[ Page 12615 ]

CONTENTS

Routine Proceedings

Oral Questions

Lottery grants. Mr. Clark –– 12615

Use of MLA letterhead. Mr. Reid –– 12616

Funding for alcohol and substance abuse prevention program.

Ms. A. Hagen –– 12616

Government advertising restriction. Mr. Blencoe –– 12617

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

On vote 38: minister's office –– 12617

Mr. Perry

Mr. Barlee

Mr. Zirnhelt

Hon. Mr. Weisgerber

Mr. Jones

MONDAY, JUNE 10, 1991

The House met at 2:03 p.m.

Prayers.

MRS. McCARTHY: One of the great traditions of our House is the British Columbia Youth Parliament, which meets annually. We're honoured today to have in the gallery the official Leader of the Opposition, Jason Herbert, from Vancouver South; the Deputy Speaker, George Nast, who represents Richmond; the Attorney-General, Rhonda Vanderfluit, who represents the constituency of Vancouver–Point Grey; and the Minister of Sessional Affairs, Matthew Bissett, who is the representative for Vancouver–Little Mountain. Will the House please make them welcome.

MR. ROSE: I'm informed that Mr. Gord Faulkes, 60 grade 7 students from Cedar Drive Elementary School and their parents are here today from my riding to watch the goings-on. We welcome them. I hope to be able to meet with them in about an hour.

MR. LOENEN: Mr. Speaker, in your gallery are some special guests, June and Fred Walchli, the parents of one of our legislative interns, Julie. They're accompanied by Julie's aunt, Gloria Breault. Would the House please welcome them.

MR. CLARK: In the precincts today are a group of schoolchildren from St. Joseph's Elementary School in my constituency. I'd ask the House to make them welcome.

HON. MR. DUECK: Mr. Speaker, I see in the gallery today my Member of Parliament, Bob Wenman, with some special guests. Would the House please make them welcome.

HON. MR. BRUCE: Mr. Speaker, in the gallery today are Mr. and Mrs. Richard Hill from Ladysmith. They are the owners of Yellow Point Lodge, which is one of the nicest places you can find to stay anywhere on Vancouver Island. I'd ask the House to please make them welcome.

Oral Questions

LOTTERY GRANTS

MR. CLARK: Mr. Speaker, I have a question to the Provincial Secretary. After swearing in her cabinet on April 15, the Premier said the following about the granting of lottery funds in B.C.: "I don't know that there is room for abuse. It seems to me there was a lot of tightening up done last year." Does the minister believe that when the former minister responsible for lottery grants, the member for Nelson-Creston, can award at least 23 grants to his own riding, this is evidence of a system that has been tightened up?

HON. MR. VEITCH: I thank the hon. member for his question. In response to a 1990 review of the Lottery Fund by the auditor-general, program guidelines were clarified and administrative procedures were strengthened to allow for fair and consistent treatment of distribution of the lottery moneys. The ministry is adhering strictly to those guidelines, Mr. Speaker.

A special ministerial review committee reviews and makes recommendations on all grants over $150,000 or those which may fall outside the guidelines. They are done on this basis. All applications are evaluated by the project officers — staff of the ministry — on the basis of benefit to the public, assessment of the applicant's ability to complete the project successfully, the economic benefit to the community, the applicant's record of public service, previous lottery grants to the applicant or the community and the availability of lottery moneys at the time the application is reviewed.

I don't want to get into the numbers game. If the lottery applications fall within those guidelines, they are handled in that manner.

MR. CLARK: Supplementary, Mr. Speaker. One of the grants to the former Provincial Secretary's riding was to a polygamous commune, whose members say they were forced to vote Socred in the last election in order to get government grants. Has the Provincial Secretary decided to investigate the circumstances...?

Interjections.

MR. SPEAKER: Order, please. I really think we should all hear this.

MR. CLARK: Has the Provincial Secretary decided to investigate the circumstances under which this polygamous commune received a GO B.C. grant last year?

HON. MR. VEITCH: Mr. Speaker, I don't have very much to do with polygamists or other types of communes. That would probably fall more directly within the responsibility of the members on the other side of the House; they may have more experience with communes than we do — a free enterprise government. But if the hon. member is talking about a venture playground, where we issued a grant.... Firstly, I don't know how the hon. member would know how people vote. We in the Provincial Secretary's office don't have access to finding out how people vote, and we don't take that into consideration when we're issuing grants.

MR. SPEAKER: I must ask for a new question. Has the member got a new question?

MR. CLARK: Yes, Mr. Speaker. This polygamous commune got a lottery grant for a recreation playground within the commune. Can the minister assure the House that that grant benefits the people of the community at large, not just the members of the commune, and therefore is consistent with the rules applied by the auditor-general?

[ Page 12616 ]

HON. MR. VEITCH: Mr. Speaker, again, I don't know how one gets into or out of a commune. I don't have much expertise in that particular area, other than travelling in the eastern bloc at one time — and I didn't like it very much. But I can tell you that the grant that I believe the hon. member is referring to is a school, and it is open to the general public. This is the information that I have been given, and I assume it's correct.

USE OF MLA LETTERHEAD

MR. REID: Mr. Speaker, I have a question for the Provincial Secretary. I think this one is pressing and urgent.

Mr. Minister, would you look into the actions that are necessary to provide this House with recourse to a member who mixes personal business with the office of an MLA? It has come to my attention that Trevor Lautens, who has provided quite an article relative to the member for Esquimalt–Port Renfrew, advised, in relation to letters of November 30, 1988, and February 1989, that that member advised...personal business on MLA letterhead, relative to some actions of his family business. Would the Provincial Secretary look into that matter?

MR. SPEAKER: I must ask the member to rephrase the question, because the way you phrased it is out of order. The way you want to rephrase it is: has the minister decided? Otherwise it's future action, and it's out of order.

MR. REID: Has the minister decided to look into this matter, which is pressing and urgent, relative to a member of this House mixing personal and business matters?

HON. MR. VEITCH: Mr. Speaker, I obviously haven't had time to examine the material that the member has available to him, but if it is a problem of ethics.... I remember that the Leader of the Opposition suggested we have an ethics committee of this House. Indeed, we do have a conflict-of-interest and ethics committee, and your information may very well be referred to that committee as soon as it is struck.

FUNDING FOR ALCOHOL AND SUBSTANCE
ABUSE PREVENTION PROGRAM

MS. A. HAGEN: I have a question to the Minister of Consumer Services. On May 17 the minister spent 90 minutes with an enthusiastic delegation of New Westminster students and promised that he would not abandon the school's successful alcohol and substance abuse program, which is funded by his ministry. In an emergency letter today to the program's sponsor, the minister repeats the moral commitment to the program, but fails to commit any dollars for its continuance. Is the minister now prepared to state publicly what he stated to these students — that he is prepared to provide the essential support so that dedicated staff and students can continue to build this effective alcohol and substance abuse prevention program?

HON. MR. RABBITT: Mr. Speaker, earlier today I replied to the principal of the school, and a Mr. Doug Walker of the chamber of commerce in New Westminster, with regard to this question. I also sent a copy of my correspondence to the member. In that correspondence I stated categorically that I would live up to the commitment I made to those students on May 17. As I informed the member, I also instructed my ministry as follows: first, to develop a school-based alcohol and drug awareness program that could be utilized by schools throughout the province; second, to develop a program based on funds available to my ministry; third, to have the program ready for implementation for the new school year this fall; fourth, not to duplicate any existing programs or services; and fifth, to consider the future summer program that would coincide with that particular program. In addition, I indicated very clearly that I considered the New Westminster high school a priority, and I asked the ministry to consider that when they implement the program this fall.

[2:15]

MS. A. HAGEN: A further question to the minister. For eight months New Westminster's community leaders have been having discussions with your ministry about the future of this program for secondary and elementary students. In today's June 10 rush letter, you do indeed indicate that there will be a program ready for implementation in schools in the new school year this fall. Yet the minister is leaving this program in jeopardy because he hasn't been able to get his planning and spending priorities....

MR. SPEAKER: Order, please. Hon. member, questions during question period. A little preamble is all right, but the rest should be saved for estimates.

MS. A. HAGEN: Thank you, Mr. Speaker. Let me proceed to the question. Has the minister decided that he will act on his promise to do — and I quote from his letter — "whatever is necessary to see a program exists in the New Westminster schools in the coming school year" in time to save this program from cancellation?

HON. MR. RABBITT: The TRY program was a three-year program. We're now in the fourth year of that particular one, and the ministry is doing a total evaluation of all the programs they've been funding for the past three years. One of the programs we are re-evaluating is this particular one. It was one of several pilot programs done in the lower mainland — not only in New Westminster but in Burnaby and Vancouver. We're looking at all of these programs and trying to assess which ones are delivering the best possible service for the dollars put into them. Within the next few weeks my staff will be developing and finalizing the new program which will be implemented this fall.

If you're asking me if I'm going to fund, on an ad hoc basis, a school program in the summer months to the tune of $12,000 when those students are not in the school, the answer, hon. member, is no.

[ Page 12617 ]

GOVERNMENT ADVERTISING RESTRICTION

MR. BLENCOE: I have a question for the minister responsible for the public affairs bureau — the Provincial Secretary. When the Premier swore in her cabinet on April 15, she said: "Government advertising will be restricted.... There will be no exceptions to this restriction, except as determined by the Premier's office." My question to the minister is: what special circumstances led the Premier, this minister, and therefore the government, to break their promise and revert to this government's worst habit of forcing taxpayers to fund government propaganda, the latest issue of which hit the doorsteps this weekend?

HON. MR. VEITCH: I'm not a psychiatrist, a psychologist or anything else, and I can't get inside anybody's cranium — least of all that member's. Mr. Speaker, I don't know what he's talking about.

MR. BLENCOE: Let's be clear what the Premier said on April 15: "Government advertising will be restricted to tender calls, legal requirements and items such as public meetings and public hearings." This is not a tender call or a legally required item. This is clearly government propaganda.

I want to know why the Premier, who said that she and this government had changed, has gone back on her promise of April 15 to the people of British Columbia.

HON. MR. VEITCH: This government has always and always will be an open government. One of the best ways to remain an open government is to ensure that the public is always completely and absolutely informed.

If he is talking about the information that goes out in "B.C. Reports" explaining the wonderful budget that was introduced recently in this House, it is a service to the people of British Columbia that we keep them informed. It does quite a bit to overcome some of the misinformation that comes from the other side of the House.

MR. SPEAKER: I would remind the second member for Victoria that if he has a document, he may ask leave to table it, but he may not just stow it on his desk. Exhibits are prohibited. If you wish to be recognized, please stow your exhibits.

MR. BLENCOE: Mr. Speaker, it may be a prop but it's propaganda of the worst sort, I can tell you that.

A supplementary question to the minister. It's bad enough that taxpayers have to pay for this propaganda, but it's worse that they're paying for untruths and distortions about the government's deficit. A quote from this propaganda item to the people of British Columbia: "...a small deficit of $395 million." The question to the minister is: why did the Premier, and therefore this minister and this government, approve of a publication that uses taxpayers' money to distort and fib to the people of the province about the real state of the provincial finances? Why did this government resort to this?

HON. MR. VEITCH: I know the Minister of Finance spent a lot of time trying to educate the only member for Vancouver East with respect to the budget. It would take more time than this House has available to work on this member so he would come to some kind of knowledge with respect to the budget.

If you read the document, hon. member, you will find it is in fact correct. You may have a different opinion, but I suppose that's up to you. The information is correct, and when the Minister of Finance comes back he'll give you a lecture as well.

MR. REID: I'd like to give notice of a matter of privilege that I'll be raising at a later date.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

On vote 38: minister's office, $360,045 (continued).

HON. MR. STRACHAN: At the outset I would like to extend my condolences to my critic the second member for Vancouver–Point Grey and his family. I know how he feels; I've been through a similar situation myself. So if I can open with that comment, I will.

With respect to our agenda today, because of the critic's family concern, I had not anticipated that we would be doing the Health estimates today, and I made one appointment for people visiting me from the Queen Charlotte Islands. I would like to keep that appointment; it will brief. I'll ask another minister to sit in for me, but I'll make that comment now so that everyone can be prepared for my brief absence at 4 p.m.

Just briefly, in opening the estimates, Id like to say that I've had some time now to visit a few hospitals and associations. I've found the mood of the health constituency to be generally positive and good. Naturally they are expressing some concerns, but I don't think there's anything we can't manage.

I had the good fortune to be at the Royal Columbian Hospital in New Westminster today, as well as at the B.C. Research Corp. dealing with another health issue. I had the good fortune to attend the British Columbia Medical Association conference in Kamloops on Saturday. I met with their incoming president, Dr. Har Singh, who is a Kamloops neurosurgeon. Of course, I had a good conversation with the outgoing president, Dr. Hedy Fry.

Generally, the B.C. Medical Association expressed a concern for health care in the province in terms of the increasing cost and where it is going to be. My comments to them were that we had to be more innovative and efficient and continue to look for better ways of providing health care services, while maintain-

[ Page 12618 ]

ing some control over the costs. I think they all agreed with that. It was a very positive afternoon with the B.C. Medical Association, and I found their response to my comments to be generally positive.

From what I've heard of the rest of their conference that day, they are genuinely concerned with the provision of health care in Canada — not only in our province. They are concerned that if left unchecked and without appropriate innovations and efficiencies, it may in fact collapse under its own weight. So it was a generally positive afternoon spent with those good people, the members of the B.C. Medical Association.

With those brief comments, Mr. Chairman, I'll take my place and await further comments from members with respect to the estimates of the Ministry of Health.

MR. PERRY: Mr. Chairman, at the outset, let me thank the Minister of Health, the government House Leader and the government for their courtesy in deferring the estimates debate last week. I'm very grateful for the courtesy, and I'm also happy to be back here pursuing the debate.

Since the minister referred to the recent meeting of the B.C. Medical Association in Kamloops, I wonder if he could give us his views on the initiative by the incoming president of the B.C. Medical Association, Dr. Singh, to raise the desirability of user fees for medical services in British Columbia. Has the government contemplated a change in policy in a direction that would be presently illegal under the Canada Health Act?

HON. MR. STRACHAN: I've been advised by my deputy that I got the name wrong; I talked about Dr. Har Singh. There is a Dr. Har Singh, who is an assistant deputy minister in the Ministry of Advanced Education. The name of the incoming president of the B.C. Medical Association is Dr. Gur Singh. My apologies to Gur for that mispronunciation.

With respect to Dr. Singh's comments about user fees, it is clearly not the intention of the government of British Columbia to raise the issue of user fees. I was questioned by the press on that in Kamloops on Saturday, in response to Dr. Singh's remarks and his request for a user-fee program, but my answer was clearly in the negative. We are not contemplating at this time any change in current policy.

Members will recall that in years past, in a previous administration, we did have user fees. As the member for Vancouver–Point Grey correctly pointed out, they in fact are contrary to the current Canada Health Act. So inasmuch as there is no change foreseen there, and as we don't feel it would be in the best interest of British Columbians to enter into such a system or policy, I can assure this committee that the current policy will remain unchanged, and that user fees are not contemplated in any fashion by this administration.

MR. PERRY: Mr. Chairman, I'm reassured by that answer. I suspect there was perhaps an attempt to run that issue up the flagpole in Kamloops. The policy that my party has taken against user fees has been grounded quite firmly in the experience of Saskatchewan, where under a Liberal administration user fees were introduced in the 1960s for medical services and appeared to have a discriminatory effect against poor people and people most likely to need medical service. There is also the experience in Quebec prior to the introduction of medicare, where it was learned that when universal access to medicare became available under the prepaid health insurance system, utilization of health services by poor people increased.

I'm reassured to know that the government agrees with us on the wisdom of that policy. I suspect — and I hope — that we share the same reservations about the administrative costs of implementing an additional user-fee collection system, which might well outrun any benefit in revenue. I see the minister nodding, so it's nice to know that once in a while even we agree on important issues.

This is a minor issue, but one that I think I should clear up now. I will raise it as delicately as I can. The minister will know that within the Richard Blanshard Building, a seat of the Ministry of Health, there has been for some time a firm anti-smoking policy. Rumours have reached my ears that the policy is occasionally honoured in the breach by administrators at very high levels and that this has eroded the morale of some employees of the ministry. I wonder if the minister could assure the Legislature that the non-smoking policy within the Ministry of Health will be rigidly enforced from bottom to top, top to bottom, stem to gudgeon, and that all employees will be encouraged to respect the ministerial policy.

[2:30]

HON. MR. STRACHAN: Briefly on the previous matter, the member mentioned the administrative costs of a user-fee program. There is not only that, of course, but also the policy under the Canada Health Act with transfer payments — EPF. If we did charge a user fee, it would be deducted from the EPF payments. So there would be no benefit whatsoever to the province if we were to enter into this type of extra collection.

With respect to the anti-smoking policy in the Blanshard Building, I will look into that matter and ensure that the member and also the people who work in the building have an answer to that question. I understand what he's getting at. I share his concern.

MR. PERRY: While we're on that topic, it's appropriate that we recognize some leadership in the anti-smoking field in British Columbia when we see it. I'd like to acknowledge a very nice recent example, because it sets an example for government and for politicians. A 20-year-old man from Delta named Jamie Wills, who works in a gas station, made the Province yesterday because of his refusal to sell cigarettes to pregnant women. I don't know whether his refusal technically violates the law, but it certainly conforms to the best traditions of public health. I see, according to the news story, that his boss has supported him. The minister and I would probably share some admiration for somebody who's spunky enough to encourage those most vulnerable to cigarette smoke and who exposes

[ Page 12619 ]

an unwilling victim in such a gutsy way. I'd just like to recognize him in the Legislature.

The article also points out that, like Coquitlam, a number of British Columbia municipalities have passed bylaws requiring restaurants and pubs to post signs warning pregnant women about the dangers of drinking. This is an old practice in many American states. It's something for which the Alcohol-Drug Education Service in B.C. and others have been asking for a long time. I'm aware that the jurisdiction for alcohol lies in the Ministry of Labour at present, but I wonder whether the minister would tell us whether he has made representations in favour of stronger health warnings on alcoholic beverages in British Columbia, specifically warnings about consumption during pregnancy. Has he made such representations to the Ministry of Labour? Of course, many of us have regretted that the alcohol and drug programs were removed some years ago from the Health ministry, but it doesn't remove all responsibility from the Health ministry towards this tremendous health problem.

I notice one practical thing that he might be able to reassure us about today. The Province article yesterday refers to the need by the Health ministry to approve a municipal bylaw in Coquitlam requiring warning signs in pubs and restaurants for pregnant women about alcohol consumption. The article suggests that the mayor of Coquitlam expects that bylaw to be approved by the end of the summer. Perhaps the minister could reassure us that the bylaw could expect routine approval within the next week or two and Coquitlam could get on with installing those signs.

HON. MR. STRACHAN: First of all, with respect to the young lad in Richmond, I agree with the member. I didn't have the advantage of seeing the newspaper article, but I certainly would agree that the young lad took a courageous step and stood up with the courage of his convictions. In terms of better health for not only the expectant mother but also the baby she was carrying, I would encourage all people in that situation, whether they feel their employer is behind them or not, to make their opinion known, particularly to expectant mothers. Of course, we know that in the United States cigarette manufacturers are now required to label their cigarette packages with the warning that smoking may cause damage to expectant mothers and also to the child that they're carrying.

With respect to the issue of the bylaws, we have taken a positive stand on this, Mr. Member. We have given our approval to the liquor control and licensing branch, because they have the mandate to control all signage within a pub or within any licensed premises. We have told them that we are certainly in support of all of these bylaws, and we want them to review the issue with a view to facilitating the municipality's desire to pass such bylaws.

So we haven't ducked the issue nor set it aside by giving it to Labour and Consumer Services. We have told them to pursue it with vigour, but they do have the final word on signage in a licensed facility. They have our sound encouragement, and we will do anything we can to encourage such signage and bylaws in municipalities. We are leaving the application to the Ministry of Labour and Consumer Services. I understand from my notes that they're most cooperative on this issue.

MR. PERRY: In the spirit of the government's new ostensible commitment to openness, would the minister care to provide the House with copies of the recommendations made by the Ministry of Health to the Ministry of Labour and Consumer Services, so that we know exactly what has been recommended. When we get to the estimates debate, we'll be in a position to ask why we haven't seen more expedient action.

HON. MR. STRACHAN: The member has my undertaking that I will provide the appropriate correspondence, if it deals with that issue only and nothing of a more sensitive nature. As I have done earlier, I will find the material the member wants and table it when the committee rises in the Legislative Assembly at the first possible opportunity.

MR. PERRY: Just before I forget, I'd like to clarify that there were a number of other documents I requested on Monday, and I haven't had time to refresh my memory of the list. The ones that come to mind were documents referred to in the interim supply debate by the Minister of Finance and the former Minister of Health regarding unpredicted expenditures on certain drugs under Pharmacare in fiscal year 1990-91. Has the minister located those documents yet, and if so, have they been sent to me? Could we clarify that, because I'd like to refer to them later in this debate?

HON. MR. STRACHAN: I've just been briefed on the issue, and apparently there is some work being done now. The material is not ready to be sent. I guess Finance has some concern, but we will endeavour, as always, to provide the appropriate material at the earliest convenience.

MR. PERRY: Let me turn for a moment to another issue which I suspect the minister, as I and other members, has been receiving abundant correspondence on. Like other issues, it seems to come in waves. The latest wave bids fair to inundating me, perhaps in the next few weeks. But this issue has been around for a while, and I think it's fair to ask for some comments on it.

I'm asking about early retirement for nurses. I believe I raised this issue briefly in last year's debate and perhaps also in 1989. I'd like to read briefly from a letter I received today from a nurse in Vancouver, which summarizes the issue rather succinctly:

"Enclosed please find a copy of a letter which I have sent to the Premier and to the Minister of Health", dated May 28. I and many other nurses are seeking the support, in this case, of the NDP to help B.C. hospital nurses achieve a fair retirement package. I have now been nursing for 36 years without a break in service, and there are many like me who are literally worn out. Thank you for your attention to this request."

[ Page 12620 ]

Perhaps the minister has some familiarity with the training and working conditions that a nurse like her would have experienced. To have worked 36 years means that she graduated, I guess, in 1955, and in those days nursing training typically was a matter of working virtually every day, most nights and often all weekends as well. Often the nurses were virtually incarcerated in the hospital where they trained, and they were paid nothing or next to nothing. In those days they went immediately into very hard work which was very low-paying, for the most part.

A woman like this who has worked for 36 years has really given an enormous service to the province, particularly in uninterrupted service during which, if she raised a family — she doesn't clarify that — she somehow managed to do while working. If not, she made a phenomenal contribution simply in her hospital work.

The question I'd like to ask is: where does the ministry stand on the issue of early retirement for nurses? I'm sure the minister has received at least as many copies of the form letter as I have, and it ought to be referred to briefly as well, so that those members of the public following this debate can perhaps understand the issue. I'll quote from one of the form letters I've received from another nurse in Vancouver:

"Presently nurses are in group 4 of the municipal pension act, with the retirement age being 65 and the early retirement age being 60. The nurses' union is hoping to change this to group 2 — retirement at 60 and early retirement at 55 — as is the case with corrections officers, firefighters and police officers."

Given the nature of the nursing profession, this seems only reasonable. I quote again:

"Hospital nursing is an occupation which requires a 24-hour, seven-day-a-week schedule. Therefore most general-duty nurses will spend their entire working lives doing shift work. It is well known that shift work negatively affects one's health and length of life. In addition, nursing has always been a physically and emotionally demanding career. In recent years these demands have escalated because of the increased acuity of the patient population. Moreover, the nursing shortage, with the resulting increased workload on nurses, has further compounded the stressors inherent in the profession. In turn, the increased stressors heighten nurses' personal risk of injury and/or illness."

There was a good example of that last week in Richmond, I think, when a psychotic patient attacked and injured two nurses at Richmond General Hospital. I'm not familiar with the details of the case, but I presume that the facilities were not really adequate to look after aggressive psychotic patients.

[2:45]

Mr. Chair, I've read that excerpt from the letter in order to describe the real issue, which I think is fairly simple. I recognize that this is being negotiated now as part of a labour negotiation, and what I'm asking from the minister is to give us some general comments on the ministry's philosophy, not a specific position in the midst of a labour negotiation. When I look at this issue it strikes me as fairly simple. Nurses have worked at least as hard as police and firemen. Nurses work in a rather high-risk profession where, in the past in particular, the risk of hepatitis was extremely high, the risk of back injury was extremely high and the risk of other injury and psychological stress was enormous. Nurses, like firefighters and police, often have to confront very difficult emotional situations — the death of young patients or unexpected death.

As I try to look at this issue dispassionately, I can reach only one conclusion as to why nurses are not included in the same benefits that firemen, corrections officers and police are. I see the Deputy Minister of Health waiting for the next line, which is inescapable: it's because they are predominantly women. There's no other possible explanation for that inequality in our societal arrangements.

I would like to know how the Minister of Health and the ministry look at this issue on general principles, so that the public can know — in the unlikely event that the present government is re-elected — what direction they might expect to see in the next few years from the present governing team.

HON. MR. STRACHAN: I appreciate the line of questioning that the member is pursuing. As I said at the outset of my comments, I had the opportunity to visit Royal Columbian this morning on my way down from Prince George to Victoria. I was taken around by the head nurse through a number of wards at Royal Columbian, and in all instances saw the excellent care that is given by the nursing profession to those who are in hospital. I visited everything from pediatrics to emergency to the head injury section. I appreciate, as I guess as we all do, that the care given by the nursing profession is indeed first-class and outstanding, and it is truly appreciated by all who are in hospitals or are in any way treated by a nurse.

The issue is difficult for me to respond to on an official basis for two reasons. First, the contract did run out March 31, so negotiations are continuing now and it would be very difficult for me as one of the ministers responsible for this issue to make an official comment — so I can't. The second thing is a parliamentary caution, Mr. Chairman, and it's this: any change to the nurses' pension or date of pension availability would be done by statute, so clearly we are discussing the necessity for legislation here. I don't want to enter into that intense debate or a debate which would be that specific, because it would be infringing on our rules and would require that I comment on the necessity for legislation. So I won't make an official comment for that reason as well.

In terms of how I feel personally about this and what I can say in this committee as the Minister of Health, I must admit I have some sympathy for what the nurses are saying, what the member is presenting and what nurses have mentioned in their letters. If I can lay out an unofficial position just from my own heart, that would be it. I have some sympathy with your comments and their argument, recognizing, of course, that it would be a tremendous economic cost to the health care system if we were to anticipate this. But maybe there is an argument there and a way that in

[ Page 12621 ]

these upcoming negotiations something can be arrived at.

I certainly would not want to pre-empt meaningful negotiations between parties, so I won't say much further on a formal basis. I will say that I do have in my own heart and mind some sympathy with the arguments that have been advanced both by the nurses and by the member opposite.

MR. PERRY: Well, under the circumstances I appreciate the minister's comments. Clearly there is agreement that this is an important issue to be addressed. It's an appropriate one to consider in the global context of a $1.2 billion deficit budget, where the total supply of money is limited. Perhaps we can hope that it may be a priority in the upcoming negotiations. As I look at it, it certainly strikes me as an important issue of fairness, knowing what I know personally of the working conditions of older nurses — the conditions they underwent during their training and the kind of working conditions they have lived through for decades, usually without complaining very much. They were a very hard-working group of people who did their work without expressing their grievances very often. I would certainly see this as a priority area to be addressed in the upcoming negotiations. I see some agreement from the minister, so I'm pleased with that.

Let me turn, if I may, to another relatively urgent issue. We spoke last week and also in the interim supply debate about the issue of intermediate care in Kaslo. One of the reasons that intermediate care in Kaslo strikes me as a priority issue — the development of some intermediate-care capability — is that the home support services are quite limited. In the debate last Monday — or perhaps it was in interim supply debate — I raised some examples of the most recent statistics I had on the hours of home care in the Kaslo district.

Since then I've received notice of an even more significant problem, perhaps, in the Nelson and district home support area. I'd like to read some excerpts from a copy of a letter I've received, which was sent to the hon. Minister of Development, Trade and Tourism, the member for Nelson-Creston. The letter speaks for itself. It is from the president of the Nelson and District Home Support Services Society to the member for Nelson-Creston, copied to me and dated May 22, regarding home support funding in Nelson:

"The board of directors of our society have asked me to express their disappointment that almost two months after our initial contact with your office requesting a meeting, you have apparently been unable to get any response from the Ministry of Health regarding this serious funding situation summarized in our one-page brief faxed to you last month on an urgent basis."

That would have been in April.

"An immediate increase in the hourly rate paid to our society for home care merely to bring us close to the rate paid to other home support societies of similar size in the area seems a reasonable and easily justified request. This situation is adversely affecting, directly or indirectly, IGO employees and over 400 of our clients in your constituency. Quite frankly, we are at a loss to know what further we can do if even yourself as our MLA and a senior cabinet minister are unable to get action from the department involved."

The ministry, of course, is the Ministry of Health.

"We are enclosing another copy of our summary outlining the crisis situation we face and how it can easily be solved, and sincerely hope that you will eventually be able to assist us in obtaining a favourable outcome."

As I look at this memorandum dated April 17, 1991, to the hon. member for Nelson-Creston, the local MLA, I find their argument very convincing. I'll again quote briefly from it and then ask the minister to explain what's going on. This is a memorandum from the Nelson and District Home Support Services Society, signed by the president, Tim Kendrick, on April 17, 1991:

"The problem: service to our home support clients is at the point of breakdown because the hourly rate of funding we receive is not enough to hire the bare minimum number of supervisors needed. We have about 420 clients and 85 home support workers but can only afford two field supervisors. The caseload continues to grow. The strain of continual overtime, trying to look after all the clients, has already led to three senior supervisors leaving at short notice on the point of breakdown. This turnover means even more stress and less efficiency.

"We cannot continue like this and thus may need to start refusing service to some clients. This would mean that they would literally suffer or have to be admitted to care facilities at a vastly increased cost to the health care system."

They propose a solution. This is one of those rare documents which actually is a brief; it's one page long.

"The solution: to cut through the bureaucratic red tape and immediately provide the society with a long overdue increase of at least 50 cents in the hourly home support rate, preferably retroactive to January 1. This would enable us to hire the one additional supervisor needed."

They offer a comparison with other home care districts. They say: "Even a 50 cent per hour increase would only bring our rate up to $16.04." That's the amount paid to the home support society, of which probably about half in turn is paid to the worker who is working with ill people in their homes. Some of it is used for administering the service, coordinating the workers and doing the initial interviews.

I quote again: "This would still be below the rates already paid to comparable agencies at Trail, which gets $16.94 per hour; Castlegar, $16.25 per hour; Grand Forks, $16.17 per hour." Nelson was proposing an increase from $15.54 to $16.04. "Our request therefore seems both justified and modest."

Mr. Chair, I have to underline the action to date described in this memorandum.

"Urgent requests by other channels have apparently fallen on deaf ears. October 31, 1990: letter from Joan Reichardt to Derek Underwood, continuing care — no result. November 2, 1990: personal plea from Jana Brych, program coordinator, to the Minister of Health, copy to the Premier. Letters and promises of research from both — no result."

I quote the brief conclusion to this memorandum:

[ Page 12622 ]

"Our board believes that in most cases it is best for our staff to work through normal channels. This situation is exceptional, however, having already reached crisis point, and we are therefore appealing to you personally for assistance."

Mr. Chair, I visited that society last October. I remember discussing with the program coordinator the increasing demands on the service, which are a very good thing. Let us not mistake increasing demands for home support as something bad to be curtailed or managed. Increasing demands for home support mean people can be looked after in their own home and community rather than in a hospital. Home support provides a higher level of service to the individual and usually a significant cost savings over the cost of hospital care. Delivering more home support enables us not to spend on capital facilities like hospitals and intermediate-care units. In general, more home support clients are a good thing. We should not fall into the trap of penalizing agencies which are increasing their enrolment.

I remember visiting them. The director, Joan Reichardt, described to me how difficult it was meeting the needs of even the relatively seriously ill clients they attempted to look after. She described one young woman with multiple sclerosis who had to be hospitalized because they could not provide sufficient home care hours to keep her in her home, even though she desperately wanted to stay there.

The question I've got for the minister is: what is really going on here? The situation is patently unfair. The difficulty in obtaining a response from the ministry is alarming, and the fact that the home support society has felt compelled to raise this matter with the opposition after months of trying to deal with it through the normal channels suggests a serious breakdown in communication. What is going on?

[3:00]

HON. MR. STRACHAN: At the outset, let me describe the home support services in general throughout the province, as we find it in the budget. I do want to advise the Legislative Assembly that our stated "blue book" cost for home support services was $126,623,589 in fiscal year 1990-91; that has been raised substantially in our budget for 1991-92, where we are estimating $147,066,193 for home support services. The percentage change, which is a remarkable increase, is 16 percent in home support services. Let me point out that the letters going to each individual society have not been sent yet, but they will be receiving their respective budget notification letters later on next week. As I said, the change is 16 percent; the increase is $20,442,604. Of that $20 million increase, $12.8 million is for wages and benefits. There are some substantial increases going to home support services throughout the province.

To get the matter of Kaslo on the record, the Victorian Hospital of Kaslo, in conjunction with the Kaslo and District Health Planning Society, have requested development of intermediate-care beds at the hospital. The continuing-care division has investigated the request and is unable to support an intermediate-care facility for a community of approximately 3,700 people.

The hospital in Kaslo has an approved operating capacity of seven acute and three intermediate-care beds. Of the seven acute beds, only three are in use. Hospital care and the administrator of the hospital are aware of the problems of filling acute beds and would be amenable to a transfer of three acute beds to continuing care for funding as intermediate care beds; that bed distribution would be 40 percent acute — or four beds — and 60 percent intermediate care for six.

At this point, we have trouble justifying building an intermediate-care facility for Kaslo. We could use the acute bed surplus in Kaslo for its intermediate care bed needs. I will advise the committee that the hospital care and continuing care in the hospital negotiate the transfer of three acute beds for use as intermediate care beds, and that the demand for home support hours in Kaslo is the same this year as it was last year.

With respect to the issue in Nelson, we're just getting a briefing on that now, and I can't comment officially on what the member has described to the committee in his letter of the summary of events in Nelson. But as soon as that material is brought to me in the Legislative Assembly, I'll be able to provide a more complete answer to the member's inquiry.

MR. PERRY: I'm happy to wait until the information about Nelson is available. If it can be brought up either later today or tomorrow or at a later stage in the debates, that would be quite satisfactory.

In regard to the Kaslo situation, I'm very pleased to hear that answer, although I've been searching all through my files for the letter I'm convinced I sent to the ministry last October. I know the former Minister of Health stated the other day that he hadn't heard from me on it. I thought I had written to him last October, and I haven't been able to turn up the letter. I think there was one.

The observation I made after a visit to Kaslo was that a rational interim solution was to convert a few beds. I'm delighted if the ministry will be getting on with that proposal, because it can be a major benefit to people in Kaslo.

While we're on the subject of home support, by some turn of logic it leads into a local matter of great concern to me, and that is the provision of services within the University Endowment Lands in my constituency. The minister will be aware, probably from the press and certainly from letters from the parents of Theodore Barber, that by an anomaly, the University Endowment Lands in the very western tip of Vancouver but not in the city of Vancouver appear to be the only part of British Columbia not entitled to the full range of public and community health services which the rest of the province enjoys.

Although I grew up in that area, I wasn't aware of this — partly because the city of Vancouver, under a contract with the Ministry of Health, has provided basic public health services, inspection of restaurants and home care nurses. That probably constitutes the majority of demand for service.

[ Page 12623 ]

[Mr. De Jong in the chair.]

But the parents of young Theodore Barber recently encountered the situation when their son was eligible for tens of thousands of dollars of appropriate public expenditure to repair a hole in his heart. He was even sent to Toronto for surgery. Yet when he had a major speech disorder requiring speech therapy, he was not eligible for speech therapy.

The parents are students, along with much of the population of that area. It's not all extremely wealthy people, as some of my colleagues like to believe; there are many students living on very low incomes in the University Endowment Lands. They are not eligible under the present arrangement for services such as occupational therapy, speech therapy and physiotherapy.

I've recently received a letter concerning a somewhat different matter, which points out that another child living in the University Endowment Lands who has a cleft lip and palate was not eligible to receive speech therapy, but was fortunate enough to receive it briefly through the courtesy of the University Hospital at UBC. But as the father of that child puts it: "This window has been closed, and speech therapy services are no longer available to other children who live on the University Endowment Lands."

I hope the minister will have received a letter I wrote to him recently after being apprised of that situation. The solution is fairly simple. It's to negotiate, when the contract with the city of Vancouver comes up this month, a renewal of the contract on a basis that's equitable with the rest of the province and that provides the full range of community health services.

So I would like to ask the minister to reassure the House that when the contract comes up for renegotiation with the Vancouver health department this month, those ancillary services will be provided and we can be assured that as of July 1 the residents of my constituency in the University Endowment Lands will have the same access to services as people elsewhere in B.C.

HON. MR. STRACHAN: I was aware of the situation. I read about it in the paper, although the situation wasn't totally as stated in the newspaper report.

However, the member more or less describes the vacuum that seems to exist in terms of services in that area. But I can tell the member that we are negotiating now with Vancouver for provision of services to the residents of Vancouver–Point Grey. I would suspect that the services offered in Vancouver–Point Grey will be the same as in every other part of the province when the negotiations are completed.

MR. PERRY: That's another small victory for the people of Vancouver–Point Grey. While I'm on Point Grey issues, perhaps I can refer again to a somewhat different issue, which is the brief by the faculty of medicine at UBC to the Royal Commission on Health. The faculty made what might have seemed a rather unusual suggestion a few years ago, which is that 2 percent of the annual Health budget be spent to ensure that the dollars spent in the health care system achieve the greatest benefit possible.

I have a recent letter from the dean of the faculty of medicine, Dr. Hollenberg, and one could hardly find a higher source than the dean of a medical school to make a statement like this. "I suspect a great deal of what we do in medicine in the treatment of patients has never been fully validated by objective assessment outcome analysis, particularly in relation to cost-effectiveness." He points out that his faculty therefore recommended a commitment of the ministry to allocate 2 percent of the budget towards assessing the effectiveness and efficiency of the delivery of health services.

I think I pointed out last year that there's nothing new about that concept. One of the perhaps least known in this country but most resilient classics in the history of medicine is a book called Effectiveness and Efficiency, published in the early fifties or the late forties by Cochrane, based on lectures delivered for the BBC on the effectiveness of health services in the United Kingdom. At that time, Cochrane pointed out that much of what was done was untested, untried and of no proven value, and here we are 30 or 40 years later in much the same position: relearning the old lessons over and over again and addressing new technologies often with a lack of understanding by the public.

I would like to point out that I believe this ministry in British Columbia has been one of the leaders in North America in attempting to restrain the inappropriate use of unproven technology. Sometimes I feel they've been a bit overzealous, and I've told them so many times. But I think the intent of the ministry over the last few years has been generally sound in attempting to ensure that new technologies are introduced only when there were proven benefits and when the return would justify not only the capital expenditure but the recurrent operating costs.

However, that philosophy has not permeated widely through the community; it's getting somewhere perhaps. But faced with the barrage of propaganda from the press about new health improvements, including the respectable press and the less respectable press like the National Enquirer, it's very difficult to get the message across to the people that bigger and more is not always better, that sometimes home care is a much more efficient and humane service to provide, and that raising the wage of a home care worker from $8 an hour to $9 or $10 an hour might be a much more useful and efficient investment than buying a fancy new machine for a million dollars and running it for another couple of million dollars per year.

[3:15]

I think, therefore, that the suggestion of the dean of medicine at UBC that the ministry formally commit a set percentage of its budget to health care assessment and to promoting the public's understanding that we need to be critical about new technology, new drugs and new techniques is very sound. I wrestled with that one in my mind when I first heard it. Is it an arbitrary figure? Of course it is, 2 percent — it might have been 1.9 or 2.1. Clearly it's arbitrary, but it's symbolic. It's a large sum of money, and it might actually get us the

[ Page 12624 ]

punch that would allow us to save a much larger percentage over the long haul in our health care costs.

I'd like to see the minister stand up and say he's going to be very aggressive about that — much more than the ministry has been in the past; that he's going to learn from some of the overzealous mistakes, such as MRI scanning in the Vancouver General Hospital; and that in the remaining short days left to him in this government and then when he sits on the opposition side, if by any chance he's re-elected — I don't suppose he will, but if he should grace these benches — he's going to be a fervent campaigner for cost evaluation and efficiency and effectiveness evaluation.

HON. MR. STRACHAN: The member gives me a great entry here from my former Ministry of Advanced Education, Training and Technology, where an awful lot of money was spent on research. I can assure the member, and I think past budgets that I introduced to this House will show, that I was and still am a very strong supporter of research in British Columbia. Indeed, a couple of days previous to my being appointed to the portfolio of Advanced Ed in November 1989 I was the good-news recipient that in fact British Columbia had done extremely well. We found out that British Columbia, in terms of centres of excellence and research awards, led Canada. We have about 12 percent of the population and we received 40 percent of the funding from that federal program. In all the portfolios that I've been in — and they're getting to be considerable now — I have been encouraging research, which is a very wise investment for the province.

One more thing, back to Theodore Barber, the young lad from Vancouver–Point Grey. Speech therapy services are available for Theodore Barber, as they are for every other resident in Vancouver and have been since 1990, when the UEL received services as required from the Boundary Health Unit and the Coast-Garibaldi Health Unit. We negotiated that contract in 1990. So the provision of services is there.

Back to the member's comments about research. As he said, his comments were based on a submission to the royal commission. I certainly don't want to pre-empt the royal commission in terms of their assessment of that submission. They will make their recommendations from all the information that's been provided to them through the hearings, meetings and submissions that have been made. I wouldn't attempt to prejudge how they're going to view this issue. Philosophically, the member and this committee know that I'm strongly supportive of money invested into research, as it clearly is an investment.

As the member knows, and as the committee will understand, we have the B.C. Health Research Foundation. I've been a member of that as Minister of Advanced Education, and now I am chairman, as the Minister of Health always is. The budget is $10.75 million for this year, approximately a 5 percent increase over last year's budget.

We have provided $360,000 to provide an office for health technology assessment. The health-human resources research unit we've funded to the tune of $540,000, and the health development fund, $2.9 million.

What the submission to the royal commission recommended was a 2 percent increase in our budget. That calculates out to $108 million in this current budget, which coincidentally is the budget of the University Hospital. I think I have to say with regret that I don't know if we could spend that money immediately. As I found out in Advanced Ed when we discussed the issue of percentage funding for research and development, it's questionable whether or not Canada has the appropriate manpower to spend that money in an appropriate way. We're looking at specially trained people at a professional level, at a good number of very specially trained technologists and other people who will assist the professional investigators in research. It's questionable whether we could spend that at this point. That's just a peripheral remark on my behalf with respect to the comment of 2 percent of the Health budget spent on that.

Secondly, I would still advocate from a policy point of view, although the Ministry of Health does have, as I indicated earlier, a substantial commitment to health and research.... Perhaps the Ministry of Advanced Education, Training and Technology is the more appropriate body to undertake some of that funding.

We must be reminded at all times that good health research doesn't necessarily come just from medical doctors. It comes from people who are investigators and specialists from many other disciplines. Many disciplines in the sciences and social sciences do excellent investigation with respect to health issues in our province. I wouldn't confine any research money just to the medical field. If you want better health results, there's a lot of money that can be spent by a variety of specialists investigating better ways and better provisions of health service, and new and better techniques, research methods and therapies outside of the medical profession. So that's my comment on that.

I strongly agree with what the member has said. I think I just philosophically differ in the focus of this type of research. In research funding, the committee will know that as an administration in the last five years, we have considerably upped the amount of money that goes into research and development. We, of course, have advanced the notion in the strongest terms of the kaon facility at TRIUMF. We have introduced the $420 million science and technology fund. Over the five years, we have invested heavily in research in this province, and that will continue to be a commitment and priority of this government. I'm sure the member knows that and is aware of what we've done, and he and this committee have my assurance that research and development will always be a priority with this government.

MR. PERRY: We're in a somewhat nebulous area. Of course, I agree with the minister it would be unlikely we could immediately spend $100 million on health care efficiency research. We might well not be able to find the appropriate people to conduct studies; and sometimes even the ideas as to what should be studied

[ Page 12625 ]

aren't that clear. But it's a goal that we should be striving for.

To make it a little less nebulous, let's look at that $10.7 million budget — if I've got it right — to the B.C. Health Research Foundation and the 5 percent increase over the previous year. The University of B.C. has just sent out an urgent alarm to its members describing the reduction in Medical Research Council funding and the very low success rate of applicants for new federal Medical Research Council grants in health research. The reason for the low 17 percent funding rate is not that the grant proposals are not good or are inadequate; some of them are, some of them aren't.

But the rate of success has been declining over the last few years. The reason that it's going down is because the amount of money supplied to the Medical Research Council has been reduced. In absolute terms, in actual dollars, the amount has gone down. In real terms the amount has gone down much more, because health research costs always escalate much more than the rate of inflation, regrettably. The cost of supplies and machinery tends to go up much faster than the rate of inflation. Salaries for technical workers in research have, if anything, probably lagged behind inflation. I don't know, but I suspect that not salaries but factors beyond our control are the cause of the inflation. Equipment made mainly in the United States, Germany, Sweden and England goes up at incredibly fast rates.

A 5 percent increase in the B.C. Health Research Foundation dollars amounts to a net decrease in the actual amount of research that we can buy. To the extent that we have good ideas to study, I don't think we should be proud of a 5 percent increase in funding in British Columbia, particularly at a time when federal funding for medical research is being cut back. We've been through this game before back in the seventies when the Trudeau government was in power. The then Minister of State for Science and Technology, Mr. Drury, preferred that there not be any medical research in Canada. I think the member for Coquitlam-Moody probably remembers that the then federal minister wanted to simply let the Americans do the research and we could ride on the coat-tails. It looks as if maybe we're getting back into that rather short-sighted view at the federal level.

I think we need a much more vigorous commitment. What I'm really trying to get at here is that it's not the exact dollar figure. It's not a commitment to exactly the 2 percent target; it's a commitment to the long-term idea that health care research will probably not only improve the quality of the health of British Columbians, but save us money in the long run.

I'd like to give a very small example that relates to the B.C. Health Research Foundation projects on asthma research, which, if I recall accurately, have been generously funded by that body. During my short medical career the conception and understanding of asthma has been revolutionized, in part by research done at UBC and St. Paul's Hospital. That research has focused attention on the fact that treatment for asthma has not been very successful. The number of deaths due to childhood asthma, if anything, has risen in developed countries around the world, and something was being done wrong. That research group has had a profound influence, along with others like it in Canada. Canadians perhaps have led the world in this field, in understanding that the then modern medical conception of asthma was rather mistaken and in fostering an improved understanding of how to treat people better. That message has been very difficult to get out into the medical world. Doctors are pretty darn stodgy and are very slow to change on issues like that. That's been proven over and over again. The research people — Dr. Perry, Dr. Hogg and others at St. Paul's Hospital and UBC; and Dr. Jody Wright, who recently received a teaching award at UBC for that kind of work — have had a profound impact on clinical practice, which will continue and will improve the health of British Columbians and others.

I'd like to see the minister committing himself to something more than a 5 percent increase in the B.C. Health Research Foundation total budget. I think that's pretty measly.

HON. MR. STRACHAN: Let me get on the record that the member may feel 5 percent is measly, and I guess I do for this year, too. However, over the years the grants awarded to the British Columbia Health Research Foundation have stayed well ahead of inflation. I make no apology whatsoever for our commitment to research and development, and the record shows that. Five percent this year — sure, it could have been higher. But over the long term our record is solid and clear and shows a solid commitment to research in health areas. It is clear that we have maintained this level of funding well above any measures of inflation.

With respect to the other comments the member made, I couldn't agree more. He has presented an interesting debate and discussion with respect to asthma research. I accept that we have some leaders in British Columbia, and that's good. We will continue to provide them with the best possible resources in every fashion we can.

[3:30]

MR. PERRY: Before I yield to the member for Boundary-Similkameen, I'll just follow up with one other very concrete suggestion. The minister indicated last week that he welcomed constructive suggestions. I'd like to reiterate one which I made last year and I think the year before to the then Ministers of Health.

One factor which greatly curtails the ability to promote constructive health research and the application of new knowledge in health fields is the extremely difficult funding situation not only of the UBC faculty of medicine but also of the associated faculties of nursing and physical and rehabilitation sciences. One of the most constructive steps the Ministry of Health could take would be to bring our policy in line with other provinces and allow some direct Health ministry funding for teaching positions within those faculties.

I can speak best for the faculty of medicine, which I'm familiar with personally, in which young medical scientists undergo very sophisticated training at considerable financial sacrifice and usually end up with no

[ Page 12626 ]

reliable source of funding to teach in a faculty of medicine. The situation has been very desperate in the last five years or longer, and we have lost a lot of very good people to clinical practice — where they cost the taxpayer a lot more money than they would in a university; they don't work any harder, they just bill a much larger amount in clinical practice — or to other provinces or other countries.

If we want to improve the quality of our teaching for young doctors and other health professionals in B.C., we need reliable support for those faculties. The universities have been so constrained in the recent difficult financial times that the resources have not been directed in that direction. I would like to see the minister indicating some commitment to perhaps shifting a small portion of that enormous Health ministry budget towards funding a few more long-term positions, so that young medical scientists and other professionals in the health sciences would have security of employment — to know that it's worth investing in that kind of career, and particularly investing in teaching careers in the teaching of real excellence and efficient practice in the health sciences.

HON. MR. STRACHAN: Once again I will say that I'm in agreement with the member's concerns and advise the committee and also the member that we have the Barer-Stoddart report, which is advising us on medical manpower. That will be released or coming to us shortly, and we are sure that it's going to make recommendations along those lines of improving research and the investigative process and making better use of the medical and scientific manpower that we are developing in the province of British Columbia.

Generally I would say that I welcome the member's suggestions. I would have no problem at all in instructing our staff, the staff at the university and also staff within the Ministry of Advanced Education, Training and Technology to review these issues. When the Barer-Stoddart report is available to us, maybe we'll feel that the changes that the member has suggested are appropriate and can be carried out.

MR. BARLEE: I canvassed this very briefly last week when the minister was unavoidably absent from the House, and the answers I received from your stand-in were not, I feel, adequate. It's a matter from my own particular riding — Boundary-Similkameen — and it concerns a request for an intermediate-care facility in a town. I outlined some of the reasons last week, and I will go over this again.

First of all, this particular town, Keremeos in the south Similkameen — I'm sure the minister is familiar with it — is a town of several thousand people. They have the second-highest percentage of seniors in the province, after White Rock, according to my figures. This is a unique community in that it is generally a poor community by economic standards. Their average income per family is about $10,000 behind other families in British Columbia. That's in the 1980s.

The people in that area have consistently asked the government to provide some funds for an intermediate-care home. In fact, 1,100 letters were written. These were not form letters; these were individual letters from various people in the community, which means virtually everyone of legal age in that community wrote a letter to the ministry. I think it's very important for several reasons. First, it is a community that requires this type of help because of the makeup of its inhabitants. Secondly, I think that the ministry's criteria.... I have letters from the ministry saying that the request from Keremeos does not meet the criteria set down by the ministry. Well, I wonder if the criteria are an accurate reflection of the need of the people in this particular area. I know that the articulate member for Vancouver–Point Grey mentioned Kaslo; it seems to me in somewhat the same boat.

What it requires is this, really. There are people there in their seventies or early eighties who have been married 50 or 55 years. If there is no intermediate-care home in Keremeos, they're required to go usually to Summerland. That's an 80-mile round trip — miles, not kilometres. It's sometimes simply not possible. So people who have been partners for 50 years, in many instances, are essentially separated: one of the partners is in Keremeos, the other in Summerland.

This town requires it for a number of reasons, not just health reasons; also for economic reasons. The unemployment rate is about 20 percent, about the highest in the province of British Columbia. So in the criteria I measure by, certainly this town should be considered. The letters we have received from the ministry have consistently indicated it does not meet the criteria. I'd like to hear the minister's answer to that, please.

HON. MR. STRACHAN: I regret to tell the member, Mr. Chairman, that the criteria have not changed, and neither has the answer. The community is situated southwest of Penticton, and as the member indicates, it has a population of approximately 3,700 people, of which 22 percent are over the age of 65, or seniors. For that reason the community receives well over 10,000 hours of home support annually from Keremeos and District Home Support Services. It is felt that if there is an identified need for intermediate-care beds in the south Okanagan, these beds should be located in the Penticton and Osoyoos-Oliver areas, due to the availability of support services, the age of the population and the need for additional beds.

That is the answer to Keremeos. I wish I could be more forthcoming for the member, but at this point that's our ministry policy, so the answer is unchanged.

MR. BARLEE: I thank the minister for his answer. My figures differ somewhat from yours. You say 22 percent; mine say very close to 30 percent. I would like to know when your figures were obtained; perhaps they're very recent. According to the individuals in the area, it's considerably above 22 percent.

A letter I just received from the two doctors in Keremeos — there are two doctors there, Dr. Jeanes and Dr. Partridge — indicate that they do require an intermediate-care facility. I know you've heard this story before, but I think what they point out in the bottom line of their letter is really quite important:

[ Page 12627 ]

"Our seniors should be able to live out their lives in this valley, without having to move elsewhere to have their health care needs met."

A government who state that they're keen on decentralization should give a higher priority to this. There are 3,700 people, and it is growing at a very rapid clip. A number of seniors are retiring there, because of the low cost of housing and the relative cheapness of living in this part of the south Similkameen. It is different from the south Okanagan in that Oliver, Osoyoos and the Okanagan trough, of which Summerland is a part, are all contiguous to each other. This means going over a mountain road, in the middle of the winter, either over Richter Pass or Highway 3A. In fact, last year two people were killed doing that precise thing: visiting relatives in a care home in Oliver.

I would like the minister to examine it again, and to check the figures. And could you possibly tell me where you obtained the figure of 22 percent?

HON. MR. STRACHAN: To answer the last question first, we've done recent studies on this issue, because as the member indicates it has been brought to our attention and has been presented as a concern to the Ministry of Health. I would expect that the figures I provided in terms of seniors as a percentage of the population are correct — at least to within the last couple of months. However, we'll certainly review our source of information to find out why it doesn't appear to be corresponding identically to the numbers that the member opposite has advanced.

[Mr. Ree in the chair.]

With respect to the larger concern of providing intermediate care in Keremeos, I guess we can say generally that if we know that a population increase is coming — particularly in the senior population — then it is of course going to change our thinking with respect to providing those services. If that population increases, it would make provision of those services and the expense involved far more appropriate.

The member has my commitment that we will continue to monitor the situation. I clearly understand his concern that even in the lovely southern part of our province — the Boundary area — they do get snow and inclement weather from time to time and that travel, particularly over the mountain passes, can be rigorous and at times dangerous. I'll take those suggestions as noted and pursue the issue on behalf of the good people of Keremeos.

MR. ZIRNHELT: My question to the minister has to do with the G.R. Baker Memorial Hospital in Quesnel, where for a year and a half now there's been a request to consider leasing out unutilized space in the hospital — some 30,000 square feet — to other Ministry of Health and related services. Recently the Minister of Government Services said that she would get involved, and I know there's some resistance to this because of the supposed inadequacy of space having to do with moving the administration part of the hospital. I wonder if this minister is committed to looking into this. The reason I ask is that a $15 million expansion was put into this hospital in order to free up space to coordinate Ministry of Health services. Have you looked into this, Mr. Minister, and what is the result of your investigation?

HON. MR. STRACHAN: The member is discussing the issue of the present health unit building in Quesnel and its need for major repairs and renovations. Just to give the committee some background, the G.R. Baker Memorial Hospital is a community general hospital offering a full range of services. It has 68 acute-care beds, including four ICU, and 40 extended-care beds. Their '90-91 operating grant was $9,170,451.

A bed-replacement program was completed a few years ago, and the vacated space was not demolished. So local groups, including the city of Quesnel and the regional hospital district, in addition to the hospital, support the use of this space for community health services. As a result, space and planning facilities management has put the planning of the proposed health centre on hold, and the hospital will be asked to prepare a long-range plan of its needs which will clearly indicate that they can make a long-term commitment to supplying community health care services.

The long and the short of it, Mr. Chairman, is that we have requested the hospital to develop a master site plan. I'll advise the member — I'm sure he's aware of this policy and philosophy — that we certainly support locating community health services, when it's economically feasible and appropriate, in combination with hospital facilities. There's no question about that, and if it's possible for G.R. Baker Memorial Hospital to make a long-term commitment, that space will be available in that facility for community health services in Quesnel. We are certainly prepared to consider the hospital location as an option.

I might point out that a good friend of mine, Ken Last, is the administrator there. I knew Ken in McBride and later in Kitimat, and now he's at Quesnel. He's a first-class fellow, and I'm sure any recommendations that he and his board arrive at will be considered seriously and with some positive stance by at least this minister and, I'm sure, by this ministry.

MR. ZIRNHELT: I trust that there's active coordination going on with BCBC and the minister responsible for BCBC to ensure some coordination on this?

HON. MR. STRACHAN: Aye.

MR. ZIRNHELT: I thank the minister for his comments. I'm sure we'll hear more if they do have a long-range plan that can make space available.

My next question has to do with the provision of catastrophe relief for hemophiliacs who contract AIDS from tainted blood that was approved by the federal and provincial government. I understand the provincial government has not yet approved a program of compensation. I raise this because a number of my constituents are in danger. I have received several letters from one person who never knows when his last

[ Page 12628 ]

day is and who is quite concerned about his family being able to cope afterwards. Has the minister approved of the program already approved by the federal government to compensate victims of this catastrophe?

[3:45]

HON. MR. STRACHAN: That's an extremely sad and devastating situation the member has described. We are sympathetic towards it. We're not aware of what other governments have done, but what we have done is this: as federal aid is supplied to these affected hemophiliacs, we have not had that aid component deducted from any provincial payments. So we are recognizing that special assistance is required, and we are certainly providing that in terms of our policy.

MR. ZIRNHELT: Just to clarify. The province is not in any way hindering the delivery of this catastrophe relief to these victims?

HON. MR. STRACHAN: No, absolutely not. In fact, that is not our policy at all. It's the opposite. We are not hindering. I can say that with some assurance.

MR. ZIRNHELT: A supplementary question to that. Is there any provincial funding going into relief for those families?

HON. MR. STRACHAN: Not specifically to those hemophiliacs so affected. But any provincial assistance given to people with AIDS is, of course, provided to those hemophiliacs who are so affected.

MR. ZIRNHELT: My next question has to do with the provision of ambulance services in the Anahim Lake area. The minister may be familiar with this situation, as it did come before the regional advisory committee. The situation is such that there have been a number of lives saved and attributed to the fact that the ambulance attendant in the area happened to have the required training to deal with the trauma. It's over a hundred miles to the nearest hospital. More likely you would have to go 200 miles to the Williams Lake hospital if there was a serious accident.

The inflexibility and lack of coordination among the various ministries involved has led to a situation there where the position had been staffed by a person who is qualified and very much in danger of losing that, because of being paid only on a fee-for-service basis. This is a remote outpost. There was virtually no change made to medical facilities there when major industry was developed, which has been responsible for a number of accidents — the trucking and sawmilling industries.

I wonder if the minister can give some assurance that his officials have discussed this matter with the federal Ministry of Health, which takes care of native people in the area, with a view to trying to coordinate some positions there so that a person qualified to deal with trauma of this sort on a first-aid basis is available in the area.

HON. MR. STRACHAN: First of all, let me tell the committee that that's one of my favourite parts of the world. I really enjoy the Chilcotins and the Anahim Lake area; I've been there many a time. My most recent visit was in January 1990. I have considerable interest and genuine fondness for the area.

There are currently five active part-time attendants in the area who respond to about 150 calls each year. As it happens, the unit chief has been trained to the EMA 2 level, which is of course a desirable thing for the community to have. They would like the unit chief to be employed on a full-time basis, which we can't do with the call volume. Therein lies the problem. I will give the member some assurances that we will look at this, but this would have an implication on policy throughout the province. There is obviously a very good part-time core of people there who are providing an excellent service. We will take the member's comment and respond in an appropriate manner.

MR. ZIRNHELT: I wonder if you noted the part of my comment that dealt with the need to coordinate between the federal and the provincial health services, because there is considerable staffing by the federal health services there. It seems to me, looking holistically, that perhaps there could be shuffling of services or positions so that we could end up with a person with the necessary qualifications. I'm not speaking here necessarily about any particular individual, but a position where the person is trained to deal with this sort of trauma.

HON. MR. STRACHAN: That's a good suggestion, Mr. Chairman. We'll look at it. I'm aware of that concern. As I said earlier, I've spent some time in that area and have been apprised of the situation — particularly of the federal-provincial relationships up there as they pertain to health care. The concern and the questions are not unknown to me, and we will have a response for the area.

MR. ZIRNHELT: I'd like to thank the minister for his interest and concern on that matter. I know that both the chief in council and the members of the community would appreciate him looking into it.

MR. PERRY: The minister has to leave at 4 o'clock promptly?

HON. MR. STRACHAN: I'll just qualify that: yes, I have guests who are expected in my office at 4 o'clock. As I said earlier, they're from the Queen Charlottes. If the member, the critics or the committee could excuse me and have other members carry on the debate, I would certainly appreciate that. As I said, the hour for that appointment is 4 o'clock, so we have about six or seven minutes to continue on this debate. But I thank the member for his courtesy.

MR. PERRY: A few more short snappers then for the minister in the interval. Virtually anyone from the Queen Charlottes, particularly in the health field, are friends of mine. I don't know who his visitors are, but I

[ Page 12629 ]

hope he will take them my greetings when he meets them.

In the short time until the minister slips out, let's go back just for a moment to debate the anti-smoking strategy. A week ago today.... I would like to pursue that some more, and I'll probably pursue it a few more times yet in this debate — at least once a day.

I've had a chance to glance in a very cursory way at the remarks of the minister from June 3, and I note that he reiterated what I referred to last year as the excessively modest goal of the Ministry of Health to reduce the percentage of tobacco smokers in B.C. from an estimated 22 percent in 1990 to 20 percent by the turn of the century. That strikes me as a typical example of a Socred business plan. It's sort of like establishing a business plan and then going to the bank with a proposal to lose money every year for the life of the business.

We know that the percentage of smokers is gradually falling no matter what government does, because smoking is increasingly regarded as a disgusting habit by society in general. The minister and I agree on that completely, as did many members of the government side as well as this side. For once we've got something we can agree on. But when you think about it, a decline from 22 percent to 20 percent of the population smoking over ten years is really sort of like setting out with a large capital investment to lose money for as long as you can, because it doesn't represent anything.

I argued last year that we could maybe have an ambitious goal like cutting it to 15 percent or 10 percent. Or we could be really ambitious and not have any new smokers in the year 2000. Now what disturbs me — and the reason I raise this — is that without some goal, without some ambition, there's no hope for change or progress.

I've seen that beautiful little brief, "Tobacco Reduction Strategy," produced in the health promotion office in the Ministry of Health. What a wonderful little document that was. I think I embarrassed some of its authors last year by praising it so warmly. Maybe they thought I was making fun of it, but I wasn't. I thought it was one of the most beautiful little documents I've seen because it was brief — one or two pages — punchy and incredibly ambitious. If that strategy were implemented, we would perhaps be the world leaders in controlling tobacco abuse and putting addiction pushers in their place.

I referred last week to Mr. Bill Neville. I thought somebody would accuse me of unparliamentary language for mentioning his name in here. It's certainly a bad name in the health profession and is a name that ought not to be mentioned. But unfortunately he is still on the loose; he is rampant. He is virtually riding on the Prime Minister's back, because he is a key lobbyist for tobacco manufacturers. I know that the minister is as committed as I am. I am not an ex-smoker, but we share the same passion. I keep wondering: does Bill Neville have his little finger somewhere in the British Columbia government so that we're not getting a more ambitious policy? Can the minister give us some assurance that he will, for once, unchain his bureaucrats? I see them champing at the bit to actually move somewhere in this direction. Unchain them, and let them go do something wonderful for the people of B.C.

HON. MR. STRACHAN: God, I can just imagine an unchained bureaucrat.

At the outset, reducing the figure to 20 percent.... I agree with him, maybe we should change that to ten. Maybe we should set our sights higher. Maybe we should show more concern. I don't know what changing the number would do except to change a number. The member has indicated — and I agree totally with his concerns about smoking — that there is no one purer than the purified, of which I am.

I'm glad he liked the brochure. I can tell the member that there is no one from the smoking lobby talking to anyone in the Ministry of Health nor from any other lobby, because that's not the way I do business nor would I expect anyone in the ministry to do it. Any initiatives taken by the fellow mentioned by my critic, if he wants to take it up with the federal government, he can. Any overtures made to me, this ministry or anyone in our cabinet would be soundly turned down immediately, and I can give this committee that assurance.

[4:00]

With respect to the 20 percent, maybe it would be worth our while to change that number in the material we are providing. I can tell the committee now that with only 22 percent of the population smoking, we have the smallest percentage by population of smokers by province in Canada. Of course, as you get to the real hard-core puffers, it's pretty hard to talk them out of it. As you decrease to the low 20s, any thought of getting that number lower becomes more and more difficult because you are dealing with some very hard-core and committed smokers.

I'm going to be excusing myself for just a few moments now, but for those of you who do smoke and who are listening, I'm reminded of a comment by a fellow. As a matter of fact, he was an ambulance attendant in Valemount and a real good guy. He was really concerned about his health and everybody else's health, and he said to me: "I want you to remember that everybody quits smoking sooner or later." This is one of the thoughts that made me think about quitting smoking. That does have a tendency to focus your attention on the concern and on the fact that it's a very serious health issue. We can talk about smoking-cessation programs and government policy all we want. I'd be more than happy to do so and will continue to. I assure this committee, members opposite and members on this side as well that when it comes to this issue, any cessation strategy has my total and uncommitted support.

As I said, I'm going to exit briefly because I have some good people from the health industry who are visiting us from the Queen Charlotte Islands. I don't know if any other members on this side are going to leap into the breach and discuss health issues, or maybe the debate will continue from the opposition side of the House. Nevertheless the staff will stay here, ever on the ready, and any concerns that are addressed by members will be responded to in the fullness of

[ Page 12630 ]

time and as quickly as possible. With that said, I thank you, and I'll see you soon.

MR. PERRY: I wasn't clear on the procedure. Perhaps one of the ministers is going to temporarily take the place of the Minister of Health to respond. Or are the government members sufficiently enjoying my discourse that they would like me to continue with some long snappers? I await the Minister of Energy's indication as to how we should proceed.

MR. CHAIRMAN: If no members are on their feet, I will ask the question.

Interjection.

MR. PERRY: My colleague the second member for Cariboo suggests a very intriguing line of inquiry, which is the whole subject of native health. Because we have in our presence the former Minister of Native Affairs, it seems an appropriate area to pursue. We know in this province, as in much of the rest of the country, that native people enjoy a standard of living which is considerably inferior to non-native British Columbians. Despite the remarks of the former Minister of Finance about the gravy train, the figures are well established.

Infant mortality is higher, as is the tuberculosis rate, the rate of complicated pregnancies and the prevalence of diabetes, arthritis and severe arthritis, and the problems of child health are generally more severe. Alcoholism is a major problem, and the treatment facilities tend to be often little short of pathetic.

I'd like to, if I can ascertain what's happening now on the government side....

AN HON. MEMBER: It's a cabinet shuffle.

MR. PERRY: For those who are only watching on television and can't understand what's happening, there's a cabinet shuffle apparently going on right now. Can you advise, Mr. Chairman, to whom I should pose my questions?

MR. CHAIRMAN: Hon. member, I can understand why maybe a television audience can't understand, when some members of the House can't even understand. No member may stand and speak at a desk other than that assigned, so the minister had to attend at his own desk, and I'm sure you now appreciate this.

MR. PERRY: I now appreciate that. Thank you, Mr. Chair.

I'll continue that line of questioning. I'd like to ask the minister and his officials what initiatives are contemplated in the new budget year for the improvement of native health services.

HON. MR. WEISGERBER: In starting, I'd like to suggest to the opposition critic and other members who may wish to rise and ask questions while I'm filling in for the Minister of Health that if in fact you can ask long questions that can be answered with very short answers, this will probably move along reasonably well. Otherwise it will be a short question time.

The question of health in Indian communities in Canada — particularly those on reserves — is a serious concern. Because of lower incomes and conditions found with people with lower incomes generally, the standard of health often is much lower for the native community.

This is particularly true for those Indian people who live on reserves. First of all, their health care services come under the federal government. The reserves are often located in very remote areas where doctors, hospitals and other kinds of health care services that most of us take for granted are not readily available.

The government of British Columbia is very much concerned with health care in Indian communities. We understand that no one is static. People who live on reserves often spend a considerable portion of the year off reserve, either working or in Vancouver for some other reason. We've tried to develop some plans not only within the ministry but also with the federal government to address some of these issues that are of particular concern to native people.

MR. PERRY: I was privileged to be briefed by the Vancouver Native Health Society earlier this year about developments in the funding of a new native health clinic in the downtown east side of Vancouver to attempt to reach out to a large population of native people who seem to be marginalized by the present system — or by their own cultural background. I wonder if the minister could provide us some update on the status of that Vancouver Native Health Society clinic proposal.

HON. MR. WEISGERBER: I'm pleased to advise the House that in this year's budget the ministry has provided an extra $440,000 specifically for a native health access program that will be delivered by the Vancouver Native Health Society. You might also be interested in knowing that the ministry has just announced a $1 million contribution to the B.C. Health Research Foundation. It will be specifically targeted at native Indian groups for proposals they would put forward on innovative ways to deal with health care problems in their communities. The ministry is very much aware of the concerns. Aside from focusing attention within the ministry, specific programs have been developed to try and deal with those as well.

MR. ZIRNHELT: I appreciate the minister — with his familiarity — answering some of the questions. I wonder if he could tell me if the ministry has considered a similar program to that done for education, where there is a local agreement negotiated between an Indian government and the provincial government for the provision of services. It would simplify and coordinate and would also be a direct negotiated contract for services between two levels of government, not unlike the master tuition agreement.

[ Page 12631 ]

MR. GABELMANN: I wonder, Mr. Chairman, if I might have leave to make an introduction.

Leave granted.

MR. GABELMANN: In the gallery are a group of students from Willow Point Elementary School in Campbell River. I'd like the House to make them welcome.

HON. MR. WEISGERBER: Certainly we're interested in proposals similar to the education program from native communities. In fact, the Nisga'a in the northwest now have their own school board. I'm almost positive they're providing some health care services by contract to members of their community.

In many cases it depends on the size and readiness of the community to enter into those kinds of agreements. I think the education agreements are a good start. Generally — and I think this goes beyond the Ministry of Health — there's a philosophy within the government that looks favourably on the local delivery of government services through native-run organizations, whether they be in Vancouver or in remote parts of the province. Certainly another good example of that has been the delivery of drug and alcohol counselling services through the native friendship centres and other native-run organizations. Whenever a band or tribal council comes forward, we look very seriously at proposals that allow us to see government services delivered by a native-run organization.

MR. PERRY: Just while the Minister of Health is out, I'm trying to follow up a few other issues left over from last week. I don't believe an answer was provided at the time to a rather technical question I raised — perhaps the officials have it now — about the provision of very expensive drugs like cyclosporin to people with unusual conditions. Maybe if the present minister is comfortable with getting the answer from the officials, I'll raise this one more generally.

There are a number of drugs coming onto the market now which are paid for under research protocols while they are experimental and which, when they reach the market, are phenomenally expensive. One good example is cyclosporin, which is used widely and routinely in organ transplantation. The cost of the drug is then paid for by Pacific Organ Retrieval for Transplantation, or PORT, so that patients don't have to worry about the upfront expenditure on that drug.

The drug recently has been approved for a wider range of uses, including some unusual diseases. I see in my file a letter from a young woman with juvenile rheumatoid arthritis whom I mentioned last week, and also a young woman with mixed connective-tissue disease that is destroying her lungs and that will eventually cause her either to require a heart-lung transplant or to die. The drug appears to be essential in those conditions, but as I understand from their letters, it has not been covered by Pharmacare, so the expenditure has become enormous. Both of these young women are suggesting they might have to go onto GAIN in order to pay for a lifesaving drug.

I'll raise one further example on which I and the Leader of the Opposition have had correspondence: a newer even more expensive drug called alpha 1 antitrypsin; the trade name is Prolastin. If I'm not mistaken, the manufacturer has put this drug on the market at a cost of around $60,000 per year. I pull that out of my memory; I don't have the paper in front of me. Obviously an expense of that order is beyond the means of virtually any British Columbian. Yet the drug is thought to be potentially lifesaving for people with a severe genetic disorder called alpha 1 antitrypsin deficiency.

[4:15]

Those people don't really have much of a choice other than facing potential lung transplantation, which might be less successful and even more expensive. They don't really have the choice of whether they have that disease or not. It's determined from the moment of conception as a random event, and usually their parents aren't even aware that they are carriers for that genetic condition. So we're talking about a very small group of people with a condition beyond their control who are really stuck in a financial bind.

Does the ministry have a policy now on how to deal with these problems proactively so that people who are extremely vulnerable, like the young women who have written to me, do not have to resort to writing to opposition members? Of course, they're exercising their democratic rights, but I can see from the minister's demeanour that he can understand that it's a difficult position to put people in.

HON. MR. WEISGERBER: I thank the member for the nice, long question as well.

I'm advised that in British Columbia everyone qualifies for Pharmacare. If a drug is approved and is approved for the treatment for which its being used, it would qualify under Pharmacare under the following formula: the person taking the drug would be responsible, as you and I are, for the first $375 of drugs on an annual basis; after that, Pharmacare would pay 80 percent of the cost of those drugs to a maximum of a contribution by the person getting the drugs of $2,000, after which Pharmacare would accept responsibility for all of the cost. It would appear to me that if the drug has been approved for the purpose for which it is taken, the maximum exposure for any individual would be $2,375. No one could reasonably be expected to pay more than that over the year, regardless of the price of the drugs.

MR. PERRY: The minister has made my point for me. Typically, people with such severe illnesses as juvenile rheumatoid arthritis, which is often a very crippling disorder and can, at times, produce quadriplegia, or severe alpha-l-antitrypsin deficiency, or the mixed connective-tissue disease I referred to.... They produce profound disability. Often such individuals are on GAIN or GAIN for the handicapped and may have a monthly income in the range of $675; or if they're not, their income may be similarly modest. For many people earning a net income in the range of $6,000 to $8,000 per year, $2,375 per year may be an

[ Page 12632 ]

overwhelming cost. It's compounded, even for those with more generous government assistance, by the problem of putting up front the purchase cost for the drug.

To my knowledge, Pharmacare has usually been quite efficient in turning around payment requests, usually with a turnaround time in the range of a week when patients request repayment of their up-front capital costs. But at times the up-front costs are in the range of $600 or $800 a shot. And sometimes Pharmacare falls down. We've had a rash of complaint telephone calls in the opposition recently about longer delays in reimbursing Pharmacare costs.

One of the matters which had disturbed me that I raised with the Minister of Health a week ago was that when we passed on routine citizen complaints of that kind, we were told they must be raised in writing to the minister. I hasten to add that my experience with the director of Pharmacare has always been exemplary in that regard. But it was admitted that there have been some recent problems. Normally it wouldn't be a big deal for the average citizen to wait a week or two or even a month for a bill of $50, but a $600 bill for a person who is on very limited income is a major impediment.

What I'm getting at, by way of a speech rather than a question, or a rhetorical question, is the need for a more flexible policy that will respond proactively and more rapidly.

I see the associate deputy minister watching me. I know he has been involved in the very difficult matter of deciding how to cover new, expensive drugs and how to ensure that they're used rationally and to the maximum benefit. Naturally the province should have some reservations about entering into treatment which might cost $60,000 per patient per year. Of course, it's important to remember that these are the initial costs when the drug is first marketed, and they will often come down very rapidly, particularly if we could see some enhanced interprovincial cooperation in bulk purchasing. We might well see savings in the range of a tenfold reduction for expensive drugs, if they were purchased in bulk on an interprovincial basis or through federal government cooperation. It's one of the reasons I happen to believe that it's still worth holding onto our country. We have some advantages as a medium-sized country that we don't as a province with a relatively modest population base.

Let me leave it as a suggestion with the ministerial staff and the Minister of Energy to relay to his colleague that it would be humane to this small group of British Columbians — perhaps numbering in the hundreds at most — who are on unusual, newly introduced or extremely expensive drugs for rare and very disabling conditions, if we could design a policy which proactively helps them out first, before they have to come to their politicians. I think it's within the capability of the ministry, and I'm pleased to state my confidence in the ministerial officials in their presence.

HON. MR. WEISGERBER: First of all, I didn't want to downplay the difficulty that some people may have in paying $2,300 or $2,400 toward the cost of drugs. But in the example that you mention, I think it's important for people to understand as well that anyone covered by social services on social assistance has all their drug costs paid. Many of the people you talk about would find it necessary to go for social services from the government. I think it's an appropriate mechanism; it recognizes that difficulty and would deal with it.

There will be some people, though, who find themselves hard-pressed to make these payments, and delays in refunds are a serious problem for drugs that have a large price tag on them. That's compounded at certain times of the year for the Pharmacare program, particularly the end of the year, since many of us gather up our receipts, hold them for a year and then send them in. So there is always a period when cheques go out more slowly.

It's also important to put on the record that the $375 and $2,000 cap is a family unit figure, not an individual figure. The ministry is working on something called the pharmacy computer network, which I hope will see a situation fairly soon where usage of the drug has been recorded in the computer, payments would be made by the person getting the prescription and the family unit would be on record. It would then be easy for the pharmacist to determine when the patient had already paid the maximum, so it would no longer be necessary to bill them a prescription fee for an amount. This certainly would deal specifically with the problems you mentioned of late payments coming back or of people being hard-pressed to find the cash for drugs. The ministry is working quite aggressively on that, and I hope that in the very near future we will have some better response to this issue.

MR. PERRY: I find it ironic, particularly because I know this minister is a relatively thoughtful guy, that I have to make the point again that our system tends to push people onto social assistance. Here I am, a member of a party often accused by the government benches of wanting to put everybody on social assistance, pointing out to the government that one of the problems of our present system is that if you're close to the margin, you do better going onto social assistance or GAIN for Handicapped. If you're a member of the working poor, you can be hit by that large Pharmacare deductible, which virtually forces people onto social assistance.

Clearly there are people who have, by virtue of their health status, found it impossible to survive in the market economy and been forced onto social assistance, where they do not want to be. If we had a somewhat more flexible policy of assistance that was tailored to the genuine medical needs of the patient, we could help people retain their independence. None of them want to be put in that situation. I don't know if the minister wants to respond, but I'll leave it at that.

HON. MR. WEISGERBER: My observation of the people on social services was simply...you used the example of a quadriplegic or someone in that situation. My response was that the person in such a situation would very likely be already benefiting from some social service programs. I'm not suggesting that they

[ Page 12633 ]

should go on social services to get the drug without deduction; I'm simply stating that the circumstances those folks would find themselves in would likely give you the expectation that they wouldn't be paying their deductible because they were already getting some kind of services.

I'm not going to try to pretend that there aren't circumstances where the working poor in this country don't find themselves in the most difficult position. We see those people on social services being provided with a safety network that's not available to the working poor. I admire the people who hang in there, face some very tough situations and do it on their own.

I don't think that raising the level of social services payments is the answer. I suspect that even if you go to Ontario and find folks who are getting the equivalent of $25,000 or $35,000 a year, there are still going to be working poor in Ontario who don't get the same level of benefits. So I don't think the answer is increasing social services, and I wouldn't ever put that forward as a remedy. I do think that we should find ways not only with Pharmacare but in many areas of graduating what we expect those working people on low incomes to pay. I don't have any difficulty with that notion at all.

Perhaps it's worth noting that we're now back to the real Minister of Health.

MR. PERRY: Perhaps I spoke too soon about the Minister of Energy when I said he was a very thoughtful man. Of course, I wasn't arguing in that question for the issue of social assistance rates per se; I was arguing for ways to prevent people from needing social assistance by ensuring that they have access in principle to the same benefits that other British Columbians take for granted. Just because the dollar amount of a very expensive drug required for medical treatment may be much higher for one individual than another, it does not mean that the individual with a very costly disease should be forced onto social assistance. That's the exact point I was trying to make. I don't think they should.

[4:30]

While the Minister of Energy is still in the chamber, I will raise one other issue I was going to address to him before the Minister of Health returned. Since the Minister of Energy had been a member of the Special Committee of Selection, I thought I would again raise the issue of the report of the Clerk of Committees regarding sittings of the select standing and special committees of the Legislature and, as he puts it on the front page of the report, the "activity" — which I think I've said before is a euphemism for torpor — of the Select Standing Committee on Health, Education and Social Services.

I was going to address this to the Minister of Energy, since he was a member of that honourable selection committee, but I see that the present Minister of Health was also. As he sat on that selection committee doing the people's business and spending the people's money on his own salary and that of other members he must have had dreams of what those committees might have done. I feel for him, Mr. Chairman, because those dreams have been frustrated by the torpor of that Health, Education and Social Services Committee, which has met in this parliament four times for about 20 minutes altogether.

The time I was present there last year, it sat for about five minutes — long enough to elect a convener, but not long enough to consider my motion as a member that we conduct some business. Through every possible avenue— letters to the Chair of the committee, to the subsequent Chair and to the minister — I had proposed a motion on the order paper that the committee sit to consider some of the complex issues facing us.

I would like to suggest it again, and I'd like to ask the minister's opinion. I feel this is a legitimate question, because we're now debating the issue of his salary as Minister of Health. In the presence of our distinguished Clerk of Committees, who I know would dearly like to see those committees function, I'd like to know whether the Minister of Health thinks it's a good idea for our bipartisan Committee on Health, Education and Social Services to consider some serious business before the next election.

I'll give the minister two good examples, Mr. Chairman. One would be to begin to do some thoughtful consideration of the review of the Mental Health Act. For a period of several years now, the ministry has initiated a process to begin the study of the Mental Health Act in order to bring it up to date with other jurisdictions and to deal with some outstanding issues of the rights of mentally ill people and the needs of society to protect itself from people who are seriously mentally ill and to protect those people themselves. Many British Columbians have felt that the balance has been out of kilter in that field, but it's a tremendously complex area.

I frequently get representations from agencies such as the Community Legal Assistance Society, who are working on a project to review the Mental Health Act. I recently discussed this matter with Mr. Bill Trott of the Community Legal Assistance Society and indicated some of my anxieties that when and if a revised Mental Health Act is brought forward....

MR. CHAIRMAN: Order, please, hon. member. In the minister's estimates it is improper to discuss the need for or existing legislation. All we're dealing with here are the administrative estimates of the Minister of Health. Likewise, conversation or debate dealing with what may or may not have taken place in a committee other than this committee is also unparliamentary.

MR. PERRY: I'm peering at the minister to see whether he's going to.... I don't mean to challenge your ruling in any way, but I had the suspicion he wanted to reply or say something anyway.

MR. CHAIRMAN: Hon. member, it's not the Chair's ruling. It is the procedures that are set out by the authorities and the members of this chamber. The Chair can only adhere to the authority given to it by this chamber, not by the Chair itself.

HON. MR. STRACHAN: I'll advise the second member for Vancouver–Point Grey that, prior to his

[ Page 12634 ]

coming to this assembly, I was Deputy Speaker for four years, and the Chairman's ruling is absolutely correct. It's not appropriate to discuss legislation nor work that has gone on in another committee.

But I do hear you, and I guess we can point to the record generally of some very good committee work that has gone on — not in the area of your interest, I'll agree, but some that has gone on has been quite productive over the years.

In terms of your request.... Of course, a motion would have to come from the Legislative Assembly to strike a committee, and you have every opportunity to present such a motion on the order paper if you wish. When we do have a royal commission in place that is going to report to us, all members, all associations and all of those interested in health care and health care costs, have, as you know, the opportunity to make a submission to that commission. That's probably the most appropriate form of public input that we can seek at this time, which is why we struck the royal commission in the first place. There's not much more we can say about the select standing committee that you've been discussing, and that I've been trying to avoid. To finish on this issue, I agree with your concern for more input, and I agree with your concern as a member who's vitally interested in health issues. That's really all I can say to conclude your comments about the select standing committee.

[Mr. De Jong in the chair.]

MR. BARLEE: The minister and I were discussing the possibility of an intermediate-care facility in Keremeos. He quoted the figure of 22 percent, and I felt that was incorrect. I said that it was just over 30 percent. According to statistics from the provincial government, it is just slightly over 32 percent. That might make a difference as far as the criteria are concerned, so I assume that the 22 percent figure is at least 10 percent out — it may be almost 33 percent now.

HON. MR. STRACHAN: I'd give you a quick bit of arithmetic: if it was 32 instead of 22, that's not 10 percent. But that's neither here nor there. It's ten, but it's not 10 percent. I'll take your numbers under advisement.

Clearly you have a growing seniors population there, so my answer earlier — we'll look at it — stands, and I guess the best thing to do for the community in that type of development would be a continued increase in the seniors population. Given the fine weather, the reasonably good and affordable accommodation and prices there, I can't see why that community won't continue to grow. We will look at all of the concerns you have expressed. Thank you.

MR. JONES: I had not intended to raise this particular issue in the House, in that it is the kind of thing I would much prefer to deal with via the ministry through normal channels. But I feel I have lost control of this issue because it affects two constituencies, and I had tried to work through the office of a member of the government side, because the parents of the young woman affected reside in that community.

This has to do with a young woman who for some 16 years has been a TPN patient. For the minister — not that I am any expert in this area — I think that stands for total parenteral nutrition. Let me describe the situation to you. This is a patient whose digestive system is unable to absorb nutrition and so, as a result, the individual receives her nutrition through an in-line catheter. I'm sure it is not the most convenient thing, but I think it works, and for 16 years this young woman has effectively been able to feed herself via this method.

The problem arises with this inline catheter because infection sets in. In this situation with this young woman, there are only a few drugs that resolve her infection problems with the catheter. As it turns out, these drugs are incredibly expensive — as much as $400 a gram for these particular antibiotics. If patients with this kind of infection can afford it, they purchase the drugs at these very expensive prices and administer them themselves in the home. However, my understanding is that if they can't afford those costs, they can admit themselves to a hospital, go through a treatment procedure for ten days at some $800 per day and be treated in that way. It is good service, but to me is not the most efficient way of doing it.

This young woman has turned out to be a very productive member of society. She's holding down two jobs. She does not want to check herself into the hospital for ten days. When she checks herself into the hospital, she provides her own antibiotic delivery, just as she provides her own nutrition. She really has no need for the nurses or health care services that are available in the hospital, so the hospital costs of this kind of non-treatment — because she's really treating herself when she's in the hospital — could be as much as $8,000.

It seems to me, if my understanding of this situation is correct, that we really have a two-tiered system here. One tier is the person who can afford to purchase these drugs and self-administer; the other is the person who cannot afford the drugs, checks herself into the hospital and then self-administers inside the hospital. Now, with respect to this young woman, she has the full support of her doctor to self-administer these drugs. It seems a very acceptable situation to her physician and the hospital for her to stay at home, administer these drugs and carry on a normal, productive lifestyle, rather than checking into the hospital.

Clearly, this is an area where hospitals could save money and overcome this two-tiered nature of treatment that patients get. My understanding is that there has been a study of this problem with respect to the Kelowna General Hospital. It was estimated that the Kelowna General Hospital could save over 1,000 patient-days of hospital stays. That's just in Kelowna alone. It seems to me that both for the sake of patients like this young woman and for the costs of our health care system, a logical kind of thing like this would be very practical to implement.

The reason I raise it today is that my understanding is a member from the government side wrote to the

[ Page 12635 ]

ministry some time back and has not had a response. It seems to me that if the Kelowna General Hospital can save 1,000 patient-days at $800 a day, even the delay on a response to this is very costly to the government.

I hope I have the situation correct. I'd be very interested in getting some kind of response from the minister. If it's not possible to give a direct response at this time, I'd very much appreciate a commitment on the part of the minister to take a serious look at this. I think it's a win-win in terms of cost to the system and service to patients.

HON. MR. STRACHAN: I would have to agree that the member for Burnaby North makes a good point, just on the evidence he has presented to the committee in the last 15 minutes or so. But the condition and concern that he presents is certainly not consistent with our policy of expanding home care. I would agree clearly with the issue he has raised and will give him and the committee my commitment to seek a remedy. It does, of course, enter into the whole concern of Pharmacare, and that's something we're looking at on a regular basis.

Just for the benefit of the committee, we can't really categorize a hospital bed as costing $800 a day, where a patient, such as has been described, is in fact treating herself. The only way you can save money on a hospital bed is to close it. That's not to say that the member's argument is wrong in terms of treatment and our policy. But I did want to point out that some of the numbers don't always follow through, particularly when you are not providing any intensive acute care. In this case we certainly wouldn't be; therefore one would not have the expense that the member alluded to.

But his argument is generally sound. I give my commitment to you, Mr. Chairman, and the committee that I will examine this and other similar instances with some dispatch. I would like to provide a remedy to this concern as quickly as possible.

[4:45]

MR. PERRY: That's very reassuring. It leads to another logical example of a similar phenomenon. I'm not sure that I can lay my hands on it right now, but I will go from memory if I can't. I'd like to read from an excellent letter sent to the former Minister of Health, the member for Chilliwack, on March 4, 1991, by a Mr. Jim Beattie of Penticton, describing a bizarre anomaly.

Interjection.

MR. PERRY: Yes, he's constituency assistant to the Member of Parliament for — Okanagan South, is it? I think that's how he learned about this case.

He describes a bizarre anomaly. There's really no other way to describe this situation in the payment of an insured service. I'd like to read briefly from this letter, because he describes it rather succinctly: "In April of 1990, it is my understanding that there was a policy change which disallowed the charging of out-of-province purchases of medically required oxygen to the provincial home oxygen program."

People who enter the provincial home oxygen program must pass rigorous, formal written criteria before they are allowed to receive oxygen at home paid for by the province. Mr. Chairman, you must have seen them, and I'm sure all members have seen them: usually older people, sometimes younger people, with lung disease, either in their own homes or sometimes in public, with a small flask of oxygen which can be strapped to the waist or attached to an electric wheelchair or similar device. In order to get on that program, people must have a medical condition which passes the formal criteria, and they must be certified by a coordinator for home oxygen delivery. I have every reason to believe it's a fairly toughly, properly administered program to get onto.

Mr. Beattie points out that the change in policy affects people who travel out of province either for some essential reason or for a holiday and who require oxygen. They cannot exist without the oxygen. They can't transport enough oxygen with them, because the tanks are heavy. I don't know what the tanks are made of; maybe the member for Boundary-Similkameen would know. They're probably steel. I've tried lifting them into ambulances or air ambulances, and they're darn heavy. You can't load up your RV, if you're lucky, or if you're less lucky you can't drag these things in a suitcase onto an airplane to go visit a relative or make a business trip or travel for whatever other reason. You can carry a limited supply, but you can't carry enough for a week or two.

Therefore it's imperative that anyone who travels must buy oxygen locally. Fortunately, as you know, Mr. Chair, the Lord supplied us with oxygen everywhere. It's 21 percent of the atmosphere, and it's the same all over the world, so you can get oxygen anywhere you travel that they have a compressor which can concentrate it. It's about the same price anywhere. The irony is that under this new policy British Columbians aren't allowed to go buy some somewhere and be reimbursed, whereas if they bought the oxygen in the province they would be.

The policy for drugs in general is a sound one. The rationale or theory behind the policy is that if you're going to buy drugs which are covered by Pharmacare, you may as well buy them in British Columbia, where whatever economic benefit there is stays in British Columbia, but most importantly we have some control over the price that's paid. That's a good, sound policy for most drugs, because the virtue of most drugs is that they're little wee things that you can carry in your pocket, purse or suitcase. But this drug, oxygen — it's little wee molecules, of course, but it comes in huge steel tanks, and you can't carry them with you. In this case, it's a drug; it's also an element and a molecule.

Jim Beattie, in writing, explains all those arguments. He says:

"This change of policy appears to be related to the transference of the program to the Pharmacare section of the ministry" — the program being the home oxygen program — "a transfer which professionals in the field generally hail for the improvement in efficiency in the processing of applications and other paperwork. I assume that the cancellation of the out-of-province purchase privilege is to bring oxygen into line with the

[ Page 12636 ]

Pharmacare policy of not allowing any drugs purchased out of province to be charged to the program."

He goes on and points out the weight of the tanks. For example, one local individual requires four 30-kilogram tanks, which cost $134 each for the oxygen in them. I quote again:

"Mr. Minister, many of the oxygen-dependent have pressing reasons for leaving British Columbia. Some leave winter conditions for a more favourable climate to ease their respiratory suffering. Many leave to visit family members in other provinces and some travel for enjoyment. The respiratory therapists I've spoken to encourage travel, for whatever reason, where travel is possible.

"The symptoms of emphysema, asthma and other respiratory illnesses are both physically and psychologically debilitating. The challenge is to keep these people healthy and active in order to retain as much independence as possible. This independence brings well-being and also substantial saving to the medical system in saved hospital or home care.

"Given that there's an existing dollar limit" — you're only allowed so much oxygen per month — "what are the reasons for this policy change? There can't be any significant cost attached to out-of-province purchases of oxygen" — because there's a dollar limit — "yet the impact on individuals is significant.

"Is it practical or compassionate to restrict people's movement for the purpose of consistency when the merits of the situation seem to indicate the need for an exception?"

This letter is a marvel of lucid argument of a rational point. Yet, when I last saw Mr. Beattie a couple of weeks ago he had not had any reply to this. Maybe the minister can give us the reassurance that this anomalous and apparently ludicrous policy has been corrected.

HON. MR. STRACHAN: The second member for Vancouver–Point Grey has pretty well described the situation and the policy as it exists. Our Pharmacare policy is consistent; that is, out-of-province expenses are not eligible for reimbursement. Expenses incurred while out of province for all Pharmacare benefits are therefore the financial responsibility of the individual. In the past, Pharmacare has received approximately 40 to 50 requests per year for reimbursement of out-of-province expenses.

Since the inception of the policy that limits reimbursement to British Columbia suppliers, there has been a significant decrease in these requests. Further, Pharmacare has no control or influence over the costs charged in other jurisdictions, and our experience has been that costs in the United States are significantly higher than in British Columbia.

I do, though, find the member's argument appealing — and compelling, I guess, to some degree — because he's absolutely right. You can load up on a bottle of pills or medicine and take it with you on vacation, but unless you've got a tractor-trailer, it's pretty hard to carry a lot of oxygen around because of the way that it's packaged in large steel containers, as you know.

I can't offer a remedy right now to the member. I can certainly sympathize with the concern of his constituents. We have a policy that we generally think is fair whereby we limit our expenditures and the amount that we're going to spend on these supplies to basically B.C. suppliers, and this is consistent with the Pharmacare benefit program that we have in place.

Although I would love to — on the floor of the House today in committee — say we are going to look after this issue, I know inherently that I should give it some more investigation before making any commitment. It is an anomaly. I wouldn't call it a bizarre anomaly, but I would certainly characterize it as being an anomaly.

I understand that a letter has been sent to the ministry with respect to this issue, and I undertake to give the member a response to his concern — not only the one expressed by letter but also the questions posed in the committee this afternoon.

MR. PERRY: I know the minister can't make policy on the fly, on his feet, in the Legislature, and therefore I'd be satisfied with an answer on this during the course of this estimates debate. We'll probably be here for at least a few more days — maybe a few weeks — depending on our progress. You'll have time.

Just to encourage him, he understands the basic issue. I want to submit, it really is a bizarre policy. I thought of an example that will make it even clearer. When the minister — I haven't had this privilege yet; I hope to some day — travels out of province on government business, he's not expected to pack all of his lunches with him, or take all the food on the plane, down to an interministerial conference in Charlottetown or whatever. He's given an expense allowance so that he can eat when he is there. There is a limit; at least, we hope there is a limit. The first member for Vancouver–Point Grey attempts to be scrupulous in ensuring that there is some limit on the amount spent down there, but he's free to choose whether it will be lobster, steak or whatever. But there is a fixed daily limit he can spend.

It's the same with the patient receiving home oxygen: the flow is prescribed by the physician — maybe two litres a minute, or three; perhaps more during exercise. There's a set limit as to how much can be spent. Surely the answer is the same as the expense allowance policy we allow our bureaucrats or our ministers when they travel: that you can take the money with you, and you can buy what it will get you in another province or in the United States. Surely we have enough of a country left that, within our country at least, we can negotiate some gentlemanly reciprocal agreement with other provinces that we will honour their patients' needs and they'll honour ours, or that they will supply at the British Columbia price to our patients if we supply at their price to people from other provinces. I don't think this one is beyond even the power of a Social Credit cabinet minister to resolve. I have that much faith in the old traditions of the Social Credit Party that there's something left there that can resolve this one before the end of this debate.

I'll raise another matter, unless the minister wants to respond. Maybe we could come back. I can find a small but significant saving that would make debates of this nature unnecessary.

[ Page 12637 ]

I want to come back to the lessons to be learned from the recent laundry non-tendering issue in the Greater Victoria Hospital Society. In response to questions in the Legislature, we received a report from the Minister of Health about the investigation done by the ministry into the change of the laundry service contract of two hospitals on the Saanich Peninsula. The report made crystal-clear that the hospital administrators at the two hospitals involved did not follow clear Ministry of Health policy, which had been clearly enunciated to them in written form. The report also made clear that the hospital administrators and boards of the two Saanich hospitals, whether inadvertently or not, did not even follow their own bylaws approved by the Ministry of Health.

[5:00]

I do not fault the ministry staff for what was done by those two hospitals, because clearly they had attempted, after irregularities last year, in a circular of August 1990 to prevent this kind of event happening. But what I do remain concerned about is the overall failure of some kind of rational fiscal vision, and the failure of the ministerial report to describe the net costs of the experience.

My understanding is that while the motivation for the Saanich hospitals to shift their laundry service from the Greater Victoria Hospital Society laundry to a new proponent who did not even own a laundry.... He had worked in the Greater Victoria Hospital Society for many years but actually did not even have a physical plant at the time of his bid. The reason they did not tender, and the reason they went for that bid, is presumably that they thought they could save some money and that the annual saving to the two hospitals may have been in the range of $25,000 to $50,000 per year. My understanding is also that the loss of revenue — which translates into additional expense to the taxpayer, in effect — to the Greater Victoria Hospital Society was in the range of $300,000 per year.

The reason is quite simple. Greater Victoria Hospital Society had an existing laundry which was serving those hospitals as well as the GVHS hospitals. It had an existing physical plant; maybe an elderly one, somewhat run down, but it was working. It also had proposals to modernize it on a regional basis, which may have been sensible. I don't know; perhaps that was a reasonable long-term goal. But there were fixed overheads which remain: the overhead of the lighting and heating costs, the capital cost of the facility perhaps, the cost of the baseline staffing of the facility, and presumably the need to maintain some emergency capabilities. The fixed overhead does not decrease just because the business has been transferred to the two Saanich hospitals.

My information is that the Greater Victoria Hospital Society — and this was alluded to by the vice-president of the hospital in a newspaper article a month or two ago — estimated its net costs as $300,000. Since all money for all hospitals for operating costs comes from the Ministry of Health, the net cost to the taxpayer of a saving on the one hand of $25,000 or $50,000 and a cost on the other hand of $300,000 seems to be $250,000 per year. Over a five-year contract, that means that the taxpayer will have to fork over an additional $1.25 million.

If those figures are true, somewhere that reflects a great failure of planning and foresight in the Ministry of Health, and a failure to control the self-interested actions of local hospitals. Note that I am not saying that the hospitals deliberately intended to rip off the taxpayer. Presumably their administrators, trying to meet a fixed budget, thought they were acting appropriately. It may not have smelled very good in public, given the circumstances — the fact that it wasn't tendered, that it violated all the rules — but I haven't seen any evidence yet that they were deliberately trying to harm the taxpayer. But the net effect of what they did, and what the ministry knowingly or not presided over, appears to have been to cost the taxpayer $1.25 million over five years.

I'd like to know from the minister.... The ministry's report doesn't include any cost figures. Was there a draft of the report which included the cost figures? Is there written documentation he can show us, and can he confirm that the information I've alluded to of the net loss to the taxpayer of roughly $1.25 million is accurate?

HON. MR. STRACHAN: I would have to say generally no, and I responded to the member's question in the Legislative Assembly a little while ago.

Let's not lose sight of the fact that we have gone from a three-shift operation down to a two-shift operation. This is very important, and it's important from the taxpayers' point of view. That laundry service was an old facility. It had been added to considerably since the fire at Glendale, so it had taken on extra capacity and was operating at overcapacity, and it was an old facility.

As I mentioned earlier, the costs of the washing units are $100,000 or more, and breakdown was inevitable. So by these two smaller laundries taking their load off that society's facility, we were able to reduce its capacity and put it into a far better situation, which didn't overextend it, from both the point of view of its technical capacity to keep up with the load and the personnel point of view.

The two hospitals have paid a tremendous price for this violation of their bylaws. The member has indicated that he didn't consider that they did anything with any malice aforethought, and they didn't. Our investigation shows that they simply ignored their bylaws. Maybe they just weren't aware of what their bylaws said with respect to tendering contracts. Now we have told them that they have to have all their bylaws approved by us — all their spending and all their substantial contracts. So they have paid a pretty substantial price in terms of their own autonomy for the actions they took. It's our opinion that this should be a good signal for the rest of the industry — that there are bylaws in place. We have model bylaws ourselves. They can follow those, or they can develop similar ones of their own. But all hospitals spending the people's money have a responsibility to spend it in the appropriate manner and not avoid proper procedures as specified in the bylaws.

[ Page 12638 ]

There is not much more we can do at this point. To in any way terminate those contracts now signed would cause some serious legal questions — and no doubt litigation and another expense to the Crown. So there's no point in doing that. I don't see that voiding the contracts or having retenderings is a viable option. I'm sure the members can understand that. That would, as I said, only add more expense to the Crown.

I am satisfied that the staff in the Ministry of Health acted in an expeditious and appropriate manner and presented to me all the information that I needed to have. The recommendations were sound, and I am convinced that other hospitals throughout the province are aware of this. The first thing I did when I became aware of this was to issue an immediate press release to all hospital administrators saying: "You cannot violate your own bylaws with respect to any substantial contracting, and you must follow the law." This case gave those orders sufficient profile that I'm sure the bylaws are going to be adhered to in all management decisions by all hospital boards in the future.

That pretty well concludes the issue. I can't accept the member's arithmetic in trying to assess what the loss, if any, is to the Crown by the tendering of these contracts. There was a saving there. There's certainly a demonstrated saving in taking the stress off that current facility, which was really overstressed and was subject to considerable breakdown. We've gone from three shifts to two. We have contracts that cannot legally be broken at this point.

Let me say that finally we are committed to a new laundry facility in the greater Victoria area that will have the capacity to appropriately handle all the laundry that is produced here. We expect to have that in place — in five years or maybe even before that — by the time the contracts for laundry are to be retendered at the two Saanich Peninsula hospitals. That could very well remedy the system and bring a facility on line that would have the capacity to handle with some ease all the laundry that's generated here.

So that's in the long term. But in the short term, let me conclude by saying that I find the member's numbers and arithmetic suspicious. I don't think they're true, particularly if you consider the extra maintenance we would have to incur.

I'm convinced the staff in the Ministry of Health did a first-class job in their investigation, and I can assure you that it would not be in anyone's best interests to try to void the contracts now. That would amount to a greater cost to the Crown and to the taxpayers. I think it's highly unlikely that any other hospitals are going to even consider entering into any type of agreement, business arrangement or process without consulting and following their own bylaws.

MR. PERRY: I'm still having a lot of trouble getting my mind around this issue. What I don't understand is why.... The Greater Victoria Hospital Society, by merging four hospitals, is one of the larger hospitals in the province. So when that hospital takes a position, it's certainly worthy of consideration. It's not guaranteed to be true, correct or accurate, but it always makes me wonder what's going on, when I understand from the published remarks of the vice-president that there was a substantial cost involved.

My own sources suggest to me that there was a cost in the range of what I quoted to you. I am still troubled. Why would the Greater Victoria Hospital Society continue to insist that the net cost to the hospital, which will have to be diverted from other parts of its budget, will be in the range of $300,000? I would be delighted to learn that that's wrong. Having had it suggested to me in a way that convinces me the hospital might well know what it is talking about, I find it a little difficult to accept the bland assurance of the minister: "No, no, no; everything's quite all right. There's no financial problem here."

I would like to see the figures. I'd like to know the answer to the question: did the ministry, in that exhaustive investigation, inspect the GVHS books and test the question: "What will be the cost to GVHS?" Does the hospital agree with the position that its boilers are about to break down, and that the laundry is decrepit? Or does the hospital take the opposite position, as I have been led to believe?

I think we should know the answers to those questions, and I would very much like to see them in writing. Perhaps I could ask the minister if he would agree to table them, when we're back in full session of the Legislature. Or would he agree to provide me with...? Could he provide me now or tomorrow with the information or the factual breakdown that can be tested against the hospital's position?

I'm not in a position, Mr. Chairman, to suggest that the minister now intervene to break contracts. I have to accept his word and his considered opinion that it may be impossible to do or more costly than it would be worth. Certainly I'm not in a position to contest that; I do not have access to the knowledge or the facts. However, another public gain can be served. I admire his resoluteness in notifying all hospitals by press release of the need to respect ministry policy. I admired it when the former minister sent the circular last August attempting to ensure that would happen. That was good administrative practice, but it didn't work in August. Hopefully, it will work more effectively this time, and the minister cannot be faulted for his action in that sense.

However, more can be done. For example, professional organizations are in the habit of publishing the misdemeanours of their members, so that other members may learn from the experience. When a physician, nurse, physiotherapist or psychologist makes a serious error, whether deliberate or not, often the error is published. It's not as often as I would like to see it, but often enough that other health professionals may learn from those mistakes. They are encouraged to do so and are expected not to make the mistake again, at peril of their legal rights.

[5:15]

But what lesson could be learned here? If there really was a net cost to the taxpayer of $250,000 a year, it's very important that British Columbia hospitals be aware of that. If there wasn't, fine. I'd be delighted to let the matter rest if I could be convinced of that. Obviously I am returning to this question for the

[ Page 12639 ]

fourth or fifth time in this Legislature because I'm not convinced, Mr. Chair. I'm elected to ask hard questions and to try to get the answers to them. That's what the people of B.C. are paying me for. The people have a stake, because if there was an additional cost, there's a lesson.

Let me make it perfectly clear to the minister again, if he hasn't grasped my point: the lesson is that hospitals must look beyond their immediate interest before they try to save money in a narrow focus for their own exclusive benefit. The ministry has been wrestling with this problem with hospitals for years.

I see the wry smiles on the faces of the senior ministerial officials. I know it well from the Vancouver hospitals — trying to persuade them that one hospital should not attempt to do something which may save it money but may cost all the others more money. I see it even when I visit the hospital I'm associated with. I see poor elderly patients lying in the corridor outside of one emergency room, waiting 24 hours to get into a ward when there are empty beds in another ward. We need more cooperation between hospitals to address the public's needs and to save money.

[Mr. Ree in the chair.]

If there was a net cost to the taxpayer of this deal, I don't personally blame that minister. He wasn't even the minister at the time it went through. I don't think he should have any shame in letting the figures out into the light of day. Let's say an honest mistake was made here, and let's get it out for everyone to see so we don't make the same mistake again. With that rationale, I'd like to ask again if the minister could provide us with some of the written evidence so we know who is mistaken. I'm not suggesting anyone is not telling the truth, but whose interpretation is mistaken? Has the hospital misinterpreted the cost to them of this deal?

AN HON. MEMBER: Whose version of the truth?

MR. PERRY: Whose version of the truth is more complete? Let me emphasize that I'm trying to raise this as diplomatically as I can. Maybe the ministry has confidential information which makes clear that the point I'm arguing is not correct. But if so, let's see it, and we on this side of the House will be convinced. If it is correct, let's get the truth out — let's lance the boil and let the pus out so it won't happen again.

HON. MR. STRACHAN: All the numbers I've given have been supplied to us by the hospitals involved. I will provide more information to the member if it's agreeable to the hospitals.

I should also point out that the Greater Victoria Hospital Society told us about the undercapacity of the facility and said that repairs were imminent, and that if they kept going at that level of production, there were going to be considerable maintenance costs. All the information we have gleaned, we have gleaned from them. We've provided it as quickly and in as forthright a manner as we could to this Legislative Assembly.

In terms of getting the news out to the hospital, I can assure you, Mr. Member, that if I know the hospital grapevine — and I know it pretty well, having known a couple of administrators personally for some time — probably within 25 minutes of tabling the report in the Legislative Assembly which pointed out that the sanctions taken against those two hospitals would mean government approval of any of their contracts of substance, those sanctions were known throughout the province. I don't think we needed a major publicity move to ensure that every administrator and board in the province was well aware of the fact that we meant business when we told hospitals to follow the guidelines.

You spoke earlier of August press releases. I don't know what the previous minister did, but I can tell you what I did. We issued a press release immediately, accompanied by the regulations and a circular. We then pointed out in our recommendations with respect to the Saanich hospitals that they had totally lost their autonomy with respect to contracts of any substance. This is an onerous sanction on them. I'm sure that if you're aware of hospital governance, Mr. Member — or any members here — you're aware of how serious that is. We have also indicated that we're going to be doing spot audits, and we are going to be reviewing compliance of these orders as a natural part of our operational review.

In retrospect, I have to say that although I'm not very happy at all about the situation as it developed, I can assure this committee and the people of British Columbia that we acted quickly, efficiently and in a manner that is going to have some impact on this process and will ensure that it doesn't happen again.

Finally, I couldn't agree more with the member's comment that hospital boards must make decisions on a holistic basis — in other words, they have to look not just at their own plant and operation but at what is good for the whole system. That is part of the atmosphere and environment that we're trying to build in the province in terms of governance, so I would agree with the member on it. We encourage hospitals to look at not only their only particular vested, narrow interests as a facility and an operation but, when they are making any type of decisions, at ensuring that it's best for the whole health care delivery system, particularly as it affects the health community in their geographical area.

MR. PERRY: Lest we have frightened all of the hospital administrators in the province and they're quaking in their boots right now, let me assure the minister that some of my best friends are hospital administrators, as the saying goes. They're doing a good job in general. I think we can agree that they're doing their best, but it's a difficult job.

I may seem like I'm jumping around, Mr. Chair, but this debate is proving so stimulating to me that my mind has gone into overdrive. Other members may not be impressed.

While we're on the subject of hospital accountability, I have a particularly persistent constituent who delivered to my office on Saturday.... I had failed to

[ Page 12640 ]

acknowledge her earlier letter, and she even suspected it of having found its way into the round filing cabinet. It did not; it found its way somewhere into this pile. This persistent constituent has a good point. With some embarrassment, I confess that she is describing the hospital with which I am affiliated — which shall remain nameless unless the minister wishes to identify it.

Her complaint is that that hospital allows a smokers' lounge in the hospital even though it has bold anti-smoking policy signs at the front door and in the lobby. Her complaint is a little more serious. She describes a woman very seriously ill with a terminal illness who was exposed to second-hand smoke by virtue of being situated in a room adjacent to the smoking room.

My constituent, Mrs. Jo Cameron of Vancouver, points out that her complaints were, so to speak, brushed off and that during her own stay in the hospital she observed that the smoking lounge ostensibly reserved for patients who were so addicted that they couldn't possibly get by without smoking, even while acutely ill, actually was occupied about 50 percent of the time by non-patient relatives or friends, and that a constant pall of smoke surrounded the door whether it was open or not.

The minister could perhaps be helpful to Mrs. Cameron and other such patients by encouraging hospitals through a similar directive to review their smoking policies. Some, like the Vancouver General Hospital, have been extremely aggressive. Mrs. Cameron has resorted to correspondence with a hospital board member, formerly on the board of Vancouver General Hospital, who had pushed for that policy. Others, like the otherwise excellent but in this case lamentable Lions Gate Hospital, have actually gone to great expense to facilitate the smoking experience in their hospital and even provoked one physician, who must be a genuinely bizarre anomaly, to run for the Social Credit Party in the next election, largely because of that peculiar policy. That doctor put up a good, strong fight against the $20,000 smoking lounge at Lions Gate Hospital and lost, and has gone into politics subsequently.

What I'm getting at is that maybe the minister could give a little friendly nudge to the hospitals of B.C. to re-examine their policies posthaste and get with it before we enter the twenty-first century — perhaps even before the end of the month.

HON. MR. STRACHAN: The answer is yes to that suggestion.

MR. CHAIRMAN: The second member for Vancouver–Point Grey.

MR. PERRY: Thank you, Mr. Chair. Please be assured that none of this is directed at you personally — other than in the most congenial sense of counselling from the minister and myself.

We're making such good progress in this debate that I'm beginning to look forward to being here for a few months and not just a few weeks. I think we're actually getting somewhere with some issues.

MR. JONES: Substantial progress.

MR. PERRY: Yes, substantial.

As we're beginning to wane in time today, I want to come back quickly to a couple of information requests. I'm not sure if my memory has slipped and the minister has answered them already; I think not. I've been looking back over the debate from last week, and I don't think we got the answer, so I want to serve notice again.

I would be encouraged to have a little bit more precise answer from the minister about the funding commitment to the expansion of postgraduate training programs at UBC in time for the mandatory two-year postgraduate licensing requirement for new doctors in B.C. I pointed out in the interim supply debate, I think, that there was some urgency to the matter of allowing start-up funds to the faculty of medicine to get these training programs going. The former Minister of Health, the Minister of Finance, agreed that the program was an excellent idea and said that discussions were underway, but I haven't got a clear answer as to whether start-up funds are going to be available in time for July 1, which the faculty of medicine seems to feel is urgent in order to meet these needs.

I emphasize for those members on the government side who had trouble making the connection: I have no personal stake in this issue. This is not a matter which benefits me. It's a program aimed at benefiting the people of northern and rural B.C. and at improving the standard of medical practice by enhancing the training of physicians, bringing us in line with provinces like Alberta which have had a two-year postgraduate training requirement for at least ten years. I think there's a small urgency, a small amount of money required. Maybe the minister could reassure us on that one.

[5:30]

I've got one other comment on information requests. I had been asking for clarification — I think I raised this in interim supply on May 31; the minister may want to refer to it tomorrow — of the remarkable discrepancy between Pharmacare estimates and Pharmacare expenditures in contrast to the estimates and expenditures, let us say, in the Medical Services Plan. I raised the issue of whether Pharmacare expenditures were deliberately underestimated by the ministry to Treasury Board, or at the request of Treasury Board — at request at the political level — to suggest a smaller budget than was the real expenditure for Pharmacare.

I would like to again clarify the issue of the Pharmacare advisory committee report, which was in effect promised by the former Minister of Health implicitly for the end of the fiscal year. I'm aware that that report has been through various drafts. It has extremely useful information, which, interestingly enough, would not be condemnatory of the government. The government and the public have everything to gain by the release of this report, to facilitate discussion about how we can maintain access to good

[ Page 12641 ]

drugs for people who really need them but control Pharmacare expenditures on drugs which are polluting the Strait of Georgia and the Georgia basin without actually benefiting patients. I'd like to know from the minister whether we could expect to have that Pharmacare advisory report — if it has been submitted in final form — in time for discussion here. And if it hasn't been submitted, can he tell us when it will be submitted and assure us that it will be published as soon as it's submitted?

HON. MR. STRACHAN: We have a variety of questions here. Parenthetically, the member talked about debate tomorrow. I'm under the understanding that another set of estimates is going to be up tomorrow, and I would advise the member of that. However, we will be forthcoming, and we will give the committee an undertaking now to provide as much information as has been requested by the member opposite.

With respect to the two-year program, we....

Interjection.

HON. MR. STRACHAN: Yes, that's my advice, but I guess that should be discussed with you and someone else. I'll talk to you about it later.

Interjection.

HON. MR. STRACHAN: Finance. I'll talk to you about that later.

Back to the Ministry of Health estimates. We realize that this two-year postgraduate pre-licensing requirement will create a substantial opportunity to better prepare graduating physicians to deal with the complexities of the problems that are set upon them. We generally acknowledge that this will improve the quality of medical care. We do have a bit of concern with arriving at the cost of this: the curricula have not yet been approved, and until that is done it becomes difficult for us to arrive at a cost. The curricula will not be approved until later on in the summer, so it becomes difficult to comment further on that. But I do agree with the member: it's something that will be done.

If there are some hiccups during the first phases, those are to be expected, because no new program is ever without its problems. But we will endeavour, along with the universities and the Ministry of Advanced Education, which looks after the university side — we look after the hospital side — to ensure that this happens as speedily as possible and with as few problems as possible. But until we have the curriculum established, it's very difficult to comment further on actual funding and where we are and what we will be able to provide. We don't develop curricula, so it's a bit out of our hands at this point.

In terms of Pharmacare, there have been some substantial increases. Mr. Chairman, members of the committee will note that if they look at the estimates book, vote 40, which includes the Medical Services Commission and Pharmacare, in fiscal '90-91 was $228,640,545. There is a considerable increase this year for fiscal '91-92, to $285,656,087. That does indicate that we have recognized a significant increase in the program, and I'll tell you why. Pharmacare costs have really gone up considerably. In plan A for seniors, the drug cost is $15.8 million; plan B, $2.4 million; plan C, which is Social Services and Housing, $3.1 million; plan E, the universal plan, up $1.2 million — and that's the reason we have these considerable increases in Pharmacare.

We're quite proud of the program. I guess there will always be concerns, such as the one we were talking about earlier regarding oxygen and other issues, but I maintain — and I think our budget will demonstrate — that we are certainly budgeting for this. We recognize the increased costs in our budget. We are not hiding our head in the sand in this, and we certainly have provided the appropriate funding resources where required.

In terms of the Pharmacare advisory committee report, it was received only recently. Staff have not had a chance to discuss the issues in the report themselves or with me, and we have not had an opportunity to meet with the committee. I don't think it would be in anyone's best interests until such time as we have met with the committee and I've had a chance to be briefed by the staff and to put my policy input into the report. It would be inappropriate to release that report to the member. But I can tell him that it has been received. As soon as we can conceivably make it public, with all the protocol and courtesy in place, we will do that.

I think I've answered all the member's questions that I'm able to answer at this point. But we have a few more minutes Mr. Chairman, so I'll take my place in case the member has any other issues he wishes to consider.

MR. PERRY: A week ago the minister asked for suggestions. I will make one more very charitably. The Pharmacare review report has included some very good minds. Some members of that committee have thought a great deal about rational drug use in British Columbia. I would have thought they moved at the pace of a tortoise rather than a hare, but perhaps it will be worth it in the end.

Interjection.

MR. PERRY: Or a rabbit — not to offend the member for Yale-Lillooet.

But the report is useless unless its conclusions get out, and I want to make a constructive suggestion. I do a little bit of teaching in this area. I was able to obtain, through the generosity of Pharmacare, some data that I feel belongs to all of the public. I took that information to two small communities in British Columbia recently and showed practising doctors the costs of some of the drugs they're using. Their response was very constructive. They were alarmed at the costs of some of what is going on. They recognize that the costs in the calendar year 1990 of one drug alone — which is probably being inappropriately used by conventional standards — would have been enough to clear up the hospital deficits of seven medium-sized hospitals in B.C. They were impressed by those numbers.

[ Page 12642 ]

Getting the information out to the people who are actually making the decisions in prescribing is in my view the only way — short of a radical, oppressive government solution — we can make savings.

We do have something of a crisis. I don't use the word "crisis" very often in health care, for the reasons I described last week, but in Pharmacare we do have something of a crisis when the costs have gone up in the order of 25 percent in one year. If we knew the benefits were going up that much, then I'd argue it was wonderful. But we don't know that. It's a complex problem needing complex solutions, but it needs some action, and one of the actions is to get that report out promptly.

I see the staff of the ministry nodding again. I'd be encouraged to see them stay up late on a Friday night reading that report, maybe even on a Saturday or Sunday, and get that report into our hands as fast as possible, and get it into the hands of the people prescribing the drugs so that they can take some action and learn from it.

I want to make another concrete, simple suggestion, maybe pretty radical; I think it's actually a modest proposal. I have before me a brief that the British Columbia Cardiac Society submitted to the Royal Commission on Health Care and Costs. I think this may have been in January or March; I forget the exact date, but it was this year. There is an interesting suggestion on page 11 of the final version of the B.C. Cardiac Society brief. They are rather hard-nosed doctors often; I'm sure the ministry officials have had a lot of exciting dialogue with them over the years. They consulted fairly widely in preparing their brief, and I think they came up with some rather interesting ideas.

To put it properly in context, I'll quote the whole paragraph. The first part may sound boastful, but the second part of the paragraph is where the meat is.

"Medical training in Canada and British Columbia ranks among the best in the world. No one should question the medical preparedness of our physicians, whether primary care or specialists."

That may be laying it on a little bit, but that's what they said.

"However, nowhere in their medical school, internship or residency training have doctors been taught to be effective managers of anything except the seriously ill."

Don't get me or anyone else wrong; there's nothing wrong with that. That's what medicine traditionally has been. I continue to quote:

"Courses taught on cost management, economics, cost-benefit analysis and/or effective utilization of available services for doctors are not readily available. Professional development courses on better forms of cost control and treatment alternatives do not exist."

That's a very damning statement, isn't it, Mr. Chair? Its very striking, because it probably wouldn't have been made by physicians in this province even five years ago — certainly not ten years ago. They might not have been aware of that issue, and if they were, they probably wouldn't have admitted it in public like this. I continue to quote:

"If the government expects physicians to seriously address the province's concerns about the growing cost of health care, the Ministry of Health must do three things. First, the ministry must ensure that medical students and practising physicians are given the management and economic skills necessary to make effective cost-analysis decisions."

There are two other recommendations, one of which is a little more self-serving than that. The third one is that the ministry must put in place professional cost-benefit analysts to advise doctors and hospitals on appropriate methods of becoming more cost-effective practitioners. To some extent, the third recommendation has been implemented. I don't think it's been implemented quite as creatively as it might be, but there's been movement in that direction.

The first recommendation, on the teaching of efficiency and good management skills, has been sorely lacking. I have a constructive proposal for the minister, something which could be implemented conceivably as early perhaps as next September. Maybe it would take a little more time, but it would be interesting. It is for the minister to specifically allot out of that minister's discretionary budget a modest sum, mandate a course like that and ensure that it gets taught to this year's crop of UBC medical graduates — or to the incoming class, but preferably to those going out. It's too late to get the last class; they've just finished up. Maybe it could be taught to the interns or the postgraduate trainees in British Columbia, who are the ones actually going out to be loosed on the public. I think that's a creative suggestion. There are many people within the university and the ministry who know what needs to be taught, and it would be a tremendously innovative step in the right direction for the ministry to launch a program like that. The ground is finally fertile for it. I couldn't have said that a few years ago, maybe not even two years ago, but now the time's right. I leave that with the minister.

HON. MR. STRACHAN: It's nice to hear the member agree that I'll still be in cabinet next September; that's my idea too. I don't know if I'll still be Minister of Health, but it's nice to know you have every confidence in us forming government again. I can assure you that as we continue on with good government in this province over the ensuing years, Mr. Member, I will take your comments to heart.

[5:45]

Needless to say — and I don't want to duck the issue — that would be more an issue between the universities and the Ministry of Advanced Education. But you make a very good point, and I'm sure all and sundry, including the university and the ministry, are listening to your suggestions.

This comes again from my former ministry, but the member indicated that medical schools in Canada are generally good. As a matter of fact, they're exceptional. From my previous movie I remember having the good fortune to attend an OECD conference in Paris on the state of education with the OECD countries. I was one of three provincial ministers to attend. You will know, Mr. Chairman, that there are no federal Ministers of Education; there are only provincial ministers. I had the good fortune to attend with Russell King, who is a medical doctor and minister in New Brunswick, and Phil Warren, who is a university instructor at Memorial

[ Page 12643 ]

and representing the government of Newfoundland and Labrador.

Upon discussion with staff and upon making our presentation to the OECD we had to conclude that number one, all Canadian universities are generally very good, and you can transfer, say, from second-year university at UVic to third-year into Memorial University of Newfoundland — the other end of the country — and generally be accepted and understand and be at a very high level.

The other thing that Russell King talked to us about — and we confirmed — is that all Canadian medical schools are exceptional. There aren't any bad ones; they're generally very good. I think that speaks well for, first, our university and medical school system, and secondly, for the expectations that Canadians have and for the work that successive governments in all provinces have done to ensure that we have first-class medical care in our country. So that speaks well to that.

We are going to be continuing, as I understand, for some days on these debates, so any questions that have been posed today and as yet are unanswered will be answered. Mr. Chairman, I give my commitment to you and the committee that we will as forthcoming as we can, unless there is any information that is confidential.

With that said, and keeping in mind the hour of the evening, I will move the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Strachan moved adjournment of the House.

Motion approved.

The House adjourned at 5:48 p.m.