[ Page 5007 ]

CONTENTS

Routine Proceedings

Tabling Documents –– 5007

Pension (Miscellaneous Amendments) Act, 1988 (Bill 39). Hon. Mr. Veitch

Introduction and first reading –– 5007

Ministerial Statements

Bicycle safety campaign. Hon. Mr. Dueck –– 5008

Ms. A. Hagen

Seniors' Week. Hon. Mr. Dueck –– 5008

Ms. A. Hagen

Oral Questions

School Canadiana. Mr. Harcourt –– 5009

Closure of South Hazelton sawmill. Mr. Miller –– 5009

Sale of B.C. Hydro gas division. Mr. G. Hanson –– 5009

Irradiated food processing. Mr. Rose –– 5010

BCEC sale to Stolle Developments. Mr. Williams –– 5010

Court fees. Mr. Sihota –– 5010

Tabling Documents –– 5011

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

On vote 45: minister's office –– 5011

Mr. Rose

Mr. Harcourt

Mr. Cashore

Mrs. Boone

Mr. R. Fraser

The House met at 2:07 p.m.

Prayers.

HON. MR. VEITCH: On the floor of the House today we have two very distinguished Canadians. First, when one thinks of the Senate and of constitutional reform, this name always comes to mind. The hon. gentleman is a distinguished scholar; he was a distinguished senator for many years, a university professor and a trade union official. He ran for public office several times — I think for most political parties, as a matter of fact. He's best known as one of Canada's greatest constitutionalists, whose insight and pithy observations are always highly regarded. He has retired from the Senate and is presently visiting Victoria. Would you please greet the Hon. Eugene Forsey, PhD.

Accompanying Dr. Forsey today is Mr. Donald Munro, formerly Member of Parliament for Esquimalt-Saanich. He served his constituency faithfully from 1974 to 1984. Mr. Munro was the Canadian ambassador to Costa Rica, Nicaragua, Honduras, El Salvador and Panama. He is now retired and lives in Sidney, B.C., and he's swapping stories with the hon. senator. I would ask the House to bid him welcome.

MR. ROSE: On behalf of my party, I feel a little intimidated in welcoming such distinguished visitors today. First of all, I'd like to join with the government in honouring a distinguished Canadian — the senator — one of the founders, I believe, of the League for Social Reconstruction. He has been a nomadic politician. He once headed the CCF in Quebec, he was later appointed to the Senate by Pierre Trudeau and now he appears behind the Socreds. [Laughter.] Despite this, I think all of us recognize that Senator Forsey has an outstanding reputation as a constitutional expert, and as we learned today as well — some of us who had lunch with him — he is an entertaining and fascinating raconteur. Welcome, Senator Forsey.

As far as my old friend Donny Munro is concerned, I spent a long time in the House of Commons with him. Perhaps it seemed longer to him than to me, and as a matter of fact it was longer: he lasted longer. He had a very distinguished career as a Member of Parliament, and his background in the diplomatic corps helped a great deal. I would hardly call him on the left of politics, but again, despite this, he spoke out about his convictions, and I think he did the Victoria area proud as a Member of Parliament.

HON. B.R. SMITH: I want to add my words of greeting to Senator Forsey, who has been an acquaintance of mine for over 20 years. Despite his variegated and maybe questionable political associations over those years, he has been an adviser, friend and critic, I think, to many of us in government over many years, and it was impossible not to he captivated by his letters and his reviews of articles. If you sent an article or a draft of something to Senator Forsey, he gave unstintingly in his positive criticism; what he came back with was usually about twice the length of your article. He is, without a doubt, the leading expert in the western world on the King-Byng crisis and probably the best authority on the prerogative of the Crown, and he has written absolutely impeccable, unsurpassed material on those subjects over a period of 25 years.

I miss his letters in the Toronto Globe and Mail, which I think he just had a short respite from. I remember that when Meech Lake was starting, those letters were there, and I am sure we are going to have more of them.

This is a Canadian of great intellect and attainment, so I congratulate him and also my old friend Don Munro, who served this country so well at home and abroad.

HON. MRS. JOHNSTON: I would like to recognize three people we have in the gallery this afternoon: Mrs. Jeanne Lamb, chairman of the Okanagan-Similkameen Regional District; Mrs. Vanessa Sutton, the secretary administrator-treasurer of the Okanagan-Similkameen Regional District, and Mr. Don Lid stone, who is accompanying them. Don Lidstone, as some of you may recall, formerly worked in the Premier's office — when the Premier was the Minister of Municipal Affairs — as his executive assistant, and is now practising municipal law. I would ask the House to please make them welcome.

MS. SMALLWOOD: I'm very happy that I happened to look up, because I just noticed a very good friend in the House, and I'd like the House to recognize and make welcome Mrs. Chris Beddis.

HON. MR. DUECK: In the House today we have a number of people from the B.C. Head Injury Association. These people are here to talk to the Ministry of Health in regard to their plight when it comes to members of their families and people known to them who have this very severe handicap and must go through life bearing quite a burden. With us today are Nancy and Howard Wood, Peggy Smith, John Simpson, John Scollon, Judy Fisher, Betty Craig, Martha Uhlenberg, Loretta Stitilis and Kim Lubyk. Would the House please make them welcome.

MR. LOVICK: In the House today is a group of students from Ladysmith Secondary School, along with their teacher Ken Helnikay. I would ask members of the House to please join me and my colleague the first member for Nanaimo (Mr. Stupich) in welcoming them.

[2:15]

Hon. Mr. Veitch tabled the annual report of the Ministry of Provincial Secretary and Government Services.

Introduction of Bills

PENSION (MISCELLANEOUS
AMENDMENTS) ACT, 1988

Hon. Mr. Veitch presented a message from His Honour the Lieutenant-Governor: a bill intituled Pension (Miscellaneous Amendments) Act, 1988.

HON. MR. VEITCH: Mr. Speaker, I move first reading of the bill accompanying the message.

I'm very pleased to introduce this bill, which will upgrade the public sector pension statutes in a number of ways. Briefly, Mr. Speaker, the proposed changes are minor in nature. They've been developed through extensive consultation with plan participants and respond in a very positive manner to recent general developments in pension plan design.

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The result of the proposed changes will be that the public sector pension plans will be more accessible to public sector employees, provide greater portability within the British Columbia public sector, address some of the concerns of women with regard to certain benefit provisions, and lastly, provide access to the pension plan for older employees who enter public sector employment.

In conclusion, Mr. Speaker, it's my pleasure to introduce this bill, which will modernize the design of our public sector pension plans.

Bill 39 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Ministerial Statements

BICYCLE SAFETY CAMPAIGN

HON. MR. DUECK: Mr. Speaker, I have two ministerial statements at this time.

I rise today to congratulate the British Columbia Medical Association for taking a lead role in developing a greater public awareness of bicycle safety. I'm referring to the special poster campaign the BCMA announced last week in conjunction with the Insurance Corporation of B.C., the Bicycling Association of B.C. and the B.C. Home and School Federation. The intent of the campaign is to encourage a broader use of cycling helmets, a major factor in reducing deaths and serious injuries as a result of cycling accidents.

Mr. Speaker, the Ministry of Health is only too aware of the devastation caused by head injuries in B.C. each year. This year alone it is estimated that between 300 and 400 victims will endure permanent severe head injuries. Those 300 to 400 will join the 4,000 to 6,000 who are already hospitalized. The list grows each year, and this silent epidemic will leave more people the victims of paralysis, blindness and mental disorders. Another startling fact is that most victims are in their twenties or younger, and three out of four are males.

In the future the Ministry of Health will be looking at developing preventive programs which specifically address the area of head injuries. Hopefully as part of future strategies we can initiate programs which will enhance and support the endeavours being undertaken today by the BCMA and others.

Through our involvement in this area we have become painfully aware that head injuries have a serious impact on more than the victim alone. The difficulties faced by families who have to take on lifelong commitments of caring for victims are an onerous burden indeed. If through campaigns such as this joint one of the BCMA, ICBC, B.C. Bicycling Association and B.C. Home and School Federation one potential victim can be saved, it has a been a worthwhile effort.

On July 1 of this year, the Vancouver Island Head Injury Society will be embarking from Victoria on a cross-country tour to help create a greater public awareness of head injuries in Canada, and particularly in British Columbia. We must salute such endeavours by concerned citizens' groups.

I'm sure that I can say on behalf of all members of this House that we wish every success to both the Head Injury Society and to the BCMA for their respective campaigns.

While we do not have cures for many head-related injuries, we can prevent them through better education and awareness programs such as those that I mentioned today. To bicycle riders throughout the province, I urge you not to jeopardize your health and safety by riding without proper protection. To the BCMA I offer my congratulations for helping to address this critical problem.

MS. A. HAGEN: I want to join with the minister today in speaking to this issue which highlights such a very serious problem for many people and families in the province. Certainly the idea of prevention, which is a part of the campaign that the B.C. Medical Association, ICBC and the B.C. Home and School Federation have embarked upon, is a very important aspect of protecting young riders in this very healthful sport.

I would hope also, as we look to this issue and the cost that it has to young lives and to the families of those young people, that we would he looking as a government and a province to many of the other aspects that need to be addressed in order for bicycle safety and protection to be a reality that prevents injuries. Those issues could involve the Ministry of Highways, municipalities and many groups within our society to ensure that this healthful sport and activity could be conducted with safety. This is a good start. It's one of many initiatives that need to be taken, and for this start we are happy. Let's continue with other initiatives that would indeed see fewer injuries in the future.

SENIORS' WEEK

HON. MR. DUECK: If I could rise again and make another statement, with a special sense of pride I would like to officially recognize Seniors' Week in British Columbia. I know that many of my colleagues will agree that I look far too young to say that I can personally relate to our senior citizens, but in all sincerity, I can say that after having traveled extensively throughout the province, I feel I have a very good appreciation of the concerns and opinions of seniors. More important than my understanding of issues affecting our elders is the very deep respect I have developed for the immense contribution they have made in making this province the great place it is.

As a government, and particularly within the Ministry of Health, we are strongly committed to ensuring that the senior residents of this province begin to enjoy the fruits of their labour in building the strong social and economic core of this province.

Today we have many programs in place which demonstrate our support of seniors. In our continuing commitment to strengthening families in British Columbia, we also recognize the very significant role of our elders in maintaining strong families. In our cultures — be they of native origin or of immigrant families — there is a deep abiding respect for the contribution of the senior members of the family and the wisdom they carry.

It is indeed a very great pleasure and a humbling experience for me to officially recognize those contributions, which I am sure I do with the full support of all the members of this House. As we all strive to maintain dignity and good health in our ageing years, let us remember with respect that we can all be very thankful to our seniors for that we which enjoy today.

Let us not forget that there are those too who are less fortunate. For those people, let us demonstrate compassion,

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understanding and a willingness to work collectively toward providing the necessary support in their golden years.

To the seniors of this province we owe a special debt. It is a debt we can continue to honour through recognition and action.

Finally, let us never forget the sense of pride and accomplishment in which all our elders share.

MS. A. HAGEN: A moment ago we were talking about pedaling, and in response to the minister's statement about seniors, I'd like to talk about brakes. Those would be some breaks for seniors and some brakes on some of the ways in which this government has not upheld the rhetoric we find in the minister's speech.

Older people are a very significant force in our society today, and they do — as the minister has said — bring much wisdom. They also bring an activism which I find very helpful and healthy. Today I want to acknowledge that activism which is speaking to the very needs of seniors and their contribution to society. it is an activism reflected in the work of seniors' organizations which speak out for seniors and ask for respect and consultation on decisions that affect them. Many of those organizations have spoken out recently, and I'm sure we'll continue to hear from them. We should listen and heed them as a significant force in our society.

The other groups I want to acknowledge in my response to the minister's comments today are those older people who are contributing to the well-being of seniors in our communities, and who are contributing at this time with very little or no support from the people of the province. I want to acknowledge their contributions and say that we should, in honouring them this week, reflect on the ways in which we can work in partnership with the older people of the province. In that way, the wisdom they bring and the accumulation of their contributions to us as people in our society can bear fruit that all of us want to see. As a society acknowledges its elders and works with them, so is the well-being of a society nurtured. We on this side of the House want to ensure that is the way older people in our society are in fact consulted and worked with, as we plan together for a future that has been such a major force in our communities.

Oral Questions

SCHOOL CANADIANA

MR. HARCOURT: I have a question for the minister of post-secondary education about Vancouver Community College closing the School Canadiana. The school has successfully provided English-as-a-second-language training to new Canadians for 18 years. It's being cut despite the fact that Vancouver Community College already has waiting-lists for on-campus ESL programs. My question to the minister is: can he explain why Vancouver Community College is forced to cut a program like this to cover its deficit if, as he claims, our colleges are adequately funded?

HON. S. HAGEN: I appreciate the question from the hon. member. As a matter of fact, I questioned the members of the board who made this decision. The reason for closing School Canadiana is that they feel that they can place ESL in more centres in the community to achieve greater efficiency and access for the people who need it.

MR. HARCOURT: Supplementary. Mr. Speaker, that may come as a surprise to many members of the ethnic communities and those involved in ESL, because B.C. spends far less per person on services for new Canadians than do Alberta, Saskatchewan, Manitoba, Ontario and Quebec — only about $15 per person. School Canadiana has served ethnic groups well in the past, and today it's particularly important to the Chinese community. Will the minister take this opportunity to show his support for multiculturalism and ensure that Vancouver Community College has enough funds to keep School Canadiana open?

HON. S. HAGEN: Mr. Speaker, this is a decision that the board at Vancouver Community College has taken. Their commitment is that they will be able to offer ESL in more centres and to more students who need ESL courses.

[2:30]

CLOSURE OF SOUTH HAZELTON SAWMILL

MR. MILLER: Mr. Speaker, a question to the Minister of Forests. Last Thursday, when I asked the Minister of Forests about his comments on the closure of Westar's South Hazelton sawmill, his memory failed him. Those present at the meeting have now confirmed that the minister did say: "You know as well as I do that in any other culture they would move to look for work." Will the minister now apologize for this blatantly racist remark?

HON. MR. PARKER: I still don't recall using those words, and I don't see any reason for an apology.

MR. MILLER: I'm quite prepared to take the word of Alice Maitland, the mayor of Hazelton, and say you did say it.

A further question to the minister. You've been appointed the minister of state for region 6, which has a number of native communities — they have existed for thousands of years in that region — that have extremely high unemployment rates. As well, you are responsible for the sensitive negotiations on the Stein Valley, and we get disquieting reports about that. Does the minister not think that public statements of the kind he has made have really destroyed his credibility and that his only hope of regaining it is a full retraction and a complete apology?

HON. MR. PARKER: No.

MR. MILLER: Finally, would the minister, faced with the testimony of people present at the meeting, advise the House exactly what he did say?

HON. MR. PARKER: I did not keep a record of my conversations with the group, but the members I have spoken to can't recall the comment either.

SALE OF B.C. HYDRO GAS DIVISION

MR. G. HANSON: A question to the Minister of Energy. It's a question of interest to approximately 4,000 people in this region of Vancouver Island. Last week, as part of the ongoing process to privatize certain sections of B.C. Hydro, the minister promised that mainland gas prices would be frozen until July 1, 1991, even if that division is sold. Why did the minister not afford the same protection on gas rates to people in this region?

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HON. MR. DAVIS: The gas rates in this area — it's a propane and air system — are high, and there would be no point in freezing the rates at a high level when there's a possibility of them being reduced.

MR. G. HANSON: The minister might think the prospect of gas increases of 150 percent is funny, but the people of this area certainly don't think 150 percent is funny. We don't get natural gas and we pay more. These particular prospects indicate that a deficit of $4 million to $5 million is going to be picked up by 4,000 people — that's a 150 percent increase, or $1,000 per gas customer. Will the minister give the protection that people in this area deserve?

HON. MR. DAVIS: Hopefully within the next two years, we'll have a supply of natural gas here on the Island, and the price of gas, as a fuel, will be much less than the cost of propane air. If the likelihood that the gas line is built is finalized before the sale of the facilities here in Victoria, they'll take on added value. Indeed, the sale of the system here might well be contingent on negotiations between the province and Ottawa re a gas line to the Island.

MR. G. HANSON: We usually only hear about a gas pipeline prior to a provincial election, so perhaps there's been some discussion in cabinet that we're not aware of.

The electricity that serves Vancouver Island through the Cheekye-Dunsmuir line in the Electric Plus program.... Will the minister give the people of Vancouver Island a firm commitment in terms of the same reduced price — noninterruptible — and give the people the surplus electricity that is theirs?

HON. MR. DAVIS: The Electric Plus program, which was announced about this time last year, cuts the cost of using electricity — admittedly, interruptible — to roughly half, and it will continue. It's a program which is available, however, provincewide. Were natural gas to be available here, the cost of fuel in this area would be roughly half of what it is currently.

MR. G. HANSON: The point I'm trying to make to the minister is that the people of Vancouver Island and this region are second-class citizens of British Columbia when it comes to energy, and we would like some action from the minister. We appreciated the step that he took in Electric Plus. In the short-term, until such time as a gas pipeline is provided, would he give the people of this province a freeze on gas prices, or the same non-interruptible electric rates that everyone else in this province has?

HON. MR. DAVIS: The residents of Vancouver Island are not second-class citizens in respect to power rates, since the power rates are general across the province — not exclusive to this area — and oil prices are comparable across the province. Hopefully we can have natural gas rates comparable across the province, but that is contingent on a pipeline being built. To freeze the present gas rates — the propane air rates in this area — would be to discriminate really against the people here. We should have the prospect of lower prices available.

IRRADIATED FOOD PROCESSING

MR. ROSE: To the Minister of Agriculture. Recently the federal Health minister, in announcing changes concerning irradiated food processing, has allowed 60 days for people to comment on the new regulations under the Food and Drugs Act. What concerns are being submitted by your ministry to the federal minister on behalf of the people of this province?

HON. MR. SAVAGE: To my hon. critic, we are filling out a report within our ministry relative to our concern as it relates to irradiated food. There have been some studies done that indicate the concern, and in a number of cases they have not been verified as any risks to the health of the user or the consumer.

MR. ROSE: Many people in the province are concerned about irradiated food and the inconclusiveness of the toxicity tests that have been done already. In view of this concern, has the minister decided to put a moratorium on irradiated foods in B.C.? Is he prepared to prohibit the sale of irradiated food until adequate studies are completed along the lines that this controversial process is being treated in places like Maine, where it's been banned, and is being considered for banning in both New Jersey and Ontario?

HON. MR. SAVAGE: We are not at the stage of considering a ban until such time as we have a report from the federal research that's being done.

BCEC SALE TO STOLLE DEVELOPMENTS

MR. WILLIAMS: To the Minister of Economic Development regarding the sale from BCEC to Stolle Developments at a fire-sale price. There's now a court case that indicates that $5.5 million profit is anticipated, some $30,000 per waterfront condo unit. Could the minister advise why an appropriate appraisal or upset price was not established and that profiteering on this scale will take place?

HON. MRS. McCARTHY: The member who asked the question puts it in the context of profiteering and all the words that are so familiar to him, but I would prefer to bring the correct report back to this House on the land development in the Songhees, including the piece of property that he mentions. It has been a very good transaction undertaken by B.C. Enterprise Corporation. I'll be pleased to give the detailed response tomorrow.

COURT FEES

MR. SIHOTA: A question to the Attorney-General in relation to the schedule of court fees that imposes these unfair and high fees on litigants in court. Under the rules, a person who is declared to be indigent can have those fees returned. However, that requires people to get a lawyer that they can't afford to make an application to go to the court to have those fees waived. The question to the Attorney-General is this: is he prepared to establish a non-court process, a summary process, whereby those fees could be. waived without the need for counsel or without the need to take up a judge's time?

HON. B.R. SMITH: Yes.

MR. SIHOTA: If the Attorney-General is prepared to do that, could he tell this House when? Because people are paying these fees. How is he going to do it? When can we expect an announcement from the Attorney-General so that

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people can seek or have this relief which they desperately need?

HON. B.R. SMITH: We have a Justice Reform Committee that has held a number of hearings and is writing a report. We'll have that report this summer. The government is going to make it public and is going to act upon it. In the meantime, there is a process by which indigent litigants can get that relief. It's called the registrar of the court. Those orders can be made.

There was a recent court case in Victoria in which that provision was interpreted. I think it's quite clear that the registrar has the authority to forgive those fees. It doesn't require high-priced legal help to get you through that maze. That's what we're trying to bring about by this Law Reform Committee: ways in which ordinary people can get into the courts without huge costs and without consulting lawyers every time they have to turn around.

MR. SIHOTA: Mr. Speaker, it's somewhat hypocritical for the Attorney-General to now hide behind the Justice Reform Committee, when he bypassed it and imposed these fees. If he could do it then to impose the fees, certainly he can do it now to have a review of the process as it relates to those fees, and certainly with respect to the registrar it requires a counsel, particularly for someone who's poor and a client of modest means.

Is the Attorney-General prepared to establish a process which does not require counsel or registrar but some type of summary non-court, non-chambers process so that people can have these fees waived?

HON. B.R. SMITH: To bring this subject to an end, I said yes, and I say yes again: I am prepared to look at that. But I would remind that member that court expenses are a very small part of the cost that is crippling people from getting their court cases on, through and decided. It's the time wasted, the time spent, the complicated process and the legal fees that are killing people.

Hon. Mr. Couvelier tabled the report of guarantees and indemnities issued for the fiscal year ended March 31, 1988, in accordance with section 56(8) of the Financial Administration Act.

Orders of the Day

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

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

[2:45]

ESTIMATES; MINISTRY OF HEALTH
(continued)

On vote 45: minister's office, $305,183.

MR. ROSE: I was just going to get up and explain how much I enjoyed the part of this debate last Thursday and how forthright the minister was in dealing with my questions. I wanted to know whether he took my advice or not about not being too involved and excited, and whether, over the week-end, he did sit back, put his feet up and have some milk and cookies to bring his blood pressure down a little bit — and how he enjoyed the cookie I gave him.

In the meantime, with that intervention we perhaps might have a speaker.

MR. HARCOURT: I'm very pleased to be speaking on the Health ministry estimates. What I want to talk about is the kind of positive health care system that British Columbians deserve, and what New Democrats would like to see happen to bring that about. We would like to see a health care system that provides quality care for all British Columbians, not just for those who can afford it. We would like to see health care that allows for equal and fair access to the health services. Also, New Democrats want a health care system that responds to the needs of average British Columbians — not the Social Credit agenda of user fees and cuts and unfairness to ordinary British Columbians.

Today I want to look at some of those areas where the government is not being fair to British Columbians. There are four in particular that I want to bring to the minister's attention. The first is the issue of privatization, and in particular, Riverview. The second, which exemplifies the overall unfair approach of the Social Credit government, is the approach that has been taken to AIDS patients and their access to the drug AZT. Third is the issue of waiting-lists, particularly for critical operations to heart patients and to children. Fourth is the very negative and damaging program of the Social Credit government to bring about a two-tiered health care system.

In regard to the first item I mentioned — privatization or the contracting out of services — Riverview exemplifies the haste with which the Social Credit government has proceeded with their triumph of ideology over common sense, which the members on this side of the House have pointed out time and time again. Because we felt it was so important in this sensitive area dealing with people with severe difficulties, a number of us met with the officials at Riverview — in particular, our Health critic, the member for Prince George North (Mrs. Boone) ; the member for Maillardville Coquitlam (Mr. Cashore), our Social Services and Housing critic; and our member for New Westminster (Ms. A. Hagen), who has a specific critic role in regard to the issues affecting seniors.

I also met — with the second member for Vancouver-Point Grey (Ms. Marzari) — with officials of the greater Vancouver and Richmond mental health association. We specifically discussed with them the ministry's plans and the government's fall 1987 "Mental Health Consultation Report," which was a draft plan to replace Riverview Hospital. I appreciate that we have had some remarks from the minister assuring us that they're making haste slowly, that the quite unrealistic time frames that were originally being talked about when I mentioned this to him last fall have been dropped, and that at least in this one small area, there's a second look taking place from this government whose leader — the Premier — does not only take second looks, but prides himself on not listening to what people have to say, particularly after the by-election result in Boundary-Similkameen.

We have those assurances, and we also have the words of the minister that this plan to replace Riverview Hospital is going to be full of benefits. In particular, it's going to be cost effective and humane at the same time. We have concerns about that, because right now, without any more changes to

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Riverview, there is a very serious problem throughout this province and in my riding in Vancouver Centre in particular. There is a lack of services right now for patients who have been deinstitutionalized — let alone the 1,100 people in Riverview. They lack funding to deal with the existing patients.

I want to make it very clear that we're not criticizing those who are providing the service, such as the outfits that I just mentioned — the greater Vancouver and Richmond mental health association, the Coast Foundation Society or the Mental Patient's Association and others. They are trying to do a good job with a severe shortage of resources.

That was reinforced when I met with members of the downtown east side community at the Carnegie library with the senior member for Vancouver Centre (Mr. Barnes). We met our constituents on Thursday night, June 9, and once again we had it reinforced how serious the existing situation is on the streets of Vancouver for people with emotional and mental disabilities who are on the streets without care and housing right now — without any further changes to Riverview. As a matter of fact, there are over 200 people on waiting-lists for housing, and a number of the boarding homes and other facilities under code are under threat of demolition by developers' wrecking balls to be replaced with high-priced condominiums. So the existing situation is quite severe.

Deinstitutionalization isn't a concept that we disagree with. We want to make sure, though, that the resources are there to do the job for these people.

We're also concerned with the remaining 1,100 patients in Riverview, who cannot, I'm sure the minister would agree, easily be fitted into the community. There are the 350 or so patients who not only have severe disabilities but are elderly, are suffering from Alzheimer's disease and other such disorders. Nor is it proper to have the criminally disposed on the streets where they could be a danger, most importantly to the public, but also to themselves. And there are others — of whom I'm sure the minister and his officials are aware — who require institutional care because they feel they cannot cope with society; they cannot cope with the strains of being out on their own or even in a community care facility.

What we want from the minister and his officials are assurances that there will be funding in place for these many Riverviews, if I can put it that way — containment facilities — so that these patients are not out walking around the streets. This is, I may say, a particular problem in the Fraser Valley. The officials at Riverview made it clear that 50 percent of the patients they're dealing with are from the Fraser Valley, where there are no resources — or very scarce resources — and that includes the minister's own riding and the ridings of a number of the members of the government. These people have severe problems, but there are no facilities in the Fraser Valley for them, their families, their neighbourhoods.

I have three questions in this area that I would like the minister to answer. First, can the minister guarantee that the $73 million in savings from the closing of Riverview are secure and will be funnelled back into the system to beef up mental health services and provide for additional housing? Second, can the minister guarantee that there will be adequate bridge financing for the switch-over period when Riverview is closed? And third, what guarantee of funds over a longer period of time is there for these programs that communities clearly need and in order to catch up on the backlog that I talked about earlier?

The second area that I want to bring to the minister's attention is the drug AZT. Again, it shows an alarming, disturbing attitude on behalf of this government and this minister when the government makes a very clear discriminatory decision not to supply AZT in the way that other provinces supply it, which is without the patients having to put up $2,000 to $3,000 of their own money to receive this particular drug. We find this alarming. Every other province pays the costs and funds AZT. We're not talking about a huge amount here but about a principle of how people should be treated. They should be treated fairly and equitably. We're only talking about a hundred patients in British Columbia.

We can find no reasonable justification from the explanations that the minister has made. I know he feels exasperated on occasion when we ask him some of these questions, but we've only heard one explanation so far: that is, that we would be overwhelmed by patients moving from other provinces. The government seems unable to understand and accept that homosexuals have friends and family too. Why would a man or a woman living in Toronto or Winnipeg and diagnosed as having AIDS decide to leave their friends and family behind and move to British Columbia? We've asked the minister about this for quite a long time.

We have some questions, and they come in the area of fair and equitable treatment. The minister was willing to withdraw from an untenable position in terms of supplying hormone drugs to the families of children with growth deficiencies but wasn't prepared to do the same thing in regard to AZT. First, why won't the minister act to supply AZT to AIDS patients in the same way that every other province funds AZT? And could he try to finally enlighten us on what the real rationale is behind the government's decision?

The third area that we have concerns about for ordinary British Columbians is that of the long waiting-list for critical operations. On December 8 the Minister of Health said in the House: "...I have asked the advisory subcommittee on cardiac care to look at the standard practices applied in the field of open-heart surgery in this province and to consider establishing guidelines which may help to alleviate the degree of current concern." Mr. Chairman, you will remember that in December I asked the minister about these long waiting-lists. Funding was provided to a certain extent to some of the hospitals to try to cope with this particular problem. When I asked the minister about this matter a couple of months ago, he responded that the results were starting to show, that the waiting-list was only 432 people. When I asked that question in December, the waiting-list was about 400 people. If that's progress, I'd hate to see real progress, because we are really starting to get way behind in the waiting-lists.

So I have four questions for the minister on the issue of waiting-lists. The first is: could the minister advise what the advisory subcommittee has determined? The second is: what are the guidelines for open-heart surgery? Third: when will the minister act on those guidelines? And fourth: when will the committee's results be made public?

The fourth area I want to place before the minister is that of the two-tier health care system. What we have seen so far that adds to our concerns about the establishment of a two-tier health care system are a number of disturbing initiatives that the minister and the government have taken. First of all, this Social Credit government has floated a plan for wealthier patients to pay for their treatment and jump queues. On top of

[ Page 5013 ]

that, they've had discussions with U.S. health care management companies about turning over the management of our hospitals and health care to these private U.S. companies — in anticipation of the free trade deal, of course.

[3:00]

MR. CHAIRMAN: Sorry, hon. member, your time has expired under standing orders.

MR. ROSE: I am intervening for the very obvious purpose that my leader hasn't finished his remarks. The standing orders require an intervening speaker, and I'm it.

MR. CHAIRMAN: If the hon. Leader of the Opposition would bear with the Chair for just a moment, the member for Burnaby-Edmonds has asked leave to make an introduction.

Leave granted.

MR. MERCIER: Although the talk by the hon. member was most interesting, he has a captive audience who have been waiting for this introduction. There are two couples: Bert and Joyce Whitehead, who have friends with them from England. Bert and Joyce have helped me in many election campaigns at the municipal level for many years. They have been big supporters and are much appreciated. With them are Desmond and Jean Sear. I'd like the House to make them welcome.

MR. HARCOURT: I was discussing some of the alarming initiatives, actions and discussions of the Social Credit government around the issue of a two-tier health care system — one for the rich and another for the rest of us. I mentioned the trial balloons and the ideas that have been floated for wealthier patients to be able to go to private hospitals and queue-jump the waiting-list for very serious operations. That was floated by the Premier himself. As I said, we've had ministry discussions with a U.S. health care management company — in anticipation of this Mulroney trade deal that we think is going to, in this area of services and in many other areas, be very harmful to this province.

Thirdly, we had the direct intervention of the Premier to prevent funding for abortion services, which would have had the effect of allowing wealthier women freedom of choice while denying poor women the same right.

Fourth is one that has been received very negatively by many British Columbians. I may say that as recently as two weeks ago, when I visited Boundary-Similkameen, this was one of the areas where.... Seniors and citizens of all sorts felt that the hike of user fees for seniors in extended-care homes from 75 percent to 85 percent of income was unfair and was going to deprive a number of our senior citizens of a good portion — as a matter of fact, 40 percent — of their discretionary income. British Columbians really feel that this is going too far. I've talked to a number of seniors who are going to be affected not just in their toiletries and other basic necessities but in those resources that allow them to have a sense of freedom. They want to be like most citizens, to be able to get out and around, to have a cup of coffee with their friends downtown....

An example that exemplifies the cruelty of this particular move was when I was in Penticton at the fabulous senior citizens' centre there. I ran into an elderly gentleman who told me that he was going to lose his cart. He wasn't going to be able to afford his cart, which allows him to leave the centre and go two or three blocks downtown to visit with his friends and the people he grew up with in this fine community of Penticton. That's an example of the negative impact it's going to have on a lot of our pioneers who built up this great province of ours.

I would hope that the minister would understand that we didn't just hear that in Penticton, Osoyoos and throughout Boundary-Similkameen but have heard, it from scores of British Columbians. Our question is very straightforward: why won't the minister reconsider this regressive policy of hiking user fees for seniors in extended care homes from 75 to 85 percent?

We are opposed to this policy of dismantling medicare, which through guile, subterfuge and a thousand nicks and cuts of user fees is cutting off services and cutting down the quality of care in the public sector and therefore increasing the possibilities for the private sector to take over this service. As the political movement in this country that started medicare, we are not about to let it be torn down. I want to make that very clear, Mr. Chairman. We are not going to let this government realize the cherished goal of the Premier, which is to bring in a two-tiered health care system. It's unfair; it's not wanted. Ordinary British Columbians don't want it. The New Democrats in this province don't want it, and we await with interest the answers of the minister to these questions.

HON. MR. DUECK: The first question or subject was Riverview, about closing it down and letting people into the community, and resources not being available for these people. As we go on and on through a lot of the suggestions and comments that were being made, many of them were blatantly erroneous, and I take exception to that. One should at least stick to the actual facts and how they came about rather than use certain innuendos. It's unfair to do that. It's unfair to me; it's unfair to the seniors; it's unfair to anyone in the community who has to listen to that.

Riverview Hospital. It has been said many times, I've got up in the House and at other occasions.... We've done a very in-depth report, the "Mental Health Consultation Report," and that was tabled. The public has been assured that we were not shutting down Riverview, that many people had had input into this report — from your side of the House as well, and we appreciated that. It wasn't the Socred report; it was the report from all the people involved in mental health — societies and individuals from all walks of life. I haven't got the figure before me right now, but it is in the hundreds. Seven hundred, I am told, were involved in this particular consultation, and unanimously, without exception, they agreed that it was a good move for those people who could cope in a facility without endangering themselves or other people. They should have the opportunity — the same as you and I have — to live in the community, to have the quality of life that we enjoy, with the support systems in place.

I have assured everyone, but you keep bringing it up. Perhaps another individual who has not heard the assurances could be frightened by this, so we say it again and again. I have said it over and over again that we are not shutting down Riverview, and when we do downsize Riverview, those resources will be in place. I've given that statement in the House, outside the House, in letters and in speeches wherever I've gone. What more can I say? If you don't believe that, I'm sorry. I'll just sit down. I can just repeat it again. There will always be a facility like Riverview. Whether that

[ Page 5014 ]

will be one facility or two or three — maybe one up north, maybe one in the Okanagan, maybe one in the current location — we will have to house people who are a danger to themselves and to others. It's society's responsibility, I believe — my responsibility and yours as well — that those people have to be looked after, and I certainly intend to do that. Adequate financing, of course, has to be there, because it may cost a little more to begin with for this changeover, and that is something that we will have to took at very carefully.

There was also mention made about mental health patients in the community, and my particular community was referred to. I know of no complaint from my community. I'm sorry, maybe I don't go there often enough. I go there at least once a week, but I have had no complaints. We have a new facility there now that houses 30, 1 believe, and the people in that particular facility and the people in the community are very happy. There was some concern to begin with, yes. Whenever you have one of these facilities, people are concerned. I think it's also our responsibility.... We hope it never happens, but it has done, where someone who is dangerous takes off and things do occur. I feel very badly about that. But it can also happen to people that live in very safe environments with very good neighbours, and suddenly disgusting crimes are committed. I'm sorry that that happens, and I'm also sorry it happens occasionally to people who come out of Riverview. It does happen, and I wish it didn't. We'll do everything we can to avoid that happening again.

When we talk about the communities themselves in Vancouver, senior ministry staff meet with the Vancouver city council, the people of the mental health societies and with anyone interested in seeing what the problems are. We're sympathetic toward the concerns for mental health in the city of Vancouver. It is acknowledged that Vancouver has one of the best urban mental health services in Canada, and I think British Columbia has one of the best mental health services in all of Canada. We do from time to time run into some problems, but I don't think there's any system that is perfect.

In Vancouver, $11 million was spent to provide a full spectrum of community health services. The Greater Vancouver Mental Health Service, Coast Foundation Society and Mental Patients' Association are regularly cited by the federal government, national media, academic authorities and other provincial organizations as exemplary mental health services providers. Many developments have occurred to improve services in Vancouver over the past years. I have a list of them here, and I think I might as well get them into the record. They are: the development of Car 87, a joint initiative involving Vancouver city police and mental health staff in emergency services; commencement of work to replace Venture and upgrade from 10 to 20 beds; multi-service network projects; social housing projects; 40 new mental health beds opened in 1987-1988 in greater Vancouver; new initiatives to develop children's mental health services; an intensive case-management project to follow up ex-Riverview patients, the interministerial project; case management for multi-system users; new funding for the Canadian Mental Health Association to provide a public health education program about mental illness; committees on effects of deinstitutionalization on the criminal justice system; an increase in psychiatric sessions at Vancouver General Hospital; the development of psychiatric service for the elderly; an extension of emergency services at St. Paul's; creation of a hospital issues committee; the completion of the Vancouver review; and it goes on and on.

[3:15]

We have at the present time, I believe, 2,000 beds in the community for mentally ill patients. You asked about longterm financing. I certainly would trust that moneys will be available when they get into the community. I don't know at what stage, whether it's one or two years down the road, but there will be long-term financing. I understand that if we did not move them out of Riverview and replaced the buildings currently on the site, it would cost roughly $100 million. So having that in mind, I would hope that that money can be used to house people and look after those who are able to get into the community.

AZT. I didn't know whether we should go into that whole area again, but the question was asked and I suppose I will have to give my answer the same as I've done a number of times. It's often referred to that we are the only province that doesn't fund AZT for AIDS patients. I could also go on to say we are the only province that does something else that other provinces don't do, by way of giving extra in some other areas. Pharmacare is a perfect example. We have a Pharmacare program that is universal and probably better than most provinces'. I could go over that Pharmacare program again, with your patience. Since you asked me, I will do so.

The AZT drug is covered by the province under the Pharmacare program to AIDS patients with a full or partial coverage for AZT, depending on which plan or what type of individual qualifies. Coverage differs under four different plans.

Under plan A, partial reimbursement of costs is made to seniors holding a valid Pharmacare card who pay a 75 percent dispensing fee to a maximum annual limit of $125, after which full benefits are provided by Pharmacare. When that was introduced, you will well remember, those on GAIN got an extra $125. Again, if we are speaking of the unfortunate, the poor, I think your comments were very wrong and erroneous, saying we had a two-tier system. We have provided for exactly that group that cannot help themselves. That's why we've said that introduction of the 75 percent dispensing fee was countered by the extra $125 for the GAIN that those seniors would receive.

Plan B: 100 percent payment of benefits is made direct to pharmacy suppliers for benefits provided to individual residents in licensed care facilities. You are talking about the aged; you're talking about people who can't help themselves. I'm saying to you, and I've said it before.... It's not as if you don't know, because you are an intelligent person; you know these things, but you keep bringing them up. To repeat again: 100 percent is paid,

Plan C: 100 percent payment of benefits is made direct to Pharmacare suppliers for benefits provided individuals and dependents eligible for medical benefits under the Social Services and Housing ministry. Anyone in that category has free Pharmacare. You always wrap them up all in one flag and say everybody is under the gun, and there's a two-tier system. Not so. Those people get the total benefit: 100 percent.

Plan D: 80 percent reimbursement of benefit costs above an annual family deduction of $300 with a maximum of $2,000. We've never had that portion in there of the $2,000, It came about because the cost of drugs was constantly going up, and it was felt that there should be an upper limit. Then we start getting criticism because we put a ceiling on it. Why did we not then get a thank-you and say the ceiling should be

[ Page 5015 ]

lowered? We had no ceiling before. The change we made is that we put a ceiling on. You might argue that the ceiling is too high; that's a different argument. But you are criticizing that we changed that plan, and we've put a ceiling on it.

You also mentioned: "Why don't you do the same as you do to the people or the youngsters that have to take the growth hormone?" Again, you're wrong. They are under the Pharmacare program. It's never been changed. You haven't done your homework. You haven't looked at what the program is and how it operates. You're shooting through your hat and making comments that are not legitimate, that are erroneous. I wish you wouldn't do that, because it puts us both in a very bad position.

[Mr. Rabbitt in the chair.]

Also, we did an investigation of the AIDS people in the city of Vancouver, and I would like to say at this time again.... It's happened before. From your remarks it was insinuated or one was led to believe that somehow I think the AIDS people shouldn't be looked after. I think that is wrong. I'd like to correct that. Of course, all I say won't mean anything to you, because you'll keep coming back and saying that I don't care about those people and somehow I'm homophobic and all those words that are being used, That's not so. My natural tendency when it comes to health and health care is that I feel very strongly and very deeply that anyone who's sick.... I don't make any difference between one class and the other, or how they got their illness: whether that person was intoxicated and slammed into a post and injured himself; whether he was on a drug and jumped from a building; whether he got AIDS from some method, whether from a needle because he's a drug addict or from other activities. That should make absolutely no difference when it comes to health.

MR. CHAIRMAN: Mr. Minister, I hate to interrupt, but according to standing orders your time has run out.

HON. MR. DUECK: I hope somebody will help me out.

MR. REE: I find the minister's comments very enlightening. I know it takes a great deal of time to try to get some of these ideas to penetrate the minds of the opposition. I'd like to hear more from the minister.

HON. MR. DUECK: I have such kind people on the other side of the House.

Because I was concerned, we also investigated when I heard that some people could not afford AZT and consequently would go without the drug, and that perhaps their life would end sooner. It may well be that by extending a person's life some other drug could be developed, and these people could be helped in the meantime. I looked into it, because it was a concern of mine. The drug has helped people live longer. We've got evidence that it has had some effect on the longevity of those suffering from this disease.

We found that approximately — I can't give you exact figures, but they are close — 150 people are using AZT at the present time in British Columbia. Fifty of them are on social services; they pay nothing. We believe that another 50 could qualify, don't, and continue to pay. We believe approximately 50 — again, I'm using approximate figures; it's very difficult to narrow it down exactly — could also qualify, or most of them could. They don't bother to make an application, and they just don't pay and say: "Catch me when you can."

I've given information to the hospitals. I've given information on the radio on talk shows and have said that any individual out there who needs to take this particular drug should please contact me or the Ministry of Social Services and Housing, and we will look at individual cases. I've made that offer. To date I have not had one call. Is that fair or not? We have a Pharmacare program for people who need pharmaceutical drugs. As long as that program is in place, that is how we operate that part of our ministry programs.

Also, I've never made the statement that if we provided them with that drug free of charge, people would start moving to British Columbia. Again, I wish you would not say that in the House as though I have made that statement, because I haven't. Therefore I want that stricken from the record; at least, I want my words to go on the record that that is not so. I have never made that statement, and I think the member should know that.

In the other question that was asked, mention was made of open-heart surgery. I'd like to go back some time to when this issue was very much in the news, as the hon. member certainly remembers. That was when we were falling behind quite severely. We did have a discussion with the three hospitals that were doing this procedure. We had funded — I've mentioned this before — for 2,200, and in that period the hospitals were only able to do 1,700 because of various reasons. Again, those reasons are familiar to the member. I know that, because I've mentioned them often enough. They were the shortage of critical-care nurses and perfusionists, and other reasons that.... I'm not quite sure if the money was required in other areas and was used in that way.

I think I made a point of saying this in the House. The records could be checked, but I'm quite sure I did. As a matter of fact, we had a news release on it. We have a new operating theatre in VGH, which gives them a much greater capacity. We have given VGH increased funding to the tune of $3.4 million. We gave them over $600,000 extra to increase their angioplasty, which is often used in place of open-heart surgery, and it sometimes prevents that extra major operation. This is an operation where they put a little tube in your vein, pump it up and crush the blockages. They assure me that with this extra funding, the extra money for the angioplasty and the new operating theatre, they will be able to catch up with the waiting-list substantially. It should become an appropriate waiting period for someone wanting that particular operation.

I believe that a lot of these waiting periods sometimes are due to a lot of patients wanting one particular specialist. We have records of that. I am no different from anyone else. If I had a very serious health problem, I would seek the most knowledgeable expert in that area, and I would want him or her to look after me. We find that certain physicians have a long waiting-list; others have a much shorter waiting-list. We also found that the hospital in Victoria consistently had a shorter waiting-list, and we've transferred some patients from the mainland to Victoria to help them, so they could get through this process sooner.

I can well understand that people are very concerned — and I have met some of them personally — when they know that their lives may be ended in a week or two unless they get this operation. I must also say that when it comes to a person's life, heart disease and a heart operation, they will not

[ Page 5016 ]

necessarily live because they have that operation. Records show that's not necessarily so. The doctors and physicians certainly try their best, and we know that it has helped many hundreds of people, and they have lived longer.

When we hear these criticisms from many people and check them out, we find that the physicians themselves have said: "No, we'd better wait until you get a little stronger. We can't operate on you right now." We also find that physicians will put people on a waiting-list and say: "You are not an emergency." I don't make that decision; the Ministry of Health doesn't make that decision. The physicians themselves make that decision. When they say that you will be in line next month or the month after — six weeks, three weeks or whatever it is — that's a decision made by the hospital and by those physicians.

I think I've said enough about that particular subject. I'm sorry I am going on like this, but your questions were very in depth, and it's very difficult to answer them with a yes or no.

[3:30]

MR. ROSE: They were deep questions.

HON. MR. DUECK: They required an in-depth response, because they weren't just superficial "yes or no" questions.

A note was just handed to me, and this may be something you would be interested in. Waiting times for cardiac surgery or any other procedure are affected by a number of considerations: urgency of the patient's condition — I think I mentioned that — choice of physician, choice of facility, the number of operations performed under category C and D, waiting period, waiting-list B and C — which is the above. Then these are applied to the individual institution. Right now the latest information we have — I'm trying to look at the date — is the end of December. Royal Jubilee had approximately a two-week waiting period; St. Paul's had 15 weeks; Vancouver General had 16 weeks. That is improving day by day with the improvements that I mentioned to you. It should improve from now on.

You also mentioned a two-tiered system. There is nothing in my ministry that has ever been discussed.... I've gone on record again and again as saying that as long as I'm in this ministry as the Minister of Health, I will fight tooth and nail so that we will not have a two-tiered system. I sincerely believe this. I don't think that we want a two-tiered system; I don't think we should have a two-tiered system. I think if people need medical care — whether they've got no money in the bank or millions — they should have equal access. I've said this before, and I say it again.

Senior citizens. Again, I do not believe that we are in any way penalizing senior citizens. Since we brought in the increased premiums that were alluded to, would you believe that in British Columbia today there are 60,000 people who pay less? Mark that down — 60,000 people pay less than they did before we increased the premium. Is that a small number? I would say that is a tremendous number of people, and those are the people who are poor. Why is that? Because we increased the level for subsidized premium from $3,500 to $6,500 taxable income. It was $2,500 for the 95 percent premium and $3,500 for the 55 percent premium; now we say it's $6,500 for the 55 percent premium. Thus we have 60,000 more in British Columbia who are now paying less.

It really bothers me, because I also travel the province — as you do, I'm sure, hon. member — and talk to seniors. I go into the homes and I speak to groups. When I explain what we are doing and how it is affecting them, sure there will be some that are not happy, but by and large our senior citizens are well looked after. We have a good system. We have the best system.

In the next two years we will be adding another 1,200 senior citizen beds; that's intermediate and extended care. How can you say that we are not looking after seniors? Not too many years ago we had hardly any homes. We are increasing them by many every year, and you say that we are destroying the health care system. I just can't buy that.

We also have to look at the future. We have to say it's not just for me or you. I think I'm a little older than you, although I have more hair, but I will go through this life all right. I think they will have a bed for me. But how about your children? How about your children's children? It's easy to say: "Give them anything and everything." Why not give me $150,000 a year for being Minister of Health? That would be wonderful. Why not give everybody whatever they ask for? What we have done with senior citizens.... We've got a safety net, and the worst-case scenario — if I could put it that way — is $150 a month with everything paid. We are saying that incontinence supplies should not be charged. Anything in the home should not cost the senior anything except personal items — if they want a TV, a telephone, things like that. Everything else should be paid for. If they are the ones I just mentioned, they are under GAIN. They don't pay premiums; they get $150 each. We are treating couples the same as singles so that they will not be discriminated against. That was also a change we brought in; before this change in the structure, couples were treated with somewhat of a penalty.

That's as much as I need to say on that particular subject. I think I'm at the end of the list. I may have missed something. If I have, you can remind me.

MR. HARCOURT: It's true, you do have slightly more hair than I have, but I'm sure that your deputy minister would agree with me that there is a well-known expression that we both agree with: God made perfect people and put hair on the rest of you. My condolences to you, Mr. Minister.

MR. REE: What about the rest of your body?

MR. HARCOURT: I wouldn't talk like that, Mr. Whip, with a body like yours. You are one of the reasons we have such a costly health care system, but it's the minister's problem for the next two years at least, to have to deal with that kind of ill health. That's his concern for the next year or two, and then we'll have a New Democrat Minister of Health to whip the system into good health and have you jogging finally, not smoking, and doing all the things that the minister wishes you would do.

MR. REE: In a police state.

MR. HARCOURT: No, not a police state at all. We believe in good health and citizens figuring that out for themselves rather than ramming our personal views down the throats of the people of British Columbia like the Premier wants to do so much. You are the party that wants to do that. It's Social Credit that wants to ram personal opinions down the throats of the citizens of this province, not New Democrats. We're democrats. I would look in the mirror and see who you are speaking to before you make those statements.

[ Page 5017 ]

I would like to deal with some of the minister's comments. First of all, Mr. Minister, I have appreciated your taking the time to go over the items that I mentioned to you. I would briefly like to say that it is not a question of my believing you or not. I think you are an honest person and that you work hard at your job. You've said that two or three times to me, and I just want to assure you that it has nothing at all to do with my believing the veracity of your remarks. I do. In turn I want you to feel that I am not trying, through innuendo and otherwise, to question your credibility. I don't want you to continually say that I am exaggerating and making blatantly unfair remarks.

I was talking about the people involved in and around Riverview. I just want you to do the following things. First of all, we agreed that the mental health consultation report was a good document and a good idea. I've given those assurances to the people at Riverview, to the greater Vancouver and Richmond mental health association, to the city of Vancouver's health department, to the Coast Foundation, to the Mental Patient's Association and to your own officials. We've made that very clear. We have no objection, as a matter of fact. We fully support the deinstitutionalization approach.

Our problem is that you haven't taken care of the deinstitutionalization that's occurred. I don't make this up. I have spoken — and I've made that very clear to officials at Riverview — with members of my caucus; I have spoken face to face with some of your MLAs — the member for Point Grey — and to representatives of the greater Vancouver mental health association, one of whom is Marguerite Ford, who is now head of the Alzheimer Society, and she's scared witless about more deinstitutionalization without dealing with existing problems. It's not me making this up. These are real people; they are not a figment of my imagination — I'm not in need of these facilities. These are real leaders in a fine mental health system. The people working in it are devoted. They need the resources. Right now there's a need for 200 beds — a waiting-list in Vancouver, without anything more happening to Riverview. I would feel a lot better.... Again, I'm not questioning your veracity, Mr. Minister, your use of truthful statements. I accept that you are. But you are not dealing with my point.

My point is that there's a problem now. I want assurances from you that you'll deal with the existing shortage, and that when you do move to the deinstitutionalization recommended in the consultative report, there will be funding in place, there will be bridging finance, there will be facilities. Even though Matsqui has a 30-bed facility, there is a need, I am told by the officials at Riverview, because half of the patients who will be deinstitutionalized out of Riverview will be from the Fraser Valley, and there aren't the resources for them.

I don't make that up. I'm used to preparing my statements carefully, as a lawyer or as a mayor or as a private developer prepping pro formas for housing developments. I don't usually do these things off the top of my head. These are people I've spoken to. Either here or in the future, I would like assurances from you that you will deal with the existing problem that I've just talked about, that I confirmed as of Thursday night with some of my own citizens in the downtown east side; and that you will deal with some of the problems of new institutions required in the community, to bring about what you want and what we want, which is the right of the people in Riverview that we're talking about — those who can — to have community living with support systems in place. Those were your own words: "with support systems in place." That bottom line is what I have been talking about for almost a year. That is the point I would like you to address, without dealing with innuendo, unfairness or my questioning your veracity. I don't intend to do that, and I don't appreciate you doing the reverse. Just deal with the concerns that I have expressed about the existing problem and about the potential problem of releasing more people onto the streets without resources.

Secondly, in regard to the drug AZT, you went into some detail to miss my point. You talked about all sorts of categories and all sorts of AIDS assistance that are available. But there are still over 100 patients in British Columbia who do not have equitable access to this drug. You talked about Pharmacare, you talked about GAIN, you talked about this, you talked about that, but it still misses my point. There are 100 people paying $2,000 to $3,000 a year, and they aren't in other provinces. We think that's unfair. That's my point.

The third issue I wanted you to address was the questions I gave you on waiting-lists — that is, your advisory subcommittee on cardiac care. I didn't receive an answer to any of the four questions I asked, which were: (1) What has the ministry's advisory subcommittee determined? (2) What are the guidelines? (3) When will you act on the guidelines? (4) When will the committee make their results public?

[3:45]

The last issue. We on this side are pleased that the Minister of Health is utterly opposed to a two-tier health care system. However, we'd feel a lot better if the Premier felt the same way. When you have a one-man government, and a Premier who says that nothing is sacred — who said that yes, he'd be prepared to look at private hospitals, and yes, there are no sacred cows in health care; he makes those statements on quite a few occasions — then I would just hope this is one area where this one-man government is not going to be able to succeed before there is a change in government.

HON. MR. DUECK: Again, I don't want to get into an argument with a lawyer of renown, so I'm not going to take you on at all. I just want to defend myself. When I get attacked and accused of making statements that I did not make, I feel I must do that.

You mentioned this task report. Yes, we have it. There are some things in the report that we are not making public at the present time, because many things have to be considered before we do. So I can't really go into depth on that report.

You mentioned the existing situation. That, of course, is an ongoing thing, because we never have enough people, we never have enough money, we never have enough beds and we never have enough resources. I assure you that this is something we're working with on just about a daily basis. I wish I could have made an announcement a week or two ago on some of the improvements we have coming, which, could I have done this a week or two ago, would have helped me a lot in these discussions here today. But we're not quite ready for that.

We are taking the appropriate steps to correct some of the shortfalls and, as you said, gaps. This is a cliché that's used more today than it was a few years ago: everybody's falling between the cracks and the gaps. This is used in every situation where there's a problem with one segment, whether it's in business or what have you. It explains it quite well, because some people don't fit into either little square; they fall between. No one wants to take them on, or they're

[ Page 5018 ]

forgotten, or they have a situation that doesn't quite fit the norm. There's no question that we have people like that, and this is being addressed daily. I think we've made many improvements.

I can assure you that before we move any of the people out when we're downsizing.... We're not downsizing, but there are a stream of people who go in and out. That's the way the system works, because they are appropriately released by the authorities and the psychiatrists, and they must go back into the community.

We also have some who there's very little opportunity to help, because they refuse help. I think I brought that out last year, and I got into all kinds of trouble. But it's true. There are a number who you can put into an appropriate facility and they do not wish to stay. By their own choice they go on to other areas, to live in different surroundings.

There are people who have to be looked after who haven't got the capacity themselves; I admit that. They need help in many areas, and you practically have to lead them to that source of help. We're doing that. If you criticize us for not doing it well enough.... If you can criticize me in specific areas, I could zero in on it perhaps a little more accurately.

In general terms — and we're speaking in general terms — we are somewhat behind. I could stand more resources. I could have more help out there, but by and large, when we meet with these service-providers.... With the funds and resources available, I think the ministry, the people who work for us and the service-providers are doing a fairly good job and will continue to do so.

MR. CASHORE: I have listened with interest to the dialogue between the Leader of the Opposition and the Minister of Health as they have canvassed a variety of topics, and I will be coming back to some of those topics during my remarks, comments and questions.

I want to say that in reading over the introductory comments of the Minister of Health, the minister mentioned that he did not want the discussion of health care in the province to be apolitical discussion. I would just like to say at the outset that I fundamentally want to acknowledge that there is a political reality to what we discuss in this House. More often than not we agree on what the goal is and that we all want to work together to achieve that goal, but I think the very nature of the process we're involved in here is that there is a political reality to it. That's one of the reasons the public has the opportunity to observe the results of our lively discussion and debate and to form opinions with regard to the various perspectives that are held. So it's within that context that I make my comments.

Also, I want to say early in my remarks that I had the opportunity in the past few months to make extensive use of the medical care system in the province. I had what some people would consider major surgery on February 8 in New Westminster. I believe that I received the benefit of very good quality care at that time. I came out of that procedure with a great deal of respect for all the people who work in that hospital, and I felt that I was well served.

I did observe, however, that the working conditions were difficult. I was in the old section of the hospital. I understand that there are some plans in place now for that section to be replaced; I actually had an opportunity to discuss that possibility with the physician who treated me. I was very much aware of staff bending over backwards, running off their feet to try to keep up with the needs of the patients. Even some of the people within the hospital whom we don't often think about — the cleaners — were so busy that they really didn't have the time to do a decent job. That probably affected their self-esteem and was a factor in the working conditions in the entire unit.

Having said that, I just want to support what my colleague the MLA for Coquitlam-Moody (Mr. Rose) mentioned, which is also a concern of mine. Although Eagle Ridge Hospital is not located within my riding, generally half of the people in my riding, those in the northern part, would tend to go to Eagle Ridge Hospital in an emergency. Perhaps those in the southern portion of my riding would tend to go to the Royal Columbian. I've heard announcements on many occasions indicating some optimism about the possibility of the emergency ward and some of the unused portions of that beautiful new hospital being used, and we still await some definite word on that. I hope that the minister would take the opportunity during the Health estimates to announce that the emergency ward of Eagle Ridge Hospital will indeed be opened. That would certainly stand the minister in good stead. Apart from the political reality that I mentioned a few moments ago, Mr. Minister, it simply makes excellent sense in the delivery of preventive health care, which in the long run saves the people of this province a lot of money, when we take more than just one year to look at a bottom line.

I would like to move on to another point, ask a question and then listen to the minister respond. In the House exactly two weeks ago today, on May 29, I asked a question of the minister about the backlog of children in the Simon Fraser health unit area who require assessment for speech impairment. When I asked the question, the minister said that if I could be more specific, he'd be able to give me a specific answer. At that time one of the specifics was.... I asked the minister to confirm that there were 150 of these preschool children on the waiting-list. Since then, I have discovered that in actual fact, according to people in the community who are very close to this issue, the minister has received a letter from these people, dated May 29. These two people — one from the Glenayre Leaming Centre and the other from the Step-by-Step society — point out that there are approximately 250 children on the speech therapy waiting-list in the Coquitlam area.

Another specific to the minister is that according to people in the know — and I understand these to be people both involved in the assessment of speech therapy needs and who are members of the Reach-for-Speech organization in the area — it takes from one year to 18 months on the waiting-list to receive assessment. Mr. Chairman, number one, I understand — and it's possible that the minister can confirm — that this is the most distressing situation in speech therapy in the entire province. But I don't know that for sure. I certainly hope that there is no area of the province that is any worse off than that.

I'm sure that with the minister having declared, especially in recent months, the importance of a preventive approach, he will recognize that the formative years — the years between birth and six — are the years that are most important in terms of making any adjustments that will enable children to grow and mature in a way that allows them to fulfil their potential. Those first six years are crucial years. Given that children don't usually start speaking until well beyond the first year of life, that leaves a window of opportunity of some four or four and a half years. If within that four-and-a-half-year period a parent of a child is faced with a

[ Page 5019 ]

wait of a year and a half, how on earth can we justify this? We can’t justify it on the basis of this being the pattern throughout the province, because apparently it isn't. We can't justify it on the basis of it being a justifiable item to delay for when we can afford it, because if we don't provide the children with this service when they need it, it's going to cost us an enormous amount beyond that in later years in terms of the difficult social adjustment they will have to deal with and the additional educational costs.

To the minister: you took my question on notice two weeks ago, and I understand that. I understand, though, that you have now had ample time to research my question and to receive a letter almost two weeks ago from some people in my constituency and also in the constituencies of the member for New Westminster (Ms. A. Hagen) and the member for Coquitlam-Moody (Mr. Rose), and to respond. I would hope, Mr. Minister, that your response would include (a) some extraordinary measures to deal with the backlog and (b) some long-term measures to deal with the need to have that assessment done without delay.

There should not be a delay of more than six weeks. I believe that it is a bad economic process if that delay is any longer than that, because of the damage that can be done. So I will take my seat now and listen to the minister's response on this point.

[4:00]

HON. MR. DUECK: I want to make a couple of comments also, because they were part of the introductory remarks. When I said not to be political when it comes to the health of the people — and I think we agree on it, and we'll forget it after this — I meant not to use health to score political points. We are political in the House — there's no question about it; I accept that; you accept that — but not to score points. That's what I meant when I made that statement, and I think you feel the same way about that.

I must say I did not know you had been in the hospital, and I was going to mention that had I known, I would have visited you — but you would probably have become more ill if I had. I'm glad you're back in the House, and you look good.

[Mr. Weisgerber in the chair.]

As far as the statements made or the question asked, you alluded to perhaps some news with Eagle Ridge. Of course, this is an ongoing thing, so I'm not spilling anything. We've been discussing this with the mayors in the areas and with the health professionals. If you people wouldn't keep me so long in the House on these estimates, maybe I could already do something about that. I'm not going to say any more than that.

You mentioned a little bit about preventive health. This is the thrust this government has and the direction in which it is going and has instructed me to go. That is preventive health, and that's in all areas, whether it be diet or exercise or letting your blood pressure go too high by getting excited in the House. All those things are part and parcel of looking after yourself.

It also includes such things as smoking and abuse of alcohol. These are legal commodities, so when I say these things, I'll probably have half the people on my side here chastising me after this session. But I do believe that this is all part of preventive medicine. And not only a small part; I think the part is so huge — when we talk about alcohol abuse and cigarette or tobacco use — that thousands of people die every year. As a matter of fact, 6,000 people die a year in Canada from the results of the use of tobacco. Having said that, I won't go any further in talking about those two items. That's also part of the preventive care: that we can look after ourselves and it won't cost us anything; as a matter of fact, it could save us money. But do we do that? No, we ask the government to throw more money at the subject, and somehow the other things will just go away. I know you don't smoke, and I don't smoke, so we can talk like that. We like the odd little drink, I'm sure, but I'm talking about abuse of either product.

In the area of speech therapy and hearing, the difficulty has been in recruiting therapists. I'm responding to the question that I took on notice. I'm sorry I didn't respond sooner. Apparently these were ready some time ago, and I have just neglected to do that. As a matter of fact, I forgot until you mentioned it, and the light went on. I just had them brought from the office. It has been a real problem. Our salaries for speech therapists are not comparable to other employers of speech pathologists, and we can't seem to keep them. For example, school districts pay something like $40,000 plus in addition to attractive benefits, and health therapists quickly move on to school districts.

As you know, we look after the children until they go into school, and then the school district looks after them from there. There are about 20 communities where speech therapy services are either non-existent or unable to meet the demand. You're right that that is an area we're looking at very closely, and we are not happy with it at all. The need for additional speech pathologists is being documented, and an internal review is looking at a more efficient delivery of speech services for preschoolers. When you zero in on the Simon Fraser Health Unit, my information is that the waiting period for services in that area is anywhere from 12 to 18 months, and that seems excessive. I wish we could change it soon, but it is a fact that these children have to wait that period of time.

All the waiting-lists for speech therapy are public information. You mentioned the other day that you could not get that information. Quite frankly, it should be easily available to a member of the public upon inquiry, and I'm sorry if you didn't....

MR. CASHORE: We got it sent.

HON. MR. DUECK: Okay, thank you.

The Simon Fraser unit, incidentally, is one of the heaviest referral areas of speech therapy for preschool children. We admit that the present waiting-list of therapists is too high, and the demand for speech services is of concern to the ministry. The ministry is currently undergoing a reorganization which will see the amalgamation of preventive and community care services into a new division, and we call it community and family health. We believe that by combining those we can streamline that whole system.

My deputy has done quite a bit since coming back to the ministry, and I'm thankful to have him back, although he should shut his ears when I'm talking about him. I refer to him as my old new deputy. He knows the health care system well. I trust that with my direction and his enthusiasm, we will be able to correct that waiting-list and bring it down to a more manageable level. I don't want to use excuses; the

[ Page 5020 ]

waiting-period is too long in that area. I admit that freely. We're trying to correct it.

MR. CASHORE: I want to thank the minister for that response, but also to say that I would expect within a very short period of time — possibly one week — something much more definitive. I do appreciate what the minister is saying with regard to reorganization and the fact that his deputy is undertaking a number of initiatives; but there is no question — and I think the minister has recognized that — that this is a problem of crisis proportions in the Simon Fraser Health Unit area.

Maybe I can just give some additional information. Yes, Mr. Minister, you are correct: we did manage to get the information with subsequent phone calls. I wanted to make that clear for the record. Given that the health unit deals with preschoolers and also with people who are 20 years of age and older, and based on some 1986 census figures.... I think you'd find these interesting. The Simon Fraser Health Unit has four offices: Coquitlam, Port Coquitlam, New Westminster and Port Moody. We have three speech therapists for those four locations. One of those speech therapists was going on maternity leave, and there was some question with regard to whether or not she would be replaced. I understand now that she has been replaced and that there are three. But in the Coquitlam health unit the population is 55,926; Port Coquitlam, 22,260; New Westminster, 36,172; and Port Moody, 12,319. So you can see that in the Coquitlam health unit, where there's one speech therapist to a population of 55,926, that's a stark contrast to the Port Coquitlam Health Unit, which has one speech therapist to 22,260. Perhaps there's some arrangement whereby those people can share the responsibilities. I'll just say that this is an absolutely intolerable situation, and I expect to hear something on this very soon.

I understand that some of the issues that have been pointed out deal with the difficulty of attracting speech therapists into the health system, and that there's a real discrepancy in wages between those in the health system and those in the education system. Some of those issues have to be addressed, and I think they have t o be addressed very soon.

Mr. Chairman, I'd like to move on now to another topic. Does the minister want to respond to that right now?

HON. MR. DUECK: Yes, I can give an answer on that right now. We've just had a little meeting, and we're going to transfer some people. We're going to get a flying squad to go in there and correct the situation that exists in your particular riding.

MR. CASHORE: That is very good news, and we will certainly be following up on that. I appreciate the announcement, and we'll be getting in touch with the people in our community. I'm sure that they will look upon it as a report of substantial progress, and I do appreciate it.

Mr. Chairman, I'm going to move on now to some issues dealing with mental health. I beg the indulgence of the House, if I recanvass some topics that my leader has canvassed. I will try not to do so, because I think he did that very ably, and I listened carefully to the discussion.

During the minister's introductory remarks, I read with interest that he said: "...decentralization...for the mentally ill, providing that replacement resources are developed in the community prior to any corresponding changes at Riverview...." Obviously I've left a couple of words out there in my writing-down from the transcript, but basically I understand the minister to have said and reiterated in the House that there will be no further downsizing until there are corresponding changes. He says that there will be "no reductions in Riverview programs until the community system is strengthened and replacement resources are in place." Therefore, careful attention to patient care requirements and any community concerns will be required.

I understand that this is the context in which the minister has made those points, and I want to ask what is happening. If there is no further downsizing going on, what is the present situation with regard to the development of community care facilities, group homes and other types of facilities within the community? Does that mean that these too are on hold? Or are these developments taking place to prepare for the day when there can be further downsizing at Riverview? Just what is the situation at the present time?

HON. MR. DUECK: The "Mental Health Consultation Report" has been received. I have not yet taken it to cabinet. When it is taken to cabinet, and they decide whether that's the direction we're going in, that's when the process will begin. So it hasn't gone that far up to the current period in time.

[4:15]

MR. CASHORE: I'm still experiencing some confusion with regard to the development of community care facilities. I would assume it is still in process. As a matter of fact, I've had some discussions with people in North Vancouver who have had extensive discussions about the development of a community care facility in their community. I would ask the minister to confirm if by what he has just said he means that there is no continuing development of community care facilities at this time. Would you clarify that, please?

HON. MR. DUECK: I was talking about the downsizing of Riverview. That part of the program has not yet begun, because it will be a direction from cabinet for facilities for downsizing. As far as the community is concerned, these people who come into the system and leave the system on a regular basis, which you well know.... I don't mind admitting that you know more about those areas than even I do, because that has been your line of work for a long time. We know there is a service delivery gap from time to time, and we're endeavouring to identify it and take appropriate steps. During the next few months we're going to be announcing a significant improvement in the number of psychiatric beds that will become available. There is quite a plan in place at the current time, and these announcements will be coming forward soon.

MR. CASHORE: So I take it that while the minister has stated that the downsizing of Riverview is on hold, there the process of developing facilities in the community is still underway.

I would like to point out to the minister that in an article in the Vancouver Sun on May 12 the minister referred to 18 initiatives to deal with the mental health services outlined in the report, and said the concern that the ministry will keep discharging patients from Riverview and flooding the city is not correct. However, we do have some circumstances in the city that, if the downsizing is on hold, are factors that seem to

[ Page 5021 ]

be enormous. While I welcome hearing that more beds are going to be made available and that there's an announcement coming forward, I think that we get into an area here where two of our huge ministries, the Ministry of Health and the Ministry of Social Services and Housing, experience what I would call crossovers — in other words, people leaving the health care system and sometimes going into group homes and other facilities, and then disappearing for one reason or another. Possibly things just didn't go well there and they ended up wandering off downtown or some place, sometimes never to be heard from again, but quite often disappearing from the health care system and arriving in the social services system.

I want to ask the minister if, in his role in government, he's had any discussions with the Minister of Social Services and Housing (Hon. Mr. Richmond) relevant to the reorganization in that ministry that has seen the loss of 40 social workers from the Vancouver area at the very time we're hearing so many stories about the difficult circumstances being experienced by ex-mental patients. In the context of the crossovers of people in the health system who end up in the social services system and the fact that there's a loss of 40 social workers and that the minister is concerned about what happens to those people, it seems to me an intolerable situation. If nothing else, there needs to be some coordination within this government between these two ministries if the needs of these people are really to be addressed.

HON. MR. DUECK: If you will allow me, I want to go back. I was looking for this information before, when we were talking about professional speech and hearing.... We are also cooperating in that area with Education, in that we're trying to do it as two ministries rather than each going in its own direction. As a pilot project, we have funded ten speech pathology positions, approved by the Ministry of Health. We're developing a private program in communities.... It's not in all communities, but the communities we are presently looking at — and in some of them it's already in operation — are Alberni, Lillooet, Revelstoke, Howe Sound, Burns Lake, Lake Cowichan, North Thompson, Nechako, Queen Charlotte Islands and Fort Nelson. I say this because of the concern you had whether we cooperate and work with other agencies and other ministries.

As far as mental health is concerned, and the question you asked just now about whether we do in fact liaise with the Ministry of Social Services and Housing, it just so happens that the deputies of Health and Social Services and Housing will be meeting with officials of the city of Vancouver to discuss program crossovers this coming Friday. All I'm trying to tell you is: yes, we do — and we should do more. I think ministries have had more cooperation and crossover discussions about their problems, because so often, especially when it comes to health, social services and education, so many of these things are not entirely one or the other; somehow they all dovetail. We are working with the other ministries, and we will continue to do so. Your remarks were dead on.

MR. CASHORE: I'm very glad to hear that these discussions take place, but there must be an enormous sense of concern, realizing that these crossovers take place and realizing the loss of 40 social workers from the Vancouver area. I would like to ask the minister to comment specifically on how he feels about that and how he envisages a plan he is discussing with the Minister of Social Services on how to address the concern.

HON. MR. DUECK: Just to clarify, you were talking about Social Services employees? I cannot comment. Of course it's a concern if they have lost 40 workers. I suppose it's an even greater concern to the Minister of Social Services and Housing. I also hope that when they meet they discuss those problems, because they do impact on Health as well. I can't comment on what they're doing, why they lost them, whether they've got some coming, whether they've replaced some of them, or whether the others will be replaced next week. There has been a shortage of professional people in many of the health and social services areas, and it is a problem; it's very real, and it causes us a lot of concern, no question about it. Very often we're dealing with children or even adults who have a problem.

I've got some information here that may help. I understand that 36 new staff have been hired into the mental health service centres and that each centre now has a program coordinator for child and youth mental health services. These senior clinical staff have the responsibility to develop and oversee local programs. We're talking about the children's programs; maybe you weren't zeroing in specifically on those. Some new staff positions have been filled in that area — 36 of them, as a matter of fact.

MR. CASHORE: Throughout the province?

HON. MR. DUECK: That's throughout the province, yes.

MR. CASHORE: The reason we can discuss these crossovers, and the reason it's appropriate to mention the loss of 40 social workers from downtown Vancouver, even though it comes under another ministry, is that this ministry has expressed on numerous occasions recently its holistic approach to the delivery of health care and its belief in a preventive approach. One preventive approach is to address the things that oppress people so that their lifestyle can be such that they are less likely to have a mental breakdown, which is often related to stress among other factors, and then find themselves back in the health care system. It works both ways, those crossovers. My only point was that while I'm pleased to hear about other health care workers coming into the field, it seems that we're still losing ground on an issue that you, Mr. Minister, must be concerned about; you have expressed concern about it. There are some indications that we are losing ground significantly in terms of these lost people in our society who don't seem to fit in anywhere. Certainly they are people who spend a lot of time in a revolving door within the care and keeping of the ministry.

In the "Mental Health Consultation Report," it's interesting that one of the terms used in referring to the role of a physician in all this is that the physician would be seen as a gatekeeper, in a position to decide when a person should be taken into care, based on the Mental Health Act. and when a person should be discharged. We also know of the role of the review panel in that. I note that one of the comments of the Mental Patients' Association is that a more holistic approach would be to look upon that person as an initiator rather than a gatekeeper, and to move away, from the strong allegiance to a custodial concept into a concept in which there is really bridge-building between the institution and the community.

[ Page 5022 ]

There are a number of organizations doing outstanding work out there in the community that are outside the health care system. They are organizations such as the Mental Patients' Association, the Friends of Schizophrenics, the Alzheimer Society, the Coast Foundation and the Canadian Mental Health Association.

I note with interest that the minister has recently entered into a project with the Canadian Mental Health Association. I wonder if the minister recognizes the resource available in those organizations to help achieve the kinds of results needed if a program of deinstitutionalization is to work. You see, Mr. Minister, one of my real concerns as we go through this process — and it has been experienced in major cities throughout North America — is that as people leave institutions.... There is certainly a philosophical basis for that to take place. As that so-called process is put in place in order to receive those people in the communities.... I'm not saying this as any direct accusation with regard to the program. What I am saying is that I don't see any indication that monitoring and advocacy services are supported to the extent that they should be if such a process is going to work.

[4:30]

This has been an extensive experience throughout North America, and it goes something like this. Increasing numbers of people are in an institution. In that institution there are some economies of scale, but as you have pointed out, the cost of maintaining those buildings is prohibitive. But in a sense the people located in that place are much more visible. It's a place where the volunteer organizations can go and focus on that large group of people who happen to be in that institution. It's a place where the various advocacy or self-help groups can go and focus.

But when these people go out into the community, as important as that is and as important as it is that it be done well.... Incidentally, I think it's done better when it is under the aegis of a society such as the Mental Patients' Association or the Coast Foundation. I prefer not to see those community care facilities become private for-profit operations; I personally prefer that they go to an organization whose bottom line is service. But it's still important that someone from the ministry with special training in this field conduct the evaluation, the ongoing monitoring, and also that organizations such as MPA, the Coast Foundation and Friends of Schizophrenics receive support so that they can carry on some of the advocacy procedures.

Indeed, when that happens, it might even result once in a while in a government being criticized by those organizations. I would think it's a mark of maturity in government when that government is willing to enable that group to exist and function, because they best understand how to help their peers, their colleagues and their friends, even though the price sometimes is that there will be some constructive criticism coming from the organization.

I understand that in the city of Vancouver.... I think that while we often focus on Vancouver, it's for a reason: a great many ex-mental patients tend to end up in downtown Vancouver. There are also examples of this type of scenario in other cities and communities throughout the province, and I think we need to remember that.

I have some figures for the Vancouver area that aren't entirely in keeping with what I heard the minister say a few moments ago. I believe I heard him say that there are 2,000 beds in the community for the mentally ill.

Interjection.

MR. CASHORE: Okay, that's provincewide.

I understand that in Vancouver there are 350 boarding-home beds, 150 independent housing units that ex-mental patients live in, and 100 miscellaneous units, for a total of 600. Yet it's estimated that in the city of Vancouver there are 20,000 persons living on their own who have serious mental health problems. I would think that these are people who come in touch with the system from time to time. Most of these people live independently in the community now; therefore they have a need for a resource. I think that the clubhouse models that have been developed by some mental health organizations are a real opportunity to put something in place that will help make this plan work. Having said that, if the ministry was really to examine the financial support received by those organizations to provide their day care support out of those drop-in centres, you would find that it would have a tremendous influence.

It works something like this. If a person who has been in hospital is on medication and out in the community, after a time when that person gets up in the morning, where does he or she go? What are the alternatives? What are the possibilities? Usually this is a person on limited income. Where can that person go in the community? They might go down to a pub, and that might be okay. They might go and visit some of their friends in some part of town, and that might be okay. If there's a place, if there's a centre that they know of as a warm, caring and friendly place that they can go, and if the time were to come that their medication was not doing the job it was intended to do, more often than not it would be another ex-mental patient who would take that person by the hand and say: "Come on with me. I think we should go down and visit the community care team."

It would be those people who would actually be providing the buffer that prevents those people from completely becoming dysfunctional and either ending up lost off the face of the earth — and I have seen people sleeping in dumpsters in the downtown east side — or being taken back into costly acute care. I would say to the minister that I think organizations like Coast Foundation, the Mental Patients' Association, the Friends of Schizophrenics and CMHA — and I'm sure there are others — would provide a tremendous service if they could be receiving more support for this type of activity, and it would be a win-win.

Beyond that drop-in centre model, I would also think that these organizations should be encouraged to provide advocacy services for other ex-mental patients. I think they have established an excellent track record over the years with regard to how to do that.

Look at the Mental Patients' Association, for instance. I won't go into that again this year; I read some of the statistics into the record last year. There is a progression that certainly has been taking place over the past seven or eight years that has been documented by Marilyn Sarti, a court worker with the Mental Patients' Association, indicating sometimes an alarming increase in the number of ex-mental patients charged with such things as theft under $1,000, assault and mischief.

I believe that if the facilities of these organizations that are trusted by these people could be enhanced.... Maybe it would be a place where someone could get a free cup of coffee, or maybe a person to help putting on a pot of soup, something that would create a warm, caring and compassionate environment so that those people, when they get up in the morning and go out the door, would know it was there as a

[ Page 5023 ]

positive alternative rather than some of the alternatives that sometimes lead to despair and rejection and the type of hurt that results in tragic consequences for them and costly consequences for all of us on the long run.

MR. CHAIRMAN: The member for Yale-Lillooet requests leave to make an introduction.

Leave granted.

MR. RABBITT: With us in the members' gallery today are three residents from the district of Logan Lake: Ove Christensen, mayor; Al Kemp alderman; and Tom Day, administrator. I would ask that this House give these three residents from the little jewel of Logan Lake a very warm welcome.

HON. MR. DUECK: The suggestions that the hon. member made regarding the role that some of these people with mental illness could play in talking to their peers is certainly interesting, and I think it's worth pursuing. I should mention that if we are speaking of the city of Vancouver, I think the member knows very well that the city of Vancouver is funded by us through the Greater Vancouver Mental Health Service Society. It may be something that we should discuss with them. We don't really go into their programming and how they're going to run their business, but we often consult with them, and this is one area that I think deserves more discussion and communication. It may work quite well. We work very closely with many groups, as you know. The communication is ongoing, and it works well.

We just had a letter — and I'll look for it; I had it just the other day — where the Canadian Mental Health Association.... We gave them $500,000 for exactly what you were mentioning, to do a lot of these things and develop systems to look after mentally ill people.

Maybe our record is not as good as you would like it, but it's not that bad. We are doing many of the things you are suggesting, and with your help.... You and I toured a lot of these places last year. It was certainly an eye-opener for me, and I appreciated your coming with me, because a lot of these things were very new to me. They still are not that familiar, but it was a great help and that day certainly gave me an insight into some of the problems that these people have.

MR. CASHORE: I just wanted to mention that one of those clubhouse models — I think the one operated by Coast Foundation — actually has a membership, and they have a self-help program. They are able to provide employment opportunities and vocational training, presumably in conjunction with other resources that are available in the province. They tell me that in 1988 they put 200-plus people through this process and they managed to place these 200 people.

[Mr. Rabbit in the chair.]

They also mentioned that research indicates that this type of approach helps to decrease hospitalization by a very high percentage — as much as 90 percent — which brings me to the last point that I want to make on the mental health issue. There is just one other point, while I think of it. I've got two more points I want to make on the mental health issue.

The first is to read into the record that Health and Welfare Canada is participating through a grant of $186,000 in a project that will pay for an evaluation in British Columbia on how two groups of 30 psychiatric patients fare in the community on discharge. One group will receive an intensive form of community support involving the types of organizations that I was just talking about. The second group will receive care from mental health services. The patients receiving intensive care are expected to be less likely to be placed back in hospital, according to project director Dr. John Higenbottam. As you know, Dr. Higenbottam is very well known in this field in British Columbia, and I'm delighted that he is able to conduct this research. I believe that when the findings of that research come in, they will give a clear indication to this ministry of where to put resources. Dr. Higenbottam is quoted as saving:

"At Riverview, 40 percent of patients discharged are rehospitalized. That's very tragic. It carries high economic and social costs. We're basing our study on the Bridge program in Chicago, where only 12 to 14 percent of patients discharged were rehospitalized within one year."

The point is, Mr. Chairman, that deinstitutionalization in itself is not necessarily good and it's not necessarily bad; it depends on how it is done. Obviously there are models that indicate that an appropriate way of doing it deals with the invisibility of those people once they are out in the community. There have been other tragic examples where cities in North America have ignored that fact and these people have just continued to pile up and become part of the underclass, with tragic consequences. One day we wake up and say: "My God, what have we allowed our society to become?" We don't want that in British Columbia, and yet there are signs. When you go into certain parts of the province, there are signs that that really is a deep concern.

[4:45]

I just wanted to mention that I was contacted last week by a father whose 15-year-old son had left home and been on the street. I tell this story to try to outline the tragic consequences of some of the problems that people experience who need the benefit of the health care system. It's not so much to point the finger, but to say that the incredible dilemma that we have out there indicates that we have to do an awful lot better job of putting our best thinking together with the best possible policy in order to help these people.

The first thing that the father told me was that he gets a sense that the people who are working both in Social Services and Housing and in Health are awfully busy and that there is a tendency sometimes — at least he gets this impression — to think that that parent must have either physically or sexually abused the child. Whether or not he has any foundation for feeling this, he feels he is being judged and found guilty before he even has a chance to deal with the situation.

Recently this child, who was on the street, tried to take his own life. The father thought that at least now he was going to be able to get some help. He spent the night in the emergency ward, and when the father was talking to one of the psychiatrists he really got the impression that his son would be held there for a while. Yet the next day he was discharged and went back out on the street. The painful dilemma that the father was asking me about was: "Won't anybody help my son? I recognize that I haven't been able to help him. Isn't there anybody out there who will help him?" I tried to explain to him the narrow definitions within the Mental Health Act and why it's part of our reality in terms of our concern for human rights.

[ Page 5024 ]

It really did disturb me that a child of that age could be that intent on taking his own life and yet not be found suffering from a disorder of the mind that constitutes a danger to himself. It seemed to me that at least for a few days he would fit into that category.

It's not something that I am reading into the record to try to say that this is a glaring fault of this government, but in a way it is a glaring fault of our society that we haven't found a way to move in and support a person at that crucial time. I do believe the more we find that people cannot have sufficient to live on, cannot have hope for the future and cannot get assessment when they need it, the more we find that these problems are exacerbated.

The last point I want to make is to say that while the program to deinstitutionalize Riverview Hospital is on hold, we are left with the working conditions of the staff there. Admittedly, the minister has pointed out that the conditions there are really not good to the extent that it would not be costeffective to repair the facilities. Several of us went on a tour of Riverview Hospital, and we were really concerned to see the working conditions.

I would appreciate it if the minister would in his comments recognize the staff that are there and the conditions they're experiencing. I understand that there is a hiring freeze, and so there is a limit on the number of people who may be employed there. I see both of you shaking your heads, so I'd be interested in hearing some comment on that. I think we do have some very real morale problems among the staff working in those circumstances. I understand the catch-22 the minister is in. The plan is on hold until certain other things are in place, but while it's on hold I guess you can't be doing repairs and upgrading the working conditions and the living conditions for the people there — or perhaps you can. I'm wondering how you're dealing with that dilemma.

One last comment. I did appreciate the minister's following through on the discussion that we had in the estimates a year ago that resulted in our touring the downtown east side together. We should do that again. It is the area where the vast majority of people end up who are not able to make it when they come through the system. I want to pay tribute to the people who work in that area and try to provide some compassion and care to those people. A great many of them are ministry staff, and a great many of them are volunteers.

HON. MR. DUECK: The Riverview institution, of course, has now been changed from our own employees to a society. To the best of my knowledge there is no freeze on now. I think it's going back to a full complement. That's what I understand, and I hope it is true, that we're not holding back where they're needed, we're not going to hire.... I suppose the society gets X number of dollars like hospitals. In the very near future it will be a community board, which it isn't at this time. It's operated under a board comprising people from my ministry, but it's changing over to a total community board and will be operated in the same manner as a hospital in the community.

Again, some of this information comes after you ask the question. I was looking for this letter a little while ago. I've got a letter of thanks for the $500,000 that we provided the Canadian Mental Health Association. They were very appreciative of it. They are a good organization, as you well know.

To the other question. You were talking about this club, and it really intrigued me. I think I mentioned that it's something we should look at. Well, lo and behold, I get information that last year we gave the Mental Patients' Association $221,000 for exactly that purpose, and to the Coast Foundation we gave $185,000 — for exactly what you were speaking of now. To quote from that foundation, the total annual funding they received was $729,000, and the Mental Patients' Association received $305,000, including the moneys I just mentioned — that's inclusive.

I didn't even realize this, but when you mentioned it, it twigged an intrigue in my mind and I said, "Well, why don't we look at it?" and here I see that we already incorporated it starting last year. This makes me feel good, that we're on the same track — only I'm a little ahead of you.

MR. CASHORE: Before the minister breaks his arm patting himself on the back.... Yes, I'm aware of that, and I'm aware that the government has recognized for quite some time that there is a resource within those organizations. I think the history has been that it's tended to move through the boarding homes and that sort of thing, and their provision of housing. There has been a drop-in centre that MPA has operated for quite some time. But the fact is that they are operating on an extremely tight budget when you consider the extensive work they do and the value for the dollar, which is absolutely incredible. I think that any independent review would indicate that there's excellent value from the money that goes into that. For instance, I understand that for the Mental Patients' Association, only $5,000 is available for them to provide certain types of amenities that help make that place attractive and one that people would genuinely want to come to.

There's that. But there's also probably a need for more satellite drop-ins throughout the province as a very important adjunct to the placements we can be anticipating over the next few years.

HON. MR. DUECK: Yes, I agree with the comments you made.

MRS. BOONE: I'd like to thank the minister initially for coming to Mackenzie. My only request is that next time you stop in Prince George to pick up the minister of state, you could also pick me up. Then I won't be late for the opening ceremonies. But thank you. We really appreciate the hospital up there; it's a great hospital,

I'm not sure whether you spoke to many people in Mackenzie while you were there about some of the local issues, but one of the driving concerns there is the mental health issue. Currently they have an alcohol and drug counsellor through the Mackenzie Counselling Services. Of course, this is now under the Ministry of Labour. This worker has always, out of necessity, done all family counselling involved, in addition to the alcohol and drug counselling, just because there was nobody else there. Apparently the mandate has now come down that they are not to do any mental health counselling at all; they are strictly to do alcohol and drug counselling, which is their mandate. That leaves the people in Mackenzie very much up the creek.

They have two mental health workers from Prince George who come in once a month, and they have a psychologist with the school district who comes in, I believe, once or twice a month as well. I think you and anybody must understand that for a true prevention service, once a month is not enough to do any kind of prevention at all. It's virtually a joke. You say to people: "Well, if you are depressed, wait for four weeks

[ Page 5025 ]

until the mental health counsellor is going to be here. You feel suicidal? Wait until the mental health counsellor gets here in three weeks." There is just nothing out there.

Mackenzie is very similar to any of the small areas around. Many of them are working one or two days a month. In some places such as Cassiar, they don't get anybody up there. It's a serious situation and one that I hope the minister can help with. There's been a joint application put in by the Mackenzie Counselling Services and the Ministry of Social Services and Housing for funding for a mental health counsellor, and apparently they were told that there was no money this year for such a position. However, I believe that it's a serious situation and one that the ministry should look at now — this year — and try to fit in somewhere. Perhaps there's money through the family program. Surely if we are putting $20 million into a family program, then one of the mandates ought to be to try and get a counsellor up there. I'd like the minister to respond to that issue because it's a very serious one. I'm picking on Mackenzie because it's one that I know all the items about, but it is very similar to any of the outlying communities that don't have enough staff there to house a full-time mental health worker. It's of grave concern to the people in that community.

HON. MR. DUECK: Yes, I spoke at length to the people up there. They did not mention their concern in this regard, and I can understand that, because it was an official opening of a facility, and they wouldn't necessarily come and make me feel bad at that time. I can understand that. I was just asking my deputy if that is so. You're talking about counsellors. You're not talking about drug and alcohol counsellors, because unfortunately they are separated now. In one sense, I'm sorry to see them go because so often we could use one in the other area, and now they seem to be separated.

I'm assured that we are looking at that particular area — Mackenzie — specifically. I can't give you any answer at this point in time, although they have some people coming from Prince George, I believe. You say that's not sufficient because they need it there on a more regular basis. All I can tell you at this time is that we'll look at it.

[5:00]

MRS. BOONE: I will continue to bother you on this issue, because it's of grave concern to us. The other one is.... I'm not quite sure in what depth my colleague went into this, but he just reiterated a problem. It's a similar area, and it has to do with the whole general problem with youth in this province when it comes to counselling services: mental health counselling, psychiatric services, psychology or drug and alcohol counselling. You name it — any kind of services at all for young people are virtually nonexistent.

In January, I was in contact with the previous deputy minister about a situation we were trying to work out. It was about a young 15-year-old boy in Kamloops who had been referred by his family doctor. The private psychiatrist that he was going to, the social worker, the parents — everybody who was dealing with this young fellow — had the same impression that he was in a crisis situation, and that there was no place for him to go. He had been in and out of the psychiatric unit in Kamloops, and the doctors were not willing to accept him back in there because it was an inappropriate place for him to be.

He was in a group home, and it was felt that it was not an acceptable place for him to be. He could not be held in. It was thought that he was going to be of danger to himself and to other people — and to young boys in particular. Nobody could get anybody to do anything about this. They were told that they could get him into the Maples, and then they were told there was no space for him. This boy was virtually living on the edge for a whole month — waiting. Or his parents were living on the edge; I guess the boy wasn't. He was doing whatever he had to do, but the parents and everybody involved with this child were on pins and needles waiting for a month to find out what could happen to him, and where they could put him so that he could not be of danger to himself or to other people.

The sad situation was that the people involved — social workers and psychiatrists — who I spoke to actually indicated that they hoped he would be arrested and charged, so that he could be put into the Attorney-General's department, because he would get some help there. I think that's a very sad comment on our situation. When I talked to the previous deputy, he indicated that that's probably what would happen to this boy anyway: he would be arrested and end up in the Attorney-General's department.

I'm making a plea to you to review the facilities and the services we have for children and to try to put in place something for these young people who are falling through the cracks. I don't think it's coincidental that we have an extremely high rate of suicide in many areas of this province when there's virtually no place for our young people to go and nothing for them to do.

I understand that when the Maples switched over to the Attorney-General's ministry, there were going to be beds being built in other parts. I understand there are some in the Fraser Valley and on the Island, but there are still not enough. There is nothing in the interior, and there is still not enough to deal with the situation we have. I would like the minister to respond and tell me what is in the works for our young people, because it's a grave situation out there.

HON. MR. DUECK: That, of course, if you want to go over all the programs that we have — I haven't got them all before me — requires quite a lengthy.... The ministry is certainly committed to providing the best specialized psychiatric services in remote and northern communities. We do it with outreach programs operated in partnership with the university, and have done so for some time. You say there are still some areas that haven't got the full complement of people when they need them; in other words, it's sparse. I can accept that. It's very difficult to have a permanent person in every isolated community.

However, the budget allocated to child and youth mental health services has been increased by $4,300,000. Thirty-six new mental health centre staff have been hired. Each now has a program coordinator for child and youth mental health services. Senior clinical staff have the responsibility to develop and oversee local programs. A total of $2,200,000 has been allocated to provide grants to community agencies to enhance and extend mental health services to youngsters. A psychiatric consultant has been recruited to provide overall clinical direction and has responsibility for training psychiatric outreach in collaboration with hospital and other psychiatric services.

A pilot project has been initiated to demonstrate the effectiveness of specialized residential treatment for youth. As you know, Ledger House, a 25-bed child and adolescent acute care psychiatric facility, was opened in September of

[ Page 5026 ]

last year to serve Vancouver Island. I suppose I could go on and list all the ones that we've got around the province, which maybe still doesn't answer one specific remote area. If you're asking about Mackenzie in particular, we will try to get you information on that.

We've provided 36 mental health staff, as I told you. We've got the extra funding. We're going in the right direction, but according to you it isn't enough. According to me we're providing pretty good service, I think better than ever, and we're improving it from year to year. We're asking and begging for more money. It's not always just money; it's also the allocation of people and the priorization that we make in the ministry. Sometimes we find we could do with less staff in one area, and then we change them and try to fill in other areas. We're quite flexible. We don't say, "These belong here, and we're not touching that," and some area gets no service.

We've been doing a lot of this flying in of squads in cooperation with UBC. We've tried to do that with the isolated areas, because some of them are so small that you can't really have a permanent person in there.

MRS. BOONE: I certainly understand that you can't have a permanent person. I think I suggested at one time traveling squads that could go in and deal with some of the remote areas — SWAT teams, yes, in many cases.

I don't think you're dealing with the situation. For years the Maples was the only place throughout the whole of B.C. that a child could be referred to if you wanted that child to be in a place where they were not going to be of any danger to themselves. Currently you have the situation on Vancouver Island. You indicated last year that there was going to be something in the Fraser Valley. All the mental health workers in the world aren't going to help if you've got a child anywhere throughout B.C....

Outside of the lower mainland, we don't have any place for these children to go. We have no place at all. We have the absolutely unhealthy situation of children being put into the psychiatric wards of hospitals and locked in rooms, or in some cases of being put into jails because they have no other areas around. It is not a situation that I think is improving at all. I haven't seen any improvement whatsoever in that area. The Maples has been closed down. The beds are being switched over to the Attorney-General's department, and I don't know where the beds are for the kids from the interior. Where are the beds for anybody outside the lower mainland? Where are these children to be sent to?

If some parent phones me once again.... I spent about a week on this one case in Kamloops, and only through perseverance and through phoning everybody, including the Premier, did they manage to get a commitment to have their child put into the Maples within a two-week period. They persevered; there are others out there who don't persevere and are in a sad situation and, as I said, are a danger to themselves and to other people. It's a similar situation that my friend for Maillardville-Coquitlam mentioned, where a child is suicidal and he's let back out onto the street again. When you have every authority in the area saying that a person is a danger, there ought to be some place we can send those people so that they can be protected from themselves. We don't have that for our young population. It's a shame and really isn't acceptable.

HON. MR. DUECK: I think I mentioned that the Maples looks after some; Ledger House is another one; Vancouver General has a children's psych ward; and Eric Martin Institute. By and large, children are dealt with as out-patients. It depends on what age you're talking about, but it's not that often that you take children into a facility, but we have some facilities that provide space for those. In most cases they believe — and it's been proven; it's a medical decision that's made by the physician — that it's better to treat the child as an out-patient rather than put him in a confined area. Then there are other institutions, I believe, even privately run. Salvation Army has one in Langley; it's for youth, not children, but we're talking youth now. There are 'some societies that do look after funding through our funding or through the public funding process from donations and service organizations that help in this regard. But I believe most of the ones are looked after on an out-patient basis, and it works quite well.

We're talking about a different clientele now. To put them in an institution, unless absolutely the last resort, is in many cases damaging to their individual need. If at all possible we try and keep them with the families and give them out-patient counselling. And that we do. If it's an isolated area, we'll fly in these teams on a regular basis. Perhaps, according to your perception and mine too, it would be not often enough, but that's what we have been doing up to this point in time.

MRS. BOONE: Certainly anybody would agree that children ought to be serviced on an out-patient basis when necessary. But I think everybody would also agree.... Your words would not be of any comfort at all to the parents who are sitting there knowing that their child may cause someone else harm, and they can't find a place to put him away where he can get some treatment and be protected from himself. It's just not acceptable. We have not dealt with this issue, and we still are not dealing with this issue. I don't want to see these kids locked up in jail or in an adult psychiatric ward. If they are a danger to themselves, they are going to end up in jail; that is what is going to happen to these people.

A 15-year-old boy that is causing bodily harm to himself and to other people will end up in the penal system. And in many cases in the remote areas they have no alternative but to put them into jail until they find some place else to take them. They may bring them down, but they spend a period of time in a jail because there's nothing else for them. It's obvious that I'm not going to get very far on this, but I really do think that you ought to look into it further. We have children out there, as I said, that are just falling through the cracks. They are not getting the necessary services at all.

[5:15]

You keep mentioning the societies. I have some real concerns about what is happening on the mental health scene when it comes to the societies. I've traveled throughout the province, and I've met with a lot of societies, community centres, various places like this, who are doing some really good work, very worthwhile work. But you find there's an overall trend in these societies to take over work previously done by the Ministry of Social Services. Since 1983, when family support workers were eliminated, they have taken up the call. They know there's a need out there. They've done these jobs, often with minimum support from the government. You'll find that a great many of these societies are doing tremendous jobs, and they are paying their people minimum wage, or in many cases they aren't able to hire qualified people. My concern, when I see that the money is going out into the mental health field rather than through the existing ministry structure and hiring people within the

[ Page 5027 ]

Ministry of Health and mental health workers, is that there be established criteria for employment standards so that people are going to make sure that if you have somebody counselling on suicide, you know you have a qualified person doing it; if you have people doing counselling and they are given a grant or what have you to assume responsibility for such a service, that there be some commitment for an ongoing thing. Through societies there is no guarantee of anything.

I've worked for societies, and it's very much a hit-and miss.... You sit there at the end of the year and wonder each time whether the funding is going to be there for you to continue your work, whether you can plan the next year. You find that you have some very well-meaning people, frequently working for minimum wage, doing a job that should be done by four or five more people, because they don't have the staff. I hope the ministry is not taking societies as a means of saving money, as a means of being able to withdraw funds later on if they don't feel like it, as a means of not being able to pay their staff people appropriately, and as a means of hiring less qualified people.

I would like the minister to assure me that societies that are putting in applications for funding to do different things.... I have lists here of some of the things that contracts are being given out for: dealing with chronically mentally ill youth, suicide prevention crisis line, counselling for chronic mental patients, all kinds of different things. I would like the minister to establish some standards of employment so that they would know that persons working in such a situation have a degree; they must have the qualifications they would have if they were working for the mental health services. The people out there who are being served deserve nothing but the best, and we must make sure that the societies that are serving these areas are funded appropriately so that they can staff their areas properly and provide their staff with adequate financial income as well.

It's really a shame. I've gone to places and seen extremely qualified people working for minimum wages.

MR. R. FRASER: I would just like to take my place in this debate, Mr. Chairman. I would like to ask the member opposite who referred to me as the man from Vancouver South to refer to me as the first member, so that my colleague, the Hon. Stephen Rogers, will not be caught in this nasty, unbelievably difficult, severe attack on the credibility of the member from South.

I would like to talk a little bit. One of the things the opposition likes to talk about is: why don't we have more of this, and why don't we have more of that, and why don't we fund this group and why don't we fund that group, and why don't we continue to ask the taxpayers for more and more money all the time so that we can spend it in more and more places? When they were talking last week about the great loss in Boundary-Similkameen and asked every question about Boundary-Similkameen, they never did talk about that great statute that came in last year that they were so violently opposed to: the Health Statutes Amendment Act, 1987. They were screaming that it was a terrible thing to do. The Minister of Health took a lot of abuse, but quietly and carefully the government program went through, and those people who have communicable diseases that are a hazard to everybody in the community can be isolated for the benefit of the whole community. Not a bad idea, I say; not a bad idea at all.

When the minister talked about it and said that it would be people with TB we would be trying to get off the streets and out of the public eye.... One cough into an air conditioning system in a building can go around the whole building, and the chance is that it might affect someone in that building. How many people would that endanger? We don't know, but certainly more than one, and we can't have that kind of thing. Did they defend it? No. They spoke violently against it, as I remember — this great little act right here. They shouldn't have, should they? They should have known.

They oppose for the sake of opposing; they spend for the sake of spending. You never hear the earnings side. Where is the money going to come from? It's got to come from you and you and you, because that's the source, The people in the galleries know it's coming from their pockets, and they want to hear something from both sides of this House. They want to hear how effectively this money is going to be spent. Should we spend the money at all? How much money should we spend? Where should we spend it? Who should spend it?

I spent this morning in Vancouver meeting with a group of doctors who are asking for more money. They seemed to think that our great Minister of Finance (Hon. Mr. Couvelier) was picking on them, being hard on them, because he said health care is expensive. They were sort of surprised when I told them that the modest increase in the health care budget this year, done with this great Minister of Health, was something in the order of $360 million. That's an extra $1 million a day. They felt somehow hard done by and picked on, and I was very surprised that the doctors felt that way. Some doctors in Vancouver....

MR. ROSE: Do they still talk to you?

MR. R. FRASER: They are still talking about being picked on by this great government. I can't believe it. When you get a $360 million increase through the great auspices of that minister right there, the Minister of Health, you have to think: isn't that wonderful, what the government is doing for people out there — all the senior citizens' homes and the intermediate-care homes. We find out that a tertiary hospital bed, which handles all the patients from all over the province — Vancouver General, for example — can cost as much as $550 per day. Now that is a lot of money. Not many of us would ever even be able to look at a hotel room that cost that much, but when we go to the hospital....

MRS. BOONE: You could. Certainly none of us over here could.

MR. R. FRASER: The member from Prince George tells me that none of the members on that side of the House can ever look at a hotel room that would cost $550 a day. I've always been impressed with the number of $1,000 suits I see across the way, and the Mercedes I used to watch going back and forth, and now we have a member over there who owns a gold mine. Now tell me how bad it is. I'm looking forward to seeing.... Maybe he'll be the Finance critic.

Getting back to health care and the cost of health care, I'm beginning to wonder how efficient the system is when I hear the doctors complaining that they are not getting enough. This morning the doctors told me that the nurses were too powerful, that they were exerting their influence on the health care system and actually running the hospitals, That one really did dazzle me. I always thought the administrator was the mean guy; but now it's the nurses who are doing it. Last week the member over there was saying that

[ Page 5028 ]

nurses aren't getting enough money for the good work they do and that we don't have enough nurses.

MR. PETERSON: Not enough, did you say?

MR. R. FRASER: Not enough. You certainly hear that a lot.

I want to hear from the minister what some of this health care he is providing costs per day per person. I want to hear more about that, because we don't spend enough time thinking about the taxpayer. We don't ask the taxpayers often enough and the people out there: "Do you have to go to the doctor? Are you really sick? If you just stayed home...." I know you want me to stay home more often. If we just stayed home and took better care of ourselves, wouldn't that do it? Don't we have some responsibility? I think we do.

MR. ROSE: You might fall out of bed, Russ.

MR. R. FRASER: Actually, that wouldn't be the longest fall I've ever had.

Mr. Chairman, I want to hear more about what the costs are and where we're going on this. It's too important. I wasn't trying to be funny, as the member over there suggested. Health is not funny; people drinking too much is not funny; people getting into trouble is not funny. All of us in the chamber right here have to do our part along with the people in the gallery and the people in the communities to make sure that every cent that we spend is spent with care.

MRS. BOONE: I'm certainly glad to hear that, and I wonder how that member voted when we were dealing with the Coquihalla issue and the overspending there — not a cent spent without any kind of issue.

The issue is, when you're talking about funding.... We have not been asking for a tremendous amount. It was the members over there on that side of the House who stood up and said: "We need a new CAT scanner. We need a new intermediate-care facility." Those were the members who were asking for the facilities; it was not the members on this side of the House. We've been asking for fairness, for equity and for sensible health care. We know what we need to get.

I can tell you, Mr. First Member for Vancouver South, if your people had to travel the length of the province to get adequate health care, then you would not be sitting there talking in those terms. It's a different matter in the rest of this province from the way it is in Vancouver South.

MR. ROSE: Scold him some more.

MRS. BOONE: Scold him some more? I think the member for Maillardville-Coquitlam has some questions here.

HON. MR. DUECK: Mr. Chairman, should I not answer some of the questions that were asked before? Isn't that proper?

You mentioned guidelines or standards. We certainly do have guidelines and standards. We don't just give funding to a society because they say they're going to do all these wonderful things. We just couldn't do that. You may well remember last year. We had quite a drive on — they put pressure on us — by the Breakaway program. They did not meet our standards, and for that reason we did not fund them.

Although I think they did a fairly good job in peer counselling — it appeared that they were doing a good job — my ministry never funded them, simply because they did not meet our guidelines or the criteria we set out and the standards we had. So yes, we most certainly watch them very closely, because even then we can get into situations and problems from time to time.

I want to talk just a little bit about my friend the first member.... It may be appropriate that I mention at this time what the cost of health care is. I'm sure everyone knows, but for the record, it might be interesting. In 1974 I think it was $300 for every man, woman and child in British Columbia. It is now over $1,300 for every man, woman and child, and that is without drug and alcohol programs, which have been taken away. It costs $7,000 per minute. It costs quite a bit over $10 million a day, 365 days of the year.

The question, of course, begs to be asked: is it appropriate? Are we allocating the moneys properly? Is it efficient? I have to tell you that this is on our minds constantly. We're looking at areas of efficiency all the time. We have people doing nothing but looking at programs. Are we as efficient as possible?

I think your point was well taken when you said they still haven't got enough money. We're probably even going to the point where we're cutting back more than we should. Some of these societies are doing one fantastic job with the small amount of funds they have. We give them a global budget: for this year X number of dollars. I don't think any society is afraid of cutbacks, unless it's something we've funded only with seed money.

There are some societies that say: "Just give us some money to get started, and we'll be away and do it on our own." That could happen, but by and large the societies that have been working for us in providing services are quite sure of the funding they are going to get from year to year. Generally it's an increase. There may be some exceptions, but that's by and large.

I had the list here yesterday. There are pages and pages of societies that we fund, and rightly so. If we had to fund them with salaried staff from Victoria or from the communities, we couldn't be as efficient as they are, because they employ so many volunteers. They do so many things that you can't possibly do with hired people.

Those are just some of them. Of course, you are familiar with them, and that's not the exhaustive list. There are more than that.

[5:30]

They are very valuable people. They have tremendous people working with them and for them. We appreciate them. I would never, ever say that we should not fund them. They are a great help to us. If we had to provide all those FTEs on a salaried basis.... My gosh, we're talking about $4 billion now; maybe we'd be looking at $5 billion. So we appreciate those people.

MR. CASHORE: Mr. Chairman, I wasn't going to deal with this, because I didn't think we had time. But apropos of the first member for Vancouver South's (Mr. R. Fraser's) remarks about the....

Interjection.

MR. CASHORE: Well, he moved in to support the minister and point out that the minister doesn't spend money

[ Page 5029 ]

unless the money absolutely needs to be spent. He was making accusations about who throws money away and that sort of thing. The fact is that we are very frugal and costeffective in what we call for, because we believe that the government policies in many instances are penny wise and pound foolish. Sometimes you can't even say they're penny wise.

Mr. Minister, what is this press release dated April 27, 1988: "Vital statistics to issue new pamphlet on most popular baby names in B.C."? Is this the ministry that's short of funds? Is this the ministry that cannot provide the salaries and wages that are sometimes needed by health care professionals? Is this the ministry that cannot deal with some of the situations that we hear about? We hear the minister saying: "Well, we try to help where we can, but we can't help in every instance because there's only so much money, and it can only go so far." Here we have this piece of fluff coming out of vital statistics.

MR. PETERSON: To keep the people informed.

MR. CASHORE: To keep the people informed, my friend says. We've got it here. It's on the press release. Who knows what is stated in this pamphlet? Presumably the pamphlet says more than the press release, but the press release says that Michael was used 614 times, Matthew used 530 times and Amanda used 481 times. This is an example of the cost-effective work that the hon. member for Vancouver South refers to as representative of the work that the ministry and the government are up to, This is the real nitty-gritty.

I say to the member for Vancouver South that this is the kind of thing that typifies that which causes the people of British Columbia to wonder what on earth.... I'm trying not to be political, but this member brings it out of me; I can't help it. I go through a kind of Pavlovian response and I can't control myself. I'm completely out of control now, having to deal with the comments he made and the fact that this ministry has spent I would like to know how much money telling the people of British Columbia.... And I want to know why the name John isn't even on the list. [Laughter.] Is the name Mark on the list? Daniel is 404.

I want to turn from that to ask a few questions that I don't particularly expect the minister to have answers to at his fingertips, and it would suit me quite well if he were to take some time to get the data and answer them tomorrow. This question has to do with the adoption registry that was passed in legislation last year under the Ministry of Social Services, but for which the responsibility has been transferred into vital statistics.

How many applications have there been to register with the registry? What is the breakdown of the kinds of applications? How many reunions have been brought about as a result of the work of the registry? And I'd be interested in further comments that the minister has at that time.

I now move into a subject that I want to question the minister on. It has to do with the announcement that came out on Friday that the provincial cabinet had passed a regulation removing cosmetic surgery and two other treatments from procedures covered by medical insurance. Specifically I want to focus on one aspect of this announcement, that of sex change operations. I want to ask the minister to tell the House why this OIC was passed, and I know the minister is going to make reference to Bill 34, which the member for Vancouver South referred to a few minutes ago. I would like to ask the minister how much money he expects to save by removing this procedure from the Medical Services Plan, and I would like to ask him how this procedure differs from those that are still funded. What are the criteria the minister would apply in removing this procedure from the other procedures that would be funded?

HON. MR. DUECK: I didn't get the last one. Was that on sex reassignment?

MR. CASHORE: Yes.

HON. MR. DUECK: I want to go back a little bit. I think I owe it to the member who asked the question about children's names. I think it's very important, because I'm going to have a new grandson today or tomorrow, and I think it would be of the utmost importance for them that they don't name it anything but "Peter."

I should tell you that this publication is the most popular publication we publish. Every province in Canada does this, although ours is the most modest. We spend $3,000, too, but if we didn't, you on that side of the House would probably criticize us highly that for a few lousy dollars we wouldn't print such a publication as every province has, and what's the matter with the Ministry of Health, not doing it? So having said that, I guess....

But we do have other publications that perhaps the members would like to mention, such as Baby's Best Chance, where I think we're doing a very good job in supplying information to mothers and to-be mothers and young children. I think we are doing some things that are valuable. I think Baby's Best Chance has had one of the most looked-after publications. It is the most sought application that one could imagine, because there's a lot of information in it. I think we should be.... I know it was meant in jest. I don't think you really meant to criticize us for printing those names.

As far as some of these eliminations of the Medical Plan and also hospital, as you know that section that was introduced last year dealt with exactly what we have done, because the Medical Services Plan always had that in place — that we could eliminate some from the program and add others to it — but we didn't have that in the hospital legislation, so we have changed it. Now we have cosmetic surgery, which we didn't pay for before under MSP. We will not pay now when they need hospital residency for something that is not medically required. That may apply to a number of items. It is for the physician, of course, to make the decision. It is certainly not made by me or my ministry people.

The sex reassignment. We haven't done any for a long time, as you know; it's been on hold. The order-in-council just went through the other day eliminating it, because we felt it was not medically required. That no longer is being performed under payment from the plan — neither from the hospital.

The overall saving would be roughly $1 million. We did not eliminate those operations that had been started, because it goes through a number of procedures. We or Social Services did continue to pay for some of them. But as far as the medical plan and the Hospital Act are concerned, they will no longer be covered.

MR. CASHORE: I would take it, then, that the criterion the minister uses is that of something that is not medically

[ Page 5030 ]

required, and I think it requires further definition. It sounds to me as though the designation is a panacea that can be used in any way the minister wants to use it. I did not hear the minister say anything that really explained in which way the procedure would not be medically required.

I refer you to Hansard from December 8, 1987, when we were discussing Bill 59. At that time I asked the minister: "Does the minister intend to state in response to my question that transsexual operations would not be allowed following passage of this bill?" The minister responded: "I'm not saying that at all, but this would give us the authority not to give hospital coverage if they were eliminated from the MSP side. However, all of these operations, of course, are done out of province, and they would have to have prior approval in any event." To which I responded: "I would like to ask the minister if he would explain whether or not the reference he made recently to putting it on hold applies in this case. Does the minister intend to place transsexual operations on hold?"

At that point, the minister responded: "I have instruct my staff not to give any approval unless it is an operation that is already in process — to complete that particular operation because it requires, I understand, a number of tri s to the hospital, not just one. I'm not sure, but we may have some that have gone part way, and I think it would be unfair to not complete that particular surgical procedure. Other than that, I have instructed them not to give approval to any new cases that come forward at this time."

Then I asked another question, and to that the minister said: "That will come out once we do a review of a number of these items, and I cannot comment on that at this time." I should read what my question was: "I would like to ask the minister if he would explain to the House, given the qualification he has just made, why he has placed this procedure on hold."

We are still not getting a definition from this minister that indicates why this is not a medical procedure. In fairness to these people who have been waiting for this procedure — I'll say a bit more about that in a few moments — I would like to ask the minister to explain very clearly why this is not a medical procedure. Also, in reference to the last question that I referred to where the minister said that there would be a review, I want to ask the minister if a review has been done.

[5:45]

HON. MR. DUECK: When we talked about a review, we talked about all these different areas that may require further consultation on whether or not a procedure is medically required. I think I made it very clear at the time that we were not proceeding with any more sex reassignment. I don't think I ever hedged on that whatsoever, and I said we were putting them on hold. We weren't doing any. We were not going to approve any, and this legislation we were going to put forward — which we did — now gave us the opportunity to put through an order-in-council.

I don't think that I say that the procedure is not medically required. Of course it is — or the procedure is a medical procedure, but it's not required. We feel that it is not a required procedure. Someone may well wish to have that done. It certainly is a medical procedure, and it would have to be done in a hospital by physicians, but they will have to pay for it themselves. That's what we're saying. That order-in-council has gone through, period. We're not paying for sex reassignment.

MR. CASHORE: The minister has not said why. He has not given definition to the terms that he is using. He is just saying it won't be done, period. I would remind the minister of his comments at the beginning of estimates: "During 1988-89 the Ministry of Health will continue to take the lead role in promoting responsible, healthy lifestyles. " How does that tie in with promoting a healthy lifestyle for those diagnosed by the gender transition clinic by medical doctors, those who require sex-change operations in order to be able to enjoy the kind of healthy lifestyle that the minister referred to in his comments? Yes, it is a medical procedure, but it's also a procedure that medical opinion would say is medically required. I'm not quite sure that the minister is prepared to answer the question with regard to why he has made this decision.

I believe this decision discriminates against some people in our society who desperately need some help~ and it has been diagnosed as a medical procedure. I would point out to the minister that the standard diagnostic reference in North America, DSM 3 — the Diagnostic and Statistical Manual of Mental Disorders — put out by the American Psychiatric Association, lists this type of problem as being a legitimate medical problem under the definitions of a psychiatric disorder.

I would like to point out to the minister that in a letter written November 16, 1987, by Dr. Diane Watson.... She states this in a letter to Dr. Bolton of the Medical Services Plan:

"A total of 13 patients have been approved for reassignment surgery by the clinic over the last 12 months. At Dr. Schneider's suggestion in his letter of March 6, 1986, we resubmitted requests of patients who had previously been refused by MSP. A backlog had accumulated over the decade that we have been following patients, so there was understandably some initial catch-up. Although we have over 200 patients registered in our clinic, there are currently only approximately 20 patients who are likely to be approved for genital reassignment surgery over the next two years."

This is a situation that the medical professionals in that clinic look upon as a very serious need.

She goes on to say:

"If access to surgery is denied, it implies some other possible recourse or alternative treatment. We would appreciate knowing what therapy you are endorsing."

There's no satisfactory answer to these questions forthcoming. What recourse do these people have?

I would go on to another letter written by Diane Watson on November 15 to Dr. David Jones, president of the BCMA:

"Mr. Dueck publicly announced that the Minister of Health is holding a review of MSP policy for partial reimbursement of reassignment surgery. But he has consistently ignored our request for a meeting with the statement, 'We are fully aware of the issues surrounding this subject, and when a determination has been reached, I will be pleased to inform you.'

"To my knowledge, none of the physicians in MSP or the ministry have ever treated a gender dysphoria patient, so I find it puzzling that they make policy decisions with major clinical ramifications without any consultation with specialists. They have given us no explanation as to why there is a freeze on funding or need for a review.

"2. If MSP discontinues reimbursement, B.C. will be the only province in Canada not funding

[ Page 5031 ]

reassignment procedures. A West German court ruled in October 1987 that a medical insurance company had to pay the costs of reassignment surgery.

"3. Sex reassignment is not optional for true transsexuals. There is no other effective form of treatment. The outcome is as good as, if not better than, the results of treatment for any medical condition, with an 85 to 90 percent success rate. The discordant gender identity in a transsexual is the result of a biological etiology completely unresponsive to psychological treatment. The search for resolution of the gender conflict is so intense and so relentless that, untreated, the patients are a very high risk for suicide, self-mutilation, psychosomatic conditions, depression, anxiety, and drug and alcohol problems.

"Precluding reassignment procedures is a false economy for many reasons. The complications of untreated transsexualism lead to a continued high demand for physician and allied medical services, hospital admissions and laboratory investigations. The use of health care services is reduced significantly post-surgically. The pre-surgical patient is unable to get a birth certificate and other identification which would increase their employability. The cost for treatment of the complications — medical and social — far outweighs the outlay for surgery itself.

"4. The decision to review funding could not have a purely financial basis. Only 13 patients had reassignment surgery over the last 12 months, with a cost to MSP of $700 to $1,200 per patient.

"5. The psychological effect on the patient of government funding for the procedure, even if only partial reimbursement, is enormous. They feel understood and cared for. Withdrawal of service fuels their already marked sense of alienation and discrimination, and it makes our job as physicians very much more difficult with this population. The patients feel so desperate that their search for surgery becomes a battle, and I can assure the minister that they won't give up."

In view of the comments that the minister himself has made at the beginning of these estimates, where he talks about promoting a responsible healthy lifestyle, and given that there is medical opinion that this procedure enables some very unfortunate people in our society to enjoy a responsible healthy lifestyle such as they could not have received under other circumstances, I ask this minister how, in the name of anything that is humane and in the name of any kind of decency, we as a province could, for either the amount of money that the minister has referred to or the amount referred to in this letter, deny these human beings this procedure which could remove the stress that is in their lives and sometimes results in self-inflicted violence and very often results in a much greater cost to the body politic as a result of the needs that these people have with their attendant psychiatric and other problems when this issue is not addressed. How can you do this, Mr. Minister? I'm asking you this in the name of compassion, in the name of a group of people in our society who have been put at risk by the announcement made on Friday. I would hope the minister would in some way understand the jeopardy these people have been put in as a result of our society turning its back on them in such an inappropriate way.

HON. MR. DUECK: I'm certainly not going to debate with someone who has written to the member, a physician who has his or her own point of view. Physicians differ greatly on the subject, and I'm not going to get into debate as to which physician has the right answer and which one hasn't. The Medical Services Commission of our ministry has recommended that it's not medically required, the order-in-council has gone through, and we will no longer pay for those operations.

MR. CASHORE: Mr. Chairman, I move the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Strachan moved adjournment of the House.

Motion approved.

The House adjourned at 5:57 p.m.