[ Page 5033 ]

CONTENTS

Routine Proceedings

Resource Investment Corporation Amendment Act, 1988 (Bill 44). Hon. Mr. Veitch

Introduction and first reading –– 5033

Dental Technicians Amendment Act, 1988 (Bill 37). Hon. Mr. Dueck

Introduction and first reading –– 5033

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

On vote 45: minister's office –– 5033

Mr. Sihota

Mr. Rose

Mrs. Boone

Mr. Gabelmann, Mr. R. Fraser

Mr. Darcy

The House met at 10:06 a.m.

Prayers.

MR. SERWA: On behalf of the second member for Okanagan South (Mr. Chalmers) and myself, I would like to introduce a class from Raymer Elementary School in Kelowna. There are 40 young people here in the House this morning, accompanied by teachers Robert Daniel, Mrs. Lorraine Frost, Mrs. Ann Waldo and a parent, Gordon Falkowsky. Would the House please make this class from the great constituency of Okanagan South welcome.

Introduction of Bills

RESOURCE INVESTMENT CORPORATION
AMENDMENT ACT, 1988

Hon. Mr. Veitch presented a message from His Honour the Lieutenant-Governor: a bill intituled Resource Investment Corporation Amendment Act, 1988.

HON. MR. VEITCH: This bill amends the Resource Investment Corporation Act by allowing the British Columbia Resources Investment Corp. to operate in the same manner as any other reporting company and with the same freedoms and restrictions as any other company operating in our province's private sector. This bill therefore completes a process that began with the passage of the original act in 1977.

These amendments repeal most of the act, save for those parts dealing with the rights of the holders of bearer shares — the five free shares given to each and every eligible member within the province. These amendments are government's response to the company's request to change its name to Westar Group Ltd. and to have legislative changes made to place it in a position no different from that of any other publicly held company in our province.

I move that the Resource Investment Corporation Amendment Act, 1988, be introduced and read a first time now.

Bill 44 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.

DENTAL TECHNICIANS AMENDMENT ACT, 1988

Hon. Mr. Dueck presented a message from His Honour the Lieutenant-Governor: a bill intituled Dental Technicians Amendment Act, 1988.

HON. MR. DUECK: This bill is essentially minor in nature. It increases the number of members on the committee; it tightens up some of the rules of the legislation and it eliminates the oral certificate that was required in the past. I'll speak a little more to it at second reading.

Bill 37 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.

Orders of the Day

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

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

MR. SIHOTA: I want to take the opportunity this morning to talk briefly about the erosion of health care in British Columbia. I really want to look at it from the perspective of those who work in the field and of the consumers of that service — namely the patients.

The more I travel around this province and more particularly around my riding, the more I become concerned about the delivery and quality of health care services in British Columbia. I'm sure that that's a concern the minister has as well. I must confess I'm alarmed at some of the stories that I hear, some of the things to which I am witness and the conclusions that one arrives at about the erosion of these services.

I received a letter the other day which I'd like to put on the record. It came from a former constituent of mine, and it was addressed to the Minister of Health with a copy to myself. He says:

" I write you with respect to health care services available to my father...."  I won't state the name. Continuing: "For the record, my father was born in Scotland rather than Canada, because my grandmother, who is still residing in New Westminster at the age of 96. stayed with her family while my grandfather was stationed overseas with the Canadian army during World War I. Since his family's return to Canada in 1919, my father has been a productive member of this society. He worked over 41 years in the B.C. forest industry, with time out during World War II to do his bit, like his father before him. He has been an active member of this community, volunteering his time with many organizations. Most of his free time was spent with the B.C. minor boys' baseball association. With the same wife for 50 years, he is at present retired and residing in his own home in Surrey.

"In January his doctors determined that he requires a heart operation. Unless the operation takes place, the prognosis is terminal. He has been waiting ever since. Even though he was rushed off to hospital for a heart-related problem last week, he was sent home within six hours, and his place on the waiting list remains unchanged. How much longer will this , no room at the inn' approach to health care continue? I would like direction from you as to how our family should deal with this situation."

That’s just one of several letters that I've received over the last year from families in British Columbia who are expressing their anguish over the state of health care in British Columbia.

[ Page 5034 ]

I want to tell the minister another story I'm familiar with. It's of an East Indian woman who used to live in Ladysmith, She came to Canada 40 to 45 years ago, I would say. She raised a number of children here in B.C., most of the time on her own, because her husband had died at a very early age. She was a productive member of society. She seldom — and I want to emphasize that word "seldom" — ever needed to consult a physician or take advantage of the program of health care that we have in this province.

[10:15]

Earlier this year a woman that a know a little bit about — I didn't know her that well, but I know a little bit about her — suffered a cerebral aneurysm. The ambulance came to take her to a facility in Ladysmith which could not deal with her, so they went to Nanaimo. She was turned away from Nanaimo because the facility was overcrowded and could not handle her. Then they drove her to Duncan and ran into the same problem. The ambulance then zipped over to Victoria, and she was left at Victoria. Shortly after that, she died.

I'm not saying — nor can I say, because I don't have the skills of a physician — whether or not the delay in transportation all over southern Vancouver Island contributed to her untimely death. What I can say is that I talked to the family, because they came to me after that death occurred and wondered out loud how this could happen — how a woman could be transported around the southern portion of the Island without a hospital that was prepared to accept her. It brought home to them all of those headlines and news bulletins that had sort of flashed past their minds, but that they really didn't attach to. They walked away with a sense of anguish about the state of our health care services in British Columbia because of that very telling experience which lives with them today.

It's one story; it's one death statistic in British Columbia. It's not a situation that gets any media attention or comes to the desk of the minister. It's just a statistic. It's just something that happened, but something that should not happen.

I have occasion to talk to people who work in the health care field. I don't think there's any hiding the fact that my wife is a registered nurse. As a consequence of that, perhaps I'm privy to more events than others. I don't really want to select things that I'm told in that fashion, but the stories that I hear as I meet nurses and go to the floor and talk to them while I pop up to see my wife over her dinner break or something like that are astonishing. Nurses at places like the Royal Jubilee have seen their patient load increase astronomically — I would submit, from a workload of three or four patients to about ten now. Perhaps even that can be handled. But then you see the elimination of support services, of aides, so now nurses are responsible for cleaning the garbage pails and doing some of the work that was traditionally left to aides. These are situations that I hear over and over again at a place like the Jubilee, where there's one orderly to look after the whole hospital, including the Eric Martin Pavilian. Staff are incensed at that.

Just the other day, Mr. Speaker, a patient died on one of the wards at the Royal Jubilee because there was inadequate — it's very true, inadequate is the word to emphasize — staffing. The nurses, of course, attended to the body, and because there were demands from Emergency to make sure that a bed was available for someone who had come in, the body was placed in the coffee room that the nurses have. No one knew about that; for about two hours it was kind of forgotten. A new shift of nurses came on. One of them happened to walk into the coffee room and was confronted by this corpse that lay there. During the course of the same shift, while most of the staff were downstairs for their lunch break, there was a cardiac arrest. Again, there was some delay in nurses getting up to the unit to attend to that person.

I guess the point I'm trying to make is that when you talk about the people who work there.... The feedback I get from the people who work there is not only a sense of disillusionment and not knowing why the level of work is increasing and the level of stress is accentuated.... That's one element of the problem. They never seem to know why hospital boards make certain decisions or why money never seems to come down to the floor in the fashion that all the press releases suggest the government is handing it out to the hospitals. There's no understanding at the floor level why some of these things are happening.

Far more important than that, morale suffers. This is symptomatic of the whole public sector these days, given this government's propensity to attack public sector workers. Within the health care system there is a morale problem. People perform their jobs; they come from a training — particularly nurses — where they believe in providing quality service and they are willing to give of themselves to make sure there is an adequate delivery of those services. They are prepared to toil under some incredible circumstances to try to make the system work. But the demands that are being placed, the situation as it relates to the workplace, the environment, and the conditions under which they work are quickly becoming intolerable, and morale is exceptionally low.

Many of these things are far removed from the desk of the minister and from the confines of this chamber and from all the political rhetoric that goes on back and forth in the banter of this House. But these are important things, because what we are here for is to make sure that patients have access to first-class health services without financial barrier, so you don't need women transported all around British Columbia to see whether or not there is a hospital to receive them. People deserve to work in an environment where there is proper staff, where morale is good, where you can utilize to the full extent their genuine talent.

I know I've brought to the minister's attention other situations that cause one to shake his head. I have a physician in my riding who has been practising as a general practitioner for some time. I don't want to get into the details, because I know the minister is looking at it. Here you have someone who is young, who's moved to this community, who is prepared to set up in this community, who hasn't gone out and acquired a practice but set up and, through his own labour, built his own practice. Because he's chosen to take that route, effectively, he is now denied privileges at all local hospitals. That's frustrating and costly, because it means that he has to now fill in another physician who has those privileges, which costs the taxpayer, in order to make sure that his patients are attended to when they inevitably arrive at a hospital.

Think of the patient. Think of the mother-to-be who has been under the care of a particular physician for some time who then tells her: "Well, I'm not going to be there for the delivery because I can't get privileges at the hospital." It really is a sad state of affairs.

I know what the minister is going to say: he's trying to do his best, and he understands all these problems, and you can't simply come up with a definitive number of dollars to attend to these matters. I've heard the minister say that several times

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in this House. The feeling that I get more and more is that it's not just the cash that's lacking; it's the political will that appears to be absent in addressing these types of problems. I think that the people of British Columbia, the people that we're all asked to serve, deserve a lot better.

I think I've made my point. I don't want to belabour it, and I don't want to flourish it with type of language that sometimes even I use in this House. I think the minister understands what I've got to say.

I want, however, to ask the minister just one question, and if the minister does not have the information at hand to answer that's fine. I talked to Mr. Dubas about it yesterday. I'm just wondering if I can get an update as to whether we see the possibility of a health clinic in Esquimalt. We are the only community in the four core areas of greater Victoria who do not have a health clinic. The CRD has approved the concept. The municipality has set aside land for it. In fact, we started that process when I was on council, prior to the 1986 election. Can the minister bring us up to date with respect to that issue?

HON. MR. DUECK: I'm certainly pleased he's not going to go into the language and excitement that he does at times — he admitted that he did at times — and neither will I. I think we'll keep it on that basis.

I'll deal first with the Esquimalt issue. I understand there has been some formal application made. It's being reviewed now by my staff, with Dr. Perry Kendall. I have no further information as to where it's at, but I will keep you up to date on it as I get that information.

I think the hon. member mentioned to begin with that perhaps I wasn't concerned. I think we all are concerned. I think both sides of the House are concerned when it comes to health. Maybe I can't accomplish everything I want to accomplish, and therefore it appears, when you talk about certain instances that happened or certain times when the system is not operating as it should, as though because I'm the minister and responsible the concern is lacking. But I want to assure you that is not so.

I also don't think I ever indicated that I fully understand all the problems. I do not. I will freely admit that. I do not understand all the problems, and I'm not going to tell you that I understand what they are and how to solve them. It is something that you do on a day-to-day basis, because every problem is different and the solutions are different.

The hon. member started his remarks by saying that there is an erosion of health care. I must take exception to that statement. There is not an erosion of health care. As a matter of fact, the health care in our province — and you can go back 5, 10, 15, 20 years — is better than it's ever been. There are faults; there are things that are not right; there are things that need correcting which are corrected — some not as soon as you may wish, and maybe not as soon as I would like to see. But they are being looked after, and the system is not eroding. It has to be the best system in the world. For every letter I get that has a complaint — and, I might say, a legitimate complaint; it must be followed through and looked at to see why it happened — I get hundreds of people who say: "I can't believe the service I got while I was in the hospital." I get this again and again, notwithstanding the fact that there are people who have legitimate problems, who perhaps have a reason to say that things didn't go right while they were in a hospital.

However, when we're talking about specific incidents.... I know you didn't mention names, although I know the letter you speak of. I don't think I can comment on that either, because it takes time to follow it through. It will certainly be looked at and corrected.

As Minister of Health — I think you are aware of this — I don't make hospital or medical decisions. We fund the hospitals on a global basis. If there is a serious matter, we do check, follow through, find out and try to help people who have a problem, who are concerned. Basically we fund the hospitals, and we give them a global budget. That's why they have a board, a president and an administrator. They function as an autonomous body. I'm glad they do, because heavens, I wouldn't want to be involved in the day-to-day operation of all 135 hospitals in the province. I must say again that by and large the hospitals operate very efficiently. Maybe it's at the point where they're so efficient it hurts some members of the staff, and sometimes corrections have to be made.

When we're talking about nurses and the role they play in the total system. I cannot argue with you: they work very hard and diligently. They do their job very well; they are very dedicated. But they are not all unhappy, as you might indicate. I meet many of them. I've got relatives and friends who are in the nursing business, physicians who are in the nursing business, presidents.... I know many people in this business, and the majority of them are very happy. They do their best to make the system better from day to day, and they do improve it in many areas.

I do not believe that we have such a tremendous morale problem. I think there are times when certain sections are more unhappy than others, especially when it comes closer to negotiation time, of course. Then it becomes even more so.

The incident you mentioned about someone being turned away from a hospital.... Again, I'm not going to comment. We're speaking of specific incidents, and that's not for estimate time — going into detail. When someone is ill in the hospital, I can certainly understand that they have anguish. You're not going to get anyone in the hospital who hasn't got some concern, and family members are the same way. You will have people say and do things that perhaps under normal circumstances wouldn't be an issue.

[10:30]

I  sympathize with those people, and they must be looked after the best way possible. Their anguish is such that very often the concern is on that particular person, and rightly so. I think our staff — the nurses, the hospitals themselves — have a concern. I don't know what you're speaking of when you say that people aren't looked after and that the system is eroding. I really can't buy that. If you talk about specific instances where perhaps someone erred and a mistake was made, yes.

We have roughly 28,000 nurses in British Columbia. I'm sure there are unhappy ones. Some are very happy; some are very dedicated; others are perhaps not as dedicated. But I have found or have heard of very few who were not dedicated to their work, because with the pay they get and the burnout rate, they have to be dedicated to be in that business. It is a tough business. I hear them talk and I know people in that profession, and it is not easy; it is a tough job.

I understand that your wife is a nurse and a very good one. She should know better than anyone that the system is pretty good. I would like to speak to her alone sometime. I think she knows that the system is operating quite well, by and large; it is a very complex system.

You mentioned cardiac arrest and some of the problems that arose. It's certainly something for the critical care team

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to look after, and again I cannot comment on an individual case.

You mentioned a doctor who was denied privileges. Again, it's a specific thing that I don't think I'd want to discuss in public at this time, and I don't think you would wish me to.

I think I've gone through most of it. By and large, I think the main emphasis, your theme, was that the system was eroding, and I have to take exception to that, because I don't think it is. I truly believe it is not eroding. There are problems, and there will be problems whether you become government or whether there's another Minister of Health from this side. There will be problems as long as you have a complex system like the health care system in British Columbia or, for that matter, anywhere in Canada. But it's still the best system in the world, and I think British Columbia ranks with the highest in Canada as far as our total operation is concerned.

Mr. Chairman, I would like to answer a question I took yesterday and was going to bring information back. It was in regard to the adoption reunion registry. Questions were asked about how many people had registered and what success rate there had been in the time since the new legislation was passed. We have had 413 who have registered with the registry: 190 were parents, 223 were children, and four matches have occurred to date. That's the latest information.

MR. ROSE: I'd like to make a couple of remarks following those of the member for Esquimalt-Port Renfrew (Mr. Sihota).

I have no idea whether the health care is better or worse than it was before this minister took office or over the past 20 years. But I will tell the minister that in the 20 years I've been in politics I've never heard so frequently of cardiac ping-pong in the admission of people in a crisis situation. There were two examples in my own riding over the last year where people got ping-ponged from hospital to hospital before they got admission. That's very frightening. I don't know the reasons for it, but I will confirm that it happened. The member didn't raise an isolated issue. I don't know how frequent it is, but I know that in my own riding, two people got in touch with me about this matter.

I've heard of other people who say they've had their parents in the corridors rather than in a room at Royal Columbian Hospital. I didn't go down there and see them in the corridor, but this is the kind of report we're getting. I think the minister should be aware that it's not isolated.

Sure, this minister can confirm that there's more money going into health care, but I think the point made by my colleague is an important one. Maybe it doesn't trickle down to the floor, or maybe it's going elsewhere than into direct patient care. I'm not going to say that the care is bad in hospitals. My mother was in there two years ago and received excellent care. I was very grateful. I was in there every day. The only problem I saw in Mission hospital was that some of their beds were taken up by mental patients instead of chronically ill people, because there was no other place for them to go at the time.

I would just like to emphasize that this business of cardiac ping-pong is not isolated; it's fairly common. It happens in Esquimalt; it happens in the lower mainland and in my own riding. I'm one of 20-odd ridings in the lower mainland, so I assume it must happen elsewhere as well.

Yesterday I got a call from a woman upset about her daughter's care in a hospital in Victoria. She said one nurse is looking after 14 babies in the nursery, and in terms of her own concern, there was not decent cleaning done in various places. There were no gowns. The child wasn't bathed. Those are serious charges.

The minister made an excellent point: when people are in hospital they are emotionally upset. I am not saying that this woman was exaggerating at all; I don't know. But I think there's an unease out there about it. The minister should know about it, and in my view this is a proper forum. I'm not making charges against the minister, the care, the nurses or anybody else, but I know this: if there are choices that have to be made, sometimes the things like this woman phoned me about in this particular hospital in greater Victoria are coming to the surface. Also, the things my colleague from Esquimalt-Port Renfrew mentioned are true: if there are choices to be made, sometimes the cuts are made at the floor level rather than elsewhere. God, I wouldn't want to have to make some of those decision, so, again, I'm not being critical about that, but this is information that should be important to the minister.

HON. MR. DUECK: The so-called ping-pong you are talking about perhaps didn't occur in previous years because we never did open-heart surgery some years back. You have to take into account that we are doing now in one year over 2,000 open-heart surgeries and many angioplasties, which wasn't the case just a few years ago. The new technology....

MR. ROSE: Could I interrupt just for clarification? This is a heart attack. This wasn't waiting for open-heart surgery. That well might have resulted in the future; I don't know about that. I'm talking about somebody suffering from a severe heart attack and trying to get admission to a hospital. I'm not talking about open-heart surgery.

HON. MR. DUECK: I didn't quite understand what you meant. I thought you meant open-heart surgery when you said ping-pong from one hospital to the other. I can tell you that if someone has a heart attack, they will get attendance immediately. If you gave me a case where someone was down with a heart attack and could not get entrance into hospital, I'm telling you that there would be problems with that hospital or any other hospital. I'd like to know that specific instance. If somebody is down with a heart attack, they get admission immediately. They have to. Any emergency would get it immediately. If that physician thought, in his good judgment, that this was a mild whatever and they could wait another day, that may be so, but I've talked to enough physicians, and if there is an emergent case or an emergency, they will get attention. I hope I am correct.

As far as the Royal Columbian — you mentioned that — yes. When it comes to emergencies, they don't come on a regular basis. You may have one day when there are hardly any and then you'll have a whole number of people come in on another day and you will have crowded facilities. If we had to provide facilities — instant beds — in every hospital to cope with emergencies every day all days, you and I could not afford it, and you know that. That is impossible. There will be exceptions and there will be low days and high days — it varies. When you look at their daily monitoring, waiting-lists, emergency entrance and hospital admittance, there is quite a difference. You can check with any hospital

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that you like and that is so, especially since we took off the emergency user fee in the emergency department. That went up drastically in that particular section too — but not every day; it differed,

We have many improvements. If you are talking about the advancement in health care, we can go into that a little too. For example, lithotripter — where we used to have three or four days or maybe a week in a hospital with a major operation — now takes a couple of hours. So there are many advances. All these advances of course cost money — some save money — but in general terms they are certainly much better for the individual and for the people in the province.

You spoke about maybe the rooms not being clean. I'm sorry to hear that. A hospital has to go through an accreditation program, and if there is a lack of cleanliness in a hospital, that certainly is not good. I agree with you that it should not happen. If it does, it should be brought to our attention or to that of the accreditation committee that comes around. My office, for example, wasn't cleaned last night. I'm sure that's not the rule, but it so happened. So I suppose that there could be instances in a hospital also where some cleaning person on the contract that was let to that particular firm did not do a good job, and they probably would have to re-evaluate that particular business that's doing it on contract or otherwise.

Hospital programs monitor the non-emergency surgery waiting-lists, in-patient and day care of the province's 13 largest hospitals on a monthly basis. Over the last two years there has been an increase of 3.7 percent in the overall number of patients on the waiting-list, so there is an increase. There continues to be backlogs for specific types of surgery such as hip replacement, due to availability of surgeons, shortages of specialists or of critical care staff and increased workloads at individual hospitals,

[10:45]

On average, approximately 80 percent of in-patients and 85 percent of day care patients wait less than eight weeks for non-emergency procedures. I'm saying that if it is emergent, it should be done immediately, but if it is non-emergent, 85 percent wait eight weeks. Hospital medical staff agree that in most instances a four- to eight-week booking time for non-emergent surgery is required for effective management.

I think I mentioned it yesterday, but just in case I didn't, we have given the Vancouver General Hospital an extra $3 million plus some odd hundred thousand to do an extra 250 open-heart surgeries. Hopefully this will catch up on the waiting-list, which was a concern of ours too. I think everyone waiting for that operation had a concern, and I can understand that. I believe this year will be much better than last year.

MR. ROSE: The minister mentioned the pile-up in emergency services that happen from time to time. He mentioned that in response to my mention of Royal Columbian. In that event, there's a hospital in my riding that's half empty. When does the minister intend to open emergency and other services for that community — including obstetrics and a number of other services that are very important to young families?

HON. MR. DUECK: I can't give you the date, although I'm sure the hon. member is aware that this is under consideration. Perhaps if you let me get out of the House soon, I can get this thing started and make some announcements. There have been negotiations going on with the mayors and the people of the area. There were some problems to begin with, and they weren't all coming from the ministry's point of view — and not all financial either. There were some other problems where physicians did not wish to go to that particular hospital. There were many problems, but I think we've got them pretty well ironed out, and we've got a report back that's in the ministry's hands now of the hospitals involved in that particular catchment area. We've come to an understanding and an agreement, and you will hear some good news very soon for your constituency.

MRS. BOONE: I wasn't going to get into this issue at this point, but I'll make a short comment here because of the minister's comments with regards to the ping-pong effect. We're talking cardiac. The member for Esquimalt-Port Renfrew was also talking about a cardiac arrest problem where the person was not admitted to hospital. I find it a little hard to understand how the minister can say that they can't provide all those services and yet, for a change, the outlying areas seem to be able to cope a lot better.

I don't know of any emergency that's ever been turned away from a community that has one hospital. They certainly don't ping-pong people between Prince George and Quesnel, for example. We just have the one hospital there, and that hasn't occurred. If the areas with a single hospital are able to provide sufficient emergency services for their community, then surely the other community hospitals ought to be able to do the same for their communities. It's just not acceptable to have people in cardiac arrest being bounced from hospital to hospital.

I'd like to get into the prevention end of things. I mentioned in my initial comments that the government is talking prevention, but I don't see a lot happening in that respect. Yesterday we talked a little about mental health services, and I expressed my concerns about the lack of services in the mental health areas and the cutbacks that have occurred there. It was interesting because while we were trying to figure out just what was taking place in mental health, we phoned around to many of the mental health areas and got some pretty standard answers, until we got to a couple of them who said, "This is the answer, " and then off the record: "This is what's happening."

It became quite clear that there is definitely a move out there to privatize many of the services. You're doing it through the contracting-out process. When you contract to individual psychiatrists in areas, they — as we all know — come on contract at a rate much higher than the individuals employed by the ministry. Again, the issue that I was talking about yesterday was with regard to moving some of our services over to societies and having societies providing those services, rather than the ministry actually hiring people and putting people into communities, so that the ministry is responsible. As I stated, societies do a very good job, but the ministry has the ultimate responsibility in providing these services. We just don't see those services happening in our areas.

There are some other prevention things that I just don't understand. The Minister of Finance (Hon. Mr. Couvelier) in his budget speech mentioned the commitment to prevention and keeping people well, which is something that I promoted last year; yet the total expenditure in the preventive service budget is only up 1 percent. A 1 percent increase does not show a very strong commitment to ensuring that prevention is

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promoted in the province. The total operating costs are actually down 5 percent, yet we've seen increases in professional services up 25 percent. I think there's a message there. Professionals contracting out services are getting a larger chunk of the budget, yet the overall operating costs of the ministry in the preventive services area are actually down. Fees, allowances and expenditures: expenses are up 74 percent in those areas. We see a 1 percent increase in prevention, and then some large increases in expenditures that I believe are going to outside contractors and not being held within the ministry. There is a strong concern that we hear lip-service; we do not see the programs taking place, and we do not see prevention really being promoted in the province of British Columbia.

I understand the ministry has been working with the health units, the union boards of health, to develop a community-based health system, which of course is something that we have been promoting. The use of community clinics is something that has long been a New Democratic process, and something that we have promoted at all times. But I'm a little concerned when I hear and read the suggestion that the union boards of health be given taxing powers; that is a resolution coming from the union boards of health. The suggestion that the communities review their needs and then develop the ability to service those needs suggests to me that perhaps there's going to be a shift back onto the local taxpayer again, as the communities develop a list of their needs, saying: "This is what we believe are our priorities." Then the ministry will say, as they've said to the schools: "You as a union board must go to the local taxpayer in order to support these programs," I pointed out to the minister in my opening remarks that you can't just take the amount that the ministry spends and say that this is what health is costing in the province of British Columbia. We as taxpayers are paying constantly out of our pockets for health as well. You have to take those considerations into account.

If the ministry is to put it back onto the local taxpayer, that is not reducing the health costs at all. If the ministry puts things back in the form of user fees, that is not reducing the overall cost of health care to the people of British Columbia. It means that your tax bill may not be as high, but it means that you're paying out of the pocket in user fees; you're paying out of the pocket in other areas of taxation, and usually in a regressive area of taxation, not a progressive one. So you have to consider all of those things.

I'm really concerned as to what's happening with this community health board, and the fact that they are trying to give the union boards taxation power, and what it would mean to the people of B.C. if we have the municipalities taxing for their local taxes, for sewers and water and roads within their cities. You have school board taxing for schools to achieve the same level, and now we are going to have our union boards of health taxing people so that they can achieve certain standards of health in their communities. This is totally opposite to the universality that we should be striving for in this province.

I would really like to have the minister's comments with regard to the suggestion that the union boards of health have taxing power; and also the fact that the budget has only increased 1 percent, and how can you promote prevention when you have only a 1 percent increase?

HON. MR. DUECK: Mr. Chairman, in regard to the increase, perhaps the member would like to know that we have taken a number of things out of that section of the budget and transferred them to Pharmacare. For example, for the funding for advertising related to the prevention of unwanted pregnancies, there was $525,000 — that's been put into Pharmacare. The responsibility for the home oxygen program was transferred to Pharmacare. That leaves an increase in preventive services of 2.9 percent rather than 1 percent, as you suggested, so it may explain a little bit of that.

I want to go back a little bit, because the member started with emergencies being turned away. I hope that when you have a specific incident like that, somehow either the individuals involved or the family — whoever — would bring it to our attention. I just cannot imagine in my wildest dreams, if it is serious, and someone is having an attack, that they would.... I didn't use the word "ping-pong"; I only repeated it. It was your member that suggested that phrase. Maybe it is appropriate wording to use, but it sounds rather inappropriate, to my way of thinking. I hope that doesn't happen. If it does, I would like to know about it, because it certainly is not acceptable.

We contract out to professionals — I think you went on for quite a while, hon. member, on this — but we find it very hard to actually attract people on salary. These professionals do not wish to work on salary; they prefer to work on contract, on a sessional basis. There are some communities that wouldn't have any service at all unless we had them on a sessional basis. So it's not just that we are contracting out, perhaps indicating that this has something to do with privatization. This has been going on all the time, and we find it more and more difficult to put someone on staff. They would rather work on a sessional basis. That is probably one reason that there are more of them working in that area than on salary.

Community boards of health. You were talking about various ways of taxation. Actually, a lot of this flows from the people involved in the community, from the members of the board. They're asking for this type of authority. It's not necessarily that we are suggesting that they should go in that direction, but rather that they want more autonomy. This has been brought to us again and again. They come and meet with us and say: "Let us tax. Let us use the money. Let us spend it in our own way. We can look after it better than you can." So it's not a thrust from the ministry as much as it is from these people who are in fact requesting it. Thus far, of course, it has not been done.

User fees versus what you call a progressive tax. That's a matter of philosophy; that's an option. Yes, we can argue here for hours about which is better and which way it should be. Perhaps you've got a point, and perhaps I've got a point. The present system is the way it is. You can criticize that and perhaps make some good points using a progressive tax method, where everyone is taxed on income rather than by a user fee.

[11:00]

In the area of prevention I think you mentioned that very little is done. In the last year, this government has perhaps done more in prevention and has been going in that direction at a greater speed, or has put more emphasis on it, than ever before. Just for the record, I would like to name some of the areas so that you are aware of the ideas we have in mind and the direction in which we'd like to see our thrust or our emphasis being placed. In the area of priorities, for example, non-smoking is often played down, because it's a legal commodity and we all have friends and relatives who use that particular product. But we find — and I think yesterday I

[ Page 5039 ]

mentioned 6,000 — 60,000 a year dying in Canada of tobacco use. That area alone, if we could eliminate the use of tobacco and the abuse of alcohol, would probably have most of the hospitals half-empty. We're not putting much emphasis on that, but it's a very big-ticket item in Canada today, and we should all be very concerned about it.

We're talking about healthy diets; that's one of our priorities. We're talking about dental health. We're talking about infectious disease control, and that includes AIDS, sexually transmitted diseases and immunization. We're talking about physical fitness. Much emphasis has been put on physical fitness by the Canadian government and also by ours. Accident prevention, child and family health, workplace health and safety....

What are some of the things we're doing at the present time? This is perhaps a very small item, yet I think it's very important: we're distributing the Baby's Best Chance handbook to expectant parents in British Columbia. I think it's a second edition now; we printed it last year. It's very widely accepted and used. I think it's very important. There is much information in that little book that deals with exactly what you are speaking of.

Providing community support for the family life education program from grades 7 to 12; providing health expertise for the new health and guidance curriculum which was put in last fall; distribution of AIDS information to the general public; information line; AIDS information to the workplace, which was distributed here about three months ago, in addition to the one that went to every household; distribution of the back injury prevention program, back check, to hospitals; development of employee health and productivity programs in the workplace; design and distribution of wellness promotion programs for seniors and retirees; "keep well — choosing health, " which is very much involved with the Victoria Health Project that's just getting off the ground now; assistance in initiating volunteer senior support programs; peer counselling; obtaining cooperation of restaurants in identifying and offering low-fat diet choices on their menus; continued promotion of non-smoking environment; and Counterattack, which has been extremely successful: these are all preventive measures that this government has taken and has been very active in delivering to the public.

The ministry's Advisory Committee on Health Promotion and Wellness has just begun, as I said. It is working to develop strategic objectives for future programs and activities in the field of health promotion. That is something very new, and we haven't really seen the results of it yet because it's just in the beginning stages. I believe it's a good program. It will do much, especially for seniors, but also for the other segments of the population that aren't necessarily in that category.

You mentioned that your government at one time had promoted this and had introduced this type of health care. I have to admit to you that it was good. We may do some things just a little differently with new technology that's on the market today. Things change from time to time. But the thrust that your government was endeavouring to deliver in this province.... I believe the direction we're going now coincides very well with the approach you had some years ago.

MRS. BOONE: I thank the minister. I certainly agree that we should be promoting anti-smoking in our schools as much as possible. I have no friends in the industry, so I don't feel reluctant to say that at all. And the alcohol prevention. We have, at various times, stood and asked this House to acknowledge the problem in alcohol, as the minister has done, and to stop the privatization of the liquor stores, which we feel is not in the best interests of prevention. As you know, the private sector are in the business to make a profit; they are there to promote, and we don't need the promotion of alcohol in this province at all. We feel very strongly on those issues. I'd like to see the minister taking a stand on that as well — taking a stand openly against the privatization of the liquor stores. It hasn't come out in public at all, Mr. Minister.

There are a lot of issues that I don't believe are being addressed. I'm not sure whether this change from the transfer to Pharmacare affects us or not. Usually when something is transferred within the budget, the last year's figures are revised accordingly. That's always happened in other areas. I have a feeling that we still may have some problem with regard to the overall budget.

There are still some tremendous things that are against exactly what you are saying. You are promoting prevention, and the government has stated that this is what they are trying to do: keeping people well. Yet you still maintain the user fees on physiotherapists and the massage practitioners, and all of those areas which are, as you have acknowledged, preventive. They keep people well, they keep people mobile, they keep people in their homes, they allow them to stay out of hospital — all of those things. As you yourself indicated last year, these fees are there to deter people from using these areas which you have now agreed are prevention. Surely if we are serious about prevention, we ought to be promoting the use of these areas to keep people well and in their homes.

I still have some very strong concerns about the taxing powers for the union boards of health. This is what I was talking to you about. You mentioned that the union boards of health are saying they want more say in how moneys are spent within their areas. I certainly agree that communities ought to have more say in how moneys are spent within their areas, but I know that union boards of health, through the associated boards of health, are trying to get taxing powers for their boards. As I stated. this is a process that I certainly would not support. I don't believe it's in the best interests of the public, because once again we're going to get into the situation, as we have with school boards, where the provincial funding is held back and it comes more and more onto the shoulders of the local taxpayers to provide the services in their communities.

The minister states that the union boards have asked for this. The union boards may have asked for it, but can we get a commitment from you that this is not going to happen — that we will not see local taxation occurring in order to support local programs in the health care field?

There are some other areas that I'm concerned about within the whole prevention end that takes place at the health unit. One is a standing problem that is occurring all the time, and it has to do with the staffing of specialists in outlying areas. The minister has my sympathy; it's a very difficult area, and one that I think any government would have difficulty in dealing with. We did some calling around to try to find out what the staffing problems were. We phoned the various regional offices and found that it's the same as it has been for years and years: they have problems attracting and maintaining the speech pathologists, audiologists, dental hygienists and physiotherapists. The minister dealt with this problem in Prince George by putting in the dental hygienists'

[ Page 5040 ]

program, and it is one that we're very grateful for. Hopefully we will be seeing the results of that in a short time. I believe, as many people in the province believe, that that is the way to go about this.

Right now we still do not have enough physiotherapists being trained at UBC. There has been an increase, but it has not been substantial enough to deal with the backlog. I know that the minister has to work with another minister in trying to get that put through in the post-secondary field. I would encourage the minister to press his adjoining minister in postsecondary education and job training to provide training at the local level for those services. I don't care which area of the province you go to, there is a two-year syndrome there, particularly with the speech pathologists and audiologists. We constantly bring in people from the U.S. for a two-year period. They have to stay two years; if they leave before that period they don't get their transfer money paid. They wait for two years plus a day, then they're gone, and the community is back seeking some way to service those areas.

We feel very strongly that if our own people were able to train within their own communities, we would stand a far better chance of keeping them, as we hope to do with the dental hygienists through the dental hygiene program in Prince George. What I'm asking the minister, then, is: what are the results of your discussions with the Minister of Advanced Education and Job Training (Hon. S. Hagen) on this issue? It's not one you can handle on your own. You have to get agreement. It's certainly one that I know you're aware of and are struggling to deal with, as ministers of Health have done for past years, and probably will for many years to come. It's certainly one we must address, because it's a real problem in the outlying areas.

HON. MR. DUECK: Again, user fees on supplementary services are in place. It is doing what it is intended to do. The people who need it have access to it, and the low-income people do not pay the $5 charge. If I had my druthers, I would also have a user fee in doctors' offices and hospital emergencies. As long as we have a very generous safety net, I think we would do well with that type of system. That happens to be my philosophy and not necessarily yours.

[11:15]

Taxing power. Yes, the municipalities have asked for it, but when we're talking about the average municipality, it certainly hasn't got that taxing power, and whether or not they will ever have it I can't state at this time. When it comes to revenue, of course, it's in the purview of the Minister of Finance. Some municipalities — for example, the city of Vancouver with the enhanced services they offer — already do tax people for health services. It is in place in areas like that.

As far as the universities are concerned, I think the same question was asked last year. Yes, I'm in constant communication with the Minister of Advanced Education, and we lobby very hard because this is a problem. When it comes to physiotherapists, occupational therapists, speech pathologists and audiologists, we are in short supply. We have the bursary program, which I think you are aware of, and it started in 1986. We've established a grant program for allied health services which is working quite well where we offer a $5,000 award upon graduation to positions in areas of need as designated by the Ministry of Health. We have a number of them who have actually graduated and are working. I'm glad to say at this time that it has been successful, and we're very happy about that.

We still have shortages, especially lately with the speech pathologists and audiologists. We find that many of those people like to work for fee-for-service rather than work for us. They're very difficult to attract. One of our main objectives is to fill those vacancies that now exist. There has been some talk about a university in the north. I'm sure that you, being from that area, are well aware of it. If that should happen — and I'm not in any way suggesting it will — and they could train individuals living in that area as health professionals, I think it would go a long way in keeping people in that general northern location. I'm hoping that this will come about, and maybe some of our problems in the shortage of some of those health professionals would be.... If not entirely eliminated, certainly it would help.

I understand UBC is doubling the size of the class of physios. They are going from 20 to 40 this coming year. I hadn't heard that before. That is a big amount; it is double the number. I'm glad to hear that.

We also have ongoing committees that work with the Advanced Education and Job Training ministry. We're not looking just at these professions. We're looking at registered psychiatric nurses and alternative training and upgrading of education of RNs. We have many now seeking to advance their education so that they can become registered nurses, and I hope that continues. In all the areas of these professions, we have a general short supply. It is a common phenomenon. It's not that there are less people in the industry. There are probably more than ever before, but the need for them and the use of these professionals is greater than it has ever been. There is a shortage in all those areas, but we see some light at the end of the tunnel with some of the things that I have mentioned to you.

MRS. BOONE: It's nice to know. Can I quote the minister by saying that the Minister of Health supports a university in Prince George? Is that right?

I have another area of concern, and that is some changes that are taking place within the whole dental prevention program. There's a problem, as we know, in obtaining and keeping dental hygienists. In the past, the dental program was under a dentist, Dr. Gray, who was in Victoria, and they had control of their FTEs. The FTEs have now been transferred under the control of the medical health officer. As a result, positions are being filled that were designated dental positions. Because of the difficulty in filling them, they are being filled with other capacities — nursing capacities, for example. That makes sense in the short term, in that you've got the FTEs there and you might as well use them, but the long term is: what is the result of this to the dental program? When you fill a position on a temporary basis.... For example, if you hire an auxiliary nurse, you obviously have a program you are fitting that nurse into; you have something that has been planned, and that person has to be there for a required period. If during that time a dental hygienist becomes available, then obviously you're not going to be able to hire that person, because you've already filled the position with an auxiliary.

I'm really fearful of what I see as the demise of the dental program in British Columbia, a program that has a proven record. It has statistics that show the number of cavities and the number of teeth extracted. All of these things are reduced when the dental teams go into the schools and refer children from there to dentists. It's working so well and dentists are doing such a good job in prevention that they're fearful for

[ Page 5041 ]

their jobs in the future. It is a very good program, one that has a proven record of being able to work by early intervention. I'm very concerned that it is going to fall by the wayside because of the priorities being placed on it.

I have a letter from the East Kootenay Health Unit which indicates that there's a change in focus:

"To facilitate this change in focus we are reviewing services with a view to transferring some of our functions to other disciplines within preventive services.

"This has implications for school health services, particularly vision and hearing screening. The goal for the 1988-89 school year is that the audiology division will coordinate hearing-screening and dental division will assume vision-screening."

There is definitely a move there to take those people and use them in areas that they have not been trained in. We are taking trained qualified dental people and using them to do vision screening, which seems a real problem.

I understand that this is because of the lack of ability to attract dental hygienists, but I have some real concern as to what's going to be the eventual end with this program. Is it going to eventually just fall by the wayside as the medical health officer consistently fills positions with nursing positions and creates programs that those nurses are going to do? Are we eventually going to have no dental hygienists in that area? Without our maintaining those FTEs and keeping them there and making a determined effort to fill them, I can see that eventually we won't have a dental program.

HON. MR. DUECK: Dr. Gray has taken early retirement, as I'm sure you are aware, and I understand that he is going to be replaced. The dental program is not in jeopardy. It will not fall by the wayside. We certainly have no intention of discontinuing it. There are reviews going on from time to time. Dental hygienists, for example, are in short supply; sure, that's true. We are working with the dental college constantly, reviewing and trying to fill positions that have become vacant. I can assure you that we are concerned about this area and we are not in any way indicating or even going in the direction of trying to discontinue that program.

MR. GABELMANN: I want to very briefly raise a matter to do with speech therapy and child development in the North Island area. The problem that we have not only in Campbell River but throughout the north end of the Island is that there are not nearly sufficient resources for speech therapy. At the present time there are two centres in both the riding of the member for Comox (Hon. S. Hagen) and in my own riding which offer diagnosis and remediation. One is in the Upper Island Health Unit in Campbell River and the other is in the Comox Valley Child Development Centre in Cumberland. The Cumberland centre, as I understand it, a few weeks ago had a waiting-list of 38 children, and it's at least an hour away for people from Campbell River and at least four hours away for people from the Port Hardy-Port McNeill area at the north end of the Island. What that effectively means — the combination of the distance and the waiting-lists — is that a great many children are not able to receive any speech therapy training whatsoever.

Let me correct what I just said. The 38-children waiting list is at the health centre in Campbell River, and the Cumberland facility, which is always running full, is the one that's as much as four hours away. I think I left the wrong impression by the way I put it initially.

We have a situation where people in that area of the Island would feel not that it was a satisfactory solution but that it was at least a solution if they could have the proper facilities in Campbell River to meet the demands of all the children involved, and not have a waiting-list. The Chevrolet solution as opposed to the Volkswagen solution would be to provide a speech therapist in the north end of the Island as well, in the Port Hardy-Port McNeill area — a child development program for speech therapy.

I wonder if the minister has had any discussions with his community care people about the obvious crisis, It's a crisis, in my view, that could be painted in very dramatic political terms. I have refrained from doing that at any point in the last few years, as we've pursued assistance, given my view that to politicize these kinds of issues doesn't produce a solution. I would prefer that we could agree that there is a problem and work together to find the necessary solution.

I see the minister reviewing notes, and I wonder if he's had a chance now to do that and give me some response on the long waiting-list in Campbell River and the long distance for those who feel they need to travel to Cumberland.

HON. MR. DUECK: I haven't got the information as to those specific areas at this time, unless I can get it from someone in the next short while. I did mention yesterday that we're also cooperating with the Education ministry for this particular service. We look after speech pathology until they go to school and then the school system takes over from there. There is a tremendous shortage of these professionals. This type of therapy has increased tremendously over the past years. There remains, as you mentioned, a serious gap in service to rural and remote areas.

In some cases, because the school system does theirs and we get out of it when the school system takes over, we find that we are not attempting to do this in a streamlined manner but rather ad hoc, where each one does their thing. We believe that cooperating and coordinating this service would certainly help. This plan was approved; our two deputies have agreed to it, and it's now going forward.

[11:30]

I think I mentioned yesterday that funding for ten speech pathology positions was approved by the Ministry of Health to be used in developing pilot programs in communities where current service is inadequate or uncoordinated. Communities which fell into those categories were invited to develop cooperative service plans and request funding for speech pathology services. Ten communities have been selected to participate in the pilot project: Alberni, Lillooet, Revelstoke, Howe Sound, Bums Lake, Lake Cowichan, North Thompson, Nechako, Queen Charlotte Islands and Fort Nelson.

If your area has the same problem, perhaps it should also be looked at — whether we can do something in that area of coordinating with the Education ministry to alleviate that particular pressure. I would like to perhaps take that as notice, and perhaps follow through with you about your concerns in your particular area. Perhaps we can help you in that.

There is a shortage, I admit. We can't seem to find enough professionals to fill those vacancies. It's not a matter of funding only, although funding is always a consideration. When it comes to speech pathology, it has been a matter of trying to fill those positions.

[ Page 5042 ]

MR. GABELMANN: The Campbell River Association for the Mentally Handicapped participates quite actively in accepting referrals from the health unit for speech pathology and speech therapy. In a letter to me dated March 29 of this year, the association says — among much else; it's a long letter — that the preschool operated by the mentally handicapped association "receives many referrals from the health unit as well as some from the centre in Cumberland. Currently there are approximately 20 children at Peter Pan" — that's their preschool facility — "who require assessment or speech therapy, while only five receive any help at all." This is the association for mentally handicapped people who are obviously in that situation.

I raised the question with them in discussion about the line we hear all along that there aren't enough trained speech pathologists available to do the work. Their response to me is that in Campbell River alone today, there are four unemployed, fully trained speech pathologists who are available to work. In my understanding, these are women who are unemployed. Their spouses work in some other line of work in Campbell River. It may well be that some of them are senior people who could be transferred out of the community, in respect of the male's job in the family, which is usually the lead job in these situations. But I'm told — I can't do more than just pass on what the Association for the Mentally Handicapped say to me — that there are four individuals who are trained and qualified and may well be available to work, if not full-time then certainly part-time.

I don't know if we've put enough emphasis on trying to retain these qualified individuals. Part of the problem, it seems to me — and I'm not particularly knowledgeable on this subject — is that much of the service is being provided by, for example, the Association for the Mentally Handicapped. Their budget is such that they can't go out and hire more people, but perhaps we can work together to find a way. I accept the minister's invitation to pursue this matter further. I have written to Bradford Gee on the subject as recently as May 25, and perhaps through the process in the ministry we could get together and have a longer discussion about it in the near future.

I want to conclude by saying that if there are people available to work, whether full-time or part-time, for the ministry or for a community agency, let's find a way of putting these people to work, because there are just too many children now not receiving any therapy whatsoever. I am sure there is no debate about this: society is going to pay a real price in the years to come if we don't have these programs fully operational at this point in those children's lives.

HON. MR. DUECK: All I'm going to say on this issue is that I appreciate what you mentioned and we will certainly endeavour to look into it and inquire whether this is fact and whether we can help the situation — the shortage of professionals for that area.

MR. R. FRASER: I am going to go back to a story given to us this morning by the member for Esquimalt-Port Renfrew (Mr. Sihota) with respect to the woman who was taken from her home in Ladysmith to the hospital there, and thence to Nanaimo, Duncan and Victoria. I suggest that if anybody should be furious about the system that worked for that lady, it should be her family and, indeed, ourselves.

I can think of nothing more ridiculous than transferring the lady all over the Island if she has to go to the hospital. I suspect that this would be a perfectly legitimate excuse to privatize the ambulance system, if we've got people driving all over the Island. Either that, or we've got a problem with the hospitals not being adequately managed, because there must be one emergency bed somewhere in that hospital that could take that lady.

It didn't matter to me that he mentioned that she happened to be an East Indian woman, because that was not important as far as I am concerned. There is no way that a person in real need should be driven all over the lower mainland, or the lower half of Vancouver Island either. My understanding from the minister is that certainly in the lower mainland the ambulance services have radio contact with the hospitals, and I presume that the same system applies on the lower half of the Island.

The question is: what was happening inside that ambulance? Why weren't phone calls being made? Why wasn't some preparation being made? Indeed, if she can't go to her own community, you would expect that before they drove to two or three other places there would have been some contact with a hospital somewhere that would have given those drivers an answer as to what was available. I don't know why that happened, but certainly I expect the minister will look into that and will be talking to the member for Esquimalt-Port Renfrew to find out when that happened and why. As far as I am concerned, it is inexcusable.

He also talked about people waiting for heart operations. It's my understanding, Mr. Chairman, that the determination of the risk of the patient is solely that of the doctor. I've had phone calls from constituents who've said to me: "The doctor told me to phone my MLA, because he said it was the government's fault that my husband" — or wife, whatever — "couldn't get an operation." I've investigated every single one of those phone calls, and in every case I found that the doctor's assessment was that the risk was low; it was not a big problem. But in order to get the spouse onto some other tack, they've been pushed onto me. Frankly, I have little respect for doctors that do that sort of thing, because they should say to the patient: "Your husband or your wife is not at a great risk." We all know that doctors aren't perfect.

The other thing doctors tell me is that one of the reasons that patients can't get into the hospital, even when they're scheduled to come in, is that we have emergency people taking up the beds: accidents on Friday and Saturday nights, and Sunday and Monday and Tuesday. So it's not possible to perform even the planned operations, because of emergencies of the previous day. I don't know that we're ever going to be able to solve that problem, unless we're going to think of spending hundreds of millions of dollars having extra spaces available. I've got a feeling that since we fund the hospitals on the basis of occupancy, some of the emergency wards are kept full when they really don't need to be. That does raise some interest in my mind.

What worries me more than any of the conversation I've heard on this particular set of estimates is the suggestion by the Leader of the Opposition that we should be spending something in the order of $3 billion more in health care, education and social services. While I say it in a very calm voice, it's strikes me that if we were to even contemplate spending $3 billion more, we again have to relate it to the taxpayer, the person who pays the bill. It would take our budget from $10 billion to $13 billion, which obviously would have a drastic effect on either the deficit that we run or the taxes that we raise. The taxes that we raise the price

[ Page 5043 ]

of the product, and the product has to be competitive, otherwise we don't make the sale. It's a huge problem.

I understand that he said very casually in an interview after the Boundary-Similkameen election that he would increase welfare rates by 50 percent — a casual off-the-cuff remark about a 50 percent increase in welfare rates which would cost the taxpayers of British Columbia something in the order of $500 million. I don't know who's paying attention to some of these numbers, but those are big numbers, and every one of you in the gallery and all of us down here will be taxed for that if it takes place — a very serious suggestion by him, as I see it. I don't know whether he had any idea of what kind of total numbers he was talking about.

There's another problem related to that when it comes to health: if we are paying too many people to stay at home, who is going to pay the taxes? That will certainly be a big problem.

MR. BLENCOE: Where were you on Coquihalla?

MR. R. FRASER: If you want to talk about budgets not being correct, if you want to talk about the fact that there should be better estimating work done and more pre-engineering work done on some engineering projects, I agree with you. I have no problem with that.

I know there is some problem with specialists being out of town. I don't know what the member for Prince George North (Mrs. Boone) would do, but I don't know if we really want to get to the point where we insist that you, the specialist, will live there. I suppose we could do that, but I'm not certain whether it's better to do that or to have a centre where patients can be sent quickly in order to get the best possible medical care available. If that happens to be in Victoria, Prince George, Vancouver or wherever, it doesn't really worry me too much.

With health care we sometimes do to patients something that I think is quite unreasonable. I recently got a letter from a constituent who said: "I am a resident of your riding, and my doctor wants me to go to Grace Hospital. Because I live in your riding, why shouldn't I be able to go to Grace, and I want you to do something about it." We understand that Grace Hospital is one of the better hospitals for delivering women who have high-risk pregnancies, so presumably the reason this particular woman couldn't get into the Grace Hospital was that she was considered to be a low risk. She even said so herself. If we're now going to shift everybody into the Grace Hospital because it happens to be very good, we are causing problems by having an extra-good facility, I presume that the tens of thousands of children born in Vancouver General or St. Paul's or Royal Columbia or any of the other hospitals around the province.... They do a perfectly good job of delivering babies and will continue to do that. I would really hope that the medical profession, the members opposite, my colleagues, etc., would be very quick to say to anybody who wants to go to a particular hospital because they believe it to be the best — and maybe it won't necessarily be best for them — that they would be well cared for elsewhere.

It's an interesting thing, this health care problem. We heard some chat today about the fact that we shouldn't privatize the sale or distribution of liquor because it would impinge on the health budget. I'm not convinced that that's true. I don't think it matters whether we have liquor sales in a government-run store or a private store. The hours are managed by regulation everywhere. I think it would be more efficient to do it that way, I don't have any difficulty with that. Having been in a number of other places, as you know, it seems to work very well. I don't know why we worry about that.

I do hope that the minister will give us some idea about the ambulance trip that woman took, because I think it's crazy. Indeed, I would suspect, having heard it from the opposition members before, that they would be really upset about the ambulance service because of that story and other stories like it. Had it been a private service as opposed to a public service, I presume they would be outraged and would want to take it over as a government service. Yet somehow we can take it as a government service and say it's not bad and blame the minister. I don't understand how you get to that logic.

The ambulance service is critical, and I think we should learn more about how it works. I'd like the minister to give us a bit more information.

[11:45]

HON. MR. RICHMOND: Mr. Chairman, I ask leave to make an introduction.

Leave granted.

HON. MR. RICHMOND: I would like the House to join me in welcoming about 50 grade 7 students from Aberdeen Elementary School in Kamloops. They are here with some of their parents and their teacher, Mr. Carl Gustafson, as they endeavour to learn something about our parliamentary system. On behalf of the second member and myself, I'd ask the House to make them very welcome.

HON. MR. DUECK: Mr. Chairman, I have just a short remark. My colleague mentioned the ambulance service, and I would like to say that the particular incident in question earlier will be looked into. We will try to find out why — for what reason. These vehicles are in constant contact with the hospitals, and they respond to the hospital's instructions. So I'm not sure what happened in that particular case. What I hear — if it is true — bothers me. It shouldn't happen.

I must come to the defence of our ambulance service in general. They are excellent. We have no intention of privatizing them, and I think they are doing a fantastic job.

MR. GABELMANN: I want to draw another subject altogether to the minister's attention, and it relates to transitional group homes for mentally handicapped people. The Glendale downsizing is accompanied by a fair amount of money to assist the return to the community of the people involved. But there is a gap in the delivery which I want to draw to the minister's attention, not necessarily for any comment or response now, but for further discussion as time goes on.

Many mentally handicapped persons have lived with their parents for many years and, rather than being institutionalized, have in fact been looked after at home. Again, I'm speaking in terms of Campbell River. Many of these parents now are into their late sixties, and some I can think of are into

[ Page 5044 ]

their seventies. We are facing a critical situation in terms of what happens to these adults living at home with parents who are reaching that age. There isn't sufficient money attached to the transition that occurs for that particular group of people. There are reasonable amounts in terms of Glendale — in comparison at least — but there seems to be a gap now in respect of what we do with people who will no longer be able to be at home with their parents, or their parents may be passing on or getting too old to continue the service. The Association for the Mentally Handicapped again, in this instance, isn't given the proper resources to provide some transition for those particular people.

HON. MR. DUECK: Yes, those comments are valid. It is true that we don't have enough resources or facilities for them. Some of them are living with parents, and they are getting aged, and something has to be done. We are addressing that issue, I understand, with the association of mentally handicapped persons at the present time. It's certainly a valid comment.

MR. D'ARCY: I want to bring up something with the Health minister that I've already raised a couple of times in the chamber with the Finance minister (Hon. Mr. Couvelier): the rather draconian fees which have been instituted as of April 1 for individuals who are putting in or simply improving a septic tank system in their homes, I note that there have been no fees on these kinds of septic fields before.

I believe, and I hope the minister would agree, that these inspections are not designed to interfere bureaucratically with people. Rather, they happen to protect the public interest, the interests of the residents as well as the interests of the neighbours and the public at large, from the spread of diseases which can be transported by the improper handling of sewage.

I hope you would agree, Mr. Chairman, because in your riding you probably have a large number of people who do not have the opportunity to connect to a municipal sewage system. You might think it's long way away, but in my riding probably only about 20 percent of my constituents fall into that category; the rest do have municipal sewage systems. I would note that the government has liquor inspectors out there, once again to protect the public interest. There are gas fitting inspectors, once again to protect the public interest, not just of the homeowner but of the community at large. The province even has gaming-hall inspectors. The province also has health inspectors to protect the public interest in terms of restaurants, bars and sewage systems.

I think it's totally unreasonable for the province to insist that the public out there, in order to protect themselves, pay these rather onerous fees. I know the philosophy that the Finance ministry seems to have, something like the property purchase tax. They probably assume that with a new subdivision and the house price probably averaging $100,000, what's an extra $200? What the government seems to have forgotten is that there are large numbers of people who already have homes and already exist in.... I hate to use the term rural areas, because it's a much-abused term; it seems to have become anything beyond Saanich Road here or beyond the Pitt River in the lower mainland. In those areas which do not have municipal systems, which is a large part of the province of British Columbia, there are many people who have no choice but to have their own septic systems.

I also want to point out that a well-installed septic sewage system in sandy or gravel soils will last almost indefinitely, without repairs or servicing, but in clay soils the best septic system will need servicing every few years, if not repairs. Just for servicing or repairs, to get a new certificate costs $100; for a new system or a major modification it is $200.

The minister may disagree with the imposition of these fees. It may be that Treasury Board or the Finance minister did it over his head, but I hope he would do what he can to get them rescinded. I think they're totally unnecessary.

As I said in my first remarks, I think that where something is happening to protect the public interest, the public has an interest in not discouraging people from having inspections. That is, in effect, what in all too many cases is going to happen. People don't have the money, and they are going to say: "I think I know how best to...." I'm not suggesting that people will try to put in cheap systems. There may be a few individuals that way, but I think that in many cases people will just go on their own and say: "I think I know how this has to be done. This is the way we've always done it." These are the kinds of repairs they're going to make, and they may not be the kinds of repairs your ministry — quite correctly — requires.

I realize we're getting close to adjournment, but I'd very much appreciate hearing the minister's comments on this.

HON. MR. DUECK: Yes, there was an increase in inspection fees for septic tanks or sewage systems less than 5,000 gallons. The fees are based on cost recovery. That is the theory that prompted this. As far as revenue-producing areas of government are concerned, that's the responsibility of the Ministry of Finance. I can't say much more than that on this particular subject.

MR. D'ARCY: The point I'm making, and the point I made to the Finance minister, is that in other areas of inspection there doesn't seem to be this same slavish commitment to what the Health minister calls cost recovery. It certainly doesn't exist with business inspections. It doesn't exist with gaming-hall inspections. It doesn't exist with liquor inspections. It doesn't exist with building inspections. I have no idea what municipal government in the province normally charges for a building permit or to send an inspector out for an electrical system, or for an entire building, but in most cases I doubt it's $200. We're not talking about an entire building. We're not talking about something that might blow up. We're talking about a septic system.

As I say, the government seems to have a double standard. In some areas they don't seem to be too interested in any cost recovery. In other areas where there is clearly a question of the public's interest and not just the interest of the person being inspected, I can appreciate that the government may say: "Look, it's a service to the user. Maybe the users should pay. Maybe they shouldn't pay $200, but they should pay something." I don't agree with it, but the government may say it. The reason for these inspections is to protect the rest of the neighbourhood and community. With the cost in your ministry, if there are disease and problems as a result of improperly handled sewage, we know what cost that's going to bring to the ministry and to the taxpayer, as well as what suffering it can cause the community. So that's the reason for them in the first place, and I would hope that when we talk about cost recovery, the minister would realize that as well.

[ Page 5045 ]

HON. MR. DUECK: Mr. Chairman, I think we're mixing municipal inspection with provincial — not necessarily when you mentioned building inspection, which is municipal, and you say on some we charge and on some we don't.... But I get your message. I know what you're talking about, and I know what you're saying. I will accept your comments and your opinion of the charges.

HON. MR. STRACHAN: On the subject of septic tanks, to the victor belong the spoils. I will move that 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 11:58 a.m.