[ Page 2465 ]

CONTENTS

Routine Proceedings

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

On vote 38: minister's office –– 2465

Mrs. Boone

Mr. R. Fraser

Ms. A. Hagen

Ms. Smallwood

Mr. Rose

The House met at 10:05 a.m.

Prayers.

MR. SKELLY: Mr. Speaker, I would ask the House to welcome a longtime resident of Port Alberni and an operator of a jewelry store in that community, which is now the salmon capital of the world, Mrs. Maria Janssen. She has with her a guest from Holland, Mr. Jan Rayer. I'd also like to introduce Mrs. Janssen's daughter-in-law, Kathy Janssen, and her granddaughter, Jennifer Janssen, who are here today.

MR. RABBITT: Today we have in the gallery a resident of Hope who is the president of Emil Anderson Construction, one of the main construction firms of our riding. I would like this House to give Gil Jacobs a very warm welcome.

Orders of the Day

HON. MR. STRACHAN: Committee of Supply, Mr. Speaker.

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

ESTIMATES: MINISTRY OF HEALTH
(continued)

On vote 38: minister's office, $220,893.

MRS. BOONE: Mr. Chairman, I'd like to ask the minister a couple of questions that I'm trying to get some information on, and something that I've heard about recently, a public health planning task force report that I understand will be released within the next week or so. It is our understanding from the information that we've had — although it's very hard to clarify some of the information — that this is reviewing the entire health services in British Columbia, reviewing how these are presented, with a possible idea of privatizing many public health services.

Can the minister please give me some more information, explain to me what this task force is, when the report is due and what the mandate of this task force is?

HON. MR. DUECK: I'm not quite sure what task force you're referring to. Perhaps you could be more specific. We have a review going on for the Premier, which should be ready by the end of July. Is that the one you are referring to? Or are you perhaps referring to one that's being taken on by the Ministry of Finance? Maybe you could be more specific.

MRS. BOONE: It is our understanding that the name of this report is "The Public Health Planning Task Force Report." I don't know where it comes from, I don't know who originates it, but it is our understanding that it deals with privatization. Perhaps the minister can tell us if there is any group looking at or dealing with the privatization of the health services in British Columbia.

HON. MR. DUECK: As far as the task force is concerned, I'm still not quite clear what you're referring to. It may be the Premier's task force or the Premier's review that was called when we were first appointed. If that's the case, it will be out the end of July. As far as the privatization is concerned, I've said it in the House before, and I will repeat it: I would be preempting the minister in charge of privatization, who is looking at all ministries and whether there are any segments of any ministry that would be better served by the private sector rather than the government. I am not at liberty As a matter of fact, I am not even sure which areas are being looked at in my ministry, and if I did know, I would not say, because this is something about which he's going to come forward with a report to cabinet, and then, of course, I will submit my recommendations if I agree or disagree. Then it will go back to cabinet and a decision will be made, and it will be made public at that time.

So I don't want to start any speculation. I've had many letters from various groups concerned about privatization. I've also had many letters from people asking whether they could in fact purchase or be involved in a certain segment of my ministry, for example. I've said the same thing again and again: that privatization is something that the Intergovernmental Relations ministry is looking at, and it would not be my privilege to give any information on that whatsoever.

MRS. BOONE: As the minister has indicated, he will be receiving the report and making recommendations from that report. I imagine that your recommendations will be heavily weighed when taken into consideration. Can the minister assure us, then, that he will not see profit made off the illness of the people in British Columbia? Can he assure us that various areas, such as the ambulance services, areas where people are requiring services, will not be a profit-making organization where people can profit from other people's illness? Can the minister give us that assurance from his own perspective?

HON. MR. DUECK: Mr. Chairman, all I can say is that whenever we look at health issues, we always look at the taxpayer, the patients, the ministry — all aspects are considered. At no time would we engage — at least, I hope we wouldn't engage — in an activity that would cost the taxpayer more and would be a disadvantage to the patient. First of all, we've got to look after ill people; and second, it cannot cost more than it would by going in another direction. I hope that will always be the case, especially in Health, the ministry I'm responsible for.

If it came to privatization — if in fact we were talking privatization — I cannot speak for or against, because I'm not even sure what area is being looked at; I haven't got a clue. No one has talked to me; I have no idea. But I know that when it comes forward, I will be very cautious: first, that patient care is not at risk in any, way shape or form; and second, that it is more economic. Those two things must coincide. Number one is the patient care, and number two, it must be economic. I can assure you on that. But whether we'll go for non-profit or profit, privatization or not privatization, I cannot speak to that at this time.

MRS. BOONE: From our perspective, I have some very strong opinions with regard to the type of care received. I do not see how the minister can even consider privatizing many of our health care services, if you take into consideration that the basic idea, the basic premise, of the people taking over those services is actually to earn money. When they are doing that, it is obvious that in order to earn money and to make a

[ Page 2466 ]

profit, they have to cut back at various areas. So it's not possible for them to maintain the same type of service and give the same type of service to their patients, to the people out there whom we are taking care of, and still expect to make a profit off it.

That's a very basic thing. If you are a profit-oriented person or group who is hoping to purchase something, that is your prime objective — to make money. You will cut back on services and cut comers and areas where you feel you can, just as long as you can maintain your own profit margin. To me, that is not what I see our health care system as being, and I find it very scary to think that we can even be considering privatizing our ambulance services or any health care services at this point. It's not something that we should even be looking at.

[10:15]

I'd like to move on a little bit to medical services and the practitioners' numbers — the billing numbers you have right now. Recently, the physicians who are unable to obtain billing numbers have requested the minister to review the whole process. I've done some inquiries myself I've looked into the issues. I've spoken to many people in the field and people in your offices as well, and I have some real concerns as to how these things are being implemented and the effects on the system if we maintain the same practice of limiting billing numbers.

I can understand the minister's intent: to force doctors into going into remote areas. But what's happening is the exact opposite. Doctors are not moving to remote areas, because they are very fearful that they may be stuck forever in a remote area because they have a geographically restrictive billing number. I am hearing from many of them that unless you are well off and can purchase a billing number in some manner, or you have connections with some other doctor who can speak on your behalf to the Medical Services Plan, or to the various hospitals to get you hospital privileges, you are not able to get a billing number either.

It seems to me that we are going to lose many of our physicians who come from a lower socio-economic area where they can't afford to go out and purchase a practice or a billing number. That is not good for the province of B.C., because what we're doing is relegating ourselves to having a limited, exclusive physicians' group. I don't think we want that, and I don't think it's what the people in the province want.

There are additional problems with regard to the whole billing number route that the government has chosen to go. For example, requiring.... I know this happened in Nanaimo just recently. Hospital privileges were given to two new physicians in that area, and by the time they went for their billing numbers, two unrestricted doctors had moved into that area, and therefore they were turned down on their billing numbers. It seems that you must review this whole process and look at some other means of dealing with the issue of forcing doctors into the northern half of the province or into the remote areas. The way that you are doing it right now just is not working, and it is creating an exclusive physicians' club that has billing numbers, and one that doesn't. Can the minister please respond as to whether he is going to be taking the physicians up on their request to review the whole process of issuing billing numbers, and whether he thinks there is some means other than restricting the billing numbers, such as they are doing right now?

MR. R. FRASER: Mr. Chairman, I also would like the minister to examine the idea of privatization, because I view it differently than the member opposite does. I decide that what we're trying to do is not to make money off of somebody's sickness. What the minister, I presume, will be trying to do is to deliver the most effective health care, by making sure the money is diverted to the patient, which would be a nice change. I presume that what the minister will want to talk about is how we can make the cost of delivery lower, so the patient can have all the care the patient needs, whatever that might happen to be.

"Privatize" is not an ugly word to some people, nor is "governmentize." The fact is that when it comes to privatizing, we're talking about effective delivery, and that's it. We're not going to make money from people's sickness any more than we are now.

We talk about billing numbers. Should doctors, who get educated at tremendous public expense and who ultimately make lots of money, be given an unfettered opportunity to rip the system off because they want to live here? It is their right to go to university at public expense and to then get a billing number that gives them an exclusive opportunity that is almost unchallengeable.... The question is undecided. I think that if the public is going to educate people who then end up working as government employees, which doctors effectively do whether they think so or not, then they may have to take some of the jobs they don't always want; like maybe they should take a job out of town. We have so many doctors in the lower mainland that we are unchallenged on a per capita doctor basis, as I understand, Mr. Minister.... You can tell us later.

We talk about the hinterland. Our late friend from Atlin, who worked with the former Minister of Health to get some health care services in Atlin, where they had trouble getting a doctor.... I don't think we have any problem with asking people who are educated at public expense, and who then go on to public-salaried jobs to work in remove areas. We have to keep the cost of health care in line.

As the minister said yesterday, the cost of his ministry is so extraordinarily high that it eclipses all other ministries. Only 20 percent of the cost of the Ministry of Health would pay for all the post-secondary education in the province, be it university, college or institute. So even the most modest reduction in cost, if we could achieve that, would completely finance many other ministries. It is the objective not to just spend ad nauseam and to constantly ask the taxpayer for more money but to delivery effectively those services that are required. That's what we're looking forward to; that's what we're trying to do.

It's no wonder the Minister of Health is trying to find a way to keep a lid on his costs. He spends what must be 30 percent of the total provincial budget, which is three-point something billion dollars. One third of that — $1 billion — goes to doctors' salaries. When I get a letter from a doctor that says to me, "The system is underfunded; it's deteriorating; I'm tired of being treated like a civil servant" — I've known the man for a lot of years — and then I find out that his billing costs to the Medical Services Plan alone — and never mind other sources of income — is $285,000, I have to say to myself that I wouldn't mind being a civil servant making $285,000. A lot of our people — in fact all our people — make less than that. I know he's got to pay his office costs out of that. I don't have any problem with that, but I think the doctors are doing very well — far more affluent than any

[ Page 2467 ]

other group in society, far more affluent than our university professors or any other group — and with no disrespect to the Clerk, even more than some lawyers. The fact is, doctors are doing well. We have to have some new approach to the cost of health care that will deliver the money into the care of the patient. That's my view of what the minister is trying to do, and I would like him to confirm that.

HON. MR. DUECK: Mr. Chairman, I just want to go back to the for-profit and not-for-profit agencies, whether they are in health care or in other lines of work. I'm a free enterpriser at heart, and also by my experience. In the homecare service, we have found in some long-term and continuing-care services that there are a number of for-profit agencies that give better service and cost less, so let's not throw them out with the bathwater and say that anyone who takes a profit obviously is stealing from some patient. That's not the case. It definitely isn't, so I don't buy that argument at all.

Although I will say that if someone is doing the service for profit, and they are in fact taking the profit, so to speak, off the backs of patients, then it's wrong. We will not tolerate that, and we watch it very, very closely. The competition in that area is good and we have some for profit. It keeps both parties in line, and the competition when they bid for that service is healthy.

As far as the billing numbers are concerned, I inherited this, of course, from other ministers in the past. This item has been on the agenda for the health ministry for a number of years, and I don't want to go through all the history. It was put into place but wasn't legislated; then it was reneged on and finally it was legislated. It was appealed and was lost and it's now under appeal again. There are many, many long-standing issues on that.

However, I have to admit to you — and I think my hon. colleague referred to this somewhat — that we have more doctors in Canada than any province. We have, for example, one physician for every 511 people, the highest ratio in Canada, compared to Quebec which has one for every 542, to Ontario which has one for 562, to Alberta that has one for every 678.

Now if you want to get it even closer than that, we have roughly one doctor for every 387 or something in the lower mainland. You must understand we have a free enterprise system as far as doctors are concerned, but we've got socialized medicine. I'm not speaking for or against either one; I'm just saying these are facts.

Now we have the free-enterpriser who goes out and gets all the business he can get, with no receivables and with guaranteed payment from the taxpayer. The two don't mesh. You have to have some control. I'm not saying that billing numbers is the best way to go, not at all. There may be other methods. There may be other ways. We've explored this. I meet with the BCMA on a monthly basis. I keep asking the president; he keeps bringing it up. I ask anyone who suggests we shouldn't have billing numbers to please tell me how. They have all kinds of ideas, but when it comes down to the nitty-gritty, they have none. They just say: "Let us practise." As a matter of fact, the biggest argument is,"Do you really believe that someone will come to a doctor when they don't need to come?" and I say: "Yes."

Do you really believe that a doctor, if he is slow in his practice, would ask a patient to come again next week and the week after when maybe it's not really necessary, but he's in the private business of making money? Yes, it does happen. It is a fact. I have doctors coming to me personally, just eyeball to eyeball, telling me all kinds of stories. Most of the doctors are very honourable, but the way the system is set up begs for these things to happen. We not only want to do this to restrict billing numbers to save some money or reduce the supply of doctors in the metropolitan area or the lower mainland, but also to try to get them into the northern areas.

You say it doesn't work. Oh yes, it does work. It works very well. Not as well as we would like, but it does work. We have other things we do for doctors, too, to get people into the isolated areas. You should be aware of that; you're from Prince George, and surely if you talk to the hospitals there and to some of the doctors — and not just one or two doctors; talk to all of them — they will tell you that in addition to the restriction of physicians, the Ministry of Health has taken a number of measures — for example, for the distribution of physicians.

One, the northern isolated allowance program provides payments to physicians of 15 percent of the normal fee charged elsewhere. We also have in the north isolated travel allowance programs. Further, we have subsidized income programs. If someone wishes to go to an area we specify where we have a problem getting a physician, we will guarantee that person up to S42,000 a year to go into that area.

As far as buying practices are concerned, it doesn't take a wealthy person. I don't think there is any reason to believe that numbers are being sold, but what in fact happens is that an elderly doctor, for example, will say: "I want to retire." It creates a vacancy, so someone buys that practice for a very few dollars down and maybe 10 percent a year for ten years.

[10:30]

With that kind of a contract, any bank would give any doctor that has a degree and a billing number.... He can get it. Doctors are not known as suffering financially, so it's open to anyone. I don't particularly like that system. We look at whether there's a vacancy, a demand, at whether they have hospital privileges. We can see when they have all that. We then look at it again. Maybe the demand isn't there. Maybe we don't even want to fill that vacancy; we may not necessarily give another billing number out. It's not the best system; it's the only system we have at this time. Bill 41 said that an advisory committee would be set up. The chairman of this committee is a well-known doctor, and he meets with his committee to look at ways of eliminating billing numbers and still controlling the cost of health care. They report to me regularly. They have not come up with an answer. You say that there are all kinds of other methods. I would like you to tell me what method we can use. Until we develop a better mousetrap, we'll keep the one we have.

I stand very solid on this, because we cannot afford it. We have evidence that for every billing number we issue, the cost to the Medical Services Plan goes up roughly $150,000 to $200,000. These are statistics. I'm not saying the doctors are cheating; not at all. Who am I to argue with a physician if he says,"Come back again next week," rather than: "If you have no more problems, fine. Don't bother showing up. If you have a problem, see me." The doctor can argue, and rightly so, because a person's health is a unique thing. It's certainly admirable for a doctor to say: "I would like to see you again in so many days." It doesn't take a doctor too long to set up a business. Any good doctor will have a good practice going in a very short time. I have relatives and friends who are doctors, so I'm familiar with that scene. They

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are honourable people by and large, but there are rotten eggs, which every discipline or industry has.

By and large the billing number has worked well. It has not entirely achieved what we set out to do. I personally don't like restricting free enterprise, but I have to keep in mind the balancing act with socialized medicine, which is absolutely free. No accounts receivable. They do the service, and the cheque is there immediately. They get that money. You have to balance these two. If you have any other ideas, or if anyone, even from our side, can give us suggestions I have doctors calling me up and groups coming in, such as the young doctors. It really bothers me, quite frankly, because these are the people we want to get into the field: young, eager, enthusiastic. They've got the latest methods. Those are the ones we want, but how can we do it? How can we afford it? When I'm at $3.2 billion, I'm past the point of no return.

I talked to a doctor from New Zealand — I don't know if I mentioned that here the other day — who is practising in British Columbia at this time. He says: "You know, in New Zealand we have complete socialized medicine. Everything is free. Ambulance, you name it. There is no charge for anything." And I said: "Really? That's very nice." I knew that, because I visited New Zealand a couple of years ago. He followed that up by saying: "Let me tell you something. Just about all of us — anyone who can afford it — carries Blue Cross. And when we need a doctor, we go to one who is not in the plan." That's first hand. That tells you something. It tells me an awful lot.

I believe we've got this system so that we don't get a two-tier system, and I'll stand up and protect it. I will go so far as to say that even if I never get elected again, I will protect our health care system as long as I can, regardless of the politics involved. I don't care what anybody says. If I can improvise a better system, yes. I will listen to all suggestions gladly. Someday we will arrive at something. I know a method of doing this: put all the doctors on salary. Would that work? Do you think we could do that? I don't know. But that would be a method. Then we would certainly control it.

MRS. BOONE: The minister has hit on one suggestion that possibly could be an answer. Perhaps he should look at that.

A real concern to me is in regard to the issuing of billing numbers, and I don't think the minister has addressed this. The hospital manpower committees determine hospital needs and who gets privileges in the various hospitals. Those manpower committees are in fact controlled by the physicians. They are controlling their own destiny. The physicians in a hospital determine how many doctors are required, how many people get hospital privileges and who does not get hospital privileges. You are talking in terms of these people perhaps calling people back to their offices for unwarranted visits. Then what is to stop these physicians from limiting physicians in a particular hospital, a limit that is going to protect their own practice and protect the amount that they can get out of a practice? This is happening. This is happening in many centres, where doctors establish a level and say there are no billing numbers or no hospital privileges issued over and above that number, and therefore their practice is protected. They have an income there. For somebody who is a free-enterpriser, I find it really funny to think that you want to give these established physicians the protection to establish their own income and their own level and to keep it at that. What we are finding in many cases is that practices in those areas where they have limited numbers have increased tremendously. I've heard of areas where practices are now worth $100,000, and that seems to me a tremendous amount of money. So it's a protection quality that they have there.

If this manpower committee consisted of people within the community, the hospital administrator, some people from the health unit, some people from the local municipality and some people from within the community who had a say as to what level of services they could expect in their community, then that would be a little more justified than giving the doctors the power to establish their own numbers and the power to establish what their competition is going to be.

I'm sure any free enterpriser there that opens a doughnut shop, or what have you, would dearly love to have the ability to stop anybody else from opening another doughnut shop down the street. It is a very basic thing that these people should not be in control of other professional people and able to say that they shall or shall not have the ability to have billing numbers. If the minister would consider implementing some community control over the issuing and the determination of their needs in their community, then that would at least be a start to taking the control out of the hands of the physicians so they don't control their own dollar values there. Would the minister consider implementing some such thing as that?

HON. MR. DUECK: When I spoke of the manpower advisory committee, that was not suggesting that those were the manpower committees of the local hospital boards. The manpower advisory committee that reports to me has nothing to do with the hospitals themselves. But the hospitals do each have a manpower committee; you're quite correct.

I don't know if you've ever served on a hospital board. I have served many years. It is not up to the doctors entirely. They may make a recommendation, but the board decides. I have had cases many times when the doctors said we needed a certain discipline or didn't need it, and we would not go — the direction of the board itself. We would say, no, or we would say: "Yes, we want this particular doctor in our hospital." So it's not quite what you say. There may be protectionism built in, but by and large, doctors feel very strongly that the hospital be served with as many disciplines as possible. So the hospital I served in found, actually, that they would ask for more doctors than we would approve. We generally put the brakes on, whereas they would say: "We need another one. We need one in this area or in another area." So it's really the reverse of what you're saying. The policing part from the board is not.... The doctors find it more easy to get a colleague in, because they feel the spinoff will give them more business.

Another thing I would like to just touch on is that when the hospitals give privileges to a new doctor, it's generally because they want that particular discipline. For example, a growing hospital may want a specialist in a certain area. So although they have enough doctors and they cannot use one that has just graduated, they may get one from overseas, unfortunately, or from another province, because that particular discipline is needed in that particular hospital. This goes against the new doctors who have just graduated and who wish to get work. For example, last year — or in the last few years, as a matter of fact — we have graduated between 120 and 130 medical doctors per year, but would you believe that last year we issued 159 permanent billing numbers, plus

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228 locums? People don't realize; they think we're graduating all these doctors and then we don't give billing numbers. We give far more billing numbers than we graduate. But there is constantly a movement afoot, and how do you put the brakes on and say: "The Alberta border, that's the line, and we will only give privileges to someone that has graduated in British Columbia"?

The other thing is that I, as the Minister of Health, cannot put those restrictions on at all, because it's the hospital that hires or gives privileges.... I shouldn't say "hires," because they don't hire the doctors; they're in practice on their own. They're free-enterprisers. But they give privileges and say: "Yes, we would like you to practise in this hospital. We'll give you hospital privileges."

So when we talk about billing numbers, really there's a constant increase in the number of doctors we need in the community. I wish there was some system by which we could tell all the older doctors they should retire. Again, I don't think that with our Charter of Rights we could tell someone who reaches the age of 65 or 70, or whatever: "Sorry, but your time has come. Please hand in your billing number and create a vacancy."

When you really look at this whole issue, it is not that simple. It is not black and white. I've struggled over this since I've come into the ministry, because this was brand-new to me. I knew there were billing numbers issued, but I didn't know all the various aspects of it and how far-reaching it was. I've spent an awful lot of time on this particular issue, and I still have not found anything better than a billing number. That's why I say I will stand pat on the billing number until we have an alternative that serves the people of this province — the patients, the taxpayer — better than the billing number does.

MRS. BOONE: I beg to differ with the minister with regard to your manpower committees, because I think they do hold a lot of power, and in many cases they are protecting themselves. But I can see we will have to agree to disagree on many of these issues with regard to billing numbers, except I would like the minister to listen to the new doctors that are out there, to take a look at the process by which they receive their billing numbers. That is what they are asking you to do right now, because they feel very strongly that numbers are not being issued on a fair basis; that some of them are issued on the basis of who you know and not necessarily what you know or what's required. I'd really like the minister to take a look at that and to review that whole process, as requested by the physicians who don't have billing numbers right now.

I'd like to move on at this point to some very brief comments with regard to AIDS, which is, of course, a very volatile issue in this province, as it is in the rest of the world, something that all of us take very seriously. The questions that I have to do with what I perceive is the ministry's inability to utilize the existing services that are there. I'm really disturbed that groups such as AIDS Vancouver and AIDS Vancouver Island, people who have been working with AIDS victims for many years now and have been providing services to them, have been left out of the whole process of the development of the AIDS program, and that in fact they are not being funded.

[10:45]

I understand the minister is saying that there is a duplication of services, and that these services are being offered elsewhere. But these organizations bring with them many volunteers, volunteers who have put in a lot of time and effort and are dedicated to doing the best they can for the victims of AIDS. It seems that we are not doing the best we can when we're ignoring all that these two groups of people have to offer and the support services that are already there in existence, and what they have already developed. Instead of utilizing that and integrating that into your own programs, you're going off and formulating your other side, and ignoring any funding for them at all.

I understand that the minister has forwarded on the letters and the request for funding from those agencies to the group that is formally looking at the AIDS program, but I would like the minister to really take in hand the whole issue himself and make some assurances to these groups that there will be funding for them, that they can exist. They are providing a very worthwhile service, as are the cancer support groups and the other support groups that do receive some funding from the minister. These people, as I say, have been there. They know what they're doing. They've been working with the people. They have the support and the confidence of the people they're dealing with, and they've already established telephone lines, helplines and all of those things. It's really not necessary for the ministry to go out and establish more of these things, and then say that these people are duplicating their services. Let's utilize what we already have.

Can the minister please comment on the funding issue with regard to those organizations?

HON. MR. DUECK: Mr. Chairman, we're rehashing, of course, material that we've gone over and over. Every news medium, every paper and every TV station.... I don't think there's anything I can say that hasn't been said a dozen times. The member is very well aware, but for the record I will go through it again.

To begin with, I was very highly criticized for saying that I have no objection to these people looking after their own kind. I want it on the record, and I want it very, very clear this time, that I met with AIDS Vancouver on a number of occasions. And on one occasion that I met with them, when they asked for funding, they said, "Give us the funding, because we can look after our own better than you can," and I said I had no objection. That's where that statement came from, and I want it to be known, and I want everybody to know.

I've said it before, but somehow it doesn't sink through, because it's so nice to accuse somebody of saying something that in fact he never did say in that context. It's been said in the House, it's been printed in the paper, it's been said on TV on talk shows again and again: "Dueck's biases, his religious background...." Have I ever in this House — speaking to people on any occasion, whether it be on abortion or AIDS — brought in anything about my background, or any feeling about these people in any way, shape or form? Never; never once. I was neutral. I did my job as Minister of Health to the best of my ability, and to have someone accuse me of slighting a group is very hurting to me as a person, because I'm not that kind of person.

They mentioned helping their own: it would be more profitable, because they could look after their own people better than we could; therefore the funding would be of more value. On that basis I agreed that perhaps that was true, although the Ministry of Health had a certain responsibility in running the health care system, and it was more than just

[ Page 2470 ]

providing a telephone line and some counselling — much, much more. We're spending many, many dollars.

When I read some of the articles in the paper, where they say: "Here is an association that spends all this time and money, and the government is doing nothing...... That is absolute, utter nonsense, and you know it, because I've told you before; it is nonsense. This province probably spends more per AIDS person than any province in Canada. We are very concerned. We are very concerned about the person who has AIDS; we are very concerned about the spread of AIDS; we are very concerned that this information get out.

I will take criticism that we didn't do it soon enough. I will blame that on my inexperience and on being in the ministry a very short time when this whole thing expanded. I will take criticism on that, but I will not take criticism that this government has not done quite a bit in this area, and is not continuing to do so.

I have never said that there was duplication. You said: "The minister said there was duplication." I have never said that. AIDS Vancouver said there was duplication; I didn't say that. I believe volunteers are an added advantage to any community. I would never, ever discount the value of volunteer workers in a community. I should know, because I've worked with many volunteer groups of various kinds, and I can't praise them enough. It doesn't matter what area it's in. If they are volunteers helping mankind — people helping people — that's what we need, and that's what I'm in favour Of.

As far as AIDS Vancouver is concerned, they're doing a commendable job. I have never ridiculed or attacked them for what they're doing. I said that the Ministry of Health has a responsibility to go into a certain area to assist in the education for AIDS — to the patients. It's an expanding problem that the world is facing. We're going into that area. Apparently this year we have spent in round figures $6 million. You can't say that because AIDS Vancouver is doing this big thing, what we are doing is nothing, that we are just sitting by and letting them do it. That is not so. Let's get the record straight. This government is doing an awful lot for AIDS — perhaps not enough; maybe we should have more money. I am constantly looking for more money.

The Finance minister isn't here. He would tell you how often I bug his office to try to get more money. There are many areas where we need more money. I will outline to you just a few things we are doing for AIDS patients. We have a high-risk dental clinic which shall be in operation very soon. A number of preventive initiatives have been undertaken and are being developed for use by physicians, public and schools.

There is additional funding to St. Paul's Hospital, because they are overcrowded. At one time they had three to five AIDS patients. They now have ten or 15 at one time. It's taking beds from other areas, so we have to give them extra funding. We have $800,000 to open a lab to culture the AIDS virus, which is expected shortly, if it's not already in operation.

An AIDS testing and counselling service has been established for British Columbia centres for disease control. We have funded all testing of Red Cross blood since 1985. We've tested all sperm since 1985. We've established an AIDS advisory committee, which has come up with a film package that was circulated to all the schools. We have 500 video stores throughout the province offering this video tape free of charge to any person or group that wish to self-educate their children or their group about the horrors of this particular disease.

So don't tell me that AIDS Vancouver is doing this big thing. I'm not discounting it; they're doing a good job. But the Ministry of Health has a far bigger responsibility, and we're filling that responsibility — $6 million this year. You cannot say that we are not doing anything for AIDS. We're doing as much as the budget will allow, and I will continue. I know that my children are at risk; I know that my grandchildren are at risk; my friends' children are at risk. I am no different from you, and you people on that side of the House are no different than the people on this side of the House. It's going to affect all of us. Race, creed, colour or sex won't matter. We're all vulnerable to this disease, and I accept that. I've accepted that for many months now, and we're doing everything we can to stop it because it is one horrible disease.

MRS. BOONE: I was really interested to hear the minister's responses there, but I don't know who he was responding to. I never questioned your actions, or the ministry's actions, or the amount that you've spent, or said that you've not spent enough. I certainly never questioned your remarks in the media. That was not part of my questions at all. My questions centred around the provision of funding for the two agencies. I acknowledge that the ministry is now doing a great deal for AIDS, and I commend you on that. Contrary to you, I don't blame you for not spending money in the past, because you only just came on to the job, much as the rest of us did, and had to learn a lot about it. I certainly wasn't criticizing that.

I do think that the ministry should be looking at providing some assistance to those two organizations that are out there in the field. I don't say they're doing massive things, but they are in a position of actively doing things for assistance for the AIDS victims. I would like to see the ministry assisting these people financially. They're not asking for a tremendous amount of money, as you know. You forwarded one of the letters from AIDS Vancouver Island, and it was, I think, $20,000 or $30,000, which would keep that community based centre open. That centre is acknowledged, and people understand and they know where to go and they know the line and they know the numbers, and all of those things.

I'm asking the minister for a commitment to try to assist these community organizations. I have not, and I never will, criticize what is taking place with regard to the funding that is going on in AIDS. I do have some considerations about the education program. I'm not all that sure that the film we have out there really deals with the question. It doesn't deal with the whole prevention aspect of it. But that's another attitude. I believe that there should be much more in that film, but that's totally separate as far as I'm concerned; that's the education issue.

What I want is a commitment from you to try to assist these organizations — the two organizations that are community-based. That's where we've got to start to deal with the AIDS problems: at the community level.

MR. CHAIRMAN: Shall vote 38 pass?

I just remind hon. members The discussion is moving along quite nicely, but there seems to be a tendency to address your remarks across the floor to each other as opposed to through the Chair. It provides much better control over the debate if the control is through the Chair.

On a point of order, the first member for Victoria.

[ Page 2471 ]

MR. G. HANSON: That vote was not to pass. The debate leader has not concluded her remarks.

MR. CHAIRMAN: No, I understand that. I have to call the vote once in a while.

[11:00]

MRS. BOONE: I'd just like to deal a bit with the prevention aspect. As you know, I thoroughly believe that this is where we should be concentrating a lot of our services. We've done a lot in the past, and I think we can continue to do this.

At a recent workshop that was sponsored by the British Columbia Public Health Association on strengthening community health, there seemed to be recurring concerns expressed by many of the professionals — and those professionals came from throughout the whole of the public health area. One of those concerns was a lack of real community control without control of budgetary discretion and the need for the community participating in planning control of resources and accountability — more decentralization. I think you can see that when I'm talking about community control, I think the whole process with regard to AIDS Vancouver and AIDS Vancouver Island is indicative of the type of things that are or aren't happening in those areas. And there was the lack of long-term planning goals and objectives; agency linkage problems with each other and with the community — there seems to be some problem within the areas there; identification of health needs and prioritizing them; informing the consumer — and I mentioned this yesterday — as to what their responsibilities are and what the costs involved are; reviewing the role of the health care professionals and getting them on line with keeping people well.

Work within the community. The ministry currently places responsibility for administering budgets on local people, and yet budgets are set in Victoria. Programs are added or deleted, not often according to the community needs but according to centralized decisions. We see that happening with regard to the speech pathologist who has been eliminated for the child development centre in the Prince George area, despite what community needs there are. I would really like to see us developing a process that involves the community, so that they have much more say in the delivery of services in their areas.

There are some things that I would like the minister to address with regard to the dental health program. The dental health program I think is a program that shows just how well a program can work. If you look at any of the results from where they have the dental people going out into the field, and you see what's happening, the amount of cavities and the amount of dental work that is required when they go out a second or a third time after being out in those areas is reduced. It shows that they do provide a very worthwhile service.

I sat on the union board of health in the northern interior health district for several years, and we kept suggesting to the ministry to re-implement the seniors' dental program and to reintroduce the dental program for children on low income and welfare recipients. Those were two things that we constantly suggested to the board, because what we found was that dental assistants were going out and doing their checks, and then when they were going out again they found in many cases seniors were unable to have their work done because they just couldn't afford it. Therefore they contracted gum disease and all kinds of things like that. Prevention does work; it's proven in the dental field. In fact, when I was talking to the dentists, as you've probably done, their concern is that they are not going to have any patients within the next ten years because they are doing their prevention work so well. That's what we should be doing all the time: really pushing it.

It's a good program. The staff out there do an excellent job, but we need to look at those areas so we can really make sure that prevention is extended to all the people out there, not just to those who have dental plans, which is currently happening in many cases. Has the minister considered re-implementing this, perhaps in a future year?

HON. MR. DUECK: There were a number of questions; I'll start from the beginning.

You mentioned volunteer work at AIDS Vancouver, which is a volunteer group, although they get some money from the city and I believe they get some money from the federal government. Let me tell you something about volunteer work. I believe volunteer help is a very necessary ingredient in any community. They did a test not too long ago in the States. They had some hospital workers that were paid and they had a group that was not paid, that was completely voluntary. Within a short period of time, the people who were paid.... They weren't paid all their wages, but they were given a travel allowance and all kinds of...you know, for their effort. The people who were paid.... Their services deteriorated in no time at all, and the purely volunteer people flourished.

So let's never take away the importance and the value of volunteers. They do that work willingly, and they do it because it's needed. And that's what AIDS Vancouver.... I could name you dozens and dozens of volunteer groups that do that so well. It's people helping people, and that should be. We appreciate that and we accept that.

But as far as funding is concerned, we don't fund administration, and that's what it was for. You said they probably wanted $23,000; they were asking well in excess of $200,000. I didn't have it in the budget, because it was explained to them at the time we gave them the bridging grant.... It was very clearly understood: $30,000. When I came into the ministry, because I heard that they were still short, I gave them another $15,000, again with a very clear understanding that that was it. There was no misunderstanding. I had nothing in the budget for it, and that's the way it was. So let's put that to rest. We're not giving any money to AIDS Vancouver, period.

I'm shocked that you say it's not a good film. I've had so much contact with so many people, and again and again they say it's the best film out for that purpose. You say it doesn't show prevention. My gosh, what do you want shown? I just don't understand you. I am completely baffled by the statement you made. But be that as it may, you don't necessarily have to like it. It's not necessarily for you, because I'm sure that you know about AIDS and you're not going to look at that film to help you personally.

Talking about autonomy and making choices, the perfect example is the Royal Columbian, which is now running into quite a few difficulties which we're trying to help with. They started a palliative care program and a psychiatric ward on their own, within their budget. We didn't say that they should do this. They saw the need, and they opened these programs. They have that authority. But they've found out since that it costs too much, and they want to make some changes. They

[ Page 2472 ]

think there are other priorities now that they would like to follow. So the Ministry of Health is going to get involved to make sure that these people are not out in the cold, and that someone will pick up that slack.

As far as dental care is concerned, you said "the elderly" again. You are always inferring that the elderly are poor; I wish you would change your tune on that. I know so many elderly who spend all their winter months in Florida; I just wish I was that elderly rich person. So don't talk about the elderly; rather talk about the poor. There are young and old people who are poor. The poor people are looked after for dental care. They are looked after through Social Services. Again, you might criticize the level of the cutoff, and that's fair criticism. But there is a safety net, and young children also get dental health care.

The final word that I would like to say is that I would like to do all these things; they're all good things. Everything you've mentioned is admirable and excellent and good, but I can't get those dollars. I am at the absolute maximum for this year. I just cannot expand.

MS. A. HAGEN: Mr. Chairman, I'd like to just briefly follow the minister's comments on the Royal Columbian Hospital and to ask him a question which, he'll be pleased to note, doesn't involve dollars.

The Royal Columbian Hospital is now administered by a new society called the Fraser-Burrard Hospital Society, responsible for that hospital which is 125 years old this year and probably the second most important hospital facility in the province in terms of the extent of the region for which it provides service and of its range of services. It is now combined with the new Eagle Ridge Hospital, which sits in my neighbouring community of Coquitlam, Port Coquitlam and Port Moody.

Mr. Minister, one issue about the whole matter of community planning and the role of people in the community is having a voice in their institutions. When the new Fraser Burrard Hospital Society was formed, it was formed without one single representative from the city of New Westminster, and that state of affairs still exists today. It is a matter that causes great distress in my community, because my community was in fact responsible for the establishment of that board in its early days and has a long history of being involved. It is an issue that impedes communication and impedes the community's sharing in the dealing with the problems of trying to rationalize services by hospitals in my region. New Westminster is a major centre for health care, not just for that small city, but, as I've noted, for a very large region.

I'd like to ask the minister if he's prepared to make a commitment to deal with this major deficit in the representation from New Westminster on the board of the Fraser Burrard Hospital Society. I say this without any reflection on its membership, but simply in the interest of ensuring that the community — which regards the Royal Columbian Hospital as its hospital — is involved directly, through representation in its board, in the planning both for the community facilities of that hospital and for its regional role. I'd like to ask the minister if he's prepared to make a commitment to overcome what in my community is seen to be a very major misjudgment on the part of the ministry in the appointment of that new board.

HON. MR. DUECK: Mr. Chairman, I'm happy to answer that question. This was brought to my attention some time ago. I wasn't aware that New Westminster did not have a representative. That is being rectified in the very near future. I think it was an error that you did not have representation from the city of New Westminster, and that's being looked after. The Fraser-Burrard Hospital Society — of course I was well aware that it's included with the other hospital at the present time.

I'm sure you are very closely involved with the workings of Royal Columbian. It's a fine institution, and hopefully we can get the problems resolved that exist at the present time, and I will be speaking to you sometime in the next few days. I'm as much concerned about that as you are, and I believe we can solve the problems that exist today.

MS. A. HAGEN: Thank you, Mr. Minister, for putting that on the record, and I'll look forward to that discussion with you at the earliest time. I think it will be beneficial to the health of that board.

The next question I have to ask does cost money but, again, it is something I'd like to briefly mention to you. The Simon Fraser Union Board of Health is, in its New Westminster component, funded very significantly by the city. I can't give you an exact figure, but it's up to 80 percent. It is a matter that, in the interest of equity, the city would like to see rectified, so that at least the funding that comes to it is equivalent to the funding that comes to municipalities which also make up the Simon Fraser Union Board of Health. Would the minister be prepared to make a commitment to address this issue in the interest of equity and funding for that health unit?

[11:15]

HON. MR. DUECK: Mr. Chairman, this is a problem not just with that area. There seem to be various funding formulas throughout the province, and it's being looked at. I met with the mayor of Vancouver just recently, and he had the same concern. I believe Richmond has that concern. We have some health units operated totally by the ministry. We have others that have a sharing program, and all the services rendered are not the same. In other words, maybe we should look at some formula that would be equal per capita. The conclusion of that would be at least equal to all, so that we would have equity throughout the system. Then, if a particular city would like to add to that service, it would be up to them. We're looking at that now, and it does cost money. As a matter of fact, I had some figures brought to me about a month ago, and we're talking about very big dollars. Again, I inherited the problem. I haven't got an answer for you today on how I'm going to solve it, but I know the problem exists. I don't particularly appreciate the difference in funding that exists at the present time.

MS. SMALLWOOD: My question deals with the $2 million allocated in the budget specifically for encouraging alternatives to abortion. The minister provided a breakdown, some information about that expenditure. Could the minister give us a progress report on the work he has done in that area and on how specifically that money will be spent?

HON. MR. DUECK: I haven't got the latest year right before me, but I know that in the last few days we have

[ Page 2473 ]

appointed the blue-ribbon committee mentioned in the abortion report. I think the other services have not been implemented. There may be a task force working on it, but so far as I know I have no report of any ongoing progress at the present time.

Interjection.

HON. MR. DUECK: You are of course aware of what we want to do in this particular report. You're not asking what we intended to do; you're asking for an update of what we have done to date. Other than that the blue-ribbon committee has been appointed, I have nothing to report.

MS. SMALLWOOD: Could the minister give us the terms of reference and the names of the people appointed to the blue-ribbon committee?

HON. MR. DUECK: Those names have been approved by cabinet, and they have agreed to sit on this committee; but the announcement has not yet been made. It would be premature to announce it in the House before that happens.

MS. SMALLWOOD: Would the minister give us the terms of reference for that committee?

HON. MR. DUECK: Perhaps we want to go on to another question. I'll look it up and give it to you in a minute.

MS. SMALLWOOD: The first recommendation is for educational and contraceptive programs. Could the minister give us some indication of how this $875,000 will be spent and in what areas? What exactly is this program and how will it be implemented? The second recommendation is to promote awareness of alternatives to abortion. What is the intent for the expenditure of the $450,000 that's there? The third recommendation is for additional assistance for pregnant women. How will that $500,000 be allocated? What is the mandate of that program? What assistance will be given?

The minister already has my question on the mandate of the blue-ribbon committee.

HON. MR. DUECK: As I said, I haven't got a report as to the progress. I can't answer the question until the committee that is going to look after these things reports to me and gives me recommendations as to the direction they're going to go.

MS. SMALLWOOD: I'm sorry, I didn't quite understand what the minister said. I would assume, with the ministry asking this House for the expenditure of $2 million, that he had it very clear in his mind as to the intent and how he would put that money to work. For the minister to suggest to us at this point that he won't have that information until the committee sits doesn't quite jibe. Perhaps the minister can clarify that.

HON. MR. DUECK: I said earlier — and perhaps I didn't make it too clear — that a task force is going to look at it, and until they come forward with recommendations, I cannot give you that answer. It's just as plain as that. There's a task force that's going to come forward with a recommendation to say what they're going to do and how they're going to do it. When that happens, I can give you that report. I'm not personally going to say how that money is to be spent. They're going to decide. For example, you mentioned very accurately the different points given: better education, contraceptive programs. Am I going to go to the school and say: "This is how we're going to do it"? The task force that's in charge of this is going to come to me and say,"This is our recommendation," or "These are the choices;" then we'll make a decision and we will know. The blue-ribbon committee is going to do exactly the same thing. They're going to come forward with recommendations. We will look at them; they may have options; we will then decide. At that point in time I can give you that information, but right now I can't, so for goodness' sake, get off my back.

MS. SMALLWOOD: That's a beautiful opener, Mr. Minister.

The minister talks about a task force and a blue-ribbon committee. How will this committee operate? When the minister refers to a task force, is he interchanging the words "blue-ribbon committee?" Is it the mandate of that committee to outline these programs? That was my initial question, Mr. Minister, and I'm still not clear if you're talking about the same group. Do you have two groups out there working?

HON. MR. DUECK: Mr. Chairman, the member is making it a little clearer now, because at first she wanted a progress report, and I had no progress report. Now you're saying something different. We have two task forces: one is the blue-ribbon committee, and one is a task force looking at the other items. On the initiatives, I'll give you the parameters in the areas that they're going to look at. Initiative one, expand educational and contraceptive programs; expanded staffing for public health units and funding for community agencies; appointment of ministry coordinator. They will then come forward with these recommendations. It's also in conjunction with Social Services, and Education comes into it too, so it's three ministries coordinating that.

Initiative two, promote awareness of alternatives to abortion; information program for Health and Social Services professionals, and public media campaign; toll-free information on referral line; funding for privately operated pregnancy counselling centres. They've not been established, but these are the things we're looking at. This is the direction we're going.

Initiative three, provide additional assistance for pregnant women. This could include innovative pilot projects designed to address educational, job training and housing needs. We haven't established that yet, but this is the area that we're looking at and the direction we're going.

Initiative four, establish blue-ribbon committee. I've told you about this. This deals with ethical issues. The panel will be asked to develop voluntary public guidelines for the approval of abortion applications by therapeutic abortion committees. The budget allocation will cover travel expenses and per diems. This is the committee that's going to come in with voluntary guidelines. Perhaps we can get some sanity into the hospitals so they deal with this whole issue on a more even basis, rather than one hospital doing none, and the other doing all. We'd like to get some guidance, some ethical information from this blue-ribbon committee to work at that.

Initiative five, introduce regular auditing and therapeutic abortion committees.

Initiative six, use the federal government to amend the Criminal Code. That is to give us an interpretation of the

[ Page 2474 ]

words "health of the mother." Exactly what do they mean? I've been in touch with the federal government on a number of occasions, and I've talked with the minister in charge and sent him letters. Thus far they're not saying much, but they're not about to change it at this time.

MS. SMALLWOOD: I would like to thank the minister for his further clarification, and ask another question about the task force. The minister has acknowledged that there are two bodies working here: that we've got a blue-ribbon panel and a task force. I'm gathering from the minister's comments that it is an interministerial task force, because it deals with some other considerations. Can the minister indicate to us who is on that task force, and how it is conducting its business? Can the province look forward to an open public process on this question?

HON. MR. DUECK: Mr. Chairman, now the member is aware that there are two committees. I'm sure you've had the report in your hands; we've circulated it and it was all spelled out very, very clearly — the mandate and that there would be two committees. It was public information. However, the Ministries of Health, Education, Advanced Education and Job Training, and Social Services and Housing have formed a small task force of senior officials to consider the implementation of the report's recommendations.

MS. SMALLWOOD: I'm concerned, and I'm very sorry that the minister is so anxious about this topic, but many people in this province are likewise anxious and would like some more information about how their tax money is spent and how their health care is provided. The minister has said that it's an interministerial task force made up of staff members. My question is, how will they investigate and how will they bring the recommendation forward? Can the province expect from either of these two working bodies an actual public process? Can the province be assured that that process will be an open one, and that everyone in this province will have some say in the decisions that are being made?

HON. MR. DUECK: The blue-ribbon committee is public. The other task force will be senior officials.

I don't quite know what you mean by me being anxious. Why should I be anxious? I get testy like everyone else. I think I've kept my cool fairly well. You keep badgering me; I suppose that's fair game, and I should take it in its course. If you can't stand the heat you've got to get out of the kitchen, and I want to remain in this kitchen for a while. So I'm not anxious about that or anything else. I enjoy my work. Whether you talk about abortion or AIDS or billing numbers, no, I'm not anxious at all. I'll stand my ground, but I'm not anxious.

As far as the committee's work is concerned, once we have the recommendations and our initiatives are in place, it will be public knowledge, just like the report was — absolutely public. We're not trying to hide anything. We're not going to do anything other than with public knowledge. But if you're asking whether we're going to have other members from the public on this particular committee, at the present time the answer is no.

MRS. BOONE: I'd like to get back to some of the other areas of prevention in speech and hearing. My question to the minister deals with the shortages of personnel, which I'm sure he realizes exist. Some are attributable, I believe, to our training programs, or our lack of training programs; to our inability to provide people in those areas. Is the interministerial committee looking at providing more training for the speech and hearing people so that we develop a strong program and produce our own people here? Currently, most of the people from speech and hearing — those who go up into the northern communities, anyway — come from the U.S. or from other areas of the country. Given our unemployment levels, it would seem very reasonable to start training our own people. Is the interministerial committee looking at any of those areas?

[11:30]

HON. MR. DUECK: I hope you don't think this interministerial committee on abortion is also on the other, because they're separate. I'm sure you know that.

We're trying to work with the Ministry of Education. At one time the Ministry of Education did one portion of it and Health did another, and it was ludicrous. So we're joining forces. If we have personnel that previously worked for the Ministry of Education, they can also look after the people who were covered under the health program. We're coordinating those two and trying to solve that problem. And there has been a problem. We haven't been able to get enough personnel to cover the needs across the province. There's no question about that. I admit that, and it's a constant worry. It's in my office on a daily basis — one of the things we have to deal with.

To the other member who asked about the terms of reference, I asked you to wait a minute until we found that, and I'll give it to you now. It was also in the abortion committee report, so if you have that book, you can read it for yourself. But I will put it into record at this time if you so desire. This is the blue-ribbon committee that you talked about:

"To identify and clarify major ethical issues in the field of health care, such as those related to unwanted pregnancies and abortion, euthanasia, genetic engineering and the use of human embryonic tissue for scientific purposes.

"To review the range of standards and solutions extant in other health care jurisdictions to seek and develop areas of consensus in British Columbia with respect to such issues.

"To advise the Ministry of Health and to develop practical guidelines for the handling of such issues by the health field in British Columbia."

Those were the terms of reference.

MS. SMALLWOOD: Mr. Chairman, nowhere in those terms of reference does it direct the committee to do its work in a public fashion. Will the minister assure the House that it is his intention to have this be a public panel, and that the minister will ensure that there will be representation from a cross-section of the province on this issue?

HON. MR. DUECK: This committee, of course, is an advisory committee to the minister, and the reports will come forward to the public when they are ready.

MS. SMALLWOOD: What the minister is saying is that the ministry will draft its report in consultation with the blue-ribbon committee, and that the public will get that report after

[ Page 2475 ]

the report is finished. That is directly contrary to what I have been asking the minister for.

What we have seen in the past is that the Premier of this government sits down for a full hour with a special interest group on the issue of abortion and denies any access to his office to the opposite side, the groups that represented the pro-choice issue. The Premier, during that process, that so-called consultative process that drafted your initial report, didn't even have the decency to return the letters of inquiry to the pro-choice organization.

I want assurances that $2 million of the taxpayers' money will be spent representing this province, not the narrow perspective of this government.

HON. MR. DUECK: I'm sorry the Premier isn't here, because I'm certainly not going to defend the Premier; I think he's quite capable of doing that himself I think you said some pretty harsh words about him, and he should be in the House to hear that.

However, as far as my office is concerned, I've had both groups in; I've had presentations from both. My office is open to anyone at any time, providing I have the time at the particular time they request. I can only speak for my ministry and not for the Premier. This was directed at the Premier and I didn't particularly appreciate your being that harsh on the Premier when he's not present in the House.

MS. SMALLWOOD: I'm looking for assurances, Mr. Minister, that the spending of the $2 million will be a process that is accountable and open. I am saying to you, Mr. Minister, that your ministry and your government's credibility on this issue is at stake here. We're looking for some assurances that the report and the conduct of this blue-ribbon committee will be an open and accountable public process.

HON. MR. DUECK: I would have to tell you that I am responsible to this Legislature and that's why we're going through this process right now. I'm not going to tell you at this time how we structure the committees or when we structure the committees. I was elected to a job, I was appointed to do a job, and I will do that the way I see is best and fair.

I am not going to appoint a committee just because you say that's how I should do it. That's my responsibility. I will do it the best way I can. I will do it the most responsible way I can, and everything I do will be public.

Interjections.

MS. SMALLWOOD: My last comment on this issue, Mr. Chairman. I would remind the minister that he is in estimates, that he has come before the people of this province for approval to spend $2 million, and the minister is unable to provide any information or any assurances that the spending of that money will be done in an unbiased and open way.

Interjections.

HON. MR. DUECK: Mr. Chairman, I don't want to get into a debate on that issue, because we are in estimates. We are going to spend $2 million. I just finished telling you I don't know at this point in time how we are going to spend it. I gave you the terms of reference, and that committee is going to come to me with recommendations. What more do you want?

Interjections.

MRS. BOONE: I'd like to go back to the speech and hearing business that we were talking about — an easier, calmer area.

We were talking about the interministerial committee. You mentioned that they are working together to exchange people. What I want to know is: are you working with the Ministry of Education to assure that we are training and putting into the system our training programs, so that we are training our own people here in British Columbia in those areas at a number to provide for our services that are required. Is the Minister of Health working with the Minister of Advanced Education and Job Training (Hon. S. Hagen) to make sure that those two areas are covered?

HON. MR. DUECK: Of course, the training of these professional people is in the Ministry of Advanced Education. We are constantly asking for more people. He's constantly seeking more room to supply that space. I think we're making headway. I think we're getting more people through the system. But we also have a bursary program, where in fact we will provide $5,000 per year for certain professions that are in short supply if they go to an area of our selection; in other words, into an isolated area where the need is much greater than perhaps in the lower mainland. So we're providing that. We've got students graduating now who have taken advantage of that program, and are now going to serve. Let's say they've had three years at $5,000 a year; they are now going to serve three years in an area that we designate. It's working. I'm glad we did it, because it's a good program.

MRS. BOONE: The minister is right; it is a good program to supply those areas.

Has the minister considered sending people.... ? Dentists currently are sent around the province to areas where there aren't dentists. They have a program that's movable. And they can go to areas like Grassy Plains, Blue River, and what have you, where they didn't have a dentist there, and set up practice until somebody comes in. Has the minister thought of sending some of these specialists out into the areas on that basis, to provide services in areas where they just can't get them? If they can't get a speech pathologist, for example, in some of those areas, has the minister considered extending that to areas other than strictly the dentistry area?

HON. MR. DUECK: The only ones that I know we sent around are perhaps on a sessional basis pediatric care type of professionals; but other than that, dentists are really by and large not under our control at all.

MRS. BOONE: On your alcohol and drug program, I'm happy to see the increases and the things that you are doing for the youth out there. I think that's something that is really required. When I've gone through any area of the province, that's what I'm finding: our young people are falling through the cracks out there frequently, and we're not dealing with them.

The programs that you are implementing, do they include working within the school system? Is that part of the programs that you have implemented on the alcohol and drug prevention program that you've started in your ministry?

[ Page 2476 ]

HON. MR. DUECK: Mr. Chairman, the one program we have in schools is the Decisions program, grades 7 and 8, which is anti-smoking and alcohol. The others are through various agencies either funded or our own and are mostly day-type services, not the overnight type of facilities that some of these societies operate, like Kinghaven. They have women's now...and that's for adults. For the young people I don't think we have any facility where they can be brought in for a two-week period, where they have an overnight stay. But we provide counselling services for them in various places right around the province.

MRS. BOONE: I'd like to commend the ministry. I know the staff in the Nechako Centre in the Prince George region are taking their services out to the reserves and doing an onsite 30-day program on the various reserves in the area. I'm anxious to see the success level. I think this is a start in dealing with the problem that we have in some of our native communities. I compliment the ministry on their positive actions on behalf of those.

In going to some of the long-term detainment and detox centres, like Nechako Centre, one of the things we found — and the staff were telling us — is that the welfare recipients are taken care of; they're fine; they're handled fine and dandy; they can go into those centres. And the wealthy are fine. But again we've got a level of people out there that are unable to go into those centres because they don't qualify for welfare and they just don't have the money themselves. This goes back to the same thing that I think you keep saying. Perhaps you have to acknowledge that maybe you have to enlarge the level of that catchment for those areas that are requiring assistance, because the level right now is so low that in many cases people aren't being served by them. So perhaps this is another one you can look at in terms of increasing the level so that people can get in to get assistance in something that is really required. It costs us money in the long-term when we don't deal with these people and get them through a centre so that they do become dry.

One of the areas that I would like the minister to address is this: in some of the areas outside the lower mainland, the treatment centres cover a very large area. For example, the Nechako Centre in the Prince George area covers the whole of the north from 100 Mile House up. Does the minister have any plans to put in further treatment centres so that people can be served — they don't have to be large ones — perhaps in the Rupert area, in the Peace River area, or what have you, so they don't have to come all the way to the Prince George area? It is a difficult thing for people to do. I am sure these centres are servicing the areas around the region, but I am equally certain that the further away you get from the Prince George region the less those people are going to be apt to come in to get into a treatment centre.

Has the minister considered making some smaller treatment centres around the province?

[11:45]

HON. MR. DUECK: Again, it comes back to dollars. Of course we've considered it; of course we've thought about it and talked about it. As dollars become available we'll do just that. Right now, I cannot think too much in that area because it does involve dollars, and I just haven't got them.

However, when you are talking about catchment areas that are large, we do find that most people who need help.... Especially if they want help — I think that's the key. So many people are loose in the world and they're not really seeking help. If they seek help, there is help available. If anyone has problems with finances, of course, that comes under Social Services, and hopefully they can get some relief there if they are unable to cope.

I know also that with the provincial prison system, when someone has gone through prison because of alcohol abuse, they go into some of these centres for detox. I know that a number of them, for example, have gone to Kinghaven in the Abbotsford area. They've now just opened up Peardonville House, which is for women who have alcohol problems. I admire these people; it's a totally volunteer group, and we give them some funding to operate and the rest comes from donations and volunteers. It's working well, and they're doing an excellent job. If we could just get more of these in all the areas, we'd be well off.

MRS. BOONE: I'd like to move on to institutionalized services, and I believe the member for Coquitlam-Moody would like to get in on this, so I will turn this over to him.

MR. ROSE: I pledge to be verbally parsimonious, which will be a new experience for all of us.

I'd like to talk about a little local problem having to do with a hospital in my riding, Eagle Ridge. Of course, it's in tandem now with the Fraser-Burrard district. This was in a committee appointed. The merger was really forced by the previous minister, and it left a bad taste in the mouths of many local people, because they worked for years to develop in Port Moody a community hospital. On the day it was opened, suddenly their director was transferred, and they found that their hospital was now under the direction of some superboard over which they had little or no control. The Westminster people feel equally badly, because they actually don't have a resident in Coquitlam or in the Royal City on the board at the moment.

Now there is a Cardiff report that's about to be published on how to best divide up the various services among four hospitals in the area. My first question is: when do we expect that report to receive the light of day, and what is the impediment at the moment which is holding up its publication? It has been ongoing for a long time. There are some leaked documents out, but these don't have a wide distribution — but they're around. That's number one.

Number two is that I got a phone call from a very distressed person the other day whose mother had been misdiagnosed, sent to Royal Columbian and put in a medical ward, because there was no palliative services for her. She was strapped in a chair. She had a brain tumour and, because there was no other assistance for her at the moment, had to suffer some extreme agonies over some days. It was a very serious matter, and the woman, besides being tremendously grief ridden, was bitter about the treatment.

The reason that occurs is because of cutbacks and crowding. I took a tour of Royal Columbian the other day and, in spite of its many fine areas, some of it is positively Dickensian. And here we have Eagle Ridge on the other hand — partially empty, and it has been for two or three years. Its mandate as a community hospital is not being fulfilled. I think one of the problems is medical politics. The doctors, even though they live in North Van, don't want to go out to Eagle Ridge.

So I'd like to know from the minister — briefly — what he intends to do about it. We've got a building there, lacking

[ Page 2477 ]

services of physiotherapists, this, that and the other thing — and that has been touched on earlier, so I won't go into that. But the simple questions are these. When is the Cardiff report going to be published? When are we going to get pediatric, obstetric and services such as emergency services? I don't know how well the minister knows the geography there, but at certain times of day it's virtually impossible to move because of traffic arteries in there — or the lack of them — in that general area. And I guess the third one is: what's he going to do about the provision of the distribution of services among those four hospitals and when can we expect some action on it?

HON. MR. DUECK: Well, Mr. Chairman, as far as the amalgamation is concerned, of course, it was prior to my time, but I understand that there were some very serious problems to begin with. The cooperation was not all that good, but apparently it's working quite well now. I visited both hospitals. I visited with the staff, the chairman, the president. They are functioning quite well, and I think they have become accustomed to that arrangement. I think it's more efficient than it was before and, I think in the long run, it will be the best direction.

The Cardiff report you just mentioned is, of course, commissioned by the hospitals. We have not yet received it; we hope to receive it soon. I understand it's nearly ready, if not ready now. We're going to receive that soon; we're looking forward to it. That should give some indication of the direction these hospitals should go.

It's unfortunate when you mention individual cases like the one with the brain damage. I think I mentioned earlier that these programs were brought about by the initiative of the board of the hospital itself. They were never recommended by us, neither did we ask them to. But the palliative....

MR. ROSE: The removal of that.

HON. MR. DUECK: No, the going into those services was a decision the board made in their global funding. It had nothing to do with our administration. We did not ask for it; neither did they tell us. They just said they wanted to provide these services because there was a need and they were going to do it in their global funding. Now they tell us they have other priorities and they'd like to get out of it. This problem has to be addressed — no question about it. It will be addressed, and the Cardiff report, I hope, will shed some light.... We're working on some issues there that I think will help us resolve that.

You mentioned cutbacks. That's not true; there are no cutbacks, There may not be as much money as they asked for, but there's a difference between a cutback and not getting what you asked for. If someone received $50 million and the next year he wants $60 million, and we say we'll give you $55 million, that institution does not get a $5 million cutback. That institution got a $5 million increase. I want to make that very clear.

As far as the operations of Eagle Ridge are concerned, I'm well aware of them. I've toured that hospital; it's a beautiful hospital. There are all these gorgeous rooms and beds ready to be moved in, and I have not got the funding for it at this time. But I believe that in the next budget year I will be able to accomplish that.

The reason we haven't started an emergency service: we knew we couldn't complete a total emergency service because the costs were too high at this time. You cannot have emergency service for eight hours and then shut it down. Because once people know there's an emergency service, you must provide emergency service 24 hours a day. This is why we asked them not to start an emergency service: because we didn't have the funding for a total package. But that will come about. I'm sorry to say that we couldn't do it this year; we just didn't have the money. But we will. It is a beautiful hospital and it should be opened; I agree with you 100 percent.

As for the board members on Fraser-Burrard, I don't know whether you, Mr. Member, were in when that question was asked. I agree with you. When I heard about it, I didn't understand why this would happen, why the Royal City would not have a board member. We're correcting that now.

MR. ROSE: Before we close at noon, I'd like the minister, if he could, to assure us that he won't.... There are services there to be shared among four hospitals. There will be recommendations made. There will be some under the Cardiff report. There will be some obstinacy and attempt to hold onto what they have because of the tradition of the various competing members: that is, the four hospitals.

The minister can use a lot of pressure because he handles the funds. One of those hospitals has a deficit of about a million bucks. That is one of the more difficult hospitals to gain cooperation among the other three. So I would like the minister to assure us that he will use his considerable influence and he as self-righteous with them as sometimes he is in the House with us. Let them know that because it happens to be a sort of parish-pump tradition somewhere.... The best services for the region should be the prime consideration, not a power-grab or attempt to hold onto something that is no longer relevant in terms of services.

HON. MR. DUECK: I'm aware of what you're saying and agree. I'm actually quite thrilled about the power I've got. I didn't realize I had that kind of power. Awesome. It's something like the commercial: awesome.

The other thing is self-righteous. I hope that I didn't come across that way, because I'll tell you, I'm not self-righteous. If you want to know some of the bad things about me, I can go on for hours. I feel very insignificant. I don't feel self-righteous at all. As a matter of fact, I've been shaking in my boots here for hours. I'm not self-righteous.

MR. ROSE: I'll withdraw the self-righteous part of it. But he does have a tendency to scold us once in a while, as unruly schoolchildren. Maybe his background as a tycoon has something to do with it. I don't really know.

Let me end by saying that I think the minister does a very good job administratively. We might disagree with him on various medical and moral issues, but they are not part of the debate we are indulging in.

MRS. BOONE: I'll ask leave of the Chair. I have about a half-hour left. Does the Chair wish me to continue at this point?

MR. CHAIRMAN: Please proceed, hon. member.

MRS. BOONE: I'd like to move into the hospital and to the staff. I'd like to start by commending the minister on the

[ Page 2478 ]

consultative approach he has used with the registered nurses. I understand that he has come to an agreement with them with regard to their registration process, and rather than do that, he has agreed to protect the title of "nurse." I would like a commitment from the minister at this time to bring about the necessary changes to the nurses' act that will protect the title of "nurse." Can the minister please give that commitment at this time?

[12:00]

HON. MR. DUECK: We have not yet got an agreement; it's an understanding. An agreement is when it's signed. But we are getting closer. That just goes to show you that I'm not self-righteous. I'm really a very nice guy. Otherwise, we never would have got this far.

As to what will be in that agreement, I think you'll have to wait and see until that agreement is endorsed by both parties. I can't tell you at this time exactly how it will be spelled out, whether it's the RNs versus the professional group.... At this point in time I'd rather not speak to it, because the tentative agreement is in the process of being finalized. We'd better leave that alone for the time being.

MRS. BOONE: In my discussions with the RNs they felt that they had almost come to an agreement with you, and that in fact they would accept rather than the registered...that every nurse be required to be a registered nurse rather than keeping to their original request for that; that they had acknowledged and accepted your idea that protection for the title of "nurse" be put into the act. That's why I wanted a commitment from you at this time. But I certainly would urge the minister to continue to work with this group, so that we do come to a recognition of their status and their need to keep up standards in their profession, which is what they've been searching for.

With regard to the whole nursing profession, I have some concerns about what is happening in the nursing profession. I understand that they got an increase just recently — their wages were substantially lower than anybody else's within Canada — but there still is a real problem of morale out in the nursing profession, to such an extent that we have people, as the ad says here, coming from Texas to try to lure our nurses away.

As you know, we have a tremendous nurse shortage right now as it is. We need to do what we can to make this profession a strong one, one that provides good opportunities for people and gives a good working atmosphere. Right now the nurses that are in our hospitals are tremendously overworked. Their workloads are very high. You and I have both received letters from people indicating problems that they've had in hospitals. They never question the quality of the nursing and they never question the nurses, but what you get is that they have at times been neglected, and it's usually due to the poor, overworked nurse who has so much to do in the hospital. This is contributing to the problems that we have out there with nurses not staying in the profession; with them leaving the profession, getting burned out and wanting to go to other areas.

One of the areas that you can be addressing as a ministry — and I know this is dollars again — is to increase the numbers out there so that they aren't overworked, so that their staffing levels are up and they're not overburdened. Also you could make some commitment to increase morale; and some of those things would be through making funding available for post-graduate courses, basic courses in specialty areas which are really neglected and badly in need of people.

Dealing with the whole area of the shortage of critical care nurses, as the minister knows, there are hospital beds in this province.... I know that the hospital beds in Delta, for example, are closed, and they're closed because of nurse shortage and the inability to obtain some critical care nurses.

If I was a nurse, I wouldn't be going into critical care nursing either, and I can tell you why. In order to go into critical care nursing, a nurse must take a leave of absence, without pay, from her position. She then goes out and takes the training at her own cost, wherever the training place may be. After going through that, of being without pay and being out of pocket for the training, she can then go back into her original position, but she gets no extra money for that.

I don't see any professional or any person around who would be willing to put money out of their own pocket, take extra time off, take leave of absence without pay, and all for no extra remuneration. Surely the minister must realize that if we truly have a shortage of critical care nurses, which we do, then we must be providing some incentives to these nurses to train in that area, so that they in fact find it something that is going to be an advantage to them and is not going to put them out of pocket.

Can the minister please comment on some of the things I have raised here, please?

HON. MR. DUECK: First of all, I didn't want to be evasive on the nurses' agreement that has to go through legislation — all of the ramifications. Just because the negotiating committee came to some agreement — even if they have a solid agreement — it still has to be ratified by their membership. Also, the committee reports back to us. It has to go that route through the legislation committee and then to the House. That's why I didn't want to touch on that area, not because I didn't want to give the answers.

As far as the critical care area in Delta is concerned and their closing of some beds, I understand they wish to get out of that particular area of operations anyway. They are a small hospital, and they do not wish to continue with that type of hospital care.

Wages for the critical care nurses. You're right; they have to take time off and go to school if they haven't got the education advance. But what you neglected to say is that for years we've said we want to pay those nurses more, but the BCNU won't let us. It's not us; it's the union. They say no, we don't want any differential. So please don't hang that on us. We've said before that we need critical care nurses and they ought to be paid more in those specific jobs, but the BCNU says no way. Just to make that clear.

Talking about the shortage of nurses, it's not just British Columbia. My ex-deputy was in Toronto before he switched over to Economic Development. I don't know why he switched, because this is such an interesting ministry — lucky for Noble here. When he was in Toronto he picked up a paper and the first thing that hit him was a big headline: "Shortage of Nurses." It's all over. And you can understand it. There are enough nurses in the system, but to this point most of them have been women, and most women have families. There's always a great number of nurses who are not working for one reason or another, and I can understand that. So we need more — many more. Also, at any given time there are roughly 800 nurses on UIC in the province, and probably rightly so. They can't get their specialized job in the

[ Page 2479 ]

area where they live, or their husband is transferred and they're out of work.

So there are enough nurses, but they cannot seem to match up with the hospitals that need them. I'm not saying that's good. It's bad. We still have a shortage. In summer we find there's generally a shortage. That's why we often close hospital beds: because a lot of nurses like to take summer holidays off with their families.

I would just like to go over a couple of things as to funding that we do for upgrading nurses. Vancouver General Hospital is the only hospital operating a school of nursing. Total 1985-86 cost of operating the schools was $1.8 million, of which $209,000 went to stipends for student nurses. The balance was for the administration, teachers and so on.

In addition, the Royal Columbian Hospital and St. Paul's Hospital ran critical care nursing programs at the hospitals during 1986-87. This was to train critical care nurses for positions within those hospitals. Hospital programs provided funding of $39,000-and-some-odd to Royal Columbian and $33,000 to St. Paul's for these programs.

Also, the university Health Sciences Centre hospital ran a critical care nursing program during 1986-87. This program was funded by UBC and the Ministry of Post-Secondary Education, $100,000, and hospital programs, $40,000. This program provided critical care training to nurses employed outside the lower mainland. This program is to be transferred to BCIT commencing 1987-88.

You say maybe we shouldn't do so many studies, but we are looking at the whole issue of critical care nurses and other nursing shortages and what we can do for the future. In other words, there was a lot of talk today about planning. We are planning; we are saying there is a problem. Let's not just fight the fire of today, but let's see what we can do for the future and how we should do this. It's not fair to say that we're not planning. We are, and we're looking at all these areas. We're looking at it not just for today; we're looking at it for time to come.

I would like to ask leave of the House to make an introduction at this time.

Leave granted.

HON. MR. DUECK: We have in the gallery today a very good friend of mine. I only got to know her since I got into this business, and that was through negotiations with the nurses. She is Gloria Parker, and with her is Bea Holland, whom I met.... At just about every occasion I go to, there is this grand lady. I would ask this House to welcome them, please.

MRS. BOONE: I thank the minister for his answers. I'm glad to see that you are investigating or reviewing the whole process and the shortages that we have. You've got to be doing something to alleviate the problems that we have right now.

The shortage of critical care nurses right now is causing severe problems with regard to open-heart surgery. You indicate that doctors may take holidays, and that's probably very true, but there have been problems throughout the year, regardless of whether it's in the summertime or what have you, with regard to the cutting back of the services in open-heart surgery. A great deal of it has to do with the shortages of the critical care nursing staff. That is causing severe hardships for the people in this province who require open-heart surgery. I know that in many cases it's life and death. So we can't afford to sit back and not deal with this issue. We must deal with the critical care nursing; we must deal with the training. One of my earlier questions to the minister was with regard to funding for the post-graduate courses — basic courses in specialty areas. Is there any move by the minister to make some funding available to the nurses in those areas, some incentives for them to get into the specialty areas, to develop themselves professionally and do some post-graduate work?

HON. MR. DUECK: I want to back up to the first part of the hon. member's statement, and that's the open-heart surgery. It is true; we have a long waiting-list. Not all hospitals are the same. In Victoria the waiting-list is much shorter. But it's not just a shortage of critical care nurses; we also have a shortage of perfusionists. Then there's the problem of the special doctor. There will be a long list of patients waiting to have a particular doctor do the operation because he's more popular or more efficient, or more of a specialist than the others, and they prefer that doctor. If there's an emergency case, it will be looked after in a very short period of time. But with a doctor's advice, a certain patient can be put on the waiting list and wait somewhat longer.

[12:15]

Those are the ones that have to wait a longer period of time. Quite frankly, it is too long. It really bothers me too. But when you talk about health and death, a doctor can check you out today 100 percent, and you may drop dead this afternoon. Human life can't be dictated that accurately. Just because someone's waiting for open-heart surgery and may die from some cause, or maybe even that cause, not necessarily could he have been saved had he been able to get into hospital, or get to the hospital sooner. But there is a problem in that area.

I've said before — I admit it; I'm not going to pussyfoot around it — that it's not just critical care nurses; it's the doctor involved, it's the perfusionist, and it's also the critical care nurse. There are a number of items that come in, such as funding. Although we find some hospitals had enough funding to do more open-heart surgery, because of other reasons they didn't fulfil the allocation that we had given them at the beginning of the year in their global budget.

MRS. BOONE: Well, I'm glad that the minister has indicated that funding is a problem, because it definitely is a problem in many areas. We have received word that due to funding cuts, 50 percent of the beds for open-heart surgery are cut, and it has nothing to do with the staff at all in those cases, although there could very well be some problems there still. But when that happens, what we're being told by the hospitals, or what you are telling the hospitals, is that it's a matter of their priorities, that they are allocating their funds in a way that they shouldn't and that they should be putting more money into open-heart surgery.

Again, that is a decision that's made at the local level. It goes back to one of the original statements that I made, where you are given the authority for people to handle their own budgets, but then the budgets are maintained and determined by Victoria. So if their overall global budget is not sufficient, they then have to rob Peter to pay Paul, and in many cases that means that open-heart surgery is the one that goes down the tube because of the problems that exist there.

[ Page 2480 ]

I can't accept the comparison of a person going to a doctor and then dropping dead the next day, because that in fact happens many times. But somebody waiting for open-heart surgery knows that they've got a problem; they know that their valves are closed or that something is wrong with their heart, and they know they need surgery and that can make a difference. With people who visit their doctors and then drop dead, those people are unaware that they have a problem. So what we are saying is that it is just not a comparison at all. We've got people who we know have a problem, and we've got to deal with them and give them the assistance if possible to keep them alive.

One of the problems I see when I'm talking to people in hospitals — and I see this as being a staffing problem as well; probably something that is not happening at the moment but which could happen in the near future — is our inability to keep up with the salary levels and with the support staff for the specialists that we have in those areas. In fact, we are rapidly becoming uncompetitive with other areas for the specialists, and we are having difficulty in keeping our specialists.

I think if you look at the UBC Health Sciences Centre Hospital, you will find that the president, who just resigned, will give you some indications of the problems and of why he felt he had to leave. He felt he wasn't able to provide the services required in that hospital. We have to deal with this, because if we are going to provide services, we have to be able to attract specialists and keep them in our hospitals. It is rapidly becoming such that we are not going to be able to do so. They are going to be moving to areas where they do have support and much more research available to them.

Can the minister please address the problem of the specialists?

HON. MR. DUECK: By and large, specialists earn good money. There is no question about that.

Just back up a bit to open-heart surgery. The waiting-list is down by 17 percent since 1981. In 1987 St. Paul's decreased their waiting-list by 15.6 percent, and Vancouver General by 16. I percent. I'm not saying it's good, but at least it's going in the right direction. We're making some progress.

When you're talking about the Health Sciences Centre and a certain individual that left the employ.... I don't think that I'm going to say anything about that in this House. People come and go as they please. When you talk about researchers leaving our institution and going to an eastern institution, whether it's Toronto or wherever, I think that if they do research work, it's just as good that they do it there as here, because we all benefit.

We have researchers coming from the east out here; we have some moving in the other direction. When someone leaves a position, often there are reasons, and I'm not going to go into that at this time. The Health Sciences Centre is one of the very fine institutions and it's certainly in my books as one that has to be supported. Some of the problems they are having now will be looked at and hopefully resolved.

MS. SMALLWOOD: Mr. Chairman, I'd like to change the topic a bit here, and while this is a very small department of the minister's responsibility, I want to make this point, because it's clear that the issue of radiation protection and the effect that the uranium issue has on this province are significant ones.

I'd like to bring to the minister's attention that during the Bates inquiry of '79-80, the Ministry of Health prepared two significant reports and since that time has, on an ongoing basis, done some work on the critical biological pathways of uranium and radium in the environment. That work has been very slow, and the projects undertaken by Radiation Protection are very small considering the impact this contaminant has in the environment. I'll just leave that comment with the minister, and ask the minister if he has had any opportunity to talk to Radiation Protection and look at the kind of work they are doing, realizing that his ministry may very well be on the cutting edge of this significant problem.

HON. MR. DUECK: Yes, there have been some reports going forward on uranium mining and the effects that uranium itself would have on human life and health. Our reports have gone to the proper authorities, such as to cabinet, but the Ministry of Health at the present time is satisfied that the proposed uranium exploration regulations will provide adequate safeguards to ensure that health concerns are met and also that we're monitoring it as necessary.

MS. SMALLWOOD: I'm sure the House is enlightened to know that the minister has caucus solidarity on this issue. However, the work that has been done with radiation protection has dealt with issues like uranium concentration in the environment in root crops and forage crops. Can the minister tell the House whether the ministry, through either the local boards of health or Radiation Protection, is monitoring the effects of other industrial activities in watersheds, as it pertains to uranium in the water?

HON. MR. DUECK: I'm not sure, but I think it's the Ministry of Environment that would be in charge of that.

MRS. BOONE: I'd like to thank the minister for his responses during this time. Aside from a few little comments, such as the one to the member for Surrey-Guildford-Walley (Ms. Smallwood), I think he's managed to keep his cool, and I appreciate the forthright answers.

There are a few things I'd like to point out as to the linkages I see with regard to the cutbacks — your deputy should be able to assist you with this — that have taken place in Social Services and Housing and how they connect with the demands currently coming onto our health care systems. We've seen cuts in transition houses, services for abused women and children, community programs for the disabled and older persons, and welfare benefits. All of these have an effect on the people out there which comes back to the health care cost. We've seen illnesses, suicides, injuries, abuse of children — all of those things which the Ministry of Health is now having to cope with. The unemployment situation is not helping either, because we've seen increases in bankruptcies and alcohol and drug abuse throughout the system. Suicide of teens, all of these things. The systems now are picking up and bearing the brunt of cuts that we've seen in the past.

From your responses I believe that you are sincere in your concern for human beings, and I truly believe that you will seek remedies to try to stop these things and prevent what is happening in our society. The minister has those powers, although he was saying he didn't think he was that powerful. I think he does have some of those powers in his hands to deal with things, to take our society and take some preventive measures, to increase the programs on the prevention end.

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I'm not undermining what you've already done, because I think you've done a great deal, and I think you can continue to do even more, which I would support under all circumstances. But there is definitely a linkage there to what's happened in the past, and we're paying the cost of it right now.

However, given all that, and the things that I do think you are accomplishing, we on the opposition side cannot ignore some of the things that we feel are not acceptable, such as the user fees and the implementation of the dispensing fees for seniors. Therefore, in closing my debate, I'd like to move that the minister's salary be reduced by the cost of a user fee, $5.

MR. CHAIRMAN: Would the hon. member repeat her motion? Is it in the same form as the motion that's been forwarded to the table?

Interjection.

MR. CHAIRMAN: Hon. member, if that's the case, the Chair must advise you that this particular format, although we appreciate what the member is trying to do, is not in order. We do have a standard format for this type of thing. But the way that this one is laid out, it's not in order. So I will call the question on vote 38.

Vote 38: minister's office, $220,893 — approved on division.

Vote 39: management operations, $70,114,417 — approved.

Vote 40: Pharmacare, $155,990,000 — approved.

Vote 41: Medical Services Commission, $540,373,948 — approved.

Vote 42: preventive and community care services, $245,420,959

Vote 43, institutional services, $1, 923,913,040 — approved.

HON. MR. STRACHAN: I move the committee rise, report resolution and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Strachan moved adjournment of the House.

Motion approved.

The House adjourned at 12:31 p.m.