Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, JUNE 23, 1992

Volume 4, No. 25

[ Page 2905 ]

The House met at 10:06 a.m.

Prayers.

B. Copping: On behalf of my colleague the member for Victoria-Beacon Hill, I'm very pleased to introduce to the House today approximately 40 grade 5 students from Sir James Douglas Elementary with their teacher, Mr. Seckhon. Would the House please make them welcome.

The Speaker: Hon. members, I am informed that His Honour the Lieutenant-Governor is about to enter the chamber.

His Honour the Lieutenant-Governor entered the chamber and took his place in the chair.

Clerk-Assistant:

Health Special Account Act

British Columbia Endowment Fund Act

Financial Administration Amendment Act, 1992

Enforcement of Canadian Judgments Act

Municipal Finance Authority Amendment Act, 1992

Taxation (Rural Area) Amendment Act, 1992

Employee Investment Amendment Act, 1992

Attorney General Statutes Amendment Act, 1992

Limitation Amendment Act, 1992

Social Services Statutes Amendment Act, 1992

Agriculture, Fisheries and Food Statutes Amendment Act, 1992

Private Investigators and Security Agencies Amendment Act, 1992

Statute Revision Act

Statute Revision Miscellaneous Amendment Act, 1992

School Amendment Act, 1992

Municipal Affairs, Recreation and Housing Statutes Amendment Act (No. 2), 1992

Farming and Fishing Industries Development Amendment Act, 1992

Vancouver Charter Amendment Act, 1992

Pension Statutes (Transitional Arrangement) Act

Range Amendment Act, 1992

Commissioner on Resources and Environment Act

Personal Property Security Amendment Act, 1992

Attorney General Statutes Amendment Act (No. 2), 1992

Securities Amendment Act, 1992

Cooperative Association Amendment Act, 1992

Forest Amendment Act, 1992

Human Rights Amendment Act, 1992

Architects Amendment Act, 1992

Guaranteed Available Income for Need Amendment Act, 1992

Clerk of the House: In Her Majesty's name, His Honour the Lieutenant-Governor doth assent to these bills.

His Honour the Lieutenant-Governor retired from the chamber.

Orders of the Day

Hon. G. Clark: I call adjourned debate on second reading of Bill 71.

MEDICAL AND HEALTH CARE
SERVICES ACT
(continued)

C. Serwa: When I spoke yesterday on Bill 71, I was talking about the philosophy and principles, and obviously referring to the cap. I note that in the general recommendations of the Royal Commission on Health Care there is a recommendation that a global cap be placed on gross payments to physicians through the Medical Services Plan. It says that the cap should be adjusted to population and not changed to utilization. I would like to amplify on that. When they're talking about not adjusting for utilization, they're talking about increased utilization from a more or less static population or a percentage of a growing population.

In British Columbia we have a different situation than this recommendation actually envisioned. We have a population that has grown by 5 to 6 percent. A substantial percentage of that population is seniors 65 and over, and they are demanding a much greater intensity of utilization of medical health services. So the proposed cap by the government of the day of 2.4 percent is totally unrealistic. It doesn't advance the necessity for the growth in population -- albeit if that was at a lower level.... It certainly doesn't take into consideration the demands of an aging group of citizens in the province. I applaud the efforts to control health care spending, but the government has missed the mark by a country mile.

[10:15]

I want to speak very briefly about the Medical Services Commission -- and I refer as well as to the subcommittees -- in the last few minutes that I have on this. The apparent intent of the government is to have more of the public involved and given the opportunity to serve on the commission and subcommittees. But in the short history of the government in power, it has been clearly evident that that intent is really a smokescreen. It actually becomes a charade. We have seen that by the appointment of directors to a number of Crown corporations: ICBC, B.C. Transit, B.C. Ferries, B.C. Rail and B.C. Hydro. What was brought forward was not an opportunity for a number of diverse public individuals to produce diverse perspectives and recommendations; rather, it was an opportunity to advance the partisan political philosophy of a one-issue government through boards and purvey that as being representative of the public.

My concern is primarily that these subcommittees will be structured so that they all have very close ties with the New Democratic Party, and they will only promote what the party deems necessary. The other thing that has come to mind is the building of a small, well-paid army that will be actively engaged in the campaign in the next federal election. I suggest that part 

[ Page 2906 ]

of the enhanced utilization of committees and subcommittees will be in that direction.

In conclusion, Bill 71 will fail because it's deeply flawed. It will create longer waiting-lists for surgery and treatment. It will fail because it will place restrictions on patient tests that can be ordered. It will fail because it will ration patient care. The fact remains that it will also force doctors either out of the province or to opt out of the system. It will fail British Columbians, and it should not pass.

J. Weisgerber: I am pleased to have an opportunity to rise, join in debate on Bill 71 and speak against the bill. It seems to me, in the brief time that we've had to look at this legislation, that there are a number of fairly serious problems with the bill, problems that have been identified not necessarily by us as MLAs but by practitioners and professionals and people who work in the field who have expressed grave concerns about the implications of this legislation for the medical profession and the delivery of medical services in British Columbia. I can't think of an issue that is more important to most British Columbians than this issue, the delivery of health care and access to services by doctors in the province.

The delivery and level of service have been significantly high in this province over the last number of years. Indeed, all Canadians take a great deal of satisfaction in the fine health care system that we have in this country and are concerned any time a government starts to tinker with the system, particularly when they appear to be tinkering without having had an opportunity to consider the proposals that they're putting forward in any depth. That concerns me, and I think it should concern all British Columbians, not only doctors or people who are in the delivery system but also patients and people who depend on and get a sense of well-being in the knowledge that there is a good system there to serve us.

Specifically, there appear to be some concerns around the establishment of a commission. Saying that, it's hard to argue with the basic philosophy that you would put in place a commission that represents government, the medical profession and the population at large. If that commission were going to have the authority that it should have, I wouldn't be raising this point in debate. But the chair of the commission is appointed by cabinet and is accountable to cabinet. The minister said that the government is willing to take a chance and see members appointed -- three by the government, three by the medical profession and three by allowing those to involve themselves in the appointment of the other three. I remember the minister saying how brave it was of the government to leave this issue in the hands of the commission. In fact, the government has kept a club insofar as it appoints the chair and the chair reports to cabinet. While there is an illusion of a commission that is totally balanced, the fact of the matter is the chair gives the balance clearly to the government and to the cabinet. Furthermore, even with the control of the chair, if the government is not happy they can abolish the commission and appoint a public administrator. While the government is putting this commission forward to give the impression of putting the issue at arm's length, in fact they're maintaining control in a number of ways. And to go further, to make sure the government doesn't lose control of the system, the legislation appears to be drafted in a way that would allow the cabinet to appoint committees and subcommittees that could circumvent the work of the commission in any event.

Again we're looking at a complex piece of legislation introduced at the last minute, introduced even before the previous legislation that was tabled has been withdrawn. It appears that the government is simply going to keep putting up legislation until it's able to find something that will meet its objectives, and then, I suppose, we will see the minister rise in the House and withdraw the other bits of legislation that were equally hastily introduced.

There are concerns not only from doctors and medical professionals but from users of the system as well about the ability of this act to have investigations of patients' files. I guess there's nothing that's more sacred in the relationship between a doctor and a patient than the knowledge of confidentiality; the fact that a patient can sit down with their doctor -- or could until this bill was introduced -- fully confident that the information that individual shared with their doctor would be protected by what is probably the most respected oath in the western hemisphere. The oath of confidentiality for a doctor is probably.... I can't think of any other oath of confidentiality that is more widely accepted, more widely believed, more widely understood than that one. This legislation appears to give auditors an opportunity to go in and examine files in an attempt, no doubt, to ensure that doctors' billings are appropriate. But the ramifications of that truly go to the heart of the relationship between a doctor and a patient. I think that everyone should have a great deal of concern about the implications of that part of the act. There doesn't appear to have been sufficient thought given to the kinds of protections that should be in place to ensure that confidentiality, to in no way diminish the relationship between a patient and his doctor.

There also appear to be no allowances for an aging population in the capping portions of the bill, and particularly no allowances for technology increases. Almost daily we see in the newspapers and hear on the television about new techniques, new treatments, new ways of dealing with serious ailments. I can understand people who are afflicted expecting to be able to access the best possible treatment. To expect doctors to somehow ration that treatment seems to be something that is being thrust upon the profession in a way that somehow doesn't seem quite fair. I'm not sure, quite honestly, whether we can simply continue to afford these new treatments, and whether we, as a society, want to continue to afford these new treatments and these new technologies. I think it's something that we have to think about, and something that we as legislators are going to have to take a hand in. If we're going to ration treatment, if we're going to ration access to the medical profession, then government's going to have to take a hand in it. I don't think it's fair for government to simply, by an act, pass the responsibility to the medical 

[ Page 2907 ]

profession, to the service provider, and say: "You're going to have to decide. You're going to have to decide who gets what treatments and how often they're able to access them." I think that puts an unfair burden on the service delivery organization and takes away from the funding body -- the government -- more responsibility than is fair in a balanced sort of way.

It seems to me, in this session of three and a half months, that we've seen two significant pieces of legislation introduced to deal with this issue. Fairly early in the session the government brought in Bill 13, and Bill 14 along with it -- this from a government that had spent most of the last five years talking about the need for more consultation and negotiation. If I had a dollar for every time those two words were uttered in this House by the NDP on this side of the Legislature, I wouldn't have to worry about a pension. I would simply cash in my consultation and negotiation dollars, and I would be very well set.

Now we see a government which, after all of those brave words, has decided that the real way to settle a dispute is by legislation -- not consultation, not negotiation. Bring in a piece of legislation, bring in a stick. Whack them once with it and see how they like it. If that doesn't work, bring in another one -- bring in a bigger stick -- and whack them again. Ask them how they like that one, and see whether they're tender and softened up to the point where they're going to negotiate. That's what we've got here; that's what we're passing. We're passing the big stick, we're passing the club for the government...to go back and do what it should have done over the last two or three months, and that is some serious consultation, negotiation and coming to an agreement with a group of individuals who are reasonable and attempting to deliver a service.

My understanding is that the profession offered to negotiate a cap on this year's payments, if the government would enter into serious negotiations and consultations on a long-term solution. The profession was prepared to accept the cap, so the argument for the need to rush this legislation through seems hollow. The government, in fact, could have accepted the offer by the profession, capped this year's payments to them and sat down and genuinely negotiated a settlement that would more equally and equitably meet the needs of doctors, patients and taxpayers. That's what this is all about. It's balancing the interests of those three significant groups in society. Instead we see a bill that was introduced a few days ago, and that will be pushed by the government through second reading probably today and at least attempted third reading this week.

[10:30]

I've said before, and I will say again, that when the government brings in these significant pieces of legislation and rams them through within the bare legal or procedural guidelines, that is not good legislation. That's not the way to develop good legislation. Good legislation is tabled and provides an opportunity for the interested groups and individuals to examine the legislation and to come back to government and opposition with recommendations for change. Those are considered not as if they were threatening, but in a constructive way. I have had the opportunity over the last five and a half years to see significant pieces of legislation dealt with in both ways: some brought in and pushed through; others brought in, put on the order paper, considered by British Columbians and then acted upon. I believe that in every instance, the legislation that was given an opportunity for input, was considered and was amended where necessary was always -- as a matter of fact, I would challenge someone to show me a case where it wasn't -- better legislation.

I'm genuinely disappointed that the government has seen fit to stage its -- I hesitate to say negotiations -- bargaining with the doctors, and that it has seen fit to ram through this piece of legislation in order to have a larger club when it sits down with the BCMA to find a resolution to what is truly an important issue in British Columbia. I would encourage the government to reconsider. It has demonstrated to the profession what its intentions are. This would certainly be an appropriate time for the government to pause, go back to the table, do some good-faith bargaining and, to use those words that that party loves so dearly, engage in some genuine consultation and negotiation and get away from the need to deal with the resolution of this problem by legislation.

I expect all of the members on this side will be voting against Bill 71.

B. Copping: I rise to speak on Bill 71.

Interjection.

B. Copping: In favour -- I support the bill.

For 17 years I have been practising medicine, up until I was elected here. I would say this about being a physician: it becomes the very fabric of your being in the same way you are a man or a woman. When I leave politics I will be an ex-politician. I will be a medical doctor until the day I die.

That's what's happening with this bill. Bill 71 is about change, and with change comes fear, with fear comes anger. We have all received the letters from physicians; certainly my colleague from Little Mountain has; I think I have received more than anybody, next to the Minister of Health. I understand those letters. I understand that the physicians are worried; they're upset; they're frightened of change because, yes, this is change.

We saw it when our party pioneered medicare in Saskatchewan. We heard the same arguments. They were frightened of medicare. Why were they? They were frightened, because they were worried that their patients would not get good-quality care. That is what is happening this time. However, it is rather ironic, because they are worried about the loss of medicare in the same they were worried in Saskatchewan about the introduction of it.

The whole intent of this bill is the protection of medicare. It's happening in two different directions. I would expect my colleagues in the medical profession to have the reaction they are having. I really would, because they are going to fight tooth and nail. They are busy practising medicine. They do not have the time to 

[ Page 2908 ]

study the bills. In my own biased way I could go on at length about my admiration of the medical profession; but I can also go on at length about my admiration for the Minister of Health, because I have come to know her very well in the last few weeks. I know what her intent is; I know the intent of this legislation. I have seen her change the legislation. We're being criticized for having introduced a bill and having withdrawn it. I would hope that all of us do that every day in our lives. I hope we change something that we see is wrong in what we're doing. I will say that I was very unhappy when Bill 13 came in -- and how it came about. Nevertheless, I have had many discussions with our hon. minister. I know she is listening. I know her intent. I guess what's unfortunate in this is the involvement of the public, because when there's any dispute going on, of course, the public only hears half....

L. Reid: They should be involved.

B. Copping: The Health critic says that they should be involved. Of course they should be involved, and that's what this legislation is all about. That goes without saying.

I'm worried about how they are being involved by being caught up in the dispute. I would even think that it borders on irresponsibility when you hear terms like rationing and tinkering. Consultation has gone on and will continue to go on. There might be changes or there might not be. If there are, that's fine. It will be because we have listened.

The public should not be frightened. What they are hearing from physicians is their reaction in order to protect medicare. What they're seeing from this government is a bill that will protect medicare. We have to do something about the costs, and that is the only way medicare will be protected. I will say to the public that there is nothing to fear, because you have the government, the opposition and the medical profession working to protect medicare. With so many groups recognizing the importance of medicare and with our government being flexible, being based on consultation and having the wonderful Health minister that we do, medicare will be protected.

R. Kasper: I ask leave to make an introduction.

Leave granted.

R. Kasper: In the precincts today we have a grade 5 and 6 class visiting us from Glenlake Elementary School in my riding. They're accompanied by their teacher, Mr. Kerley. Will the House please make them welcome.

K. Jones: It is a very nice opportunity to be able stand here and speak on Bill 71. This bill has a lot of people in our communities concerned. It's going to have a far-reaching impact on the effectiveness of our health care. There is quite bit of concern among primary health care practitioners, and doctors are very concerned about this whole direction of control. This legislation has definitely brought forward a very heavy-handed control program.

I can understand why the member for Port Moody-Burnaby Mountain, a practitioner herself, would have been concerned about Bill 13, but she should also be taking a serious look at this bill, and she should be a lot more concerned about it. Much more time is needed to deal with this. The potential for changes indicated by the member from Port Moody-Burnaby Mountain is theoretical. There's an opportunity for change after consultation. In the process, the fact is that consultation should come before writing the bill so that we have a very well-thought-out bill to start with -- not the confrontational situation we see in the province today, but one in which the medical profession and the public have a clear opportunity to cooperate and bring together the very best health care program that we can possibly provide. We have a responsibility to all of the people of British Columbia to provide the very best health care.

We talked about the impact of this legislation -- as was mentioned by our colleague to my left here -- and it was identified that there was a concern about the access to records, records that, through historical precedence, have been private between the doctor and the patient. These are now, by this legislation, going to be opened to "auditors." I don't know who these auditors may be. They're at the will and wish of the minister and her administration. She is abrogating the intent of the legislation that we've just been working on, the Freedom of Information and Protection of Privacy Act. We have a clear defence of the privacy of the individual, yet this goes totally against the intent of that legislation. We should get the ministers who are involved together -- the Attorney General and the Minister of Health -- to start bringing their acts together. It looks like they are operating in two different streams.

I don't know who's in charge over there, but it's obviously not between those two people. The Premier obviously isn't in charge, because the Premier's never here. It must be a cooperative thing. Maybe the Minister of Finance is in charge. He seems to rise to the defence whenever there's a problem. He comes in and resolves the problem. Perhaps the fact that he's not here is another indication of one of the problems that we have here. Maybe the Minister of Finance should be sitting down with the Minister of Health and working out the differences between the Attorney General's and the Minister of Health's legislation.

The auditing has to be done by professional people. It has to be done by people who are going to maintain confidentiality. I'm not against some auditing of the process, but let's make sure that the process doesn't become an opportunity for government to go in there and get whatever information they want at any time they want it within reasonable hours -- I think that's the way it's said -- of an office being available.

[10:45]

I'd also like to address the area of the commission's subcommittees. This is rather scary. We establish a commission, and then we create subcommittees of that commission that are then going to be empowered with the responsibilities of the commission. It would appear that these powers can actually be more powerful and 

[ Page 2909 ]

can change the direction of the commission's decisions. These committees have the ability, for instance, to remove or limit coverage for beneficiaries and to de-enrol practitioners. That's to prevent doctors from practising. That's not the commission; that's a subcommittee of the commission, which the minister can establish. They can remove and approve laboratories. It says "labs" in here. I don't know whether that's an abbreviation for Labrador dogs or what. It's not that clear. Perhaps it should say laboratories. They can check up on the billing practices of practitioners. If there's an indication of some problem in the billing practices of practitioners, then an audit should be able to go in there and verify that. That would be an audit from a financial standpoint, not a subcommittee of people appointed by the minister -- perhaps from the same philosophical or political party to make up these subcommittees. We have the overall commission, which could appear to be made up of an unbiased group of people, and at the same time we could have subcommittees, which have the real power, being totally made up of members of the minister's own party. There's no protection for the people of British Columbia from the type of philosophical control that this provides.

There is another area of concern, and that's with regard to the fact that the powers given to these subcommittees can be given not only to one subcommittee but to more than one. Either the minister doesn't like the first subcommittee's decision and establishes a second subcommittee to be able to go forward and finally get the type of result that she wants out of the subcommittee, or else you have two subcommittees going in two different directions, having no unified recommendations, no unified actions, and maybe even investigating the same information from two different directions and interfering with each other's work. There's no way of coordinating these committees in this legislation.

In my riding there has been a great deal of concern expressed by doctors about the whole concept of this legislation interfering with their ability to work. It really causes them serious thinking about opting out of this process, about becoming a private practitioner where they will just bill patients directly. In many cases, where we have highly trained, outstanding specialists in our communities working both in special clinics and in our hospitals, some of our top surgeons are now looking at going elsewhere. They are looking at leaving the province.

This is a shameful situation. We cannot afford it. We need more doctors and more medical professionals. With the growth that's going on in this province, we need an immense increase in the number of people involved in this committee to provide for the increasing demand for health care. We cannot afford to make these professional people unhappy to the point where they find it's easier and a much more lucrative opportunity for them to live in the United States or other parts of the world.

We are really in the process today of destroying the health care program, the medicare program that this NDP government took pride in saying they were the instigator of years back. Today they may also be the creator of the death knell of the medical care program in British Columbia by this type of legislation. I really urge the minister to take this legislation back. Let the consultation process work. Take the time. It doesn't cost money to take time. It allows people to really see what is being brought forward, and allows the input that will make it into a better and much fairer piece of legislation. I would ask the minister to seriously consider what is being done here. Don't rush into this. Let's put it off until a fall session or until the spring, when this type of legislation can be thoroughly addressed by all parts of the community, so we can bring consensus to the community and bring peace to our health care. We have so many problems in our health care field today. We don't need this type of confrontation.

F. Garden: I just want to take a few moments to express my views on Bill 71. I want to stand in support of it. One of the things I want to talk about is consultation. I've heard it stated time and time again from the opposition benches that there has been no consultation. I refuse to accept that. The previous government, with all their faults, set out a commission in this province -- a good commission -- and over 18 months that commission went into just about every community in this province and was given over 300 written submissions. They had submissions from physicians, municipalities, boards of health, hospital boards and individuals all over this province. They consulted broadly with the people of British Columbia over that period. That commission made their report to the government and has been quoted by some of the opposition members in protest against this bill. One of the major recommendations that the commission made was that a global cap be placed on physicians' fees. It also went further and said this should be done immediately.

I come from a community up north. It's faced with all the difficulties of bringing doctors to that area. I would suggest that this bill makes provision for looking after these regional disparities. I've had many submissions from doctors in my community. They were very strong in their opposition to Bill 13. They presented me with a petition to that effect, which I presented in the House. I met for two hours with a group of doctors there, and they gave me several reasons why they didn't like Bill 13 as it was presented. I presented that to the minister. I would like to think it was these kinds of submissions that made the government or the Health minister come in with a different program for the doctors. Yes, Bill 71 includes some of the features of Bill 13. It includes the cap on salaries, but it's not as harsh as was previously suggested. I suggest that is because of these submissions made by the physicians in my area, to some extent.

It's also been said there's been no consultation at all on Bill 71. That's just not true. From February of this year there have been meetings with the BCMA on this legislation. Because of these meetings and suggestions made by the BCMA, there have been almost 59 substantial changes made to the draft legislation. If you take the two years that the Seaton commission was doing its thing -- finding out from the people of British 

[ Page 2910 ]

Columbia how they felt about health care -- plus the consultation that we've had since February, I think we've had reasonable consultation.

Now there comes a point when a government has to make decisions. Legislation is not done by negotiation. Legislation takes into account everything that's put into that pot, from the Seaton commission to the representations we've had from the doctors. Many of the people here have been on local boards, councils, school boards and commissions, and they've had to make decisions. These decisions have not always been popular, but one of the reasons you're a politician is to come to the point where you make that decision. I believe the consultation has been there, over the last couple of years, on the future of medicare in this province. We are preserving it. There is a need for some scrutinizing of billing practices in the medicare system, and that's what we're supposed to do. We are supposed to look after the dollars being spent in the system, and if you're not doing it properly, you are not proper stewards of the system. That's what you're sent here to do: to keep an eye on the tax dollar for your constituents.

These inspections -- or audits, as I've heard them called -- will be done by their peers. Medical practitioners will be examining the records of medical practitioners. Presently, medical records are exchanged on a confidential basis when you go from doctor to doctor. I'm convinced that if medical practitioners are used in the inspection process, then that confidentiality will be kept, based on the strict provisions for it in the act and, as was mentioned the previous day, on the code of ethics that these practitioners are under, under their own colleges.

I would suggest that it's a progressive bill. Sure, it hurts. But it hurt the homeowners when we had to do something in that regard. It hurt the business people when we brought in our capital tax. People all over this province have had to live up to the fact that we are in a bind financially. This is good legislation. It's based on recommendations from a good commission and on changes suggested by the BCMA. It's time to get away from the rhetoric of the situation. We need these doctors in the community. I believe that when they look at the long-standing implications of the bill and at what it will do in the future for the consultation process by having this joint commission, they will see that it will be for the betterment of their profession and medicare.

[The Speaker in the chair.]

C. Tanner: I rise to tell the House something that will be a surprise to everybody, I suspect: that I'm going to vote against this bill for three simple reasons, really. These three simple reasons have been enunciated time and time again in this House; they were illustrated by the last speaker when he suggested that the Seaton commission went around the province talking to various people, which they did, and very successfully. The commission that was organized by the previous government went around the province consulting with people and got an enormous amount of information, which arrived on the desks of every MLA in this House that I know of, and on my desk and the desk of the Minister of Health at approximately the same time. That was in January.

When you talk about a consultative process, it means a two-way street. You don't just bring in information; you react to it, you make suggestions to it, you make changes to it, and then you give it back. Normally you ask for a reaction from the very people who had input in the first place, and that has been ignored. This bill should have been a White Paper. If it had been a White Paper, we on this side of the House would have had no trouble discussing it with intelligence and input into the formation of this legislation.

[11:00]

You must understand why we're suspicious, when this late in the session the minister brings in a bill under these circumstances, where we're all under pressure of time, where there's a great deal to be discussed. They didn't give us the opportunity to properly discuss it. It will be our suggestion that we remove this bill from the House and take it to another place.

As far as the timing is concerned, in the first place it should have been a White Paper. It shouldn't have been a bill. You've got to wonder why they are in such a hurry. The member who represents Oak Bay and is the Minister of Health knows full well that this party on this side of the House ran on a platform that was, in many circumstances, very similar to the one they ran on, in that we too believe you've got to bring health to the communities.

In many instances in my constituency, when I was debating with members of her party and others, I was in a minority of one, or certainly just she and I -- the NDP member I ran against -- were in a minority of two with five people running, where we were defending the very theory and the very basis of the minister's arguments. We are of the same opinion, but we need to have some input, Madam Minister. We don't know why you need to rush it through. Give us a White Paper; let us discuss it. We'd be happy to discuss it in committee, and we'll give you some fairly good suggestions. At the same time, the consultation that the member to my left mentioned could take place.

The third thing that worries me about this bill is that the reason for the speed, according to the Minister of Health, is that they've got a problem with the doctors' negotiations. I have heard with my own ears, it's been stated in the press and the BCMA has made the statement that they are prepared to make a reasonable agreement with the minister for this year so that they too can have some input into the bill. They will not impede the ability of this House, this Legislature, this minister and that government to properly look after the funds that are allocated to medicine and medicare in this province.

That is not a reason, Madam Minister; it is an excuse. It is about time that you seriously looked at placing this bill where it belongs -- in a committee -- and giving an opportunity to every member of this House to have reasonable input.

L. Reid: I beg leave to make an introduction.

Leave granted.

[ Page 2911 ]

L. Reid: I would ask the House to join me today in welcoming Karen Legeer to the galleries. She is a dear friend and colleague and has come to hear how this government is going to be handling this bill.

L. Stephens: I rise this morning to speak in opposition to Bill 71, the Medical and Health Care Services Act. This bill makes some major fundamental changes to the delivery of health care in British Columbia. Bill 71 is a result of the withdrawal of Bills 13 and 14, and contains many elements of those two deservedly criticized pieces of proposed legislation. As many of my opposition colleagues have spoken against this bill, I will be very brief.

Some of the major concerns that have been expressed about this bill are commission operations, delegation of commission responsibilities by cabinet, restricting access to beneficiaries for cause, physicians as watchdogs of the system, circumvention of the responsibilities and authority of licensing bodies, and powers of audit and inspection.

We on the opposition side of the House have seen some not well-thought-out and hastily presented proposed legislation placed before us for our consideration, as other members of this House have also pointed out. In my view, this government simply hasn't taken the time to evaluate the ramifications of Bill 71. There needs to be a more thorough, consultative approach for all of the parties concerned, so I move an amendment that all of the words after "that" be deleted, and that "that" be followed by "Bill 71 be not now read a second time, but that the subject matter be referred to the Select Standing Committee on Health and Social Services."

On the amendment.

D. Jarvis: I'm in favour of this amendment, naturally, as it appears to me that this government is justifying the ramming-through of the capping of the doctors' billings on the belief that the cost of medicare is out of control, and that the doctors are partially responsible for this. The fact is that the health care budget and the doctors' billings have been in fairly equal proportion to the total provincial budget, despite the technological increases and the ever-growing population of seniors that has been making quite a drain, or strong demands, on the system.

As a result of this capping set by the government -- arbitrarily, I might add -- below that of the doctors' billings, a great many of the doctors will be working for a lot less, while their expenses escalate due to inflation, etc. Accordingly, we will see a cutback on their workload, so we are going to see less work, more waiting-lists and more suffering. Where do you expect patients to go when there's a lack of services? Why should you expect the doctors to carry such a heavy load for less pay?

I'd like to read an excerpt of a letter received from a gentleman in my riding who is a medical doctor. Prior to reading it, I would just like to clarify that yesterday I read another excerpt from a letter, and it was misinterpreted by the member for Vancouver-Kensington. He is not here today, so he will probably misinterpret my statement about a fascist that I quoted from the letter again. If he will put down his pocketbook and pay attention to the speeches in future, maybe he will remember. However, this quote from the doctor says: "I invite you to spend one day or one hour in my practice so that you may appreciate better the work we perform. I leave home regularly at 7 a.m., return at 7 p.m. -- if I'm not on call in ourh emergency clinic -- rarely have lunch, see 40 patients, receive 30 phone calls, perform hospital rounds every day of the year...." It's just about as bad as an MLA, isn't it?

He makes rounds to the hospitals every day of the year including holidays, and he delivers babies in the middle of the night and works from one to five on weekends, spends evenings doing reports and on the phone with all his patients. He has spent ten years training to be family physician, and he asks that we stop the confrontation between the government and the medical society before they destroy entirely one of the cornerstones of Canadian society -- that is, the prized health care system.

There's an old saying that the best healing is good cheer. This is not a good-cheer government, believe me. Highly trained specialists are leaving this province; in my own area of North Vancouver, two out of the three remaining neurosurgeons are now planning to leave. There are approximately 200 neurosurgeons in this province, and there's a shortage of approximately 200 neurosurgeons in the United States. You all can see that a brain drain is either on its way or will occur eventually, along with one in the technological industry as well.

One aspect of Bill 71 is its highly public profile. Here again it is this government's agenda....

Deputy Speaker: Hon. member, just a moment, please. I would remind you that you are speaking to the amendment, which is to hoist the bill, in effect. You may wish to relate your comments to the reasons for the hoist motion.

D. Jarvis: I appreciate that. I am definitely speaking in favour of this amendment. I was saying that this is the NDP's consensus to chaos. Not only can they not read a balance sheet, they have no concept of how to make money, and they now show they can't negotiate. We are headed into a season of conflict on this consensus of chaos. Every major bill or thought they have put forward in this session has resulted in citizens being pitted against each other.

The Premier himself said months ago that he would support binding arbitration with the doctors, and now he abandons this philosophy. It's another broken promise -- No. 38, I believe. The NDP's approach to health care is a thoughtless approach to a serious matter. It is a crude attempt at an agenda of mismanagement by a socialist government....

B. Jones: Point of order. The opposition has brought in a hoist motion, which is fully appropriate and should be debated in this chamber. I have listened to the hon. member opposite very carefully. That member has made absolutely no attempt to relate his 

[ Page 2912 ]

comments to the hoist motion that we're debating at this time.

G. Farrell-Collins: A further point of order, in response to the point of order raised by the member for Burnaby North. The member is merely stating the reasons why he believes this bill should be sent to the Select Standing Committee on Health and Social Services and taken back to the public. I think the House should allow him to give the reasons for that and to finish his presentation.

Deputy Speaker: Both points of order are well taken. I should, for clarification, rephrase my explanation to the House. The motion is not technically a hoist, but it is a referral motion to committee for consideration of the subject. Nonetheless, the member speaking should address his remarks to reasons for this.

D. Jarvis: I feel exactly that way. As I was saying, the reason I am supporting this amendment is that I believe this government is on the wrong track, in that they can plan people's lives better than people can plan their own. I don't believe this agenda of theirs will work. They can't ram it through. I don't believe they should be able to ram this bill through. It just won't work, just as their philosophy won't.

The members from the government side have contended that when they discuss inspectors going into doctors' offices to examine their files.... I want to ask a question of the members for Port Moody-Burnaby Mountain and Vancouver-Little Mountain. When they are discussing this aspect of the oath allowing the inspectors to go in, which do they abide by -- the Hippocratic oath or the hypocritical NDP oath, when it comes down to the point?

D. Schreck: Point of order. The member for North Vancouver-Seymour has spoken once on the main motion before the House. The substance of the current remarks should have something to do with the amendment to refer the main motion to the Select Standing Committee on Health and Social Services. Not one comment has been made on the need to refer. We are hearing a second debate on the main motion. Not only that, those remarks are from written form rather than extemporaneous. The member is clearly out of order.

G. Farrell-Collins: Point of order. The member, once again, is obviously getting hot under the collar. Whenever the debate turns tough, he tends to do this.

The member is very clearly stating the reasons why he believes.... If the member would read Hansard, he would know that. This member believes that this bill should be referred to the Select Standing Committee on Health and Social Services for the reasons that he's stating. The member should allow the hon. member on this side to make his case as to why this bill should be referred to the standing committee and brought back to the public.

Deputy Speaker: I suggest that the member take those comments in the good spirit in which they were intended and try to keep his remarks as close as possible to the purpose of the amendment.

[11:15]

D. Jarvis: Another reason why I'm supporting this amendment is that the government is asking doctors to take money from their own pockets to pay for costs that are beyond their control. This would only result in the average citizen being faced with less accessible care. If the doctors strive to save the system money, who do you expect will receive the least care? Is it this government's belief...? Are they so naive that they cannot realize that their ill-conceived approach is only going to make health care less accessible to the public?

In conclusion, while speaking to this amendment I'd like to say that the greatest vice of capitalism is the inequity of wealth; however, the great virtue of socialism is the equity of misery it leaves behind.

L. Reid: Speaking to the amendment that the subject matter be referred to the Select Standing Committee on Health and Social Services, this amendment speaks directly to the need for process and consultation in this House. Yesterday in this House a cabinet member, who is a doctor, said: "Think before you act." That is what we are asking this government to do. This bill deserves some consideration and consultation.

The Minister of Government Services suggested yesterday that there have been days and days of consultation -- in fact, probably weeks. In three and a half months, the Minister of Health has met only six times with the BCMA, for a total of only 23 hours, and has been unavailable to meet since June 14. This is not a commitment, hon. Speaker.

Allow me to go through some dates. On March 26, 1992, we had the tabling Bills 13 and 14. There was no consultation with regard to the unilateral cancellation of the negotiated physician benefit plan and the introduction of a fixed global cap for physician service payments.

We go to May 7: BCMA officers and four MLAs meet to see if they have common ground; meeting explores the area of global budget for 1992 and 1993; development of due process for future negotiations in the physician benefit plan. They met from 7 to 11 p.m. on that day -- four hours of consultation.

May 11, seven to 12 midnight: government and BCMA reached tentative agreement on a revised physician benefit plan; government and BCMA agreed to defer discussions on the 1992-93 budget. Again, there are some discussions here about consultation. Nowhere does this suggest that they met extensively, as it seemed to the eyes of the Minister of Government Services yesterday. We are now up to eight hours of discussion on something that is the cornerstone of health care in this province -- something that is fundamentally flawed in the form of Bill 71.

May 28, two weeks later, two to 5 p.m.: short meeting between the government and the BCMA identifies a process to expand the Medical Services Commission and to have the BCMA, the government and the public included as members of the commission; consensus 

[ Page 2913 ]

could not be reached on a model prior to the minister excusing herself from the meeting.

We wait a week and then go to May 31, 12 noon to 5 p.m.: further discussions on the tripartite commission and on a process for co-management and dispute resolution. Once again, due to the minister's departure, the meeting concluded with only an agreement to discuss the above concepts with the BCMA board and cabinet. Government representatives also indicated that the tentative agreement for a physician benefit plan, as agreed to on May 11, was now void and that they were only willing to agree to negotiate a new benefit plan for physicians without recognizing compensation for the existing plan. That is not consultation; that is simply not effective. That is not the way we want to go in this province.

The Minister of Government Services said yesterday in this House that there had been extensive consultation over a period of days and weeks. We are only up to 23 hours on something that is going to fundamentally change how we deliver health care in the province. I have some significant difficulties with that. We waited until June 16 to introduce Bill 71, the Medical and Health Care Services Act, in the Legislature. I would like to quote from a letter of August 14, 1990:

"As I have already expressed to doctors, the New Democratic Party is committed to fair and honest negotiation with all aspects of the medical community. Health care must be a priority in terms of government spending, and we can't control costs by continuing to squeeze those who supply the services. Unfortunately, I cannot hold out any hope for a change to what you describe as a 'desperate situation' until there is a change of government.

"In the meantime, please be assured that my New Democratic Party colleagues and I will continue to fight for quality health care and for honest negotiations with all of the health care community. Thank you again for taking the time to write to me about this matter. Please do not hesitate to get in touch with me in the future, if I can be of further assistance.

"Elizabeth Cull, MLA
"Oak Bay-Gordon Head"

That is vastly different from what we have in this province today. Less than two years ago somebody stood for something in this province. The MLA for Oak Bay-Gordon Head stood for consultation and honest negotiation. Today, that's no longer viable in her eyes. That is something that this House cannot allow to continue. We must have consultation. I speak of consultative process. We were promised a government that would listen. Instead, we have before us today a government that makes arbitrary decisions, delivers edicts without consultation. No, I do not believe that 23 hours is a legitimate consultation in this province. I do not believe that there is a significant commitment on the part of this government to go forward and deliver health care in concert with the key players in partnership. I cannot believe that any more members of this New Democratic government are going to stand up and cite partnership, consultation, open government. "A Better Way" -- 48 points looked at consultation, at open government. That is not reflected here today.

Why not sit down? Why not refer this to the Select Standing Committee on Health and Social Services? It's time that the public had an opportunity to examine this bill in detail. This is not just about physicians. This is about how taxpayers in this province will receive their health care. This is a cornerstone document for the delivery of health care in this province.

The public needs some time to take a look at it. We will not have reasonable health care delivery in this province if this bill goes through. We cannot have haste -- urgency -- somehow overlying and eliminating common sense. It is not appropriate that we allow this bill to go forward at this time. Legitimate legislators in this House cannot see the value of ramming this through the House at this time. In fact, Bill 71 is a bit like a chameleon -- one day it's a carrot; the other day it's a huge stick. It's not getting any better in terms of this government having the population, the public at large, understand that this is a significant bill. This is incredibly significant in terms of how health care is delivered. To put it to the select standing committee makes common sense. It's incredibly appropriate that we take a look at how the public is going to be involved in the delivery of that.

I saw the minister nodding her head earlier. Yes, it is more than just the doctors who are involved in this bill. It's the public, the taxpayers in this province, and they will not appreciate a bill of this magnitude being put through this House in less than ten days. It is absolutely not appropriate.

Again, this government has spoken to open consultation. They have spoken to sitting down and negotiating. Talk is cheap, hon. Speaker. We need to see some action. We need to see a practical reality for this bill, and quite frankly, we've not seen that yet. We have whitewashing. We have a sales job, if you will, a marketing scam, to suggest that this is somehow decent legislation. It absolutely is not decent legislation.

It could be improved dramatically by sending it to a select standing committee. I spoke yesterday with the chair of the select standing committee. He believes it's a credible vehicle. He believes the committee can do some work. If something of this magnitude were put to that committee, the committee may have something to put its teeth into; it may be able to do the work of this province. This is still constituent representation in British Columbia. In my view, consultation means an ability to come together to advise and to seek counsel. It doesn't mean 23 hours to change how health care is delivered in the province. It means seeking advice and opinions; it means referring; it means deliberating; it means truly getting down to the issues. The public deserves that, hon. Speaker. So again I ask all the seasoned thinkers in this House to give serious consideration to the amendment on the floor today and to putting this piece of legislation to the Select Standing Committee on Health and Social Services.

Deputy Speaker: Before recognizing the hon. member for North Vancouver-Lonsdale, I would like to just remind the House that we cannot do indirectly what cannot be done directly with respect to referring to members by their names. When the hon. member who just took her seat referred to the minister by her name when quoting from the correspondence, she 

[ Page 2914 ]

should in fact have referred to her by the position she holds. That's just for your information.

D. Schreck: I note that the opposition Health critic has referred to the credibility of the Select Standing Committee on Health and Social Services, which I have the privilege of chairing, and which, with the opposition Health critic and other members of this House, will soon be reviewing regulations to control the sale of tobacco to minors. The task of reviewing the sale of tobacco to minors is a manageable task. The task....

[The Speaker in the chair.]

K. Jones: On a point of order, hon. Speaker, I don't think the member is speaking to the amendment. Could you ask the member to please speak to the amendment.

The Speaker: Thank you for your point of order, hon. member. I'm sure all the members now realize that we are on the amendment to Bill 71, that the subject matter be referred. I'm confident that the hon. member will speak to the amendment.

D. Schreck: My point is simply this. The matter, on which we have held consultations, that is coming before the committee is a manageable task. The subject matter that the opposition now wants to put before the committee is an unmanageable task which essentially asks the committee....

Interjections.

The Speaker: Order, please, hon. members. Only one member has the floor at one time.

D. Schreck: The jumble of heckling from multiple members on that side of the House all at one time illustrates the type of consultation that those members desire to undertake. It is nothing but a muddle, nothing but the type of confusion that emanates from those opposition benches.

C. Tanner: Point of order. If the member who just spoke is not going to keep to the point, surely the Chair is going to rule him out of order.

The Speaker: Hon. member, it is the responsibility of the Chair to keep order in the House. I have called the House to order.

Would the hon. member please continue with the debate on the amendment.

D. Schreck: My point is simply that the taxpayers of British Columbia paid over $6 million for the report of the Royal Commission on Health Care and Costs. Bill 71 implements many of those recommendations, following a process of consultation with the medical profession and the British Columbia Medical Association. It really goes back over ten years, since an attempt was made in the mid-eighties to redraft the Medical Services Commission legislation. That was intensified and brought in line with subsequent negotiations between the British Columbia Medical Association and the Medical Services Commission under the guidance of this minister. These negotiations reached the point many times of being but a hair's breadth apart on agreement and implementation of this co-management approach.

Referral to the committee at this stage is no more consultation than is the jumble of heckling from the opposition benches. Referral at this stage is an attempt to stall, with a price tag to the taxpayer in this province of between $50 million and $100 million. Perhaps the members on those opposition benches want to inflict a $50 million to $100 million price tag by returning to a blank-cheque approach to health care in this province. I say that the Select Standing Committee on Health and Social Services has a valuable, meaningful task before it -- a doable task -- and we don't need the stalling tactics proposed by the opposition.

[11:30]

A. Warnke: I'm rising to support this amendment, which is to refer this to the Select Standing Committee on Health and Social Services. The mover of this motion -- either that member or the member for Langley -- pointed out how hastily the legislation was put forward, and that there was a problem of consultation. My colleague from Langley is not alone in expressing the problems that we see with regard to consultation. I spoke on this yesterday. Today the member for Richmond East eloquently put forward how there is a very serious problem in terms of consultation. Therefore I too want to raise reservations I have that can be put in the context of supporting this amendment moved by my colleague the member for Langley.

One of the reflections I have from hearing the debates this morning.... I listened to the remarks of the member for Port Moody-Burnaby Mountain, and I thought that member made some very positive remarks. It seemed to me that particular member did understand some of the problems facing British Columbians and the medical community. As a matter of fact, I applaud her for some of the comments she made this morning.

I recognize and I respect that the member obviously will vote for the government bill. I am assuming -- maybe too prematurely -- that the member will also be voting against this amendment. But I think the member hit the nail right on the head in outlining that there seems to be some anxiety on behalf of British Columbians in anticipating changes within the system -- changes which generate fear; fear which generates anger. That struck a very solid chord in me, and I certainly recognize some of her very candid and honest statements with regard to being uncomfortable with earlier bills introduced into this Legislature.

I think that really hits the nub of the issue. There is this concern, fear and anger by the public. Therefore the public has some reservations about establishing yet another commission when it is not really clear what the composition of this commission or the process is all about. Indeed, in some of my remarks yesterday I noted that the so-called co-management model that defines the composition of this particular commission is 

[ Page 2915 ]

flawed. The process which establishes the purpose and the nature of this commission is flawed, which many members on this side have expressed. The accountability of this commission is flawed. Indeed, one of our colleagues in this chamber.... We're all colleagues in this chamber, but I listened particularly to the member for Peace River South, who pointed out the illusion of the commission. I think that member had a very strong point. If there is this illusion -- and it seems to me that there is -- that apparently there's this commission that has some sort of balance of representation, yet we know that the government and the cabinet can intervene in the critical phase, then it is necessary to point out that there is a flawed process here. There is also a flawed process in that if the government is not pleased with the commission, there is a way out. In fact, all they have to do is appoint a public administrator. There is something flawed in that there is not something definite; there is no certainty here. That is a problem.

I also noted yesterday that section 43 is not satisfactorily written. This is relevant to the motion. The mover of the motion pointed out that there is a lack of consultation, and I too think there is when we begin to address the whole question of confidentiality. I agree with what one member said this morning -- that confidentiality between the doctor and the patient is absolutely sacrosanct in our society. As it is, I can think of another profession, although that member didn't; I can think of the relationship between the lawyer and the client. These are cornerstones upon which civilized society is based. That is sacred. The relationship between the lawyer and the client, and the doctor and the patient.

Therefore I want to support the amendment that has been put forward. I think the select standing committee is the proper way to go here. It is so constructive, simply because it may actually address some of the concerns that I expressed earlier. Some of these reservations that we have about the composition of the commission and the procedure, some of the problems involving the nature of the commission, some of the problems involving government and its relationship to the commission and ultimately its relationship to physicians and patients, can be properly and thoroughly addressed through the select standing committee. That is why it's so constructive to put this amendment forward. That's why I enthusiastically embrace this amendment. It is a constructive option and alternative that has been put forward.

By accepting this amendment, I believe we can actually instil confidence in the concerns that have been addressed. The physicians, the medical community and the patients will have confidence in the system that ultimately will evolve. We're not afraid of change. As a matter of fact, one of the key principles and points of Liberalism is that it embraces and accepts change. We are in favour of change. We see an evolution occurring, but an evolution that is based on some sort of reason. I do not have to reiterate what I said about that yesterday when one of the members opposite talked about a rational system. Reason means: even in addition to some of the consultation that has taken place. The Seaton report is not the be-all and end-all of all consultation, which we can now ignore and go ahead with our agenda. Indeed, that was just the very beginning, whereby consultation with the opposition parties, the public and so forth can actually move us in a direction where we can put forward a reasoned and rational system.

It has to be more than that. It has to instil confidence in the medical community, the physicians and the public. They have to feel confident in their system. And they feel confidence once we begin to address a whole myriad of problems, issues and questions. Of course, the Minister of Health is very familiar with the problems that we are going to face in the future, as indeed are all ministries of health across this country and perhaps elsewhere. There are issues and concerns that will not be easily addressed. Therefore, to take a very prudent direction here by moving in a reasoned fashion will, I believe, move us to addressing some of these issues, problems and concerns in such a way that we can hopefully come up with solutions. If there are arguments, if the government really feels strongly about some of its proposals, I would suggest that what it must do in order to instil confidence in the public is elaborate its arguments. There is nothing wrong with that -- elaborate the arguments, give everyone a solid reason for the direction they are going. I think the government has not done that so far.

I would suggest that what we have to do is move in a direction that encourages consultation, especially on such serious matters as the future of health services in British Columbia. I think the way to go -- and it's an important step, not just something rhetorical that we've introduced here in the chamber -- is a move toward establishing the Select Standing Committee on Health and Social Services to really address some of these problems and instil that confidence from all of us, from all sides of this chamber, so that the public can believe that public business, especially on health, will be fully addressed.

Hon. E. Cull: I rise to speak in opposition to the amendment. I agree with the previous speaker that there is a flawed process going on here. The flawed process is the thinking that has gone into this amendment. The problem with the amendment is that it's based on faulty logic, a failure to read the bill properly, faulty research and some selective reading.

Let me just talk about the failure to read the bill properly and some of the faulty logic. I've heard many members over here talk about capping of individual doctors' salaries. Nowhere in Bill 71 is the capping of individual salaries set out. They talk about no negotiations. The bill enables negotiations on the fee structure for the BCMA and doctors in this province. There are negotiations enabled by this bill. Negotiations have always taken place with the Medical Services Commission, and they will continue to take place with the Medical Services Commission.

I hear a lot of talk about subcommittees and what's going on with the subcommittees, and the misreading of what these subcommittees might in fact be able to do. Well, let me tell the members on the other side that doctors aren't the only health care providers in this 

[ Page 2916 ]

province to be covered by the Medical Services Commission. We have chiropractors, massage therapists, physiotherapists, podiatrists, optometrists and many other individual health care providers. They do not want to be part of a Medical Services Commission that only has doctors representing the health care providers. So we have provided another mechanism whereby every time we have a complementary health care provider we can establish a similar co-management model for them: government, public and that particular health care provider, be it chiropractors or optometrists or whatever. That's what those subcommittees are there for, and if the members on the other side want to suggest to the complementary practitioners that they be governed by a Medical Services Plan that does not have any representation from their members on it, then I think they'll have a real problem on their hands. That is totally unfair to those health care providers. We're trying to provide that model to them through the subcommittees.

I hear all this talk about audit -- this horrible fear that something terrible is going to happen about audits. Well, let me tell you that your hospital records are already audited, and they have been for years and years -- decades. We will be the eighth province in Canada to bring in audit provisions. As one of our colleagues mentioned yesterday, two of the provinces that have already moved down this road are Liberal-government provinces. The other side glosses over how this audit provision will actually take place. They talk about inspectors as if we're going to be sending out tax accountants.

[11:45]

G. Farrell-Collins: On a point of order, the portion of the debate we're involved in now -- as I think the minister knows -- is on the amendment to refer this to the Select Standing Committee on Health and Social Services. I'd like to know why the minister does not support that portion of the amendment, not hear further debate on the bill itself.

The Speaker: Hon. members, as the Chair reminded members yesterday -- and a couple of times already today -- the practice of this House has been to allow fairly wide-ranging debate at second reading stage, and that also applies to the amendment stage.

While members may feel strongly about topics that are debated in this House -- and that is as it should be -- the Chair does feel that in order to have wide-ranging debate there must be order, and one of the first rules of order in this House is to respect the fact that when a member has the floor, they are listened to, and that goes for any time a member has the floor.

Hon. E. Cull: I am directly on topic here; I'm trying to explain to the members opposite why they are using faulty logic and misinformation to oppose the passage of this bill and to try to move it off to a committee where we won't be able to get on with dealing with the very serious problems that are affecting us here in British Columbia around medicare.

Let me continue, then, with their faulty logic when it comes to the audit provisions. They keep talking about inspectors as if we're sending out some kind of tax auditor. I agree with the leader of the....

A. Warnke: On a point of order, hon. Speaker. The minister is talking about audits. I do not recall, in any of the debate so far on the amendment, where there was one mention of the audit. I think the minister should keep that in mind.

The Speaker: The Chair has not determined that the debate thus far is out of order. I assume that the minister will quite quickly be showing how her comments relate to why she does not support the amendment to refer this subject matter.

Hon. E. Cull: Hon. Speaker, members on the other side are making the argument that this needs to be referred to a select standing committee, to have a look at all of the provisions and to question, among other things, the audit provisions that are in here. I have to tell them that the way they have been interpreting and debating this particular provision in the legislation is incorrect. Again, I will continue....

C. Tanner: Point of order. What we're looking for from the minister is the reason why....

The Speaker: Your point of order, hon. member.

C. Tanner: The point of order is that she is not addressing the reason why we shouldn't amend this bill. She hasn't given us any reasons; she's just telling us about the same arguments we had before.

The Speaker: Just one or two minutes ago the Chair explained the Chair's position on this. This amendment is to refer the subject matter -- not the bill but the subject matter. Therefore debate on the subject matter that will eventually relate to why it should or should not be referred is in order.

Minister, please proceed, and please be mindful of the points of order that have been raised.

Hon. E. Cull: I'm trying to be mindful. If I have no further interruptions I can quickly move off the subject of audit.

I was starting to say that I agree with the comments made by the leader of the third party. He said that the oath of confidentiality for doctors is the most respected in the western hemisphere, I believe. The only people who will be looking at medical records for the purpose of confirming a billing to the Medical Services Plan will in fact be medical doctors, and they will be bound by that same oath of confidentiality.

I've heard statements made about doctors leaving the province. I suggest that the members opposite have a look at the figures for doctors leaving all Canadian provinces over the last five years. They will see that 

[ Page 2917 ]

there is a very clear pattern. It has remained dead constant all over no matter what has been going on in any province. There is always a small number who will leave.

That summarizes very briefly some of the major issues that the other side has been using in saying that we need to have another look at this through a standing committee.

I want to talk about two other items that were raised directly as we talked to this amendment. Why the rush? That's what I keep hearing from the other side. They say: "Let's refer it to a standing committee and look at this a bit further." I have to make it absolutely clear that there has not been a rush on this bill. Some parts of this legislation were discussed with the B.C. Medical Association in 1988. I don't know how much more you want to slow things down, but that has been a considerable amount of time -- five years by my calculation. This specific bill, Bill 71, was discussed in draft stage with the B.C. Medical Association as early as February of this year; and it has been through a number of discussions at the staff level with them. The consultation that has taken place further to that around the specifics of the joint management commission and everything else started on March 26, almost three months ago, when I met with the B.C. Medical Association executive.

I have to talk about some of the faulty research again. If you're going to rely on one of the parties that's opposing this legislation as your research officer, you'll have to do a little independent third-party research, because the chronology you're reading from is missing a few key important dates that I'm kind of surprised they'd leave out, such as March 27, the day after the budget came down, when I met with the executive in Vancouver; April 6, when I and the Premier met with the B.C. Medical Association executive. Do you know, I'm really quite surprised that something that is supposed to be a true and complete chronology of the events since budget day would actually omit a meeting with the Premier of this province. You kind of wonder what the agenda is here.

Interjections.

The Speaker: Order, please. Would the House please come to order.

Hon. E. Cull: The chronology also fails to mention the meetings of June 12 and 14. When you start adding up all the consultation that has taken place, I have personally met with them on ten separate occasions. I daresay that is more times than any previos Health minister has met with the B.C. association before in any four-year term.

What is the urgency, though, about this bill? The urgency is clearly that if we do not start to get hold of our budget now, we are driving ourselves towards a $45 million to $50 million overrun at the end of this year. That is based simply on looking at last year's utilization rate and saying if that continues unchecked, what will it be this year? Now $40 million to $45 million could do an awful lot of things for us. If we were able to save that money and put it into programs for children at risk, or education, or housing.... There are all kinds of crying needs, which have, I daresay, more impact on the health of British Columbians than putting another $45 million to $50 million into physicians' services. We should be putting that there.

Interjections.

The Speaker: Order, please. I will call the hon. member for Fort Langley-Aldergrove and the member for Saanich North and the Islands to order, please, during this debate.

Hon. E. Cull: The other alternative, which seems to be the one that's being promoted on the other side of the floor, is: "Gee, what's another $40 million or $50 million cost overrun at the end of the year? You'll just sign a special warrant. It's been done every year before." The problem, at the big-picture level, is if we don't get control of the finances of this province, reduce our deficit and start to be fiscally responsible, we'll lose our credit rating and our ability to fund the very social services that we're all saying we're standing here and fighting for.

Look at this very simply. Look at this the way you deal with your own household finances. If you know you have to balance your budget at the end of the month, you don't start doing it on day 28, because in those last two days it's going to be pretty hard to make the mortgage payment if you've already spent everything all the way down the line in the first three and half weeks. We have to start now. We're almost a third of the way into this fiscal year. We have to start now if we're going to make sure that we don't end up with this situation at the end of the year where we've overspent our budget, or we have to chop services in some other areas to balance it. That's why we need this legislation now. That's why I don't support sending this to the committee at this stage.

I have to agree with my colleague from Port Moody-Burnaby Mountain that change is frightening. It's frightening to all of us. But there comes a point when you have to make some decisions. You can't go on consulting and studying and thinking and planning forever; sooner or later you have to make some decisions. Sometimes those decisions are tough. Sometimes they're unpopular. But I have to tell you folks that right now, all the way across Canada, each and every Health minister in the ten provinces and the two territories, regardless of which political party they come from, is making the same kinds of decisions. There are six other provinces with legislation similar to this -- some of it, I daresay, a lot more draconian in terms of how it has been imposed or how it might be used.

The time has come to make some decisions about medicare. The pressures on the system are here now, and they're very real pressures. If we do nothing, we're not going to be able to stop the erosion of probably the most important social program in this country. That's why we're opposing referral to the select standing 

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committee. It's time to get on with this. It's time to move now.

L. Fox: I rise to support the amendment, but as I've just had the time pointed out to me, I would move that we adjourn the debate until the next sitting of the House.

Motion approved.

Hon. E. Cull moved adjournment of the House.

Motion approved.

The House adjourned at 11:57 a.m.

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