[ Page 12713 ]

CONTENTS

Routine Proceedings

Presenting Reports –– 12713

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

On vote 38: minister's office –– 12713

Mr. Lovick

Mr. Reid

Ms. Marzari

Mr. Perry

Mr. Vander Zalm

The House met at 10:03 a.m.

Prayers.

MR. REID: It's with a great deal of pleasure that I introduce to the House today the approximately 45 grades 5 and 6 students and their teachers, Mr. Mellecke and Ms. Stresman, from the Zion Lutheran School in my constituency. Would the House please make them welcome; they're in the precincts.

Presenting Reports

HON. MR. RICHMOND: I have the honour to present the report of the Special Committee of Selection, and I move that it be taken as read and received.

Motion approved.

HON. MR. RICHMOND: By leave, I move that the rules be suspended to permit the moving of a motion to adopt the report.

Leave granted.

HON. MR. RICHMOND: I move that the report be adopted.

Motion approved.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

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

MR. LOVICK: Mr. Chairman, I want to focus for a short time this morning on a number of constituency-specific issues. Before I do that, however, I wonder if I might pose a question to the minister concerning the impact of federal government activities on our health care system. As we know with Bill C-69, the Government Expenditures Restraint Act, we're looking at a descending figure of funding for provincial health care systems across Canada, at 3 percent a year for a number of years. Recognizing that some 40 percent of the total provincial health budget is accounted for by federal transfer payments, that sends a clear signal to us that is perhaps alarming. I don't recall hearing anything from the minister about that problem, and I'm wondering if he might address it briefly now: whether there is any response from this government, and whether we're looking at some cost efficiencies and ways to modify and otherwise streamline the system so we can ensure that the fundamental principles of medicare will be maintained.

HON. MR. STRACHAN: Mr. Chairman, the federal cutback began last year, and as a minister in another movie I had the same sort of problems inflicted on me. The reason we haven't said much about it this year is that it's a year-old story now. The first cutbacks came to Advanced Education and to Health last year. That was released by the federal government — I have a note here — on February 20, 1990. So that explains our lack of comment about the initiative this year: it is now a year old.

With respect to the member's more general and, I guess, philosophical question about the Canada Health Act and what this will mean with respect to more provincial jurisdiction and his question about how provinces are going to manage their own health care systems as the federal government offloads, that is a good question. My comment to date has been that we are in no way considering any departure from the Medical Services Plan, medicare or the health system administration as we know it now.

Some quarters, particularly the B.C. Medical Association, have advanced the notion of user fees. Although that was a feature of this government some years ago, we did away with them some time ago, and there's no reason for us to consider implementing them at this time.

I will advise the member that Benoit Bouchard has called all provincial Ministers of Health to a meeting in Ottawa. Regrettably I can't go because of legislative activity and other issues, but more may be discussed at the federal level at that point. But in terms of any change of policy, I can assure the committee that we have no intention of changing our current policy with respect to our Medical Services Plan program.

MR. LOVICK: I appreciate the answer, and I am delighted to hear that we aren't talking about any kind of Draconian steps to accommodate that potential funding shortfall — and existing funding shortfall, in fact.

However, I'm wondering whether the debate about user fees isn't — with all due deference — a bit of a red herring, given the five principles of medicare that we are apparently bound by statutorily. Insofar as we get the federal transfer payment, doesn't the principle of accessibility more or less guarantee that user fees can't be invoked, at least not without the risk of getting into a major legal battle?

HON. MR. STRACHAN: I've just been advised that Quebec has introduced a $5 non-emergency user fee, and one would have to see what happens in terms of the jurisdictional dispute on that issue. We continue to support the underlying principles of the Canada Health Act. I don't know what more I can say about that.

MR. LOVICK: Mais Quebec, comme vous savez, n'est pas une province comme les autres — just in passing I have to say that. They always have marched to a somewhat different tune. The famous slogan in Quebec, as we all know, has always been that they are

[ Page 12714 ]

not a province like the others. That was the point I was making.

I want then to turn more specifically to Nanaimo and the concerns at Nanaimo Regional General Hospital. We left off with some questions from the second member for Nanaimo on June 3, the last time we had an opportunity to discuss the minister's estimates.

I want to pick it up by beginning with the whole concept of funding formula. My understanding is that we have in place a new funding formula that is no longer based just on the reported workload of the hospital as it used to be, but based to some degree on a population demographic study. To start with, I'm wondering if the minister would be good enough to explain how that base funding is determined.

HON. MR. STRACHAN: With respect to the comment about la belle province, let me just say chacun à son goût.

With respect to Nanaimo — back into English — I'll give the member a briefing note that has been provided to me. Since April 1, 1988 until this fiscal '91, the Nanaimo Regional General Hospital received an increase of $9.4 million in its base funding, which is a 29.7 percent increase. Some $3.1 million or 9.7 percent has been in excess of the funds required to meet inflationary increases and was available to the Nanaimo Regional General Hospital for new or increased programs to meet the needs of the population, which has grown by 4.3 percent since that same date of April 1, 1988. During the same period the Nanaimo Regional General Hospital received $700,000 in equipment grants and major building projects in excess of $25 million. The Nanaimo Regional General Hospital has received per capita funding comparable to that allocated to other hospitals in its peer group.

I can tell you that the model we use is based on population demographics, and then we have various refinements from there. The model starts with the average provincial utilization rates by age and by sex for several different services, which are acute days, critical-care days, surgery visits and long-term acute care. These are used to calculate the changing service requirements to the population changes, which are growth and aging. Of course, when we look at age and sex in determining hospital programs and hospital care, we know that older people and women require more services of a hospital. That's why we use that as an allocation model.

[10:15]

In order to consolidate the various types of service into a common measure, they are combined using a factor which we identify as the weighted-patient-day factor. The resulting growth in weighted-patient-day factors for each hospital area is then allocated to the various hospitals in the province using 1987-88 data on referral patterns for acute days. That means that each hospital's share of the total increase is composed of some proportion of the impact of the population growth within the hospital's home area — the area normally being, in all cases, the school district — that's the geographical description we use — plus a share of the referral activity caused by growth in other areas.

To recognize the differences in production costs between hospitals, the resulting weighted-patient-day factors are weighted by the current average cost per day, such that each hospital's share of the total allocation reflects a proportion of its costs times its weighted — patient-day factor to the sum of the entire province — all of which is summed, squared and divided by N minus 1.

MR. LOVICK: I am smiling, Mr. Chairman, because if there were ever such a thing as the information overload principle in action, we have seen it here. I appreciate hearing the briefing note. I am familiar with some bits of that note. I would ask if the minister would do me the kindness of giving that to me so I can have a closer look at some point.

Is it not the case, though, notwithstanding all that you have told me, that the board, the finance committee and the administrator at Nanaimo Regional General Hospital argue the case quite passionately that the funding formula is, in effect, punitive to Nanaimo Regional General Hospital? They say that the intricacies of the formula do not address the problems at Nanaimo. Isn't that the case?

HON. MR. STRACHAN: I guess they may argue that, although I don't know how passionate or compelling the argument has been — and I have heard many. I think what we try to do fairly.... Let me recall a comment that was made to me years and years ago when I was a brand-new member of the Legislative Assembly and went to see one of the administrators in my own hospital in Prince George. We talked about health care funding from the provincial government, and my friend said: "I have been in the hospital administration business for some time now." It was 1979 when I spoke to him and he had been in hospital care during the governments of W.A.C. Bennett, Dave Barrett and, of course, Bill Bennett, so he'd seen a variety of administrations, programs and management methods pertaining to hospital care and funding.

His opinion was that it's in the government's best interest always to ensure that we maintain extreme pressure on hospitals to keep them efficient, to keep them innovative, and to ensure that we don't have any runaway spending, because in the area of health care you really can have rampant and quick spending, unless you're watching it very closely.

To be frank with you, Mr. Member and members of the committee, it's almost a cruel system in terms of administration. We really examine with a fine-tooth comb and a fine glass the affairs and management of hospitals, and we try to keep them as efficient as possible. We continually turn the screws down on them. It's only in that way that we can ensure that we have adequate funding for everybody. Hospital boards make compelling and passionate arguments to me — as to previous Ministers of Health — every day, and in some cases we'll admit that maybe we are being too punitive, or we haven't examined all the issues; in other cases we feel quite resolute in terms of our determination of what we provided for them. But by and large, I have to tell this committee that it is in the

[ Page 12715 ]

best interests of the province of British Columbia and of the health care system as a whole for us to be quite nasty and tough to get along with, as a ministry, and we are that way.

If the member has further information that the ministry is not aware of in terms of a specific situation at Nanaimo Regional General Hospital, we'll certainly have a look at it. But by saying what I've said about the tough measures taken by this ministry, I hope I've expressed to this committee the feeling and the position that we have. As I've tried to indicate, it's not any different; all governments have operated the same in terms of hospital funding and ensured that the people of the province are getting the best possible value for their health care dollar. We maintain absolute and very tight control over hospital management systems and the funding of those hospitals.

MR. REID: I appreciate the tough stance you must take, because I know, from my constituency and the area which I represent, there are two hospitals, Peace Arch and Surrey Memorial, which continue to make a case for additional funding, and they talk about the meanness of you and your staff, Mr. Minister. I know it's not true; you have to be fiscally responsible and deal with the question of ability to pay.

Mr. Minister, you are aware that my constituency the other day presented me with a petition dealing with the question of capital acquisition for a new hospital in the general area of Surrey. The petition was for a location being considered at Cloverdale. From your former position with Advanced Education you are aware of the population projections for the general area. If you can recall from those maps and numbers we looked at, relative to the population projections, those projections indicated Cloverdale as the centre of population growth for the Fraser Valley area. Mr. Minister, I would hope that with the petition that I and other interested citizens of the area were able to present you and with information on the growth that's coming, you would direct your staff to give serious consideration to a capital expenditure for a new hospital. If it's to be located in the general area of Surrey, it should be located in the Cloverdale area, as the petition indicates.

Keep up the good work relative to how you disburse funds, as best you can. I know that in my particular area of South Surrey–White Rock they're appreciative of your efforts and the allocation they get. I know they can always use more, but also I know that the hospital in our constituency is certainly served well by your ministry.

HON. MR. STRACHAN: I'll be brief. As the member has indicated — and I can also advise him of this from my previous ministry — we do have remarkable growth occurring in the Fraser Valley, and we're well aware of that. It's probably the fastest growing neighbourhood in North America. It's big, and it's getting bigger.

To that end we have put together a South Fraser strategic planning group to look at hospital needs in the area, and they will be making recommendations to me. I'll take the member's concerns as noted and keep them in mind when the planning group finally reports. But I think it's appropriate that we allow the processes in place to continue before making any specific ministerial response.

MR. LOVICK: To resume the questioning I was proceeding with and the minister was responding to. I thought that an introduction was going to be made, thus I yielded my place. I didn't intend to do this on a kind of regular interruption basis, so I ask the minister's indulgence if it takes me a moment to get back on track.

Nobody on this side of the House questions the need for value for money and efficiency I think it's probably safe to say that not too many of us on this side of the House, if any, would say that there must be a huge additional amount of money invested in health care. We know that is a significant and, indeed, major portion of the provincial budget. What we're talking about and what I am talking about, though, has to do with equity and fairness and with a reasonably equal distribution of resources across the province so that people in one area are getting their fair share compared to people in other areas. I submit that that may not be the case in the instance of the Nanaimo Regional General Hospital.

The argument that I have listened to for the past four and a half years, meeting with the board on a number of occasions, talking to doctors and staff at the hospital, and the administrative staff and the financial people there, is that the principle of equity seems to be offended by the funding given to Nanaimo. Nanaimo points to the fact that the various reports and studies carried out on that particular regional hospital demonstrate that the hospital is indeed efficient and operating effectively. Furthermore, we are a growth area with an aging population.

The problem, however, is that we continue to be underserved in particular areas. Accordingly, one of the phenomena we have to deal with is what in economic terms we call leakage from the region: people who go for their health care outside Nanaimo despite the fact that we have a huge capital investment in infrastructure in Nanaimo. I'm suggesting that if it is the case that people have to go for surgery outside the region, that is probably not cost-efficient and is probably bad economics.

The arguments I'm hearing, then, are that we in Nanaimo are, as I say, not being treated fairly; we are indeed being discriminated against. We are a rapidly growing region with many new seniors. According to the hospital staff, our community care is underfunded in contrast to other health units. Our regional hospital is well below provincial averages for funded acute-care beds and programs. We have among the longest surgical waiting-lists in the province. Our mental health capacities are inadequate for the demands of our community. Our long-term care is demonstrably inadequate: we have a gross shortage of beds for our older population.

I'm not suggesting necessarily that we have to spend a whole bunch more money in the system. But I am

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suggesting that, given that Nanaimo is a regional hospital and that we have already invested huge dollars in making it a regional hospital in every sense of the term, it does not seem to be getting the treatment it ought to.

Let me just offer one brief illustration of that point — and I can develop some of these at greater length. The minister will recall that the other day I quoted from a Nanaimo Regional General Hospital review conducted in 1990. A couple of paragraphs will make the point rather effectively. Under the executive summary review of the recommendations, let me quote review finding No. 3:

"The resources approved for the hospital in terms of beds per 1,000 population are lower than those in the province as a whole, both in the acute rehabilitation area and extended care. As a consequence of this, the hospital is unable to provide all the services utilized by the local community, resulting in the high utilization of hospitals in Victoria and Vancouver by patients from this area."

I would note that the next review finding addresses the fact that the hospital is generally efficient, and their study shows that the hospital is operating at a lower cost than its peers. The evidence would suggest that surely this hospital ought to deserve better treatment and that it is not getting its equitable and fair share of resources. I would ask the minister for a response to that observation.

HON. MR. STRACHAN: Generally, to begin my response to the member's comments, I must say that I will recognize, and that we do recognize, that there are anomalies within the system. We work continually to ensure that those differences are smoothed out. As a matter of fact, we have a committee, I understand. We are working with the B.C. Health Association to ensure that we can alleviate some of those differences and anomalies that occur.

If we look at Nanaimo Regional General Hospital in terms of its peer group, it's sitting there right in with the average. Its peer group, by the way, includes Burnaby, Lions Gate, Surrey, Kelowna, Nanaimo of course, Prince George and Royal Inland in Kamloops, so it is sitting in well with its peer group.

For the 1991-92 fiscal year, in terms of capital improvements, on April 19 of this year we completed and opened phase one of a capital program, which includes an expansion of emergency, laboratory, radiology, social services, administration, material management and medical records. The Ministry of Health is currently reviewing the hospital master development group program to review phases two and three of the construction program, which will provide construction enhancements to enable an increase in surgery.

[10:30]

Further, with respect to the member's concern about extended care beds, we agree, and to that extent we have announced a 75-bed extended-care unit for the Parksville-Qualicum area which will open in 1992. This will greatly alleviate the problem of long-term care patients currently in the Nanaimo Regional General Hospital acute beds. So we are aware of those concerns, and as I've indicated with the announcement of the capital program at Parksville-Qualicum, we can alleviate that situation in Nanaimo.

MR. LOVICK: I want to focus specifically on the minister's answer and the reference to peer group analysis suggesting that, by comparison with other comparable jurisdictions and hospitals, Nanaimo is doing okay.

Just before I do that, let me say that we recognize that the expansion project phases one, two and three are proceeding apace. We're delighted by that. The problem, as the minister alluded to, is that the expansion program isn't doing anything for the present to reduce the surgical waiting-list. It isn't solving our immediate problem. But the tragedy and the irony of the Nanaimo hospital is that we have the capital facility there, and we're not using it. That's the tragedy of our funding crisis and the reason for our long waiting-list. For want of some 10 or 12 acute-care beds, this massive operation — this incredibly expensive operation — is being underutilized. That's the tragedy.

I don't want to personalize this in any way, shape or form, Mr. Chairman, because I realize that the minister is new. I'm happy to see that the Minister of Advanced Education — a former Minister of Health — is now in the House, He has had this discussion with me and has certainly heard the complaints, and we have exchanged numerous letters, as I have with his successor the current Finance minister. So I don't want to personalize it or blame individual ministers, because I believe individual ministers are pursuing by their best lights in trying to do what they can.

But I am drawing your attention to a problem that has persisted for the time I have been in this Legislature and for Lord knows how many years before. We can't seem to make this government understand that we are not functioning as efficiently and effectively as we ought to be. We aren't using our resource that's already paid for as efficiently and effectively as we ought to be for want of a relatively small amount of money and a reallocation.

Let me then come very briefly back to the issue of peer group analysis. If it were the case, Mr. Minister, that comparable jurisdictions were treated comparably, then certainly some of the argument I am presenting would be undermined and at least called into question. But with all due deference, I don't think that argument has been called into question.

Let me remind the minister of the letter I wrote to him on behalf of me and my colleague the second member for Nanaimo, dated April 4. I know you have it. You answered my letter and you quoted your answer to my letter the other day in the Legislature. Unfortunately, your answer to my letter didn't respond to the fundamental question of the letter. I'm not about to blame anybody for that; I can understand the exigencies of office and the difficulties, and I accept that. But I do want to raise the issue now and see if I can get an answer.

Let me, if I might, just briefly say what the letter said. I won't quote directly. I met with the finance committee of the board of trustees for Nanaimo Re-

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gional General Hospital a short while ago and was presented with some startling information — information that I named "alarming" in my letter.

Nanaimo's problem with long waiting-lists for surgery is clearly the worst in the province. I attached to my document another one provided by the ministry itself that substantiates that claim. Some 44.9 percent of people waiting for surgery in Nanaimo must wait for more than four months, while the average wait across the province is some 14 percent. That statistic — as I said in my letter — is absolutely scandalous, in my opinion.

I said further that I think the ministry owes me and the people of my community and my fellow MLA an explanation. There are other statistics indicated by the document that are equally alarming, and I don't need, I am sure, to point them all out to you here, Mr. Minister. The fact that only 42.6 percent of patients in Nanaimo had their surgery performed in fewer than eight weeks, while the provincial average is 71.79 percent, and the fact that Nanaimo fares very badly by comparison with the two hospitals in the province most comparable — Kelowna General Hospital and the Royal Inland Hospital in Kamloops…. That's your information, Mr. Minister, not mine — your statistics. The two most comparable peer groups are treated considerably better than Nanaimo, by your own statistics. Please explain that to me and tell me where I err in my analysis.

HON. MR. STRACHAN: The member has indicated some partially correct statistics about the waiting-list. There is more to waiting-lists than the Ministry of Health can manage, and many of the decisions that account for that waiting-list are in fact made by the hospital. I can advise the member and also the committee — and I have a surgical waiting-list chart for the Nanaimo hospital in front of me — that since 1987, when it did peak at close to 2,500 patients on the list, it has lessened considerably. The trend is downward and it would appear from all indications that it will continue downward. As the member knows, and as I have indicated, phase 2 of their capital plan will be to construct enhancements to enable an increase in surgical throughput.

[Mr. De Jong in the chair.]

The member quoted a high percentage of people in the waiting-period category that waited over 16 weeks, and it does appear to be higher than the peer group hospitals. However, if I look at some of the other statistics, I can see that in some areas the Nanaimo Regional is less than other hospitals in its peer group. For example, waiting periods of under eight weeks, eight to 12 weeks and 12 to 16 weeks are less than for other hospitals in the peer group. So it appears to be hospital management that has made some decisions that have accounted for some of these anomalies and why Nanaimo doesn't always agree in terms of waiting-lists or compare with other hospitals.

As I said, I guess the ultimate answer is the phase 2 construction which we are committed to. As soon as we receive the hospital development group's master plan, we will get on with phase 2 and phase 3 of the construction program.

We recognize that we want to see those waiting-lists down, not just in Nanaimo but throughout the province. We are endeavouring to do that. As the member knows as well, the Ministry of Health budget has the biggest increase of any portfolio. I hope that demonstrates to him and to members of the committee and to the people of British Columbia that we certainly see health care as a priority in terms of funding and in terms of government policy.

MR. LOVICK: Mr. Chairman, I've probably made my points. I think the minister understands full well my concerns and my contention, and the validity of the case I present.

I wonder if I might end my brief contribution to this particular estimates debate by just asking the minister for an assurance. I ask him whether he will give me an assurance — as a new Minister of Health who hasn't been involved in the activities for the past four and a half years — that he will look at the submissions that have been made by the board of the Nanaimo Regional General Hospital for the past three years, and the fact that those were ringing the alarm bells — and I don't overstate the case, believe me — saying that we are in crisis in our community; that something must be done; that on the basis of all the evidence we have to present, we aren't getting our fair share. All I'm asking the minister to do is to give me the assurance that he will indeed undertake that review, examine all those presentations that have been made, and perhaps agree to meet with me and the members of the Nanaimo regional hospital board and staff so we can see whether their case is valid and resolve once and for all this fundamental question of whether equitable treatment of hospitals is being provided throughout the province. Can the minister give me that?

HON. MR. STRACHAN: Yes. Let me restate one more time, though, that since 1988 we have been listening to the concerns of Nanaimo Regional General Hospital. As I mentioned in my first comments, they've received a 29.7 percent increase in their base funding, and for the hospital care division of the ministry we'll provide an extra 8.6 percent increase over 1990-91. So we have close to 40 percent increases since 1988. I will submit to the committee, Mr. Chairman, that we have some genuine concern with respect to Nanaimo Regional General Hospital and in fact have answered that concern.

As to meeting with the board, I'm more than pleased to do so. I've been meeting with as many boards as I can, as quickly as I can. That's the way I like to operate. As soon as it is mutually convenient for the board and for me to meet, I will be more than happy to talk to them and review their submissions.

MS. MARZARI: Women and women's health have become a major issue for this province in the last five years, as you well know, Mr. Minister. I want to canvass a few questions about women's health in this province,

[ Page 12718 ]

and I'd like you to bring me up to date on a couple of issues that have reached public attention over the last little while.

A few months ago there was some controversy about the mammography unit in Vancouver — basically through B.C. Cancer Research, I would imagine. There was some suggestion — and some controversy which played itself out in the Vancouver Sun — about whether the provincial government should be paying for the screening for women between the ages of 40 and 50 or whether it should be cut off for women under 50 years of age. It is my understanding that the program costs the province about $27 million a year and that it has been very successful in doing early diagnosis of breast cancer in women. Five hundred and forty women die of breast cancer every year in British Columbia, and I gather that the program has been proven successful in reducing the death rate from breast cancer. Would the minister tell the House whether that funding is secure and whether women between the ages of 40 and 50 are now fully eligible for screening?

[10:45]

HON. MR. STRACHAN: The answer to both is yes. I believe that the medical opinion is that women under the age of 40 would not normally undergo such testing unless their doctor recommended it because something was suspected. You could perhaps check that out with your colleague from Point Grey. But the funding is secure. As the committee will know, we introduced this program throughout British Columbia. My conversations with a friend of mine — a surgeon in Prince George — have indicated to me that in his opinion we really do lead Canada in this type of investigation, and so I think it's been a very good thing for us. But in response to the member's question, yes, certainly the program is in place and will stay in place.

In this sort of instance we follow the advice of the Cancer Agency. If they tell us what we should be doing, we do it; and if they tell us that we should continue with certain procedures, we certainly will. But the member has my assurance that there is no thought whatsoever of reducing this program in any way.

MS. MARZARI: Since the program has achieved such credibility and has become a natural part of most women's regular medical procedure and checkups, has the minister begun to discuss the possibility of expanding the mammography units so that they are geographically accessible to more women in the province? I know that Vancouver is reasonably well served, but would the minister contemplate — or has he put his mind to — the thought that women's health units throughout the province, properly located in various clinics, might make this service much more readily available? Has the minister done any thinking about cost estimates for taking more mammography units throughout the province?

HON. MR. STRACHAN: The answer with respect to expansion is a definite yes. We are expanding; we have expanded in Victoria and in other areas. We have the mobile units, and as I said earlier, we are expanding as we are advised to by the Cancer Agency. We want to ensure that every woman in British Columbia is covered with as little inconvenience as possible. So the answer to the expansion question is a definite yes.

MS. MARZARI: A few years ago I rose in this House and spoke to the incidence of eating disorders among young girls and women in British Columbia. At that time the statistics were enough to suggest a dramatic incidence in high-school girls of eating disorders from anorexia nervosa through to bulimia. I talked to the then Minister of Health about funding for such programs; the Minister of Health had just commissioned a task force to report back on eating disorders in the province.

It was true. The task force came back with some recommendations around a serious problem for young girls and women in our province. Judging from these numbers, it's entirely possible — probable — that one in 100 girls in high school has a serious eating disorder that could put her health at risk. Would the Health minister care to comment on two things. First, the amount of energy, time and money which is being devoted to the medical treatment of these problems, which the report concentrated on.... When it came back, it talked about the necessity of treating these young people — mostly girls and women — in the hospital using a medical model. That's the first thing I'd like the minister to comment on. Are those programs expanding in this budget? Are they being cut back? Are the programs targeting and finding the correct young people — and women, mainly — to treat?

The second — and perhaps more important — question is: has the minister thought through the possibility of treating eating disorders through community programs, through the use of medical health officers and their staff and through the education system, to try to ensure that there's a decent preventive program going on so that young girls and women do not end up needing serious medical attention, which obviously costs a lot more and is far more radical to a young person's life? In dealing with this community eating disorder program, has the minister been approached by medical health officers? Has he thought this through with his staff in terms of the savings that might be made by going to a preventive, community model?

HON. MR. STRACHAN: If I could give the committee some background, let me say that the service demands for young people with eating disorders — anorexia, bulimia and obesity — have steadily increased over the past few years. The child and youth mental health services have funded several initiatives relating to eating disorders. These have included staff training, a public education pamphlet, financial support for self-help groups in the greater Vancouver and Fraser Valley areas, and an innovative summer camp treatment program. Early in 1990 we funded the McCreary Centre Society, which operates out of Sunny

[ Page 12719 ]

Hill, to form a task force and submit a report considering the scope of the problem of eating disorders and recommending a provincewide framework for developing services. The framework identified in the report is based on assumptions on which there is general agreement within the ministry. I would say that we feel we can do more and will endeavour to do more. There's nothing you can't do if you have more money. We are looking at this, and we consider it a serious concern.

For the fiscal year '90-91, $90,000 is allocated to child and youth mental health services for the provision of community treatment resources and hospital discharge planning services for young people with eating disorders. Services are being provided in Vernon and Vancouver. In Vernon a psychologist specializing in eating disorders provides treatment services, and in Vancouver the ministry supports Camp Elsewhere, a summer camp operated by the McCreary Centre Society for youngsters with eating disorders.

The proposed consolidation of hospital-based psychiatric services for children and youth in Vancouver includes ten additional beds, and a yet to be determined portion of these additional beds will be earmarked for in-patient treatment of young persons with eating disorders. With the preparation of educational materials through the health education resources project, we are taking steps to meet the recommendations made in the 1990 McCreary task force report. In addition, child and youth mental health services will continue with an annual commitment of $90,000 to provide enhanced treatment services for young people and their families suffering from these eating disorder diseases.

As I said at the outset, though, I don't think there's any question that we recognize we could do more, and we will do more as we learn more and discover more programs on how to deal with this condition. I agree with the member's concern, will note her concern and assure this committee that all we can do that is fiscally and therapeutically responsible will be done by this ministry.

MS. MARZARI: Perhaps the most contentious issue which has ever come to this House since 1987, Mr. Minister, is the issue of abortion and its availability and accessibility to women in this province, both geographically and legally. As you know, some few years ago the Premier actually tried to deny access to abortion services for women in this province by simply refusing to pay for it. Would the minister be good enough to tell the House what the existing policy is of this government on the provision of abortion services — their availability throughout the province, their availability to women who need them, and whether or not the minister is prepared to start assisting with operating grants the abortion clinics which exist now in Vancouver, so that they can provide the necessary counselling services to young women and women who need abortion services?

HON. MR. STRACHAN: The member knows the policy, I'm sure, but I'll restate it for the benefit of the committee. We pay for the procedure, but we don't pay for the operating costs of any free-standing clinics, no matter what procedure they're performing. That's it. Those are the requirements of the Canada Health Act for medically necessary services, and that's what we provide for.

MS. MARZARI: Would the minister be good enough to tell the House his stance with hospital boards which refuse to provide the service even though the federal Canada Health Act regards it as a necessary service?

HON. MR. STRACHAN: Hospital boards are legally autonomous entities and make decisions with respect to the management of their facilities.

MS. MARZARI: Is the minister not prepared, then, to take any stand with hospital boards which refuse to provide a necessary medical service, when our receipt as a province of Canada health dollars revolves around our meeting that contract?

HON. MR. STRACHAN: Not all hospitals can do all procedures. We recognize that. It doesn't appear to be a problem in terms of this procedure, and I would take no position whatsoever in wanting to intervene with respect to the procedures that the hospital is prepared to undertake or not undertake.

MS. MARZARI: I won't follow that up at this moment.

One last question to the minister. In the last few months evidence has come before the public through a court case in Prince George in which a doctor was tried when 12 women complained that he had sexually harassed and abused them while they were his patients.... The doctor was released; he was not convicted. In fact, the judge made the highly provocative statement that the word of 12 women was not enough to convict a doctor in this case.

I don't have the transcript of that judgment in front of me; the transcript of the judge's judgment is not available. In fact, even my attempt as an MLA to obtain the judge's transcript has simply been vetoed by the courts. That in itself is an issue.

After that particular case and the Tyhurst case, where the doctor has been found guilty of sexual assault of female patients, my question is: given this evidence and the fact that the silence around violence towards women and sexual assault of women is finally breaking in this province — and we are witnessing new cases every day in the papers — is the minister prepared to commission a governmental review or committee that will guarantee the women of this province that they are being protected vis-à-vis their relationships with medical professionals? The relationship between a doctor and a patient is very powerful, particularly when a male doctor and a female patient are involved. Can the minister assure the women of this province who seek medical attention that they will be properly protected, using the first step of a commis-

[ Page 12720 ]

sion or a committee to review the cases thus far and the situation as it presently exists?

[11:00]

HON. MR. STRACHAN: At the outset, Mr. Chairman, let me tell the committee and the first member for Vancouver–Point Grey that I will do whatever I can. And I'm sure that any responsible minister of this cabinet will do whatever he can, with measures available to him, in terms of protecting against the abuse of anyone — women, seniors, children or anyone vulnerable to abuse in our society. I can assure the committee that I feel just as strongly as the member opposite does about these issues.

With respect to the court cases, as the committee will know, I would not be prepared as Minister of Health to comment on a decision of the court. That question may be more appropriately placed to the Attorney-General; but I guess as a parliamentarian I can also advise the committee that it would be highly unlikely that the Attorney-General would provide any comment on court cases.

I can tell the member and the committee that the College of Physicians and Surgeons is instigating a hotline. I understand they are also doing some investigation into the concern expressed by the member for Vancouver–Point Grey, and I would encourage them to do so. They are the disciplinary body for physicians and surgeons in the province. They have the authority to discipline, as they properly should have, and to investigate their members' patterns of practice and behaviour.

As a matter of fact, from a philosophical point of view, I would not want to ever intrude into a professional group if they have appropriate legislation which I govern. If they have appropriate measures of looking after their own professional disciplinary matters, I think it would be very intrusive for any government to say that they can do a better job. There are laws and statutes. There are bodies responsible for this type of investigation, and I think it should be left with them.

I am encouraged that they are investigating these issues. I understand that in Ontario there's a similar investigation going on with respect to patterns of practice, and we'll be looking at the work that they do. I am encouraged when I hear that the College of Physicians and Surgeons has established a hotline for patients who may feel that they have been abused or improperly treated in any way by a doctor in British Columbia. So I think those cautions and mechanisms that are being put in place are appropriate.

Probably the most important thing that has come from these sorry incidents is that we may have a good-news story for other people. We now have more awareness of the concern. Women — or any patients — who feel in any way abused by a doctor's treatment of them are now aware that they can take the appropriate procedures. They should be aware that a hotline is available; that they're probably not alone; and that all people in our society are fallible at one time or another, and no one is perfect. As long as we have the concern out there.... I think the fact that there is a remedy known to all people is good.

I'll leave my comments at that. I don't know if I've been able to provide all the answers to the member, and she may not agree with my answers. But that, of course, is the position of the government at this time.

I've been handed another note. It has been written by a doctor, I think, so I can't read it. It simply says that the College of Physicians and Surgeons has a group, chaired by Dr. Pat Rebbeck, which is looking into the general question of sexual misconduct by physicians. That is for the benefit of the committee.

MS. MARZARI: The committee that's meeting in Ontario has reported. It was an open committee commissioned by the government, not by the College of Physicians and Surgeons. The college has many useful functions that regulate, supervise and monitor licensed physicians. But when you come into an area such as sexual harassment and abuse of patients by doctors, would the minister not agree that it might be a good idea for an open committee, accountable to the House, to conduct its work? The work in Ontario was conducted under the auspices of Marilou McPhedran, a lawyer, and has reported publicly — in fact, its findings were on the CBC "Journal" last week. The exercise in British Columbia to this point under Dr. Rebbeck is very credible, but I would ask the minister if this is not an area.... Would he not be prepared to make this a public committee and to make these findings and results available to the public — working with the College of Physicians and Surgeons, obviously, but making the committee an open committee that reports publicly to this House?

HON. MR. STRACHAN: Just let me correct the member on one issue. I'm advised — and I stand to be corrected — that the Ontario committee was a committee not of the Legislature but of the Ontario college. It was open, and I don't think there's anything wrong with that suggestion. I'll certainly talk to the college about that — about an open committee that would maybe have a couple of lay members on it, and not just be physicians and surgeons. I can make those suggestions and requests, and I guess by way of saying this now to you and on television I have done that; so that's there.

It is still up to them. I guess that from a philosophical point of view it's still up to that college to hold the disciplinary and investigative powers. I don't think it would be appropriate for government to take those powers away from the college. But by virtue of what I've said now, I hope the college is listening to me and would consider a public review of the issue and, from my point of view, the benefit that some lay members could be on that committee.

MR. PERRY: I'm relieved to hear the minister say that he will discuss this with the College of Physicians and Surgeons; I'm rather surprised that by implication he has not had any discussion so far. I've certainly discussed it with the registrar of the College of Physicians and Surgeons of British Columbia, because it's a matter of enormous public concern and interest — not only to the public. The recent revelations in Ontario

[ Page 12721 ]

and in British Columbia have been humiliating and mortifying for physicians.

Two prominent psychiatrists who were recently in the press have expressed their concern that the College of Physicians and Surgeons should not only act fairly and effectively but be seen by the public to act fairly and effectively, and have specifically recommended.... Dr. Kate Parfitt and Dr. Derryck Smith, both prominent psychiatrists, have specifically recommended that lay people be included on an appropriate committee of the College of Physicians and Surgeons.

I know it's common practice for the ombudsman to discuss informally matters of concern with the College of Physicians and Surgeons; certainly other politicians have had ongoing correspondence and dialogue with the college. I admit to being surprised that the ministry has not had some discussion on this matter, and I certainly encourage the minister to ensure that the public interest is well represented.

Both the first member for Vancouver–Point Grey and I are acquainted with the professional reputation of Dr. Rebbeck, which is absolutely sterling, and would not in any way wish to undermine her credibility or her dedication to seeing this issue through. But sometimes it is difficult for the professionals involved to see things the same way the public does. Clearly that's the lesson of the Ontario experience.

[Mr. Ree in the chair.]

I want to follow up on another issue raised by the first member for Vancouver–Point Grey, the critic for women's issues for the opposition: the policy of funding of independent free-standing abortion clinics. I would like to ask the minister whether he or any of his predecessors in this government has ever visited one of the two free-standing clinics in British Columbia — the Everywoman's Health Centre and the Elizabeth Bagshaw Clinic — or any other equivalent clinic elsewhere in Canada or the world.

HON. MR. STRACHAN: On the first issue of the College of Physicians and Surgeons and their more open investigation, the member indicated that I hadn't met with the college. He's right. I've only been in this portfolio for about two months, and I've met with the BCMA and many other groups, but I haven't had the opportunity yet to meet with the college. So I won't accept criticism that I didn't leap immediately into this issue, because there have been lots of other things to consider in the last couple of months. But I have made my commitment, and now that I am.... I will encourage the College of Physicians and Surgeons to consider a more public review of this issue of sexual misconduct by physicians. It will be my opinion that laypeople should be involved.

With respect to the two abortion clinics operating in the province of British Columbia, I gave an answer earlier in terms of the position of the government. At this point we pay for the procedures, but we do not pay for the operating expenses of clinics, whether they be abortion clinics or handling other medical procedures. That is our policy at this time, and I have no reason to think it's going to change.

In terms of visiting an abortion clinic, I haven't. If time permits, I may. But I've got a lot of other hospital boards and people to meet in this position. You will recognize there are over 120 hospitals in the province, and I'm trying to meet with as many boards as I can as quickly as I can. So there's a big lineup ahead of me. I can't tell the member if any previous Ministers of Health have visited either of the abortion clinics in the province. The member would have to speak to those ministers about that.

MR. PERRY: I think we're partway there. I wonder if I could make the natural follow-up, which is to ask whether the present Minister of Health — in the probable maximum of 90 days likely to remain to him as minister — if he does receive an invitation from one of those two non-profit society-run abortion and women's health care clinics in Vancouver or, for example, from the ministry-operated clinic in Cumberland that the member for North Island reminds me of, would commit to visiting them. I think it would be most advantageous if he visited one or both of the two in Vancouver operated by non-profit societies, because he might see some of the things I have seen there. I have visited, and so has the first member for Vancouver–Point Grey, as have a number of other members on this side of the Legislature — I see the member for Surrey-Guildford-Whalley nodding. He might actually learn something, amazingly enough. I wonder if he has ever visited a hospital ward in which abortions are performed. He might be struck by some of the contrasts. He might be struck that the non-profit clinics — or perhaps the clinic in Cumberland, which I haven't had the privilege to visit — can offer a more humane, more reasonable service to women.

That is exactly why they were founded. It's noteworthy that they were founded in British Columbia. They began in Vancouver, in an area where hospital abortions are available, not so much because it was impossible to obtain an abortion under the existing hospital and medical system, but because the conditions were relatively humiliating to women and certainly far from optimal. The non-profit societies were formed in an attempt to render it possible for women to receive a necessary medical procedure in a more humane and less degrading environment.

The facilities are sufficiently excellent that the Everywoman's Health Centre received on its initial application a three-year accreditation from the College of Physicians and Surgeons of B.C. in terms of its medical services. With the politically charged circumstances surrounding abortion, I find it astonishing that they were able to achieve from the College of Physicians and Surgeons of B.C. a three-year initial certificate. I believe it's a recognition of the confidence that the college had in the medical abilities of the physicians working in the Everywoman's Health Centre and in the overall administration.

[11:15]

I think it might be instructive for the minister, if he can't go personally, to at least assign some of his senior

[ Page 12722 ]

staff — such as the deputy minister — to visit that facility. I suspect that the conclusion he would arrive at after visiting would be identical to that arrived at over three years ago today by the Special Advisory Panel on Ethical Issues in Health Care in their position paper on abortion dated May, 1988. This is the committee appointed by the former Minister of Health — the first member for Central Fraser Valley — and chaired by Dr. David Boyes. The Boyes ethics committee report was withheld from the public for two years until the former Minister of Health finally released it last year under our pressure.

I quote recommendation 5 on abortion funding: "Abortion should be treated as are other procedures of comparable severity. Hospital and medical costs related to abortion should be publicly funded." Note that it does not specifically say community care costs, but the clear intent is that abortions are medical services and their overall costs ought to be funded out of public funds just like other medical services. Nowhere does the report suggest that there should be a distinction made between a non-profit clinic offering services — hopefully less expensively than hospitals and certainly in a more humane environment — and the hospitals. There's nothing in this report that suggests it would somehow be reasonable for the ministry to agree to fund a procedure in a hospital, which is an overly technological environment and far too overbuilt for a procedure which is generally extremely simple in the first trimester.... It wouldn't make any sense. It's a ministry policy that has never made sense. It perhaps made sense only to the disgraced former Premier. I don't know if it even made sense to him. It certainly did not make fiscal sense. It made sense to him somehow to impose his own morality on the women of British Columbia, and I suppose it still does. But it does not make sense in terms of delivering health services.

The sixth recommendation of that report is entitled "Reasonable Access," and I quote: "The women of this province should have reasonable access to abortion." Clearly one implication of that policy.... I want to emphasize that the debate is not over whether one is pro-abortion or anti-abortion, or whether we should have more abortions in British Columbia. I believe very strongly, and Id like to make it clear, that we could enhance the reproductive freedom of women and have fewer abortions by improving education and access to birth control. I think all of us in this Legislature could agree on that as a goal.

In the interim, the issue is one of providing a humane, legal medical service to women who require it, under the best possible conditions and in the most cost-effective manner. The reason that clinics sprang up in British Columbia is that they had long ago been pioneered in other more innovative jurisdictions — in Europe, in North America, in Africa, in Latin America, in China, in other parts of Asia. This is not a big deal It's a very extraordinary, irrational policy by the Ministry of Health, and I don't think it's quite good enough for the minister to just get up, in 1991, and state it over and over again. Can he give us any rational reason why the ministry expects people to pay out of pocket for this one service and subsidize the tax-paid health system? Why does government continue to feel that some medical services are more justified than others?

HON. MR. STRACHAN: First of all, I'd like to correct a couple of comments the member has made — and also some incorrect impressions he may have left with this committee. First, the Cumberland operation is a diagnostic and treatment centre operated by a society, like any other D and T centre. It is not, as he says, a government-operated society Secondly, we don't take the position that the abortion clinics provide a good job or a bad job; we simply don't provide the operating costs to clinics. We pay for the procedure. But whether it's an eye clinic or a plastic surgery clinic, we pay for the procedure only and not the administration costs.

The member quoted from the ethics committee — which is interesting — chaired by Dr. David Boyes. Again, he left some misimpressions — if I can characterize what he said that way. The Boyes committee report's recommendation I is that abortion on demand is not supported. Recommendation 5 is that abortion should be treated as are other procedures of comparable severity: hospital and medical costs — not clinic costs but hospital costs — related to abortion should be publicly funded. That is the status quo and that's the position of the government.

I guess, in closing, I could ask the member what the position of his party would be on this issue.

MR. PERRY: It's a rare opportunity that the minister has just given me. We don't usually get to answer such questions. I'm delighted to state our policy. It has been very clear for years, reiterated at every possible opportunity. Our party's policy is that non-profit, community-based centres providing abortion when necessary and other related reproductive health services, including counselling and birth control, will be funded out of public funds. That's been a principle that we're proud of. It has been our policy for years, as far as I know. It has certainly been reiterated recently in convention resolutions, and it's absolutely unequivocal. I thank the minister for the opportunity to state it in this forum.

I may have made a technical mistake in referring to the Cumberland clinic, but my understanding from the member for North Island and from the physicians in that region is that abortion services are performed in that clinic. If that's incorrect, perhaps the minister could correct me. If they are, of course, they would be funded through government funding provided to the Cumberland clinic.

What I'm establishing is really a contradiction between the policy of funding that clinic run by a non-profit society and not funding the operating costs of a clinic such as the Elizabeth Bagshaw or the Everywoman's Health Centre, costs which unfortunately have been tremendously exaggerated by the illegal harassment of anti-choice activists, including imported ones from the United States who think they know better than we do how to run our health care system. I suppose there's nothing new about that; the

[ Page 12723 ]

Americans have often felt that about many other countries, including ours, on many issues.

I would like to know from the minister: has the ministry reviewed the issue of what is the relative cost to the taxpayer of an abortion performed in the Cumberland clinic or an abortion...? In this case the cost is not to the taxpayer, but the basic cost split between the taxpayer and the non-profit society such as Everywoman's Health Centre or Elizabeth Bagshaw.... How does that cost compare with the average cost of an abortion service provided in one of the hospitals in British Columbia? Let's make it very concrete. How would the cost compare in, let's say, Vancouver General Hospital, Nanaimo Regional General Hospital or Campbell River hospital with the cost as performed in the Cumberland health centre?

I'm not looking simply for a dollar-and-cents figure. I'm looking for a rational analysis of the quality of the service provided, including whether pre- and post-counselling of an acceptable quality is provided to the woman, whether birth control information is provided, whether options to abortion are clearly explained and whether it is all documented, as it is in the non-profit societies and undoubtedly the Cumberland clinic.

I'd like to know: has the minister ever seriously looked at that issue, and can he provide us now, tomorrow or Monday with the results of that analysis?

HON. MR. STRACHAN: I'd like to get a couple of things straight here, Mr. Speaker. First of all, many of the diagnostic and treatment centres — not just Cumberland — do abortions. It's a procedure. They do all sorts of procedures. They are not single-procedure facilities; therefore they can do everything that's within the scope of practice and scope of provision of care of a D and T centre. I have one in my riding in Valemont. So they're not unknown, and there's nothing unique about Cumberland. Don't you understand that? It's a D and T centre like any other society-operated D and T centre in the province.

With respect to the costs and quality of care, the quality of care, of course, is left up to the doctor providing the procedure. I am sure that most responsible physicians, irrespective of the procedure they're doing, are going to do appropriate counselling with the patient, because that, I would argue, is a very important part of medicine.

In answer to the member's last question about the cost of procedures, we don't cost procedures. We don't know what the cost of a procedure is in a hospital. We fund the hospital globally. We know what the doctors charge for a procedure, but we don't cost it ourselves We are not aware of the costs in private societies, nor would we want to go to the two you're referring to and ask them for their costs. That's not appropriate; they are private societies. We are funding the procedure only and not their other costs, so it's not appropriate for us to ask them for that type of information. They may want to offer it, but we would not be in a position, nor would we want, to ask them what their total costs are so we could make any comparison. You may want to find out yourself, but it's not of any interest to me.

Finally, the policy is clear. On clinics that provide one service only — whether it be plastic surgery or dental surgery — we fund just the procedure. If you're a D and T centre, if you're operated by a society, if you're a hospital, then we fund your operating costs. The policy is standard for all procedures and is consistent with other funding processes. Although this issue is politically charged for the New Democrats, it certainly isn't for us, and I see no reason why we are going to change our policy, which is standard with respect to single-issue procedures.

MR. PERRY: I think the minister has illustrated far better than I could the depth of his ignorance about this subject. To refer to these non-profit society clinics as single-issue procedure clinics is just.... It's appalling, the ignorance.

The abortion procedure is not the only activity which takes place in a good clinic such as those run in Vancouver. There is extensive counselling and support for the woman both before and after the procedure, if the woman elects it. There is counselling for women who may elect not to proceed with abortion. There is detailed birth control counselling and demonstration of technique by highly skilled practitioners who specialize in that field. There is the ability to address difficulties in contraception technique failures and problems with it, in an environment that is distinguished by its privacy. That's the whole beauty of the system: the system is potentially — should be — far more confidential than a hospital can be. Despite the constraints on hospitals, they are open places where naturally many people are involved. A small clinic is different.

[11:30]

I fail to understand how the minister can stand here and commit over and over again this logical inconsistency of saying it's all right for the government to fund something in a diagnostic and treatment centre, but we couldn't possibly do that with a non-profit society.

Let's be clear: this is not a politically charged issue on this side of the Legislature. We do not regard it as a political issue. We have absolute consensus. I've enunciated our very clear policy, and it is supported by approximately 80 percent of British Columbians — if we can believe repeated public opinion soundings over the years; not just one spot sounding, but over and over again. We represent the vast majority of public opinion in British Columbia that abortion, whether or not one personally approves of it in principle, should be treated as a medical procedure left to the woman and her physician to decide — and ultimately to the woman as the individual who carries the pregnancy.

The logical inconsistency is that the minister is saying that as government they can support the overhead costs of British Columbians' medical treatment and other supportive treatment in non-profit societies, and sometimes even in private facilities, for any other issue. If it were a child with a mental or physical disability, they can pay a very large sum of daily costs to maintain a child in a non-profit-society home, even in a for-profit facility. If we're talking about group homes for the mentally ill, the ministry has no diffi-

[ Page 12724 ]

culty in paying funds to a non-profit society. To the best of my knowledge, this is the only exception for a non-profit society. I would have no difficulty if the minister were saying: "We're not keen on getting into more for-profit funding. I don't rule that out entirely, but I have very serious reservations about putting public funds into for-profit facilities as a general principle." Sometimes it may be the best alternative. If he were saying, "We're not interested in funding a for-profit abortion clinic" or "we're not interested in funding that ridiculous and offensive doctor who's trying to do sex determinations on fetuses, " we would be 100 percent behind the minister. But he's saying, because of the political issue that his party perceives and the political debate in his own party on this one issue: "We will discriminate against clinics trying to offer a good reproductive health service to women."

That's why I think it would be so instructive for him or his senior staff to visit some of these facilities. Perhaps he would see that they are not perfect. One that I visited has rather cramped quarters for women. Perhaps if they had some assistance in the funding and didn't have to rely exclusively on the women themselves or on fund-raising in the community, they might be able to improve that aspect of their service. But if he visited them, I think he would see overall that the environment is chosen by many women because it is less humiliating than the relatively cold, sterile atmosphere of a hospital.

He would also see what virtually every other country in the world has seen: we don't need a hospital to do first-trimester abortions, and it's an enormous waste of public money in general to be doing them in hospitals. He and the disgraced former Premier and others on that side of the House have presided over the waste of vast amounts of public money in providing a service which they were unable to stop. They tried very hard to stop it, but the Supreme Court ultimately prevented them from denying women this service. So they have gone on blithely with an old, retrogressive policy of providing services through an exclusively medical hospital model, when they might have moved in a more progressive direction that could have saved British Columbians; a lot of money and delivered more reasonable access.

I want to ask one other question, because it's inseparably connected to this issue. Will the minister now commit to reversing the traditional discrimination against Planned Parenthood, which is an organization that has the most effective record internationally in delivering good birth control advice to young women and young men — boys and girls — and that has traditionally suffered from discrimination? In part, perhaps, it relates again to the Premier's personal biases. Catholic agencies withdrew from the United Way in the past because the United Way accepted Planned Parenthood into its fold, an organization which has an international reputation. Perhaps it was the Premier's own religious beliefs, because of the withdrawal of the Catholic social agencies from the United Way over that issue, that have prevented Planned Parenthood from being treated equally with other excellent organizations by this provincial government. Will the minister now commit that we will enter the twentieth century and recognize Planned Parenthood as one of the most constructive and excellent organizations in the field of sexual education, birth control and prevention of abortion that we've got in B.C.? Will he treat them fairly from now on?

HON. MR. STRACHAN: To answer the last question first, I won't comment on that organization. I don't know how fairly or unfairly we are treating them.

Let's get back to the issue of government policy on clinics. Whether it's cataract surgery at an eye clinic or an abortion at the Everywoman's Health Centre, we do not provide for costs other than that of the procedure. I'll repeat that for you if you didn't get it: we do not provide for costs other than the procedure, whether it be cataract surgery or an abortion. I hope we understand that. We make no distinction. The policy is clear.

Secondly, I do find it curious that the member who is an MD would come to the conclusion that doctors in hospitals don't do counselling, and that for some reason, a doctor at this Everywoman's Health Centre does better counselling than a gynecologist at a hospital or D and T centre. I find that unacceptable, and I'm sure many of your colleagues will as well, because I've always considered and been told that the good part of practising medicine is the solid counselling before and after surgery, or whatever the procedure has been.

Finally, I find it difficult to accept the member's condemnation of hospitals. In this issue, just this one procedure only, the member says that hospitals don't do a good job. I can't accept that, as well. I think the hospitals and the D and T centres we have throughout the province do an excellent job. I don't find anything unclean or unkind about their atmosphere, and I don't accept the member's criticism of those facilities. Why he would enter into that type of debate is beyond me.

I think in these past couple of minutes, Mr. Chairman, I have been able to reiterate, with some tedious repetition, the government's policy.

[Mr. Pelton in the chair.]

There is one other issue Id like to bring to the floor of the committee, and that has to do with the College of Physicians and Surgeons, and the issue of sexual abuse of patients by physicians. I can report to the committee that recently my colleague the Minister of Women's Programs and Government Services and Minister Responsible for Families wrote to Dr. Handley, the registrar of the College of Physicians and Surgeons, commented on the Ontario report and asked the college what their position would be in terms of similar action. I want that on the record, to show that although I'm new in this ministry and was not aware of all the issues surrounding sexual abuse by physicians, I can assure you that this government is, and I'm pleased that my colleague was able to respond and question the College of Physicians and Surgeons on this issue. I can also tell you that my colleague the Minister of Women's Programs wrote a similar letter to Dr. Hedy Fry, who at that time was the president of the British Columbia Medical Association, asking about the Ontario findings

[ Page 12725 ]

and the Ontario report. The committee is assured, Mr. Chairman, that our government sees this concern of sexual abuse by physicians as a very serious concern, and has acted on the evidence on the issue before us.

MR. VANDER ZALM: Mr. Chairman, I've been listening to the second member for Vancouver–Point Grey, the Health critic, make a number of requests and some suggestions to the minister with respect to the provision of health care in this province. I would like to introduce a few more thoughts so that perhaps the minister would also have the benefit of other views on those issues raised by the member.

First of all, I've just come back from a short journey to Holland. Frankly, I was somewhat disappointed last evening when I turned on the television and one of the first things I saw was criticism of the health system in the province. I had the benefit of not only visiting with relations and touring through Holland during my short journey there but also visiting some friends in hospitals. I was surprised, to say the least, at the quality of facilities and care generally in Holland, which is certainly very advanced in many respects, and in the provision of social services too. The difference between the quality there and here.... Yet the first thing I saw on television on my return was criticism of the health system and the provision of care in this province.

I say without hesitation, from the facilities I've visited elsewhere, that ours is by far the best anywhere. It's too bad that we continue to see this negativism. We see it through the media consistently and certainly hear it from a good many groups of people. I guess we must expect to when they're constantly being fed this stuff through the media, but it's so disappointing to see one who has served in this Legislature, the critic-the member for Vancouver–Point Grey — continually be so negative as well about what I deem to be an excellent system with wonderful hospitals providing excellent care.

It's my first day back and I'm listening to all the debate centred on abortion, as though that were the most critical health issue in the province. There are those of us — I'm one of them; I can't speak for others — who do not deem abortion to be a health issue in the first place. I certainly deem it to be a choice people make. I don't agree with it, but others do — and that's fine. But I certainly don't see it to be a health issue, least of all a most critical health issue. When I hear the NDP — particularly the critic, who one day, I suppose, would like to see himself as the Minister of Health, making the rules, setting the priorities for the people.... That's how he sees it. I hope he never makes it; I doubt he'll ever make it. But he certainly sees himself as that. He stands up and spends all the time here this morning talking about abortion. What about those seniors or others who are looking for other health services, such as heart surgery or cancer treatment? I deem those to be issues that might be addressed and probably ought to be addressed far more effectively than I've heard done by the NDP.

Mr. Minister, from what I've heard said, there is also — and Id like you to consider this — a great inconsistency in what the NDP is saying. They would like the minister and members of government to provide to abortion clinics moneys that are presently going into the health care system. They have to recognize — and I'm sure they do, but I suppose it's their priority — that when you take money out of the health system to give it to abortion clinics, you must take it from that which might be needed to provide other critical health services.

[11:45]

I suppose it's great to be here as part of the NDP team attempting to appeal to a particular group, but it has to be recognized — and I've not heard it said — that there are people seeking health services because they suffer from cancer or some heart disease. Do they not deserve that priority consideration? Are the NDP suggesting that we should take the money that might otherwise be provided them in order to fund abortion clinics? I ask that question in all honesty, Mr. Chairman. I think I know the NDP motive; it's to try and appeal to selective groups. But is that fair to those watching at home and reading the coverage of the Legislature, who have someone in their family suffering because they need heart treatment or cancer treatment?

Obviously I've touched a very delicate point with the NDP. I listen to the right of me — though they're obviously far to the left philosophically — to all the clattering, the jammering and the complaining. They know in their heart of hearts that they're doing the wrong thing and a disservice to the people by continually going after that particular issue at the expense of other issues that are legitimate and rightly a matter of concern to many people when they're looking to our excellent — the best in the world — health care system for treatment.

It's also an inconsistency, Mr. Chairman, when you hear the NDP talk about funding private or society-run abortion clinics. I can recall that not so long ago when someone suggested we might consider, as we see in the U.S., clinics or facilities that provide other health services privately or through a society, the NDP, including the critic for Health, thought this to be a horrendous wrong. To think that the private sector, through a corporation or a society, might somehow involve itself in the delivery of a health service was a terrible crime. It was something that we should certainly never consider in any way, shape or form. That was their view of it, and that continues to be their view when it comes to providing health services privately through a corporation or a society.

But when it comes to abortions, then it's a whole other story. Their philosophy suddenly changes tremendously, because again they're catering to a particular group. Mr. Chairman, I think it is terribly unfortunate that the opposition has no better criticism or suggestions to offer to this Legislature or to the people of the province, than to spend an entire morning talking about abortions and abortion clinics.

I know that all of us in this legislative chamber and many out in my constituency and elsewhere are truly, honestly and understandably concerned about health services being available to them or their families. When

[ Page 12726 ]

you have someone suffering in your family — elderly or child — because they're in need of a particular health service, then tomorrow, the next day, a week from now or a month from now is never soon enough. Understandably, people would like these services to be available immediately. I suppose we'll never find an affordable system anywhere that would provide all these services on demand. But I gather — and I suppose there's some truth to this — that if we could possibly encourage private sector groups to become involved, it would give us an alternative. I suppose in some ways that could relieve the system generally and provide a service to those who would be prepared to take that sort of service. But we've not heard that mentioned by the NDP Instead, they continue to hammer on about how they would fund abortion clinics and, I suppose, have them located in every community through a society and eventually through other groups or individuals who might similarly want to provide that service, because that is their priority.

I ask the minister to consider what I've said and not to simply consider only that which was given him by the NDP, who are seeking to find further moneys within a health system that is already burdened with cost, in order to provide a greater opportunity for abortion services in the private sector.

MR. PERRY: I think had the former Premier been here working like the rest of us for the last few weeks, rather than on holiday, he would know that we began this debate by reminding the public that we have an excellent health care system in British Columbia generally. I specifically began my remarks by reminding members and the public that, in general, we have achieved a very good health care system and that the purpose of these debates is to try to find ways to make it better. I pointed out that the former Premier used to quote me — and I was very flattered that he quoted me in his electioneering leaflets — complimenting the system and what it has achieved.

But the purpose of these debates is not to sit here patting ourselves on the back. We have a Legislature to try to improve our system and to ensure that the government spends money in the most effective way possible. That's why we're asking questions about.... It's not because we don't think hospitals do a good job. The minister took advantage of the chance to twist some of my words. I was quite happy to stand on the printed or televised record. I've made clear many times my admiration for the hospitals in this province, but they are not by nature the optimum place to provide services that can be done on an out-patient basis.

He carefully twisted the issue about funding for non-profit clinics. Let us take the example of cataract surgery. Were there non-profit societies offering to perform cataract surgery on an out-patient basis and an ophthalmologist willing to work there, it would be an excellent idea for government to fund those non-profit societies. The reason I share his reluctance to fund the clinics is that they are owned by ophthalmologists and are inherently "for-profit." Any additional funding saving will go into the pockets of the doctors. We can't support that with public funds.

Hospitals have been moving rapidly to achieve the same purpose with cataract surgery, which does not have the emotional and psychological overlay that abortions do. Hospitals lend themselves better in their out-patient departments to cataract surgery, so we may not need specific non-profit cataract surgery clinics. Perhaps we do. Maybe we should be getting into that area and saving some more money. That's certainly something that an NDP government would look at — to see where we can save money and serve the people better. We're not so committed to the status quo, so absolutely convinced that everything is perfect, as was the former Premier, that we're not willing to look for better ways to do things.

Mr. Chair, I just have to mention in passing that I raised the issue of Planned Parenthood with the former Minister of Health last year, page 11418 of Hansard on July 25, 1990. He declined to answer the question then. I see again that the minister has declined to answer the question about Planned Parenthood. He obviously continues to discriminate against a very reputable organization. It's very disappointing.

I want to return to a comment raised by the former Premier over what we have to say about cancer. Let me read from a letter I received today, dated June 6, 1991. I can't identify either the doctor or the town without potentially identifying the patient, so I won't. But the minister could find this letter in his files easily, because it's dated June 6 and his name is misspelled as "Mr. Strachan, " as in "bracken." He'll be able to find this letter if he wants to.

I'm going to quote from it. It reminds me of the points that I raised many times last year — and raised outside of this Legislature often. I quote:

"Dear Mr. Strachan:

"I am extremely perturbed about the situation of waiting-lists at the Cancer Control Agency and also about the waiting-list for bypass surgery in the province of British Columbia.

"I presently have a patient waiting for radiotherapy and possible chemotherapy at the Cancer Control Agency. He has a cancer of the lung and was told initially that he would probably be called for within the week at most, or two weeks, to the Cancer Control Agency. That is now over two weeks ago.

"When I contacted the agency today" — that would be June 6, the date he wrote this letter — "they told me that it would be a further three weeks before he is likely to be called. However, if the option of going to Seattle was to be taken up, this could possibly be arranged by June 11. The patient in the meantime is having focal seizures and is on anti-seizure drugs and also steroids to try to shrink the tumor in his motor cortex. Otherwise his condition is perfectly satisfactory."

Let me explain to you, Mr. Chair, what that means. That means his lung cancer has spread to his brain. He has some of the tumor in his brain, and it may either kill him or render him unable to speak or to use his arm, just like a stroke; or render him confused and put him into coma. That is an emergency situation. The treatment may not — will not — be able to save his life, but it can allow him weeks to months of good health if delivered in a timely way. It is an emergency, and radiation treatment used to be available within a few

[ Page 12727 ]

days in British Columbia — a maximum of a week or two.

Five years ago that patient could have been radiated and have had his symptoms relieved within a few days. Now he potentially has to be sent to Seattle because this government, led at the time by the former disgraced Premier, presided over the failure to develop sufficient radiotherapy services for us to maintain — not create, maintain — a satisfactory standard of treatment.

Let me go back to the letter:

"He is extremely anxious and has been waiting by the phone every day for a call from the Cancer Control Agency. I have rung on his behalf on three separate occasions and finally received some sort of date, although I know from my experience with dealing with two other patients with cancer of the lung waiting for treatment that delays and postponements seem to be the order of the day.

"I would like to make it quite clear that I do not blame the Cancer Control Agency, or the dedicated staff that work there, for the situation that now pertains. I think the responsibility for this ongoing sad situation must rest squarely with the government. I feel the rapid expansion of treatment facilities in B.C. is absolutely vital."

What have we had from this government? Nothing but dithering about the location of the interior site. We've had the cancer agency asked to pay to put up signs in Kelowna and Kamloops so that the Social Credit members there could get credit for a facility for which the planning hasn't even been done, due to the political finagling and shenanigans within the cabinet, led by that former Premier. That's why I find his remarks so hypocritically offensive.

Mr. Chair, I go on:

"A similar situation pertains for patients waiting for coronary bypass surgery. I recently had the unfortunate experience of a 57-year-old patient dying while waiting for bypass surgery, despite my having written to the cardiologist and the cardiac surgeon involved. The patient's condition was critical, inasmuch as he was getting ongoing angina. I have not taken up this matter with this patient's relatives, as I felt their grief was more than enough without telling them that this was a completely preventable and unnecessary death.

Again, I feel rapid expansion of services for coronary artery bypass surgery is vital.

"I would be grateful for an early reply to my letter."

Mr. Chair, you can understand from that last paragraph why I could not reveal the name of the physician or the town, but suffice it to say it's in British Columbia, and the minister has that letter.

[12:00]

Just before we adjourn, I want to end on a positive note which will take me about one minute, if I may. I want to echo a news story last night and news stories in the Vancouver Province today describing two young children who could benefit from bone marrow transplantation. One of them is a British Columbian who....

HON. MR. RICHMOND: With respect, Mr. Chairman, I draw your attention to the clock.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Richmond moved adjournment of the House.

MR. SPEAKER: The normal adjournment hour is two o'clock this afternoon. I believe other arrangements have been made. Is it until two o'clock this afternoon or until ten o'clock tomorrow morning?

HON. MR. RICHMOND: I remind the members that, by agreement, we are adjourning the House for the afternoon sitting so that members may attend the Order of B.C. presentations. The House will sit again tomorrow morning.

Motion approved.

The House adjourned at 12:01 p.m.