[ Page 12883 ]

CONTENTS

Routine Proceedings

Tabling Documents –– 12883

Ministerial Statement

Dismissal of Attorney-General's executive assistant. Hon. Mr. Fraser –– 12883

Mr. Sihota

Oral Questions

Okanagan representation on Agricultural Land Commission. Mr. Barlee –– 12885

Increase in gasoline tax. Mr. Loenen –– 12886

Mr. Barlee

Government rental of office space. Ms. Marzari –– 12886

B.C. lottery advertisement. Ms. Cull –– 12887

Range Amendment Act, 1991 (Bill 5). Second reading

Hon. Mr. Richmond –– 12887

Mr. Barlee –– 12887

Mr. Zirnhelt –– 12887

Mr. Miller –– 12888

Hon. Mr. Richmond –– 12888

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

On vote 38: minister's office –– 12888

Mrs. Boone

Mr. Miller

Ms. Marzari

Hon. Mr. Dueck

Ms. Pullinger

Mr. Jones

Mr. De Jong

Mr. Perry

WEDNESDAY, JUNE 19, 1991

The House met at 2:04 p.m.

Prayers.

HON. MR. RICHMOND: It's my pleasure today to welcome three guests to the members' gallery: first of all, my wife; my executive assistant Marg Robertson; and the young lady who is our receptionist. It's her first time observing the House. Would you welcome Lisa Sorenson.

MS. PULLINGER: It's a pleasure for me today to introduce someone who's very special to me and who is known to a number of people on both sides of the House, and that's my brother Don Pullinger, in the members' gallery. With him today is my son Brett Ferguson and my brother's son Wally Pullinger. Will the House please help me make them welcome.

MR. LOENEN: The Victoria Health Project is a real success story for the Minister of Health and for the communities associated with it. The executive coordinator is in the gallery today, and I would ask the House to please welcome Susan Iles.

HON. J. JANSEN: We have visitors from the best constituency in the province today. We have here some grade 5 and 6 students from Chilliwack Central Elementary School. Would you please make them welcome.

Hon. Mr. Parker tabled the annual report of the Ministry of Crown Lands for the period April 1, 1989, to March 31, 1990.

Hon. L. Hanson tabled the financial statements for B.C. Rail for the fiscal period ended December 31, 1990.

Ministerial Statement

DISMISSAL OF ATTORNEY-GENERALS
EXECUTIVE ASSISTANT

HON. MR. FRASER: Yesterday in the House the hon. member for Esquimalt–Port Renfrew raised the matter of the dismissal of my executive assistant. I responded that the matter was a personnel issue, and that is still my belief. Nonetheless, in response to questions and reports in the media, I would like to provide the House with the following information. In 1988 a lengthy letter by private investigator George Peden, which contained numerous allegations against a number of individuals, was received by Grace McCarthy, then the Minister of Economic Development. The member from Little Mountain in turn referred this document to the then Attorney-General Brian Smith. Ministry of Attorney-General officials confirmed at this time that the matter was under police consideration.

By September 1988, members of the RCMP and the Vancouver police department determined that the allegations were groundless. This conclusion was confirmed today by Assistant Commissioner Palmer of the RCMP. In late 1990 the same letter — or a letter containing similar allegations — was brought to my attention by my executive assistant, Bob Walsh. In reviewing the document, I decided that the allegations appeared to be without substance. Following my discussion with Mr. Walsh, he on his own initiative turned the document over to Peter Engstad, the director of the Coordinated Law Enforcement Unit. Mr. Engstad referred the document to the RCMP, who advised Mr. Engstad that they had already reviewed these allegations. The document delivered by Mr. Walsh did not disclose any new allegations, and in the opinion of the police the allegations were without substance. This fact was also confirmed with Assistant Commissioner Palmer today.

On May 21, Deputy Attorney-General Bob Edwards was confidentially advised that this document was inappropriately disclosed by Mr. Walsh to a person outside the ministry or any police agency. Mr. Edwards then conducted an investigation concerning this allegation of inappropriate disclosure, and last Thursday advised me of this matter. This was the first time I became aware of this inappropriate disclosure.

The deputy and I agreed that the proper course of conduct was for Mr. Edwards to speak to Mr. Walsh directly, which he did immediately. During this meeting Mr. Walsh confirmed that he had made the alleged disclosure. Following discussions with my deputy, I came to the conclusion that Mr. Walsh's conduct was unacceptable and required his dismissal. I advised Mr. Walsh of my decision on Friday, June 14, 1991.

Mr. Walsh requested an extensive severance payment of some three months, or until he had time to find a job. This request was refused, and he was advised that he would get exactly what was coming to him, not a penny more and not a penny less. Mr. Walsh was not satisfied and indicated he would make the matter public in some fashion. I have no information, other than just stated, as to any other persons who may have access to Mr. Peden's letter.

Mr. Walsh did not resign. He was dismissed for inappropriately releasing confidential information to a person outside the ministry or any police agency. This disclosure did not compromise an ongoing police investigation or a criminal prosecution. The circumstances of this disclosure demonstrate a lack of judgment concerning material he had obtained in his capacity as my executive assistant, and any future disclosures of this nature would produce a similar result. I am not aware of any other inappropriate disclosures of confidential information by Mr. Walsh — certainly not anything that would jeopardize an ongoing police investigation or criminal prosecution.

The dismissal of Mr. Walsh is in no way connected to the alleged disclosure of information from the Ministry of Attorney-General concerning the legal opinions dealing with the departure of Mr. Couvelier as Minister of Finance in April.

The 1988 letter by George Peden appears to have been made available to members of the media. As the allegations contained in it were determined by the police to be without substance, in my view it is not

[ Page 12884 ]

appropriate for me to discuss the details in a public forum. I refer members to the Owen report, which clearly addressed the issue of public disclosure of police investigations. As the allegations were investigated by the police in 1988 and as I have taken appropriate steps to deal with the problem in my office, a further inquiry is not required.

While it is the tradition of the Attorney-General to be provided the assistance of an executive assistant, this incident is of such concern to me that I have requested the Deputy Attorney-General to prepare a report and recommendations on the appropriate role of an executive assistant to the Attorney-General. It is my intention to act upon these recommendations provided, and I welcome any of you to provide me with any recommendations you may also have.

I might add that according to the Sun newspaper this morning, it has been suggested that Mr. Peden made allegations in 1975 that the CIA had infiltrated the NDP.

When allegations such as the ones raised by the member for Esquimalt–Port Renfrew come to light, there is an appropriate procedure to follow to ensure that justice is done and is seen to be done. Allegations of this nature are not to be dealt with in a public forum. The conduct of the member for Esquimalt–Port Renfrew was severely called into question in the Owen report. It appears that the member for Esquimalt–Port Renfrew has again proceeded down the same path. That brings into question his role as the justice critic, and that of the Leader of the Opposition in leaving him in that post.

MR. SPEAKER: Order, please. Before recognizing the next member to speak.... I did not interrupt the minister in the procedure of making his statement, but when people read statements that are prepared by people unfamiliar with the rules of this House, it would be the preferred course of action that members who are still members of this House be referred to by their constituencies and not by their names. There were several violations of that fundamental rule in your statement.

[2:15]

MR. ROSE: Mr. Speaker, I couldn't agree with you more. It went far beyond the bounds of a ministerial statement, which has to do with administration....

Interjections.

MR. ROSE: Are you finished? You guys learned to harrumph when you were about 15.

Mr. Speaker, it went well beyond the policy and administration guidelines assigned to ministerial statements. We didn't interrupt because it was an extremely important matter. Occasionally we like to get the truth from this government.

This case is a very serious matter. It involves a public servant, his termination, his personal life, his future and his whole reputation, and we on this side of the House don't.... Since we didn't receive any kind of notice about this.... We didn't receive the courtesy of a copy of the ministerial statement. We're prepared to respond to the minister, but we would like to ask leave to have our response delayed and deferred until we can make a very responsible, accurate and thoughtful response to the minister's statement. To proceed right now, I think, would be unfair not only to the minister and my colleague, but also Mr. Walsh.

Interjections.

MR. SPEAKER: Order, please. Leave has been requested. The normal procedure is that when a ministerial statement is made, there is an opportunity for response at that time. Of course, our rules can be waived with unanimous consent. So I'm going to ask: is such leave granted? There are several noes.

HON. MR. RICHMOND: On a point of order, Mr. Speaker, I listened very carefully to the opposition House Leader, and he did not rise on a point of order. Therefore I submit to you that they have had their response to the ministerial statement.

MR. ROSE: Mr. Speaker, I have no desire to prolong this agony, but I don't know where in the rules it says there can be only one response to a ministerial statement.

MR. SPEAKER: Order, please, hon. members. Under the circumstances.... There are times when members rise to bring matters as points of order and don't actually articulate the fact that it's a point of order. For the purpose of this interpretation, the Chair is going to make the arbitrary decision that the remarks made by the opposition House Leader were in fact a point of order to seek leave. Such leave is not granted.

I will now allow the member for Esquimalt–Port Renfrew to make a reply to the ministerial statement.

MR. SIHOTA: Mr. Speaker, the minister has made a statement to the House. My colleague the opposition House Leader has pointed out that there was no advance notice given of that, as is usually the courtesy in these matters. The minister made....

Interjections.

MR. CLARK: I would request that you ask the members on that side to refrain from their pathetic ramblings. If you wish a formal request to withdraw, I'd be happy to oblige.

MR. SPEAKER: The member for Esquimalt–Port Renfrew has been recognized, and he stood in his place. If he wishes to begin speaking he can do so; otherwise I'm afraid the Chair is powerless to stop interjections. I'm not going to comment on the editorializing or the quality of the objections.

MR. SIHOTA: As I said, it is customary to receive notice, and in this case that courtesy has not been extended to this side of the House. If that is the

[ Page 12885 ]

decision the Attorney-General has made, he has to live with the consequences of it.

At this point I have a lot of questions to ask the Attorney-General. A number of issues, in my mind, remain unanswered in the statement that he so carefully prepared and presented to this House. I would prefer, rather than dealing now with the comments he made in the House today, to review his comments in the Blues later on today and refer to this issue again later. I can assure the Attorney-General that I have a set of questions that I will be putting to him tomorrow in relation to this matter, because it seems to me that a number of issues have not been attended to. But at this point, Mr. Speaker, given the sensitivity of the issue and the absence of courtesy from the opposite side, I have no intention of responding in detail to the minister's statement.

Oral Questions

OKANAGAN REPRESENTATION ON
AGRICULTURAL LAND COMMISSION

MR. BARLEE: This is to the Minister of Agriculture, Fisheries and Food. I understand that at yesterday's meeting of the Agricultural Land Commission much of the business dealt with lands in the Okanagan — and that's not unusual, Mr. Speaker. There is considerable interest in the ALR lands in the Okanagan. That area, by the way, has had an agricultural land commissioner for 18 years. Can the minister confirm that there was no commissioner from the Okanagan at that meeting?

HON. MR. CHALMERS: I have no idea who was at that meeting. It's the first time I was aware that they'd even had a meeting.

MR. BARLEE: Supplementary to the minister. I would presume that as Minister of Agriculture, you would have some interest in the agricultural land reserve, which is the greenbelt of British Columbia. The incumbent commissioner from the Okanagan was a Mr. Rod King. His term expired on May 10. He's a longtime farmer. Can the minister, who has some connection with the Agricultural Land Commission, explain why his term was not extended?

HON. MR. CHALMERS: I can assure the member that I have a great deal of concern about all matters related to the agricultural land reserve and the Agricultural Land Commission. As far as appointments to that board are concerned, when they become vacant they are considered, and reappointments or new appointments are made in due course. I don't think that it has been the practice of any previous minister in any previous government or this government to have consultation with members opposite in the Legislature I'm not about to begin it now.

MR. BARLEE: If the minister is so concerned about the agricultural lands in the Okanagan, I wonder why Kelowna has been so wildly successful in getting lands out of the ALR.

When that decision was made, was the minister aware of Mr. King's long-term interest in the Okanagan — as a bona fide orchardist — and of his wish to stay on the commission to represent the people of the Okanagan, who are not presently represented on that commission?

HON. MR. CHALMERS: Mr. Speaker, I'm certainly very aware of not only Mr. Rod King's involvement in the agricultural community in the Okanagan, but also his father Avery. The whole family has been very, very active in the industry and very concerned that it is going to continue to survive and thrive in the Okanagan. They are also very concerned about land matters. But that has nothing whatsoever to do with the fact that the appointment has not been made. I'm not about to comment today exactly when it will be made.

MR. BARLEE: I again go back to the question. Does the minister not find it most unusual, with about half of the requests for removal from the ALR coming from the Okanagan, that there's no representative of the Okanagan to act as a watchdog?

Interjections.

MR. SPEAKER: Order, please.

MR. BARLEE: I'll repeat that question again. The government benches don't seem to be very interested in that type of question, but I think it's very important.

I would think that the minister would be very concerned that there is no watchdog on the Agricultural Land Commission from the Okanagan. This is under a great deal of pressure, and the greenbelts have been disappearing extremely rapidly. What is the minister prepared to do about it?

HON. MR. CHALMERS: First of all, I would certainly not agree with the member's assertion that land is being removed with great haste anywhere in the province, let alone the Okanagan.

Any decision made by the Agricultural Land Commission is for them to make, and I certainly have not tried in the past — nor will I try in the future — to influence the decisions that the Agricultural Land Commission makes. That's a decision that the), are to make.

As far as the matter of having someone from the Okanagan is concerned, that will be dealt with in due course. I'm sure you will be able to read about it in the Vancouver Sun when it happens.

MR. BARLEE: The minister suggested that the Okanagan was not being affected by the removal of land from the agricultural land reserve. Since 1988 there have been 15 golf courses removed in Kelowna alone, which is the minister's own back yard — some of them up to 200 acres. Would the minister like to reply to that? I've got the figures right here.

MR. SPEAKER: I didn't hear a question.

[ Page 12886 ]

HON. MR. CHALMERS: I didn't hear his question, Mr. Speaker.

MR. SPEAKER: There wasn't a question; there were statements. The second member for Richmond.

MR. LOENEN: Thank you, Mr. Speaker. I have a....

Interjection.

MR. SPEAKER: Order, please. Read Standing Orders. For members who are not aware of the procedure, the member stood. If there are two members standing at one time, the Chair has the prerogative of choosing whichever member it wants. There have been so many members standing today, I've recognized two ministers who just turned out to be going for a walk. But I am aware that the member wanted a question. Can I have the second member for Richmond.

INCREASE IN GASOLINE TAX

MR. LOENEN: Mr. Speaker, I'm not about to go for a walk. I have a question for the minister responsible for transit. We know that Mayor Campbell of Vancouver wants to add a very onerous tax levy on gasoline. Will the minister reassure the consumers that this government does not agree with the Vancouver mayor's request for that additional increase in gasoline tax?

HON. L. HANSON: First of all, the recommendation from the city of Vancouver will go before the transit board before it arrives at the government level as a request. It's my suspicion that it will not go further than that.

We have a very difficult time in British Columbia with the erosion of our economy because of cross-border shopping and so on. We also have great concerns about how the fuel tax reflects on the cost of goods in British Columbia and our competitiveness with our neighbours to the south. I can assure the member that in the ministry's opinion it is not in our interest that we would even consider that sort of an increase.

MR. BARLEE: I find that answer absolutely startling, and I'll tell you why: because he mentioned the onerous effect of taxes. Listen, the question is this: is the minister aware that in Washington the average price of our low-grade fuel is 30 cents a litre in Canadian funds? Their taxes are 10 cents. That leaves the oil companies with a 20 cent profit in the state of Washington. Is the minister also aware that in British Columbia our average low-priced gas is 54.9 cents and our taxes are 22.4 cents? The oil companies....

Interjections.

MR. BARLEE: I'll get to the question. The oil companies in British Columbia are making 32.5 cents per litre –– 65 percent more than their counterparts in Washington. Is the minister prepared to do something about that?

[2:30]

HON. L. HANSON: The question asked was to do with B.C. Transit and the tax applied to fuel as a result of that. I suggest the member go back and do some arithmetic and research his figures, because they're not correct.

GOVERNMENT RENTAL OF OFFICE SPACE

MS. MARZARI: I have a question for the minister of management services and women. On March 14, when addressing a sorry record of government waste, the minister offered the House a platitude. She said: "I want to acknowledge that empty office space, whether it's in the private sector or in government, is not desirable." Taxpayers don't swallow that. Can the minister confirm that her government is currently spending over $1 million a year on empty office space?

HON. MRS. GRAN: First of all, I would really appreciate it if the opposition would put Women's Programs first; it's important for women to come first.

I recognize the sensitivity the NDP opposition has to the incompetence in Ontario; I recognize very clearly why you're talking about empty office space. In British Columbia the government — regardless of who the government is — is the biggest employer. We have 22 million square feet of space in 3,500 different buildings in this province. Less than 2 percent...

Interjections.

HON. MRS. GRAN: Well, I'm just playing it safe, Madam Member.

...is vacant, usable office space.

I want to end by reminding the members opposite about the years between 1972 and 1975 — and I know you don't want to hear this. First of all, nine questions were asked in this Legislature of the minister responsible for office space, and none was answered. The increase in office space in that short, dark period of time in the history of this province was 278 percent in three years. The increase in cost was 207 percent. I think — I know — we do a good job.

MS. MARZARI: We're making progress. Last week we had a vacancy rate of less than 1 percent. That was the quote. And now we have 2 percent. One million dollars of wasted space is $1 million too many.

In March, Women's Programs vacated a Hornby Street office nine months after signing a five-year lease with expensive renovations — $100,000 is the number that we've been told. At that time the minister said: "I don't have any hesitation in saying or admitting that it was the wrong thing to do." Well, is she ready to admit today that the $100,000-a-year space that is still sitting empty on Hornby is a result of her mistake?

HON. MRS. GRAN: Mr. Speaker, I recognize that the policy across the way would be to fill up every bit of empty space you have.

Women's Programs did move out of that office space, but at the time — and it's still the case — the office space was vacated not to another space, but to

[ Page 12887 ]

share an office that was already being paid for in order to downsize government and to save money to spend on women's programs.

B.C. LOTTERY ADVERTISEMENT

MS. CULL: I have a question to the minister responsible for B.C. Lottery. We know that air pollution is one of the major environmental issues facing our urban areas, and that emissions from cars are the major contributor to the pollution. Yet B.C. Lottery is running TV and radio ads downgrading public transit and promoting the use of private automobiles. Since this government claims to be concerned about the environment, has the minister now decided to cancel this ad program?

MR. SPEAKER: Order, please. All members should pay attention to the question that was cleverly crafted to be correct, for a change.

HON. MR. VEITCH: Mr. Speaker, I will be just as correct in the answer. The ad was cancelled on June 9.

Orders of the Day

HON. MR. RICHMOND: I call second reading of Bill 5, Mr. Speaker.

RANGE AMENDMENT ACT, 1991

HON. MR. RICHMOND: Mr. Speaker, Bill 5 amends the Range Act to enable the government to better manage and protect the Crown range resource. The bill will encourage investment in Crown range by the ranching industry.

The bill contains a provision to enable the government to maintain the relationship between a tenure and the private land associated with a tenure, by ensuring that a tenure remains with a base ranch property in the event of a lease or sale of the property expiring or not completing, or where the property is foreclosed on. This provision complements the current tenure transfer provisions and enables the Ministry of Forests to maintain economically viable and stable ranching operations.

The power to change tenure boundaries has been vested in the regional manager instead of the ministers. This will promote greater administrative efficiency. The bill also clarifies the manner in which the notice of boundary change must be given to a tenure-holder, to align the boundary change process with other provisions in the Range Act which require service of notice. The bill provides for an appeal from a regional manager's decision to change a boundary, to ensure that a tenure-holder has the opportunity to have reviewed any boundary-change decision which may significantly affect the tenure-holder. The appeal will be heard by the minister or the minister's designate.

The amount of compensation payable by government for improvements lost by a tenure-holder because of a tenure boundary change has been clarified and increased. A tenure-holder will now be compensated for the remaining value of the improvement, based on the improvement's life expectancy if not maintained. In addition, the government will pay a tenure-holder reasonable costs for improvements that the holder must construct because of a tenure boundary change. These changes recognize that boundary changes are made in the public interest by more fairly distributing the cost of a boundary change between a tenure-holder and the public. The bill will encourage tenure-holders to make appropriate improvements to Crown range, thereby enhancing and protecting the Crown range resource.

I move second reading, Mr. Speaker.

MR. BARLEE: We've looked over the bill quite closely, Mr. Speaker, and generally we are inclined to concur with it. It is a bit of a patchwork bill, in that we think that the existing Range Act is not adequate — that's why this bill is here. We know there has been some consultation between the government and the cattlemen. We believe the existing act needs almost a complete revision. The current Range Act was essentially not working that well. We've had a number of amendments to the Range Act in the last few months, and this is another.

We agree, however, that the substitution of the regional managers for the minister is welcome. It's certainly welcome to the people in the area, because I think it's a generally accepted theory that the regional managers are much more aware of what is happening on the ground in their local areas. So that transfer of administrative powers to the regional managers is very welcome.

There are some significant changes, and the new formula for compensation is probably one of the better ones. It appears to be cumbersome; it is actually a significant improvement, and I think it will work reasonably well.

The appeal process is also reasonable and seems to provide a simple method to appeal a decision — again a step in the right direction. We do wonder whether there is a proper checks-and-balances system incorporated into this bill and whether the agricultural community has a reasonable input into decisions, which are essentially under the Ministry of Forests.

This is not a major bill, but it is a necessary one. It is not without some misgivings, but we tend to concur with the bill in its general principles.

MR. ZIRNHELT: I'd like to pick up the debate where the second member for Boundary-Similkameen left off, but there's really not much point in debating if there's nobody to debate with.

I would like to make the point that the changes here are welcomed, particularly in respect of giving more authority to the regional manager to be able to reassign leases so they can stay with the land upon the default of an agreement for sale. I think that principle is welcomed.

I also think that the point needs to made that the agriculture community out there that needs range would like to see a major overhaul of the Range Act. I'd like to know from the minister why this is a piecemeal

[ Page 12888 ]

bill rather than a comprehensive amendment to the Range Act. Would he care to answer that now?

SOME HON. MEMBERS: This is second reading.

MR. ZIRNHELT: I'd like to continue, then, and make the point that the principle of developing a compensation formula is probably a good idea in that it will protect investments in the range. But I am interested in the fact that this bill has missing from it multiple-use planning; in other words, if you're going to encourage a user of a resource to invest, that person ought to be able to go through a land use planning process so that he knows that the investments made in the resource are going to be protected. This bill doesn't provide for that. Because the government in this bill is accepting liability and is setting forth a compensation formula, we need to know that built into here is a procedure to ensure that there is a guarantee that the planning has been done well — for example, if a range user invests in fencing and so on to concentrate or direct the movement of cattle in an area that might be subject to recreation, there won't then be recreation pressures which force the government, by changing the management plan, to change and alter the use and thereby encourage a cost to the Crown. That's not provided for in this act, and should be.

MR. MILLER: Mr. Speaker, I bow to the expertise of my colleagues from Boundary-Similkameen and the Cariboo; living in the region, they obviously know more about the range than I do from the cattle country of Prince Rupert. In fact, I should tell you that the last letter I received about the interaction between people and cows — and I'm sure the Minister of Forests would appreciate this — is from an individual who happened to be on his motorcycle on an undesignated highway and ran into a cow, and he killed the cow. He wrote to me because he thought that there really should be fences up to keep the cows off the road. I couldn't disagree.

That deviates somewhat from this bill. First of all, we will be supporting the bill. Clearly there are some changes here that are required and, as my colleagues have indicated, appear to be beneficial.

[2:45]

I really think a point needs to be made, though, with respect to a complete overhaul of the Range Act. I haven't done a count, but it seems to me in the time I've been here we have dealt with a significant number of Range Amendment Acts. We continually bring in these amendments to try to fix problems, but perhaps we should be looking at a complete and comprehensive overhaul of the Range Act itself which would not only incorporate the amendments but would deal with some of the issues that are still outstanding.

I am aware, for example — I know my colleague the second member for Cariboo brought this up in estimates last year — that there still are conflicts between the competing users, principally forestry and cattle. From what I heard in my latest trip to the Cariboo, people are looking for a little better mechanism to work out some of those problems, some of those competing interests.

We support the bill. We think, as I've said, that there have been a lot of amendments to the Range Act; perhaps it is time that we get on to do a comprehensive change of the whole act itself.

MR. SPEAKER: Pursuant to standing orders, the House is advised that the minister closes debate.

HON. MR. RICHMOND: I appreciate the comments from opposite, and I'm pleased that they will be supporting the bill. There is some validity to the statement that the Range Act probably needs an overhaul. We have done an extensive review of range policy, and no doubt in the very near future we will be doing a complete rewrite of the bill. In the meantime, we had extensive consultation with the ranching community on this, and they're in agreement with the changes we're making. I think they are changes that will enhance the interaction between all the users of the land — the forest, the range, the recreational and the wilderness users, whatever. So I appreciate the fact that the opposition will be supporting these moves, and I know that this bill will be well received in the ranching community.

I move second reading.

Motion approved.

Bill 5, Range Amendment Act, 1991, read a second time and referred to a Committee of the Whole House for consideration at the next sitting of the House after today.

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

ESTIMATES: MINISTRY OF HEALTH

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

HON. MR. STRACHAN: I wanted to rise briefly and quickly to discuss further the death of Mr. Stan Roberts. The other day in estimates I indicated that I had not been fully apprised of this issue. I find out now that I was incorrect, which is why I want to correct an incorrect impression left yesterday.

I had responded to Vince Cain, the chief coroner on this issue, and I want the committee to be aware of that. I'm not going to say much more about this situation, because I didn't think it was appropriate yesterday, nor do I think it appropriate now. But the response had gone to Mr. Cain from my office, and I want that on the record so that the committee is not misinformed of my action on this issue.

MRS. BOONE: I'd like to revisit something we talked to the minister about yesterday, which is the program for assistance for travel. Yesterday the minister advised us that there was no program established; there were no regulations and no process for determin-

[ Page 12889 ]

ing who received travel subsidies or any such thing as that.

I'm bringing this up again because on last night's news I saw that a young baby received assistance for travel to receive an operation. As someone who has tried to get some assistance for others in my area — and I know many of my colleagues have also tried in their regions — I want to ask the minister what process is available to people to receive such assistance as was given to that child, who traveled in the air ambulance. Is there an avenue one can go to for assistance for travel when one has been turned down by the usual powers that be? In many cases it's just as much an emergency as was the case with the baby transported down to the States for an emergency operation. How do you determine who receives that assistance, and how does one get it? I guess basically I want to know how we get that kind of assistance for others in our areas who are equally as deserving as these people here.

HON. MR. STRACHAN: First of all, with respect to the announcement made in the budget speech, let me tell the committee again — for about the fifth time now — that this item is being developed by deputies and will be coming to cabinet shortly. As we indicated in the throne speech and also the budget speech, it will be a program we will implement this year.

In terms of other travel arrangements, for some years now the government has assisted in providing travel arrangements for critical care that has to be provided out of the province because it's not available here. The at-home program, as we've described it, provides funding for both local and non-local medical transportation for children with severe disabilities. This program covers actual transportation costs for children and escorts, economical accommodation and other extraordinary costs. As I said, that's a program that's been in place since 1989.

If the member would simply write to the ministry to discuss questions that she may have had in times past with respect to patients in her riding, then the answer would have been given.

MRS. BOONE: I'd like the minister to repeat that program for me, if he can, and to advise us how to go about it.

Just a short time ago assistance was turned down for a 12-year-old girl to receive critical assistance for an operation. I'm not sure what process is involved here or how it's determined. Do you go by a medical referral? Who determines this? Is it a ministerial decision as to whether there's an exception made? Is this a program that is determined for everybody, that's open to every young person who requires assistance for travel? Frankly, I've approached the ministry at various times over the years and have never been able to find assistance for travel.

I see the minister's assistant is nodding, indicating that there hasn't been assistance for travel. Is this a new program, or is there readily available assistance for travel for young people in this province to receive medical assistance? Is this assistance available only for those that go outside the province, or is it available for people who are traveling down to Vancouver for treatment or to other areas?

HON. MR. STRACHAN: There's not much more that I can say to the member except to repeat what I did say. This is currently a program for children with severe disabilities. The rest of the program, as discussed in the budget and throne speech, will be presented soon to the people of British Columbia.

MRS. BOONE: Would the minister then please advise me what the name of this program is, how one goes about tapping into this program? Can you do it through your local hospital? Is it necessary to go to the minister's office? Who makes the final decision as to who qualifies for this? What is a severe disability? Would the minister please advise me if a severe disability is going for chemotherapy at the Children's Hospital? Is that a severe disability? I see your assistants are shaking their heads indicating that's not a severe disability. What is a severe disability for a young child?

HON. MR. STRACHAN: The health unit — where you used to work, I understand — would be the people to apply to. The children have to be severely disabled where they need special assistance; therefore leukemic children — as tragic as that condition is — would not qualify under this program.

MRS. BOONE: By disabled you mean mentally and physically disabled in some manner, not people who are ill. Can you tell me under what program this baby was transported to the States for treatment?

HON. MR. STRACHAN: Could the member identify the baby?

MRS. BOONE: I wish I could. It was on the news last night. There was a baby transported to Vancouver. They showed the B.C. Jet — the air ambulance — being loaded up with oxygen, and this baby was transported to somewhere in the U.S. for an operation that was unavailable here in British Columbia.

There are other cases of individuals going to Toronto, Seattle, Los Angeles or any number of different places for operations. I've never been able to receive assistance for travel for them in the past. Is there assistance available for individuals who have to go outside the province for medical treatment that has never been available before? Is that assistance available now?

HON. MR. STRACHAN: It's common that we do this. We provide for out-of-province hospital and medical care when that medical and hospital care is not available in-province. We do not provide the transportation. In the case of Caleb O'Connor, the child referred to in the television program last night, he has a very serious heart defect, and he will have remedial surgery — heart build-up surgery. We are providing for the

[ Page 12890 ]

hospital and medical care but not the transportation. That's standard policy.

MRS. BOONE: I'll accept the minister's explanation on that because the information given on television indicated the transportation was provided by the province, but if you say that's not the case, then obviously that's not going to be available for others.

I would like to get onto a different case. This is a case that is known to your office. I'm not going to mention this gentleman's name, because I haven't contacted him to find out if he wants his name used. It's a serious case. This gentleman waited from March 27 for open-heart surgery; it was postponed. He was told there was a bed available on May 14, but on May 14 he had severe problems with his heart. He phoned the air ambulance — he was in hospital in Prince George — at 11:30 a.m., and that air ambulance never arrived until 9:30 that night.

[3:00]

As a result of that this gentleman missed the angiogram test he was supposed to be getting in Vancouver, and he had a severe heart attack on May 15 immediately upon arriving in Vancouver. This gentleman feels very strongly that he could have avoided that heart attack, had he gotten down to Vancouver earlier. He wants some answers with regard to why he was postponed for so long, why this happened, and more importantly, why the air ambulance took from 11:30 in the morning until 9:30 at night to reach this gentleman so that he could be transported to Vancouver.

I know that he has been to your office in Prince George, so you should be aware of this situation. I would like you to respond to me as to what possibly could have held up that air ambulance for that length of time and placed this person's life in jeopardy basically.

HON. MR. STRACHAN: Well, there are many things that could have held up the air ambulance, and I don't have the details: air traffic control in Vancouver, weather anywhere and the fact that our air ambulances could have been on other calls. We have a charter arrangement as well. As has been explained, a lot of the Medivac work is done by airplanes other than government air. I don't have an explanation as to the delay of the ambulance.

MRS. BOONE: If this had been in the fall with severe fog and all of those things, I could have taken the weather. Air traffic control: I've sat on a tarmac maybe for a half hour at the most, which is nowhere near the nine or ten hours that was required here.

Obviously the minister has not been advised by his staff in Prince George about this case. Would you take it upon yourself to investigate why there was this incredible delay from 11:30 to 9:30 at night? Would you please find out why that was the case? If your staff would like to know the name of this gentleman, I would be happy to send the name across to you. I will not broadcast this over the air, but I will send it across to you so you can investigate this. Would you do that for me?

MR. MILLER: There were a couple of other issues I wanted to pursue with the minister and never had a chance yesterday. I apologize if some of this material has been covered in a general or broader sense by my colleague the Health critic, but we all like to discuss the impact of health policies and some of the issues that we face in our constituencies.

The extended care is a particular problem in some parts of my constituency in a couple of respects. First of all, in the smaller areas there really aren't the facilities available. I know that on the Charlottes there is an ongoing struggle with respect to location of facilities. In the last newspaper I read from the Charlottes, one of the aldermen from Masset was complaining about why we always talk about Queen Charlotte City, and why Queen Charlotte City always appears to get facilities. I'm also mindful of the fact that you simply can't duplicate every type of facility in every single community. There is going to have to be some dealing with costs and all the rest.

But with respect to the smaller communities particularly, and the need for extended care facilities, perhaps the minister might like to outline what approach is being taken by the ministry to try to deliver some space to the smaller communities, so that you don't have to send relatives off a great distance where it's very difficult for people to visit relatives in extendedcare facilities. Perhaps I'll leave it at that, then continue with the other aspect of the problem, and that's the rate — extended care, long-term care.

MR. CHAIRMAN: Excuse me, hon. members. Might the Chair have leave to make an introduction?

Leave granted.

MR. CHAIRMAN: It's the Chair's pleasure today to welcome, and to ask the House to welcome, 25 grades 4 to 8 students from the New Life Christian School in North Vancouver on Mountain Highway. They're under the guidance of their teacher Mrs. McCulloch. They're in the gallery, and I would ask the House to give them a very warm welcome.

HON. MR. STRACHAN: Thank you, Mr. Chairman, and my greetings go as well to the children, teachers and chaperones from North Vancouver. Welcome to Victoria. We hope you're having a nice day.

There's been a thread of the concern that you've mentioned coming to me since I've been in this ministry, and I'm seeing it myself in the two smaller communities that I serve in the riding of Prince George South — Valemount and McBride. I'm going to give you a philosophic answer first, Mr. Member, if you don't mind, and then provide you with some technical detail — though it's kind of skimpy. It's something that you and I are going to have to wrestle with as politicians and as people, as we watch ourselves and our neighbours grow older in the smaller communities.

[ Page 12891 ]

They don't want to leave those communities — we know that.

The member from the Okanagan sitting next to you presented a scenario to me last week which really illustrated that we are seeing this concern from all over the province — people growing old in McBride, Valemount, Keremeos or Sandspit want to stay there. They've lived there all their lives. They have a very comfortable living and they have friends there. Their standard of living is extremely high because the accommodation expenses are very reasonable when you compare them to Vancouver or Victoria standards. There's just no way that they want to leave those communities. Of course, as we have a healthier older population that's growing older, we're going to be facing these concerns more and more every day. All of us in this room are going to face those concerns — at least all of us in this room who are in small communities that don't really have the economy of scale that the Ministry of Health would like to see.

I agree with you. You and I have that problem, a lot of us in the Legislative Assembly have that concern, and we are concerned about those seniors who are staying healthy, living longer, but are going to be requiring more and more extended care in their own communities. And that brings into the economy of scale a question. What we are trying to do is establish multi-stage facilities in the smaller communities, where we may attach facilities for extended care to a D and T centre or a small hospital. That's sort of the technical exercise we're looking at, and it will proceed as money becomes available and as the various societies — hospital and long-term-care societies — present plans to us.

The member from Terrace — the Minister of Lands and Parks — was discussing a housing initiative in his riding the other day that we're looking at. In my investigation of that request, I found that there are 80 such proposals from throughout the province. It's clearly an issue that we have to address, and one that we are addressing. I guess we're going to have to realize as a government, and as members of a Legislative Assembly, that this is going to be an increasing cost to the health care system as we try to provide more and more residential care units in the smaller communities.

I can tell you that the residential care budget has been increased this year by $50.9 million — going from $339 million to $390 million — so we are recognizing that expense. But on a philosophical basis, I really do understand and appreciate your concern about long-term care in the smaller communities.

MR. MILLER: It might be advisable, in terms of bringing the communities into that discussion and formulating policy. For example, it doesn't make a lot of sense, let's say, in the Queen Charlotte Islands to have communities fighting among themselves — I don't want to exaggerate that; they're not pitched battles — or competing if the policy or the way you're developing in terms of the economics in an area that size.... It would be ill-advised or impossible to have two facilities. In other words, they should know this at the earliest opportunity so that they can come to grips with the issue, resolve their differences, and then fix on a location and get on with the job of putting their plans together and making the requests for capital money to get a facility in place. So I'll leave that and move on.

In dealing with a facility in Prince Rupert, Acropolis Manor.... It shows you how you progress. I was on the hospital board when we conceived this intermediate care facility. At the time that we put this project together, it was ideal. We thought we did everything right. It was attached to the hospital. There were common facilities for the food services. There were emergency services available. The population base — people waiting who would require that kind of intermediate-care facility — were clearly there and identified. We did everything right, I thought.

Now we have a situation — and not long ago I was at a meeting of concerned parents and relatives of patients in the intermediate-care facility — that instead of what we started with, which was people who, because of some impairment or handicap, simply weren't able to live on their own — it may have been a physical handicap or a medical condition, but all of them required some assistance, either in meal preparation or making sure that medication was taken at the right times.... But as I recall, those people — and some of them I knew very well — were all pretty sharp people in terms of their mental state. The facility worked, and people really liked it. They liked the attractive setting. Some people who had been living alone in rather run-down rooms were put into a facility like this. It really served its purpose well.

The tenth anniversary of that facility, which I'm unable to attend, is this week. Now that same facility has a minority of patients in the category I have just described and a majority of patients who are classed in the psychogeriatric terminology. That has caused a great deal of discomfort for those few remaining patients for whom this facility was originally intended. They fear in some cases because of what can happen.... I hope that you and I never fall into that category; it's pretty tragic sometimes to witness the ravages of Alzheimer's and other diseases. But those people who are not suffering feel some fear. They are older people. They don't feel comfortable. They feel sometimes that they may be attacked. Of course, that fear is pretty widespread.

With the best of intentions ten years ago in terms of building a facility, we now have one that seems to me is quite inappropriate for the mix of patients. Perhaps we have to be looking at a further gradient, if you like; in other words, classifying people into more categories — as much as I hate to classify anybody in a category — and designing facilities that are appropriate and unique for each of those categories.

[Mr. Pelton in the chair.]

At the same time that we have this situation, we have a very good hospital, a very good physical plant, which is attached to Acropolis Manor and has vacant beds. Yet we can't take the patients who, from my layman's point of view, might be better suited for a

[ Page 12892 ]

more extended-care facility. There's a great deal of fear in the hospital that if they convert some of their acute-care beds, you will simply downgrade them, and they'll never be able to get them back. If the notion that we talked about yesterday of having a truly regional hospital, with patients referred from all over the region, is one we accept and want to encourage, the hospital fears that by converting acute-care beds to extended care, they'll never get them back.

[3:15]

It seems to me that we again have a situation where it is very difficult for local people to try to plan what kind of facilities should be put in place. People have generally complained about this situation to me for the last couple of years. But there seems to be an inability to come to terms with it, grasp it on a local basis and develop some plans to deal with it, so much so that the real initiatives taken have been done in an ad hoc manner by people who have relatives in the facility calling on people in the community.

For years Mr. Poffenroth was chairman of the hospital board, when I was a member of the board as well. They called on him because he has had some expertise, and in a sort of an ad hoc way said: "How can we get together and formulate some plans to deal with the situation."

I guess it ties into the previous issue of how local people come to grips with some of these problems. There seems to be a lack of direction and support for these people when it comes to trying to plan these facilities in those communities. I'll leave it at that, Mr. Minister. You may care to respond to that.

HON. MR. STRACHAN: The first thing I want to do is correct a comment I made earlier about transport for Caleb O'Connor. As I said, as is usual we are paying medical and hospital care when the treatment is not available in British Columbia. I also understand that we are charging the family the $240 air ambulance charge, which is common. But we are looking after the rest of the transportation costs, because the child is going on the Challenger to Philadelphia, and that, of course, would cost far more than $248. The Challenger expenses are being looked after by MSP and care services. That is not all that common, but this is a life-and-death situation. So we have recognized the urgency of that transportation and have agreed to pay for it.

I'll get to Acropolis shortly. With respect to the Queen Charlottes, we are providing $30,000 to the Queen Charlottes comprehensive health organization to fund an initial study to help build consensus in the area, and to resolve some of the concerns that you have expressed and that, as I told you the other day, have been expressed to me by residents of the Queen Charlottes. We recognize their concern. We have advanced $30,000 so they can begin some planning to sort out those differences and come together with a comprehensive plan. I suspect that it will be successful.

With respect to Acropolis, there are lots of things I could say about that, but as you indicated in your comments, tomorrow night is their tenth anniversary, and one of my staff, Paul Pallan, will be there. I'm not going. I'll have Paul send your best wishes as well, okay? I'll ask for a briefing. We'll look at your comments. I can't respond to you now in terms of what our decision is going to be, but as I said, we'll have staff there tomorrow night at the anniversary celebration and get the details sorted out as quickly as we can, You'll be provided with an answer as soon as I have one.

Interjection.

HON. MR. STRACHAN: In terms of plans for Acropolis.

MR. MILLER: I wanted to say, first of all, with respect to the young child being flown to Philadelphia, that I think all of us respond. Our hearts go out immediately when we see that kind of situation, certainly anybody who has been a parent. I'm sure that the parents appreciate any support, and we offer our prayers that this young child will indeed do better as a result of the medical treatment that he will receive in Philadelphia.

Just very briefly, is there a general issue with regard to the mix of patients that I talked about? Is that happening in other locations? And what plans do you really have to deal with that? Really, it's an inappropriate mix. It's inappropriate for the patients; it makes it difficult for the staff. We have very minor problems: you can't lock the door; there's got to be a fire exit; yet some patients are prone to taking a walk. It's very difficult to deal with. I didn't hear you really respond to that issue.

I want to move on and cover all of the remaining points while I'm on my feet. I wanted to talk about the diagnostic and treatment centre in the Nass Valley. I don't know how familiar the minister is with the situation there, but essentially the Nisga'as have taken over — as they have in other fields like education, where the Nisga'a Valley is a school district — responsibility for health care. They have a diagnostic and treatment centre — it's not a hospital — in which they try to offer a range of services, as there is not a hospital. This is a unique situation. As I understand it, the province globally bears about 20 percent of the cost, and the rest is borne by the federal government. I had a long meeting with the board earlier this year, and it appears to me that it has the potential — if it hasn't already got to that point — to develop into one of those situations, where you get the federal-provincial ping-pong game. The federal government says: "No, it's not my responsibility; it's the province's." And the province says: "No, it's not our responsibility; it's a federal responsibility." The clients in the middle really aren't satisfied. I really see a potential for that developing. The federal commitment to health care, as I've been advised, was frozen in 1984. A series of issues needs to be addressed, not the least of which is that the treatment centre is located on an Indian reserve. In a constitutional sense, perhaps the province doesn't feel it has responsibility there and feels it is a federal responsibility. But there are some deficiencies, and I think they need to be covered off.

[ Page 12893 ]

I think you have to deal, first of all, with the issue of federal — provincial ping-pong, because if it keeps going, it can only get worse. Perhaps that's something the federal and provincial governments have to sit down and iron out, because it's really unfair to the clients if that continues. But at the same time there are some anomalies in terms of the federal-provincial overlap which need to be addressed.

There can't be a physiotherapist. The province won't fund a physiotherapist in the village, although there are four villages — three really, because Kincolith is at the mouth of the Nass. Yet you find that the budget for transporting people to Terrace for physiotherapy is about $40,000. From a layman's point of view it doesn't seem to make a lot of sense. You would think it would make more sense to have somebody established in the Nass Valley, if it were possible to recruit one, rather than spend what appears to be almost the amount of money that it would cost to transport patients down to Terrace. That seems to me, from a practical point of view, to be something that should be dealt with.

The ambulance crews. Again, some of your colleagues have driven the road — and I know there are efforts to improve the road down to Terrace. But currently the ambulance is staffed by volunteers. I talked to the young woman in charge of that. She appeared to be a very competent woman and quite dedicated to what she was doing — but she's on her own. There need to be — and they've requested — two full-time paid unit chiefs for the ambulance crew. I don't know what you've done with regard to that request, but certainly it would appear that a reasonable case has been made for full-time assistance in staffing the ambulance — really, the lifeline into Terrace — and making sure it is available.

I really appreciate the work that volunteers do in dedicating so much of their time to maintaining this service which is so critical. At the same time, the ambulance they have is two-wheel-drive. In the wintertime, which can be a long time, that's not acceptable. They need a four-wheel-drive ambulance in the Nass. It's bad enough, Mr. Minister, driving a four-wheel drive vehicle up there sometimes. The roads are prone to flooding. The snowfall is pretty high. The logging trucks go back and forth on the gravel portion. It is not an easy road to drive at the best of times. It would seem to be just a bottom-line position that there should be a four-wheel-drive ambulance allocated to the Nass.

Moving on in terms of that ambulance service, there is the need for helipads. There is a study.... I'm not certain how much of the Nass it incorporated or whether the Nass has, in fact, been covered off in a study, but I know we've done that on the north coast with funding from ATAP to identify a network of helipads. I can't commend you, Mr. Minister, because you had nothing to do with it, but I did commend your predecessor in this House for the work he did in locating a twin-engine helicopter in Prince Rupert. It's a very effective service, and it seems to me that we have to get on with developing that helipad system.

Again, even with a four-wheel-drive vehicle in the wintertime, when you have to move somebody quickly, clearly the best, quickest and most efficient way is an ambulance.

There are a number of other issues. We'd probably have to sit down and talk in detail for a couple of hours to get through them, so I won't here. I know my colleagues have important issues they want to raise with the minister as well. I've covered a number of topics here and concluded with issues that were raised to me by the Nisga'a Valley Health Board — very serious issues. When I talked to the board you could tell that they felt these issues had to be resolved. I ask you to give me your comments. Hopefully we can follow up on any outstanding issues outside this chamber.

[3:30]

HON. MR. STRACHAN: In response to the member for Prince Rupert, first of all, we are addressing dementia care, the care of people who have Alzheimer's and other serious and disturbing conditions in the long-term-care facilities. We are being quite aggressive. In my riding of Prince George we have approved the construction of a 25-bed addition at a facility.

MR. MILLER: What about my riding? I don't want to hear about your riding.

HON. MR. STRACHAN: I know. Yours is next, okay? Actually, it's not in my riding; it's in the riding of the member for Prince George North.

Interjection.

HON. MR. STRACHAN: Well, it's soon going to be my riding.

In any event, we have a 25-bed addition that is designed specifically to look after patients with what we characterize as dementia — typically Alzheimer's. Although it is the same facility, there is some separation there. There is a recognition that a different type of care is required. We are aware of the concern you expressed — as, I guess, the whole world is, the whole western world at least. This condition continues to present itself as people live longer. Their bodies stay healthy but their minds begin to suffer with increasing age. That's a situation we have to address and we are addressing it.

In terms of the D and T centre, I can appreciate the problems the Nisga'a would have, and I can appreciate the federal push-pull that would go on. I can see it happening there more than anywhere else. As I know, and as you know, the Nisga'a are extremely aggressive people in terms of looking after themselves. They have their own school district; they have a lot of reading material in their own language. They are very aggressive, and I'm sure Ottawa just doesn't know how to handle a community that is that aggressive in terms of looking after their own socio-economic conditions and being responsible for their own social and economic determination. But we recognize that.

I don't know why they don't have a four-wheel drive ambulance up there. It would seem logical that

[ Page 12894 ]

they should have, and we'll discuss that. That certainly is a concern of ours, and I'll look into that question.

In terms of the volunteer ambulance people, we have a formula for the ambulance system that's based on call volume. It may sound kind of hard-hearted; nevertheless, that's the way we operate that service. It's performance-driven or call-volume-driven. We fund and staff on the basis of volume.

Finally, you said you'd like to discuss a lot of issues in detail, and my brave assistant deputy minister, Chris Lovelace, has volunteered to go north and visit. We'll send you when the snow flies.

AN HON. MEMBER: Will he eat oolichan grease when he's there?

HON. MR. STRACHAN: Oh, I don't know. Will he eat oolichan grease? Sure. I think that's a feature more of.... I certainly wouldn't eat oolichan grease if I were there. Some of the best salmon-fishing in the world is in that area, and lots of other things are far better and tastier to eat.

Yes, I will commit to have staff visit and discuss, and if I get a chance to go there myself, I will. So you can assure your constituents in the Nisga'a that we will do whatever we can to address their concerns and to see whatever services we can provide them in terms of better health care provisions.

MS. MARZARI: Mr. Chairman, I'm standing to raise a couple of issues that weren't thoroughly canvassed in my previous interventions. The first item has to do with something I raised when we first discussed the possibility of a special commission or an opening of the College of Physicians and Surgeons inquiry into sexual abuse of patients.

At that first meeting a few weeks ago the minister committed himself to writing a letter to the chair of that committee, Dr. Patricia Rebbeck, requesting that she think about putting a couple of laypeople on the committee to give it a broader framework in its terms of reference.

Last week, the second time this issue was raised, my colleague the second member for Vancouver–Point Grey asked the minister how far along he had come on this issue. The minister replied that he had a letter in the works that was being prepared for him. At that point I was going to raise the question but didn't get the opportunity. The question here is about how open this whole exercise will be. Simply putting a couple of laypeople onto this committee of the College of Physicians and Surgeons still makes the report that comes back the property of the College of Physicians and Surgeons.

Today, actually, I received a call from a news broadcaster who had phoned the hotline that the college established, and he found a recorded message at the other end saying: "Please leave your name and phone number. We don't want to discuss this case over the phone with you. That would not be appropriate. We will get back to you." The news story, if it's going out right now, is that this is an insensitive way to deal with the issue of sexual abuse of patients.

1 responded to the news reporter that it was obviously a low-budget operation, that the committee was operating with the best intentions and doing the best it could with probably no additional staff to sit and staff a hotline, and that the work of the committee was probably going to be very credible because the people on the committee are credible and well respected in the community In fact, it was the college itself that suggested the route of setting up the committee.

However — here's my "however" — you sending a letter asking for a few laypeople on the board, or even suggesting that it be slightly more open, might not be enough, Mr. Minister. My request to you is: could you think through the possibility of setting up a public forum — a public commission or committee — that would work with the College of Physicians and Surgeons and would in fact own the information that comes from public hearings and individual interviews, so that we as a group of legislators might be able to deal with this issue in an open and public way. Our terms of reference would therefore be slightly different than those of the College of Physicians and Surgeons, whose main concern, obviously, is to provide a decent, reliable service and to discipline members who do not conform to medical ethics.

Our terms of reference would be much broader, I think. They would have to do with information and education of the public, allowing the public to speak to us on mechanisms and infractions and giving us as a group of legislators something broader than an internal document to work with. Could you speak to that?

HON. MR. STRACHAN: First of all, as discussed last week, a letter will be going to the college, and the letter is being prepared now. Just to clarify: the addressee will be Dr. Tom Handley, Registrar — not Dr. Rebbeck. That's protocol; he's registrar of the college, so the letter will go to him.

I will request laypeople. How open one wants this committee to be is another question, and I haven't really got my head around that, Madam Member, nor has the college. Inasmuch as it's their committee, it is difficult for me to give them specific directions. They have a responsibility under the Medical Service Act to carry out a variety of disciplinary and other functions, and I certainly wouldn't want to abuse that legislation by telling them how to operate.

But I do accept your concern. Let me just say this: having heard that you would maybe see another committee discussing other issues and how we might make the public more aware of what you are concerned with, that's a possibility, and I will certainly consider it.

One would want to have some privacy to this, because if females who feel they have been sexually abused by physicians want to discuss their case, they certainly don't want to discuss it in a public forum. They would want to discuss it with responsible members of the college and responsible lay members of this committee, but certainly not in public. They would want some assurance that the evidence they are giving

[ Page 12895 ]

is going to remain confidential, because of the very nature of the evidence they're giving.

But there's still the question of another segment of the committee, or another committee, that would have more of a public process. I don't have any problem with that. Let me think about it, and first of all, we will see what response we get from Dr. Handley of the college. Then we will consider other renditions of this public committee that we want to put in place.

MS. MARZARI: I think we're getting somewhere. I was very careful — you will notice, or you might have noticed — not to even suggest that we instruct the college to do anything or even advocate strongly for our position. I simply think we should be talking to them about the possibility of expanding their membership or doing something together, in which the information would ultimately be owned by the public. I've read in the papers too many times recently — even letters to the College of Physicians and Surgeons — recommendations from a minister or from a member of the Legislature that telling a disciplinary body how to discipline is not what to do. Obviously we have to work in a spirit of cooperation. But it strikes me as entirely possible that the committee itself, when it deliberates, might come up with a recommendation that we go the Ontario route and suggest perhaps a public commission, so that public education and private discipline of doctors will meet somewhere in the middle, and so that people — women — can be better served and feel more secure when they go for medical treatment. I think we should move one step at a time along this route.

It was the Prince George case a few months ago that was brought against Dr. Clark that raised this whole issue in British Columbia. I'm sure complaints have been raised before, but due to the fact that this case was so graphic and the decision — or at least words used in that decision — was so volatile, 150 people gathered in Prince George last Wednesday evening to express their displeasure. Many of the victims — those who had brought the case against Dr. Clark — were at that rally to speak to the fact that they felt they had been silenced by the case. In fact, there seems to be — I don't know what the correct terminology is — a gag order placed on the transcripts of the case. As I said before in this House, it's possible for any one of us, including legislators and perhaps ministers, to receive a copy of the judge's judgment as well as the full transcript of the case. I think that also might be worth looking at as a part of this overall picture of women being silenced when they speak out against a person — a doctor — who is in a position of real power over them when they try to bring their complaints to the public.

For the purposes of this discussion this issue began in Prince George. So I would hope the minister would have a particular interest in it.

The second area I wanted to raise today has to do with the child care situation in British Columbia. It might seem odd that we would raise child care in the Health estimates, but I'm sure there are enough people in the province now who understand that child care is hopelessly entwined among three ministries: Health, Education and Social Services and Housing. Whereas Social Services and Housing seems to spend the most dollars in terms of providing subsidies for two parents for spaces, the Health ministry is involved in working with local medical health officers in the 22 health units around British Columbia to ensure that licensed spaces that exist are properly monitored, that standards are kept up to par, that the day care teachers are properly supported and that the physical premises are not unsafe. It's very important that this inspection routine, mandated through the Ministry of Health, be properly planned and organized and respond to the real numbers of spaces that exist out there, so that we as parents and as legislators can know that those spaces are properly dealt with and properly licensed and evaluated.

A recent story in the Vancouver Sun dated May 3, 1991, points to a study done that looked like an instant canvass done by the reporter herself. Fourteen of the province's 22 health units were phoned and 14 responded. Those 14 units were quite forthright in their comments about the ability of the existing health professionals mandated through the provincial government under the Community Care Facility Act. They said that they are completely unable to provide the service required. They do not make any bones about it. They are willing to talk about it openly and publicly.

[3:45]

Les Potter, director of health protection for the Victoria area, said:

"No one should have any illusions that there is any reasonable level of monitoring in these facilities. The unofficial standard is that one inspector is required for every 70 facilities to allow for one inspection a year. But in some areas of the province the ratio is as high as one for 175 adult and child care facilities."

Mr. Minister, I'm only speaking of the licensed facilities. When I talk about child care facilities, I'm referring to group care — with 25 children in church basements or small portable buildings located throughout the province — and I'm also referring to family care, in which a woman, generally speaking, takes in up to five children in her own home. Those are the licensed facilities.

There are literally thousands of unlicensed facilities in this province right now. In fact the Ministry of Social Services and Housing is engaged in programs to actually encourage more of these unlicensed homes to open. They say that it's a way of getting welfare mothers off welfare — by training them and putting them back in their own home to provide a child care service. Most of these homes are not licensed. Most of these mothers are not supervised, but more importantly, not supported to provide a decent service. Consequently, we have a system which is chronically under spaced. We have 30,000 licensed spaces in the province. We have a need for about 300,000, but with those 30,000 licensed spaces we do not have an adequate supervisory system.

I would ask the minister to comment on the contracts we have with the 22 health units. How often are they monitored by the ministry itself? How many people are actually working in these 22 health units,

[ Page 12896 ]

and what contact does the ministry have with them to help support, supervise and train them?

Then I would ask the minister to comment on the unlicensed facilities and his concern about unlicensed child care, because ultimately, under community care facilities, your ministry must also accept some responsibility for the fact that they exist in our communities and are not supervised or monitored.

HON. MR. STRACHAN: The member indicates a concern that we are well aware of. Just to give some background to the issue, there are 94,000 women in the B.C. labour force with children under the age of six and a further 192,000 employed women with children under 16 years of age.

The government provides a number of child care programs. The Ministry of Social Services and Housing provides subsidies for low-income parents and parents of special-needs children, grants for non-profit societies and funding for child support service programs which recruit, train and support informal child care providers.

As the member has indicated, the Ministry of Health, under the Community Care Facility Act, is responsible for the licensing and monitoring of child care facilities and the registration of early childhood educators.

[Mr. De Jong in the chair.]

The Provincial Secretary assists non-profit societies with up-to-one-third grants of capital costs. Of course, the Ministry of Advanced Education provides funding to community colleges for early childhood education courses. And we have a variety of interministry committees, including the provincial Child Care Facilities Licensing Board, the interministry working committee on child abuse and the advisory committee on child care for public service employees.

We see the development of quality, accessible and affordable child care in British Columbia as a priority. On January 29, 1991, the Task Force on Child Care completed their study of child care in the province and presented their recommendations to the minister and to cabinet. On March 22, government approved a $55 million child care expansion strategy. These funds are over and above the $63 million that we currently spend annually on child care, of which about $50 million goes to subsidize low-income families.

What we want to do in part with the $55 million, as well as increasing subsidies, is establish a data base to support planned expansion of facilities, increase subsidies to low-income parents, expand capital funding of programs for child care, expand child care as a home-based business, and increase participation by the business sector, municipal governments, school districts and community groups.

In terms of answers to some of the member's questions.... First of all, the health units: there are 22 of them. The majority of them report to us, Madam Member, because they are our health units — the ones that aren't are in the large centres. The others are city health units, or regional district — GVRD, CRD.

Interjection.

HON. MR. STRACHAN: They're city, so we are very much involved with them.

Non-licensed facilities have three children or under, I'm advised. I can't comment on the comment the member made about the Ministry of Social Services and Housing wanting to expand that private sector, but I can tell the member and the committee that we do see this as a priority. The figures I've mentioned as having been committed are going to be spent in a variety of ministries. I see increased child care as a very serious concern and a priority of government.

In terms of the licensing of the community staff for the 16 health units that we have, for 1989-90 we had 15 new positions, in 1990-1991 there were 21 new positions, and this fiscal year there are 31 new positions. So I think we are adding staff at a most appropriate rate to address some of the concerns the member has expressed in her comments on this issue.

MS. MARZARI: So the minister is actually stating that over the last three years there have been 15 plus 21 plus 31 new people?

Interjection.

MS. MARZARI: That's cumulative. Then in total over three years we have had 31 new people. Each of these people is a licensing inspector and has been put into one of the 22 health units located throughout the province. Am I correct on that score?

HON. MR. STRACHAN: The member is correct; it's cumulative. They have been put into the 16 health units that are ours. The other six are municipal health units, and I don't have figures on their expansion.

MS. MARZARI: The question, then, becomes: have the contracts with the municipalities increased to allow for the recognition that there are increased numbers of licensed spaces in their regions, and therefore they would have an expanded contract on that basis? Here's another way of phrasing the question: does the minister have a formula by which licensing inspectors are added to staff — both provincial and municipal — depending on the number of licensed spaces on stream or coming on stream? Is there a formula that the minister is working on or has developed?

HON. MR. STRACHAN: In terms of the first question with respect to contractual agreements with the cities, the answer is yes. We are increasing their funding for these positions as well. None of us here has that information. It is a population- driven and service-driven formula, so one would suspect that.... I can advise the committee that we have increased the funding there.

In terms of developing funding for these services, we don't have a formula yet, but we are putting one in place. Hopefully that will address on an equal basis the concerns the member has brought to the committee. As the need for inspectors and other services is demon-

[ Page 12897 ]

strated by population increases and by more children coming into the system, we will have a formula whereby we respond with appropriate staffing and other resources.

MS. MARZARI: I wish we could all be lulled into a sense of comfort here, as I ask these questions and am assured that there are formulas coming on stream, and that there will be people to meet the demand. But I'm faced with an article here which basically says that the whole system is in complete chaos. I'm not even dealing with the fact that there are not enough spaces to meet the needs of children and parents who need child care. I'm just talking about chaos within the existing number of spaces — paltry as they are — which presently are there to serve children, and we don't have the inspection staff to properly support the spaces. And you're correct: the child care inspection chaos seems to be worse in areas with rapid population growth: Victoria, Nanaimo, central Fraser Valley, Surrey, Kelowna and, not surprisingly, Prince George. They all seem to be suffering chronic understaffing of licensing staff and the support of licensing staff to child care centres, group care and family care.

Would the minister confirm that every child care licensing inspector becomes responsible for up to 175 adult care and child care facilities? These are generic inspectors, I suppose. They go out and investigate nursing homes as well as child care homes. Is that the ratio that this ministry works with in terms of caseload for a licensing worker? And while we're talking about standards, is what I read in the newspaper true — that we are looking at a mere one visit a year, if they're lucky?

HON. MR. STRACHAN: Well, just let me reiterate the figures in terms of new positions. The member quoted an article written earlier before our 1991-92 budget. There are increases by ten — from 21 to 31. So ten new positions have been added. I can't comment on 147 facilities to inspect per inspector, because I'm sure we wouldn't have formulas like that. I don't have any further details on it. We will admit that population pressures are causing us problems in all areas of service delivery throughout the province, whether it be licensing positions, such as we're talking about here, or a variety of other areas where we need personnel — in just about every ministry. I guess that's a problem of success, but as the member and the committee know, our budget has increased considerably, and we will continue to fund as best we can, as revenues become available to us.

MS. MARZARI: I don't like to paint a picture of armies of inspectors marching into child care centres and adult care facilities with vast amounts of overspending going into an inspection scheme. I am concerned, however, that we are prepared in this province to set standards for community care licensing and for what a child care facility should look like, and they happen to be some of the best in the country. We set standards for what adult care should look like, and we try to keep our nursing homes up to scratch by looking good and being comfortable for their inhabitants.

[4:00]

There are probably two ways of making sure those standards are properly kept. One is to have a rigid enforcement system where licensing inspectors come in with a checklist and go down the list and say: "Your walls are too grey this year. Paint them or you'll lose your licence." The other is a system in which a licensing inspector could work with groups of child care supervisors, child care non-profit societies and child care facilities to help them monitor their own standards, and assist them in coming up with ways in which they can improve their own systems. There are all kinds of good models for how this could come about, so that the licensing inspector is not just a police enforcer of cold rules but somebody who's actually there to do community development, assist new centres in developing and, if there are problems, give the proper warnings and help the community rectify them.

I think of the child care inspector that I've had for 20 years of my child-rearing days — and I have raised children now for 20 years. It's Elaine Kliner, and she's still doing the job there in the city of Vancouver. She knows every child care facility that exists in the whole city and now, I gather, New Westminster. She's always been the one who's been there, who has showed up and who has been around for everybody. I know she has assistance now, and I don't want to romanticize her job — but, my God, what a tremendous load Elaine has carried over these many years.

It's not enough just to say: "Okay, we'll go on with the way we've got it." Nor is it enough to say: "We'll bring in armies of new inspectors." What we've got to do, Mr. Minister, is make sure that at the provincial level we set the formulas and make sure that we meet our commitments so that properly trained and licensed inspectors can go out to assist in the proper training and supporting of child care facilities.

I know you've said that we're trying to do the best we can with the money we've got. But what I'm asking you to do is take a special look at the situation, especially after a damning report such as this one as recently as May 3. Call together the medical health officers municipally, perhaps through the GVRD and, if it's a similar arrangement with contracts, through Victoria as well, and call together your health and child — care licensing inspectors at the next available opportunity. Talk to them and get their ideas about what's required and what other models could be used to assist them in their work.

Is the minister prepared to do something as simple as pulling together these workers to discuss possible alternatives if money isn't available to assist in getting them into those centres more than once a year?

HON. MR. STRACHAN: What the member is saying is constructive, and the notion of just throwing this army of inspectors out in the street certainly is not the way to go. We in the interministry committee have, in the work we've done, identified that there is a consumer resource there, a consumer responsibility. We want to involve parents in helping us to better assess

[ Page 12898 ]

the facilities themselves, and there's a variety of remedies that we are looking at in terms of answering some of the questions that the member opposite has as a consumer herself — and some of the questions that I and many other consumers would have.

I had an interesting note from the former Minister of Health — the current Minister of Advanced Education, Training and Technology — who advises me that he wanted to speak on this issue for a little while. I'll be more than happy to take my place and let him advise us on conditions in the Fraser Valley. Then we'll return to more debate on the broader issues of this subject.

HON. MR. DUECK: It's mostly to give my colleague a chance to powder his nose — it was getting kind of shiny — and to get out of here for a moment.

I found it very interesting, since I was in this ministry for quite a number of years, and I still feel some sort of strange attraction to it, although it was a hectic three and a half years. Talking about children is something that has always interested me, inasmuch as I was always concerned about people who can't help themselves. Children, from the time they're born up to the age of, let's say, ten or 12 are very much dependent on adult people. When we're talking about day care centres, I think we have to be very careful that we don't sort of brand licensed day care centres one type, and informal centres of a lesser type. I think we have to remember that it depends on that particular centre and the people running it, whether it's an informal day care centre or a licensed day care centre.

I know that in my community, for example, we have many informal day care centres. They are absolutely excellent; I would send my children to them any day of the week. They are excellent homes, where perhaps a mother has raised children, and they are at school, and she's willing to take in two or three. They provide a very good alternative. We also have day care centres that look after many more at one time, and that are licensed; and they also are good. But I do not want anyone to misunderstand that just because they are licensed, suddenly they are a better home. Far from it; they could be either. I've seen some homes.... You members on the other side, I'm sure, all recognize that there have been some homes closed that were in fact licensed and supervised and checked, and found wanting after many years of being in business. I've found many homes that have not been licensed, that are informal, that are absolutely excellent.

We cannot depend on inspectors to do the work of the individual; it's also up to the parents to make sure that they in turn know and are responsible where their children go. I think we have gone too far, as public and as government too, where we want to do everything for everybody. There is such a thing as a parent being responsible for children; but they are also responsible that those children are looked after even if they are not in their own care.

I want to make the point that we cannot have an inspector running to every day care centre every day to see whether everything is in order. But we should be very firm when there is a home that's not looking after the children properly, that they get taken out of that home, and the home is closed pronto. I think we all agree on that.

The other thing I was going to bring up is that in the central Fraser Valley there's so much talk that we haven't got enough day care centres; we haven't got enough places for children to go. I want you to know that in my community there are ads, ad nauseam, wanting children. There are all kinds of day care places where children can go. I don't know about other communities, but in the Abbotsford area there are many places. I often talk about it to my wife and say: "Look here, one after the other wanting children." They say from one to three, or whatever. These are mostly informal homes, and I know they are good homes. Mind you, not all communities are as good as the central Fraser Valley, Abbotsford-Matsqui; I think we have better people living in that area.

Anyway, since my colleague is back and his nose is not as shiny as before, I'll let him continue.

MS. PULLINGER: I just have a comment and a question. The member that was just speaking said that there were lots of child care places in the central Fraser Valley area, but he doesn't know about elsewhere in the province. I will inform the member that there are in fact approximately 60,000 children in British Columbia that have no care at all, because it doesn't exist or it's not affordable. Those are children under 12. So now you know, Mr. Member, that there are 60,000 kids who have no child care. It’s a serious problem.

I would like to ask a question. The member was talking about licensed versus unlicensed care, saying that some are good and some are not so good. That may well be true; I don't dispute that fact. However, the member made the point that through monitoring and supervision, some licensed places have been shut down because they were inadequate and weren't doing the job. I would like to offer that that is precisely the point of licensing. When you license and have some supervision, monitoring and requirements, then you know what's going on. When you find a place not functioning to the standards all children ought to have, then you can shut them down.

I would simply like to offer that point. You made it yourself, only you didn't take it far enough and didn't seem to understand the consequences of your comments. That's why we need licensed, accessible and affordable child care for all the kids in the province. If you have some other kind of logic that fits with that, be my guest. But that is precisely the point that we on this side of the House are making: we need licensed child care so we know what's going on.

HON. MR. DUECK: I can't resist the temptation to speak on Health issues. The point I was trying to make is that there is much weight put on licensing; in other words, that's the cure. You license it, and from that point on you have no problems. That is not the case. There is the responsibility the parents have to take on to find out where their child is going. It's not always so. A lot of parents say that because it's a day care centre, they'll just put their child in there and whatever

[ Page 12899 ]

happens happens. There is a responsibility, and we are somehow avoiding that responsibility as parents — or some people are. There is a responsibility.

The other point I was going to make is that there is also a trend or notion that informal day care is not as good as formal, licensed day care. I want to make sure I'm on record that the informal day cares I have visited are, in many cases, better than the licensed.

MS. MARZARI: There's a real problem here. The minister would not go out on the road in a car without a licence plate.

Interjection.

MS. MARZARI: No, I'm serious. We license cars; we license dogs. We don't have licences to show you've paid money for a licence, but to show that the car is fit and ready to go on the road and that it meets some acceptable standards. The kindest interpretation is that the minister knows, as we all know, that women in communities — the good neighbour down the street — takes in kids. She's allowed to take in up to two kids on an unlicensed basis. We know that, because we've all used them. They happen to be there because our kids couldn't get onto the waiting-lists.

Back in the early seventies the waiting-lists were so long that the chances of getting on at all.... They don't even keep waiting-lists anymore, so there's no real way of tracking the desperate need in many cities. When you look for the waiting-list, it's artificial, because centres don't keep them anymore. They are just not there. The data base is an excellent idea, Mr. Minister, and I strongly recommend that you go with it.

But things are so bad in this licensing area that a few years ago parents were given a list of things to check off — I'm not sure whether it came from the Ministry of Health or Social Services — when they went into a child care centre to help assure the parent that things were okay. They ticked off adequate water, hot water, hot lunches or whatever, and at the bottom was criminal record of the caregiver. The parent was expected to ask the caregiver if they had a criminal record. I believe that was the issue.

It was bizarre that these unlicensed, unsupervised places were in such huge array — there were so many of them — that the system could not even begin to keep track of them. They said to parents: "Here's a checklist. And by the way, ask your caregiver if they have a criminal record." This is not responsible behaviour on the part of a government that cares about children. If we care enough about dogs and cars to have them licensed, surely we should be providing parents with a sense of safety and security that their children are being safely tended in a licensed place.

More importantly, the good neighbour down the street who's running an unlicensed facility needs the security, knowledge and support of a friendly local health officer, licensing inspector, who's going to assist them in upgrading their play equipment or facilities and inform them if there's a piece of play equipment which is unsafe.

So under the guise of liking and respecting our local non-licensed centre, let's not toss the baby out with the bathwater and say licensing isn't required. Licensing is required. I'm bloody surprised that we as a government — Social Services or Health — have not been sued by parents over the years for not providing proper security and inspections. If I was putting my mom in a nursing home, I'd want to make sure that was properly tended and licensed. It's no different with kids. It's perhaps more important with kids because of the worries and fears that parents have just leaving their kid in a centre with somebody else altogether. That's difficult enough as it is, let alone knowing that the centre is not licensed.

I would ask the minister to take what he has heard with a certain, shall we say, leavening agent and figure through that responsive, supportive community licensing is the answer, not a problem.

[4:15]

HON. MR. STRACHAN: That's the last time I leave this place.

Seriously, I think the point that my colleague was trying to make was that there are very good unlicensed facilities. As a matter of fact, some parents prefer an unlicensed facility. That's not to say that everything is perfect, and I'm not going to take a Pollyanna attitude about it, because there's a lot more that we can do.

There is a responsibility.... I wasn't aware of this questionnaire that the member was referring to. In retrospect, it's not all that bad an idea when one thinks of it. If I were a parent considering an unlicensed facility — or even a licensed facility — I think I'd want to have a checklist of things that I should look for, because there might be some things ministry officials are aware of that a parent might not think of, in terms of what to look for in a facility.

[Mr. Ree in the chair.]

In terms of the criminal record, I wouldn't comment on that. But I don't disagree that a checklist isn't a bad idea. As I've said earlier, the notion of having the consumer have some responsibility with respect to this is not a bad idea either.

Notwithstanding that, let me say that I do respect what both members opposite have said. The second member for Nanaimo and the first member for Vancouver-Point Grey have raised issues of parents that I agree with. Both mv children attended a day care. As a matter of fact, I'm probably the only one in this room who used to manage a day care. Would you believe that? I was licensed. It was an indirect job. I was employed by the College of New Caledonia at the time, and we operated a day care for the benefit of ECE students and for children of students, instructors and staff. One of my administrative responsibilities in the division was for that day care centre — at least the operation of it, not the teaching part. So I became quite interested in day care. Mind you, that was years and years ago, and I'm sure things have changed, although children haven't and I'm sure the regulations haven't.

[ Page 12900 ]

So I do have an interest in day care, and I certainly respect what the members have added to this debate.

With that said, I agree with the issues and the concerns, and I'll take my place and await further questioning.

MR. JONES: I rise to ask a question that I asked yesterday I appreciate that the minister has been in the portfolio only a short time and that it's a challenging portfolio. It was not that the minister didn't give me an answer; he gave me so many different and contradictory answers that I'm more confused than when I started.

Let me outline for the peanut gallery opposite the kinds of answers the minister gave to a very simple question. The question is this: why, in a large urban hospital like Burnaby Hospital, don't we have a small out-patient chemotherapy clinic? It's a simple question.

The minister started out by implying that we didn't need such a clinic and that there were other hospitals nearby. He even made the case that Lions Gate in North Vancouver would be closer to residents of Burnaby and that there was an excellent facility on Tenth Avenue in Vancouver. The implication was that it really wasn't needed. So that was answer number one: there are lots of other spaces available; we don't really need on in Burnaby because there's a lot of other very good facilities in the lower mainland and people only have to drive a short time to get to those facilities.

This was the answer to number two: well, it's really up to the hospitals themselves; what's it got to do with the provincial government? "Hospitals are autonomous, legal entities, " quoted the minister, "and they can decide these things for themselves." So that was answer number two: don't ask me; it's up to them.

Answer number one: they can get service somewhere else; it's not needed. Answer number two: it's up to the hospital; if they want to have it, they can have it.

This is answer number three: if they want one, why don't they ask for it? The minister said they had never asked for an out-patient chemotherapy clinic at Burnaby Hospital. A simple question, and so far three answers.

Answer number four was really related to answer number three. When I asked if the minister was sure that they'd never asked for one, he suggested that: "Well, I'm not aware of any request; nobody on this side of the House — staff, etc. — is aware of any." Then the information was updated for the minister, and that response was changed. He said: "We received within the last couple of months a proposal from two agencies — B.C. Cancer Agency and Burnaby Hospital." So a proposal implies to me that something is being requested of the ministry, that some action on the part of the ministry be taken, and that the request for action was a joint request by two bodies: the B.C. Cancer Agency and Burnaby Hospital.

I got very heartened at this point, because the minister said — and I appreciated this response — that the request was likely to be approved. I wish we had stopped there, but I guess the minister didn't like answers one, two, three, four and five, and he went on further. First of all, the time was changed, and the agency making the request was changed. Then he said: "We received a proposal from the B.C. Cancer Agency that was submitted a year ago." So it wasn't now or a couple of months ago, and there hadn't been a definitive response by that time, which would be understandable. It had been a year ago. And now it wasn't a joint request from the Burnaby Hospital and the Cancer Agency; it was from the Cancer Agency. It wasn't a couple of months ago but a year ago.

Then that got changed again, and he said: "We received a revised request in January." Okay. All of these things imply to me that it's the responsibility of the Ministry of Health to respond to these proposals, requests or suggestions that this kind of service be provided in hospitals in British Columbia operating under legislation of the Ministry of Health. "That request, " suggested the minister, " required reworking before we would accept it as a ministry." Again, that implied ministerial responsibility. Those are his words.

All this is to help the minister clarify, so let me finish, and then I will provide the minister with an opportunity to give answer number 11 to the same simple question. But I'm sure he can clarify that, and I will just finish up here and give him an opportunity to do that.

Then he said, after all those different, conflicting answers, that it's currently being reviewed by the B.C. Cancer Agency. Now originally he said that the request was a joint one from the Burnaby Hospital and the Cancer Agency. Then he said the request came from the Cancer Agency, and then he said it is being reviewed by the Cancer Agency. This is a masterful display of ministerial dancing. I find it quite incredible that the minister could take a simple question and dance 12 answers all around that question. Finally, he said: "It's not the purview of the Ministry of Health to pursue these or to vet these. It's really the responsibility of the Cancer Agency."

So we went from denial to almost acceptance. In answers one through six, we almost had our chemotherapy unit there; then finally by the time we got to answer number 12, it shuffled off into some Cancer Agency which — I don't know — goes back a year. He said that the Cancer Agency originally made the proposal. So we went through so many loops on that one question that I really would like the minister to see if there is any further update, and maybe answer number 13 will be the one I'm hoping for.

HON. MR. STRACHAN: The member is cute, as he always is in his rendition and recounting of what really did take place. I noticed he wasn't reading from the Blues, so he's obviously fabricating a lot of the answers one to 14, or whatever they might be.

Interjection.

HON. MR. STRACHAN: I wish you would. You might get it right for once.

First of all, with respect to answer number one that was not in response to your question, Mr. Member, but to a question from the second member for Vancouver–Point Grey. Really, he dealt with the nausea experi-

[ Page 12901 ]

enced by a patient who had to have chemotherapy at Lions Gate. I expressed my concern for that and pointed out that one had to drive. Although I didn't say it this way, we don't have a chemotherapy unit on every block, so you're going to have to drive somewhere. I also pointed out that, although my knowledge of the geography of Vancouver–Burnaby–North Vancouver is limited, there are many cases where in fact a resident in Burnaby might be closer to Lions Gate than to another facility; similarly, someone living on the west side of Burnaby could be closer to the Vancouver cancer clinic by VGH.

Then the member skirted around the Burnaby proposal. Burnaby applied a year ago, but the B.C. Cancer Agency, which handles all of this for us, asked them to rework their proposal — which they did. They responded in January 1991. The B.C. Cancer Agency is looking at the proposal now. I think it's going to be approved, and I don't think there's much more to say. That's it; it sounds like a good proposal to me.

MR. DE JONG: Mr. Chairman, I just want to say a few things in this debate. I've listened to much of the debate. While I've heard a number of letters which have been read into the record, as well as other comments of a negative kind, I just want to say today that the experiences we in our family have had — in particular a brother of my wife and his wife, who both needed heart surgery last December.... It was only a couple of weeks before Christmas.

[4:30]

They live in the village of Lumby, which is a considerable way from Vancouver General Hospital. These folks received all of the care, not only in terms of transportation with Government Air but also in terms of transportation to and from the airport and to the hospital. In fact, these folks were both operated on within a couple of days, because the situation was urgent, and they were both back home by New Year's.

I don't think that this is the only success story. There are undoubtedly hundreds, if not thousands, of success stories due to this ministry and in particular due to the medical staff and the nursing staff of the major hospitals, particularly those where delicate operations are performed, and the care that is given. When we talk about care given and responsibility accepted, I must say that our medical profession — and in particular, the doctors and the specialists — often goes far beyond the call of duty to help the people who really need the help. I just wanted to put that on the record.

I do have a concern that I wish to canvass with the minister for a bit now, though. It applies to health inspections, which were talked about earlier. There are also a number of health inspections done on septic fields in rural areas. Apparently, over the last little while, Mr. Chairman, there have been some changes in the regulations regarding those septic fields. I'm particularly concerned about this, because it applies to many of the areas within the floodplains where from time to time the groundwater level will exceed that maximum that's required for septic tank fields.

It's my understanding, as I have been informed, that this level has been raised to 18 inches from the ground surface. The water level must be below 18 inches year-round. We all know that from time to time we get heavy rains, sometimes combined with snowmelt, where in some of the floodplain areas that minimum cannot be achieved. As a result, while many of these areas have been farmed for 80 years and farmers have lived in their houses for 80 years and really no problem has existed, all of a sudden — while we like to brag about the increase in agricultural production and agricultural activity — these farmers now cannot build a new home or rebuild an old one or start a new set of farm buildings, because they cannot get the approval for a septic field.

I've discussed this with the local health officer, and he doesn't seem to have any alternatives. In the past I served as mayor for many years; when similar problems were brought up, there was usually an alternative method that could be used in those cases.

I'm just wondering whether the minister has any thought about this specific regulation, which I believe came into force only about two or three weeks ago, and whether he intends to review that further so that indeed those cases that not only are a problem in the Abbotsford-Matsqui area but will be a problem, I'm sure, in Pitt Meadows and many other good farming areas in the lower mainland.... I believe that these farmers do deserve a house with a satisfactory septic system.

HON. MR. STRACHAN: At the outset I'd like to thank the member for his comments about the Medical Services Commission, and I'm happy that his in-laws are feeling better and receiving the appropriate treatment.

With respect to septic tanks, lagoons and other methods of looking after the problem of residential sewage, I can tell you it's a problem, Mr. Member, particularly in your area. Groundwater testing, which we do regularly, shows us that we have an increasing presence of nitrates in groundwater, caused by intensive agriculture — animals and intensive fertilization — as well as by septic tanks and septic fields. It is a concern.

We have a responsibility as the Ministry of Health to ensure that people's health comes foremost. I can assure you that I've been at the centre of many of these issues myself in Prince George with respect to residential development, where a developer wants to put in either a lagoon system or a septic tank and field system, and the Ministry of Health has had to bring in stringent regulations, look at percolation, groundwater testing and some of the other issues, and say no to the applicant. That's a difficult thing for the applicant to accept, but a person's health comes first in our opinion, and if the evidence of the technicians we have employed tells us that the installation of a system is not going to be conducive to good health and that the installation of the system may contaminate groundwater, then we have no alternative but to refuse that application.

I can sympathize with the member's concern, and I can certainly sympathize with the people of the Fraser Valley, because they want to develop; but nevertheless,

[ Page 12902 ]

the rules are there. I'm advised that 18 inches is appropriate in terms of depth, because you cannot put sewage into groundwater without contaminating neighbouring wells and nearby ditches. This is essentially what I said earlier. But I'm also advised that this is not a new regulation.

Each case is looked at individually, where necessary, to try and find customized solutions. Let's hope we will. The ideal thing would be to put in proper sewage collection and treatment and avoid ground disposal of sewage, but that would be very expensive. In the meantime, we have to maintain our regulations. We'll ensure we address your concerns in the Fraser Valley as best we can and in as innovative a fashion as we can, but one has to remember that the bottom line for us is human health. If we have any condition, installation or application that's going to take away from human health, then we have to react in a manner that ensures we do have appropriate human health measures.

MR. DE JONG: Just to follow up a little bit more. As I mentioned, these areas have been farmed for the last 80 years or more, and residences have existed on many of these properties or on surrounding properties for that same length of time. I do believe that drainage projects have been installed in many of these areas in the past 25 years, which undoubtedly has improved the drainage for those areas and hence has brought the groundwater level down because of better drainage. On occasion we do have these flash-floods. I take exception to the inspector telling me that if it only happens once a year.... He also told an applicant that he must wait for a year before he can get approval for a septic tank to be installed next to his new home. It seems to be a bit ridiculous, considering that it is essential for a farmer to be living where his operation is.

HON. MR. STRACHAN: I'll take the member's point as noted. We do want to ensure — in percolation tests and all the other testing that we do — the health of the residents of British Columbia. But the member makes a good point. We'll revisit and look at the regulations and some of the inspection processes.

MS. PULLINGER: I would just like to revisit the whole issue of child-care spaces and licensing, because I don't feel that we've quite completed the discussion The minister and a number of people on the other side of this House have argued that we don't need to license child care places — or child care spaces, child care givers — because some of them are very good. There's no question, some of them are excellent; I don't dispute that. However, what the minister doesn't seem to understand is that there are also some horror stories about children. For instance, in my riding a number of years ago, it was discovered that at one place where children were left, kids were routinely drugged through the use of cough syrup as a way of keeping order and keeping them quiet. What I would like to suggest is that if we have no licensing, no monitoring or no means of checking, then we have no means of finding those problems. There are also, as I pointed out a little bit earlier, some 60,000 children under the age of 12 in British Columbia who have no child care at all — they are left alone.

The minister talks about the responsibility of parents, and I hope the minister isn't suggesting that those people who leave their kids do so because that's their first choice. That would be a very irresponsible and uninformed position. This minister tends to be very well informed, and I would hope he wouldn't suggest that. The reality is that we do have unlicensed care, which is not doing the job, as well as very good care. We also have 60,000 kids who have no care whatsoever. Parents obviously have a significant amount of responsibility. I would also argue that parents take that responsibility to the very best of their ability and resources.

There's something going on here that I would like to talk about. I would like to have it on the record, and I would like the minister to consider it. The world that I hear the members on the other side describing is an imaginary world that is a little bit out of touch with reality for most people. It's a bit of an ivory tower when you're describing the choices people have and the time they have to check out child care. So let me just talk for a minute about what the reality is for a number of women.

In 1961, the statistics show that 65 percent of families were traditional families in which mother stayed home with the children and father went out and earned a living and looked after the family. In 1961 that was the case, and that's fairly even over time. Women have always had to work outside the home.

Today, the number of traditional breadwinner families is 16 percent maximum. That's not very many. This means that in 84 percent of all families both parents work. Before the other side jumps up and says, "Well, that's their choice; therefore they have to look after the consequences like child care; it's up to them to find it and check it out" — which I don't disagree with as far as is possible — let's just remember why those people are working. In 58 percent of those families, both parents are working because if they didn't, the family income would drop below the poverty line. Poverty in a family means children living in poverty, and that's an issue I raised in the first session here which has serious health implications. That has serious implications for where we're going, so this is a critical issue. It disturbs me to hear the other side dismissing it as if everyone had all the choices they could have and that licensing didn't matter. So we have 84 percent of the families where two parents are working, and nearly two-thirds of those work because they must work — they need the money.

On top of those statistics I would like to add that we have single parents. Of course, single parents in the vast majority of cases cashes out to mean single mothers. As we know, women earn 61.8 cents on the dollar in British Columbia, and something like 70 percent of those single mothers and their children live in poverty. Again the choices close down. They don't have cars to drive across the city, they don't have the time and they can't get good jobs. That scenario is important. The conclusion to that scenario is that we've

[ Page 12903 ]

got to have child care. It's got to be accessible and affordable, and we must have some standards. The reality of today is that we've got kids in care. Whether we like it, whether we disagree, whether we don't, that's the reality, and it's going to stay that way.

[4:45]

We also have a little problem with some divergent roles for women here. Let's not forget that women in our society are overwhelmingly left with the responsibility of raising children. So on the one hand we have women who have the responsibilities of home and family, which is deemed to be non-work in our society. When people ask if you are working, they don't mean at home; they mean are you working for wages. That job is estimated to be some 70 to 100 hours of work if you have two or three children at home; yet it's deemed to be non-work. A woman who works — whether it's her own business or a job in the paid workforce — fits in an average of another 8.5 hours of work at home and with her children, around that day of work. That's an enormous problem for women.

It's not an option for those same women to stay at home on social assistance. As we see, the government has gone to all sorts of lengths, including cutting social assistance payments by $50 for women whose children are six months old. There are all sorts of pressures. There is a stigma if you're on social assistance, and you are blamed for being there in spite of the fact that you don't have options. We've heard the other side say that children in poverty are there because mothers don't love their children enough, and if they turn to Jesus Christ, everything would be fine. We've had all sorts of foolish rhetoric from the other side.

The reality is that there are two divergent roles for women, and the only solution we've come up with so far to bridge that gap is licensed, affordable and accessible child care. We have that solution, but the government doesn't seem to be able to take seriously that divergent role and the reality of where we are today.

On May 3, 1991, we had a report in the Sun. Frances Bula interviewed a number of inspectors. What she reported is that each of the inspectors has some 30,000 children that she or he is responsible for. She says that they're not even coming close to carrying out their regular annual inspections. I think that's serious.

As my colleague the first member for Vancouver–Point Grey said, we license dogs and we license cars in order to keep some sort of control, to know what's going on and to come to acceptable standards. I think our children are at least that important — in fact a lot more so.

The minister says that the unlicensed child care places are acceptable, that they're in fact good and that they're sometimes better. As I said before, I don't dispute that that's sometimes the case. But the government's own inspectors are saying that illegal child care is proliferating in some areas of the province — illegal care, too many children, and people doing things they ought not to be doing with children. It's happening all over British Columbia. They're also saying that instead of preventing problems, the ministry's inspectors are dealing with them after the fact. Well, after a child has been damaged, whatever kind of damage it is, that's simply too late, Mr. Minister.

I think this is something that the minister ought to listen to very carefully, because the areas where the problems are the most profound are the areas where there's most growth. Those include places like Victoria, my riding of Nanaimo, and the central Fraser Valley, where the member was just saying a moment ago that care was wonderful. That's where the problems are proliferating and becoming extremely severe. The other places are Surrey, Kelowna and the minister's own riding of Prince George, which is one of the critical areas in B.C. right now.

As we know, the responsibility for monitoring and standards lies with the Ministry of Health. I would like to offer to the minister, given the scenario I've just painted, that there is no choice for most families but to have both parents working. That means there are children who need care. I would like to argue that children in British Columbia deserve to have quality care, and the only way that we can ensure the care is quality care is by keeping tabs on it — some kind of monitoring and inspecting — to make sure that they come up to some kind of standards.

I'm not sure how the minister can reconcile the comments we've been hearing on the other side with the reality, based on rooms full of studies — and I'd be happy to give the minister several of them if he would like. I don't know how you reconcile the position you're taking with the reality of what's out there facing children and their parents today. Perhaps the minister would like to enlighten the House a bit on that. I doubt that he can in any very real way, because the facts speak for themselves. Perhaps the minister would give us an undertaking that he will look at the reality of the situation of children, women and child care, and then undertake to ensure that monitoring and licensing are available and effective. Our children, as they continue to say, are our future, and I think we'd best put some real considered effort, organization and planning into it and make sure that that future is a good one.

I'd be interested to hear the minister's response.

HON. MR. STRACHAN: I can't really distinguish any serious argument between what the Minister of Advanced Education, Training and Technology said and what the member has advanced. Both members said there is good unlicensed day care. You have agreed that in some cases it's better, and so did the minister. I agree, too. I don't think it's the total answer; I know we need to have licensed day care. As I told the committee earlier, both my children attended a licensed day care. So I have no problem with that. I hope the committee is not left with the impression that the Minister of Advanced Education was advocating that we have no licensed day care, because that wasn't what I heard him say, and it clearly isn't the position of this government.

In terms of where we are, we have committed an extra $55 million for a three-year child care expansion strategy over and above the $63 million we already spend annually on child care, of which $50 million goes to subsidized low-income families. We are devel-

[ Page 12904 ]

oping strategies. We are aware of the growing population; we are aware of the economies of today. We make no apologies at all for the programs we have in place.

I know there are working parents. My wife has worked just about all of our married life and has worked all of the time we've had children. If she stayed home, she'd go crazy; it's just that simple. She works for an industry that she finds very exciting and will probably stay there for some time. She's been with the one employer now for 25 years.

Interjection.

HON. MR. STRACHAN: Actually, no. I videotape them every week and take them home, so that in her spare time she can listen to this scintillating comment. I'm also sending home the Jim Hume column.

Seriously, working parents are a fact of life. We have accepted the responsibility that we have as a government, and we have certainly seen it as a priority in terms of the resources we're putting towards resolving some of these issues.

One thing I have to comment on — and I think all members of the committee will agree — is when the second member for Nanaimo said parents have some responsibility. Madam Member, parents have an awesome responsibility for their children, not just some responsibility. I don't think we can lose sight of that I'm convinced....

Interjection.

HON. MR. STRACHAN: Anything we can do. I'm not being facetious, nor am I taking this glibly or trying to reinforce an opinion, or maybe what I understood to be an incorrect meaning, from the member opposite But anything we can do to make parents aware of the facilities available to them and of the responsibility they have, and anything we can do to make parents, as the consumer, more responsible for helping government ensure that we have quality child care, is something we should see as an initiative. It is important that we have parents working as cooperatively as they can for the children and as aggressively as they can in all issues of child care.

I think I've responded to most of the concerns that the member has expressed. I'll take my place and await further debate.

MR. PERRY: I've been suitably instructed by Mr. Hume, and I'll refrain from any humour — even inadvertent.

Let me return to some constructive suggestions. I found on my desk the coroner's judgment of inquiry in the case of Mr. Stanley Carl Roberts, which I discussed yesterday. I want to return briefly to the recommendations on the final page of the report, dated March 19, 1991. I think there are some constructive implications. I presume the minister has by now had a chance to review that report, and I'll draw to his attention the first recommendation with a preamble: "That the tragic death of Stanley Roberts be not in vain, and in an effort to prevent deaths under similar circumstances, I recommend...." Let me add that I've had the opportunity to read a number of coroners' reports in the last year, and I'd like to take the chance to compliment the coroner service on some exemplary investigations and very useful recommendations, not only in this case but in others.

The first recommendation is addressed to the Minister of Health, and comments: "It is essential that the Ministry of Health fund an agency which, upon notification by a physician of a patient with a life-threatening but treatable condition, would arrange for appropriate care." I thought about that recommendation. I think the ministry has taken some steps to establish a surgical registry and a trauma registry. I hope that in many respects that recommendation has already been fulfilled.

I have a constructive suggestion for the ministry which I think could amplify the effect of the recommendation, and it is that the ministry prepare annually or semi-annually a digest of coroners' reports of this type and circulate the important recommendations or the lessons to be learned from the cases to all physicians and all hospitals and perhaps to other health professionals.

[5:00]

In this particular case, in my view it would be more useful to, in cooperation with the chief coroner, prepare a digest rather than a facsimile reproduction of the recommendations. I think lessons could be learned from digesting the case in the same way that professional bodies draw important recommendations to their members' attention. I think it's an opportunity whose time has time, and it would be quite useful to health professionals.

The lesson I would draw from this case, among others, is how to ensure that all physicians are aware of the steps which may be taken in a difficult situation if they feel that the system is not responding to the needs of their patient. Some doctors are more creative than others in that respect, and I think those who are less creative could be encouraged by an annual circular.

The second recommendation is addressed to the Minister of Health and to the president of the Vancouver General Hospital. It states: "The Ministry of Health and hospital administrations should institute a process for the documentation and review of cases in which morbidity or mortality has occurred either directly or indirectly as a result of their decisions." I would suggest that this recommendation might be amplified to include cases in which the perception exists in the public that morbidity or mortality has occurred directly or indirectly as a result of Ministry of Health or hospital decisions. That does not mean that either the ministry or the hospital admits responsibility, but where that perception is held by the public it would be appropriate for both to conduct a formal and official review.

I emphasized yesterday that I think good hospitals automatically do that, but the record is not perfect. I'd therefore like to ask the minister what action has been taken or is contemplated on that recommendation.

[ Page 12905 ]

The third recommendation is addressed to the chief coroner. It says: "I would encourage the B.C. Coroners' Service to increase its effort to investigate and document deaths occurring either directly or indirectly as a result of imperfections in our health care system." I note that that's a very broad recommendation. It does not exclusively refer to the government, hospitals or anyone; it refers to imperfections in our health care system.

While the coroner's office falls under the jurisdiction of a different ministry, I'd be interested to know, since this report is in the hands of the minister, whether the Ministry of Health has had any communication with the chief coroner's office to ensure that this recommendation is either acted on or that there is a good reason why the coroner feels it does not need to be pursued.

HON. MR. STRACHAN: I'll begin by talking about the member's interest in an annual summary of inquiries. I agree that that's not a bad idea. I think it is something we should look at. We should summarize inquests annually for our own processes and perhaps for those of the medical profession. That may be of value to us.

[Mr. De Jong in the chair.]

In response to the inquiry and the recommendations, I'll read the first recommendation into the record again just to give a response: "It is essential that the Ministry of Health fund an agency which, upon notification by a physician of a patient with a life-threatening but treatable condition, would arrange for appropriate care." In the case of Mr. Roberts, regrettably, the referring physician classified the referral as "urgent" but not "emergent." That evidence also comes out in other correspondence. It's nice to follow.... I'm sure that everyone does. I'm sure that all physicians do follow essentially the essence of the first recommendation, but in this case it was not deemed to be an urgent condition exhibited by Mr. Roberts.

In terms of the second recommendation — "The Ministry of Health and hospital administrations should institute a process for the documentation and review of cases in which morbidity or mortality has occurred either directly or indirectly as a result of their decisions" — I responded in this way. Cases brought to the ministry's attention are reviewed by the hospitals, but it is frequently impossible to determine single causes related entirely or partially to administrative decisions. The great majority of administrative policies affecting clinical practice are designed with considerable input from clinicians, and most will have escape clauses to allow an override of the policy in emergency cases. Administrative policies can never cover all contingencies, and such appeal mechanisms are routine. One can imagine in the practice of medicine that a great many decisions are made very quickly in terms of better patient care, and having a book to follow would not be in the best interests of the system or certainly of the patient.

The third recommendation encouraged the B.C. Coroners' Service to increase its effort to investigate and document deaths occurring either directly or indirectly as a result of imperfections in our health care system. I can assure this committee, Mr. Chairman, that we do everything we can to ensure that the health of British Columbians is foremost in our minds, and I can't think of any process that we have in place that isn't designed to ensure better health, better service, better physicians and better hospital care. I can assure the committee that in no way would we discourage investigations into better practices.

I think that's all I want to say about this point. I don't know if there's going to be a case brought before a court on this issue. The member has presented his arguments, — I believe the ministry and I have responded in an appropriate manner, and I don't feel that there's much more I would want to say about this issue at this point, because we could be entering into the realm of sub judice with respect to further discussion on the issues involved in the tragic death of Mr. Roberts.

MR. PERRY: One hopes that the fact of discussing the case and some of the lessons from that case, and from the earlier case of Mrs. Sallis and other patients.... Hopefully the fact of discussing it in public enhances the sense of accountability of all of the institutions and individuals involved.

In the interest of completeness I'll simply point out that although this doesn't directly concern the minister, the fourth recommendation was that the department of neurosurgery at the hospital concerned should also review the case and attempt to learn whatever constructive lessons were possible. Clearly the point is not to punish people, but to try to learn from these experiences and not repeat them, where possible.

Let me return to one other matter raised yesterday: the case of the review of the Terrace hospital society. We had some debate in the morning, and then the minister responded with some additional information in the beginning of the afternoon session which I've read. I also contacted Mr. David Lane, the chairman of the board of trustees of the Terrace Regional Health Care Society, because the minister had suggested during discussion yesterday that the letter of complaint from Mr. Lane as chairman of that board represented only Mr. Lane's opinion and no one else's.

Mr. Lane took a different view of it when I talked with him today Not knowing him, and reading between the lines, and given that a copy of his letter had been addressed to the local NDP candidate as well as to me and to government ministers, I thought perhaps the minister was responding from knowledge that Mr. Lane was known to have some political partisanship and perhaps was a New Democrat. Maybe I misinterpreted, but I cleared up the question. Mr. Lane in fact is well known not to be a New Democrat. In fact, he was appointed initially as a government appointee — a Social Credit appointee — to the board of that hospital. He later resigned and was elected, because he tells me there was some talk that he was a puppet of government in the past. Recently he was appointed as a government appointee to the board of B.C. Hydro. So

[ Page 12906 ]

he clearly is a well-respected small businessman in his community. He is the principal of Lane Appraisals, a real estate consultant firm, as it turns out.

His concern was essentially with a process he regarded as inefficient and wasteful of taxpayers' money. He tells me that the hospital society had been pressing for a review by the regional team because it felt it was not appropriately treated in funding priorities, given the complexity of the services it provides as a regional centre. That may or may not be true. That was the hospital's perception and the hospital society's reason for pressing for a review.

In March 1991 the review team visited, according to Mr. Lane, for three days. Three months later — that would be late May or early June — they received a document which, according to Mr. Lane, was missing any financial analysis. I asked for a copy of the document and it hasn't yet arrived, so I've not seen the document myself, but I emphasize, according to the chairman of the Terrace Regional Health Care Society board, Mr. Lane.... His complaint was that the draft document submitted by the review team for discussion had factual errors describing the operation of the hospital but had no financial information in it, no dollar statistics, even though the review team had perused the hospital's books. He therefore felt that it would be a waste of time for himself and other volunteer members of the board to discuss that report, since it didn't have the crucial information which ought to be discussed with the review team.

That was his point. He says that he made that point in telephone calls to the ministry and in frustration wrote that letter which he says he has discussed with the executive of his board and which represents, as he told me, the unanimous opinion of his board. To quote him exactly: "I speak for the board with the unanimous support of the board."

He was concerned that "money would be wasted for the ministry staff to fly up and discuss one-half of the report" in Terrace without the financial information.

My question remains: is this a sensible policy? I understand the ministry's policy as elaborated by the minister yesterday; before recommendations are finalized, it makes sense to discuss them in draft form with the hospital board and administration. No one could argue with that. But is Mr. Lane accurate when he tells me that the draft report submitted three months after a three-day visit by the team contained no financial information? And if so, does the minister sympathize with Mr. Lane's concern that there might be a waste or an inefficient use of taxpayers' money in sending the team up there to discuss something which is largely meaningless from the point of view of that board?

HON. MR. STRACHAN: We spent a lot of time on this yesterday. However, the member seems to take great delight in repeating old information.

First of all, yes, I know David Lane's political affiliation. I know what he does for a living. As a matter of fact, he's done some work for the University of Northern British Columbia. He's well respected in the land business as a consultant; there's no question about that. I'm quite well aware of him. Let me repeat, probably for the fourth time during these estimates:

"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 a correction of any factual data."

This a letter to Mr. Lane.

"You have been provided the draft copies so that we can verify with the hospital the accuracy of that information in the report. As you can appreciate, it would be inappropriate for the team to come to financial conclusions until there is certainty on the facts."

That is the process used by all of the review teams in all of the reviews in the province of British Columbia. Mr. Lane is aware of it; other hospital board chairmen are aware of it. Apparently he didn't feel that it was appropriate in his case; nevertheless, that is the way the ministry operates. It seems like a perfectly logical process to me. I am going to defend it, because apparently it works in the rest of the province. I regret that Mr. Lane doesn't agree with it; nevertheless, those are the rules and that's the process in place. If there's another reason for changing it, I'll listen to arguments from Mr. Lane; but that is the process currently in place.

I further have to advise the committee again — this is becoming rather tedious — that ministry staff offered to meet with Mr. Lane at his convenience, but he was unable to keep that meeting in Terrace. I guess from that, things began to fall apart. However, we have a process in place. The hospital administrator is aware of it; hospital trustees are aware of it if they want to check. I would certainly support that process.

[5:15]

MR. CHAIRMAN: I'd just like to urge all members to avoid repetition.

MR. PERRY: Mr. Chairman, we don't get to sit in this Legislature very often. The government has been very reluctant to face the opposition. It delayed the Legislature to a historical record and....

HON. MR. STRACHAN: Point of order, Mr. Chairman. Estimates debates discuss the administrative actions of the ministry. They don't discuss political agendas of the government or callings of the House or the throne speech time or anything like that. They're to discuss the administrative actions of the ministry. Perhaps the member should be advised that that's what we're here to do.

MR. CHAIRMAN: Your point is well taken, hon. member. I would advise the member to act accordingly.

MR. PERRY: Thank you, Mr. Chairman, but I have no intention of being silenced when trying to root out waste and pursue efficient management of the health system.

What we have here is a very important issue. We have a senior hospital board chairman — someone who was appointed by the government in approximately 1981, he tells me.... He tells me in his own words that

[ Page 12907 ]

because he was thought to be a parrot for the government, he resigned his position and stood for election. He was elected; he has the confidence of the local people in Terrace. He's the chair of the board and has been chair for eight years.

He is a fiscal conservative, and he thinks that the government is wasting taxpayers' money by sending a review team up to Terrace for three days, which ends up providing what he says is a grossly inaccurate report. Three months later it prepares and submits a draft report without financial information reflecting the examination of the books of the hospital — which were made open to that team — which he and the hospital administrator feel will waste their time. He's telling us that as a volunteer board chairman, he does not want to waste the time of other volunteer board members in going over a report which he views as grossly inadequate.

I don't know how else, given that the local member is not prepared to raise this issue.... The local member had a copy of this letter. When I asked Mr. Lane why his local MLA, who is a powerful cabinet member, did not help him out on this, he said he was baffled; he had no answer to that question. Who else in the province of B.C. is going to ask for an answer to this question, if not the opposition, and, in particular, the opposition Health critic?

I know the minister finds it very tedious and unpleasant. Perhaps he finds it boring and uncomfortable. Maybe it burns him to have to justify the fiscal irresponsibility or waste that sometimes occurs in his department. He thinks he's the paragon of virtue. He would like British Columbians to think that only he and his cronies know how to spend public money wisely: like when they shot around the province in the jets burning up $1.2 million of public money last year, while patients weren't getting good treatment; like when they spent $30 million last year on government advertising; like when they told us in the throne speech that the government advertising would be cut, and then they started sending it around again; like when they distributed the flyer announcing the homemakers' pension, which was a figment of their imagination.

HON. MR. STRACHAN: Pretty testy.

MR. PERRY: The minister says I'm getting pretty testy. You're darned right. I'm getting testy at being lectured by him when he doesn't want to answer our questions. I'm asking him a perfectly legitimate question that came not from out of my head but from one of the more experienced volunteer board chairmen in the province — a man who is not a New Democrat or a New Democrat supporter. Mind you, he didn't say he was a Socred; I don't suppose you can find anyone to admit that these days. But he certainly does not have....

Interjection.

MR. PERRY: One of the government members is willing to admit it, I see.

But he's making a serious point. I'm asking — since I haven't got the report — if there are any dollar numbers in that report. Is there any assessment of the status of bookkeeping of the hospital? Is there anything that would be useful for the hospital board and administrator to discuss with that team, or is it merely a matter of confirming whether there are three operating rooms or two? And if so, why couldn't it be done by mail? Or if the mail was too slow, why couldn't it be done by fax or maybe by a telephone call?

Mr. Lane points out — I haven't had time to confirm this — that the economy return fare is as much as $750 to Terrace, and that means a team is going to go up there. It seems a bit steep to me; maybe it's a little less than that. But why do we need to send a team to discuss and review a report, which the local board chairman feels is useless? Is he really that way off base? If so, why don't you just say so? I see the official is nodding. If he's really that off base, let's get it out in the open. Maybe he'll have a chance to respond. The officials and the minister are all nodding. Let the record show that they think Mr. Lane is completely off base.

HON. MR. STRACHAN: Once again — for, I guess, the sixth time — it is the practice of the hospital care division to provide a hospital which has been reviewed with a copy of the draft report and to discuss it. I'll also point out for the benefit of the committee that there was a utilization management seminar being conducted in Terrace at that time, which other hospitals were attending and which Mr. Lane knew was happening. So there was a very good utilization of staff not only to discuss this particular issue but to attend this utilization management seminar. Mr. Lane doesn't put that in his letter, but I'll put that on the record now. Mr. Lane must have known about that, because it was not only for the Terrace Regional Health Care Society but also for other hospitals. Mr. Lane and Mr. Lane's administrator are aware of the process. Every other hospital in the province is aware of the process.

The member is advancing that it seems to be the case that everybody is out of step except the one fellow in the province who writes to me. If he wants to continue to make that point, Mr. Chairman, let him, but it's not going to make me change my process, nor convince me that one chairman of a board of trustees is right and the other 120 in the province are wrong. We have a process that is practised throughout the province. Mr. Lane and the hospital administrator are aware of it. We were using this occasion for the review to attend to another issue in Terrace that other hospitals were attending, — Mr. Lane was also aware of that. I make no apology, either for the letter written by Mr. Kenny, the executive director of that team, or for the position taken by the Ministry of Health.

MR. PERRY: Well, good. Something's out in the open. The truth will out. Let Mr. Lane and the minister discuss it. I think I've done my job in opening up the issue. The controversy is out there in the open, for a change. I think it's salutary. I think it's salubrious and useful, once in a while, for a board chair to express

[ Page 12908 ]

some mild criticism of the government and to have the nerve to say that they don't agree entirely with everything you do. I don't think things are perfect in British Columbia.

Let me raise a few other matters. This one I would have written to the minister had I known how late the Legislature would be called. I stuck it into a file thinking we were going to sit in early May and it would be simple to bring it up here. The letter was from a young quadriplegic man in Vancouver, who shall be anonymous. He says:

"I am quadriplegic and require the services of the G.F. Strong Rehabilitation Centre in order to be fitted for a new wheelchair. I have been informed by G.F. Strong medical staff that there is a four-month waiting period for this service. They have told me that there is only enough funding to operate this clinic one day per month. I would appreciate it if you could rectify that situation by requesting funding for additional clinic days. That's shortening the waiting-period not only for myself, but for other deserving British Columbians."

That's the wheelchair-seating clinic at G.F. Strong.

I raised that to bring it to the minister's attention. Clearly, someone with quadriplegia should not be waiting four months to get an assessment or an improved wheelchair seating.

Let me return to the issue of midwifery which I gave notice of a couple of times. I raised the question already to the minister. It looks fairly clear that midwives will be licensed by the Health Professions Council in due course. An application is close to being made when the council gets itself organized. I'd like to ask the minister whether he or the ministry has any vision of what the role of midwives will be in this province and how they will be paid. Will it be on a fee-for-service basis? In that case, will the fee be the same as it is for doctors? Will it be on a salaried basis? In that case, has the ministry contemplated how midwives could best be employed to improve obstetrical standards? Specifically, has there been any thought given to targeting the skills of midwives to serve the marginalized populations like native Indian women, women living in poverty, women who seek obstetrical care late in pregnancy or women in very high-risk groups for prematurity or for complications of pregnancy?

HON. MR. STRACHAN: Once again, we're dealing with issues we discussed earlier. However, I briefly advise the committee that the Health Professions Act was passed in 1990, and we anticipate that the midwifery association of British Columbia will be approaching the new Health Professions Council and looking to the council for advice. As well, the member has indicated the responsiveness that has been given to the royal commission. I'm sure they will have an opinion on that.

Finally, with respect to the member's questions on whether they are salaried people or not, I really can't answer that until we define what "midwives" are. There is a whole body of thought on that as well. I certainly wouldn't, as a layman, want to state what I think they should be. I think there's such an expert body of opinion looking at this whole issue that I would be well-served to wait until we have expert opinion available to us.

With respect to the member's comments about native women and other services in more remote areas, I would have a tendency to agree with that. Probably the better trained the people we supply to these rural areas are for the many procedures such as delivering babies, the better off we would be. So I would accept that plea and that comment as being sound, rational debate, and I have no argument with that.

With that said, there's not much more I can say, Mr. Chairman. There are so many people looking at the issue of midwifery, including our royal commission, that I believe it would be best to see what recommendations are given to us and at that point to form an opinion as a ministry of government.

MR. PERRY: Well, Mr. Chairman, I'm disappointed. I was hoping for something a little more imaginative than that out of the minister or the ministry. Am I to take it that the ministry has given no thought and has no studies underway, as to the future useful roles of midwifery in the province?

That would baffle me. As I mentioned in giving notice of this question the other day.... This is not a surprise question. I have given notice twice over the last several days that it was coming, specifically because I was interested to hear from the minister on the record.

[5:30]

I remember sitting with the assistant deputy minister, Mr. Foster, who is with us today — and also Mr. Lovelace — and being briefed about the Health Professions Act last year. Clearly, one of the reasons for passing that act, as we did with great speed last year was to facilitate the licensing of professionals who have been discriminated against, such as midwives, who have been in limbo.

I've got another letter here in my pile from a British-trained midwife who practised obstetrics for 30 years in Ontario and who faces the assertion that she's got no skills now. I could even give you many better examples than that.

There was some urgency to get that bill passed so that we could move forward, because in Canada we are the last jurisdiction among the developing countries not to employ midwives in a way that respects their skills. You would know from your background in Holland, Mr. Chairman, that midwifery is a well-established profession in western Europe. In the United States it has been developed; in Australia there have been reviews of these issues. I was certainly led to believe — perhaps I imagine too much — that the ministry had in its manpower planning some ideas for how midwives might be employed imaginatively in the future of B.C.

What I'm curious about, for example, is whether we will end up with the same problem we faced with the supply of physicians, where the government attempted to restrict supply with Bill 41. That was rejected in court. The government has had an ongoing difficult problem of trying to find a way to limit the supply of physicians so that we avoid a physician-driven Medical

[ Page 12909 ]

Services Plan to the extent possible. Has the government not given any thought to how it will incorporate midwives once they are licensed?

HON. MR. STRACHAN: The member is asking for some personal imagination on my part, and I'll tell the committee, Mr. Chairman, that I'm a very imaginative piano-player and an imaginative public speaker from time to time. Sometimes my imagination runs rampant, but I'm certainly not going to let my imagination take the place of the good sound thinking that can be supplied to me by councils and other boards and people that we have in place. I'll say it again: we think it's appropriate that the Health Professions Council, a body duly set in place by statute in British Columbia, examine all aspects of midwifery in British Columbia. We will wait for the council's recommendation before proposing any legislation.

Further, in case the member's not aware, we have a Royal Commission on Health Care and Costs in front of us now that is actively pursuing many issues, including many submissions on midwifery, and we will wait for them to report out. If this committee or those members wanted me to make all the decisions, we wouldn't need a Health Professions Council or a royal commission. I'd just go in my office and make them. But that's not democracy; that's not why we have submissions. I think it would be terrifying to have me making medical decisions.

[Mr. Pelton in the chair.]

That's why, from a ministerial point of view, I'm going to restrict my imagination. It can go crazy on me from time to time. But seriously, we have this council and the royal commission in place, and we'll await their recommendations. I'm sure they'll examine the questions some of the members have asked.

I can offer one comment in terms of offering these midwifery services to the rural communities: if that turns out to be a better way of handling deliveries, then I would certainly be in favour of it. The member, who is a physician, is advocating that we look at this, and I have no argument with that. It's appropriate. But I am certainly not going to take it upon myself to start making decisions about this very important part of the health care delivery system.

MR. PERRY: I can scarcely camouflage my disappointment. I suppose it must show on my face. I'm beginning to wonder if the Minister of Health even read the Health Professions Act after it was passed last year. The act was designed to facilitate the licensing of new professions. The council will decide in due course, decide whether to licence midwifery as a new profession. It's a relatively safe bet to say that the council will, but its role is not to then decide the manpower — or in this case probably the womanpower — issue of how midwives should be employed in British Columbia. That rests with the Ministry of Health, surely.

Maybe I can leave it again as a suggestion. It might be worth thinking about that issue in the ministry before midwives are licensed — assuming that they are likely to be — and it might be unrealistic to rely exclusively on the royal commission to resolve every issue like that. I do think that the royal commission — I've said so many times — is doing a very good job, but I think it would be unrealistic to rely on six commissioners and their modest staff to be able to resolve every issue like that.

Let me raise one other issue that's been waiting a long time for a sitting. It's been raised many times, I think, by MLAs in their constituencies, so the minister should be well aware of it. It relates to a letter dated September 12, 1990, from an employee of an intermediate-care facility, who describes the difficulty in obtaining a walker or a wheelchair for one of the residents of the facility. I'll quote briefly from the letter:

"For the past four years a number of residents in this facility have been put through needless frustrations, harassment and distress because of conflicting policies and procedures in two ministries" — i.e., Health and Social Services.

"The Ministry of Social Services has stated categorically that the supply of equipment such as walkers and wheelchairs is the responsibility of the Minister of Health."

In support of that, I'll note that this letter attached a memorandum from a financial assistance worker in the Ministry of Social Services, stating:

"I am returning the prescription for a walker for the above-named individual. The Ministry of Social Services and Housing does not provide equipment or supplies for patients in long-term-care facilities. It is the responsibility of the Ministry of Health to determine the level of care required for this lady and to provide the equipment necessary to maintain that level of care."

In case anyone didn't understand, someone has written on here in brackets: "Her request for payment for a walker is denied."

To go back to the letter, it continues: "The Minister of Health has clearly stated that in intermediate-care facilities, such equipment 'which is for the sole use of the client' is the financial responsibility of the client." The problem arises: what if the client can't afford it and, in effect, is sitting in bed for want of a walker, or sitting confined to the facility for want of a wheelchair, which could allow their client, or the resident, to go outside?

The letter I have points out: "In spite of the Ministry of Health's clear and unambiguous policy on this matter, and in spite of the Ministry of Social Services losing three tribunal hearings in a row with other clients on similar cases, they still adhere to conflicting policy." Is the minister aware of this problem? It has come through my office on multiple occasions, and I'm sure virtually every MLA has had to deal with similar problems. Has anything been done in the last year to resolve the issue? Ultimately, when the matter is brought to those people who are politically astute enough to bring it to the attention of the local MLA, and when the service is justified, the government always ends up providing it. That's my experience. As the letter-writer describes it, it puts the individual through needless harassment, and it consumes a lot of ministerial time at the lower levels of the bureaucracy

[ Page 12910 ]

for civil servants. Surely this problem could be resolved.

HON. MR. STRACHAN: I just like to briefly return to the previous discussion about midwifery and the Health Professions Act. Although I've only been in this ministry for a couple of months, I have been on the legislative committee for many years, and I knew there was something in the act about scope of practice. The member is not aware of that, but there is a scope-of-practice responsibility in the Health Professions Act. That's why it's clear that for the minister to act without the benefit of the Health Professions Act on the scope of practice for midwifery or any other treatment that would come under this act, would be inappropriate. For the member's benefit, it's sections 9(e) and 9(h).

On the non-personal equipment, the member is correct. We provide non-personal equipment for facilities but not for Mrs. X or Mr. Y. The member has also indicated correctly that individual equipment is the responsibility of the client; that is the case.

However, the member makes a good point in this instance. People do fall between the cracks. Ultimately the government will end up providing personal equipment in one form or another. We will continue to work with the Ministry of Social Services and Housing — which is more in the business of providing personal equipment than we are — to ensure that no one is left disadvantaged or without the appropriate walker, wheelchair or whatever other mechanical resource is going to make their life easier and make them more mobile. I would accept the member's concern on that issue and give the committee my commitment that we will continue to address this concern, Mr. Chairman.

MR. PERRY: I think we really are making progress in these debates, and I'm grateful for that response.

On another matter, I wonder whether the minister or his staff have had the opportunity to review a report dated June 1990, entitled "HLRA/HEU Joint Study on Utilization of HEU Members in the Delivery of Nursing Services." The title is perhaps a bit misleading. The report really concerns the utilization of LPNs — licensed practical nurses — in the health care system, particularly in the hospital and long-term-care system.

On February 22 it was sent to all members of the Legislative Assembly by the HEU, the Hospital Employees' Union. It must be a rather unusual joint study; I gather it was called for in the terms of the collective agreement between HLRA and HEU. I'm not sure that the expectations at the time the study commenced were tremendously high, but I note that both I and the Minister of Health of the time responded to a request for input.

There were some other interesting responses — for example, a letter from the British Columbia Council of Licensed Practical Nurses. For those who aren't familiar with the field, that is the regulatory body equivalent to the RNABC — the Registered Nurses' Association — or to the College of Physicians and Surgeons. One small paragraph from the letter from the British Columbia Council of Licensed Practical Nurses that is included in the report summarizes their concerns: "The council has serious concerns that these minimal competencies are not being utilized in the practice setting, and commends the HEU and HLRA for their joint undertaking to explore this issue."

What that paragraph refers to is that many LPNs in British Columbia are still trained to a higher level of competence than they are allowed to practice. I've run into one hospital in the interior where a member of the Licensed Practical Nurses' Association of B.C. told me that she was trained in the hospital to perform procedures, such as catheterization of patients, which she's not allowed to perform there. I find it paradoxical that it would be considered reasonable to train her in the hospital to do something but then not allow her to perform that skill. Somehow it shows a certain lack of confidence on the part of the hospital in its ability to teach people well. I suppose I would be embarrassed to be in that position.

[5:45]

I realize this is a difficult and tricky issue. It's very contentious. It was blown wide open, in a sense, before the royal commission when the president of the B.C. Nurses' Union disclosed that she and other colleagues had contested the reduction of LPN services at Vancouver General Hospital some years ago. As she put it, they'd be glad to have LPNs back in some of the roles they were doing then.

I'm not asking the minister any more than I would propose to tell hospitals how they should run their business, but I'm curious to know whether the ministry has given any thought to this report or to the issue of whether LPNs could be utilized in some of the roles they used to perform in hospitals in B.C. or that they still perform in other parts of the country. I suspect that's an area where we may hear something from the royal commission, which is concerned about territoriality in all health professions — not just in the nursing field but in medicine and midwifery and other areas.

I'm curious to know what study, if any, the ministry has given to that.

HON. MR. STRACHAN: I'm aware of the issue, not only from briefing notes that I have but also, as the committee is aware from previous discussions, because I was employed by the College of New Caledonia many years ago, and LPN training was done there and RN training is done there currently. I'm aware of some of the issues from talking to faculty at CNC, and they've described some of the issues to me over the years.

Without being glib and without being too brief — but the time is drawing nigh — we have to take the position in the ministry that nursing issues and nursing manpower trends are really decided by the nursing departments of hospitals. We would certainly favour using licensed practical nurses wherever it is appropriate, because they have had adequate training and in many cases they provide good care.

The member will also be aware that in the tertiary care hospitals, which are heavily on acute care, the RN is maybe more of a desirable employee because of having a greater amount of skills and training. But again, that's a decision made by hospitals. We encourage innovative programs, cost-savings and the best

[ Page 12911 ]

possible care wherever we can. That's the bottom line for us.

HON. MR. RICHMOND: Just before I move the committee rise and report progress, I would inform the House that pursuant to standing order 46 — since we have spent some 22 hours and 20 minutes on these debates, which is three times what we spent last year — at 11 a.m. tomorrow we shall be calling the vote on the estimates of the Ministry of Health. I give the members opposite enough notice so that if there are pertinent questions they still wish to ask, they have time tomorrow between 10 a.m. and 11 a.m. Having said that, I move the committee rise, report progress and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

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

Hon. Mr. Richmond moved adjournment of the House.

Motion approved.

The House adjourned at 5:49 p.m.