with a person bringing it to our attention. And I suppose a doctor has a right to fire a patient, as a patient has a right to fire the doctor. We don't force them to see a doctor other than the doctor of their choice; nor do we force doctors, I presume, to accept patients other than patients they wish to work with. No problem reviewing that. Medical Services Plan has taken the stance that tray service is included in the fee, and they have for many years. We look into these when they are reported. I think perhaps about the only exemption would be if it's an uninsured service. We'd look into anything like that, of course. But there are going to be people who misinterpret language and regulations and laws all the time. Our position and purpose is to respond to it once it's brought to our attention.

MRS. WALLACE: Mr. Chairman, it was brought to that minister's attention some long time ago.

Interjection.

MRS. WALLACE: That fellow. The answer I got back was from that short-termer that was in there between you and you — a second answer which sent me the new poster that's now been worked at. What I'm suggesting to you is that if you don't let it be known to the medical association that this is now to be allowed, and make that very clear to them, this kind of thing is going to continue. And I don't think that's fair or just to the people that are caught up in this trap, like Mr. Lowe, who has lost his physician as a result of this. Sure, he has the legal right to do that; whether he has the moral right to tell a senior citizen that he will no longer look after him simply because that senior citizen saw fit to....

Interjection.

MRS. WALLACE: Well, I wasn't in on the conversation either. The minister says he wasn't in on the conversation. But I know Mr. Lowe quite well. Mr. Lowe went to collect his $5, and that's what happened: he was told simply that he would send it to him through the mail; that he would not give it to him there. When it arrived through the mail, it came with a letter saying that he was no longer a patient of that doctor. I have another case. This one also deals with the medical coverage, but it's the dental coverage in this instance. This is a woman who was born with a congenital problem with her mouth; and it's gone on and on. She has a bill now of something like $3,750. She's unemployed. To complete the work required is going to cost something like $5,000. But this is being considered as outside the coverage, because it's being considered as sort of cosmetic. Apparently the only thing they will cover is if this work is done in a hospital. I would just like to read excerpts from her dentist's letter, which was sent to the chairman of the Medical Services Plan. It says:

"This woman has been under treatment for four months. Her present condition" — I'm not going to even attempt the words, the medical terms — "...sensitive teeth, uneven bite surfaces, some facial asymmetry, speech difficulties, and a fair amount of stress, combined with jaw, neck and shoulder pain. Her narrow palate and upper jaw growth deficiency, as compared to the lower jaw, is most likely hereditary; this, in turn, caused the deviant

[ Page 7728 ]

swallow, because there isn't sufficient space for her tongue when she swallows."

Then he goes on to talk about the treatment he has given, and so on. Mr. Bolton's reply is that the medical plan is controlled by regulation, and among other constraints this legislation limits payment for oral and maxillofacial surgery to that which is medically required to be performed in a hospital. Therefore she's not covered. He goes on to say that in view of her age and the limitations of coverage only to certain defined severe congenital abnormalities, he can't cover this.

I would suggest to the minister that this woman's age is, I would say, somewhere under 40. She has a long lifespan ahead of her. She is presently unemployed. She's been diligently looking for work. She's a bright and capable type, but she has a very grave difficulty. Her dentist has carried that bill for her. She's going to need further bridgework. We really can't expect her dentist to put up $8,000 or $10,000 for her; and she's not going to be able to pay for that.

What I'm suggesting to the minister, and asking him, is: would he review the regulations, to see if there could not be some reinterpretation or change that would allow for this kind of work when it's done by a dentist rather than when the patient is hospitalized for it? That seems to be where the problem hangs.

HON. MR. NIELSEN: Mr. Chairman, sure, I'll look at it. But it's been questioned before. If oral surgery is required and it takes place in the hospital, it's covered, because it's oral surgery.

You're talking of dentistry and.... I imagine there is a lot of orthodontic work involved in that. It is simply not covered under the Medical Service Act. It is not deemed to be a medical service, but rather it is a dental service, and it is not covered. I mean, the Medical Service Act is for medical services. This is not deemed to be one, I presume, from what you have described. Sure, I would like a copy of that letter. I presume I have seen it. There have been many cases like that, but it simply is not covered under the regulations now.

MRS. WALLACE: Obviously it is not covered, because that is why she is not getting it. What I am suggesting to the minister and requesting him to do is to have a look and see if the regulations can't be modified to cover these kinds of cases which are of a hereditary nature, a congenital nature. That is really a medical problem. But the treatment happens to not require hospitalization, when it is a medical problem. Surely those regulations could be so worded that they would allow a person in this kind of situation to be qualified and able to get that kind of support that.... Just a hair's breadth of difference as to where the treatment is done causes the difference in how the payment is made. So what I am asking him to do is to have a look at that.

I want to change the subject considerably. I want to go into public health inspection, and the problems that occur in rural subdivisions where there is no water supplied and the percolation tests are done by the health inspector. We seem to be having a continuing problem there where.... I have had letters back and forth to this minister and the interim minister on this thing, and nobody seems to be really reading what we're saying into this. They keep coming back to us with the same old thing: "Well, they can put a septic field somewhere else."

What happened there in that particular instance that I am talking about in a small subdivision outside of Duncan was that obviously there was some error made when the first percolation tests were done. Whether when the lot was staked out the inspector got on the wrong lot or what happened, I don't know. But when this person went to build their house, they checked on the percolation, and of course the prospectus of the company indicated that this had been passed by the health inspector.

He went to get his building permit from the local municipality, and they agreed to him putting in a house with a basement in the spot that he had designated. The result was that when he put his basement down he discovered that what he had understood to be the case with percolation was all incorrect, absolutely incorrect. So now he's in the situation of having to change his house plans. He's in the situation of not having a spot to put his sewage disposal without hauling in some $2,000 worth of gravel, which incidentally is contrary to the regulations, as I understand them.

You know, what he is told is that there are alternative sites where he can put this, but the alternative sites are no good either. The one site that they are suggesting is a place where the gravel that is there was simply put there when they were putting in the roads. The whole thing hasn't been properly done, and what happens is that then, based on that health inspector's report, the municipality accepts that, the company accepts it. I want you to ensure that there will be more care taken....

Interjection.

MRS. WALLACE: You can't guarantee no mistakes, but I don't think this is an isolated instance. I think what we need to do is to have some different procedures, some more careful procedures, for ensuring that one report done prior to the prospectus being issued is checked through some way to ensure that it is correct before all these other things are based on that. Because you start on a false premise and you get completely out of line, as has happened in this particular instance.

The chap who's trying to build the house is getting nothing but a runaround from this ministry and the local government involved, and of course he can't do anything about the original owner in this particular instance. They've gone into receivership. But even so, a court case would cost more than his return would merit. It is a most unfortunate situation, and all I am doing is calling to the minister's attention the need for a little more care in how those assessments are made relative to percolation: the time of year they are done, how they are done and the care in making sure that they're done in the right place.

MRS. DAILLY: Mr. Chairman, I wanted to bring up an area that hasn't been discussed, I don't believe, and it is the area of midwifery. I think the minister is probably aware that the Ontario government seems to be moving on the legalization. It is also the policy of the New Democratic Party — the official opposition — that it's time for this excellent service to be legalized. We realize, however, that some strong regulations have to be applicable when this decision is made. I'm sure the present minister has had many people come to him about this over the years that he's been minister. I understand there is a midwifery task force which has been researching the advantages and disadvantages of incorporating midwives into our health care system. Has the minister had a chance in

[ Page 7729 ]

his ministry to look at this? Are you considering any changes so that this service can be brought into a legal form?

[4:45]

HON. MR. NIELSEN: I'm advised there was a task force that was supposed to look into this. It's acknowledged that some people support various forms of home delivery — or delivery at all — and the independent practice of midwifery by other than medical practitioners and trained nurses acting under the supervision of a medical practitioner or a hospital. The Ministry of Health has long held the view that the safest environment for giving birth is a hospital where there are well-trained obstetrical nurses or nurse-midwives operating under the supervision of medical practitioners.

You know, we get into quite a discussion about what midwifery really means and so on, but the fact is that British Columbia has an excellent record and a very low perinatal and neonatal mortality rate. Midwifery was quite advanced at one time in history, compared to what the doctors knew. I would not suggest that it was the same as it is now. We've talked to some people who identify themselves with midwives and there has been discussion on midwives working in conjunction with trained professionals in hospitals. That's been fairly well received, I think right across the board; but there's been very little support, by anyone associated with the problems which can be associated with births, for midwives performing home deliveries. Other than some people who support that concept, I've found very little support elsewhere on encouraging home deliveries by other than professional people. We do have a task force on it, yes, but we haven't made any recommendations.

I'm not absolutely familiar with what Ontario has done, but I did speak to the minister about it some time back and he said they had not made any decisions. I think they basically said they would look into it; I don't think they've made decisions at all.

MRS. DAILLY: The minister's point on ensuring proper environment is of course well taken, but the question we're asking is simply: what about legal provision to be granted to midwifery? As you know, at the moment it's not legal in British Columbia for the midwife to practise — putting aside where they practise. Would you consider legalizing it if it were to be done in the proper areas under proper supervision?

HON. MR. NIELSEN: I don't think you can simply say that you would accept the training of what? — where? Over the years in British Columbia we have tried to encourage specialists in medicine or obstetrical nursing to take on this type of role with that type of training, but I'm not quite sure what training the member is speaking of. I don't think we would simply accept, in a wholesale manner, those who show up and say: "We've been trained as midwives and we wish to practise." In fact, I don't quite know what practise means. I think location, along with training, is very important.

Interjection.

HON. MR. NIELSEN: We have not said we would accept that. As I said, there is the task force. I was just reading that Ontario has set up a task force. The Hon. Minister of Health Murray Elston is relatively new in that position — since the Liberals formed their government — and I told him at our first meeting that if he's really in trouble, set up a task force.

MRS. DAILLY: Obviously he took you at your word.

You maybe have the release; I have the clipping. I note that before the announcement of the task force.... If I may quote from my Globe and Mail article, it says: "Ontario will establish midwifery as a recognized part of its health care system." Then he goes on to say that he set up a task force to examine the functions that midwives will perform and how they'll operate independently from doctors. "The task force, which does not include any midwives, will tackle the thorny question of whether midwives can become a self-regulating profession, as they want. In the past, doctors' and nurses' organizations have favoured a role for midwives under the supervision of doctors and nurses."

So the point I am making is that I believe, if we can take this article at face value, that Ontario has accepted the fact that they will recognize midwives as part of the health care system. I guess that is what I'm asking the minister. I guess that must be your first step. I mean, just to keep having task forces to talk about functions and so on, without finally making a statement on whether you believe in the acceptance and the recognition of them, could go on and on forever. I think that's really the question I'm asking you: will you consider the recognition of the midwife?

HON. MR. NIELSEN: Well, we've always said we would consider whether midwives should be recognized as a distinct, separate part of the medical practice. The question pops up once in a while — not for a very consistent period of time but once in a while — and we acknowledge the various letters when it seems to have gained the attention of somebody. There's been minimal pressure for great demands on this. There have been questions directed, but minimal pressure, and we're not in a position yet to follow the Ontario route of making a decision and then investigating the matter.

MRS. DAILLY: The minister has just said we don't make a decision and then set up a task force, but I don't think that's quite fair to the Ontario minister. I think they believe that the midwife can perform a useful service in the health care delivery system, and they've said so, and they're willing to look at complete recognition and legalization. Then to ensure that it's done properly they've set up the task force, and I think the minister is quite aware of that. So I think it is unfair to suggest that he doesn't really know what he is doing. I would hope that the minister would follow what they have done in Ontario.

MR. COCKE: I would like to ask a couple of questions. First let me ask about acupuncture. Last year the minister told us that he had set up a committee to take a look at acupuncture and to see whether or not something could be done vis-à-vis not only legalizing.... He had an opportunity last year; I had a private member's bill before the House that would have legalized the practice of acupuncture.

At the time, I said that acupuncture was a very useful therapy. It's a therapy that's been practised for over 3,000 years, and there are a number of people who believe as I do that it is most useful, particularly in the way it is practised here for pain relief, but also beyond that. Other areas of illness have been remedied with this procedure.

[ Page 7730 ]

As I said before, there was a time here when the practice of acupuncture within the association could have been carried on by people who were not particularly skilled. They did not have any real policing system. But in the last few years it has very much been smartened up by those people who are now insisting that their colleagues who are to be recognized do have the proper qualifications.

In this province, as you know, the only person who can legally practise acupuncture is the medical practitioner.

AN HON. MEMBER: That needles me.

MR. COCKE: That needles me a bit, too, Mr. Member, because, you see, the fact of the matter is that the doctors don't know a damned thing about it. They can read a book

Interjection.

MR. COCKE: Yes, I'll say that in any old situation. Because they can practise medicine, then all they have to do is read a book about, you know, here's where you put the needle in, and then they can start practising. It's just sheer nonsense. It takes an acupuncturist a long time and an awful lot of instruction to obtain that skill. As far as I'm concerned, I would far rather, if in fact I wanted that procedure, go to an acupuncturist to have it applied. Everybody here knows that I have been, and will continue to go, to an acupuncturist whenever I feel it is necessary. It's a shame that one has to do that in contravention of the Medical Practitioners Act.

I believe that by now it's time that the minister's committee has come up with some sort of a message for the minister, so that he can decide which way to go vis-à-vis the licensing and making the procedure within the bounds of our law. I would like to hear from the minister respecting this question. I will sit for a moment and hear his answer to that and then maybe bring up one or two other little thoughts.

HON. MR. NIELSEN: The committee is still working in meeting, Mr. Chairman. They have not presented me with a final report as yet. They are still apparently getting along very well in meeting, and simply have not presented a final report as yet. So I'll have to phone them and ask them when they are coming through with it, but they have not yet concluded their discussions.

MR. COCKE: Yes, Mr. Chairman, I realize that it does take some time, and certainly I'll be patient. The only thing that would destroy my patience would be if there were any war declared on them in the interim. I have been pleased, for the moment anyway, that the College of Physicians and Surgeons doesn't seem to be going out trying to stir up trouble.

I do know, however, with the number of contacts I have within that profession, that there are a great number of people within the medical profession who are quite against acupuncture, as they are counter chiropractic. As a matter of fact, I have heard words such as "quack" and that sort of thing. It's very hard to convince me in either one of those two areas, and I certainly have a respect for the medical profession. I have a respect for the medical practice. But, Mr. Chairman, I have had enough dealings with them to know that they are a little bit insular, and, in my position, as far as these two practices are concerned, to the detriment of people requiring treatment in our province. I do hope that when he comes up with that report it will be very quickly acted upon.

The second thing is the whole question of the delivery of health care in this province and its centralized nature at the present time. This government was elected in 1975 on a platform of decentralization. Somehow or another, they had pinned us, the NDP, with centralizing at that time. As a matter of fact, we spent our whole time trying to decentralize as much as we could.

But anyway, when we elected this group, the result was, as far as I was concerned, a great deal of centralization — centralization everywhere, to the extent that all the decisions had to be made in the Health minister's office or the Forests minister's office, et cetera. Mr. Chairman, I really think that we have come to a time in our lives in the history of this province where what is very badly needed is a health planning council.

[5:00]

I know it is recommended for the whole of the country, but it is certainly needed here. One of the things that would happen as a result of that, I am quite sure — and this is some of the advice that we'd be given — is that it would regionalize the province in terms of the delivery of health care. I know what the maps look like. Having once been a Minister of Health myself, I have seen the overlays. Our province is an absolute jigsaw puzzle when you see one map on top of the other and so on. But if you could probably spare a little bit of time to put a few of those ministers together to develop a regionalization based on, for instance, maybe multiple school districts with all the outside boundaries to be coterminous.... That's very desperately needed. I think that the first advice of a health planning council would be to shape up the province so that you can actually do a job of delivering.

There are so many areas that rely on one another. For instance, now you see the school problem where they're talking in terms of reducing the numbers of nursing people in the school system or taking them right out. Same thing with speech therapists. Mr. Chairman, the reason for that is because of the short-sighted decisions that are made here in Victoria. But if the province were laid out in such a way as to provide an opportunity for health and education and so on to react to one another, you might be in better shape. Right now, for example, a health boundary might intersect a school district. As a matter of fact, not might; it does in many cases. That's just sheer nonsense. I think that regionalization, health planning council.... . When I say health planning council I'm talking about the use of consumers, the use of those delivering health care, those who are involved in one way or another, great interest, and also a geographical distribution of the people that would be on that health planning council. It could be a high-powered, very enlightening and very helpful new direction. I'm not the only one who's been calling for his. Many doctors and others involved in health care have been calling for this for a long time. I believe that it very definitely has its place.

Just before I sit down on these couple of questions, earlier in the afternoon we were talking about these Expo ambulance people. Most of them are people who are already working. I have some concerns about that. In other words, we're saying moonlight. In this moonlighting, I'm afraid there are going to be people who are going to get a bit tired. Then when they're in their real job, driving or working in ambulances, they may not be as fit as they should be. There are a number of unemployed ambulance workers around the Vancouver area.

[ Page 7731 ]

I think that they should be the first priority on that list. They have their qualifications. I believe that they should have the first kick at it, because it's logical that it's better to employ somebody who's not employed than to employ somebody who's already employed and to an extent over-employing, at the jeopardy of those people who may need help.

[Mr. Ree in the chair.]

I think if the minister's going to encourage Expo in any way, one way he could encourage them would be to tell them not to be so worried about.... I realize a lot of moonlighting is going to go on down there, but encourage them to do a better job of looking around for people who could be more useful. That's just a thought for the minister, and we'll see what he has to say about it.

HON. MR. NIELSEN: The Expo thing came up earlier today, and I understand that the qualifications required by the terms and references of Expo would seem to permit only those who are working actively for the Emergency Health Services to get a position. I've asked the deputy to look into that, because I found.... I think if a person is qualified he's qualified, subject to an examination, perhaps. I don't know why we'd have to recycle only the people who are working for us now. Perhaps some are taking holidays and therefore wouldn't be affecting their other position. But we're looking into it.

The member spoke of counties or regions. There is an important factor in what the member for New Westminster was thinking about, common boundaries, because I was just making a short list, and I think we have different boundaries in the province for forests, water, parks, highways, regional districts, electoral districts, municipalities, school districts, hospital districts, health districts, human resources districts — and they are inconsistent. I guess maybe many years back it was a method of really making it difficult to regionalize anything.

My municipality of Richmond is one of the few areas and perhaps New Westminster — where you have common boundaries, federal, provincial, municipal and school. But that's very rare. Some of our members have seven school districts within their boundaries, only not the entire district but a portion of it. It's very difficult to manage on a regional level. But the Ministry of Health is working toward that regional concept. In effect, we would like to have a regional manager of the Ministry of Health in regions. That's what we would like. But whether we could achieve that, I'm not sure.

MR. COCKE: That's good. I'm glad that the ministry is. So were we. But the problem is the other ministries. You've certainly got to involve Municipal Affairs, as far as I'm concerned. Once you start looking at the regional districts, and see how they apply to.... . for instance their boundaries, vis-à-vis the school districts, and you'll find right off the bat that you're up a tree. As a matter of fact, what we did when I was minister, and it's probably even worse now.... Incidentally, Mr. Chairman, there's no way you can include electoral boundaries in this question, because electoral boundaries shift with all sorts of things. Certainly the closer you get to the one person, one vote type of thing, the more those districts are going to modify. But you certainly can in most government services.

The strangest thing that occurred was that we took these cellophane maps, these transparent maps, and we overlaid them; there were about ten on it. It was the biggest boondoggle you ever saw in your life. The boundaries were just crazy; there's just no rhyme nor reason. I believe that in order to make sense out of this province, particularly if Health is going to be quite closely associated with Education, as it should be for delivery of services in those areas, then you do need the outside boundary coterminous; it has to be. I don't think you're a heck of a lot closer now than we were then. I just think somebody's going to have to undo the dam. It's something that should be done. Human Resources also has to fit into that situation, but doesn't. Their districts are quite distinct from Health; on and on you go. The only thing that Health has that is within that one boundary, at least, is the regional hospital district, and that was there as a result of the regional districts. Anyway, I do hope that that's something that will be looked at.

I had a number of questions vis-à-vis the votes, but I don't even know if I'll ask them when we get to the votes.

MR. ROSE: You're so discouraged?

MR. COCKE: I listened to the minister, and he comes up with: "Well, it was a little bit more than we budgeted for in this. We don't have any kind of definitive numbers any longer." I don't know how many times I've seen the system of estimates change in the 17 years I've been here. It's incredible. Once you get used to one system, then they change the damn thing so you don't understand the next one. I suppose that's good governance or something, but as far as I'm concerned, it just tees me right off.

AN HON. MEMBER: Tees you?

MR. COCKE: Something like that.

I remember the good old days when you could read an estimate, and you could compare it to the year before. Now I defy you to take this year's estimates and compare them to last year, and compare them to five years ago. You're totally lost. All the modifications.... I remember when they did the printouts. Remember that? Well, that member wouldn't; he's pretty young in office. Some of us will remember the printouts that came out when they first started changing the estimates. You read the printouts, and then you were really confused. All I have to say about the estimates and about the various votes is: give us something someday that we can understand, and then maybe we can make some sense of this thing called the estimates. Until then, I guess we'll just have to remain confused.

I'm surprised that I haven't heard government backbenchers getting up and raising holy Cain about this thing. I know the rumour is out that they don't even read their estimates book. On the other hand, if they did, certainly, being good politicians, they'd get up and raise Cain with these ministers, this Treasury Board, and so on and so forth. I haven't heard a murmur, not a murmur. Probably what that Social Credit Party needs is a new berth — a new berth on the Titanic. You're dead in the water.

MR. BLENCOE: I assume the minister didn't wish to respond to that.

At the end of last week, Friday, I was discussing with the minister health issues in terms of the elderly, and brought

[ Page 7732 ]

before the House the report of the task force on the elderly. We had, I think, some interesting discussions and some viewpoints in terms of where we were going in dealing with the elderly.

A couple of things, before we finish today, that I would like to bring to the attention of the minister, and perhaps have some response.... One of the things that Victoria has been proud and privileged to have is the James Bay Community Project, which the minister is very well aware of, because his ministry funds the health component. The minister, I know, is very aware of the success of that particular project. I'm sure he is also aware that in the last few years, through government wisdom of the day, some changes have been made. Although the concept is alive and well, the resource board has gone, through the government eliminating the legislation that creates resource boards. The project is still going, and the minister continues to support it, although there have been some funding cuts.

It's not the resources or the project per se that I wish to talk about initially this afternoon; it's the actual concept of the doctors who work in the James Bay community. As the minister is well aware, and this House is aware, they are salaried doctors, not on a fee for service. I'm not aware of the salary they get, although I understand it's a reasonable salary. But one of the things those doctors do in that community.... Well, they do a number of things and are highly regarded and everybody knows them and it's old-fashioned kind of medicine and treatment. One of the things they do is make house calls, which seems to be — how do I put it — dying out in the medical profession these days. If someone has to get a doctor to call on your sick child at home, you virtually have to pull all the strings you can or all the teeth you can or an incredible impression has to be made. To get doctors to make house calls is extremely difficult.

James Bay and other projects like it have shown that you save the system a lot of money by that kind of doctoring and that kind of approach to health problems. You keep the elderly, particularly, in their home. Over the last ten or twelve years that that project has been going, all the statistics indicate the dollars saved. It has been a great success and hopefully it can expand.

The aspect I want to bring to the minister's attention is the aspect of house calls: treating people in their homes, keeping them out of the hospitals and therefore not only practising good old-fashioned medicine that works but also saving the treasury a lot of money.

I notice, Mr. Minister, that in Quebec this summer they are launching a home hospital program as a trial program through the Verdun General Hospital in Montreal whereby a team of doctors is actually going to do a house call system. They are actually calling it quite revolutionary, which shows you what's happened to....

Interjection.

MR. BLENCOE: Well, okay. They've allocated some funds for it.

Interjection.

MR. BLENCOE: I think the majority of people, Mr. Minister, believe house calls are a good component of health care, and that maybe in this province we need to try to encourage the doctors to do a little more of that kind of health service. I notice again in Quebec they are looking at this experiment because they anticipate that it can save the system a lot of money, and it can also add to the health system in a useful and exciting way. Can the minister respond to this concept? Is there any thought in this province to try to encourage the doctors to go back to some of that old kind of system of house calls and saving taxpayers' money?

[5:15]

HON. MR. NIELSEN: As the member may be aware, Mr. Chairman, the fee paid for a house call is considerably higher than an office visit. Since the last changes were made in the fee schedule and the house call amount was increased, there has been a substantial increase in house calls.

I'm not sure if the Quebec system you're speaking of is similar to the one that was introduced by one organization in Ontario. In many instances, the problem is that a person may contact their physician or doctor and suggest that there are certain symptoms of someone in the family and they'd like to have him look at it. Frequently the doctor will make a decision to either take the person to the emergency ward, bring them in the next day to the office, or perhaps they go out and see them. I would think most times it will be a recommendation to bring the person into the office the next day or soon thereafter.

The system that was in vogue for a short period of time, at least in Ontario, was doctors working under a dispatch system. You would phone your office and you'd get a different doctor and they'd come by with their automobile and stop by and check out the patient. It cost a great deal of money. One of the very real reasons house calls are less popular than they used to be is the availability of so much better diagnostic equipment today than there was previously, and that does require a hospital setting or an office setting. In many instances there is a limit as to what a doctor can actually do with that contained in his medical bag. Frequently a doctor will want to have some sort of a scan or some sort of a test conducted on the patient, which would require a hospital visit or an office visit.

It's surprising how many doctors do make house calls. There are quite a few who still make house calls, so it's not something that is gone completely, and it seems to be becoming slightly more popular today, but we're a little bit concerned about the kind of franchise house call doctors with the dispatch system they established.

MR. BLENCOE: I appreciate the minister's response. I think the minister got some good points in terms of the cost, but I'm just wondering if there is any way we can measure.... For instance, I suspect in James Bay that that system of the salaried doctor, with most of their work actually done in the home, has created an environment in that community whereby the doctor.... It's an abstract kind of thing which is really hard to qualify and to put into words or describe in statistics, but what has been created is really a very healthy community. The people call them; the doctor comes to the home; the patient may usually have wanted to go into hospital, but because they come to the home, they can treat in the home. There is a trust built up. There is, I think, in that community a feeling that a lot of things can be done in the community or in the clinic or in the home, and the last thing they have to do is to go to the hospital for treatment. It is hard to explain that, but I think the minister knows what I am getting at.

[ Page 7733 ]

Over the years what has happened in that community, and I am very well aware of it, is that they've built up the health system that it is I think because of the kind of approach to health care in the homes and in the community. We are getting a big benefit from that approach. I am just wondering, without your responding to the fee for service, and it is very expensive in the homes.... I think if we can start to look at how we can measure that kind of service and that kind of health approach, we might really start to come to terms with the astronomical costs of hospital care in this province. Do I make sense to the minister?

Again, still on some of the issues about the elderly. As the minister is aware, the Victoria Institute of Gerontology unfortunately has had to close its doors. On Friday I was talking about approaches to the elderly and how we really need to be looking at some basic premises of how we treat the elderly in health care. One of the things that unique institute was doing was research and analysis and coming up with ideas for the health enterprise. Unfortunately, that institute is being forced to close its doors. It was indeed becoming very well known for research and work in health in this community. It was a valuable resource. It worked in close cooperation with the University of Victoria, the Greater Victoria Hospital Society and the Victoria Gerontology Association. As I say, it was a base for research, professionals working with the elderly and seminars on public information on ageing. That kind of institute was doing the very thing I was trying to talk about on Friday: looking at how we deal with the elderly in health care and how we can be improving the system and therefore not only be improving the social implications of health care but, in the long term, the financial implications. This institute has closed its doors. It needed some provincial support. It needed another $40,000 to sustain itself. It did have some ongoing funding from some other areas, but it required a provincial initiative in terms of the kind of work this institute was doing. I would suggest that this institute was doing the very thing I was suggesting on Friday: coming up with innovations on how to deal with the elderly and therefore, I think, in the long term saving the taxpayer money.

HON. MR. NIELSEN: The ministry, the hospital society and the Institute of Gerontology are reviewing that matter. What happened was simply that for the period of time they were involved they did not satisfy their clients as to what type of work they were doing and what they were producing. It was allowed to lapse and now there is a review to determine how it could be constructed in such a way that it would centre on other activities. In the opinion of those who are being asked to fund it, they just weren't coming through with what had been anticipated and expected, so now an effort is being made to restructure and develop a different philosophy, I suppose, as to what product you can expect from the institution. I wouldn't be surprised to see it come back on but in a slightly different form.

MR. BLENCOE: That is good news. The first member for Victoria (Mr. Hanson) and I wrote to the former Health minister and we have had no response, so I am very pleased to hear that. Perhaps part of the problem is that they are working in a whole new area, the study of ageing, and what has happened is that those in the institute are trying to find their feet and find what's needed from government and those in the health field. What the minister is saying is good news, and I hope we will see that institute flourish.

This community — I'll finish here on this issue — could be a leader in the study of ageing. We have the highest number of people over 60 or 65 in the country on a per capita basis. There are incredible resources here; there are people who are deeply interested in this issue. Not only is it good for the health enterprise, but also the job-related aspects of this are really quite — well, not astronomical, but there is, indeed, no question of the potential. So I am pleased the minister has said today that they are going to take another look at the institute. We certainly welcome that in this community.

MR. ROSE: Like everyone says, my interjections here will be brief, being the soul of brevity.

I'd like to make a little comment about acupuncture. I don't know whether I indulged in an illegal act by taking some of it to quit smoking or not, but I would recommend the same treatment to the minister. But what bothered me a little....

Interjection.

MR. ROSE: You're not the appropriate minister. As a matter of fact, some people think you're an inappropriate minister, but I didn't say that.

I was going to say that I was kind of sorry that acupuncture wasn't recognized, because it cost me $18 instead....

Interjection.

MR. CHAIRMAN: Order, please. The Minister of Labour will have his opportunity to stand and speak. In the meantime, the minister for Coquitlam-Moody — or the member for Coquitlam-Moody — has been recognized by the Chair.

MR. ROSE: I'm really pleased at that promotion.

HON. MR. VEITCH: Which church?

MR. ROSE: No, he called me a minister. Which church? Yes, that's it.

You know, I'm not getting very far with this speech, Mr. Chairman. I'm having a lot of crossfire here, and none of it's hitting me.

I suggested that if acupuncture had been recognized, it would be covered by medicare, and then I wouldn't have had to pay that $18. It was a horrendous experience, but it worked. I'm not sure that the acupuncture worked, but I know that it was very effective. It frightened me in the sense that you get a needle in each ear, and then they plug the needle into the electric outlet in the wall, and the doctor comes along and says: "Look, quit smoking or I'll turn on the juice." So I found that if the needles didn't help, certainly the fear of returning to that man who, interestingly enough was an MD, did, He was an oriental MD who perhaps had had an opportunity to study the age-old healing art and perhaps be more familiar with them than the kind of training described by my hon. friend for New Westminster, who took that same little course, but he did his illegally and I did mine legally. So I hope that there will be something done about that soon.

The second point I wanted to raise, and a more serious one, is the future of Riverview. The other day, on April 8, my

[ Page 7734 ]

colleague asked the minister about the alleged report by the member for Maillardville-Coquitlam to the Coquitlam council about the phasing out of Riverview. He asked if this was true, not that the report of his presence at the council were true but the fact that Riverview was on its last legs and about to be phased out over a five-year period.

This is very disturbing to many of my constituents — not only the patients but also the people who work there. It's a very important part of our total economy in Coquitlam, and Maillardville-Coquitlam as well; perhaps Port Moody and even as far out as Maple Ridge and Mission.

The minister said there were a number of discussions ongoing, and that he didn't have all the details at the moment but would like to think about the matter when he heard the reports. He talked about the possible phasing-out of some of the buildings and perhaps the introduction of acute-care facilities on that site. Since it would be of vital interest to the people I represent, not only those on the councils but also citizens in that area, I wonder whether he could elaborate any further than he was able to do the other day.

HON. MR. NIELSEN: Mr. Chairman, I certainly believe that the existing facilities at Riverview, particularly West Lawn, Centre Lawn, East Lawn, have just about seen their last legs. Those buildings are on their way out. That is the primary purpose of reviewing the facilities at Riverview. It is the hope that those three main buildings will be removed and new facilities find their place at Riverview, in smaller sizes. The buildings would be smaller facilities.

[5:30]

With a view to decentralizing, we will probably set up a couple of similar facilities in other areas of the province. I know we heard from Vernon, and I believe a centre on Vancouver Island would like to consider that. Riverview will continue as a centre for treatment of the mentally ill. We don't have the final plans in yet, but hopefully it would call for the elimination of those three major blocks, replacement by a modern facility with fewer patients, and probably a more modern acute-care facility for patients suffering from mental illness but who require acute medical care as well. So it would be modernizing that facility considerably, while perhaps establishing other institutes in other locations in the province so that people being treated for mental illness need not all be congregated in one comer of the province.

It's been a long period of questioning, and I think 5,000 people were consulted along with many organizations. It's in the early preliminary stages, the idea, but it will be a vast improvement, in my opinion, for the treatment of mental illness for a large number of people in the province. The site will still be there.

MR. ROSE: I thank the minister for his reply. He intends to have smaller units more appropriately situated geographically, closer for relatives and others to visit, which seems like a reasonable thing to do, although I don't imagine those people who are currently employed at Riverview look forward to the fact that their institution will be downsized if in fact upgraded.

I want to ask the minister what further plans he has for that virtually unpronounceable word called deinstitutionalization: that is, taking people who would formerly look forward to incarceration as a patient in one of these institutions for the rest of their lives.... It has been the practice, while it is considered a progressive move in many parts, that these people, who cannot care for themselves, in the rush towards deinstitutionalization have been dumped on the streets, and many of them were unable to care for themselves and found themselves in pretty severe difficulties. Could he comment on the general trend, and what he's doing to protect those people who may be released from these institutions but into situations in which they really haven't got much background or support and left to fend for themselves?

[Mr. Strachan in the chair.]

HON. MR. NIELSEN: You are dealing in a very delicate area when it comes to institutionalizing people for mental illness. As the member would be aware, they find their way into these institutions in one of two ways: they are either voluntary patients or they are involuntarily committed. There is an obligation to review the capacity of individuals in the institution to determine if they should remain, and when a person is involuntarily committed there is an obligation to ensure that the person's condition requires a commitment. Once a person is found to no longer require that level of care, there is an obligation to let them know that should they wish to leave.... I mean, they're not in prison. So you do get situations where a person is deemed to be of such capacity that they can function in the community. Others who voluntarily commit themselves to Riverview, by way of recommendation of medical people and so on, may then decide that they no longer wish to be a voluntary patient in the institution, and perhaps they are then released as well. But only where appropriate will we recommend that patients be placed in the community — only when we feel they can function at the community level. But there is a difficulty.

MR. ROSE: What I wanted to know, Mr. Chairman, was whether or not there is a halfway house between full institutional care and partial care, rather than.... It's an either or: either you're incarcerated, and there have been some horror stories associated with that type of commitment . ... I think you've got the gist of it. I don't need to repeat it.

I have one other question, so you can answer them both at the same time. About a year ago, during this same debate, someone — perhaps it was the minister — discussed or described the difficulty they had with the business of keeping up with the requests for organ transplants. We all see pictures in the paper of little kids flying from Duncan and other places down to the States for these operations. I'd like to know, number one, what improvement in facilities here has been made. What improvements have been made in the last year so we can look after some of these very tragic cases locally?

Second, another subject which was brought up a year ago: the paucity of organs because potential donors don't realize how important it is to have this supply. We talked briefly about a reverse onus, instead of giving positive permission for this to happen — that some kind of reverse onus system could prevail, where unless they specifically said that they could not, this kind of service and organ system might be available to the general public, since we're in such short supply. Has there been any thought given to that or some version of that over the past year?

HON. MR. NIELSEN: There has not been serious consideration given to reverse onus. I can imagine the years in court over that, were we to do that.

[ Page 7735 ]

We did establish the B.C. Transplant Society. Its first job is to try to develop facilities so 100 kidneys may be transplanted yearly in B.C., up from the 30 to 32 that are happening now. Their first assignment is to increase the facilities and availability of organs, so we can conduct 100 kidney transplants a year. After they have reached that level, the Transplant Society will then give consideration to the possibility of handling the transplant of organs other than kidney. We do have good working relations with Ontario, Alberta and other jurisdictions with respect to the occasional heart transplant and heart-lung transplants. We do not seem to have the numbers yet which would justify a separate clinic of our own in B.C.

I think you will see in the future that the kidney transplant will be the speciality. I think at some point in time you'll probably see a more general transplant area of expertise, perhaps in the greater Vancouver area, where other than kidneys will start to be transplanted. There are some similarities, and some specialists who can be involved in more than one area. But for that specific organ there are highly trained specialists. They're not that easily attracted to an area where the workload may be rather limited. So we're looking for these multiple discipline specialists who can look after more than one.

The Transplant Society, I think, will function very well. We're trying, on a national basis, an interprovincial basis, to develop a program where we can educate people to understand the urgency and importance, and overcome this rather strange reluctance people have. We found by survey that 85 percent of people would agree to have organs of deceased relatives donated, but only 65 percent would consent to have their own donated. So there's a selling job to get across. We have to get the idea across at a far earlier age, so that it is not repugnant to people later on for some reason. It's going to be quite a success, I believe, in time.

MS. BROWN: I just have one short question. The minister received a letter dated April 7 about establishing a program for providing free testing and treatment of chlamydia. You don't know what that is? Okay. Chlamydia is the pelvic disease that gives rise to pelvic inflammatory ailments and can lead to, I don't know, infertility and all of those kinds of things. Apparently it affects something in the neighbourhood of 140,000 Canadians every year, male and female. It can be transmitted by men, but it has no impact on them; it is very dangerous to women. It has been recommended through this letter that a program be established for free testing and treatment of chlamydia and that it be designated a notifiable disease. I am wondering what the minister's response was to that recommendation.

HON. MR. NIELSEN: I'm sorry, Mr. Chairman, I am just not familiar with that letter of April 7. I just haven't seen it as yet. We believe very strongly in identifying diseases which should be reportable diseases, as we did — I guess it was last year — with respect to AIDS. We said that it was a reportable disease. I am just not familiar with the condition you mentioned, but if it is and should be reported, then we certainly support that, even though initially we are faced with people charging us with invasion of privacy and so on. The well-being of all is far more important than the concern of an individual, because the information remains confidential anyway.

[Mr. Ree in the chair]

MR. NICOLSON: I would like to bring up a topic which in the Ministry of Health should be a subject of embarrassment, and that is the inconsistency of the medical health officers in enforcing regulations pertaining to frozen food products. The regulations are very clear. They say that frozen food products should be stored at zero degrees Fahrenheit or lower. Then they proceed to make exceptions in the case of supermarkets where they have these open freezers which are programmed to defrost three times a day and in which I have personally measured temperatures of up to 28 degrees Fahrenheit and others down as low as 8 degrees.

I bring this up not because I criticize the fact that these open-type freezers don't keep things to regulation. I think that if a product is kept frozen and is not refrozen, it is kept in a satisfactory condition. But what one does find is that in the case of entrepreneurs who might go out and try to sell frozen products like ice cream, which if it does melt you cannot refreeze, they're prevented from doing so. I'm saying that there's real inconsistency by these bureaucrats in enforcing these regulations, which are absolutely black and white. On the one hand when they're dealing with a big company like Safeway or Overwaitea or Super-Valu they are reasonable, and I'm asking that when a small business person tries to set up shop as a street vendor, for instance, selling ice cream, they not be required to have dry ice, because dry ice isn't available anywhere in the interior. I am requesting that they be allowed to do something reasonable as well as the big entrepreneurs.

I got involved in this over two years ago and now it's something well past.... It was when my son tried to show some initiative and to create himself a summer job when he invested money.... By the way, he informed the Ministry of Health inspectors all the way and was given encouragement, but the final day when he went to open up business they shut him down. I say that that is unprofessional on their part. It is inconsistent and it smacks of something which I find very, very despicable.

[5:45]

HON. MR. NIELSEN: Mr. Chairman, I'm certainly on the side of the young entrepreneur who would like to augment his income with a little summer activity, and as long as the product seems to be healthy and is not going to cause illness, I don't know that they have to go to extremes of calling for dry ice and a venting system and whatever else. Some reasonable practical sense has to enter into this whole thing. I'd be more than pleased....

Interjection.

HON. MR. NIELSEN: That's right. I mean you're not going to sell liquid ice cream very often, but.... I'll get the assistant deputy minister responsible for that to....

MR. NICOLSON: It might create one job for somebody. It won't be my son.

HON. MR. NIELSEN: I agree. Yes, sometimes they get a little too technical.

MRS. DAILLY: Mr. Chairman, I realize we're getting onto the sixth hour, but I have a few little points here just to

[ Page 7736 ]

sort of wrap up with. They're not really little; actually to the people concerned they're major.

The first one is back again to.... I read the minister's response on hospital equipment cuts, and the explanation was that it was because last year's budget was inflated because of the kidney stone machine. That may be an answer, but the point is that we're still getting a lot of complaints about poor hospital equipment — equipment failures — and those things do scare the public. I'm wondering if the minister is not concerned about the inadequacy of the amount allocated for equipment. It really does concern me and others involved. That's the one question on that.

I also want to ask the minister about the priority for your hospital.... Back to hospitals again. Again, we're getting complaints still and mixed messages, I think, about whether there is a shortage or there is not a shortage. Is the elective surgery list and the non-elective surgery list.... . ? Are they really out of hand in some areas? I know there have been changes for the better in some hospitals. But if you read the paper, almost every day.... We have doctors still complaining in the greater Victoria area just yesterday, and I don't have the clipping in front of me, that there still are serious problems of people waiting for beds in surgery. My question to the minister is: when you check on these complaints, as I'm sure your ministry does, do you do an independent survey yourselves? Do you send officials in? How do you come back and get your facts, to say, "We're not concerned," or "Everything's okay"? I think we'd feel better if we knew how you were going about that.

I would also like to ask you about the priorities, now that you've announced your capital construction priorities, I have in front of me the list of the approvals. I'm wondering how you decide the priorities. I'd also wonder about the long lists of those still awaiting approval. For example, Bella Bella: fire upgrading; Burns Lake: extended care — I won't read them all. The minister has them. But how will you make the decisions on who out of that large group gets the next approval?

HON. MR. NIELSEN: On capital, Mr. Chairman, the list has not been exhausted. There are still some yet to be approved. That list is not complete. It's unfortunately quite a long process by the time approval is given and the regional hospital district raises their debenture or their funding. Then it comes back and is shared again. It seems to be months.

I think we're in pretty good shape with equipment. I think it's $32 million being spent. We investigate every complaint about failure of equipment. So I think we're in pretty good shape.

The bed shortage. One of the problems that is seldom explained is the internal allocation of beds. We were dealing with an area in the northern part of B.C. where a certain specialty of doctors were really complaining about the shortage of beds. We found it was internal allocation. These guys — I'm not sure if there are any women involved in that specialty — had no clout on the board. They had no clout with the medical staff, and they just were not getting bed allocation. Their percentage of the bed allocation for their load was way out of line. The beds were being used by others on the medical staff in far greater excess than this particular specialty, and their waiting-list was becoming out of line because they were not being allocated enough beds. That was an internal problem, so we had to intervene slightly to get them to open it up a bit.

As an example, in Victoria hospitals there were 800 cancellations by patients and doctors in February and March of this year, and it really causes major disruption. But there are many good reasons for it.

MRS. DAILLY: On hospitals, finally, have you done any kind of cost-efficiency study on your new corporate structure that came in with the hospitals? Have you had time to do a study to see if this new structure of amalgamation, whatever you want to call it, has really been to our advantage? Have you had any analysis of it? Because I keep hearing different stories on it.

HON. MR. NIELSEN: It's going very well. We don't have a definitive answer as to what may have been saved, but I'm very confident that it's certainly working out that way. The reports to us are that it's going very, very well. I'm quite confident that there are considerable savings.

MRS. DAILLY: I would hope that sometime you would do a detailed sort of checkup on it, and maybe report back at another session.

I just want to conclude with my part in these Health estimates by thanking the minister for the way he handles his estimates. He certainly does take time to go into great detail on it, and I appreciate that. And thank-you to his deputy. That, of course, does not mean that we approve of everything that we have been told; that's quite obvious.

However, I just want to make one final remark to the minister to say that the biggest concern that I see in the Health estimates is the concern that I expressed when we opened the debate.

Interjection.

MRS. DAILLY: I forgot the other deputies on the floor; we want to thank you also.

I want to say that our biggest concern on the official opposition's side, this year particularly, is that we are being asked, as I said earlier, to approve a budget that includes $120 million which we have no opportunity to debate and have no idea how it is going to be spent. So I make my final — I won't say "challenge" — statement to the minister. My hope is that the minister will not use this on a political basis, that the minister will turn this $120 million back to the hospital boards, who already know where to spend the money and what is needed. I think if you restored it to the boards, our faith in you as the minister would certainly also be restored.

Vote 37 approved.

Vote 38: management operations, $70,978,395 — approved.

Vote 39: Medical Services Commission, $557,348,190 — approved.

Vote 40: preventive and community health care services, $217,919,511 — approved.

Vote 41: institutional services, $1,788,094,441 — approved.

[ Page 7737 ]

ESTIMATES: MINISTRY OF
POST-SECONDARY EDUCATION

HON. MR. NIELSEN: Mr. Chairman, vote 62 — Ministry of Post-Secondary Education, minister's office.

I move the committee rise, report resolutions and ask leave to sit again.

Motion approved.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Nielsen tabled the 113th vital statistics report.

Hon. Mr. Nielsen moved adjournment of the House.

Motion approved.

The House adjourned at 5:54 p.m.