[ Page 12823 ]

CONTENTS

Routine Proceedings

Oral Questions

Provincial taxation levels. Mr. Harcourt –– 12823

Treatment of those found guilty because of insanity. Mr. Loenen –– 12823

Former executive assistant to Attorney-General. Mr. Sihota –– 12824

CLEU investigation of organized crime. Mr. Sihota –– 12824

Free trade with Mexico. Mrs. Boone –– 12824

Access to report alleging media bias against government. Mr. D'Arcy –– 12825

Ministerial Statement

Grawemeyer award in education. Hon. Mr. Dueck –– 12825

Mr. Jones

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

On vote 38: minister's office –– 12826

Mr. Miller

Mrs. Boone

Mr. Perry

Mr. Jones

Mr. G. Janssen

Ms. A. Hagen

TUESDAY, JUNE 18, 1991

The House met at 2:03 p.m.

HON. MR. DIRKS: It is my pleasure to make three introductions to this House. Here today are His Excellency Pedro Paulo De Moraes Alves Machado, Ambassador of Portugal to Canada, and his wife Mrs. Machado. Accompanying His Excellency is Mr. Miguel de Calheiros Velozo, the consul of Portugal at Vancouver. Please join me in welcoming the ambassador, Mrs. Machado and the consul to Victoria and this chamber.

HON. S. HAGEN: It is my pleasure to introduce two friends to the House today: Randy Vannatter from Coquitlam and Al Goodrich from Delta. Would the House please join me in making them welcome.

MR. CASHORE: Last week the federal Minister of the Environment, the Hon. Jean Charest, presented an environmental achievement award in the non-profit organization category to a British Columbia organization, the Western Canada Wilderness Committee. He stated that B.C.'s Western Canada Wilderness Committee is noted for its unflagging efforts to increase the public's awareness of forest ecosystems and encourage sustainable forestry. Mr. Speaker, while on both sides of the House there are often points of the WCWC we don't always agree with, I think we all do agree on the value of this organization to the province. I would ask the House to join me in congratulating them for receiving this award.

MR. REID: It's with a great deal of pleasure that I introduce three constituents of mine from the great community of Surrey-White Rock. In the Speaker's gallery are two young entrepreneur tourism-interested students from BCIT: Nikki Leach and Dean Gagnon. With them is Mr. John Leach, who is a strong supporter of this government's initiatives and free enterprise. Would the House make them all very welcome.

Oral Questions

PROVINCIAL TAXATION LEVELS

MR. HARCOURT: Mr. Speaker, on the weekend the Premier said: "The biggest problem we have in this province is taxes." Which of the 800 tax and fee increases that her government has brought in since 1986 has the Premier decided to eliminate or cut?

HON. MRS. JOHNSTON: Mr. Speaker, might I suggest the question be put to the Minister of Finance, and I'll take it on notice.

MR. SPEAKER: Order, please. The question is out of order, but if the Premier stood to answer the question, I'm prepared to accept the answer.

MR. HARCOURT: It wasn't the Minister of Finance but the Premier who said: "The biggest problem we have in this province is taxes." The Premier clearly doesn't want to be held accountable for all those tax and fee increases. Among the 800 tax and fee increases imposed by her government is the property purchase tax. Has the Premier decided to give first-time homebuyers a tax break and eliminate them from having to pay that property purchase tax — and pay for that by eliminating the loophole allowing corporations to avoid paying that tax?

HON. MRS. JOHNSTON: I would like to welcome the Leader of the Opposition here this afternoon, his attendance is very much appreciated. If he would like to put questions to a leadership candidate during an election campaign, I would like to suggest he attend the all-candidates' meetings. The question is more appropriately put there.

MR. HARCOURT: Nobody else seems to care about attending those meetings. So for those who don't want to come, I thought I'd ask the questions of the Premier. Many British Columbians would like to know if the Premier has decided to give families a tax break by, for example, cutting the spending on doctors' pensions, cutting down on government advertising and rolling back the medicare premium increases for families in this province.

HON. MRS. JOHNSTON: We went through this type of questioning yesterday by members of the opposition. The leader was not present, so he's probably not aware of the type of questioning that we had yesterday. It's strangely interesting to hear these types of questions. I believe that members of the opposition have to be smarting because of the help that their transition team gave to the Ontario government in the preparation of their own budget.

Members on this side of the House are very pleased and proud with the budget that has been tabled this session. We will continue to bring about financial security and fiscal responsibility in this province. Next time around, during the election campaign, I would be pleased to debate each of these issues on the platform with the Leader of the Opposition.

TREATMENT OF THOSE FOUND
NOT GUILTY BECAUSE OF INSANITY

MR. LOENEN: My question is to the Attorney-General. In view of current proposals with respect to the disposition of persons found not guilty by reason of insanity, what representations has the minister made to the federal justice minister to ensure that provincial cabinets retain the right to refuse to release potentially dangerous persons?

HON. MR. FRASER: This government and this minister have made representations to the federal government with respect to people who are detained and considered not guilty because of insanity. What we have said simply is this: we're not certain; in fact, we disagree with the idea that you can cap the length of time a person is incarcerated because of insanity, because we're not convinced that the danger will be

[ Page 12824 ]

reduced by time in incarceration. What we're suggesting is that people in this category should be treated as patients rather than any other way and that our efforts should be devoted to trying to make sure those patients are cured as opposed to keeping them incarcerated.

It is in the purview of the federal government, not us. But we have made representations to them in that respect. But beyond that, recent decisions by the Supreme Court have indicated that the federal government will have to come down with new laws within about six months to handle this particular question.

DISMISSAL OF ATTORNEY-GENERAL'S
EXECUTIVE ASSISTANT

MR. SIHOTA: A question to the Attorney-General. Could the Attorney-General confirm that he has terminated the employment of his assistant Mr. Robert Walsh?

HON. MR. FRASER: If the members wish to know that my executive assistant is no longer employed by me, then that's correct.

MR. SIHOTA: Would the Attorney-General care to advise the House why?

HON. MR. FRASER: I'm very happy to respond to that question, because it indicates that the opposition is prepared to talk about personnel matters at any time regardless of who it hurts or why. As far as I'm concerned, it's a personnel matter, and it's not open for discussion.

CLEU INVESTIGATION OF
ORGANIZED CRIME

MR. SIHOTA: Is the Attorney-General confident that nothing he has done has compromised the integrity of the CLEU investigation into organized crime?

HON. MR. FRASER: The organization known as CLEU is under the office of the Solicitor-General, not the Attorney-General.

FREE TRADE WITH MEXICO

MRS. BOONE: A question to the Premier. The Premier told us that she wants an active role in the negotiations of the Mexico free trade deal. The negotiations have already started, Madam Premier. You want influence, but you can't even show us on paper what you would say if you were at the table. Can the Premier tell us if, since negotiations began last Thursday, she has written to the Prime Minister to tell him of her position on this issue?

HON. MR. DIRKS: Mr. Speaker, basically that is my responsibility. I have notified the Hon. Michael Wilson that we are very concerned about where the Mexico-United States-Canada free trade negotiations are going. We intend to press our concerns in the negotiations we will have with the federal government to make sure that the interests of British Columbians are looked after in the best possible manner.

MRS. BOONE: A question to the minister, then. You say that you have a position and that you've talked to the federal people. Will you table that position in the Legislature today so that the people of the province know what position this province is taking in these negotiations, which are very important to all British Columbians and particularly to the workers of this province?

[2:15]

HON. MR. DIRKS: Some time ago I was asked a question about the report we received, or the findings we had when we went out to the private sector, and about whether we would table that. I'm very pleased to advise you that we will be tabling a report that will contain all of the information. It will not be our viewpoint, but the viewpoint of the people we talked to. We will be tabling that report very shortly.

Until those negotiations that are going on between the United States, Mexico and Canada have proceeded in a certain direction, we really can't take a decision or position, except to ensure that the desires and concerns of British Columbians are being recognized. We will reserve our decision on the negotiations and the agreement until we see what the agreement is really all about.

MRS. BOONE: Supplementary to the minister. We got nothing but platitudes from this government in the negotiations over the past deal. You sold out British Columbians and the fishing industry of this province. Has the minister decided to table in this Legislature all of the correspondence he has had with the federal government on this issue?

HON. MR. DIRKS: I had a difficult time hearing some of that question. Certainly we will table that report. I believe it will give you information about what British Columbians believe.

Also, I should advise the House that we will be setting up an advisory committee from the various sectors to not only keep us informed as to what their concerns are, but also to keep them informed as to how the negotiations are going.

MRS. BOONE: Supplementary question to the minister. The minister is missing the point here. We want to know what you have told the federal government with regard to the stand you are taking on this issue. We want to know what you are saying to the federal government. Will you table in this Legislature all correspondence that you have had with the federal government to date on this very important issue, Mr. Minister?

HON. MR. DIRKS: I guess what I have to do is talk more slowly, because what we have referred to the Minister of International Trade, the Hon. Michael Wilson, is that we have declared our interest, our

[ Page 12825 ]

concerns and our expectations with respect to the free trade negotiations. We have made it very clear that this government intends to actively champion British Columbia's interest during the federal-provincial negotiations on the issue of American free trade.

We've also made it very clear that British Columbia will reserve any judgment on any free trade agreement until we have had an opportunity to determine whether such an agreement will benefit this province.

ACCESS TO REPORT ALLEGING MEDIA
BIAS AGAINST GOVERNMENT

MR. D'ARCY: Mr. Speaker, I have a question to the Premier. A former deputy minister has quoted liberally from a confidential report that alleges media bias against the Socred government. Why is this analysis being withheld from the voters who have paid for its contents?

HON. MRS. JOHNSTON: I am unable to respond; I don't know the document being referred to. Possibly, if it were tabled or provided to us, we could have a look at it and give you an answer.

MR. D'ARCY: It would be interesting to have the Premier, who has said on several occasions that the government has nothing to hide.... We could go back to the former Premier. I know she's not responsible for any of his policies. However, I think the former Premier said on numerous occasions that he intended to make all polling information public. Can the Premier enlighten the House and the general public as to why former civil servants apparently have access to public information that is denied to everyone else in British Columbia?

HON. MRS. JOHNSTON: Mr. Speaker, I would be pleased to respond if the documents were provided to us, so that we would be able to properly research them.

Interjections.

HON. MRS. JOHNSTON: Well, they haven't been identified by the opposition.

Interjections.

MR. SPEAKER: Order, please.

MR. D'ARCY: The fact is that a former deputy minister is quoting from a significant amount of information, which he said is valid and had to do with his duties when he was a deputy in the public information branch, and which he claims he has knowledge of or access to. The point is, Mr. Speaker, that it disturbs me greatly that someone outside the government and the Legislature should have access to confidential information, which has been denied to everyone else.

HON. MRS. JOHNSTON: Mr. Speaker, I didn't receive the same brown envelope that the member opposite did, so I am unable to respond.

Ministerial Statement

GRAWEMEYER AWARD IN EDUCATION

HON. MR. DUECK: Mr. Speaker and colleagues, please join me in paying tribute to one of British Columbia's finest post-secondary educators. Simon Fraser University's Prof. Kieran Egan recently received education's equivalent of the Nobel Prize: the $150,000 Grawemeyer award in education from the University of Louisville in Kentucky. Professor Egan is a leader in developing programs to stimulate learning in young students. In his numerous books, articles and lectures, he counsels teachers to excite children's imaginations as the best way to engage their interest.

The distinguished judges of the Grawemeyer award said that the professor's insights, if widely circulated, could profoundly affect the work of curriculum developers and teacher-educators in many countries. Only one Grawemeyer award is presented each year. Professor Egan is the first Canadian to be honoured in this way. Last year an American was recognized; the year before, it was a French scholar. Mr. Speaker, I'm sure my colleagues will join me in congratulating Professor Egan and applauding his achievements. His work will have a lasting impact on generations of young minds for years to come.

MR. JONES: It's a pleasure for us on this side to join with the government in paying tribute to Professor Egan for his winning of this most prestigious award in education. I think most British Columbians believe the statement in the throne speech that suggests that education is the most important investment in the future of this province. Probably there is no more important area in education than curriculum development, the area that decides what is appropriate for young people to learn and how it is to be determined, the area that decides on how to excite children's imagination and stir their interest.

Mr. Speaker, we are proud to join with the government, and we are proud to recognize not just Professor Egan but all of the scholars in this province who work so diligently in their various areas to further man's knowledge.

MR. MICHAEL: Mr. Speaker, I ask leave to make an introduction.

Leave granted.

MR. MICHAEL: I've just received notice that there are 45 students, their parents, as well as their teacher, Mr. Lucas, from the Parkview Elementary School in the community of Sicamous, the houseboat capital of Canada in my constituency. Will the House please make the people from Sicamous welcome.

[ Page 12826 ]

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).

HON. MR. STRACHAN: Earlier this morning we were discussing correspondence from Mr. Lane, the chairman of the board of trustees of Mills Memorial Hospital in Terrace. His proper title is chairman of the board of trustees of the Terrace Regional Health Care Society. The second member for Vancouver-Point Grey expressed a concern about our review process. I'd just like to share with the committee part of a letter from Mr. Kenny, executive director of the regional review team, in response to Mr. Lane:

"It is the practice of the hospital care division to provide a hospital which has been reviewed with a copy of the draft report in order to provide an opportunity for correction of any factual data. You" — that is, Mr. Lane — "have been provided the draft copies so that we can verify with the hospital the accuracy of the information in the report. As you can appreciate, it would be inappropriate for the team to come to financial conclusions until there is a certainty on the facts. I look forward to your input on these facts, either at a meeting which I have offered, or, if you prefer, in writing."

In other words, the ministry staff were most forthcoming with Mr. Lane. They pointed out that they would like to speak with him if he had any concerns The whole idea of that discussion was to review any factual data in case corrections were needed. I can't see anything wrong with that policy. It's appropriate and above board. It certainly allows for adequate response, and it implies that before any solid recommendations come into play, there is going to be agreement on the facts.

Further, we find out from the letter — and I won't read Mr. Kenny's further comments — that Mr. Lane had shared his concern with some elected officials, presumably including the second member for Vancouver-Point Grey, but without them having the benefit of a letter from the Ministry of Health. Of course, that gives them just half the picture of what was happening at Terrace and what had gone on with the Mills Memorial review.

Finally, although Mr. Kenny made an obligation and tried to make arrangements to meet with Mr. Lane, I'm advised that Mr. Lane did not attend that meeting. In defence of the staff, and in response to what the second member for Vancouver-Point Grey has brought to the committee today, I have to say that the staff have acted in a prudent and responsible manner. I totally support the review process that goes into place, and I would encourage Mr. Lane and any other board chairmen to follow that policy, as it does give them adequate opportunity for review of all the data that the review teams arrive at.

[2:30]

MR. MILLER: I appreciate the minister's response. I wasn't here when my colleague put the question, although I was aware that the board was presumably disturbed by the methodology and the report of the review team. I believe that they simply refused to have a meeting until they had been given further information. The point my colleague was making was that it is disturbing that.... If it's misinformation or a lack of communication, that may be another matter; but these things have been operating for a couple of years now. Presumably people know each other and can pick up the phone and talk to each other, so there may be something more. I'm not able to add any more to this at the present time. My colleague might have further information and might wish to pursue it at a later date. Given that, I think my colleague from Prince George would like to raise some questions with the minister.

HON. MR. STRACHAN: I've described the process of the review and the discussions that follow a review. In a letter of June 10, which your colleague the second member for Vancouver-Point Grey has, Mr. Lane indicated that he felt that discussion of the review would be unproductive. He says: "We have not received the complete report." The idea is to discuss the draft report with the hospital, arrive at an agreement on what facts are out there and then finalize the report. You do it in concert, and you do it after some discussion.

As I said, that appears to be a perfectly acceptable process to me. Obviously it's not to Mr. Lane; nevertheless, I can't think of a fairer way of doing it. We have 120 hospital boards in the province that all operate under this process, and no one else seemed to mind it. I would presume from that observation that it is in fact an acceptable process.

MR. MILLER: The fact that not everybody writes a letter doesn't mean that everybody's happy. I didn't really want to raise that, but maybe there's a lack of communication here. Perhaps Mr. Lane has not been able to talk to his MLA, who could properly explain government policy. If he's watching now, I would highly recommend that he contact his MLA, and I'm sure he'll get the whole matter straightened out.

MRS. BOONE: I want to question the minister on something that is very important and that we have long supported: travel subsidies. As the minister knows, many people in our region and throughout the province have had considerable problems in trying to obtain medical treatment and services because of the costs involved with travelling to obtain those treatments.

I just have some very quick questions that I'd like to ask the minister about the program. How much money is scheduled for the program in this budget?

HON. MR. STRACHAN: With the greatest respect, Mr. Chairman, we have a cabinet.... As you know, this was mentioned in the throne speech and in the budget speech. There is a cabinet document being prepared now that will discuss the details of who will be eligible and the amount of money that will be required.

[ Page 12827 ]

I think I'm prepared to talk about the necessity of the program, but providing details to the committee would be most difficult and premature. We are clearly discussing future policy here, and we are discussing spending that cabinet has not yet seen. So I don't think I can in all honesty and all sincerity provide any dollar figures to the committee at this point.

MRS. BOONE: I find this very strange. This is the minister's budget; it is the only time we have an opportunity to question him on that budget. It is mentioned, as you state, in the throne speech; it is mentioned in the budget, which is your budget. Yet you can give us no information — not even a dollar figure as to the amount within your budget. One would tend to think that perhaps there isn't any money there. A lot of people out there want to know and have been phoning and have written asking how they get into this deal. How do they apply for this? Who is eligible for it? Where does the travel subsidy apply to? Does it apply only within the province of British Columbia or does it go outside the province of British Columbia? For the minister to deny any information on this issue is very irresponsible and not living up to his ministry.

HON. MR. STRACHAN: The member seems to be having trouble with what I'm saying, so I'll say it again. The program was announced in the throne speech, then the budget speech. There is a plan coming to cabinet soon — I'm advised within at least the next couple of weeks — for their consideration.

In terms of where the money will come from, it will come from vote 65, which is the contingencies vote, and that is what we have planned for. But I cannot give you a dollar figure until such time as cabinet has approved the program, nor can I tell you how to apply. Do you want me to repeat that for you?

Interjection.

HON. MR. STRACHAN: You mentioned upcoming policy from the throne speech. That's what it's for. You've attended enough throne speeches to understand that, I'm sure.

MR. MILLER: I suppose I'm not the first person, but I have some pride in authorship, if you like, because I have raised this issue now with every Minister of Health since I was elected in 1986. I haven't had the pleasure of raising it with the current Minister of Health, but things change pretty quickly around this place sometimes.

When I first raised it with the minister back in 1987, I wasn't asking that we jump right in. It's a bit irresponsible to simply say that we're going to have a travel plan. We recognize there's a problem, so we're going to implement a travel plan. Hopefully there's a lot more work to it than that, and although we can accept the need simply by receiving narratives of hardship endured by individuals and our familiarity with the situation, I asked that the ministry start to assemble some information from the sources that might be available. For example, I referred the minister to the information available from various private plans that exist. Some of the trade unions and their employers have negotiated what they call "travel riders" as additions to their health plans. Most of them are paid as a direct pay-out, as opposed to an insurance plan, with the employer absorbing the cost. In some cases the plan is administered by one of the existing health agencies, and in other cases it's administered by the employer. There's a history of experience with regard to the use of the travel rider which could prove useful for the ministry in coming to terms with the issue. Was that work undertaken?

HON. MR. STRACHAN: I believe it was. Of course, the staff have been looking at this, and as you and I both know and any member who represents an area that's outside the lower mainland.... As a matter of fact, areas outside Prince George where I come from, because we are a referral hospital — and there are many instances where people will travel to Prince George.... It's not just travel to the lower mainland for essential medical services. It's travel to the referral hospitals as well that we're considering here.

I can't give you details on all the prep work that was done, but I know from the briefing that's coming to cabinet that some was obviously done, because we have extensive material on the suggestions we will be making to cabinet as to how complex the cases will have to be and who will qualify.

MR. MILLER: So through this kind of review that I had suggested, the ministry was then able to obtain some statistical information. Was it sufficient to make a projection in terms of taking the information as it applied to the populations under the existing plans, wherever they may be? Maybe the minister's staff can advise him. Perhaps he might refer to some of the specific plans that they consulted in order to assemble the information. That would be useful. Was enough statistical evidence gathered, that could be reasonably projected on the entire population that would be served, to draw some conclusions about such things as costs and the nature of referrals that would be covered?

HON. MR. STRACHAN: We have a lot of statistics available to us, Mr. Member, as you will appreciate. I'm advised that the staff made broad assumptions about what the program would cost and who would want to be served. That's the information they have used to assemble the presentation that will be coming soon to cabinet.

I don't know that I can provide you with more specific detail on data we would have used in assembling our proposal — at least not right now. I guess if you have specific questions about historical data in terms of travel and other plans, pose those questions to us, and we'll endeavour to provide an answer to you as quickly as possible.

MR. MILLER: For example, I'm not aware that either of the two plans I'm aware of in my community was consulted. Maybe they were, and I'm simply not aware of it. But I'm unaware that either the major employer,

[ Page 12828 ]

the pulp company in Prince Rupert, or the city of Prince Rupert were consulted to actually get statistical information from them on the experience as it applies to the population base that those plans serve.

Really, I think in trying to project.... If I can just deviate for a moment, I recall the difficulty that we encountered — and when I say "we," I mean this party when we were the government — in bringing in the Pharmacare program. To some degree, as much as you try to gather statistical information and to make the best possible guess as to what a program might cost, it's very difficult when you're introducing a new program, because your information base might be limited or there are things that you don't account for. It's very difficult.

I recall my party suffering somewhat, having brought in the Pharmacare program and experienced an overrun in the Ministry of Social Services and Housing budget at that time, and being greatly chastised for that. I suppose you have to accept those things if you think the program you're bringing in is worthwhile — and certainly Pharmacare was and continues to be. I only use that example to illustrate that even with the best of intentions, it's very difficult to forecast budgets, and in terms of this issue, it is of concern.

I have corresponded with people right across the north — in the Peace River country, the central interior, my constituency and north of my constituency — as a result of mailings I did to northern people on this issue. I have received some letters that would break your heart in terms of the real life experience that people have had to go through, particularly people who have to go for referrals for a serious illness.

It is very costly, as the minister should know. What I'm trying to put together is not a complete picture, but at least some indication of where the government is heading on this. It was significant enough for the government to include it in the throne speech, and I'm sure it was well received, but we have to put some flesh on it. That's really what I'm trying to do.

[2:45]

Going back to my question, it was: in gathering statistical information, did you get enough that you could apply it across the broad public base to which this program will be available, to draw some conclusions about cost and those other issues that naturally would follow? What, for example, will be covered? Will every referral be covered? Will it depend to some degree on the nature of the illness? Is there a limit on the number of referrals that individuals could have covered under this proposal? In addition to transportation, will it cover some minimal accommodation? Is it foreseen that it would cover 100 percent or a percentage of the costs borne by individuals?

There are many specific questions, and I think it's reasonable that people want some idea. It seems to me that this is a good forum to try and draw out what you're looking at. Maybe with those I could sit down and have the minister respond.

HON. MR. STRACHAN: At the outset, I'll apologize to the member. I missed it when he talked about two plans that are available in Prince Rupert. Are these employee or union plans? Is that what you were referring to on those plans? I misunderstood that part.

Nevertheless, the answer to that question is no, we didn't speak to those people. What we have done in the preparation of our cabinet submission is look at the work which has been done in other provinces and also look at our own data with respect to travel patterns. We, of course, can track by medical card number and other forms of identification people who are travelling, say, from Prince Rupert to Vancouver or from Burns Lake to Prince George for whatever treatment they need. So that information is available to us. It's on that basis that we are preparing our document.

I think the throne speech, if I'm not mistaken, used the term "complex medical problems." We haven't fully decided on what's going to be complex and what won't be. I have my own opinion, and the staff has opinion, but this is an issue which will be dealt with by all of cabinet so that we have a good regional perspective on the program as we implement it.

I know the member for Prince Rupert thinks that my estimates may be a good forum for this, and I think it's a good forum for general discussion. In terms of discussing the plan, inasmuch as we don't have it in front of us, the forum is not so good because there's really no flesh on the bones yet to discuss. But if you want to offer suggestions to me, I'll be more than happy to take them, because I think this is a good idea. It's supported by the Ministry of Health and, as an MLA from the central interior, I certainly support it. I'm sure you do too, Mr. Member, being from an area which is even more remote and does not have the medical services available that I, for example, would have in Prince George. So I certainly can understand your concern, and I'll be more than happy to discuss and listen to any philosophical or other suggestions you may have with respect to the delivery of this program.

MR. MILLER: I don't want to get into philosophy, Mr. Chairman, because, first of all, I'm not a philosopher, and secondly, we could be here for — who knows — months and months.

I have some difficulty with the minister's answer. The minister has indicated that they did get information about travel patterns or referral patterns. What specific information do you have in house that you can obtain on that question?

HON. MR. STRACHAN: What we have and how we're identifying this is that we know which hospitals get referrals from where, the numbers and the condition. That really gives us a good description of the magnitude of the problem, or the concern, of travel patterns. From there, we are putting together a program.

Let me also tell you that we're well aware of the concern your party had with Pharmacare when you were governing. We are looking at one of the options, which is phase-in, because we realize that these things can snowball. I won't tell you that that's the way it's going to be; I'm going to say that that could be one of

[ Page 12829 ]

the options presented to cabinet — a phase-in program.

To answer your questions, we can identify which referral hospitals have people travelling, where those people are from, how many treatments are being given and the complexity of treatment that those hospitals are providing. That's the way we have a good description to identify for ourselves what we're going to have to do to provide this travel program plan.

MR. MILLER: So every hospital that receives a referred patient from another location is recorded, and that information is available in the ministry. Would you be able to account for people referred to a specialist for a consultation?

HON. MR. STRACHAN: We did hospital in-patients and also out-patients. I don't have all the details on the specialists at the referral hospitals that we spoke to, but we are also, on the other side....

Interjection.

HON. MR. STRACHAN: No, at the referral hospitals. Maybe we'd better pose that question again, because I don't want to misunderstand you.

We're also, on the other side, trying to have as many specialists as we can travel outside the lower mainland into the less-populated areas. Let me answer it this way. We tracked in-patient and out-patient referrals to the large hospitals, and that's the information we're dealing with.

MR. MILLER: Just a couple more questions on this for information. Does that allow you to draw some kind of statistical conclusion about the greater population base? In other words, does the frequency — across the range of ages, sex and those other statistical questions — allow you to draw any general conclusions about the incidence of referral? It doesn't sound as though it has. In other words, if you look at.... Well, to talk about the north, that's a misleading word in itself. We have a population base north of a line drawn through Williams Lake, if you like, which contains a certain number of people with a certain demographic makeup in terms of age and all the rest of it. So when you take the information you have gathered, does it allow you to draw any statistical conclusions about frequency as it relates to particular age classes and occupations and all those kinds of things required to put a plan into place?

While I'm on my feet, I will add: would it not have been useful to consult some private companies and some municipalities — maybe some school districts; I'm not sure of that — with regard to the frequency in their experience, in order to add to your statistical information base?

HON. MR. STRACHAN: What you suggest is not a bad idea, and we may gather data from that area.

One thing: I was just advised by the officials with me that it would be very hard to identify by occupation. You mentioned that as one of the criteria. We simply wouldn't have to — nor do I think we would want to — take that computing energy to try to identify by occupation. But all the criteria would certainly be of interest to us, particularly age and sex, which is one of the demographics we use in hospitals now. The demographic criteria we use in the hospitals now for providing their budgets and other issues would come into it.

By the information we have from the large hospitals that are taking referrals, we have arrived at a pretty good picture of what the travel practice is.

MR. MILLER: I'm trying to tie this in with another problem, which the minister mentioned, and that's trying to get medical specialists of varying degrees — some not in the actual practice of medicine; some in fields like speech pathology and audiology, and others in the psychiatric field.... It is a significant problem, and I think it goes beyond the borders of British Columbia. In fact, I know it goes beyond the borders of British Columbia. There is a current dispute in Quebec with regard to the government plan which was put in place, in part, to gain some efficiencies in the system, as well as to try to deal with the location of medical doctors — ordinary doctors and specialists as well — in the more remote locations of that province.

First of all, dealing with this anticipated program, which appears to be a ways off, is there some sense of tying these two issues together? One of the things I discovered in investigating this issue — in other words, going to bat for the people in my constituency — was that like everything else, it was far more complex than it might first appear. When we talk about it, we look for the easiest solution sometimes: what is the easiest thing?

There has been a north-south orientation, at least in my part of British Columbia. It's quick to get there — relatively quick, although I don't think so on a Friday night when I'm leaving this place; nonetheless it is. It's very expensive. Some have argued that as a result of the plans in place, we've in fact diminished our opportunity to attract specialists. You understand the logic of what I'm saying? Because people have a plan, which pays for the transportation to Vancouver — primarily it's Vancouver.... In the case I'm talking about, which is the major pulp mill, there's no question about the ability to collect the airfare and a minimal amount for accommodation. Therefore, out of preference and over a period of time, you'll find this attitude has developed where people will say that they're not going to go to a local hospital and that they'll go down south because they have more confidence in what they do there. It tends to feed on itself.

[Mr. Ree in the chair.]

In looking at this program, which is going to assist in travel costs and, hopefully, accommodation costs for medical referrals, have you looked at it in terms of the balance on this other side? I attended a meeting in our hospital with community leaders, some doctors and a person whom I'd highly recommend on this issue, Dr. Peter Newbery from the United Church. He is located

[ Page 12830 ]

in Hazelton but runs the United Church hospitals in British Columbia. Dr. Newbery has a very unique perspective on the needs of northerners in health care. He talks about things that the ordinary person would not even think about. For example, northerners really aren't represented in admissions of students to the medical faculty. We're underrepresented, and that has an impact on trying to get people to come north or trying to get students from the north into some of those facilities. I'm moving ahead of myself here, but I'd like to get your response with respect to the balance between a travel plan and the other really significant problem — trying to move medical specialists up into some of the more remote locations.

[3:00]

I should say, too, that I refuse to believe that Prince Rupert is remote. It is not remote in any classic sense of the word. Neither are those communities along Highway 16. If you start taking about places like Iskut, then you're talking remote. Any community that you can fly to in an hour and a quarter and that has 16,000 people and all the amenities is not what I would call remote.

HON. MR. STRACHAN: In no way did I imply that Prince Rupert is remote.

MR. MILLER: No, I think I did.

HON. MR. STRACHAN: Oh, you did. Okay.

The member makes a very good point, and I can assure the committee that one thing we don't want to do with this travel assistance program is undermine the services we provide to the communities now. Our fundamental policy is to get the specialists and the services to the people as opposed to having the people come to the services. That will be an underlying thought as we put this program together. The staff have been wrestling with that issue: how can you develop an effective travel plan that serves those that it has to serve without undermining the services in the more rural and isolated areas now?

Having said that, let me tell you what our physician services to the rural and isolated areas are now and what funding we have provided. The northern and isolation allowance program, which is a premium fee paid to physicians serving isolated communities, costs us $5.12 million a year. The northern and isolation travel assistance program, which assists with travel costs for specialists' services provided on a visiting basis, is $280,000 a year. The subsidized physicians program, which is a guaranteed minimum income, is $180,000 a year. The nurse practitioner services to rural and isolated areas are $680,000 a year. Special contracts to meet the needs of rural communities are $3.19 million a year. So I think that really underscores our commitment as a ministry to ensuring that we are providing services to the people.

Finally — this is something I'm particularly interested in, because we're looking at a pilot program for Prince George — there are the rural residency programs. If you've been following the medical manpower issue, you know that intern residency requirements are going to be changing from one to two years for those areas of practice which do not already require two years of postgraduate training. A family practice internship is being recommended by Prince George. I have made a strong case for that to the Ministry of Advanced Education and also to the University of British Columbia, because I think it's important that we consider it. As you know, doctors who train in the north stay in the north.

The member is bang on in terms of his suggestion and concern that, although he supports the travel plan — and I certainly support it myself, because of the constituency I represent — in no way can it undermine the services to the area that we are providing now. I hear what he's saying. I agree with his concern, and I can assure you that it is a concern of the officials as well as we put this program together. Of course, you can appreciate that when the program does come to cabinet, which I'm advised will be in the next week or two, many of the other members of cabinet who represent areas outside the lower mainland will have that concern, because it is not in our best interests to have any of the services we currently have in place diminished by a travel program.

MR. MILLER: I should have asked at the outset, Mr. Chairman, whether there's been a change of heart. When I quizzed the Minister of Health last year, he was fairly adamant in saying that they wouldn't consider this program; now it appears that you are. If it's a change of heart, fair enough.

I've calculated roughly $9.5 million for the programs you read out. Although I appreciate.... In fact, on behalf of my hospital in Prince Rupert I have lobbied the northern and isolation allowance committee for increases. They allocate money, and I think the last letter I saw on that indicated that there's really an oversubscription. In other words, the need is much larger than the budget will allow. That's probably fair to say about almost any program, but clearly it is in this case.

But this doesn't deal substantively with a fundamental issue. You seemed to indicate that it's cheaper — I don't know if those were your exact words — to take the specialists to the people than to take the people to the specialists, or something like that.

Interjection.

MR. MILLER: Okay. You say it's preferable, but not necessarily cheaper. That's an intriguing question, because that's what I was going to ask: in terms of the cost-benefit, what do the numbers look like? I would always assume that it would be. But that's an intriguing question if you consider health care generally in the province, which serves the massive geography we have. Do we have a commitment to regional hospitals with — hopefully — as many specialists as can be attracted? Because my sense of how that has been going is that we've seen an erosion of those regional hospitals, perhaps for some of the reasons I've mentioned earlier.

[ Page 12831 ]

I don't think you get too many referrals from the Queen Charlotte Islands over to Prince Rupert, and yet it seems so logical. People go to Vancouver. The reason for that is a lack of specialties — they're simply not available — and maybe some level of competence. I'm not certain of that; you may be able to enlighten me on that. I don't want to focus too narrowly on my own community, but it's the one I know best, so I'll continue to use it as an example. I get the sense that its function as a truly regional hospital has been eroded with time. Would you care to respond?

HON. MR. STRACHAN: It's a very interesting discussion. I want to get this on the record; I want to repeat this for the record. I didn't say that keeping specialists in the region was cheaper; I said that it's preferable, and that will always be our policy — to ensure that we are taking the services to the people, not the people to the services. At least that will always be my policy and I'm sure the policy of the government, because in the Legislative Assembly we represent a good number of rural constituencies. The idea is to provide services to people. I would say that that would be more expensive.

There is an economy of scale at VGH or St. Paul's — on the lower mainland. It would be nice just to load up a 737 every week and fly people from Prince Rupert, Sandspit, Prince George or Fort St. John and have them attend this super-hospital that we built somewhere. There would be an economy of scale, but it wouldn't be as good, because you'd be taking people out of their communities and not allowing for any infrastructure building in the rural areas. What we're doing now is more expensive for treatment, but it's the most preferable to ensure that the services are taken to the people as opposed to taking people to the services.

There's one caution that I was just reminded of: you cannot expect to send one specialist to a remote area and have that specialist maintain his or her skills in the discipline. They have to have backup; they have to have colleagues. So you have some medical problems when you do that. It's not as easy as saying: "Let's put specialist A here, and he'll fix all those problems." There are some other concerns that you have to deal with, and it becomes a complex medical manpower problem.

As I said earlier in my debates, we have a commission on medical manpower, and your colleague the second member for Vancouver-Point Grey will probably tell you that among physicians — and at UBC for sure — the whole question of medical manpower — where it goes, who we should be training and what disciplines are big ones and vexing for the profession itself.... It's one that faces you and I as politicians all the time; it faces hospital boards; it faces the medical manpower committees at hospitals who want to look at providing and attracting the best people for their medical staff. It's a question that we will probably never resolve to everyone's satisfaction.

In any event, I have been able to share my policy with you — at least, the policy of the government — and also, of course, my personal philosophy that it's not cheaper but it is preferable to have services supplied to the people in any way that you can.

MR. MILLER: Actually, before today I hadn't really thought too deeply about the cost ratio of moving people or doctors the other way, and it's quite an interesting answer. In some ways it could be used to justify, on a financial basis, the program that you seem to be embarking on. We'll reserve judgment. I'm not going to applaud you yet for that program, until I actually see some flesh on the bones and people know what you're talking about.

But you are right in that there's another problem that comes up. For example, apparently they don't make the ordinary general surgeon anymore — someone who can do things like taking people's appendix out or cutting them open for some minimal reason as opposed to some complex reason. I'm told that Great Britain may in fact be one of the last places where you can recruit that kind of general surgeon. Yet in the more removed areas of the north, that's precisely what you need, as opposed to the body parts that people now specialize in. I don't know if that issue is being considered by the medical manpower committee, but I certainly think it ought to be. There may be some limits in terms of how many you train. But we're having now, for example....

The other issue you raised is the fact that if you only get one surgeon in a town like Prince Rupert, he or she is on their own, and they are on call 24 hours a day. It's not that they're called 24 hours a day all the time, but I suppose there may be times when they are. But the fact is that they are simply on call 24 hours a day. They don't have the opportunity in terms of upgrading skills and all the professional things that go with being a surgeon, so they don't stay very long. We're constantly in this recruiting business.

We're now trying to recruit a surgeon, and I really hope that we get this person. We're looking at raising $100,000 in our community. We're going to the business community, to the trade unions and all around the community trying to raise $100,000 so that we can secure a surgeon.

In other specialties, such as gynecology, we have seen such a rapid turnover. We've offered these enticements throughout. I used to be on the hospital board years ago as a council appointee, so I'm familiar with some of the stuff. We offer free rent and facilities. Somebody comes up, they roll into town for two or three years and then they're gone again. That feeds into that thing I talked about earlier about the lack of confidence.

I know women who are pretty outspoken and pretty frank. If they figured they had some problem that was beyond the norm, they say there is simply no way that they would.... I hope that what I'm saying is not interpreted wrongly by the medical profession in my community. I believe I'm stating a fact that I, and perhaps others, have observed, and I don't wish to denigrate anybody in my community. In fact, I consciously argue with people that they should avail themselves of the facilities that exist in the community before seeking to leave the community for services. I

[ Page 12832 ]

take that position because we will never get quality service unless people use them. If they feel there is some deficiency, they should start to demand a higher quality. But you'll never know unless you test it.

[3:15]

How does the provincial government tie in with a small community? I don't think you're offering any additional money over and above what the doctor can obtain through billing. Here we are with this small community trying to raise $100,000, and that's only one position. What role does the province play in trying to assist...? It really goes back to the original question, too, which is: if the ministry or government deems it preferable to maintain regional hospitals, it seems to me that they have some responsibility for maintaining a decent staffing level of the various medical practitioners required.

HON. MR. STRACHAN: I agree with the member's concerns, but I want to tell the committee, Mr. Chairman, that we have many strategies in place for the concerns he has identified. I listed the $9 million of expenditures that we have to access physicians' services in British Columbia. I'll point out one available to Prince Rupert doctors: the northern and isolation allowance program. There are 70 eligible communities, of which Prince Rupert is one.

It's a fee premium for physicians who live and work in rural and isolated communities. The communities are assessed by way of an objective point scale which takes into account both medical and social isolation factors. The mechanism is that following registration with the Medical Services Plan, physicians from eligible communities automatically receive the appropriate fee premium on all fee-for-service billings. Fee premiums range from 6.2 percent to 20 percent. For 1991, there are 70 eligible communities, of which I said yours is one, and the estimated number of recipient physicians is 400. The estimated cost, as I indicated earlier, is $5.12 million. That's one way of encouraging physicians to go to the north and remain there.

I've lived in Prince George since 1966, so it's coming up to 25 years now, and my experience is that not too many have moved away. I met a lot of the doctors when they came to town; they were all young guys about my age, and they're all still there practising.

Interjection.

HON. MR. STRACHAN: They were young guys my age then; that was 25 years ago. Let's get that straight — I was a young guy once.

The majority of them have stayed there — many of the specialists and surgeons. So I think the system works. That's not to say it's perfect or we can't do more. I talked about the family practice residency program that I would like to see located in the central interior. Of course, we know that the University of Northern British Columbia is going to have an impact, because it makes the quality of life generally a little better.

You mentioned the United Church, and they are an excellent agency, along with the Queen Charlotte Islands Health Care Society. They are in receipt of the $3.19 million in special grants that we deliver throughout the province to many agencies. They're not in receipt of the whole $3.19 million, but they are part of the program that provides assistance for travel costs for specialists.

So in many ways we are attempting to address the problem to ensure that we are taking, as I said, the services to the people. Anything we can do, particularly with this current minister, to ensure that better access to physician services in the rural and isolated areas is provided will certainly be a priority with me.

MR. PERRY: I've been listening with a lot of interest to the discussion over the last hour, because this is another one of those issues raised repetitively and very effectively before the Royal Commission on Health Care and Costs. I wasn't able to attend many of the northern hearings, but it was certainly raised even in Vancouver, and the commissioners have picked up on it very strongly in their northern travels.

I wouldn't mind putting in a favourable comment on the program the minister just alluded to: the northern isolation allowance and the travel program for doctors. I know, because I once was a visiting consultant in Prince Rupert, and at that time the ministry paid not only the usual fee, but also paid for the airfare. I believe that in general they have continued to do that, if I'm not mistaken. I recall having some complaints as opposition Health critic from physicians who had trouble getting the airfare paid, but I believe that issue has been resolved. So it's fair to say that was a good initiative.

But I have another suggestion. The minister asked earlier in these debates for suggestions. It's one I've made to the dean of the faculty of medicine, and I think the minister has a little bit of leverage over him.

Prince Rupert, Quesnel, Smithers, perhaps Terrace and some other smaller towns are not quite the same as Prince George. Prince George has had troubles recently maintaining and recruiting an obstetrician, but Prince Rupert is quite a different kettle of fish, if that's the right metaphor.

The surgeon in Prince Rupert typically has been on call every second weekend or every second week year in and year out, and sometimes, when there was only one surgeon, all of the time. That means being on call for the most serious emergencies literally all the time, and that's one of the reasons it's so hard to recruit anyone when somebody retires. None of the younger generation of doctors want to get trapped into that situation, and the spouse usually is even less enthusiastic about it.

There is one possible remedy — not for the grinding on-call schedule, but at least for vacation relief and guaranteed access to continuing education. Many such surgeons or specialists have told me that they have much more difficulty recruiting a temporary replacement doctor than do the family doctors. Even for family doctors it's not easy, but for specialists like a surgeon it's often very tough.

I think you have some leverage, Mr. Minister. We've often discussed here before the request by the faculty

[ Page 12833 ]

of medicine at UBC for some more generous funding to expand health evaluation, research, salaries for young medical scientists, etc. They're asking for 2 percent of the total health budget, not just at UBC, but health research and evaluation.

When you're negotiating with them, I suggest you use some of your leverage and ask what they will do for the rural communities. Will the department of surgery, for example, undertake to provide guaranteed replacement service on a rota to some of those smaller communities that have trouble recruiting surgeons?

For example, will the department of surgery guarantee that it will assign one of its members once every five years, perhaps, for a few weeks so that Prince Rupert will have guaranteed replacement coverage for six or eight weeks per year for certain holidays or for continuing education for the surgeon there?

I don't think it's too much to ask. I would advise you from experience, having seen it in the seventies as a medical student and having read the press recently, not to follow the Quebec model; it's unnecessarily harsh. I don't think you have to throw your weight around that heavily. But just asking for something in return for improved security of funding to the medical school that they're asking for would be a fair bargain. I think the medical school is finally ready for that and sees its expanded responsibility to the rest of the province.

HON. MR. STRACHAN: That's a good suggestion, and I will take that to UBC and to my colleague the Minister of Advanced Education, Training and Technology. I'm amazed I didn't look at this before when I had that other portfolio. I will encourage in any way I can those bodies to look at that. I'll tell the committee as well what the Quebec plan was, Mr. Chairman, just for the edification of this august group.

The Quebec plan pays a sliding percentage of fee schedules, going down to 70 percent of the fee schedule in the very heavily populated areas where there are too many doctors — presumably Montreal and la ville de Quebec — and up to 120 percent in the more rural and isolated areas. The problem with that system was that everybody congregated at the border of about the 100 percent towns. It really didn't work. I can see a member there laughing, knowing how the wheels would turn. It didn't serve. I guess it looks good on paper. The first time I saw it in the paper I thought that it wasn't a bad idea, but it didn't have the effect that it was supposed to have.

In terms of the suggestion from the second member for Vancouver-Point Grey, it's a good one and we'll encourage whoever and all we can to look at it.

MR. MILLER: Gee, we come up with all kinds of good ideas in here. If we keep it up, we might actually solve some problems.

I referred earlier to a couple of issues I want to canvass. The minister may be acquainted with Mr. Weller at UNBC. I was intrigued because when I talked to Geoff a few times about the issue of training in the north or trying to attract specialists, it turns out that he had actually co-authored a couple of papers. I don't know if the minister has seen them, but I would recommend them to him. In fact, I think it was Sweden where they actually built a medical training facility in a very small community of some 25,000 people. I don't want the doctors or potential doctors out there in B.C. to get alarmed, but according to the paper it actually worked. It also worked to resolve some of the shortfalls in those smaller communities.

Something I've tried to raise every year — I may have missed the odd time — is that at one time there was a program which provided a higher level of support for people who had some skills but might require upgrading — for example, someone could upgrade to be a registered nurse by taking some courses. There was a program whereby the provincial government gave assistance over and above the normal assistance that might be available through other programs. That was available to people who were prepared to make a commitment, once they'd achieved that accreditation, to spend some time in a small community. I haven't inquired before today, so I'm not certain as to where that program might sit. I'll leave it at that for now and let the minister answer before I continue.

HON. MR. STRACHAN: First of all, the member mentioned Geoffrey Weller. He is president of the University of Northern British Columbia and a good friend of mine. I've known him for two years now. I first met him in January 1989, and he was vice-president of academic studies at Lakehead University When I was tripping around the country trying to build a cabinet case for a university in the north, it was suggested that I visit the northern Ontario universities, because they were the best examples of communities not unlike Prince George that did have universities. So I visited Thunder Bay, where I met Geoff Weller, vice-president academic at Lakehead. I also visited Laurentian University at Sudbury. They are both very good examples. My colleague the current Minister of Education, who was Minister of Advanced Education at the time, wanted to see northern universities as well, so he went to Sweden, Norway and Finland, whereas I went to Thunder Bay. That just goes to show you that I'm the hard-working guy.

[3:30]

In any event, I did meet Professor Weller. He became quite interested in our university plans, and as they developed, he applied for the job and was short-listed. Now he is our president, as you know. He was a superb choice, because he has spent 20 years at Lakehead University and is used to the environment of the smaller university and to the concerns of the smaller community. He's doing a first-class job in putting the University of Northern British Columbia in place. Mr. Member — you'll be aware of this, and I'm sure gratified — he also has 20 years' experience of outreach programs, and he knows what he has to do in Terrace and in Prince Rupert to establish the presence of his university. That's another skill that he brought to UNBC.

Interjection.

[ Page 12834 ]

HON. MR. STRACHAN: I was talking about Prince Rupert and Terrace. They're both in B.C. I know you guys in Burnaby don't know much, but I can tell you that Prince Rupert and Terrace are in British Columbia.

Getting back to Professor Weller. Interestingly enough, he is a political scientist by training, but his specialty in political science is the politics of health delivery systems. He has published extensively on the health delivery systems in Sweden, Norway and Finland, and their provision in the northern — actually into the Arctic Circle — medical and dental schools. Those three Scandinavian countries really lead the way in providing that type of very expensive but necessary training for the northern climes. So Professor Weller is a welcome addition to our northern community, because he really does understand the politics of health care in the north — how it can best be delivered and what provisions you have to consider.

[Mr. De Jong in the chair.]

Currently, although this isn't directly associated with health care, the curriculum development they're doing at UNBC is going to include bachelors' and graduate degrees in public health administration. There is a crying need for that. So that's what they're looking at — as well as the provision of other medical services.

In terms of the scholarship program — and this has been in place for some time, because the current Speaker was Minister of Health in the Bill Bennett government when this program was brought in — there is $5,000 a year provided to students taking a variety of health-related studies — dental hygiene, medical lab technology, nursing — that are important to the provision of good health care. The scholarship is $5,000 per year. If you accept that scholarship, you have to commit to staying in one of the identified communities for the amount of years that you've used the scholarship for the bursary program. I can't tell you right now what communities or what disciplines qualify, but it apparently has been reasonably successful.

We had 37 bursary applications with 26 people qualifying for assistance and committing $73,000 of the $80,000 budget for the program, leaving $6,000 left over. I've got more details here. They were nursing students, social work students, pre-med students, a family counsellor, a dental assistant, pre-dentistry, child development and psychology, sociology and long-term care — all fields that are related to the better provision of either the social services or health care services delivery.

MR. MILLER: Years ago I had a teacher, and whenever we wanted to get off work, we would mention — I forget what the topic was — a certain thing to this teacher, and he would start talking for about half an hour. I know how to turn the minister on. I'll just mention Geoff Weller, and we can talk about universities for a while.

I'm pleased to see that the program is still in place. It would appear from a cost benefit view that for a modest investment of $73,000, you're achieving — if indeed all of those 26 people achieved a certain skill level that allowed them to go out into one of those communities — a pretty fair return, at least in the delivery of those or trying to cover off those areas that are often in short supply. I see there was actually some money left over.

Perhaps because I don't watch these things, it's not generally known. Not too many people know that the program exists. Some people find out about it, and maybe there's a risk in advertising it: you'll be terribly oversubscribed. But I would argue that if we have 26 people who are going to go to small communities, then I would say that probably in terms of your own analysis, you could probably jack that up — it's a really small dollar amount — and get a pretty significant return.

You have access to the statistics of where those shortages are, and that all goes into the mix of determining which particular training areas are eligible in which communities. I would certainly recommend that you look more closely at that to increase the number of trained people in the medical field that we can get into some of those smaller communities.

When you talk about physician retention, there are some systems. The one in the Queen Charlotte Islands has been successful. I had something to do with the introduction of that concept. It was the old health and human resources councils. There were five areas in British Columbia that were picked as a model — a bit of a test I suppose. One of them was here in Victoria — the James Bay area of Victoria was one of those areas — the Houston-Granisle area, Queen Charlottes and a couple of others.

I was quite dismayed last year when I travelled through Houston to discover the fight that's taking place in that community with doctors, the war that seems to be going on in that clinic and fee-for-service. It seemed to me a rather sad state of affairs when you consider the enthusiasm that the program had at its inception. On the Queen Charlotte Islands there remains a dedication to the concept of people actively involved through these councils in the delivery — I would say even beyond the delivery — of health care; actively involved in health care in their communities.

But we've got some problems. The physical plant has deteriorated very badly. The clinic in Masset — the minister is aware of this; he's received the correspondence — quite frankly is an old, worn-out building. It is substandard by anybody's standards. It really requires a new clinic. The proposal that's been put forward — I think it's a good one and almost historic in terms of a breakthrough — is that a new clinic be established and that it be a joint facility built on land that lies halfway between the native village of Massett and the non-native community of Masset. They both have the same name, although the native community has an extra "t." There is Crown land available there upon which that facility can be built.

It seems to me to make all the sense in the world for the ministry to give its support to that proposal. There's absolutely no question that the physical plant, the clinic itself, has deteriorated to the point where it is completely inappropriate as a building which dis-

[ Page 12835 ]

penses medical services. There's absolutely no question about that. The need is there for a new facility. In terms of the cooperation that needs to exist in that area.... I go back a long ways there, and I'm aware of some of the tensions that have existed between the native community, the non-native community and the Department of National Defence, which has its own little hospital and which is sometimes seen as separate. I think everybody there tries their best, but occasionally these tensions do flare up.

Dr. Peter Newbery, whom I mentioned earlier, had done a report for the Queen Charlotte Islands Health Care Society on the issue of physician retention, contrasting the southern portion of the Queen Charlottes, the Queen Charlotte City area, with the northern portion, the Masset area, and noting the difference between their abilities to retain these kinds of services. It really delves into the difference in perception, I guess, and the difference in involvement that exists between the two communities. In fact, in my view it kind of bears out really that program that my government started, which is the health and human resources centres, actively involving people and hopefully dealing with preventive medicine as well, trying to intercede before medical services are required. Some of that is lifestyle. It's an admirable goal which we've ignored for too long.

I know I've written to the minister about the need. I wanted to raise it in this House, because it is a desperate need.

While I'm on my feet — I have another appointment — I wanted to talk about the physical plant generally. The Queen Charlotte City hospital is again a facility that needs to be.... The consultants have looked at it and essentially said that it's not worth putting money in to upgrade; a new facility is needed.

In Stewart, I suppose it was a pretty lucky situation. A vehicle leaking propane was parked beside the hospital. It leaked underneath the hospital and eventually.... It didn't cause a fire, but it ignited. That hospital was a mess to start with. It was deteriorated very badly to start with, but when this big whoomf! went off underneath the building.... Well, of course, it can't be used.

That's a problem, because here I've identified — and I don't think the minister would disagree — three instances where new buildings are required. I don't think that's in dispute. How do we move to address this need in these communities? In the case of Stewart, they are a considerable distance from the nearest, biggest centre, which is Terrace or Smithers. They require a hospital; they have to have one. We need to have a new clinic in Masset and a new hospital in Queen Charlotte City. I wouldn't be foolish enough to stand up here and say that I want them in place tomorrow. But I think if there's a plan, people are prepared to accept that you can't do everything overnight.

Interjection.

MR. MILLER: I don't know where you can get a propane truck with a leak in it, either.

I have a number of other issues important to my region. Unfortunately, I can't canvass them further with the minister at this point, in view of an appointment I have, but I shall return and will be happy to listen to your answers to my latest series of questions.

HON. MR. STRACHAN: I will be brief. You may recall, Mr. Member, that when we first began the estimates some two or three weeks ago, my critic the second member for Vancouver-Point Grey had a personal concern. I had an appointment that day at 4 o'clock, so we agreed I would take a bit of a break. At 4 o'clock I did meet with the gentlemen from Masset, two friends of ours — maybe more friends of mine than they are of yours; you know who I mean....

Interjection.

HON. MR. STRACHAN: Is he? Okay.

In any event, the situation was described to me in the Queen Charlottes with respect to the hospital society, the health society and the facilities at Queen Charlotte City and at Masset. I'm well aware of that.

We want them to provide us with a master plan. We want them, as you know, to undertake to try to get along together and to develop some comprehensive plan we can look at that will satisfy the needs of the community of Masset as well as of Queen Charlotte City and also some of the concerns expressed by the native community. That's where we are.

As I understand it, unless I'm mistaken, the ball is now in their court. We want them to provide something to us, and we will undertake to react to their response.

In the case of Stewart, we will be building an integrated health care facility there which will include acute care and other services all under one roof to look after all the necessary processes that have to happen in Stewart.

I share your concern about the Queen Charlottes, and we will endeavour to provide whatever we can as quickly as we can as soon as we can get everybody singing from the same song sheet and agreeing to a comprehensive and complementary health care program and facilities in the area.

[3:45]

MR. PERRY: Just before getting into some questions, let me correct and apologize for one statistical error I made this morning. I give credit to Hansard, who picked it out on page 7 of this morning's Blues. I had asked the minister to look at a number of figures and explain why the figures, in general, had gone up. I made a mistake in reading from my sheet at column 20 for hospital program management. The figure had actually gone down from $605,000 to $271,000. So when we come to those answers, maybe the minister would want to answer why it went down. That was an inadvertent mistake, and I apologize.

Let me just come back to another issue that we have visited several times in the last few weeks, which is problems with Pharmacare. I guess we were reassured by this Minister of Health during the interim supply,

[ Page 12836 ]

and maybe the former one, that Pharmacare was grappling as fast as it could with the problem of the turnaround time for receipts. My constituency assistant informs me by fax from yesterday of two more fresh problems. I'd just like to bring two examples to the minister's attention to convince him that the problem has not been solved.

She says both gentlemen said it was all right to use their examples but not their names, but I imagine they could be provided through my constituency assistant, Lynn Siddaway, if you need the names.

The first is a 54-year-old man on disability pension for 12 years who is diabetic and has a heart disease and who submits his claim every two weeks for reimbursement of Pharmacare costs. He says he spends $300 to $400 per month on drugs. He received a cheque from Pharmacare on June 17 — yesterday — for $600, and that covers the period February 15 to April 15. But the period April 15 to June 15 is still outstanding. So the usual turnaround time that I referred to earlier in these debates, which seems to have been acceptable, clearly is not working in that man's case if he's submitting every two weeks. This is said to cause hardship in the family, as they are on limited income and do not have sufficient resources to carry the debt.

My constituency assistant says to me: "At this man's request I asked if it was possible for him to have a Pharmacare card as seniors do. The man is certified disabled." I'm quoting my constituency assistant in writing here: "I was told by the clerk: 'It would be abused."' That's one rather disturbing example.

The second is another elderly man who had bypass surgery two weeks ago and is also diabetic. For a Pharmacare claim submitted on April 29, 1991, he received the cheque on June 17. That would be just over seven weeks. He's spending several hundred dollars each month. My constituency assistant notes: "We have had more complaints about Pharmacare than any other government program except for student loans. Constituents complain they receive very rude treatment. This has also been my experience."

I have to tell you, Mr. Chair, that my constituency assistant, Ms. Siddaway, is remarkably diplomatic and polite, and for her to say that that has also been her experience is disturbing. I just raise that for the minister's attention, because I find it troubling. My previous experience with Pharmacare had been very good, and this reflects the number of calls that opposition members have been getting from constituents. I would urge the minister again to review his policy that calls to constituents must be transmitted through his office, because it's obviously a significant problem for constituents now. Perhaps it needs some ministerial direction.

Let me just raise two other very quick points while we're on the subject of drugs before I yield to the member for Alberni. I want to raise another example of the problems people have with the present Pharmacare system where perhaps the government could be a little more proactive. This is an example — I won't use the name — raised by the Leader of the Opposition, who wrote to the former Minister of Health on November 1 concerning a woman in the Fraser Valley. The Minister of Health at the time responded on December 14, 1990. The file number is HL37761 — so it could be found. The response from the minister, I think, was adequate in that it did offer a means to address this woman's problem, but she found it rather offensive. I just want to raise it to bring it to the ministry's attention and ask the minister to think about what could be done proactively to prevent this kind of problem.

If we imagine ourselves in this woman's situation, it's not hard to see why she's disturbed. She's a 31-year-old woman with three children who has advanced lung disease from a genetic disease called alpha 1 antitrypsin deficiency. She writes on September 10, 1990: "Early last year was when I was told all this news. Later that year I was told of this wonder drug called Prolastin."

She then goes on to describe that she is taking this treatment in the hope that it will prevent her death or requirement for a lung transplant, which is the only possible treatment for her condition. She's got children of three years, five years and 11 years. She describes her expenses, which are $428 per month even after the Pharmacare subsidy. The drug apparently costs in the range of $34,000 per year. It's an enormously expensive drug right now, partly because it's new. But this woman doesn't sound like she can afford the $2,000, 20 percent share of the cost, plus the Pharmacare deductible.

To be fair, the former minister responded to her, suggesting that she contact the Social Services department if she couldn't afford to pay for it. The point I'm trying to make is that I think we need a more sensitive mechanism to deal with people like this. She's in the position of being an extremely vulnerable person with a very serious, disabling illness and young children. She's being placed in a position which she finds humiliating — having to go to Social Services — and she writes to the Leader of the Opposition what she was told by her doctor:

"My husband and I are sick worrying about paying these bills. I've been told to call the press to arms with me. My doctor tells me they'll eat this up — human interest and all that stuff. The nurses at the hospital are outraged. I can see asking the press for help, but I don't want to. My husband is proud, and I also agree to not being a sideshow for the press."

I think that makes the point. We have someone here who really needs help. She has ultimately been able to achieve it, but surely we could have a somewhat more sensitive way of responding to that.

While we're on the pharmaceutical issue, I want to raise one last, somewhat unrelated question while I see it here, which is about suggestions made to the royal commission by the Canadian Society of Hospital Pharmacists. There were a number of briefs to the royal commission last fall. This one is dated October 1990, B.C. branch, Canadian Society of Hospital Pharmacists. There are a number of similar submissions making the same general points. This one I found rather interesting — recommendation 13, page 72 of that brief:

"There is a need for improved consultation with the ministry for both strategic hospital pharmacy planning and for prospective and concurrent problem-solving. To accomplish this, a pharmacy consultant position

[ Page 12837 ]

should be established within hospital programs for a minimum trial period of three years. Part of the consultant's mandate would be a requirement to prove the cost-effectiveness of such a position by the end of the designated term."

Think about that, Mr. Chair and hon. members: a suggestion for a strategic approach to.... What they're really getting at is controlling drug costs in hospitals, getting at that perhaps $50 million I saw to be saved under Pharmacare. They are talking, of course, about the hospital programs budget, a different budget.

They are also volunteering that the position should show that it can pay for itself or be terminated. Not very many people make that request to government — to volunteer a position which would be self-terminating if it didn't pay for itself.

I think that's an interesting recommendation. I wonder whether the ministry has given it any thought. That's what I think the Leader of the Opposition had in mind when he was skeptical of the royal commission; not that he doubted the work they would do, but that there were some problems needing solutions earlier, and there are some things where we've already got plenty of good ideas out there. We don't have to wait for everything for the commission to table its report.

HON. MR. STRACHAN: As a matter of fact, I'm advised that there is some serious discussion going on now between Pharmacare, hospital programs and MSP with respect to that issue.

Staff will specifically investigate your other two concerns and respond to me and hopefully to you as quickly as we can. I can tell you that the Pharmacare claim pattern has increased by 36,000 claims over the last year. We are hiring additional staff, but there are delays, and I apologize for that. There is just an incredible increase in subscription of the program.

I'd like briefly, Mr. Chairman, if I could, to respond to some questions posed by the second member for Vancouver-Point Grey this morning. They had to do with some differences in budget estimates from '90-91 to '91-92. I'm going to briefly go through these. I'm really going to rush, Mr. Member, not to take an awful lot of time. I'll briefly describe why there are differences and hope that that will suffice.

In terms of STOB 25, information systems operating costs, there's an increase there of $609,000, about two-thirds and that's primarily attributable to the reallocation of costs for communications and information system expenses. They were formerly budgeted in administration and support.

STOB 42. There's an increase of $26,594, attributable to the realignment of funds within the program to match the budget with expenditures for job postings, recruitment in the north and advertising of specialized positions. It does not represent a change in overall program funding. So we had some special funds we had to expend last year, obviously.

Environmental, family and preventive health. We had an increase of $460,000. We had internal transfers, including transferring of public health engineers to Health from the Ministry of Environment; travel funding for additional staff who will provide direct public health service delivery to meet population growth.

Funding here was also provided for native health and to annualize programs such as child, youth, mental health, child development centres and environmental health protection.

STOB 20, which was environmental and preventive health — $32,000 accounted as a result of the transfer of public health engineers from the Ministry of Environment to the Ministry of Health.

Internal reallocations — $1,232,000 that was formerly in STOB 82 has been more appropriately coded to STOB 20, which accounts for that dramatic increase there.

The last item — $286,000 to meet population growth to annualize programs which commenced in '90-91 and for native health.

[4:00]

STOB 25. We had a reallocation of telecommunications and operating system costs formerly budgeted in another area, and also $1,032,000 for the provision of funding to meet population-driven utilization increases and to annualize programs. A lot of population-driven material here; as we know, our province is increasing.

STOBs 20, 25 and 68 are all relocation of costs that had been in other areas. None of these changes represent a change in funding for the program, but rather a change in the STOB or the category that they go under.

STOB 07 went down because that expense is more appropriately coded to STOB 10. STOB 10 went up for the same reason STOB 07 went down; we had it changed there.

I have one more here, STOB 20: professional services and ambulance services provision, a $143,000 increase, provision of funding for inflation and to meet expenditures for contracted ambulance attendants' training. These increases were provided for ambulance services only. The professional services budget for emergency health services program management has not changed.

I hope that answers your questions, and I thank you for them. Presumably this is all public material.

[Mr. Pelton in the chair.]

MR. PERRY: Maybe I could just satisfy the immense curiosity of members and ask for clarification of one example under environmental, family and preventive health, STOB 25, the information systems and operating expenses. What does that $2.75 million buy us? What are we talking about there that doubled in cost?

HON. MR. STRACHAN: These are ongoing telecommunications and information systems: that is, telephone systems, fax systems, all the operating costs that are involved in having our various health units — and it's a huge ministry — communicate with each other throughout the province.

The note says these costs were formerly budgeted in administration and support services and do not reflect a change in funding. That's $1,238,191, Mr. Member, a different category. There is a $32,512 lift, which is a provision of funding to meet population-driven utilization

[ Page 12838 ]

increases and to annualize programs commenced in 1990-1991. I can't tell you what those new programs were, but obviously, as I've indicated before on other issues, we have population-driven utilization increases, and that would account for the increase.

MR. PERRY: Am I correct in understanding that the apparent doubling is largely a shift of funds from one STOB into another, and there is a modest inflationary increase?

HON. MR. STRACHAN: Population-driven.

MR. PERRY: Population-driven.

One further example, under the ambulance services, column 10: public servant travel expenses. What are we paying for there with our $250,000?

HON. MR. STRACHAN: First of all, it's the change of STOB that I indicated earlier. It went from STOB 7 to STOB 10. Those are travel expenses for staff who are responsible for the ambulance system, travelling from area to area, I presume. We also have a smaller amount for the transfer of staff from Government Management Services. That was probably the air ambulance arm because that's GMS, the airplanes. And then the item for the provision of funding to meet ambulance attendant and other travel costs and for inflationary impact is $57,000.

It would appear that it's legitimate ministry employee travel from one area to another, and it's nothing out of the ordinary in terms of previous budgets. It's just that the coding has been changed from one STOB to another.

MR. PERRY: Last year hon. members were privileged to see something that usually gets reduced to three rather sanitized pages a year or two later in the annual report of the Ministry of Health, and that was the actual unexpurgated report of the provincial ambulance service or the annual report of the Emergency Health Services Commission. That report showed us a little over a year ago that the Emergency Health Services Commission costs had gone up $1.2 million because of the abuse of government jets for ministerial travel. Jets intended for the ambulance service were not available, and the extra charter costs incurred by the ambulance service when the government jet was not there amounted to $1.2 million. That annual report made very clear that there was an additional cost to the taxpayer incurred because of the cabinet use of jets.

This year members have not been quite so fortunate as to see the annual report of the Emergency Health Services Commission. I wonder if the minister would tell us whether the total air transport costs were less this year, given that last year they were inflated by that unnecessary $1.2 million? Or at least how did they compare? Did we end up coming out about even this year?

HON. MR. STRACHAN: First of all, I won't accept the fact that all the charter costs are the result of cabinet ministers using government airplanes. If the member had any knowledge of the north at all, he would know that in many instances the Citations can't land, so we charter other airplanes. A Citation needs 3,500 feet of uncontaminated blacktop. If the member has spent any time in the rural areas, he would know that there are not a lot of strips that qualify. We use charters for many reasons — helicopters that can take off and land on shorter strips, strips contaminated with bad weather or lots of precipitation or strips that are not paved but in fact are gravel.

The last hard figures I have for air ambulance services are for 1989-1990 at $6,600,000, and estimated for 1990-1991 is $7,800,000. There is an increase there, but that corresponds to the increase in patients, which is from 5,500 to 6,300. That's why there's an increase in air ambulance services — more patients carried.

I regret that I don't have, under the category called "in-flight volumes," the figures for.... Of course, I couldn't have them from 1991-92, because we haven't had that year yet. The last figures available are for 1990-91. The cost has gone up, but then so has the column "patients transported"; 5,597 in 1989-90, and 6,355 patients in 1990-91.

MR. PERRY: The minister does not need to inform me that charters are required sometimes; I've accompanied patients on some of them — by helicopter and small plane — in my past life. I've not only visited rural areas in the government jet; I've worked in some of them.

But the point was not that the ambulance service did not need to charter some jets in the 1989-90 fiscal year. The point was that it had to charter $1.2 million extra of private jets, specifically because the government jets were out gallivanting around with one passenger — one cabinet minister — at a time often on the frivolous business of racing each other up to Kamloops, Abbotsford or wherever it was.

My question would be: can the minister tell us — or come back to us a little bit later — how much money was saved in the 1990-91 fiscal year, which just ended? How much money was saved by the provincial ambulance service by virtue of government jets being reserved for the people they're intended to serve, thanks to our having raised that issue in the Legislature last year?

I presume that the annual report of the Emergency Health Services Commission will make that information clear just as it made the abuse clear in a report that was leaked and that members were privileged to see for the first time in the history of this province. Or perhaps it would be simpler for the minister to table the annual report unexpurgated of the Emergency Health Services Commission for last year.

HON. MR. STRACHAN: I cannot provide that information to you. In terms of filing that report, I don't know if that's ready at this point. Apparently there is no such report.

MR. PERRY: Did I hear the minister accurately? There is no such report? There is no annual report for

[ Page 12839 ]

the Emergency Health Services Commission, provincial ambulance service? If so, does that mean the ambulance service has been disciplined and told not to report, after the events of last year when its report reached the light of day and blew open the Gran Air scandal?

HON. MR. STRACHAN: That report will be part of the Ministry of Health's report. It will be a report but not singly identified or described that way. But it will be made public in the fullness of time.

MR. PERRY: Let's be clear. I guess some of us on this side of the Legislature did have trouble taking the throne speech seriously. There was that ostensible commitment to open government and freedom of information. If I remember, there was actually a line in the throne speech committing the government to a freedom of information bill — or policy, at least.

Last year when we saw the 71-page report of the Emergency Health Services Commission, it became darn well obvious why in the past that report was expurgated or edited down to a three-page, mealy-mouthed version in the annual report of the Ministry of Health. The annual report of the Ministry of Health usually comes out a year and a half to two years late, when nobody would be interested in it anymore and what's in there is irrelevant.

The whole point of the experience last year surely was that the public received — contrary to the then government policy of smothering and suppressing information — the annual report of the Emergency Health Services Commission. It did see the light of day. All members had access to it because I tabled it in the Legislature. The press had access to it. It showed that the government's abuse of the jets had cost the taxpayer $1.2 million in extra air charter costs. It showed a number of other rather disturbing features, but that was probably the worst abuse.

Surely we could learn from that and expect the ministry to now provide us, as a matter of course, with that annual report, as it might with reports of other agencies under the Ministry of Health, such as the forensic services division. Surely we're entitled to expect that and not to see — in some distant future under another government, no doubt — a watered down version of the report in an annual report of the ministry that will come out so late that nobody will even read it, let alone notice it.

If you were to attempt to make a comparison of the rather shocking and very disturbing facts and conclusions reported in the original version of that annual report to what had been reported in the three-page little summary in the previous annual reports of the ministry, there's no comparison. We don't know whether other reports were as juicy in previous years. But I'd like to ask why the minister won't just commit that when the Emergency Health Services Commission finishes its report, he will table it.

[4:15]

HON. MR. STRACHAN: Everything is going to be consolidated in the Ministry of Health report, and the information the member is seeking will be there.

MR. JONES: My colleagues, particularly those from rural communities, have done a superb job of representing the health care concerns in their communities and with their hospitals. But Id like to return to one we touched upon earlier, and that is the situation with Burnaby Hospital in Burnaby.

MR. KEMPF: He knows more about that than he knows about the rural communities.

MR. LOVICK: Behold, the volcano erupts!

MR. JONES: Wolfman Jack strikes again.

We're speaking, Mr. Chairman, of a community of 160,000 residents. Burnaby Hospital does not serve just Burnaby; it serves an area of east Vancouver as well, so it has a very large catchment area. We know cancer is a serious disease in our community, and I know the minister cares as much as any member about the problems associated with that dreadful disease. In a large population like that, one would expect a fairly large number of cancer patients.

It seems to me that in a very large community like that, one would expect there would be an out-patient cancer chemotherapy clinic in a very large hospital like Burnaby, serving a very large catchment area. My understanding is that Burnaby is certainly one of the largest hospitals not to have such a unit. Such a unit really dispenses drugs and other treatment but just happens to be in a hospital setting, and I suppose if there's a reaction to that treatment, hospital services are right there. My understanding is that the major cost of this operation is the drugs — that it is not an extremely expensive proposition to offer out-patient chemotherapy. I'm just wondering why Burnaby Hospital does not have an out-patient chemotherapy clinic.

The minister referred earlier to other treatment agencies in the lower mainland that I am sure do a marvellous job, but they are certainly not in the same proximity to the catchment area of Burnaby Hospital as Burnaby Hospital is. Why do we have a large community and a large metropolitan hospital that is one of the few not to have this kind of clinic?

HON. MR. STRACHAN: I'm just having the answer that I'm going to supply for you confirmed, but hospitals are autonomous legal bodies that decide on their own procedures. From what I'm advised, the reason they don't have a chemotherapy unit is that they've never asked for one.

MR. JONES: I'm surprised at the answer, because my understanding is that that was one of the priority items that the hospital desired. I hope when the information comes to the minister he will provide a further report or further evidence of that.

While we're waiting for that report, let me ask one further question of the minister, with respect to the CBC "The Journal" report on Burnaby Hospital which

[ Page 12840 ]

was repeated last night, a program that I think pointed out very clearly the kinds of funding problems and other problems that a large metropolitan hospital has. The program, shown across Canada by the most respected and reputable news journal television program, certainly in this country and perhaps in North America, the minister described as contrived, implying that the truth was distorted in that program, that the kinds of representations made by the "The Journal" crew were inaccurate representations of the facts of that hospital. I would ask the minister at this time to clarify the facts that he is aware of that were distorted, the kinds of representations there of the medical, health care and funding problems which exist in that hospital and that were misrepresented by the CBC "The Journal" program.

HON. MR. STRACHAN: I'll repeat what I said this morning. I watched this program last night, and it was contrived to look as though it happened within a 24-hour period. It took them two weeks to film that, and that's what I said this morning. They had to spend a lot of time getting every crisis right and condensing it to look like a one-day experience, when in fact filming did take two weeks.

MR. JONES: Again the minister used the word "contrived." Surely the minister appreciates that just showing a 20-minute clip from 20 minutes at Burnaby Hospital would not make for reasonable television, or an accurate reflection of the typical problems that exist at the hospital. Very clearly the minister understands that would not be television which would be informative to the general public, and that it was necessary for the film crew to spend some time at the hospital to put together a television program that reflected the problems which occur there. They could have spent a year there and had more wide-ranging problems depicted in the program. They didn't spend a year there. They spent a period of time there. The point I'd like to inquire about is: as the Minister of Health, are you aware of particular situations that were distorted by the CBC film crew?

HON. MR. STRACHAN: No, I'm not, and I didn't say that there were. What I did say was that I offered to the committee the information that it took two weeks to get this 20-minute — I think it was a little longer, actually — clip. I guess the member in his own argument admitted that 20 minutes at the hospital certainly isn't going to be very exciting. So to really condense all their problems into one 20-minute clip, they had to spend two weeks doing it — editing out the boring stuff and things that are mundane and working well and trying to find for 20 minutes some serious crisis problems, which I'm sure over a period of two weeks any hospital could provide to you. No, I make no comment about them finding something untoward or something they contrive in the sense of staging an emergency, a process or an unhappy event. I'm just telling the committee that the 20-minute show took two weeks to put together. I said that this morning, and I'll say it again, because that's what did happen.

While we're on the subject of Burnaby Hospital, I'll describe it briefly to the committee. It's a 386-acute-bed, 250-extended-bed hospital, which operates as a large community hospital. There is a full range of services, with many secondary services for Burnaby being provided in Vancouver. Over the past few years Burnaby Hospital has received major adjustments in its operating grant, and that goes as follows: in fiscal 1987-88 the hospital care grant was $41 million; in 1988-89 it went to $43 million; in 1989-90 to $48 million; and in 1990-91 to $53 million. So they've had good percentage increases. They are, respectively, over those four years, 9 percent, 6 percent, 11 percent and 10 percent.

We did an operational review by the hospital care division in 1988-89 and added a further base funding adjustment of $700,000. Burnaby Hospital will be undergoing its second review in this process. That review began in the middle of May 1991.

MR. JONES: Can the minister confirm that he still stands by his statement that there has been no request for an out-patient chemotherapy clinic?

HON. MR. STRACHAN: Let me respond to that again, before the member tries to imply something that I didn't say. I said that those of us sitting in the House right now are not aware of the application for chemotherapy services. But as the member will note, one of the staff people has returned now; maybe we can provide that information to the member. I'd also like to point out that Burnaby does not face the same population pressures that we are currently experiencing in the Fraser Valley.

MR. JONES: I wasn't really clear on what the minister said in his last sentence with respect to the out-patient chemotherapy clinic.

HON. MR. STRACHAN: I said that Burnaby Hospital does not face the same population pressures as the hospitals located in the Fraser Valley.

Now here is the word on the chemotherapy unit. Within the last couple of months we received a proposal from the B.C. Cancer Agency and Burnaby Hospital, along with Cancer Agency proposals for Nanaimo and Richmond, for chemotherapy units.... I can't read the writing; it's probably handwritten by some doctor. In any event, the proposal is under review and is likely to be approved. So we have recently, as I've said, received those proposals from the B.C. Cancer Agency for Burnaby, Nanaimo and Richmond.

[4:30]

MR. PERRY: Back to the Burnaby Hospital situation. I've been searching through my files. I had it here the other day, and I can't seem to lay my fingers on it, so I'll have to go from memory. There it is.

I want to ask the minister about his response to the coroner's report on the case of Stan Roberts, which was featured, among others, on CBC's "The Journal" last night. I'm still thumbing through here. I had it right to

[ Page 12841 ]

hand the other day, but I remember enough about the case that if I can't lay my hands on it all, I'll rely on my memory.

The case concerned, as it happened, a prominent British Columbian who we know now from an autopsy died of a brain abscess, an infection deep in his brain, a condition that might have been treatable had he received timely therapy. He did not receive the timely therapy that he ought to have received.

This man, who was in his mid-sixties, was found by his family apparently confused and slumped over the steering-wheel of his car, not quite sure what to do. They recognized that something was terribly wrong, and they took him to Burnaby Hospital, the closest hospital. He was well treated there in the emergency department. A serious problem was immediately recognized by the physicians in that department, and he received a timely CT scan. It was recommended that he receive a stereotactic biopsy, a procedure which at that time could only be done at Vancouver General Hospital. For complicated reasons, the biopsy was never achieved. In the meantime, the coroner's report made that clear, and since I can't unearth it right now I'll have to go from memory. If memory serves me correctly, Mr. Roberts, in critical condition, spent about three days in the emergency department at the Burnaby Hospital. Although he technically might have and probably did receive adequate medical care to the extent it could be provided in that hospital, it was clearly a very unfortunate situation for both Mr. Roberts and his family, and one which none of us would want to see repeated.

One of the recommendations of the coroner's report was that that situation be reviewed, and I raise it now. What action has the ministry taken in response to that report by Coroner Cave?

One of the recommendations, as I recall, was that the emergency room situation at Burnaby Hospital be reviewed. The coroner stated that the hospital was one of the hardest-pressed hospitals in the province. Regardless of what the population statistics in the possession of the ministry show, that hospital has an extremely high demand placed on it, which it has had great difficulty meeting. There have been other cases less serious brought to public attention. This was, I hope, the most serious and the most unfortunate case in the hospital's history, and hopefully it will not be repeated.

I'd like to remind the minister that there has been an ongoing record of problems at Burnaby Hospital due to the chronic overload there, and that the coroner drew that to the ministry's attention some months ago. I'd like to ask: what was the ministry's response to that report? While we're on it, in a broader context, what steps has the ministry taken to respond to the other recommendations of the coroner's report in the Stan Roberts case?

HON. MR. STRACHAN: The coroner's report is being reviewed by the ministry now; also by Vancouver General Hospital. We also understand — we don't have this confirmed yet, but I am going to leave it at that anyway — that this issue may be before the courts, in which case it would make it sub judice for me to continue further discussion. Even if it isn't, I'm not going to continue discussion on this issue until I've had a chance to fully review the coroner's report and the actions taken by this ministry and maybe seek some other advice from officials in government.

MR. PERRY: Forgive me, Mr. Chair, but is the minister saying that he has not read and reviewed the coroner's report? Again, I had it with me for several days, and because of the adjournments of the debates, I've probably left it in my office. It was brought to my attention. I read it very carefully several months ago, and I read it again carefully in preparation for these estimates last week, because the question was crucial. It reflected not only on the government's responsibility to provide services in a timely way but on the question of whether doctors are doing all in their power to ensure adequate treatment of emergencies. It reflected on the question of whether hospital administrators — in this case particularly at Vancouver General — had done everything in their power, and it also reflected with major implications on the question of what steps institutions take when a health catastrophe like this happens to ensure that it's not repeated. After all, in our democratic system, that is the purpose of coroners' inquests.

That's why, when the family of Mr. Roberts asked for my advice on this case, I encouraged them not to go to the courts, but to go to the coroner and if necessary ask for an inquest, and why I advised them, upon receipt of the coroner's report, that an inquest by jury was not in fact necessary, because the coroner's report made some very important recommendations. So I would find it astounding if the minister is telling us he has not read that report, or that his ministry has not completed its study. I think that is shocking.

[Mr. Ree in the chair.]

HON. MR. STRACHAN: The member is entitled to his own opinion. I can advise the committee that I have not read that report on Stan Roberts. It happened some time before my coming into this ministry. I've read others, but not that one. I am advised that the staff are looking at it, and that's all I'm prepared to say about this issue at this time.

MR. PERRY: I'm really troubled by this. Mr. Kim Roberts took that case to the Royal Commission on Health Care in January. He submitted himself to the very trying experience of describing his father's case through a grilling by two of the commissioners, including the chairman. There was no hesitation to discuss the issues that arose out of the case by the Royal Commission on Health Care.

Last year in this House we discussed the case of Mary Sallis, which also occurred at Vancouver General Hospital and raised similar questions of whether the hospital — and for that matter the provincial health system — was capable of responding in a timely and effective way to emergency conditions. This has been a major problem in this province, one that has preoccupied

[ Page 12842 ]

the public and frankly frightened a lot of people. It is not some trivial issue. Maybe the public is suffering the effects of the revolving-door syndrome — that "Fifty-four-forty or Fight, " or 42-50 or whatever it was — because the Social Credit government has been unable to maintain a consistent Minister of Health over the last five years.

I realize it's a difficult portfolio. It's difficult, if not impossible, for the minister to master it in the month that he's had. But if the minister hasn't studied that report as a priority, surely his officials should have a comprehensive position by this point as to how they would respond to the coroner's report, given that it specifically recommended that initiatives be undertaken by the ministry to ensure that hospitals do not repeat that experience. What would have been the point of Mr. Kim Roberts, Mrs. Roberts and the other children exposing their family to the experience of describing what happened to their father in public if the ministry was not prepared to act on those matters?

I would hope very sincerely — and let it be said in public — that the hospitals have acted independently on the basis of that report, and acted long before the report was prepared. It was disappointing to find out they hadn't acted immediately after the death of either Mrs. Sallis or Mr. Roberts. It was disappointing to know that Vancouver General Hospital was not even aware that Mr. Roberts had died while he was awaiting an urgent biopsy at their facility. Nobody even knew. That revealed a fundamental flaw in the feedback of good medical care.

It would be unconscionable if hospitals have not responded to the public reports of those and other cases. It would be unconscionable if departments — for example, the department of neurosurgery or the department of surgery or the medical staff at the Burnaby Hospital — have not reviewed that experience to ensure that it will not be repeated. It's equally unconscionable if the Ministry of Health does not have a position and has not acted. With respect, Mr. Chairman, I don't think it's good enough for the minister to tell us that he has not seen the report. If he hasn't seen it in the month he's had — given that he's fighting for his political life as well as that of his government; I can understand that — surely his staff can inform him of what steps they've taken to ensure that that tragedy won't be repeated.

HON. MR. STRACHAN: The member has indicated this is not a trivial issue, and it makes my point. I'm not going to discuss it in this political context. It is being reviewed by the medical vice-president of VGH; it has been reviewed by the staff; and I'm having a copy of it sent to me now. But I am not going to comment further — probably at all — during this debate, because as the second member for Vancouver-Point Grey accurately points out: "This is not a trivial issue." I am not going to take a position on this issue and that tragic circumstance during this debate. If the member wants to discuss the administrative responsibilities of this ministry, I will. If he wants to discuss the tragic situation of Mr. Roberts at VGH, it will have to take place in another forum.

MR. PERRY: I appreciate the forbearance of my colleague from Port Alberni who has been waiting to participate, but I want to bring one further issue to the attention of the minister regarding Burnaby Hospital. In a letter I received last December from an obstetrician and gynecologist, Dr. H. Ewart Woolley, he points out that: "I feel there's little point in communicating with the present incumbent since operation of the Ministry of Health appears to have been taken over by the Minister of Finance." That was under the former minister who now is the Minister of Finance. Maybe Dr. Woolley would feel it's now more worthwhile communicating directly. But he asked me to raise this in the Legislature.

He raises another example of people in real life — not just on CBC's "The Journal" program — having difficulty. He gives an example:

"I write to bring to your attention the situation which exists at Burnaby Hospital, especially as it applies to patients coming to hospital for either emergency or for short-stay surgery. At present, the emergency patients — i.e., those with proven cancer demonstrated by office biopsy — are waiting between three and four weeks to enter the hospital and sometimes even longer."

That may or may not — depending on the case — be an inordinate wait. If it's a slow-growing type of cancer, sometimes that may not be unreasonable. But any member can imagine that it's traumatic for someone who's been told they have cancer to wait three or four weeks for surgery. Even when the medical evidence suggests it doesn't make a difference, it's very difficult emotionally for people.

I quote again: "Patients in this category are those suffering from post-menopausal bleeding where a biopsy demonstrates an adenocarcinoma." That means a cancer. Definitive treatment is a hysterectomy with radiation treatment. These same patients who require a hysterectomy and radiation treatment are routinely waiting three to four weeks after their diagnosis has been confirmed.

I quote again:

"A much larger category is of patients who are having day-of-surgery procedures, such as D and C, tubal coagulation, laparoscopy for pelvic pain, or endometriosis where the waiting-list is now between six and seven months and increasing at about one week every six months."

This is evidence that the waiting-list for people requiring standard treatment is growing, in fact. That was as of December 7, 1990.

I would like to leave that with the minister to assure him that it's not just the member for Burnaby North or CBC's "The Journal" that are concerned about problems in Burnaby. There are real problems there. Of course, solutions aren't easy, but to dismiss them as something that was fabricated by telescoping two weeks into 40 minutes — is just not realistic.

[4:45]

HON. MR. STRACHAN: I want to make one comment. I've now had more of an update on the chemotherapy request from Burnaby Hospital. We received the revised version in January, so it has been more than

[ Page 12843 ]

two months. The original was submitted a year ago. This is where you would have that information. But that requires the B.C. Cancer Agency's input, and it requires input and reworking before we would accept it as a ministry. I am sure the member is aware of that. The B.C. Cancer Agency is the lead agency in terms of the provision of these types of services.

By the way, I was there the other day and the work that they do really is remarkable. It's one of the best agencies of its kind in Canada, I'm advised. As a matter of fact, there's nothing like it on a provincial basis anywhere else in Canada.

So the proposal is currently being reviewed by the B.C. Cancer Agency, and then it will come to us. As I indicated earlier, we are considering Nanaimo and Richmond as well. But it is not the purview of the Ministry of Health to vet these chemotherapy or other cancer treatment proposals. In fact, it is with the B.C. Cancer Agency, and that is in place now.

MR. G. JANSSEN: Back to the rural areas. Every rural area in British Columbia experiences some unique problems compared to those of the downtown, lower mainland areas where you may have waiting-lists, but at least you can get to a hospital within probably half an hour from any spot in the lower mainland area or the Victoria area.

In rural areas such as the west coast — the Long Beach-Ucluelet-Tofino-Clayoquot Sound area — they have a hospital, so the problem is acquiring a new hospital. It's a hospital that was built by the community in 1952. Being isolated, the communities have learned to rely on themselves and provide their own services. They have learned to depend on the neighbourhood function that existed so many years ago — even in urban areas, which I think to some degree has now disappeared. You have areas where people have lived in apartments for many years, and they don't even know their neighbours. That's not the case, of course, in communities such as Tofino, Long Beach and Ucluelet.

As recently as February they had a healthy community gathering, as they called it, and discussed some of the needs that they had. They presently have a 21-bed facility. Because of the advancement in the outlying native communities on the west coast that have developed their own health care systems, they no longer rely as heavily as they used to on the Tofino hospital, so that hospital, to a degree, is underutilized. There have been reviews done and people from the ministry have come in and suggested that perhaps that hospital is no longer needed. With the 37 percent or 40 percent occupancy rate of that hospital, the community recognizes that the hospital is underutilized. So they had a healthy community gathering and came up with a number of recommendations and identified some needs, such as long-term care services, mental health, crisis lines and so forth.

Some two years ago they requested some funding for a complete needs assessment, and they've requested it again and again, so they can start the initiation of a comprehensive health organization. If a new facility has to be built, by the ministry's own directives, this needs assessment must be done. They fully recognize that the present hospital is underutilized. It's an old physical plant, an old steam plant. It's hard to modify a concrete building; I recognize that and they recognize it. There's an operating room that's not utilized. They have radiology facilities but nobody to read the x-rays, The nursery is not utilized. Many problems.

All that the Tofino hospital board would like is a few dollars to do the needs assessment so they can identify where the community needs to go. For two years they've been requesting this funding, and the ministry keeps coming back saying: "You know, we may close your hospital, because it's underutilized."

In order to make the decision, Mr. Minister, all I'm really asking is that in these estimates and in this year's funding for your ministry you approve the funding for a needs assessment so that the communities of Tofino, Ucluelet, Long Beach and the west coast area in general can get on with planning their health needs.

HON. MR. STRACHAN: I'd like to spin this out, but I won't. I'll save you the pain. I've just been advised that there's a letter in the mail to you from me, and the answer is yes, the planning funding approval is in place.

MR. G. JANSSEN: Thank you, Mr. Minister — very timely indeed. The cheque's in the mail. I appreciate that.

I'd also like to raise the issue of the hospital in Port Alberni, which is going to have to reduce its facilities by some 18 beds — and that's only to start. I'd just like to bring to the minister's attention some comments that the former Health minister, the Minister of Finance, made yesterday in the House. I read from Hansard. When we were debating Bill 3, he said: "Is it to pay for the expansion of the hospital in his own community?" — referring to Port Alberni at the time. "Yes, absolutely. It's to pay for the expansion of the hospital in his own community."

Now I would imagine the Minister of Health recognizes immediately what the question will be: will the shortfall of some $644,430 in Port Alberni be authorized by the Minister of Finance as per his comment yesterday?

HON. MR. STRACHAN: If you're asking me if we pick up deficits, the answer is no.

MR. G. JANSSEN: I gather the Finance minister was a little lucid and a little quick to remark yesterday

There will indeed be a deficit of $644,430. The West Coast General Hospital will receive an increase of 5.66 percent for the '91-92 year. Yes, you go on to explain that these are difficult economic times. However, in the breakdown of that 5.66 percent, there is a provision of 3.75 percent for union contract salary increases, and the remaining 1.91 percent in that generous allocation must cover salary benefit costs, costs related to federal and provincial government decisions, GST, CPP, UI, pay equity and the inflation increases for supplies. After that is done the minister can see the obvious

[ Page 12844 ]

shortfall in funding. So even though the increase is 5.66 percent, in a community with an industrial base, a community that wants to deliver health care to its members, the minister has come short again in the funding allocation. Beds will be closed; services will be cut. The closing of 18 beds will not cover a $650,000 shortfall. More cuts will have to be made.

We already heard that Tofino General Hospital may possibly be closed. That will again impact West Coast General Hospital, as those people who are no longer able to access the Tofino hospital will be transported into the Alberni area. If that hospital facility does not have the space, so to speak, they will then be transferred on to Nanaimo, and if I understand the member for Nanaimo correctly, there are also lineups at that hospital. So we end up similar to Vancouver, where people are transported from hospital to hospital in short 15-minute or half-hour drives. We end up in two-and-a-half-hour transportation runs between hospitals in order for people to get adequate health care.

I know that the ministry doesn't have a bottomless pit to draw from. However, West Coast General Hospital has served the community of Alberni well. They have an active women's auxiliary, a hospital club and donations from the corporation there, from businesses, from the labour council and from individuals to try and keep the health services in that community up to a standard that has been enjoyed in previous years. By this ministry's decision to limit funding and not allow that hospital to run a deficit, it is saying to the residents of Alberni: you will receive less-than-adequate health care.

What I'm asking the minister to do is take that second look that W.A.C. Bennett was so famous for and provide the necessary health care in that community and bring the funding up to a level which will provide adequate health care.

HON. MR. STRACHAN: I'm sure the member is aware, as are all other members, that government revenues are down this year. In spite of that, this Ministry of Health received the largest budget increase of any ministry in government — over 12 percent. We've tried to be as equitable as we can in spreading the money throughout the system and providing the best possible health care services that we can, given the allotted funding.

In the case of Port Alberni, they have been given a lift which is 3.5 percent for inflation and 4.1 percent for wages and benefits. The government cap for wages and benefits is 3.75 percent, and there's a little inflationary lift on top of that.

We have also encouraged various community health organizations in Alberni, where we want to bring all services together, and this should answer at least part of the member's questions about people going to Nanaimo or other places. We want to encourage the community to be more comprehensive in their delivery of services to the people in the area, and we are providing regional funding for that. So we do recognize that we can become more innovative and more efficient in Port Alberni.

I recognize the member's concern. I would encourage him to ask his hospital board and hospital administrators to discuss their budget with the regional team, and there may be some good advice or remedies there that we can provide. We've agonized over the budget, and we are attempting throughout the province to bring to the people of British Columbia the best possible health care that we can — recognizing of course that we have to remain a responsible government and that there is a limit on the amount of revenue available to us.

[5:00]

MR. G. JANSSEN: Two years ago the health needs of Alberni Valley were identified, and the board recruited a second surgeon and an obstetrician-gynecologist. This year the underfunding of actual cost is compounded by the minister's refusal to provide sufficient funds to support the services of those two specialists. So the need was identified two years ago that more specialists were needed in the Alberni area — rather than sending people out on long waiting-lists to other hospitals. The need was identified, and two specialists were hired. This year the Health ministry says: "Sorry, but you can't afford those. We can't afford them, and therefore they won't be funded." In the past year the board has been forced to cut services in occupational therapy, dietitian counselling, mental health and physiotherapy in an attempt to meet the government's directive — or decree, as you might call it — to come in at non-deficit funding. The minister can say that they can work together, that the board can review, that things can go on and that the amount of money is limited. But the actual fact here is where the health dollars are directed and how they are utilized.

I notice you're going to build a new hospital — 75 beds and $5 million or $6 million — in Qualicum. The people of Qualicum have been waiting for this facility for some time. As you know, it is just half an hour's drive over that famous hill to Qualicum from Port Alberni. What those people should be asking themselves in Qualicum — and maybe the minister can expound on this — is whether, after that facility is built, they will actually receive the dollars with which to operate it? New buildings make great headlines. And I realize that the minister may get his picture on the front page; you don't get that when you hand out the dollars that are necessary to keep those hospitals operating. But after that facility is built, can it be guaranteed that every bed in that hospital, and all the services that are necessary there, will actually be funded? That is not the case in Port Alberni or Nanaimo, and it's not the case in other hospitals.

So it's great to have capital expenditure going up, and for the minister to stand up in this House and say: "We have allocated more and more funds to help your system." It's the direction and the placement of those funds that we are discussing here. If you had three apartments in a building empty on a continuous basis, would you build a new apartment next door? Of course you wouldn't. This is the problem that's being faced by the Ministry of Health. They keep opening up new facilities when they can't afford to operate the

[ Page 12845 ]

ones they've got. They say that they don't have the funding. The Health ministry is funding a political agenda so they can get their pictures in the paper to win those ridings that don't have hospitals. It's not an agenda that addresses the real health needs of the people of this province.

HON. MR. STRACHAN: I can assure the member that when we apply capital dollars to a capital project, we naturally take into account that it's going to require operating funding as well. That will be taken care of. Just to set the record straight, the facility that's going to be put in place at Qualicum-Parksville is a multilevel facility There may be a requirement there for acute-care beds, but we certainly are not building one empty apartment next to another empty apartment, to use the member's analogy. That clearly wouldn't be correct.

I want to point out that the member asked: "Would you fund every bed in a multilevel facility?" Maybe yes, maybe no. The member should be aware, if he has listened to these debates for the last week or two, that we look at the facility and have a regional team understand its budget and the amount of use it's going to get, and we fund for what we expect to be the anticipated use, which sometimes isn't every bed — at least not on a regular basis 365 days of the year.

Just to conclude with respect to the hospital at Port Alberni: they are claiming that there is underfunding in terms of the grant to West Coast General Hospital, which is its name. But the grant this year amounts to $12,019,495, which is the highest grant per capita in the peer group of that hospital. It is doing very well compared to its peers in that range of funding.

MR. PERRY: I'd like to go back to the pot-pourri, and I will attempt, if the minister will do the same, to be a little more succinct than I've been so far, in order to cover a number of issues somewhat more rapidly. I admit to having been trained as an academic, and all of my training was to take as much time as possible to say as little as possible. In this forum, where every word counts, I have been trying to learn. I will do my best.

Last year in the estimates on July 25, I think — I don't have the page with me today — I referred to a letter from Dr. Romayne Gallagher of Vancouver. She's a physician who's active in Physicians for Life and is a very strong opponent of abortion on ethical grounds, but recognizes the complexity of the reproductive-health-and-freedom issue. She wrote to me, in an exchange of correspondence, with some suggestions for how to improve birth control counselling to young British Columbians. She had some very interesting ideas, which I read out to the former Minister of Health at the time. Although the printed record doesn't show it, the members who were here and were listening avidly at the time will remember that the former Minister of Health indicated he would be pleased to meet Dr. Gallagher and explore the issue further.

She wrote to me on February 25 to point out that she had received a letter from the former minister on January 31, 1991, commending her an the articulate description of problems. It stated: "Thank you for suggesting we might meet to discuss the material you presented in your letter. Regrettably my schedule will not permit a meeting at this time." I wonder whether the new minister might consider meeting Dr. Gallagher, because she does have a lot to say. She's a very fine physician and is rooted in the community. I think the ministry could learn from her. I know that she was offended, because I assured her that the former minister had specifically stated he would be glad to meet her. I conveyed that to her in a letter with the extract from Hansard where we discussed those relevant matters, and she was then rebuffed. I leave it with the minister as a suggestion. For convenience, the file number, January 31, 1991, from the former minister to Dr. Gallagher, is M001856.

Another matter. I revert to the question of the assistive devices task force we discussed last week. I have a few quick points and some questions. The chair of the assistive devices task force — the force formed at the behest of the Ministry of Health to come up with solutions for the problems of people with severe disabilities who could communicate more effectively with relatively advanced technology such as a computer.... That committee has complained over and over again that they submitted their report two years ago and that essentially nothing has happened.

I note that in a letter last fall they also requested me to attempt to secure from the government a copy of a report, which is of great interest to people in the field of provisional services to the disabled, by Mr. Blair Richardson of the services-to-the-handicapped division, Ministry of Health, Victoria, B.C., dated March 1987. It's entitled: "A Report on the Provision of Medical Equipment and Supplies to the Chronically Ill and Disabled Population in British Columbia." The irony is that Mr. Don Allen, chair of the ADP task force, thanks me in his letter for the loan of this report which I had obtained, but the people with the greatest stake in the report — those who work in this field — have not been able to obtain it from the ministry. In a meeting last fall, they told me that the ministry refused to release it to them. I wonder if the minister could commit to formally providing this report to the public so that those who have copies of the purloined copy will know that it's the real thing.

Finally on that issue, let me give an example, if I may, of how much frustration over the lack of action there is in that disabled community and with the professionals who are trying to serve them well. I think of a presentation made by Mr. Karl Perrin, a speech and language pathologist of the community support team in Vancouver, to the community services task team hearings of the Premier's Advisory Council for Persons with Disabilities in late January. I happened to be in the audience, sitting in on part of that task team hearing, and I listened to his presentation about the need for communication aids. He sent me a file of copies of letters from the assistant deputy minister of job training, apprenticeship and labour market policy in the Ministry of Advanced Education, Training and Technology, pointing out that the assistant deputy minister's steering committee on disability issues was reviewing the assistive devices task force report. He

[ Page 12846 ]

sent me copies of letters from the second member for Vancouver-Little Mountain supporting the concept. That member had written to Mrs. Joyce Ganong of the Ministry of Advanced Education, Training and Technology, saying: "Please be advised I've read the above report and found it to be very well done. I would like to offer my full support of an early implementation of the report's recommendations." That was last October.

The then Premier pointed out, in a letter of October 25, 1990, that the matter was under study. The Minister of Health, in a letter to me of December 5, pointed out that the matter was under study. It's been under study for two years or so since that report was turned in. So far, virtually nothing has happened.

Let me give you an example of what this means in real life. Most of the disabled people who are actually the victims, if I can say it, of the delay in action, don't want to have their privacy violated. Many of them are actually afraid of recrimination if they were to take their case public. I've tried to contact a number who were reluctant to have their case described here because they were afraid of what might happen to them. I have tried to reassure them that they should not be afraid, but that's how they feel.

Here's an example. I'll read a letter from someone involved in this field:

"A third client was able to purchase some equipment through the Ministry of Advanced Education. Unfortunately, she was not given all the funds requested, so she was not able to pay for a full assessment. She was also not able to pay for the equipment to mount her computer to her wheelchair, nor was she able to pay for instruction or servicing of the equipment.

"Can you imagine the government buying computers for their office use without consultation on the best system to meet their needs?"

I imagine some of the more experienced members here can imagine the government doing that, but the public thinks we operate more efficiently; at least there is still one member of the public who does.

"How about buying computers with no work stations? How about buying computers and having every civil servant figure out on their own how to make it work?"

Maybe that is what happens.

"Where would we be if every time the computer didn't work we had no one to turn to for help?"

Although I won't mention them here, I've been given a number of other poignant examples where the equipment purchased was wrong for the person in question. The Ministry of Health or Social Services or Advanced Education, as the case might be, expended let's say $3,000 for the purchase of a computer which doesn't work for that disabled person.

[5:15]

There is a proposal here to have an integrated service with a multidisciplinary team that will tailor the equipment to the real needs of the person. The interministry committee appears to think it's effective, from what I've heard. The letter from the minister to me of last December says: "We're just trying to make sure we don't duplicate existing community support mechanisms." But the testimony to the royal commission made clear that the existing community support mechanisms leave some people out in the cold. Many of the voluntary and charitable support groups are saying that they're sick and tired of always being called upon to come up with needs that rightly should be met out of public funds.

I'd like to very politely put a little bit of heat on the minister and ask if we will see some action.

[Mr. De Jong in the chair.]

HON. MR. STRACHAN: The member and I agreed earlier that we would make this — I presume concluding — session brief. Brevity is the soul of wit, so here we go. The answer to the questions are yes and maybe.

Let me provide a bit more than that. With respect to Dr. Gallagher, I'll review that letter. I presume Dr. Gallagher practises in Vancouver. I make it a habit, Mr. Member, on my travel down to spend Monday morning in Vancouver visiting various people. I’ve been to the Cancer Control Agency, Royal Columbian, B.C. Research and the Rafe Mair show, just to name a couple in the last few weeks. So I will look at that and I will endeavour to visit with Dr. Gallagher at your request.

In terms of assisting devices, the committee was put into place. They submitted a report, and Joyce Ganong or one of the committee members brought to government the evidence that the report didn't include all the assisting devices that handicapped people need to carry out a far better lifestyle. Apparently the first report dealt primarily with communication devices, which are important, but there was quite a bit more information needed. So a second report has been done. My understanding is that it goes to the deputies' committee tomorrow or within the next week, and then it will come up to the Cabinet Committee on Social Policy and we will take it from there.

As the member has identified in the correspondence he introduced to the committee today, Joyce Ganong, the Assistant Deputy Minister of Advanced Education, Training and Technology, is looking into this issue, as it's the rehab side of that ministry that is most vitally concerned with it. Joyce is a very competent person. As you know, I was in that ministry for some time. I believe we will have a first-class report, and we should be seeing that as a cabinet shortly.

MR. PERRY: Let me raise another issue that we haven't yet discussed: the problems of the traumatically head-injured of British Columbia.

I confess to having only the barest of acquaintance with this issue, although I've been thinking about it since some of the organizations involved have come to see me. Thinking back, I recognize that probably people with traumatic brain injury have been in my presence and I never recognized the phenomenon — which is a symptom, I think, of a broader phenomenon. The experience of traumatic brain injury is not very well understood yet in British Columbia. It's received some attention in the last few years, but it's an area where we are struggling to catch up, perhaps to where we might have been a few years earlier.

[ Page 12847 ]

There are some very disturbing statistics presented by the British Columbia Head Injury Association. Again, I refer to their brief to the royal commission, dated October 24, 1990, because it, like some other briefs to that royal commission, neatly distills and synthesizes a lot of complex information.

One of the first points I'd like to make is that the Head Injury Association suggests that there might be as many as 6,000 new cases per year in British Columbia, of which 400 to 600 will require lifetime support of varying degrees. Those are the figures given in the brief. When they brought those figures to my attention, I thought for a minute and looked the representatives of the Head Injury Association straight in the eye and said: "I don't believe it; or at least if it's true, I'm shocked." The answer must lie in prevention first and rehabilitation as a secondary priority, because if the figures are really that big, we have a lot bigger problem in British Columbia than we've ever understood.

That's not to belittle in any way the rehabilitation needs but to raise the significance of that figure. I have great difficulty accepting it; and it turns out that that figure is based by the Head Injury Association on estimates made in Ontario, I believe, based on American data.

Does the Ministry of Health have any understanding, in keeping with the recommendation made to the Royal Commission last October...? I'll quote: "...a project to identify those persons having a primary or secondary diagnosis of traumatic brain injuries, which should be launched immediately by the Ministry of Health." That strikes me as the first priority: to know what the scope of the problem is. Do we have anything ongoing?

HON. MR. STRACHAN: First of all, I recognize clearly the problem that the member addresses; as a matter of fact, in a former vocation I worked with disabled people. Two clients of mine had severe head injuries — one from a car accident and one from an accident with a gun — and exhibited serious behaviour problems and other concerns that are quite often the result of this type of head injury So I'm well aware of the severity of the concern and what a tragic change it does make to a person's lifestyle.

Let me also say.... I was just thinking of this now that I think the Canadian Medical Association is funding up to 40 percent of the cost of bicycle helmets. Is that correct? I think that's remarkable, because that is a very good initiative, and the more awareness programs we can put in place — not only bicycle helmets but other helmets used in sports and buckling up and buying cars with airbags — and the more awareness we can have in place to avoid this type of injury, the better off we are. In any event, back to business here.

We have identified $2.038 million in our current budget to address the issues of a comprehensive program and community-based supports for survivors of serious head injuries. There is a variety of services, which include individual residential services, group residential services, regional coordinators, life skills programs, special groups and support groups. In terms of a population spread, Mr. Member, 36 percent of the funding would go to the Vancouver area, 32 percent to the Island region, 20 percent to the Okanagan and about 10 percent to the north. Again, that pretty well reflects population. That is our program to date.

With this briefing note I can't give you more specific services, but we do identify the problem. We want to ensure in every way, whether it's through seatbelt legislation, which this government introduced in 1977, or encouraging awareness of the problem, or providing services after an individual has suffered a serious head injury.... We see this as a very serious concern. It is my position that we should encourage whatever we can: first of all, an awareness program, so we can maybe cut down on the amount of head injuries; and secondly, once we have survivors of serious head injuries, programs that will allow them to function as best they can in the community.

MR. PERRY: It wasn't clear from that whether there was an answer as to when we might expect some statistical information on the true frequency of both serious and more minor head injuries. We're both primarily concerned with serious head injuries.

The second question is just to amplify on the answer: can the minister tell us whether any new transition homes for people discharged from rehabilitation centres, or any new regional units for the rehabilitation for people suffering traumatic brain injury, will be established in the current fiscal year?

HON. MR. STRACHAN: First of all, back to the member's first question about statistics. The reason I didn't answer it is that the member himself, in a briefing note he had read to the committee, did identify the seriousness of the concern in terms of numbers, and it's this. I will just repeat what the member said. Each year an estimated 4,400 to 6,400 persons in British Columbia receive head injuries serious enough to warrant hospitalization, and 400 of these individuals — in other words, a little under 10 percent depending on the injuries per year — suffer severe permanent disabilities. Survivors of head injuries have very specific psychological, physical and rehabilitative needs, and we all know that.

In terms of programs this year, Mr. Member, I'm advised that we do not have money allocated for specific capital construction for group homes or other facilities to accommodate people with these types of injuries.

MR. PERRY: Again, I'm just seeking some clarification. Do the figures quoted by the minister represent acceptance by the ministry that the estimates based on other jurisdictions are likely to be accurate? Or are they actual British Columbia information? I have stated that I'm — I suppose by nature — skeptical, and I find the figures so large and so frightening that I'm naturally inclined to be skeptical of them. It would be useful to know for sure if this information comes from hospital discharge diagnoses, from MSP diagnoses or only from

[ Page 12848 ]

an extrapolation from another jurisdiction, in which case it may or may not be accurate.

HON. MR. STRACHAN: Extrapolated information, Mr. Member.

MR. PERRY: Okay. I would just express the hope that maybe we can get our own data, because I think the implications are real. For example, if we have 400 or 600 serious head injuries requiring long-term rehabilitation each year, we want to know where the majority of those are and where the preventable ones are. If they're in bicycle injuries, for example, clearly we want legislation mandating the sale of bicycle helmets with bicycles or even the compulsory wearing of bicycle helmets if the statistics are that high. If they're coming from motor vehicle injuries, we need to know if there is anything we can do in a preventive mode in terms of automobile design requirements. If they're coming from assault, then clearly the answer might lie elsewhere. I think that's very important — not just to have the extrapolated evidence.

Similarly, I just want to note the point that the community of people suffering from head injuries and their families are very concerned that there be additional facilities and are alarmed that facilities are not keeping up with the real needs of people. Because people with head injuries appear even to health professionals to have problems similar to those of people with a mental disability or psychiatric disease, they often end up in an inappropriate environment — which might seem appropriate to the relatively inexperienced health professional, but to the person who has suffered that injury it's not appropriate at all.

I promised to yield to the member for New Westminster. I just want to again raise notice that I'd like to come back later to the questions on midwifery which I raised yesterday. For various reasons, we didn't get to them today, so I would like to return to those at a later moment.

MS. A. HAGEN: As I enter this debate there are a large number of issues that I might choose to address because I live in a constituency where we have a lot of very significant health institutions. However, I want to concentrate most of my inquiries to the minister around areas of concern to seniors and disabled people.

[5:30]

I'd like to begin by asking the minister a few questions about the Seniors' Advisory Council, which I think is just finishing its first year as an advisory body to the Ministry of Health and to government on seniors policy. It's interesting that the legislation setting up this body was passed two years ago; government waited almost a year, if I recall, before the committee was first established. Since that time a number of members have been added with the intent of making that group more representative.

Perhaps the minister could give us a bit of an overview of the work of this committee. How many members currently sit on the committee? Originally there were 14 members plus a chair mandated in the legislation. I'd like some information about the resources available to the committee and the budget for the office for seniors, seniors' secretariat and Seniors' Advisory Council — just some perspective from the minister on how this committee is working; but particularly because we are debating estimates and dealing with the budget, I would like to have some concrete information about what resources are available.

I note the minister is checking in his estimates book. The only reference I found to the office is under "Continuing Care Services" and there is a reference — it's on page 140 — which notes that, under the continuing care budget is the office for seniors and support for the secretariat for the Seniors' Advisory Council.

I hope in my comments I've given the minister and his officials enough time to find some of that information. It's a small part of this very large ministry, but a section of the ministry that is very important and that has some potential to do some very good work.

HON. MR. STRACHAN: I'll provide some of the data. The budget is $300,000; it has four FTEs, in terms of support. At the outset, in my first glance at this and in my first correspondence, I noted with some genuine interest that Dr. Howard Petch is the chairman. Of course, the committee will understand that Dr. Howard Petch is a hero of mine, again from another movie. Anything that he does will be done in a first-class manner. I wanted to have that on the record, because I think that with Howard Petch there, the affairs of this office for seniors are going to go very well. As the Minister Responsible for Seniors, I'm pleased to see that we have such an excellent person at the helm.

Briefly, to describe the program, it coordinates policy and program developments for seniors' programs within government. It liaises with all ministries, government agencies and the federal government with respect to seniors' services. It liaises with major seniors' organizations and professional groups throughout the province, and prepares correspondence, briefing notes and infobacks, conducting research projects on special issues for the ministry. Essentially, its goals are to improve the life of seniors in all areas and to ensure that the needs of seniors — I think this is most critical; I think a lot of times we make the wrong assumption about what seniors want — are understood and reflected in government policies and programs.

I guess that if there is one thing I would underscore, as the minister with that responsibility, it would be that last item. I think the member and other members would agree with me, because I think governments act far too often without really understanding why they're acting or what they ought to be doing in terms of meeting the needs of the various groups they are trying to provide services to or for.

I welcome further comments, and I assure the member and other members of the committee that this service for seniors has my total endorsement. I'm pleased to see that we have such a council.

MS. A. HAGEN: Could you give us some indication of how seniors know that the council exists and what their access to it may be? What is — I guess, in the

[ Page 12849 ]

language we use — the communication strategy, the promotion strategy, the means by which seniors are encouraged to use the council to influence the policy of government?

Perhaps in those comments the minister could tell us how many people are on the council, how often it meets and whether it meets regionally. I know it has had a recent regional meeting in Kelowna. As the opposition spokesperson on seniors, I know about that serendipitously; I have had nothing cross my desk that tells me about the work of this body. I should be part of the network, as any number of organizations should be, to be aware of the initiatives that the Seniors' Advisory Council may be taking in carrying out its mandate of communicating with seniors, receiving representations from seniors, and then influencing the policy of government around issues of importance to older people in the community.

HON. MR. STRACHAN: There are 18 members on the board, to answer that question. They meet on a regular basis, and they do travel throughout the province. The member indicated that they've met in Kelowna. They've also attended meetings in the Fraser Valley and in the Fort St. John area.

In terms of their profile and advertising, I understand they have published a brochure, which has been widely distributed. So most people interested in seniors' activities and most seniors who have their own seniors' groups should be aware of the Seniors' Advisory Council.

I can also advise the committee that we have $1 million in 12 special research projects on conditions for seniors. This is sponsored by the B.C. Health Research Foundation. Presumably this would be in the area of gerontology. Or is it straight medicine...? It would be community demonstration-type projects, I'm advised.

It appears that we're pretty active in this area. I thank the member for bringing these issues to my attention. As I go through the learning curve of this new ministry for me, it's fascinating to find out how comprehensive and responsive it is to the many needs of British Columbians, regardless of age.

MS. A. HAGEN: Is the minister aware of, and can he report on, any particular projects the council has undertaken — either the initiative of the ministry or the initiative of seniors' organizations or individuals who have asked the council to deal with matters? Can we have from the minister some sense of the work they are doing? As I noted earlier, although the minister says people are aware of the work of the council, I believe that's gilding the lily a bit. I don't think there's a broad awareness. This is an opportunity I'd like to give the minister for him to give us some indication of what issues the Seniors' Advisory Council might currently be addressing.

HON. MR. STRACHAN: I have a list of the specific projects they've been involved with.

The office for seniors organized and provided background papers for four meetings of the Seniors' Advisory Council held in 1990-91. One meeting was held in Fort St. John and others in Victoria and Vancouver. They reviewed recommendations of the Toward a Better Age report, advised the minister in priority areas, established a task force on elder abuse and access to information, and made a submission to the Royal Commission on Health Care and Costs. I happened to take part in part of that elder abuse task force.

The office for seniors coordinated Seniors Showcase '90, held in October. This partnership went between the provincial and federal governments and community senior organizations and highlighted seniors' activities and information on government programs. They provided a new guide on programs and benefits for seniors. "Information for Seniors" was developed as well as a brochure on the office for seniors and one for the Seniors' Advisory Council.

The office for seniors participated in a number of seniors' events including "The Time of Your Life, " which is obviously an interesting event. The office undertook a number of speaking engagements to seniors' organizations. We have played a key role in the issue of elder abuse through representation on the interministry committee on elder abuse, by developing procedures and protocols for community response to elder abuse, by assisting the Seniors' Advisory Council elder abuse task force and working with the Justice Institute to develop an elder abuse conference. That's the one I had the good fortune of attending a couple of weeks ago. It was first-class and very well attended by many responsible agencies from the community — members of police forces, all social service agencies and the whole continuum of people who offer care to seniors in one form or another and are concerned with elder abuse.

There's an awful lot of work going on. Also, I'm advised that Howard Petch does talk shows. That's good, as well. I don't know why he wouldn't, because he's a pretty articulate guy and would make a very entertaining guest on any talk show.

MS. A. HAGEN: I am certainly very pleased to see that one of the areas the Seniors' Advisory Council is working on is the issue of elder abuse. That particular matter has not had either the profile or the means of input.... It is an extremely important policy area. I note that the matter of access to information has been dear to my heart, because I think all too often older people don't have an easy means of getting the kind of information they need.

I would like to commend the ministry on the new booklet on seniors. It's a vast improvement, and I have been through it. It's at last pretty well up to date, and that's nice because we very often see brochures that are already a year behind when they come out; that's not very useful in terms of the information end of things.

When the legislation was debated in the House, of course we supported it. There was one issue we dealt with at that time: we asked the minister of the day to consider an amendment that would have required the annual report of the Seniors' Advisory Council to be made public. I would like to ask the minister a couple of questions around that. The council has now been in

[ Page 12850 ]

existence and working for a year. I'd like to know if it has prepared an annual report and submitted it to government. It's just about a year, I think, since the council was first appointed by the minister of the day — two or three ministers ago. Secondly, I'd like to ask the minister for a position on that report being made public.

I think we made a very strong case at the time the matter was being debated that in order for the report of the council to have currency, credibility and usefulness in the seniors' community — in this two-way communication between the seniors and government through the vehicle of the advisory council — it was important that the annual report of the Seniors' Advisory Council be available to the public. It's consistent with open government and with the annual reports of various bodies being tabled.

There was a great deal of resistance at that time — two years ago — to the concept. I remember the then Minister of Finance — the now member from Saanich — making a memorable statement to the effect that the Seniors' Advisory Council couldn't be open and candid with government if they thought that their recommendations were going to be public. I found that a very strange perspective to have, given the mandate of the very brief legislation, which was that there was to be communication both ways and that the organization had a very clear mandate to communicate with its senior advisers, who are all the older people in the province.

If my memory serves me correctly, it may have been this current Minister of Health who suggested that he had a  resolution to the fact that government wasn't prepared to consider the amendment. Certainly it was somebody on the government side — I haven't checked Hansard — who said: "We will perhaps ask the committee for its opinion on that matter."

[5:45]

So I want to raise the issue again, around there being some reporting from this important statutory body of government that advises government on policy in respect to seniors. I want to ask if the minister has a position now on that annual report being in the public domain. If he hasn't a position, has he asked the advisory council? If he hasn't asked the advisory council, is he prepared to ask them, with a recommendation from himself that he believes in open government and believes that this body — the Seniors' Advisory Council and seniors — would be well served by that annual report being made public? Back to the first question: is there a report yet from the council? If there is, we could deal with it becoming a public document. If there isn't, does he know when we might anticipate it?

So around that whole issue is an opportunity for us to revisit what we felt was not visited well when the legislation was put in place and an opportunity to open up that process through that document, along with some of the other publications that may come from that working body,

HON. MR. STRACHAN: I won't indulge in talking about the necessity for legislation. I don't think the member is doing that, so we'll avoid that. I will encourage the seniors' council to prepare a report for me, which I will be more than happy to make public — if they wish, because it will be their report; but they should publicly report. I have no problem with that. By virtue of my saying this now, I would encourage them to do it.

I can tell you one thing: neither this government nor your government has been able to avoid the sting of Howard Petch when he wants to be critical, because he has criticized the NDP government when they were government as well. He's outspoken. He doesn't pull any punches, and I'm sure if he wants to make a public issue of something, he will. I'd be more than happy to have him do that, because he's a credible, very constructive critic.

But back to your question, Madam Member. I will encourage the Seniors' Advisory Council to prepare a report for me and one that they feel should be in the public domain. That's a good thing to do, and it would further heighten the public awareness of their activities.

MS. A. HAGEN: Thank you, Mr. Minister, for that position. It's a well-taken one, and I'm sure it will be well received by the older people in the community. I take it from that that there hasn't been a report tabled with you as yet and that you're acknowledging that this is the case.

I'm mindful of the clock, and I have two or three issues that are going to take a little bit more time than the ten minutes we have before adjournment. What I'm going to do is ask the minister a couple of specific questions around some aspects of the continuing care budget. We look at the detail of that budget and try to figure out what the figures might add up to and what they might mean. We know, for example, that government contracts out quite a number of services. In continuing care, under professional services, which is where I believe contracted services might be housed, there's a fairly significant decrease in contracted-out services. Last year there was almost $1 million in contracted-out services — professional services, as they're called. This year that is reduced by about 25 percent to just over $750,000.

I'd like the minister to just give us some indication whether there are more services now under his ministry, why there is a decrease in those professional services, what they might be, what they might be used for and what the decline in dollars might represent. Then I want to go through a couple of other areas where there are very significant increases. One of the theses that I have in my head is that instead of us being able to track those professional services through that part of the budget, they're actually included in some other areas. So under STOB 20 of the details of the estimates — the professional services — what are they for and why are they decreasing?

HON. MR. STRACHAN: This is a question not unlike the one posed by the second member for Vancouver-Point Grey with respect to STOB allocations and STOB numbers identified. STOB 20 has been

[ Page 12851 ]

reduced in its professional services to government, but STOB 82 has been increased — that's service to third-party groups providing care to the community.

MS. A. HAGEN: Would the minister just care to comment. We're looking at a very large item of the budget under STOB 82. Those budgets are quite huge; they're in the neighbourhood of half a billion dollars. Is the minister just saying that some things that used to be under professional services are now in contracted services to community groups? Is there a rationale for that move?

HON. MR. STRACHAN: It's been a recoding. It was felt that some of the services to the community that had been in STOB 20 before were not appropriate for that STOB, so they have been correctly put into STOB 82. They are services to the community via third-party providers.

MS. A. HAGEN: I would believe that all professional services are third-party providers of some kind, presuming that you're contracting out to someone. But I'm presuming here that you're talking about services that are going directly to clients rather than perhaps services to the ministry.

I note that the information systems budget has doubled; whereas last year there was about a half a million dollars in information systems under continuing care, that's now more than doubled to $1.25 million. That's a pretty significant increase, given that I've heard the Premier talk about decreases in some of these areas of government advertising and so on. Perhaps the minister would care to comment why we're seeing a doubling in that area.

HON. MR. STRACHAN: You're not seeing a doubling in terms of the expenditure for that procedure; again, it's a different coding. It was from administrative and support services and now has gone to the correct coding. Funding for that type of information service has remained constant. So there is not a doubling, Madam Member. But it's a good question.

MS. A. HAGEN: One final one, since we are really looking at services to people and wanting to be sure that dollars are going to services to people. I notice that STOB 69, which is office furniture and equipment under continuing care, has increased sixfold; a modest budget of $26,000 has increased to $150,000. Again, although those dollar figures are not all that significant.... I don't know how you actually multiply, but it has increased by six times. Are we looking at some increase in costs here for this? Would the minister comment?

HON. MR. STRACHAN: There have been some increases of staff and offices in the field, a new health care centre in Kelowna and issues such as this that have caused the sixfold increase. They're all legitimate furniture and equipment expenses, primarily in the field. I guess there would be some here in Victoria, but I'm advised that most of them are for offices outside the Victoria area.

MS. A. HAGEN: I have one final question. Have there been some new buildings or new units that produced that kind of cost? That will be my last question, Mr. Chairman. I have some other matters I hope to have time to canvass during a return to estimates debate, perhaps this evening.

HON. MR. STRACHAN: There is more home-care staff, and they require offices and office furniture. There's that new health care centre in Kelowna.

MS. A. HAGEN: I just want to finish this. I don't know of any home-care staff, which is normally a contracted service. Are you talking about public health service for home-care people — nurse-assessors and things of that nature? Okay.

Mr. Chairman, with that, I would move the committee rise, report considerable 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: I move that the House at its rising do stand adjourned for five minutes.

MR. SPEAKER: The opposition House Leader, being mindful of the words of the tome written for us by that learned scholar, Mr. MacMinn, on page 69, "Debate on Motions to Adjourn." There's just one part I'd like to read: "The scope of debate on this motion is limited strictly to the arguments pro and contra the suggested...time or date" — just so the scope doesn't get too wide.

MR. ROSE: I see. Mr. Speaker, I can reassure you that I have no intention of giving a replay of my brilliant speech of last evening, although I've had many requests for it. I've had many requests for television clips of it, mainly from my relatives.

I'd just like to say, in opposing this five-minute recess, that it is just a mechanism for having us sit extra hours. It's not that the NDP doesn't want to work: the NDP wants to work. We wanted to work in January, February, March and April. We kept listening for the call; nobody called us. The government was in chaos, suffering from terminal incompetence. It was so embroiled in the chaotic mess of its own creation that we didn't get a call. We wanted to be here to debate, and we wanted to get on with the budget and the people's business and the legislation — we want to do that too.

When I stand up here, Mr. Speaker, I stand up to protest the way we've been treated as legislators. There was no reason that I can think of to have been in recess from July 20 until almost April. That's just nonsense. And now, suddenly, it's urgent that we sit every night, in the moonlight. We don't think that's true.

[ Page 12852 ]

We want to work, we want to do business, and we want to examine the estimates. That's what we're doing. It's not our fault that.... We know that the government's going to win and have its way, but it's not our fault that we have to be doing the night shift here. But if we have to do the night shift.... The government's got the power; the government can force us to do it. It's known as the tyranny of the majority, because if it comes to a vote, we know what the result is. Therefore the only defence — or weapon, if you like — the opposition has over this tyrannous majority is to continue to talk and debate. That's what we're here for; that's what parliament means. It comes from the French "to speak." That's why we're here. We're speaking up for the people of British Columbia.

[6:00]

I welcome the Attorney-General back into the House; I hope he makes as brilliant a speech as he did last night. I think it will play well — probably in Rutland or somewhere; I don't know exactly. Nevertheless, we need a review of leadership. There is no leadership; it's government incompetence and it's time for an election. People don't want any more talk; they want an election.

Interjection.

MR. ROSE: I said that last night, and I will say it Thursday night if you don't get a better motion than the one you got tonight.

You're provoked.

HON. MR. FRASER: Provoked, indeed. No, I'm reasonably hard to provoke, as you found out last year and will find out this year and next year, I'm sure. In speaking in favour of the recess, one only has to think about the important work of the people which has to be done, the necessity for passing the estimates of the various ministries in question and the legislation that will affect people's lives and which is important to pass. And when one thinks about those things, one knows that there are days when you do have to work beyond the regular day.

As most people on this side of the House will tell you, an eight-hour day is only a start and, as any farm boy would tell you, the chores are what you do before and after the work. However you describe it, the eight-hour day doesn't exist in this building, at least in the minds of the members of the government side of the House.

Therefore we should be quite happy to take a five-minute recess and come back to work until 10, 11, 12, or whatever it is. For those of us who were elected in 1983 and found out how much fun it is to work around the clock day after day, night after night.... All of us did it of course — all of us who stayed in the building. I know some of you disappeared to have your sleep, but the rest of us on the government side stayed here and worked. Of course I would support a five-minute recess so we could carry on the business of the people, get it done, get it done right and get it done in a timely fashion.

It's got lots to do with leadership, in fact, as the member opposite said, because there is leadership here in this House wherever the Premier is, whoever the Premier was. There's leadership from the government always, and I'm prepared to stand and talk for 35 or 40 minutes in favour of the five-minute recess, as the member opposite knows — the member over there who wears the collar when he's not on TV and doesn't when he is on. I don't understand that; if your neck hurts, Mr. Member, you leave it on.

But in favour of the motion, we will say aye to the recess.

MS. CULL: The Attorney-General acts as if this debate is about the logical way of going about doing the government's business, as if this five-minute recess and then carrying on this evening, last evening, and however many evenings we've got coming ahead of us is a logical way to go about doing business. That, of course, is not what's happening here. This is a government that's in so much chaos it can't even manage the agenda for the Legislature. Let's just have a look at how we got to where we are. We've just started the session; we're just into our seventh week. We spent a week debating the Education estimates. I don't know if we're up to a week yet on Health, but those are important ministries. They deserve that kind of debate. We have other areas we haven't got on to yet that certainly deserve a reasonable time for consideration of the questions and debate from this side of the House. We're pretty early into this.

Where are we in the year? We're almost midway through the year. Here we are in the middle of June, halfway through the year, and we've had eight weeks of debate in total, if we take March into consideration. The House didn't sit from last July until March, even though the government knew the fiscal year was running out. They knew that March 31 was coming. Did they recall the Legislature? Yes, they did. They called it for nine days in March. Then, without any warning, without any notice, suddenly they cut and ran. We didn't sit in April at all. Now here we are back in June.

This government is saying that things are so urgent that we have to get on — we have to have this five-minute recess so we can get into the technicality of night sittings. Mr. Speaker, what's the hurry?

Interjections.

MR. SPEAKER: Order, please. Let's hear the member who's speaking on this item and its very narrow scope of debate. Because there are so many other people speaking, the Speaker has not been able to ensure that the debate stays on that very narrow point. It's only about this tiny little piece of standing order 45(1)(k).

MS. CULL: I can assure you that I'm sticking as close to the point of debate as I can.

Mr. Speaker, what's the hurry? That's what I want to know with this government. What is the urgency of these night sittings at this early point in the session? Is

[ Page 12853 ]

it because they now have suddenly found the courage to come back into the Legislature, and they want to ram things through as quickly as they can — they want to squeeze this democratic process into such a short time that the public won't have too much time to scrutinize what's going on? Is it because they want to rush through here, cut and run, and get back out to their leadership...? I can't call it a race. It's not really a race; it's more of a crawl or a dawdle or whatever's going on out there right now. Or, as the first member for Langley said last night, democracy should be short and painless; maybe we should just hurry on with this and not have it affect us too much. Sometimes democracy is a little bit painful. That's what 800 years of parliamentary history is all about. Our job is to be here to scrutinize the spending of government.

But this government is in so much chaos that they can't even manage the legislative agenda. They can't get us here on time or set out a methodical process. They want to go through legislation by exhaustion. Mr. Speaker, we object to the cutting and running and to them ramming it through. If they're in such an all-fired hurry, why don't they just call an election?

MR. VANDER ZALM: Mr. Speaker, I was requested by the House Leader for the opposition to make some comments, and I'm pleased to oblige. It seems to me that if this were a business, we'd be long broke. Six hours today in this glorious facility, and the NDP is complaining about putting in an additional four hours tonight. We started at 10 a.m., adjourned at 12 and came back at 2 — six hours. And they're complaining about working an additional four hours. The air conditioning is on, and it's a wonderful facility. It's sitting here anyway; let's use it on behalf of the people. We have the time, and we're all here. Let's tend to the people's business and quit complaining. Let's quit this NDP complaining about having to work a few additional hours tonight. They keep saying that the reason we have to sit is "because this is a government in chaos." Every time I or anyone else dares mention Ontario, they get all fidgety. There's an example of a government in chaos.

Mr. Speaker, again let me suggest that we all support working a few additional hours tonight on behalf of the people of the province to get these estimates passed and the legislation done.

MR. D'ARCY: Mr. Speaker, this is going to be an attempt to keep this on the strictly relevant format that you yourself brought our attention to. I am pleased to hear the balance and perspective the first member for Richmond has brought to this discussion. No doubt he acquired his balance and perspective cruising the canals of Amsterdam recently.

Interjection.

MR. D'ARCY: For the last two weeks. Of course, we know that part of that balance and perspective the competent member brings to this chamber on this matter stems from his full knowledge that one of the reasons the government is once again attempting to jam through $5 billion in spending in a few hours — just like they did two weeks ago — is that when he was chairman of the executive council, the government spent months in a state of total uncertainty as to whether they would bring in a budget at all.

I have no objection to carrying on this evening. In fact, you will see that the dozen or so of my colleagues here in the House are ready, willing and able to work. We have no objection to working this evening — as opposed to the one or two members on the treasury benches over there saying they're ready to work. Where are they when it's time to work? And where are my colleagues when it's time to work? They're all here ready to go. I don't want to take up any more of this five minutes of adjournment time. Let's get on with the job here tonight.

Motion approved on division.

MR. SPEAKER: I will proclaim a five-minute recess. I'm going to leave the chair, and I will ring the division bells when I return and the House can reconvene.

The House adjourned at 6:11 p.m.