[ Page 6297 ]

CONTENTS

Routine Proceedings

Oral Questions

Funding for Gitksan land claim. Mr. Sihota –– 6297

Trial commuter-rail service to Port Coquitlam. Mr. Rose –– 6298

Discriminatory entrance limits in independent schools. Ms. A. Hagen –– 6299

Federal tax on professional health services. Mr. R. Fraser –– 6299

Royal commission on reproductive technology. Ms. Marzari –– 6299

Ministerial Statement

National Organ Donor Awareness Week. Hon. Mr. Dueck –– 6300

Mr. Perry

Committee of Supply: Ministry of Government Management Services estimates.

(Hon. Mr. Michael)

On vote 31: minister's office –– 6301

Ms. Marzari

Mr. Rogers

On vote 32: ministry operations –– 6302

Mr. Barnes

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

On vote 35: minister's office –– 6302

Mr. Perry

Mr. Serwa

Mrs. Boone

Hon. S.D. Smith

Mr. Rose

Mr. Peterson

Mr. R. Fraser

Mr. Messmer

Ms. Pullinger

International Trusts Act (Bill 18). Hon. S.D. Smith

Introduction and first reading –– 6324

The House met at 2:08 p.m.

Prayers.

HON. MR. RICHMOND: It's a pleasure for me to introduce three elected members from western Canada who are with us on the floor of the House today. They have been attending a western ministers' conference that was called last year at the behest of the Premiers of the western provinces. I am pleased to introduce the Hon. Charlotte Oleson, Minister of Family Services for Manitoba; the Hon. Grant Schmidt, Minister of Social Services, Human Resources, Labour and Employment for Saskatchewan; and the Hon. John Oldring, Minister of Family and Social Services for Alberta.

With them are several support people who are seated in the members' gallery today, and I would ask this House to bid them all a pleasant Victoria welcome.

MR. PELTON: If the hon. members will bear with me for just a moment, I have three announcements to make at this time. I would ask the hon. members to welcome Frank and Colleen Anderson from Olympia, Washington. Colleen is a longtime employee of the Washington State Legislature, and Frank serves as director of special programs with the department of personnel for the state of Washington. The Andersons are here celebrating their twenty-fifth wedding anniversary, and I would ask the House to make them welcome, please.

In the Hansard booth today we have Mr. Neil Burrell. Neil is the chief Hansard editor from Perth, Western Australia. He's visiting us to study Canadian methods of Hansard production. He'll be here for a few days and then will proceed to Edmonton, Toronto and Ottawa before returning home. Will you welcome him, please.

And last, but by no means least, the second member for Dewdney (Mr. Jacobsen) and I would like you to welcome Tony and Millie Johnson, residents of beautiful Mission, who are here today to visit the Legislature.

HON. MR. DUECK: I would like to introduce someone who really needs no introduction. This individual spent years with the Ministry of Health as assistant deputy, and he decided since then that Alberta is greener. I think he has realized that it's is not so, but I would like to welcome Stan Remple to this House.

HON. MR. DIRKS: In your gallery today is a person who has been very close to me for a number of years: my lover, my best friend for 27 years, my wife Lorna.

HON. MR. SAVAGE: Mr. Speaker, I have two announcements. The first is that I would like everyone to welcome to this assembly a lady who has worked extremely hard in the municipality of Delta and is a member of the B.C. Chamber of Commerce. Last year she was the good citizen of the year in Delta. Would this assembly, on behalf of the second member for Delta (Mr. Davidson) and me, please welcome Leslie Abramson.

Also, it is indeed a pleasure for me, and on behalf of the second member for Delta as well, to recognize that last weekend the Seaquam Seahawks cheerleaders won the Canadian cheerleading competition. I'd like to congratulate them.

HON. S.D, SMITH: In your gallery today, Mr. Speaker, are two individuals from the Thompson Nicola Regional District: the chairman, Jack Lapin, and the director of planning, Herb Virdi. Would the House join me in making them welcome.

MRS. GRAN: Visiting the precincts today and meeting with the Social Credit caucus are members of the B.C. Teachers' Federation. I'd like the House to welcome Elsie McMurphy, Ken Novakowski - a constituent in Langley - and Bob Buzza. Would the House please welcome them.

I would also like to take this opportunity on behalf of the government members to recognize that this is Secretaries' Week and to encourage everyone in the buildings to recognize the real power behind everyone.

MR. ROSE: I just wanted the House to know that despite the fact that we haven't introduced anyone today, we in the NDP do have some friends, and they'll be here tomorrow.

Oral Questions

FUNDING FOR GITKSAN LAND CLAIM

MR. SIHOTA: I have a question for the Attorney-General. It has recently been reported that the Gitksan Tribal Council is nearly out of funds with which to continue its claim against the province with respect to aboriginal title. The province, of course, has been spending literally millions of dollars on this case. Could the Attorney-General advise the House whether or not the province is prepared to level the playing-field, so to speak, to assist the natives to continue their action in court?

[2:15]

HON. S.D. SMITH: As the member may know -or should know - the issue that has arisen there is with respect to the funding by the government of Canada, who made a commitment about two years ago to provide a certain level of funding not only for the position obviously taken by the federal Crown in the case but also for the work being done by the native communities in that area. Those funds have not all been allocated. The government of Canada is now in the throes of making a decision about the allocation of those funds. I met with ministers responsible for that in Ottawa last week or the week prior. That matter generally is in hand.

[ Page 6298 ]

MR. SIHOTA: I guess there are two elements to the problem: one is the fact that there is a funding difficulty; the second - and the trigger cause - is the fact of the province's unwillingness to negotiate land settlement matters with natives. In light of these difficulties that I have just spoken about, is the province prepared now to cease its practice of legal harassment and confrontation in the courts with respect to native title and begin to negotiate land title claims with the natives?

HON. S.D. SMITH: Harassment is indeed a rather strange way to describe the process that's going on in the courts today in the Gitksan case. Nevertheless, that member, I suppose, can describe it as he sees fit.

With respect to the larger issue, the Gitksan case now has been ongoing for some five years. It is an important case not only to British Columbia but to Canada, because it will deal with the most fundamental issues of all that have never been dealt with in this country: namely, whether or not the notion of aboriginal title is distinct from title as we describe it in our land system; whether or not it exists; whether or not it was extinguished either implicitly or explicitly by the acts of Confederation; and whether or not there is a responsibility on behalf of Canada to deal with the consequences of that, if indeed it is found that it was not extinguished. That is an issue which properly is being dealt with by the courts of our land. The Supreme Court of Canada attempted to deal with it once before, and they avoided the fundamental decision when Mr. Justice Pigeon ruled on the basis of a technical matter.

To get to the issue generally of the alleged lack of negotiation on the part of the province of B.C., I would like to inform the House that this proposition is very misleading for the people of British Columbia to hear, because the province has done a significant amount of negotiating particularly in the area of land claims, where we have fundamental responsibility There are 22 outstanding cut-off claims in the province; I believe we have now successfully negotiated 14 of them. There is every expectation that we will finish the negotiations of all of them this year. That's in an area where we have sole responsibility.

British Columbia has negotiated some 13 timber agreements with natives in this province - everything from a small-business licence to a tree-farm licence. This past year the province negotiated a land use agreement with the Tahltan people with respect to a new mine that has opened up in the Atlin area More recently we successfully negotiated, in the Sechelt agreement, perhaps the most progressive piece of legislation in the country, dealing with the matter of local government for natives, and over the last number of years we have negotiated the Nisga'a School District.

So we have had, since 1976, a very strong record of negotiating agreements - land agreements, development agreements and social services agreements -with the native peoples of this province, and all members of this House should be proud of the progress we're making.

MR. SIHOTA: This province has had an abysmal record with respect to negotiation and settlement. I'm astonished that the Attorney-General would express pride in a record that has been universally condemned.

Most recently, the Canadian Bar Association indicated in a report that billions of dollars were not being invested in this province because of the ongoing dispute in British Columbia with respect to native title, that there are incredible taxpayer resources being spent on native title cases, and of course, that there's the general frustration and cost to natives as well. The CBA has recommended negotiations

MR. SPEAKER: Order, please. Does the member have a question?

MR. SIHOTA: The question to the Premier is Sorry, it's to the Attorney-General, who would like to be Premier, I'm sure. Does the Attorney-General agree with the Canadian Bar Association recommendation of negotiation?

HON. S.D. SMITH: The Canadian bar's references have some merit to them. The blanket proposition that condemns the whole process going on in British Columbia is one that I want to get to again, because it leaves in the public mind the impression that there are no negotiations going on, when in fact there are. I think that it behooves each and every one of us in this chamber to do our part to ensure that the public is well informed on the issue. It is a big issue. It's a very important issue, and it is going to get even more important as time goes on.

It is not one that has been invented in a partisan way. Every single government of British Columbia since Confederation, including the New Democratic Party government in 1972-75, has taken exactly the same position. There is no question that since 1976, when a decision was taken to negotiate settlement of the cut-off claims, there has been a significant change in the climate in British Columbia with respect to settlement of many of those issues. I think we should reflect on what has been achieved, and understand that from those achievements we will build more successes in the future. Building successes in the future is something that we ought to strive to do, and about that I would agree with the member.

TRIAL COMMUTER-RAIL SERVICE

TO PORT COQUITLAM

MR. ROSE: My question is to the Minister of Municipal Affairs on her duties and responsibilities for transit. Last year, on the eve of the federal election, the minister announced that a two-year trial rail service between Vancouver and Port Coquitlam would begin in July '89. At that time, the minister said it was going to go: "I'll tell you, it's going to go." I wonder if the minister can assure this House that the commuter-rail program will in fact begin this summer, because members from Burnaby, Coquitlam and Dewdney want to arrange their schedules so they can be there for its inaugural run.

[ Page 6299 ]

HON. MRS. JOHNSTON: That is a very valid question, and I can tell you, hon. member, that the commitment made by the provincial government is still in place. About a month ago I sent a letter to the federal government attempting to receive some assurance that their commitment is still in place. I am still waiting for a response to that letter. But as far as we're concerned provincially, the commitment was made, and we stand behind our commitment.

MR. ROSE: A supplementary question. We know that the former MP there, Gerry St. Germain, is not still in place. Could the minister tell this House which contracts have been let to build the stations and parking-lots along the route? Or has the whole scheme been derailed once again?

HON. MRS. JOHNSTON: I thought my response to the previous question was clear. The $16 million provincial commitment that was made is still in place. We are awaiting a response from the federal minister to determine whether or not the federal commitment that was made prior to the last election is still in place. I do not, at this point in time, have that assurance.

MR. ROSE: Can the minister really confirm that it's dead?

HON. MRS. JOHNSTON: The answer is no.

DISCRIMINATORY ENTRANCE LIMITS

IN INDEPENDENT SCHOOLS

MS. A. HAGEN: To the Minister of Education, Mr. Speaker. Would the minister agree that publicly funded independent schools that limit entrance of certain Canadians on the basis of racial background violate both the letter and the intent of his policy on independent schools?

HON. MR. BRUMMET: The short answer is no.

MS. A. HAGEN: Mr. Speaker, the Minister of Education's policy states that independent schools must not teach, practise or advocate racial discrimination if they receive funding. You claim, Mr. Minister, that these schools are not violating that policy. On the other hand, your ministry spokesperson says that independent funded schools can make those decisions if they wish, even if it means selecting students on the basis of race. In light of your ministry's public stance, how can you possibly state that these guidelines forbidding racial discrimination are being enforced and respected?

HON. MR. BRUMMET: I'm not sure there is a question there. Attendance is not compulsory at the independent schools. The policy stands that they are not to teach discrimination, but I guess they have some right to say how many students they take in. No student in this province is prevented from getting a quality education.

MS. A. HAGEN: If schools discriminate in terms of attendance on the basis of race, which is against your policy, what would your stance be on enforcing your policy?

HON. MR. BRUMMET: I can't answer the question, because I don't accept the premise.

FEDERAL TAX ON PROFESSIONAL

HEALTH SERVICES

MR. R. FRASER: To the Minister of Health. We saw some changes today in the federal government position on tax, but there is no indication that we won't have a tax on professional services. In your ministry, for example, the doctors' fees would be taxed but nurses' salaries would not. Do you think a federal tax on professional services would tend to increase the size of the bureaucracy?

HON. MR. DUECK: I will take that question as vice-chairman I don't quite know how to answer that; that question is loaded. I hope it doesn't have an effect on my ministry, of course. I am glad to note that the national sales tax is not proceeding. We've got word that it is not proceeding, but that there will be a refined federal sales tax put in place. We will have to wait and see what the outcome is of that.

ROYAL COMMISSION ON

REPRODUCTIVE TECHNOLOGY

MS. MARZARI: This is a question to the Minister of Health, in the absence of a minister of state for women - someone I've been looking for, On April 3 the federal government announced a new royal commission on reproductive technology, but doctors in B.C. have already started to freeze embryos for purposes of later in vitro fertilization. The question is: have you, in addition to referring this matter to your ethics committee, communicated your concerns about this to the federal government and asked them to move along this royal commission, since it hasn't done anything for a month now?

HON. MR. DUECK: I have not been in touch with the federal ministry of health on this matter. The in vitro fertilization subject has been under discussion for many months; it's nothing new. We do not fund either the MSP portion or the hospitals for in vitro fertilization. However, we do fund any area of concern of women not being able to produce. So we do fund any concerns that women may have, but the method of how or what they wish to do as far as in vitro fertilization is concerned is not funded by my ministry.

I understand that the federal government is looking at all these reproduction procedures and is going to do an in-depth investigation of them. The medical ethics committee released a very preliminary report many months ago, but it was not in any detail -except that the scientific community is looking at it.

[ Page 6300 ]

As far as the Ministry of Health is concerned, we are not involved, in that we do not fund it.

[2:30]

Ministerial Statement

NATIONAL ORGAN DONOR AWARENESS WEEK

HON. MR. DUECK: This week, April 23 to 29, is National Organ Donor Awareness Week. I ask all British Columbians to mark the week by discussing their feelings about organ and tissue donations with other family members. This national week focuses public attention on the growing number of patients whose health could be restored to them through the modern medical achievement of organ and tissue transplants.

Twenty years ago, when B.C.'s first kidney transplant was done at Vancouver General Hospital, the level of public acceptance was nothing like it is today Public opinion polls tell us that the vast majority of British Columbians now support both the concept and the practice of organ and tissue transplants. As proof of this, many British Columbians sign and carry organ donor cards.

Transplant operations have become so successful that today we are unable to meet all requests from doctors who recommend transplant operations for their patients. The opening of our new provincial multi-organ transplant unit last fall in Vancouver made news headlines across British Columbia. So did word of the first three heart transplants and the first heart-lung transplant operation to be performed there, and rightly so, Mr. Speaker. I send my personal best wishes to all patients who are recovering from transplant surgery.

However, hon. members may be surprised to learn that at this moment there are, for instance, 170 British Columbians waiting for kidney transplants. Another 300 people are on the active waiting-list for cornea transplants. There is a crucial shortage of donated organs and tissues at the present time. This situation is not unique in British Columbia; it's true right across North America.

The most important message I'd like to leave with this chamber today is this: if organ and tissue donation is something you've never thought about or discussed with your family and friends, I encourage you to do so. In recognition of National Organ Donor Awareness Week, each member of this assembly will receive an information package in his office today Included in this package are copies of "A Gift For Life, " British Columbian's organ donor brochure and official registry cards. These brochures, posters and donor registry cards can be displayed in your office this week and throughout the year.

MR. PERRY: I'm delighted by the minister's statement. It's a wonderful occasion to celebrate Organ Donor Awareness Week. I checked in my wallet, and I still have my two organ donor cards: one for the eye bank and one for all organs without restrictions. I hope that every other member in this House has one signed, and if they haven't got one signed in their wallet today - I don't see any being held up in the House for inspection - I hope they will by tomorrow or the day after the cards arrive from the minister's office.

I just want to emphasize as a physician the importance of this kind of initiative. It's very difficult for us to imagine the situation of those 170 people who are waiting, for example, on the kidney list. I know from experience of working with them that the quality of life for a patient with end-stage renal failure on dialysis is very modest. The resources required to keep these patients alive, let alone in good health, is incredible. It is usually is figured in the range of $40, 000 or more per year just to maintain hemodialysis, for example. We know that organ donation and transplantation is extremely cost-efficient for this category of disease and for many others. It's very hard to imagine the amount of suffering that is relieved by donation and by transplantation. I regard this as one of the great miracles of modern medicine.

I think there are a few other lessons to be learned from the story of organ donation. It's not a complete story. We know that in British Columbia there is tremendous public interest in expanding the bone-marrow donation program, because of the particularly frightening plight of people with acute or chronic leukemia. We know that we're becoming a world leader in this province in that aspect of transplantation as well. I think this is wonderful, although I wish the pace could be increased, but with less technical problems. I hope we will become - and the minister will continue to support - our status as a world leader in banking donors for organ transplantation for all organs.

The other important points I'd like the House to recognize is that no advance like this comes without decades of medical research. This is a strong lesson in the value of basic medical and scientific research advances that we could not have imagined 50 years ago when Sir Peter Medawar first began transplantation experiments in mice, which are now realized in this tremendous improvement in people's lives.

The last point I'd like to make is that these advances owe tremendously to the physicians and nurses in this province who have pushed transplantation at a time when government was not very interested in it. They'll continue to do so if we here ever lose interest, and will continue to do the hard work behind the scenes to make sure that the transplants work. I just want to emphasize those points and urge all members of this House to set an example for the rest of the province by signing their cards this week.

HON. MR. RICHMOND: I ask leave for the Select Standing Committee on Economic Development, Transportation and Municipal Affairs to sit today at 3 p.m.

Leave granted.

HON. S.D. SMITH: Mr. Speaker, I beg leave to move a matter to a select standing committee.

Leave granted.

[ Page 6301 ]

HON. S.D. SMITH: I move that the report and recommendations of the 1988 compensation advisory committee be referred to the Select Standing Committee on Labour, justice and Intergovernmental Relations for the purpose of recommending a resolution to the Legislative Assembly for affixing of salaries pursuant to section 7.10) and (2) of the Provincial Court Act.

Motion approved.

Orders of the Day

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

ESTIMATES: MINISTRY OF

GOVERNMENT MANAGEMENT SERVICES

On vote 31: minister's office, $259, 265 (continued).

MS. MARZARI: Mr. Minister, some days ago I asked you in this House about the management structure insofar as it pertains to women managers in the government employ. I suggested to you that since 1984 we have not really had any gender breakdown in terms of what women are doing and where they are in our government services. In answer to my question, you said that in 1984, 17 percent of management employees were in fact women, but you said we are now looking at 24.5 percent. In other words, you suggested that one-quarter of the managers, or people of management status, in our government employ are in fact women.

The questions that flow from that are the following. Subsequent to my question to you, I have heard that in 1985 a Miscellaneous Statutes Amendment Act (No. 3) was passed. In the process of passing that amendment, office assistants - 1s and 2s - were deunionized under section 84 and made "managers." My questions to you today relate to this particular transaction.

I would like to know how many of the women that comprise the 25 percent management structure in our government are in fact former office assistants? I would like to ask, too, whether these employees received any increase in pay when they lost the protection of their union agreement. Or did they just get a little letter saying "Welcome to management"?

The reason I ask this question is obvious. It strikes me that if these women were deunionized and in fact not given management positions, not given supervisory positions and not given an increase in pay, we aren't dealing with new women in management; we are dealing with office assistants who were deunionized. Would you be good enough to tell me whether you count these women as managers?

MR. ROGERS: I don't want to take too much time in the committee, but last week there was quite a lot of discussion about a particular piece of property in New Westminster. It went on at great length, and I listened quite intently to the debate and spent a little time on the weekend looking into it.

1 don't wish to say anything that may prejudice the issue now before the courts, but I knew many of the people in the B.C. Enterprise Corporation who were involved in doing this real estate transaction and others like it when I was a member of the executive council. I wasn't part of, or privy to, the information involved in this particular case, so I will not prejudice the case before the courts. I have had some experience in dealing with these people, which leads me to have no reason to question their ability to have made the proper and correct decision.

This particular piece of property is not unlike that formerly owned by the B.C. Electric Co. in False Creek, the piece currently contaminated with soil -not that the soils are contaminated, but the soils are in question. Prior to anybody building anything on this property, an enormous amount of reparation work will have to be done on the soil; that's been known for some time, In fact, the dollar amount of the reparations required before anyone can build on this property is very substantial.

For someone who did not take the time to have a proper drilling crew go out and check the footings to find out, for example, how far one would have to drive piles before reaching refusal, it might lead one to think that you can just measure the acreage of the property itself and say: "This is so many acres at such and such a location, and its buildable and zoned. We can go ahead and do it."

The one missing ingredient in the questions put last week is what the condition of the land itself is. Is the land in fact buildable? The information I have been able to gather, from people who have looked at this land for as long as 15 years, is that there is substantial reparation work required - not in a contaminated-soil way, but in the fact that the soil is not in excellent condition.

The trail that the transaction followed after it left the B.C. Enterprise group - when not only did a financial institution but also a union pension fund get involved in some other transactions - is probably best left before the courts. Perhaps we'll find out if P.T. Barnum was right on that particular aspect, and that will come out in the fullness of time.

I wanted to make it clear because of the people that I know who are involved. This piece of land is not a buildable piece of land in the normal stretch of the imagination; the preparation required before anyone could do some work on it is very substantial. I have seen estimates of well in excess of $10 million to prepare this piece of land before it could be used. Someone using the straight quotient of what a piece of raw land is worth - forgetting that the piece of land is not necessarily serviceable - might have come to a different conclusion.

Last week there were suggestions in this committee that there was either one or the other - gross stupidity or gross negligence - and I don't believe either was the case. I think there was some upright honesty, and the people who made inquiries as to the condition of the land discounted their bid appropriately because of the increased costs that they would

[ Page 6302 ]

have had in order to prepare this property to put it forward.

[2:45]

MR. SIHOTA: How many bids were there?

MR. ROGERS: I don't know how many bids there were. I'm going to try and address the Chair. But it's nice to see you had a haircut. I was going to say you needed one last week. It's a good thing you got one.

Mr. Chairman, having read my little remarks into the record, I feel that I could proceed with voting on this minister's estimates when the time comes.

HON. MR. MICHAEL: In response to the first member for Vancouver-Point Grey (Ms. Marzari), the figures given last week are correct. The percentage did in fact grow from 1986 to 1989. The 1986 percentage for females in management was 17.3 percent; today's figure is 24.5 percent. The employees to which the member refers are in schedule A, and they are in a confidential capacity. They receive the same percentage increases and the same benefits as do the BCGEU. But they are in confidential capacity and excluded from the trade union.

MS. MARZARI: Yes, they're excluded. Then you include them in management; you include office assistants 1 and 2 in management. Are you saying you don't or you do include them in your 25 percent?

HON. MR. MICHAEL: I'm sorry, Mr. Chairman, I thought I made myself clear. The ones to which the member is referring are not included. They are in schedule A. Management level employees are referred to as level 1 to level 12.

Vote 31 approved.

Vote 33: pensions and employee benefits administration, $10 - approved.

On vote 32: ministry operations, $38, 860, 496.

MR. BARNES: Mr. Chairman, I'm sorry, I really should have asked this on the minister's office, but it's just a brief question. Could the minister confirm to what extent his ministry has attempted to accommodate the tenets of the new federal multiculturalism act, In terms of policies to make opportunities accessible to the multicultural community? Have you a policy in place with respect to the act?

HON. MR. MICHAEL: I would advise the member that that question is on the order paper. We're working on it, and we'll get you a response to that at the earliest opportunity.

Vote 32 approved.

Vote 34: pension and employee benefits contributions, $10 - approved.

ESTIMATES: MINISTRY OF HEALTH

On vote 35: minister's office, $333, 960 (continued).

MR. WILLIAMS: I'm sure our critic from Point Grey would be anxious to embark on this debate. I see he's here now.

MR. PERRY: It's nice to be back facing the minister, and I look forward to trying to pick up where I left off. So much has happened in the last week that I'm sure the minister will forgive me if it takes me a moment to find my place.

I wanted to begin today with a number of smaller specific issues and then come back to some of the general themes I was developing earlier. Perhaps I will begin with the following.

There was considerable discussion in the minister's statements in the House a couple of weeks ago about the screening mammography program. I have satisfied myself that this program is on the way to becoming one of the best in the world, and I have relatively little to ask. One question still puzzles me. It is not intended to question the government's overall approach to the program, which I think is very sound; it's simply that in the interval - in the last year, for example - while the program is still getting up to full steam, the practice of the Medical Services Commission in declining to pay for preventive services such as mammography screening through the MSP budget has led to the use of the same radiographic technique labelled as a diagnostic test in some parts of the province where the screening tests were not readily available.

I still find it puzzling that when the radiologists of the province offered a cut-rate or discounted screening fee, the response of the Medical Services Plan was to refuse, presumably on the basis that it might lead to difficulty in withdrawing from that arrangement in the future. The net effect, as far as I can see, has been that over the last year the province - and the taxpayer - has paid a higher fee for the same service, be it labelled diagnostic and in fact screening: anywhere from $17 up to roughly $32. It's more per test than could have been paid if the fees were being done under the proposal from the BCMA radiology section.

I'm interested to have the minister's response to that. I want to reiterate that I am not questioning whatsoever the basic approach to the screening program; it's more a question of the interim measure of what looked to me like a reasonable proposal to save some costs for the taxpayer.

HON. MR. DUECK: Of course, when a new program is introduced, you cannot delete the services that are currently provided, and that was through referral in a doctor's office.

We have never, to my knowledge, denied any mammography test, diagnostic or otherwise, that a physician has ordered or requested. We continue to do that; exactly that practice continues. We believe -and we've got evidence, of course, with the projected costs and the numbers of women we'll be able to

[ Page 6303 ]

screen - that mammography screening can be done on a wholesale basis at a tremendous saving to the taxpayer of this province, but that will not happen until we have enough units around the province to get the volume we expect. Already the clinic in Vancouver has proven tremendously successful.

I should also mention, so that we have it in the record, that this total program was in complete cooperation with the BCMA. They were part and parcel of this. They were there when we opened the first clinic. They were singing its praises the same as we did from the government side. For any physician to suggest at this time that perhaps government foisted something on the public or on the medical profession is totally erroneous; it was done in cooperation with all of them, and particularly with the association. The then president of BCMA, Dr. Jones, spoke at the official opening of the first unit, and it's been very highly successful. We are very proud of it, and so I think should be every physician, person, taxpayer, and especially the women of British Columbia.

MR. PERRY: I think I made myself perfectly clear, and I will just reiterate in case I didn't. I am not questioning at all the government's basic approach to the screening program, which I think has been excellent I don't think any doctor is questioning that - certainly not this member.

The question I was asking which I don't think has been answered is: when the B.C. Medical Association through its radiology section proposed - before the cancer agency's screening is accessible to all women throughout the province - an interim fee of $47.55 for bilateral screening done in batches, whereas the diagnostic fees, depending on the technique, are either $65 or $81.... Why would the government not have wanted to accept that screening fee offered to them as an interim measure? I don't understand why the cost-saving wasn't attractive to the government.

HON. MR. DUECK: I did mention that there is a tremendous saving, so I did answer that question. I'm not aware of the specific request or offer made by the BCMA. However, I think you corrected yourself when you said the physicians were totally on side and agreed with this. Then you corrected yourself and said: "At least this member is." I will accept that as a correction from your earlier statement, because not all physicians were on side.

As a matter of fact, they got me into great difficulty over this issue. The thought was left in people's minds that we were no longer paying diagnostic mammography requested or referred by a physician That was totally erroneous. We have never asked them not to; we have always paid. Not a single bill has gone unpaid.

However, we believe we can do this in a much less expensive way and cover all the women at risk, who are the ones over 40. If you have evidence of a request or proposal made, I can check on it. I'm not aware of it at this time. But even to this day, every physician who refers a woman for diagnostic - or otherwise - mammography has it done and paid for

MR. PERRY: I'm not finding it right now in my files. Somewhere in my office I have a copy of the proposal, and I'd just like to clarify it again.

As I understand it, the ministry, as its standing policy, made a ruling that screening tests done for preventive purposes, with the exception of pap smears - and like other preventive services such as counselling on alcohol or smoking abuse - are not covered by MSP in this province. That's been a longstanding policy which I think is very regrettable. But it's certainly a longstanding policy of MSP that in the case of diagnostic mammography - in other words, tests done when the physician suspects a malignancy in the breast - those tests have been covered like all other diagnostic tests.

[3:00]

I agree completely with the minister, and I think a major concern of the medical profession and others has been that some diagnostic tests are overused, and that there are major potentials for savings in diagnostic tests. But interestingly, we have no limitation in the practice of medicine in B.C. on the prescription of diagnostic tests. The only thing we have limits on is preventive or screening tests. The objection, as I understood it from the BCMA - rightly or wrongly -was that the ministry's directives appeared to discourage screening tests. That put the physician contemplating screening of a woman for breast cancer -which is a medically widely accepted procedure throughout the world - into the position of having to order a diagnostic test and effectively to write on the requisition, "suspicion of breast cancer."

Because these tests are done at a higher cost than bulk screening tests could be performed, the section of radiology of the British Columbia Medical Association did develop a proposal in 1988 to supply screening mammograms at a lower cost of $47.55 per film in batches. I'm informed that this cost is still considerably more than the cost of films done through the cancer agency. Therefore, clearly the government's policy of pursuing the cancer agency's screening program is ultimately a very wise decision.

I reiterate that I'm not questioning the long-term planning; I think it's very good. But in the interim, anywhere outside the lower mainland where access to the screening program was not easy, any woman requiring a screening mammogram - and women over 50 do require them in current medical practice, and perhaps women over 40 require them in good medical practice - was required to pass through the hands of a doctor to obtain a requisition for a "diagnostic" mammogram, which was done at a higher price. In effect, the government rejected an offer from the radiology section of the BCMA to save money; that's my perception from reading the documents and talking with the people involved. I don't understand that in terms of fiscal responsibility.

HON. MR. DUECK: I said earlier that if that proposal had been brought forward, I would check into it. I'm not aware of it at this time.

It was agreed between the medical profession and the Ministry of Health that we would do the pilot

[ Page 6304 ]

project in the city of Vancouver, and that our budget was limited. I could not go any further than that; that's all I had. I think you can understand that I was very fortunate to take even that first step. The plan is, as you know, to go into the mobile unit. There's going to be a mobile unit donated, and we will fund its operations totally. We're planning on setting up another couple of stationary clinics around the province, and eventually we hope to have enough to do a total screening of those at risk.

I don't think I have much to say, other than that we have never turned down a mammography screening, diagnostic or otherwise. You mention that a physician would have to point out that there was perhaps some indication of a malignancy. That is not so. I talked to a physician just the other day, and he told me point-blank: "I send all my women over 40 to get a screening done, not at the clinic but from a radiologist."

You're trying to criticize a program that I am proud to be able to expand, and you're trying to find some way, somehow, that all was not right. I can tell you this much: there was a limitation as to budget We had to go one step at a time, and that step was to set up this screening clinic. We did not expand, as you suggested. A proposal was made, and perhaps because of budgetary limitations we could not do total screening, even at the reduced rate, until we got past this first step.

We will certainly look into the request that you mention was made. You're suggesting that it would be less expensive, and you're also suggesting that perhaps we're not fiscally responsible. I don't like to hear that, because with such limited funds I hope it never is said of the Ministry of Health that we are not fiscally responsible. I need every possible dollar in so many areas.

MR. PERRY: Let me just clarify my point once again. I think I'll take the minister's offer to look at that correspondence, and I'll also refer, perhaps on Thursday, to some of the documentation that I can't seem to find at my fingertips now.

I just want to clarify my point again, which is not to criticize in any way the current mammography program. I think it's an excellent program, and when it extends to cover the whole province, I hope and expect that it will be one of the best in the world. Nor do I think that program is fiscally irresponsible. I think it will give very good value for money, and I have nothing but compliments for it.

I share the minister's disappointment that the media did not respond very well to the announcement several weeks ago of the expansion of the program and of the cancer society's donation of a van. I understand that the cancer society was also quite disappointed at the response. It's a chronic problem that prevention somehow doesn't seem as important to the media as life-and-death emergencies involving patients, but the public knows that it's important.

I will attempt to find the documents and come back to them, maybe, on Thursday.

Let me pursue the other side of that equation, which is the treatment of breast cancer. Again, I think this is an example of problems in long-range planning for health care in this province. It's been known that the whole reason for this program is that for about every 200 mammograms performed in a screening program, one woman will ultimately turn out to have an early breast cancer. Therefore, if the program works, unfortunately we will turn up more cases of breast cancer and we will need more capacity for treatment. The cancer agency estimates that the program may prevent something in the range of three deaths per week in British Columbia, theoretically, when it's completely covering the whole province. The problem is: How are all of these patients going to be treated? Right now there are 58 women in British Columbia waiting to start radiotherapy treatment for breast cancer; 58 women who are waiting with a malignant disease. If one imagines oneself in that situation, it's a very painful place to be, knowing that you're fighting a malignancy and facing the necessity of waiting for a commonly accepted simple treatment.

In the whole province, considering all diseases classified as cancer and requiring radiotherapy, including lymphoma or Hodgkin's disease, there are 264 patients right now backlogged, waiting for treatment. Radiotherapy treatment often should be available as an emergency; sometimes it's required in the middle of the night to prevent compression of the spinal cord.

There is now funding from the Ministry of Health for two evening shifts to try to catch up on this backlog in Vancouver, but there are no technologists available to work. I think this reflects a rather serious lack of planning in this one particular sector.

Another problem is that two radiotherapy machines are needed right now in the Cancer Control Agency in Vancouver, which is the central agency for the very sophisticated treatment of cancer for the whole province, with one outlying centre here in Victoria. The need for these two radiotherapy machines was forecast several years ago by the division head of radiotherapy at the Cancer Control Agency, because of the demographic changes in British Columbia. It was foreseen that the population was aging and that this of necessity would cause us to face more cases of cancer every year. It was known that it takes two years to build a machine - not just to order it, but from the time it's ordered, actually to build the machine. To surround it with the appropriate shielding takes two years.

We now know, according to the Cancer Control Agency, that we can expect about 50 percent more cancers in the year 2001; 50 percent more new cases every year than we have now only 12 years from now, due to the aging of the B.C. population and the in-migration of older people. That will be 50 percent more than there were in the year 1986; in 15 years, a 50 percent increase.

The Cancer Control Agency recognizes that there ought to be a third cancer clinic somewhere in British Columbia, decided and committed. I know there has

[ Page 6305 ]

been a long fight between centres in the Okanagan and Kamloops and Prince George for the siting of this facility. The cancer agency also recognizes the need for more nurses, technicians and doctors specifically trained in oncology, and it feels that the new centre should be built right now.

I would like to ask the minister three specific questions. What is the situation with the new radiotherapy machines? Are there funds in the new budget committed for the purchase of new radiotherapy machines and for their operation? Another question: why was the need not foreseen earlier by the government - so we now have this waiting list of 264 patients requiring radiotherapy as of last week? Finally, has the government decided when we're going to have a third Cancer Control Agency treatment centre in B.C., and can the minister give us some indication when and where that will be and how it will be funded?

HON. MR. DUECK: Number one: the site has not yet been decided. Certainly I am not going to announce here at this time where it might be. We are looking at the Cancer Control Agency, which is our prime agent. They will no doubt come up with a recommendation for where this second site should be. More than likely we will go by their recommendation.

As far as why this was not predicted or foreseen sooner, that is a question that is really very difficult to answer. Since I've been in this ministry, I've been very much aware, and, again, the Cancer Control Agency is the prime agent. They're the ones we look to for guidance and for information.

The third question was in regard to the machines. Funding was made available in '88-89. Again we're looking at the Cancer Control Agency to get on with it and put those things in place. We have done our part. They are our prime agent, We look to them to give us guidance.

MR. PERRY: It's a matter of public record that the Cancer Control Agency has had to close beds in the last year in substantial numbers - I guess at one time there was a large ward closed - and that it has been struggling to keep up with its patient load, partly because of the increased number of patients and partly because of the increasing complexity of diseases resulting from more successful treatment. As you know, they are now treating many diseases that were not treatable, such as serious lymphomas. The Cancer Control Agency probably has the best treatment record in the world for lymphoma - the most innovative therapy. Therefore patients are living longer and the demands are always getting higher.

I think it's a well-known fact, at least in the public, that the Cancer Control Agency has been suffering from a lack of funding. I don't find it very convincing that the Cancer Control Agency should be expected to fund the new radiotherapy machines out of its global budget. I'd like to ask the minister whether he can give us any assurance that there are provisions for new capital funding for the Cancer Control

Agency to purchase those fairly expensive radiotherapy machines. I don't know the exact cost, but I assume it will be in the millions of dollars each or more.

[3:15]

HON. MR. DUECK: I think you should get some more information from the Cancer Control Agency before you start quoting some figures. They did get the funding for the machines, They did close beds because they didn't have occupancy. They only had 70 percent occupancy, Get some of this information before you bring it in the House instead of having it appear as if we are closing down beds so people with cancer can't get a bed. There were vacancies, so they made that decision. They did not need those beds.

As far as radiotherapy is concerned, we put on a second shift so we could catch up on that. Some of your facts indicate that there is - by some design -underfunding and people cannot get into the hospital for the much-needed therapy. That's not so. I looked at that very carefully when this came about. It was reported that there was a long waiting-list for radiotherapy, which we doubled the shift for. As far as the overnight beds were concerned, they did not have full occupancy. It ran around 70 percent. I want to make that very clear, and I want that on the record so that someone doesn't pick this up and distort the whole area of cancer control.

MR. PERRY: I'm surprised by the response. I'll undertake to check the facts about the reason for bed closures and return to that issue in the debate later.

In terms of the problem with the waiting-list of patients, these are the figures given to me by a source who probably prefers to remain confidential but is in a position not to make mistakes about facts like this at the Cancer Control Agency. As of last week, there were 264 patients waiting for radiotherapy. That's not a normal number.

Again, it's public knowledge. There is nothing secret or surprising about this. This includes patients with serious problems - for example, painful metastatic lesions of cancer that require palliative treatment - who are waiting. In my view, in a modern society there should not be any significant delay for that kind of treatment. The facts that I referred to before, I think, are the same. There's no question that the government has made funds available for two evening shifts to run the machines, but there are no technologists available.

As recently as one week ago the Cancer Control Agency told me that two new radiotherapy machines are required. I find it surprising that they would ask me to raise this issue in the House if the funding were already in place for those two new machines. I will undertake to the minister to reconfirm the facts, but I would be astonished if I'm mistaken about those facts. Maybe he can just address that issue. Have two new machines been funded at the Cancer Control Agency? If so, when will they be on line?

HON. MR. DUECK: Again, I don't want to confuse the waiting-list with the bed closure. I think we're

[ Page 6306 ]

starting to get confusion here, at least for people who look at the Blues. The record will show that we're talking about closure of beds at the same time we're talking about waiting-lists. There is a difference. There's no waiting-list for beds. I want to make that point very clear because the member did ask why we would close beds, indicating there were people waiting that didn't get beds. I want to make that very clear.

As far as the waiting-list for radiotherapy is concerned, we gave them an extra $638, 000 to start up those extra shifts to catch up. We've given them planning funds for the two new machines. In fact, they are now - with the planning money - in the process of telling us when, how and whether they will make them available. It appears, according to, my notes, that these should be operational by the end of the 1989 calendar year.

There have been many more cases reported - I think you mentioned that, and it's true - than in the year before. I would suspect that there will be even more in the future. The agency has given us an assurance that urgent cases requiring immediate treatment will not be delayed, and they are whom we rely on for recommendations. I have to admit in the House -and I will admit it quite freely - that there isn't an unlimited amount of money. I think you can understand that; surely you should. We have to plan and work with the funds available. I think we are doing quite well with the Cancer Control Agency, which is very responsible.

MR. PERRY: I always have to stop and think back when it sounds as if I am being misunderstood. I promise to look at the Blues tomorrow, but I think I made it quite clear that we are talking about two somewhat different issues.

My information from colleagues who work at the Cancer Control Agency is that beds that the agency would have preferred to keep open to treat patients were closed in 1988 because of financial limitations. It became quite difficult for patients to get into the Cancer Control Agency. I know, from my personal experience of referring patients, of the waiting-list for radiotherapy. It is a serious problem; I don't think I have exaggerated it at all. I will undertake to reconfirm with the Cancer Control Agency the situation on beds. I did not suggest that there were any beds closed right now; I am not aware that there are.

Maybe I can turn to another quite different issue which was alluded to in the Province's editorial today: the broader issue of reproductive services in British Columbia. I would like to begin by asking the minister the factored cost of the report, which has not been released, prepared by the minister's ethics advisory committee on abortion services in British Columbia. I would like to know what the factored cost, as a percentage of the cost of running that committee, was to the public for the report on abortion services.

HON. MR. DUECK: I haven't got that before me Are you asking the cost of their deliberations, the per diems, how many days they sat, and how many days were for abortion and how many were for some other reason? I haven't got that with me at this time. It is certainly not a large sum. The report, of course, is confidential; I've not released it. Therefore I am not going to answer that question.

MR. SERWA: just before we leave the subject of cancer and another facility in the interior of the province.... Mr. Minister, how long a time would elapse between the recommendation of the Cancer Control Agency and the time that we could expect another facility to be on-stream and operating?

Interjection.

HON. MR. DUECK: Mr. Chairman, I'm lobbied by two here: one from Kelowna and one from Kamloops. I think my best bet is to not answer at all. The Cancer Control Agency will make recommendations. It will be some years in the future.

MR. SERWA: What are the parameters that they have to make that recommendation?

HON. MR. DUECK: That will depend on the Cancer Control Agency. Certainly they will look at demographics, population, the area nearest to other cities; all that will be taken into consideration. Hopefully the recommendation will be for the best site to service an area where it is less convenient to come to Vancouver.

MR. SERWA: I would just like to say that I would be remiss if I didn't seize this opportunity to advise the minister, and hopefully through the minister the Cancer Control Agency, that the second member for Okanagan South (Mr. Chalmers) and I would appreciate sincere consideration of an Okanagan South location, seeing that we are representative of a very large retirement sector. Probably 17 or 18 percent of our population is aged 65 and over. The retirement industry is a real growth industry. With the high-tech diagnostic and treatment centre at Kelowna General Hospital, we have the ancillary facilities and a good medical staff. We would appreciate sincere consideration on that.

MRS. BOONE: I think this is going to be a first, because I think on this situation the member for Prince George South (Hon. Mr. Strachan) and the member for Prince George North will agree, Mr. Minister, that you should put this cancer clinic in Prince George. We are aware, of course, that the north does not warrant it given the population areas of the south, but we certainly hope that the minister, when making the decision, will take into consideration the transportation difficulties of people, and getting family members down there as well. Some very close friends and members of my community have had personal experiences of cancer with their children, and they virtually went through bankruptcy in order to stay with their child at that time. It's not a matter of just hopping on the Coquihalla and driving down. We have a great deal of difficulty getting to and from

[ Page 6307 ]

Vancouver, Victoria or wherever. I guess Vancouver is where it is right now.

Mr. Minister, please take those things into consideration. I'm sure you'll get agreement from the member for Prince George South on this issue.

Interjection.

MRS. BOONE: And Skeena. Yes.

HON. MR. DUECK: I can truly promise, without hesitation, that I will give every one of those sites very serious consideration.

MR. PERRY: I feel a global responsibility to the rest of the province to ask you to consider all other possible sites in the province as well so that the members who are missing here today can also send that out in their householders.

Let me come back to the issue of the ethics committee. I think there has been great public concern that.... I think this goes for government expenditures in general. We saw this last week again with the report of the Jansen commission of inquiry into the future of the University Endowment Lands, which ran up a sizeable bill, I'm sure, and certainly consumed a lot of the time of the people who attended the hearings. Yet the report was never released. I was - how shall I put it without being unparliamentary? - directed into thinking from the other side that the report could be found in the library last week, but in fact it is not in the library. That one hasn't been published.

The ethics committee is clearly one in which the public has a major stake, not so much financial as in genuine interest in knowing the results of that committee's deliberations in all of the areas that they've been asked to address. Of course, it's no secret that the refusal of the minister to publish the report of the ethics committee's review of abortion led to the resignation of the ombudsman from the committee and to the threatened resignation of the senior ethicist.

[3:30]

I would like to know the global cost of operations of that committee, because I think this is another example of government fiscal irresponsibility, to say the least. To spend money on the per diems, travel costs and meeting costs of a committee like that, whatever costs may be associated with witnesses or the preparation, study and publication of a report, and then for the public who pays for those costs out of taxes not to have access to the result is, I think, intolerable in a democracy. I would like to know for the record the total cost of operation of the ethics committee in the last fiscal year, and also what the factored cost, representing the time they would have spent on that study, would be as a proportion of the total cost.

Maybe I could also, with the Chairman's discretion, ask the minister again whether he is willing to state why this report has not been released.

HON. MR. DUECK: As far as the total cost is concerned, I will send a note to my office to see if we can get that for you. I have no hesitation in giving the costs to you when we get them.

As far as the ombudsman is concerned, I want to make it very clear, for the record - and you obviously have not got all the information - that the ombudsman did not resign because those reports were not released. We came to an understanding. It was unanimous, and the ombudsman said he could live with those conditions. But he felt, as ombudsman, that it probably would be better not to be on that committee, and I agreed with him.

As far as the other member is concerned, again for the record, he is now working for the Canadian Medical Association in Ottawa. Because of the distance he will no longer be working with this committee. Also for the record, we have resolved our differences. Again I must tell you that it was unanimous - not seven against one or two objecting, but unanimous -that the decision we have reached is that for the time being I will give them any subjects that we want investigated and we will at that time decide how the information will be disposed of when it is completed. As far as anything done before this time, they have unanimously agreed that it is up to the minister, at his discretion, whether reports should be released or not. I don't want anyone misguided that there is some misunderstanding still out there with the committee and myself as minister; there is not. It's unanimous, and we have also agreed that in future perhaps the medical ethics committee will work at arm's length rather than directly under the minister.

So I think some of the questions you are raising are really not relevant, because they have been settled. If you want to know how much it costs, I'll get you those figures.

just one more thing, Mr. Chairman. We did get a screening fee request early in 1988 - I just got this information from my office - and the cost was to be $47.50. The ministry rejected that on the basis of cost, and the cost would more than double what the screening clinics would cost. So that's the information on that particular...

I understand that the ethicist who has now joined the Canadian Medical Association has not formally resigned, but he was at that meeting when it was unanimously agreed, and everyone was very happy with the new structure and how this ethics committee was going to work with the ministry.

MR. PERRY: My understanding of that issue is that the committee members recognized that the minister, under law, had the power not to release a report, but that there was no implication whatsoever that they felt it was ethical to keep secret a report paid for by public funds. I would like to ask the minister what the justification is, when a report is compiled on a subject of major public concern, in which all members of the public have legitimate interest on both sides of the issue. What is the justification for keeping it secret? Is this a democracy or not?

HON. MR. DUECK: I don't like the line of questioning at all, because it is indicating that somehow

[ Page 6308 ]

we did not agree. Were you at the meeting? I'm telling you it was agreed upon in a very friendly...

Interjection.

HON. MR. DUECK: The member says that they didn't agree; that they knew I had the power and that's why they had to buckle under. I'm telling you that it was unanimous, straightforward. I don't think any one of those doctors and the others on the committee would bend under pressure or say: "Well, because you have the power, therefore we will buckle under." I'm telling you that they agreed. It was an amiable meeting, and we've come to a resolution. I'm not sure whether you're trying to find something in this whole meeting we had that is not to your liking. I'm telling you that we agreed. What more do you want?

MR. PERRY: I'd like to see the report.

HON. MR. DUECK: You're not going to get it.

MR. PERRY: Is the minister implying that the report will be destroyed and that, in the event the government changes, it will not be available to the public then?

I don't want to make statements here. I want to maintain the proper tone, which is to question the minister on his estimates. But I think that there is a very wide public recognition that reports paid for with public funds belong to the public. They don't belong to a single minister, whatever his bias is on a particular issue. They don't belong to a single cabinet or government. They belong to all the people, because they are paid for by the people. I think that point will stand out painfully in the record of this brief interlude in the questioning. The public expects this. I don't think the committee has buckled under to that condition. My understanding from what's been reported is that they've accepted improved working conditions for the future and they have accepted reluctantly the fact that they have no power under their terms of reference to release the former report without the minister's consent. But any committee which did accept those terms would immediately lose all credibility with the public of British Columbia. I don't think this committee has done that, but if we saw a repeat of this situation where public funds are used to fund an inquiry of this kind and the result is not released to the public, I don't think that committee would have a shred of credibility in the future. I hope that will not be the case.

Let me continue then with the problem of reproductive services. We face a very serious contradiction in this field between the government's responsibility to fulfill the needs of the people and the record that we have of a government which historically has opposed the introduction of birth control education in British Columbia through reasons of squeamishness; unwillingness to deal with human biology; frankly, in the schools, unwillingness to deal in depth with sexual behaviours and with the detailed knowledge which young people require if they are successfully going to practise birth control. This policy has inevitably led to inability to control the epidemic of unwanted pregnancy, particularly in young people. We have perhaps made some progress in the last decade or two, but it's been painfully slow.

I give you an example of the difference between our record and some other countries, from my own medical practice. It's a common observation that women from eastern Europe do not feel the same squeamishness as Canadian women at having a complete physical examination. They expect to have complete examinations, whereas in Canada young women do not.

This, in my view, reflects a very serious failing in education at the public school level, that all of our students might learn basic facts of human biology and are comfortable with human biology. I think we've been seriously hampered in making progress because of the prurient attitudes of perhaps local school boards or some local administrators. We've been sadly lacking in government leadership to achieve really effective sex education or reproductive education in B.C. I hope that in the new initiatives of the government we will see some improvement, but I'm not holding my breath.

At the same time we see that the intent of the Supreme Court judgment and the law of the land in Canada on free access to abortion services is being flouted. We've seen a situation where the Attorney-General (Hon. S.D. Smith) refused to enforce the law at the Everywoman's Health Centre and allowed undoubtedly well-motivated demonstrators.... I don't question their motivations at all. I think even the operators of the clinic have significant respect for the motivations of the protesters. But those protesters have repeatedly broken the law and have denied the women who wanted to use that clinic the services to which they are legally entitled; and the Attorney-General waited until the last possible minute to act, expecting the women themselves, or the clinic, to enforce their own rights. I think, with all respect, we saw a travesty of justice and a parody of our legal system played out on the streets of Vancouver for several months earlier this year.

Elsewhere in the province, we have the spectacle of hospital boards dominated by single-issue candidates who run for election deliberately to frustrate the intent of the government of Canada and the Supreme Court, which is that all necessary medical services should be equally available to all Canadians anywhere, whether or not we as individuals agree with them morally or politically.

We have a situation in this province like that the Vancouver Province's editorial today describes at the Richmond hospital. We have, for example, on the lower mainland 15 hospitals that theoretically offer abortions; but of these only eight are actually performing them. One hospital, the Vancouver General, does over 50 percent of the abortions performed in the whole province. Clearly there is an inequity in the distribution of services.

I would like to ask the minister how he intends to deal with this problem, closing with the reminder

[ Page 6309 ]

that neither I nor anybody else on this side of the House favours abortion. Nobody in their right mind, in my view, favours abortion. It's a last resort in reproductive choice or birth control. The real issue is how we reduce the numbers of abortions in British Columbia by effective sex education. But where they are necessary, how do we ensure that all British Columbia women have equal access and are not discriminated against owing to the prejudices of a small minority in their community? We know that the antiabortion protesters are a small minority; they do not exceed 20 percent of the population of Canada. That's my question to the minister now.

HON. MR. DUECK: There were many statements made about law-breakers, abortion clinic.... What can I say as Minister of Health? That's an issue that should be referred to the Attorney-General or the Solicitor-General, because I don't make laws, nor do I enforce them. The law, whether it was obeyed or not obeyed, is a different issue than what I'm faced with in my ministry.

[3:45]

Hospital boards. Is the member suggesting we should no longer have democratically elected boards? I was lobbied very hard before the member's time -boards that were absolutely opposite to the ones you are referring to that were so-called, let's say, pro-life and anti...

AN HON. MEMBER: Life.

HON. MR. DUECK: ... life, if you will. In other words, anti-abortion or pro-choice.

I was lobbied just as hard for those hospitals, and said: "What are you going to do in this situation?" We have boards that are pro-choice. I said to those people exactly what I'm saying to you: they are elected democratically by the system that is in place. So what you're suggesting, Mr. Member, is that I should somehow make a difference to suit one group rather than another.

I have stated clearly in this House, and to anyone who has asked me, that boards are elected; anyone can join the society. Some have even changed the society's structure so that all you do is come in and sign your name and you're a member of the society, and you can vote. Until that system is changed, Mr. Chairman, perhaps the member would like to explain whether I should then listen to the board that is elected that is pro-choice and not the one that is pro-life.

I'm telling you and I'm telling this House, Mr. Chairman, that up to this point in time I've taken the stand that whatever board was elected - and they choose the board as the governing body by democratic vote - that is how they would operate. When you're speaking of not having access to abortions, all I can say is that we nearly doubled the national average in abortions in British Columbia; roughly 11, 000 a year in a population of three million. Something does not spell correctly. If there are that many abortions in three million people, there must be access. And there may be others that are now going to the clinic or perhaps out of country.

The abortion issue is strictly on the federal government's back. I want to make that very clear. It's not this government that struck down the law; it's not this government that doesn't come to grips with it, but the federal government. They refuse because it's unpopular. Every politician that gets involved with this issue gets hurt, regardless of which side of the issue he is on. I truly hope, Mr. Chairman, that the federal government will come to grips with it and put some sanity back into the system with respect to abortions. They have chosen not to do this to this point in time. And I understand it's not on their priority list thus far. I'm very sorry that it's coming back again to this House, because you know very well it's a federal issue. They should deal with it,

Abortions are legal and can be done in any hospital that chooses to do so. Surely you're not suggesting that perhaps a Catholic hospital is going to do abortions. They choose not to; they have that right. Until that system is changed, that's how it will be.

MR. PERRY: Mr. Chairman, it strikes me there are a couple of possible answers to that dilemma. One is that when a hospital board refuses to act in the public interest, the minister has the authority to replace it -and has used it. Not this minister but previous ministers have appointed administrators - as in a case like Surrey Memorial Hospital, when the situation became intolerable. I think it would be beneficial for the minister to show some leadership in this area in terms of ensuring that services will be provided.

I agree that we have too many abortions in B.C. now. The answer to reducing the number is clearly in improved education. But I wonder whether the minister would be willing to agree with me - officially for the record - that abortion is a necessary medical procedure in some instances; that even with the best modern birth control, sometimes birth control fails and the woman ultimately must decide what is best for her health. I wonder whether he would agree that in cases of severe genetic damage or incest or rape that this is clearly a medically advisable procedure.

The reason I ask is that a little over a year ago we again had a spectacle where this government and this minister were in fact denying, or threatening to deny, necessary medical services to patients. I know that the minister is aware of this, because he and I have exchanged correspondence - mostly a one-way exchange. We had a correspondence over this issue when the 'University of British Columbia genetics clinic was threatened with folding because of its short funding. And at the very same time, I remember the case of one woman with a very severely deformed fetus, with no possible hope of surviving delivery, who was told that she would have to go to Seattle because she would not be able to obtain an abortion in British Columbia. I think the government eventually backed down on that. But I found that a shocking and a frightening experience, to put a woman into that position.

[ Page 6310 ]

[Mr. Rabbitt in the chair.]

I would like to ask the minister whether he can give us the assurance that he recognizes the medical necessity of abortion; that this is a medical service that should be decided between a woman patient and her doctor.

HON. S.D. SMITH: I want to address for a moment or two with the Minister of Health a couple of wishes outstanding in the constituency of Kamloops. The first relates to the question of extended-care services in the Clearwater area. As the minister may be aware, at the Dr. Helmcken Memorial Hospital in Clearwater and those environs, there is an in-home care situation associated with it: the Yellowhead Hospital Pioneers' Association have a facility that has been up for some time.

It's a small community, and there have been some requests in the last while for extended-care services. Although we have good services, particularly the new facility at Overlander in Kamloops, there are a number of people in those facilities who might more appropriately - if we can work something out between the extended-care and the acute-care hospitals - be served in the area where their families reside and where we could have an integrated continuum of care for the elderly. I know it has been in the planning process, and it is certainly not yet at the top of the list for assistance and support.

It is desirable for the community and something which I know is dependent, in part, upon the catchment area used in terms of the number of people who would potentially be available to go to that unit. I would recommend to the Minister of Health that you again give some consideration to that.

The community itself has been fund-raising. It's a very small community. They have now raised a significant amount - several tens of thousands of dollars - towards the capital project which they would like to be in the magnitude of a ten- to 12-bed facility It would be integrated, because it's right in the vicinity with Dr. Helmcken Hospital and the existing facility there.

I know it's in the hoops, but I would hope the ministry would take a look at it again for us to see if we can't move it along when the needs arise again, when you do the planning of the needs in that particular region.

Secondly, I say to the minister that we're very pleased with the work done between the ministry and the B.C. Buildings Corporation with respect to Ponderosa Lodge. Ponderosa is a very good facility and has outstanding relationships with the community. We have been blessed with a lot of progressive initiatives in the past, relating to extended-care services. Given the opportunity to be on the same footing as the rest of the similar hospitals, where they have their own society, I know they have many ideas in mind where they can provide continued service and a continuum of service in the extended-care area for the elderly.

I commend the Minister of Health for taking the initiative with the B.C. Buildings Corporation to really resolve what, for the last 15 years, I think, had been somewhat of an intractable problem with respect to the valuation of the lands.

We are also particularly pleased that we were able to get the kind of support and flexible administration necessary for Royal Inland Hospital to establish the pay-parking facility that they needed and which is most useful for that area.

Royal Inland Hospital is also benefiting from an influx of outstanding, new, young physicians with techniques for surgery, particularly in the laser surgical area. This is pushing that hospital somewhat more to tertiary treatment than perhaps was previously planned for it. Nevertheless it is important not only to the community but to the interior of British Columbia, because as a regional referral facility, the catchment area of its region has grown quite significantly as a result of work being done particularly by Dr. Azad and those bright, new, young physicians who have come into the area with him recently.

I think it's safe to say that there is a real increase in vitality in the entire medical community in Kamloops as a result of the work they're doing. Indeed, CBC's "Pacific Report" did a very good analysis of the changes made and the assistance they have provided both to people in the community and to the hospital itself.

Finally, I want to get some clarification from the minister with regard to the program of screening for cancer, particularly for women under 40. Like most MLAs in this chamber, last year I had to undertake the process of replying to literally hundreds of women who were seriously alarmed by statements attributed to the president of the British Columbia Medical Association, Dr. David Blair. Those statements intimated, if not said outright, that the province had changed its policies on funding mammography screening tests. People in my community, as I think is the case in virtually every other community in the province, naturally are concerned about the ever-increasing incidence of cancer in our society; it is a particularly major problem for women. Naturally it was the case that when those statements were issued by the British Columbia Medical Association, people were alarmed, and I can only conclude that that alarm must have been foreseen by the people who issued the statements.

[4:00]

My question to the minister is this: would he confirm for me, because I have taken the lead in this area to try to reduce the level of anxiety of women in our community about those statements by the B.C. Medical Association... ? I want to be confident that in fact there was, as I said, no change in government policy with regard to funding mammography; that the discretion of the physician is indeed paramount in that area; and that under no circumstances and on no occasion has a bill by a doctor for that procedure ever been refused payment by the B.C. Medical Services Plan.

[ Page 6311 ]

The reason I ask that is that I made that statement and that commitment to my constituents, and there was publicly some dispute with me by the B.C. Medical Association in that regard. I would like to be able to confirm for my constituents that it is indeed the case that in British Columbia there never has been any bill submitted by any physician for a mammography screening test that has been refused payment.

Secondly, I'd like to have it confirmed that there was in fact no change to the policy of the government, as was implied by the president of the B.C. Medical Association.

Finally, I am, on behalf of my constituents, extremely hopeful about the new screening techniques that have been developed with the very able assistance of the Cancer Control Agency and the experiments that have taken place there. As I understand it, what this process will mean is that women under 40 who use it will no longer have to make an appointment to got tested. They will not have to be on some waiting-list for an appointment at a doctor's office Rather they will be able, with some degree of anonymity, simply to show up at these clinics and receive those tests at a time which is convenient to them, and the test results will then be forwarded to the physician of their choice. It is very important to working women particularly that the schedule will be able to be theirs and that it will not be dictated by some professional person whose office hours they would have to accommodate.

Perhaps more importantly, the proposition of a mobile unit is extremely important to people who live in the constituencies of Kamloops and Yale Lillooet, because we have several communities where those medical services are not available or the availability is limited.

I would ask the minister if he can confirm that the mobile clinics and the clinics outside of the metropolitan area will be a priority for development as funding is available, because I can tell you, Mr. Minister, that the women of the interior of British Columbia, and all across British Columbia for that matter, are deeply concerned about this issue, and properly so They need your assurance that there has been no change in policy, that no fee has ever been refused a physician who ordered one of these tests, and that indeed the new screening program you are developing will make it far more convenient for them to be able to get to this very important diagnostic service and preventive medical service. I want to be assured that that process is moving along as you would be hopeful it would.

HON. MR. DUECK: There has been no change in policy. I can assure my hon. colleague of that. The pilot project is a walk-in clinic. Thus far it has been so popular that they've had to phone for an appointment to be able to get into the clinic for the time slot that they desire. However, the only request the clinic has is that they give the doctor's name so that that information can be passed on to their physician.

I've also had a lot of calls and many letters from concerned women. There was some confusion that we had changed policy and would no longer fund by referral from the doctor. This is not so. To my knowledge we have never, ever refused a bill that was submitted to us. I am pleased to say that, and I feel very good about it, because it is an issue that we've talked about for a long time in our management meetings to get this off the ground. With the cooperation of the medical profession, we were able to do so.

just to give you some statistics, to March 15, 1989, 6, 660 women have been screened and 17 previously unsuspected breast cancers have been found. A physician's referral is not required, for reasons of accessibility, convenience and costs. Walk-in patients must give the name of the physician, and that's really all that's requested.

We hope that in the future there will be enough clinics that they can actually walk in and get the screening done. The Canadian Cancer Society, British Columbia and Yukon division, has committed $240, 000 towards providing the mobile mammography van. That is now being considered. They feel that instead of a completed unit they would rather get the shell and then produce it according to their own specifications. Thus far, it will be one mobile unit. For the future, of course, we intend to have another one or two.

We are now looking at two more permanent sites, the same as in Vancouver. That should happen quite soon: another one perhaps in the greater Vancouver area and perhaps another one in the Fraser Valley.

I am very pleased. I wish that more people would talk about it, because it's something . . . . I think the government is often blamed for doing everything wrong, and very often governments do stupid things. But I think this is one area where we are doing the right thing, and I just wish that we could get everybody on board. It appears now that it is beginning to take hold and less people are speaking against it.

I have to tell this House that I got hundreds of calls and letters from people saying: "Why are you doing this? Why do you no longer pay for mammography screening?" It came from the medical profession. They went on record saying that the government wasn't doing the right thing, and they could do it another way a lot better. I talked to the president at that time, and he said: "Well, yes, but...." So they half-heartedly admitted that in fact they had created this impression that perhaps the government was now discontinuing paying referrals from a doctor. I don't speak against physicians. I am not saying this because the member there is a physician. I am saying it caused me nothing but problems. It got off to a good start with the medical profession being on board; then some statements were made and it was completely reversed. These women who were mostly at risk were tremendously frightened. I phoned some of the people back myself. I got the letters, got their names and numbers, phoned them back personally and said: "This is the Minister of Health. I am sorry you have the wrong information." The letters were very sincere; they weren't trying to knock anybody or criticize. They were sincere and they were very afraid that perhaps there was a change and they

[ Page 6312 ]

would no longer be looked after. I want this House to know that this is not so.

We are better recognized for our efforts by those outside of the province than we are in the province. We have had information, correspondence from other provinces.

Interjection.

HON. MR. DUECK: I know you are sort of bored by this, Mr. Member, but perhaps you should take it to heart that the other provinces in Canada were very pleased with what we are doing. They are coming here for information, saying: "How did you get it off the ground? How many dollars does it cost? Did you get some volunteer people involved? Did you get some donations?" And we did for the mobile unit.

People worked together. It's not just government coming up front and saying: "We're going to do all these beautiful things." It's many people, including the medical profession, the nurses and many volunteers and including corporate and individual donations. I want you to know that it is off the ground, we are doing the right thing and if you can criticize this program other than that we're not going fast enough.... I will accept that, but other than that I will not accept your criticism.

MR. PERRY: I'm a little hesitant, Mr. Chairman; I feel like I'm interrupting a love-in for mammography But what we're really here to do is to address the question of whether the minister has been fiscally responsible in spending public moneys in the Health estimates.

I must say, I thought it was wonderful to hear the Attorney-General (Hon. S.D. Smith). I was wondering why he was waxing so eloquent on the needs of women. I suddenly realized that perhaps it was because they're a majority, not a minority like the poor, downtrodden Indians that he dismissed so easily last week.

Interjection.

MR. PERRY: Oh, I'm just thinking aloud. If he can't take the heat, get out of the kitchen. I guess it was an American who said that. I suppose the Attorney-General would object to that as the Americanization of Canada.

I think ' though, Mr. Chairman, it's time to get down to earth a little bit and look at some facts.

I see the Attorney-General applauding. I hope he'll be equally happy when he hears what I have to say here.

Let's look at what actually was the Ministry of Health policy on mammography screening - and as far as I know, it still is. I'm not convinced that there were hundreds of women around the province who were frightened that they were not going to get their screening. If there are copies of letters, I'd be interested to see them.

Interjection.

MR. PERRY: Well, presumably they still exist then. Maybe they could be tabled in the Legislature, Mr. Chairman.

The real policy of the Ministry of Health.... Fortunately, I agree, this policy was not enforced, and in some ways it hasn't been strictly enforced for other preventive services, like some forms of counselling. But this happens to be the policy of the Ministry of Health in the Medical Services Plan practitioners' newsletter, dated July 1988, volume 12, No. 8. Under "Screening Mammography, " I quote: "Except for pap smears, the Medical Services Plan does not cover any 'screening' protocols in healthy persons. Thus the charges for mammography for a patient referred solely on the basis of age or other factors and not because of medical necessity based upon signs, symptoms, family history, etc. should not be billed to the plan." That means that a patient referred solely on the basis of age or other factors and not because of signs, symptoms or family history... That is the definition of screening.

This was a letter sent to all physicians in British Columbia; I know, because I received one myself in practice last year. This letter says that the government will not pay for screening mammography, period. Fortunately, that policy was not enforced, because physicians submitted diagnostic mammography requisitions at a much higher price. The facts are that the government did decline an offer from physicians to provide screening mammography at a lower price. The facts also are that the cancer agency can do it still cheaper, and probably better. Therefore I made very plain - and I'll say it again - that I support the minister's and the ministry's initiative in developing a screening program through the Cancer Control Agency.

However, in the meantime this policy is still technically in force. Physicians may have shown this to their patients, and the patients may have perfectly appropriately concluded that they would be billed for the service, which is the official policy of the Medical Services Plan. Fortunately, the policy was not enforced.

I still have an unanswered question to the minister. It's a rather simple, practical question. I still don't understand why it would not have been in the public interest to accept the offer of the radiologists to do these screening films in the parts of British Columbia outside of the lower mainland, on an interim basis at least, for $47.50 rather than for $65 or $81, which is what has been paid any time a woman or a man went for a screening mammogram. I'd be interested in the answer to that question. I don't think it's that obtuse a question; it really relates to fiscal responsibility. Maybe I'm expecting too much.

[4:15]

HON. MR. DUECK: Again, Mr. Chairman, the policy has not changed. It's the same policy that's been in place for years. To my knowledge, no referral sent in to MSP has ever been refused.

[ Page 6313 ]

MR. PERRY: Mr. Chairman, I don't want to intrude on my colleagues' time, but I'd like to ask: can the minister explain why this newsletter was sent to practitioners then? Or will it be withdrawn, since it's clearly irrelevant now?

HON. MR. DUECK: That was to clarify the existing policy.

MRS. BOONE: I find this whole issue of the mammograms really interesting. The minister keeps saying the policy has not changed. I know that's correct; you know that's correct; but the public didn't know that was correct. This letter that my colleague the second member for Vancouver-Point Grey (Mr. Perry) received in his current life as a physician was sent to all physicians, and they took it as meaning that you were going to be strictly enforcing that policy. Up until that time, the ministry had sort of ignored it. They had been paying for screenings for mammograms; sort of a nudge and a wink - "We'll pay for this, but we're not having it in the policy."

How can you blame the physicians for taking the ministry at their word when they send out a letter saying this is government policy? They understood that the government was going to strictly enforce the existing policy: no change in policy, Mr. Minister, but enforcement of the existing policy. That's what created the fears out there, not anything that the BCMA did. The BCMA merely reiterated what was sent to them; and justifiably so, because they are the ones that send in their billings. You may not have received the billings, and you may not have turned anyone down, because the physicians were doing the screening at that end. They were saying to their patients: "I am not allowed to bill for this anymore, therefore I can't send it in." Obviously they're not going to send in bills to the ministry that they think won't be paid. The fact is, the physicians understood, from the letter that was sent out, that the current policy which paid for the screening processes was not going to be carried on; it would be strictly on a diagnostic basis. I find it incredible that you can stand there and blame the BCMA for misunderstanding you when in fact you've written them the very things.

I want to talk about the vans and the screening processes that are going on right now. They are wonderful, and everybody thinks they are. You won't find anybody saying they should not be expanded and advocated. If you get a mobile unit going around ' that also will greatly help the women in this province. But a mobile van is not going to be able to reach every small community in this province within a year; it's not going to be able to reach everybody. Women who aren't able to get to that van want to know that if they should require a mammogram screening, they're able to go to their physician and have those things paid for. We would like to see those things written down in your policy and your current policy changed to state outright that this ministry will pay for screening mammograms - not necessarily in the lower mainland where they can get to the screening area, but where they don't have access to those facilities. Many areas in B.C. will not see that screening van for many years, and those women want to know they’re going to have access to the services and will not be denied them.

I would like to see some commitment that you will change the existing policy so that there is no misunderstanding and the public doesn't have to rely on the fact that the ministry is going to ignore their existing policy. I know the policy has been the same. You know the policy has been the same. You know that the people out there have been ignoring it and have been paying for the screenings. Let's get this down in writing so that people know right away exactly what is available to them. Can we get a commitment from you to review that policy and to ensure that those services are available to women throughout the province?

HON. MR. DUECK: It is up to the physician. It's his decision whether a referral should be made for a woman; it's not my decision.

The letter that was sent was asked for by the BCMA to clarify the existing policy, as you mentioned. Anyone not in the area of diagnostic screening would of course then be referred to a physician, and it's up to the physician. To my knowledge we have never turned one down, and we don't intend to in the future; but we ask the physician to make that decision.

MRS. BOONE: It's my understanding that physicians have to bill this as diagnostic testing; they can't do it as a screening process. We are then saying to physicians that if they do it as a diagnostic testing they may have to fib a little bit or do something with the documentation in order to get it covered. Why not be upfront about it? Why not change the policy so that it states right there that if there is no other facility, no screening unit, then the government will pay for that screening process to be done by their physician within their hometown, enabling physicians to be upfront so that you don't get this business of people trying to fix the system? I don't think that is in the best interests of the physicians. It's not in the best interests of the people of B.C., and it's certainly not in the best interests of the ministry to have people not being upfront with you. I would like to see the minister revisit that policy and change it to ensure that we have that service available to all women throughout the province.

I don't quite understand what the member for Kamloops was talking about when he mentioned anonymity. I really don't see where anonymity comes into it. This is not something that women are ashamed of, and it's certainly nothing that I think you need to be anonymous about. Obviously you are going to have to have the results come back, so anonymity doesn't come into it at all.

MR. ROSE: I am going to change the subject, but before I do I would like to say that I am probably the only male in this room who has gone through that procedure. I wasn't charged extra for it. I don't really

[ Page 6314 ]

know whether the prescription was for a bilateral mammogram of a lump or a screening mammogram. I understand the price is about double. There may be some others who should have one, but I think I am the only one with that experience.

I am going to talk about what might really be thought of as a staffing or labour problem that might have come under the Minister of Government Management Services (Hon. Mr. Michael). When I brought it up earlier it was suggested that I couldn't bring it up, because it really had to do with a hospital, and therefore it was a health matter. I am going to bring it up for your edification anyway.

Before I do that, I want to take this opportunity to thank both the minister and the deputy minister for responding readily and happily to the phone calls and questions I had. Sometimes I don't always like the answer I get. Like lawyers, I don't win all my cases, nor do I expect to; but I like the way I'm treated when I phone that ministry.

Having said that, this is nothing very critical, necessarily, in terms of other weighty matters that may be discussed. It is something that is happening down at Riverview Hospital. I'm sure it's happening elsewhere in government services; maybe not in health services, but certainly there.

You've got two maintenance programs down there. You've got one that is contracted out, and you've got another that is really under Government Management Services. The contracted-out service people get no fringes at all; they get $6 an hour. The ones who belong to the Government Employees' Union or the health services union - whichever it is - get something like $12 an hour plus I don't know how much in the way of fringes. Certainly it's $1, 500 or $1, 600 a year, if not $2, 000.

I think it's appalling that you have two of these systems, with two people working side by side and two distinct groups.... I have talked to some of the people down at Riverview. As you are no doubt aware, I live very close to that facility. I see them frequently. They say that in spite of what B.C. Buildings will tell you, the maintenance is not as well done on the contracted-out stuff as it is by the regular employees. According to my information, it is noticeably different,

Here we have a group of mainly immigrant women working at full-time jobs for wages that wouldn't even amount to $100 per month below the poverty line. They're getting $6 an hour through Holly Housekeepers, the service company at Riverview Hospital. I think that is an Ontario firm, For all I know, it might be an imported American firm; I don't really know.

Here is what they are asking for: an increase in wages of at least $1.50 an hour; that will take them to $7.50. It still doesn't give them $1, 000 a month, unless my calculations are incorrect. Medical benefits: they get nothing. They are working right alongside people who have the whole package: paid sick leave, maternity leave and a dental plan. They are also very concerned because they are working alongside infected persons and they don't get any medical coverage.

This is one of the joys of privatization. It's an exploitation of weak people who have no organization. I really think it's intolerable to ask a group of people to work for the government.... The government should be a model employer. It should not seek to cheat immigrant women who are unorganized, and that's really what this does. I've even heard that one of these women, in order to cover her work, has to bring her daughter along, so that's $3 an hour.

[4:30]

They work hard; they have strenuous duties. They are always dealing with chemicals and abrasives. I'm quite sure the possible effects of a mild abrasion or cut, with epidemics, AIDS and things of that nature.... It's really not very satisfactory.

I don't know what kind of answer you gave when they wrote. They wrote to a number of people: the director of services at Riverview Hospital, the B.C. Buildings Corporation, the Ministry of Labour and me. I wrote the CEO, a Mr. Truss, and he said that "the current hourly rate paid to our cleaners is $12.35." He says that we're saving a lot of money in public buildings by contracting this out. The southern plantation owners felt the same way about slaves. If you didn't have to pay any wages, you'd be saving a lot more money.

I'm trying to think of the morality of this kind of system where people working a full-time job in a public institution are paid wages less than the poverty line. I'd like to hear the minister's comments on that.

HON. MR. DUECK: It certainly bothers me when people are not getting paid a proper wage. I cannot say that is commendable. I know they are contracting out, but I've never had the....

Riverview Hospital has been changed to a society and is operating under a society now. That doesn't make any difference to the individual's take-home pay. I will look into it. I should mention that we've had similar situations with homemakers and home care, and we're trying to correct that by phasing it in over a couple of years. We've had similar situations there. I'm trying to correct that.

I will look into it and see if something can be done. When you're looking at contracting-out, it's like the marketplace. You're asking for bids - so many hours or so many people to do a job - and a firm that might even be a corporation comes in and says that they will provide this service for you at x number of dollars. Then they hire their people. I imagine this is what's happening. They in turn get people to work for a certain wage.

I can't say it's equitable if they're doing the same work as someone else. Perhaps you will allow me to look into it, and I'll get an answer back to you.

MR. ROSE: I'd be very pleased to give the minister that file, including the reply I got from the B.C. Buildings Corporation. He has this to say: "There's no question, particularly in the cleaning function, we can obtain the same service from the private sector for significantly less than it costs to provide it our-

[ Page 6315 ]

selves. In many cases, savings of more than 50 percent have been achieved...." That's right; that's what he's done.

You've gone from $12.35 an hour down to $6. These people have to shop, and they have to raise families. They have to do all these things. Who's to say that we're standing up here... ?

One of the lines from the Premier last week when he responded to the budget debate was that all we over here want is more money - more money for this; more, more, more - and we don't approve of saving money. I think we want things done efficiently, and we want it done well.

At the same time, for a group of workers to take a policy in which they have to accept a wage like that or nothing is certainly not the way a government should operate.

It was same thing with flag persons. Before we privatized the flag persons on construction, the Ministry of Highways was paying roughly $12 an hour. It's a rotten job being out in all kinds of weather, and it was exposed in the House last year that actually our contracting-out was costing us $11. The savings to the government weren't accruing there in any significant way. They were accruing to a wage contractor and not to the person on the job at all.

Thank you, I will be very pleased to send this along. I have a number of things I could have brought up having to do with various cases and problems o people in my riding. As I said in my opening words, I feel confident that these things can be handled, not in the estimates but privately through the ministry. So I'll leave it at that.

MRS. BOONE: On the same line that my colleague was on, I notice in last year's estimates that we had 4, 757 FTEs. This year's estimates show an increase in funding, but a substantial decrease in the FTEs: 4, 572. Is this the same type of thing? Is more contracting out taking place within the ministry? This is the sort of thing we have been talking about throughout estimates for quite a while.

It has come to our attention that in many different sectors of this government right now, people are working side by side, sometimes in offices, some on a contract basis, and some government employees receiving the wages and benefits that government employees have managed to negotiate while the others are being paid $6.50 an hour. In many cases, there is not a great deal of savings. In fact, the government is still spending close to the same amount of money, but a company is making a good profit from this at the expense of the workers.

Interjection.

MRS. BOONE: That's right, Off the back of the workers.

Can the minister please explain why there is a substantial decrease - about 200-odd employees -within the ministry? Is this due to further contracting out? What areas are they going to be deleted from?

How are those services going to be supplied, given the decrease in staff?

HON. MR. DUECK: Yes, I can explain that. The ambulance service, being a commission, is no longer included in the FTEs of the ministry.

MR. ROSE: I'm told that due to the changeover at Riverview and the early retirement scheme presented, there were a number of people who took early retirement. They grasped the golden handshake but actually now have been hired back in various capacities because of shortages of one kind or another. It's not just personnel shortages but skill shortages. Have you got any numbers for us on that? How many have happened?

HON. MR. DUECK: I'm not sure. I think that was last year; there were quite a number. It's true that many of these specially skilled people did take early retirement and were then brought back as employees or short-term nurses, which were very scarce at that time. But I believe the total number of FTEs were in last year's count. This year, the reduction in FTEs is because the ambulance service FTEs are now under the commission. They have been taken out and show as FTEs in the ministry as a whole.

We contract out very little in the Ministry of Health, Everything is operating pretty well the same as it has all the time, except for the change of the society versus direct employees. The ambulance service is still exactly the same as before. It was a commission before, but its FTEs are no longer counted under the Ministry of Health.

MR. ROSE: I think the earlier question might have dealt with ambulances, but mine deals with those people employed in Riverview as nurses: psychiatric nurses or ancillary nurses - I don't really know how to describe them, except as broadly as possible.

How many have you got working there now who took early retirement? That's what I'm asking. How many people working at Riverview today took early retirement a year or so ago?

HON. MR. DUECK: I'll get that figure for you; I haven't got it at this moment.

While I have the floor, I want to get back to the other member from Vancouver-Point Grey as to the cost of the ethics committee. I have that cost now. The total cost for '88-89 was $22, 658, which includes approximately $500 for in-house printing. The abortion report was $8, 750, which includes $250 for in-house printing. That gives you a fairly accurate... . I could be out a few dollars either way, but I am sure that you wouldn't necessarily... The total cost is $22, 658.

MR. PETERSON: First of all I would like to thank you, Mr. Minister, on behalf of the people of Langley for the attention you've shown us out there. I know that we're pretty demanding. You've been very good with your time and your staff's time. Perhaps we haven't got all we wanted, but in terms of providing us with the adequate health care services that we re-

[ Page 6316 ]

quire in that community, I want to take this opportunity during your estimates to thank you for your efforts. I know I can probably throw the minister bouquets all day long, but I really don't want to do that. I can throw him bouquets any time.

[Mr. Rogers in the chair.]

I want to take some time, during these estimates, to talk a bit about Children's Hospital. I probably do this with some degree of difficulty, because I have to get a little personal. Part of my modus operandi, if you like, is to not get personal in my political career. However ' I think there are times when you must make exception to every rule, and I'm going to make that exception this afternoon.

As a bit of a background, I have a son who was diagnosed as having a malignant brain tumour last June. He was only 10 years old, and it was a very horrifying experience for me, his brother, his mother and, of course, the rest of the family. However, through the efforts of some wonderful individuals at Children's Hospital.... I can't possibly name them all, but when I'm talking about the individuals there I include the medical staff, the specialists, the doctors, the nurses, the administration, the maintenance crews and the technical individuals. I have to give them the fullest credit because of their amazing ability to deal with problems like this, with a great deal of pressure on them but with such solid commitment. I just want to say that these people deserve the fullest credit we can possibly give them, and I want that placed in the record.

[4:45]

1 particularly would like to talk a little bit about some of the nurses in the oncology ward 3B in Children's Hospital. I know it well, because I probably slept there for about three months in a row. I'd just like to thank the administration at that hospital for the opportunity to be able to do that. When children are sick, the presence of parents and the love and understanding they can give - because it's a horrifying experience for them - is a real incentive for their well-being, and I don't think any medicine can provide that incentive as much as parents can in their love and support.

One of the problems I ran into during that time, perhaps, was that people from the interior who were down there with their children had a difficult time both financially and in terms of other siblings in the family being given the same attention.

I know I'm sort of rambling here, but life isn't perfect. Your ministry and the nurses and everybody must be given such full credit - all those people in that wonderful institution. Sure, it may not be perfect, and we can't supply everything. We have supplied the main ingredients that have hopefully made it possible for my son to be on his way to a cure. I think that's very precious in this province Everybody's pulling at your sleeves for more money and more funds, and probably all the requests are justifiable, but the fact is we must be fiscally responsible or we'll lose what we have. As a parent, I have become more and more understanding of this in the last year. I've been there; I'm not just talking from a political point of view; I'm talking with the deepest sincerity. It is so important.

I'd like to get back to that facility, because one thing I did find out - as any parent would do - was that the technology available to the medical staff, the nurses and everyone else there was state of the art. There was probably no better place than British Columbia for my son to receive this sort of help, from what my investigation told me. I'm very thankful about that, and I think many parents should be thankful about that.

Again, this is all meant to be non-partisan. I think all sides of the House feel this commitment. There are 69 members in this Legislative Assembly, and we should all be working towards that. Sure, we have our differences of opinion sometimes, but there are some things we all must work for and understand. Perfection doesn't exist in this world but we strive for it, and I think that's what we must do.

Again, Mr. Minister, I really want to thank all the people at that facility for the great job they do; of course, not only for my child but for all the children in B.C. who face that traumatic, scary experience of having that sort of sickness or any type of sickness face them. I think I will leave it at that. Thank you very much for listening.

MRS. BOONE: That was a very touching speech, and all of us here would certainly like to hope that your son does well and that things go well for your family.

Mr. Minister, I got my wrong book and I got my figures wrong here. It wasn't 4, 000, or whatever it is. The real figures in the FTEs for this year's estimates are 4, 530 and then a reduction to 3, 807. You say that this is done through ambulance, and yet there still is shown in this estimate $63 million-plus for budgets for ambulance services. In fact, you have salaries and benefits in here of $46 million-plus for emergency health services. How can there be salaries and a budget in here for emergency health services if you say that the FTEs have been removed from here and are in another budget right now?

HON. MR. DUECK: Right. The budget figures as far as dollars are concerned are in the budget, but the FTEs are not. They still show the dollars in our budget as the moneys that are used for that purpose, but the FTEs are not counted in our total FTE number.

MRS. BOONE: Well, Mr. Minister, you've managed to confuse me each year by changing things around and how budgets are done and by taking things....

MR. R. FRASER: Oh, it's not that hard.

MRS. BOONE: Oh, it is, it is, first member for Vancouver South, who I am so glad to see here. I am not going to be asking for money, Mr. Member.

I find it really difficult to understand why the moneys are there, but if you say they are there and that the FTEs aren't, I guess I will just have to take you on your word for that.

[ Page 6317 ]

I would like to talk to you a little bit about something that goes back to when we were talking about hospital boards there and we were talking about societies, etc. I think I've mentioned on several occasions how we perceive the whole idea of boards - whether they be pro-life or pro-choice boards - being elected from the society point of view. We would very much like to see hospital boards elected from the general public, so that everybody has an opportunity to vote in an election.

I know that everybody has an opportunity to sign up for a society, and all of those things, but the reality is that many people don't even know the societies exist. Many people don't understand how they get on those societies. I've talked to doctors who didn't even know that they had to join a society in order to vote at a hospital board.

I would very much like to see the voting privilege extended so that it is the same as school boards, municipalities and regional districts, so that people could vote at the same time on a global basis and not have it on for one night during the week, which is what usually happens with a society meeting. You have an election for one night, and if you happen to be working or out of town, then you can't vote. If it was an all-day affair, similar to municipal elections, then that franchise could be extended and would give a greater validity to the boards, so that they really did represent the communities that they served From my experience, hospital board interest surges You have a massive signing-up of members, pro-choice and pro-life trying to offset each other. Then it wanes again and surges up again.

I would like to see hospital boards - and it should be something that people are interested in and take an interest in every year - elected through a general franchise. Can the minister comment on that, please?

MR. CHAIRMAN: First member for Vancouver South. Sorry, I missed you there. Please remain in order. I am just warning you in advance, because I know you often stray.

MR. R. FRASER: How would you know that, Mr. Chairman?

I actually was listening with some interest to what the member from Prince George said, and I would like to tell you that I couldn't disagree more. There can't be anything that makes less sense than having a civic-election process for hospital board members The first thing you have to remember about elected people is that if they're going to be elected at large, they have to have a tax base. If you want to have yet another level of government in this great province, which we don't need, that would be the perfect process. If you want to tie the hospitals up more than ever, that would be the perfect process. In fact, if we even got anywhere close to having a general community election for hospital boards, then I would know for sure that the government had completely lost its mind. There is no sense in that whatsoever. You only got elected at large when you have the right to tax

Now if we change the whole system, and we get every little regional district running its own hospital, raising its own money, and we didn't need a Minister of Health, that would be the only conceivable way. But that's probably not going to happen.

To go an to enlarge a little bit on the election of hospital boards, I wonder from time to time if we shouldn't have a board running several hospitals. I think if we did that it would probably fit more neatly and perfectly into having regional hospital systems deliver health care. Since we can't have every conceivable piece of equipment at every single hospital, if we did go to a regional model, where some hospitals specialized in one form of cure and others in a different form, then you could have one board doing the work of four or five boards, and doing it very effectively.

I would like to make it very clear that I couldn't agree less with that member over there. There's no way we can have a public election for a hospital board.

HON. MR. DUECK: One board serving more than one hospital, or in other words merging or amalgamating.... We're doing that. We have, for example, the Royal Jubilee, Fairfield and Victoria General now under one board. They were all separate boards not too many years ago. We have the Royal Columbian and Eagle Ridge operated by one board, and we have Shaughnessy and the University Hospital now under one board. It is true that it works better in some instances.

Certainly we agree that hospitals should not compete for every piece of equipment just to be equal, perhaps, with the one down the street or the one a block away. We make no bones about it that when a new piece of equipment is requested, it must serve a catchment area rather than a particular hospital, only for us then to have a request from the next hospital. That happens in the rural areas perhaps even more than in the city. One hospital wants or gets a scanner, and three hospitals within so many miles all want one: "You gave it to that hospital. Why can't we have it?" Of course, we're trying to work on a regional basis rather than to have individual hospitals competing against each other. The member certainly makes sense in that area.

As far as the voting is concerned, I'm not so sure that the problem or the concern you raise would be corrected by a difference in voting structure, because you would still have the same people, who would still have their very emotional view for or against something. They would come out exactly as they do now, but there would perhaps be even greater involvement and a greater mass of people. Where the issues have really been brought to light, I think everyone in that particular catchment area did come out to vote.

We've asked the BCHA to look at that very issue, and I have met with many people from both sides who have requested a change and others who want it to remain status quo. As a matter of fact, I've suggested to some boards - and I think I alluded to this

[ Page 6318 ]

a little earlier - that they should perhaps make it easier to belong to the society rather than.... Belonging to society with a fee of $5 payable three months in advance may not be as compatible with some people, at least, as signing a sheet of paper, and that making you a member of that society. Some have in fact done that.

The BCHA also did a study and contacted many people, and they have told us that they prefer the status quo. They feel it's working very well, other than in the last issue - the abortion issue - which has come up. I don't think a change in the system of voting would necessarily rule out the two sides. They would still be there; they would still make sure both would come to vote, and they would still try to hype up their particular view. I don't think that would really change it at all.

That is my view. I've asked the BCHA to look into it. I haven't got a written report back, but I hope they will give us a written report so we can see what the views are.

[5:00]

MRS. BOONE: I'm glad to see the minister is reviewing this and looking into it. I certainly understand that the two factions would turn out, but the people in between would also turn out, because you've got a polarized viewpoint on both extremes. I think there's a good portion of people out there who would go and vote on many different issues of concern to them and on global health issues, and not necessarily on the pro-choice or pro-life thing. You would still have them, but of course you would have the others in addition, and that's why I believe that you would probably - hopefully - be able to get a board that was not strictly one-issue.

I don't care which side of the coin you flip up: I don't believe a single-issue board is in the best interests of the people of that area. I think a board ought to represent all sides, because there are so many other things that a hospital deals with. To have people elected strictly on one issue is really very sad. I don't think this serves people the best. I will leave it at this, because I know the minister is getting a report from the BCHA. I look forward to hearing from the minister as to what that report is, and what they're advising the ministry to do.

HON. MR. DUECK: I have said in this House -and I will repeat it - that one-issue boards are not necessarily good. I agree with you. There is more to running a hospital than that one issue, although it's very important for those people - as you mentioned - on either side of the coin. There is much more for a board to do than to be on that issue alone.

The member for Coquitlam-Moody (Mr. Rose) asked how many were in fact hired back at Riverview. I have that information now. Again for the record, approval was given to hire back roughly 30 nurses who had accepted early retirement; 50 nurses were contacted, and 14 agreed to come back. That's the answer to the member's question.

MR. MESSMER: I have a question to the Minister of Health. Earlier this afternoon, the member for Okanagan South asked you about the cancer control centre for that area. You very nicely suggested that there were two communities involved: Kamloops and Kelowna. A little later in the discussion, the members from Peace River got up and reminded you that they were also in the running.

I know full well, from my background in real estate, that you never tell anyone the choice that you have decided to make. I'm a little concerned, because of the Blues and what might be reported by the newspapers, that you have forgotten about Penticton. I know you have a great fear of any flipping of property. I think that's the same for both sides of the House. It's a topic of conversation today. You would not like to give Penticton the edge at this time, in case there was any flipping going on in property adjoining the only site that I know of that has already been dedicated to the cancer control agency.

I'd also like to thank the minister for the effort and time he has spent in the area of Penticton to do with hospital and health care; he has taken a great interest in it.

HON. MR. DUECK: Again for the Blues, since we're all so concerned about what's on the record, my reply was that to all those communities that requested the next cancer agency be established in their community, I promised that I would very seriously consider every one of them.

MR. PERRY: While the mood of the House is so friendly, I'd just like to reassure the minister that when he does make his decision, my riding isn't very seriously in the running, as far as I know. He will always be welcome to retreat to my riding. We'll make him welcome and comfortable there.

I'd like to take up a couple of different issues for a few minutes. just before I begin, let me also thank the second member for Langley (Mr. Peterson) for his very thoughtful comments. I have some personal experience with the Children's Hospital, too, so they were very meaningful to me.

I'd like to return to the subject that the former Attorney-General raised on Friday in his statement, which is the home support for multi-disabled children. This area also concerns the minister quite deeply, and the ministry has shown some very good leadership in it. I have had contact with some people in Victoria from the Arbutus Society for Children at the Queen Alexandra Hospital. They have made some very flattering comments about the ministry, particularly the division of family care, and how it administers the associate family program.

I think this has been a creative program. It's clearly a cost-saving program, and it's very humane. The only remaining problem is the peculiar exclusion of the natural parents from the program. The former Attorney-General referred to this so eloquently in his speech on Friday that I don't think I need to belabour the point, except to point out that the parent groups locally - and elsewhere through the province -

[ Page 6319 ]

have been working on quite vigorously for over a year now.

Local parents presented me with a rough list of some of the meetings they had held. Included on this list are meetings with the ministry in April 1988, a meeting with the then Attorney-General in May 1988, a meeting with the Deputy Minister and Associate Deputy Minister of Health in May 1988. Their brief was endorsed in June 1988 by the deputy minister's committee on social services. They met with the member for Esquimalt-Port Renfrew (Mr. Sihota) from this side in October 1988 and with the Minister of Finance (Hon. Mr. Couvelier) in December 1988, who told them that he would be their "spear carrier" in his capacity as their MLA and requested that they develop a pilot program for inclusion in the budget. I assume that it was this recent budget. They met again with the member for Oak Bay-Gordon Head (Mr. B.R. Smith) in December and on December 7 with the Minister of Health and, according to their notes, received the minister's support for their pilot project.

My own interpretation of this is that the minister is hamstrung by his Minister of Finance or cabinet and that he would readily support this if the money were available. I would just like to ask him: when does he foresee the money becoming available so that these kids can return to their homes and be looked after by their own parents?

MR. CHAIRMAN: Only the administrative responsibility of the minister and not sources of funds is in order.

HON. MR. DUECK: I think this question came up earlier in my estimates. I told the House that I have that concern. The documentation you recited in the House is accurate, and Social Services and Health will be forwarding a document again to cabinet.

We believe that it is ultimately better for many of the children to be at home. Last year I was successful in establishing the associate family program, which has been very successful. But it still leaves a gap for those natural parents who desire to have their children looked after at home. In the past we have provided and have some funding available for home support, for equipment through the Social Services ministry and for various kinds of help. But up to this point we have not had a program of funding parents in dollars and cents for looking after their own children.

It has been a matter of discussion: should governments pay parents to look after their children? My personal view is that if there is a good program laid out and a child meets the criteria for that program, then there should be an exception made - the same as funding to the associate family.

I believe it can work. The protocols could be set in such a way that it can work. I'm preparing a document once again to take to cabinet. I feel it is necessary that some of these children be looked after in the home rather than an institution. Ultimately it would be less expensive, I believe. Although you must remember - and you as a physician should know - that every bed that becomes vacant is again filled, so it will ultimately be an add-on.

Let's forget the dollars and cents for a moment and think of the child. If we think of the child, it is better if, with some respite care, the natural parents are able to look after their children at home and have some assistance. This is my goal. I'm going to follow through to the best of my ability to achieve it.

MR. PERRY: I would like to thank the minister for that statement and assure him that we will do anything we can to cooperate with that to the extent that it depends on us in any way.

I would like to ask one other short question about services to handicapped children around the province. We have, I understand, a provincial outreach program for ancillary support services for severely handicapped children, or children with handicaps with highly specialized needs, such as wheelchair-fitting for severely affected children with cerebral palsy.

The outreach program is now reaching northern British Columbia - I understand places like Prince George, Prince Rupert, Dawson Creek and Fort St. John - but the rest of the province is essentially having to come to Vancouver or Victoria for these highly specialized services. It may be not only desirable for the families for the services to be delivered in their communities, but also very cost-effective. I just want to ask the minister if he has any comments on where he sees this program going in the next year.

HON. MR. DUECK: Yes, I will gladly respond to that.

The Ministry of Health is presently, of course, doing exactly what the member mentioned. We have the teams going out to various parts of the province. We are reviewing last year's performance. Upon completion of the review, consideration will be given to expanding the program to include other communities.

[5:15]

The Ministry of Health is very pleased with the success of the traveling team thus far, and it will continue its visits to the high-priority areas currently being served. I think it is working well. The areas visited by the traveling team in this pilot project certainly have had the privilege of the service, and we wish to expand it when the review is complete. We are reviewing it now.

MR. PERRY: Since we were talking a moment ago about the Children's Hospital, I would like to ask a few questions, some of which I hope to deal with in more detail privately with the minister, but I think they are worth exploring very briefly here.

One is the long-term problem that, by most estimates, the Children's Hospital was under built. Of course, this in no way reflects on this minister; it was a decision taken long ago, and I'm sure in good faith. But the fact seems to be that Children's Hospital was under built for the needs of British Columbia and is now expected by the public to supply the kind of service which the member for Langley referred to, or

[ Page 6320 ]

which my family has experienced there, and is struggling to be able to maintain this service.

One of the problems I have alluded to several times before is the supply of nursing womanpower or manpower. Another one I would like to touch on briefly today is the physical plant of the hospital. I've not only been present there, as the member for Langley has, but I have also toured the academic facilities. This is probably the only hospital of its kind in Canada that doesn't really have a proper amphitheatre, for example, for medical teaching. There are only two small seminar rooms, very crowded, and it's impossible to hold a medical conference for the full complement of doctors, nurses and other health specialists looking after children, because they literally can't fit into the seminar room.

Similarly, there are some other physical problems They sound absurd, but I've seen them with my own eyes. The physicians, be it the fellows who work at night in the special-care nursery or be it the chief pediatrician himself, Dr. Hill, have to sleep in converted offices at night when they're looking after those children. What I mean by that is a windowless room, used in the day by a secretary, with a desk, filing cabinets, and the files literally spread out on the bed during the day. At night the doctors have to come in, pick up the files off the bed and wedge themselves into that room. The washroom facilities, including the shower, are well around the corner. It's quite primitive, to say the least, and clearly calls for a solution.

The chief pediatrician there informs me that some of his difficulty in recruiting new staff is due to the absence of any offices to put them into. Yet the hospital clearly needs more medical staff because of the growing workload and the complexity of the patients Since I am a novice to the budgeting process in the Ministry of Health, can the minister explain to me what provision is made for these problems in the current budget, if any?

HON. MR. DUECK: We're now, of course, touching on the capital budget, which is not part of this process. However, I'm only too pleased to give some information in this area also.

Shaughnessy, Grace and Children's, as you know, occupy that total site. Shaughnessy has received quite a chunk of planning money. They are now proceeding with some planning, and it will involve the other two. The other two, in conjunction with Shaughnessy, have gone into preliminary planning No planning approval has been given by us, but we know the pressures that are there. There is talk between all three: how can we utilize this total site? What are the options? Which direction should we go? What should we do for the future? I think we are aware of the concerns you raised. Certainly they are aware, and they are in contact with us. I don't think we can look at any one in isolation. It's got to be that total site. I think we'll probably have more information in the future, but it will have to be done in conjunction with all of them - a plan that will perhaps involve all three. Hopefully something can be done.

MR. PERRY: Another question, one that I look forward to exploring in more depth in a quieter setting, I think is worth raising briefly here, because it has fairly broad implications in health delivery in light of some of the concepts in the budget speech and in the minister's estimates speech of health promotion and improved efficiency within the health care system.

One of the problems I perceive in funding the health system is that support for some salaried physicians is remarkably weak compared to fee-for-service medicine, particularly in academic medicine. In so-called service medicine, be it a medical officer of health or cancer agency physicians, the salaries are reasonably generous. In academic medicine, salaries are remarkably paltry. The Children's Hospital faces a situation where they feel they need three additional full-time-equivalent staff. The amount of money they're talking about, including the administrative costs, is, if I remember correctly, only about $450, 000 a year. The kind of service that these physicians supply is exactly the kind that the member for Langley was referring to earlier, dealing with the most difficult medical problems - for example, children with cystic fibrosis, severe rheumatic diseases, oncology, difficult neurologic problems. The workload is rapidly increasing, because not only are more children being born and surviving in British Columbia, but more of the sick children are surviving longer. A case in point is cystic fibrosis patients.

I'm interested in learning how the minister feels about support for this kind of salaried service, which is an integral part as well of academic medicine. Sometimes the salaries, I gather, come through Ministry of Health budgets; sometimes they come through - presumably ultimately - the Ministry of Advanced Education.

The problem remains that those physicians do a tremendous service job, often 12 or more hours a day, sometimes seven days a week, and that the teaching hospitals don't have sufficient funding to supply the needs. We face the same problem in adult medicine as well, and I think we face the serious risk of losing very talented young medical scientists in whom the province and the government of Canada have invested in training through scholarships and fellowships but for whom it seems to be impossible to find salaries in the range of $40, 000 or $50, 000 to support them once they complete their training.

Maybe I could just ask the minister to comment on that.

HON. MR. DUECK: Some of the physicians the member refers to, of course, are paid through a mix of university and the Ministry of Health, plus many of them are allowed to bill fee-for-service over and above.

We're doing a review now to see exactly where we stand, because we don't really know. In many instances we don't know what the individual is in fact making, because we pay a portion, the university pays a portion and they bill the plant for some more. This review may be quite interesting, because we un-

[ Page 6321 ]

derstand another province did a review and some very interesting facts did come out from that review.

Perhaps it's not equitable in every case. I understand the Cancer Control Agency pays a fair salary. Some salaries are negotiated directly with physicians; others are negotiated through the BCMA. There is a combination. It's not clear, and this is why we want to do a review to see exactly where we are with some of those who work partly for the Ministry of Health and partly for the university and also bill fee-for-service. We don't really know where the dollars are coming from, and we should have a clearer picture. Just recently we requested a review of that total area because we feel, like you do, that it should be looked at and perhaps some changes made.

MS. PULLINGER: I want to enter into this debate on the Health estimates to clarify a few things about some problems that I have heard about and know about in my constituency.

I would like to preface my remarks by saying that we're all aware of the tremendous cost of health care. I know it's approximately one-third of the budget and that we need to take some care in our spending in that area. But as the Minister of Health pointed out in his initial remarks, health care directly affects the life of every man, woman and child in this province, and it's a ministry that is important to the quality of people's lives in a very direct way.

During the by-election and the months leading up to it, it became very apparent that there are some serious problems with health care in my riding. Probably most of these concerns extend a little more broadly in the province, but I'll deal more specifically with my own riding.

One of the biggest concerns that many people raised to me when I was talking to them on the doorstep and in public meetings was the Nanaimo Regional General Hospital. We have some major problems with that hospital. I don't, for a minute, condemn the administration; in fact, I commend them for the good job they're doing with the resources they have. I think the most evident symptom of the problems in our local hospital is a waiting-list of nearly 2, 000 people. It's my understanding that this is one of the longest - or perhaps the longest - waiting-lists in the province. I know the Minister of Health pointed out that the numbers weren't the issue, the important factor, but it's the time-period. How long people have to wait is what's the concern here. At the Nanaimo Regional General Hospital that waiting-list of 2, 000 cashes out to mean that people have to wait approximately a year for surgery. I would offer that some people simply can't afford to wait that long, and it causes a severe hardship for others.

For instance, there was a gentleman in my riding that I spoke to before the by-election who needed a hip replacement. He was an older man, and he had just received a phone call the day I got there to speak with him that he was number 1, 700 on the waiting list. Obviously he had some real concerns about that He felt it would be very difficult, if at all possible given his age and condition, to regain full mobility after an entire year. A similar kind of problem is a woman in Ladysmith who needed two knee operations. Her doctor's advice was that she ought to have one done and six weeks later have the other done. However, the hospital backup meant she could get one done when space became available; then she would have to wait a full year to have the other one done.

Another issue, of course, is cancellations. People have their date set and then it's cancelled, sometimes three and four times.

Other problems in our hospital, besides the waiting-list - I'm sure the minister is aware of them -are things like our antiquated emergency facilities. They are simply not adequate to deal with the numbers of people that come through the Nanaimo hospital. Another problem is that the admitting facilities are in a hallway in the Nanaimo hospital. Our laboratory facilities are far too small. They are outdated. In fact, it has been suggested that they're not even safe the way they are; they should have been replaced years ago. Similarly, the radiology department is simply outdated.

[5:30]

Just prior to the by-election, this government announced that it would begin on a $25 million program for our hospital. My understanding is that 60 percent of that funding would come through the government; 40 percent would be provided directly from tax dollars in the community, I understand also that this would be stage one of three stages of improvements to our hospital.

The minister stated at the beginning of the estimates that $155 million was designated for 14 major hospital construction programs in British Columbia. We obviously have a very serious need in Nanaimo, and as of last Friday we had no confirmation that this project would indeed begin. Will the minister confirm whether there are funds allocated out of that $155 million to do the improvements that he announced prior to the election for phase one of the renovations to our hospital?

HON. MR. DUECK: I would be only too happy to respond. I think the member knows most of the answers that I'm going to give, but I will go through the process.

Approximately a year ago we gave planning approval for the first phase. Those documents are roughly 95 percent complete at this time. The estimated tender date is June 1, and perhaps sod-turning sometime after that.

I should mention to you that we will never say that planning approval guarantees construction approval - neither in your case nor in any other hospital. I take the stand that I hope that we never go into planning approval without intending to go the construction-approval route. It can happen where there is a restraint program or a shortage of funds and suddenly everything stops. It has happened before, in '81-82. So, Mr. Chairman, I would be completely out of line in saying I will guarantee, when planning approval is complete, that construction approval will be

[ Page 6322 ]

given, because it is not in my authority to do so. But certainly the intent is.... In the past there have been cases where planning approval was given and dollars were spent - many millions of dollars - and no construction proceeded, and ten years later they had to go through the planning process again. This is not very efficient. As an individual, I certainly try and plan the capital construction program in such a way that when planning approval is complete, the intent is to move forward with construction approval.

I'm aware of the things you mention about the Nanaimo hospital. I want to also tell you that my announcement had nothing to do with the by-election, whether you believe that or not. I think the need was there, and therefore that announcement was made' I have said this in the past: I hope I will never give in to pressure other than that. It should be the need and the availability of money, and not politics, when we look at health care for any area. I think I've proven that in many instances, and I continue to take that stand.

MS. PULLINGER: I have some concern that what you're saying is a definite maybe; that we have some planning going on but there's no definite confirmation of funds. I find that a little confusing.

My colleague has just handed me a letter, and I will read it: "Thank you for your letter of January 27 regarding the recent approval of construction funds for the expansion of the Nanaimo Regional General Hospital." The folks at the hospital have been expecting confirmation of that construction funding and are a little open-mouthed, I think, at the lack of concrete confirmation, especially in the.... Would the minister care to clarify the conflict that I have here?

[Mr. Rabbitt in the chair.]

HON. MR. DUECK: I think I was quite clear that never in any hospital construction or planned construction.... It is in two phases. I have never said -in any project - that because you get planning approval, you are guaranteed that construction will follow. That is certainly the intent. I certainly believe that I will follow through on that, if at all possible. I don't see any reason why we can't.

We will not - and I emphasize.... It doesn't matter which hospital it is: it goes through two processes. One is the planning approval. When that has been looked at by our people, and it is complete and approved, then we go for construction approval. One is tied to the other only in that the intent is certainly there. We're not going to spend millions of dollars -as in the case of Nanaimo - only to say: "I'm sorry, you've got planning approval; now let's forget about it."

There have been times - and I'm referring to 1981-82.... When I came into this ministry, I saw millions of dollars that were expended, only to be repeated because the plans were stale. I told my senior staff that I didn't want this to happen, because we are short of funds. To have $5 million to $10 million out there somewhere that's lost.... What I couldn't do with that money in my program, rather than have it sitting out there in some architect's pocket only to go through the process again....

I want to make it very clear that that is the intent. The member just mentioned that it's iffy or something; that's completely out of context. I hope you don't start on that route, because that's not how we operate, and I hope we never will.

After planning approval has been given and the final figures come in, only then do we know what the cost is going to be. That must fit into the capital dollars available. This year I have something like $150 million. If every project is over by 20 percent, I have to make some adjustment, because I can't go back and get more money. Last year it was no problem; the year before it was no problem. We went absolutely according to schedule. Everything worked out well, and I hope that will continue this year.

I have one project with a tremendous surprise. It's up millions of dollars over the preliminary estimate that was given prior to planning approval. It depends on the economy, and it depends on how rich the process is. There may even be some changes in the planning that weren't anticipated at the time planning approval was given. Sometimes there's a shift; sometimes there's an influx in population. Surrey's got some tremendous pressure; Nanaimo has; my own community has, because of increase in population and the demographics of the age group also. So things change. They're not exactly what we think they will be when we start the process. But I want to make it very clear: planning approval does not guarantee construction approval; neither does it guarantee the date of construction approval. My intent is - and I say this very sincerely - that if I have any doubt that construction approval will be given, I will not give planning approval.

MS. PULLINGER: I find your responses very confusing. On the one hand, if you have doubt that construction approval will be given, you won't give planning approval. On the other hand, you won't guarantee or even give any very positive response that construction approval will come.

I find your response very surprising, especially given the costs and so on, because in the by-election it was put out very clearly that it was $25 million and that you knew where you were going with this. In fact, my Social Credit opposition in the by-election, who argued again and again that he had a direct pipeline to the cabinet, was outraged when I suggested at an all-candidates meeting that that funding just might not be as solid as it appeared.

In any case, it is very clear that Nanaimo hospital is in a crisis situation. I think that what needs to be looked at is that phase 1 only deals with the emergency ward, lab facilities and radiology department. We have a lineup of 2, 000 people, a year's waiting list, and phase 1 funding, if we should get it, doesn't touch that problem at all. It's my understanding that neither does phase 2 of this hospital improvement. It's only when we get to phase 3, which is obviously a long way down the road, that we start to address the

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shortage of beds, the fact that people are waiting a year for surgery.

It seems to me that the problem here is a lack of planning. The growth of the area and the increased demands on the hospital have not been dealt with before they reached crisis proportions.

Given that that's not secure, I would hope that the minister would look at some alternatives. We have, for instance, space for 60 more beds that has been vacant for almost two years, since September 1987, in our hospital. People are handling the pressure very well, or as well as they can; however, it's increasing and becoming worse, not better. The problem here is that we have the space for beds, but the beds aren't there and there is not enough funding to hire nurses and other staff to operate that section of the hospital. It seems to me that that would be an immediate solution to what's becoming a very grave crisis in our hospital system in Nanaimo.

The problem obviously is going to get worse. We have understaffing. Patients are being sent home more quickly to relieve the load a little bit. Therefore the nursing staff are dealing with sicker patients. In my talks with people who are nursing, I hear that they are getting very close to burnout. They just can't carry on with the load that they have and the critically ill patients that they have.

For instance, we've had in the last year, or just over a year, several incidents in the psychiatric ward of the Nanaimo hospital in which both staff and patients were injured. That's a serious lack of staff. We need more operating funds in our hospital to deal with that. If we can't get a commitment to have expansion of the hospital to relieve the load, I hope that we will have a commitment for more operating funds to relieve the load and to better use the facilities that we have. Will the minister tell us whether he will provide some of the operating funds necessary to ease the load on the staff and to ensure the health and safety of both the staff and the patients, so that we don't see repetitions of the incidents that we've seen over the last year and a half in the psychiatric unit?

HON. MR. DUECK: I reject the statement that the member made. I should be kind to a new member, because people were kind to me when I first entered this job as Minister of Health. But you obviously don't understand the system.

I am telling you once more that it goes in phases. Planning approval is the first phase. Planning approval does not guarantee construction, and everyone knows that. Check with your people. I've told you before, but you don't want to believe it. You stand up and say: "Oh, that's iffy. Maybe we don't, maybe we do."

No one has a pipeline, whether they run for election or otherwise. I haven't talked about the issue at all with the person you ran against. It was done exactly like any other hospital, according to process. Planning approval was given. You bring that report forward....

[5:45]

Interjections.

HON. MR. DUECK: I'll just wait until the conversation's finished, Mr. Chairman.

MR. CHAIRMAN: Please proceed, Mr. Minister,

MR. LOVICK: Keep going.

HON. MR. DUECK: I want to make a point. If they're speaking, I can't answer. It's very difficult. The question will come up again. I've said it three times now, and the fourth time it gets monotonous.

MR. CHAIRMAN: I'll ask all members to try and concentrate and listen. Please proceed.

HON. MR. DUECK: Again, for the last time. I've said it as clearly as I can. I gave instructions to my staff that if there's any doubt that construction cannot follow within a reasonable time, we will not go....

I'm sorry, Mr. Chairman. May I please answer through you to the member?

MR. CHAIRMAN: Yes, please direct your remarks to the Chair. The Chair is most interested.

HON. MR. DUECK: I believe this is a very important point. I'm not making an exception with Nanaimo or with MSA. MSA in my own community asks when they can start construction. I tell them to give me the planning documents, and we will look at them and see what the costs are. Then I'll look at my capital budget and see where it fits in. I can tell you that last year and the year before, if we went through planning process we went to the construction process, because that is the intent of this government.

There have been in the past.... Somewhere down the road all of a sudden something will happen, the roof will cave in and we don't construct any more beds. I can't guarantee that won't happen. I'm only the Minister of Health, the lowliest man on the totem pole.

HON. MR. RICHMOND: Oh, come on now, that's not true.

HON. MR. DUECK: Mr. Chairman, I want to assure the member they will be treated exactly the same as every other hospital. I know the pressures that exist in Nanaimo. I accept them, and we will try and do everything we can.

I should also mention that on April 1, 1988, they did receive additional moneys for their budget. That was $529, 867. In '89 that becomes the increase base. We're not neglecting your hospital, and we shouldn't. They have those numbers and they do require that extra funding.

Also, I would like to say that they have requested a review of their operations. It is true that we give every hospital a global budget. It is true that we expect hospitals to operate within that budget; we do not fund deficits. They got the extra $529, 000. We weren't funding deficits, but if they can prove they

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need that extra money, beyond their control.... We will do a complete review. When that review is finished, we will suggest some improvements in areas where they can make some changes.

The hospital recently requested that review, and a review of psychiatric services has been undertaken by Dr. Walter Goresky, consultant in the mental health services division. The regional team, mental health services and the hospital are presently reviewing the findings from this particular review. When that comes in, it will be the subject of discussion and perhaps further assistance, if possible.

Back to the question you had. I hope I made that clear, because it Is an important point. It is no more or no less important than in any construction. It goes in those phases and will continue to do that. You will not get guarantee or approval of construction until that first phase, that planning process, is complete.

MS. PULLINGER: No matter how you slice it, it still sounds to me like a definite maybe for a very serious problem. You say that you are concerned and definitely not neglecting the hospital, but there are some 2, 000 people, a whole lot of nurses and, I suspect, an awful lot of the administrative staff who are beginning to wonder just what your intentions are However, given that we can't definitely count on anything, maybe we can count on something to address the problems of the hospital.

I wonder what is being done to alleviate the load on the hospital. For instance, the government keeps talking about preventive services, home care and other assistance to people to keep them out of the system, which sounds like a great idea to me. However, home support services, as we all know, have been drastically cut over the last few years. For instance, Gabriola Island used to have a health nurse to do things like give B12 shots, dressing changes and post-operative care - that kind of thing; also preventive kinds of things, like prenatal and postnatal care for mothers and infants. That nurse is no longer there. There is no one to come over. So those folks are going from Gabriola Island, making a trip into Nanaimo and using a hospital system that's already overloaded, as I have pointed out once or twice, They have been five years without a nurse there now. They would like to see one. It seems to me it would be a good allocation of funds, to alleviate a much more expensive hospital system that the people are using instead, at their inconvenience.

There are other ways to keep people out of the system. Another one is the child development centre In Nanaimo. It's obviously a preventive kind of care - and very effective, from all that I know about it which is quite a bit over the years. The people there are having problems. They're saying that they're starting to spend more time fund-raising than they are dealing with special needs infants and the therapy programs that they ought to be dealing with. The people who run that place have made it very clear that the introduction of a special needs child into a family that's just making it creates all sorts of other crises, which reflect and create another burden on the system. This kind of support system is underfunded. They're not able to efficiently and effectively do their job, because they have to fund-raise rather than deal with the problems. That's another area where there ought to be some funding.

Also, something like hospice. It's been made clear that a separate hospice unit of six to eight beds, essentially semi-medical, if you like, where people could come for two weeks to adjust their medication and stabilize their condition.... Then they could go back out into the community. An awful lot of people could use that facility, which is better for the families, healthier for the individuals involved and an awful lot cheaper - half or less - than putting people into the hospital system.

Given that no definite improvement is going to be made to the hospital in the very near future, and given that even if there were, it doesn't touch the problem of a shortage of beds and the waiting-list of a year, is the minister going to take steps to adequately fund these other programs, like hospice, like respite care, like home care - those kinds of things that keep people out of the system, and look after their needs at half the cost or less?

HON. MR. DUECK: Mr. Chairman, I agree with.... I should say this quite willingly: you've brought up some very good points, and they're all valid. Although we're not meeting all the wishes of all the people, I think we've got adequate funding for the areas that you mentioned. Sometimes we have to reallocate from one to another. It is done on the basis of need.

You mentioned various areas, so it's hard to address each question or each concern that you had. You also mentioned - and I thought I'd get back to that - the burnout of nurses who do a commendable job in hospitals all over the province. I certainly meet more of those people who work in hospitals than you do. I find that the burnout rate is high. I would also like to see them go back to an eight-hour shift from the 12-hour shift. I cannot imagine a person working a 12-hour shift in the critical-care nursing area. It is just too much. I wish they would go back to a shorter shift.

Mr. Chairman, I 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.

Introduction of Bills

INTERNATIONAL TRUSTS ACT

Hon. S.D. Smith presented a message from His Honour the Lieutenant-Governor: a bill intituled International Trusts Act.

HON. S.D. SMITH: Mr. Speaker, this bill is based on a uniform statute of the Uniform Law Conference of Canada and adopts the Hague convention of the

[ Page 6325 ]

law applicable to trusts and their recognition. This bill will protect the legal interests of British Columbians relating to trusts, where the beneficiaries, the trustees or the trust property are in a country which does not recognize the trust as a legal concept and institution.

The bill provides a set of rules by which a court in a jurisdiction which does not recognize the trust, when presented with a document creating a trust, can recognize the trust and ascertain the rules of law by which the trust shall be interpreted and applied.

This bill will benefit international trade and business by helping to provide greater uniformity and clarity in the law.

Mr. Speaker, this is, you'll be pleased to know, only a brief introduction of this bill. I commend this bill for consideration and urge its speedy passage. I move that the bill be introduced and read a first time now.

Bill 18 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.

Hon. Mr. Richmond moved adjournment of the House.

Motion approved.

The House adjourned at 5:58 p.m.