1993 Legislative Session: 2nd Session, 35th Parliament HANSARD
The following electronic version is for informational purposes only. The printed version remains the official version.
FRIDAY, MAY 14, 1993
Morning Sitting
Volume 10, Number 2
[ Page 6287 ]
The House met at 10:04 a.m.
Deputy Clerk: Pursuant to standing orders, the House is advised of the unavoidable absence of the Speaker.
[E. Barnes in the chair.]
Prayers.
A. Warnke: On the subject that I'm talking about today -- justice, laws and protecting the public good -- I would require half an hour under normal circumstances. Nonetheless, I'm not prepared to wait, because I really feel there is an urgent need to address this particular subject. Before getting into the details as to why this subject is so important to us now -- because I really believe that the public has a sincere desire to address some of the problems concerning crime and violence in our society -- the reason I referred to the public good is that it's always instructive to look at the past and recognize that the good involves the moral purposes of human life. The good is associated with the morality of a society that includes both the ends and the means. Naturally, we can take a look at the inspiration given to us from Plato and the Platonic ideal that the essence of a society is the pursuit of justice. He went so far as to suggest that the just person and just society must coincide with one another.
This is what establishes the basis for legitimate authority. Contrary to what many people believe about Plato's reference to the men of gold, silver and bronze, Plato referred to a class which really involves us -- those who are responsible for legitimate authority; secondly, those who are responsible for providing the safety and securing of society -- namely our police forces and military; and thirdly, those who are responsible for the administering of public policy. This is the essence of legal justice and how it has evolved over time. The purpose of legal justice is twofold: it is a mechanism for settling disputes, because whether we like it or not, we are forced as human beings into a state of conflict. The philosophers of the past, from Hobbes to Locke, have all addressed how human beings have that possibility of being in a perpetual state of conflict and how legal justice is therefore a mechanism for settling disputes. It is also a mechanism for regulating human behaviour. That's not the be-all of any legal system, however. What we have seen, especially in the last two hundred to three hundred years, is the evolution of various positive freedoms. Much of that has been discussed in this House since we were elected in October 1991.
We have seen the evolution of legal freedom and the evolution of public support for human rights. We need not go through a comprehensive list, but I think we're all aware of some of the freedoms that we have enhanced: the freedom of religion, the freedom of speech in the press, the freedom from want and the need for social security, the freedom of the right of association, the right of property, the freedom of contract and so forth. I would advise anyone needing any sort of list to read Lloyd's Idea of Law. But how does that involve us? We are in a state whereby there is the perception and the reality of increased crime and violence in our society. Governments do respond. Indeed I applaud the efforts of the present federal government announced yesterday -- and I hope they meet with success before their government is terminated -- to deal effectively and concretely with pornography, especially when it involves children. I think the steps taken by the federal government are not only positive, but need our support.
We've also seen some other attempts to deal with crime and violence in society as they affect women. Those who think sensibly and sensitively on this subject realize that it is a priority in society to deal with the problems of violence against women.
These are not just some sort of new innovations, but are an attempt to enhance freedom. It is extremely necessary, therefore, to address the problem insofar as it relates to the community. The community is, in essence, a desire for the observance of standards of right. People are concerned that their social surroundings are being jeopardized -- our day to day living, what we do in our neighbourhoods, how we live in our families. Naturally, there is an instinctive reaction to want to put more police out there and seek similar kinds of remedies. Rather, what we need is to concentrate more on the community and to recognize that the community is the centre by which we develop our laws. In my concluding remarks I will have some very concrete suggestions as to where I believe we should go. For the time being I think it's necessary first to recognize that people feel jeopardized and vulnerable, and that could lead to disorder or insecurity. Such chaos and disorder means that people have no sense of community.
L. Krog: I want to thank my colleague the member for Richmond-Steveston for that most interesting series of remarks about justice, the laws and protecting the public good.
I think we should be mindful in this chamber, as we are the great collector of taxes in this province and the redistributor of wealth in the most direct sense, that much crime is related to issues of poverty. Issues of violence are related to issues of poverty. When unemployment is high, crime is high. Indeed, I know that the head of the RCMP in my own community is able to predict a recession far faster and with far more talent than many economists. He can tell that when the number of break-and-enters increases in the community. He knows then that there is serious financial difficulty. He's observed it in community after community across this country.
Freedom is a wonderful concept. Janis Joplin, that wonderful singer who many of us grew up listening to,
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once said: "Freedom's just another word for nothin' left to lose."
If we in this House are to address the issues of freedom and security in our lives and in our communities, we have to address the gut issue, which is poverty. It is out of that poverty, in large measure, that crime flows. I accept absolutely that evil exists in the world, that some crime and some things that go wrong in our society are not related to poverty. But I also accept absolutely that the crime that relates to poverty is our greatest threat. If we as a province, as a people and as a nation are to succeed in eliminating crime, in restoring that sense of security to people in a very transient society -- and we are all transient; we move more frequently and shift our careers more frequently than our mothers and fathers did; our relationships break down with a higher rate of frequency -- if we are to address all of those issues, then we will see a reduction in the level of crime and we will restore some sense of community.
But that is a multifaceted problem, and I'm looking forward to what the hon. member has to say in terms of solutions. I think the solutions have been with us for a long time and are most readily apparent, but we as a society have failed to commit ourselves to the necessary resources. We have sat back, as they have in the United States in many of their inner cities, and said that somehow, if we just all wait, things will solve themselves, that these problems will go away. We know that crime comes from increasing population, the poverty of inner cities and the poverty in our own communities that we ignore. We know that it reaches a crisis point where law and order is more primitive than in that magical image of the frontier west, where violence, fear and threat were what justice was all about. We know that in many inner cities that is exactly the kind of justice meted out in the streets, in the back alleys and in the back rooms of places where none of us would want to be seen or go.
[10:15]
If we want to talk about protecting the public good, let us talk about protecting children in homes where there is violence. Let us talk about protecting our health and school systems. Let us talk about all those things, for they are far more important solutions to justice and protecting the legal system, which is what marks us as a civilized society. They are far more important to protecting the public good than anything else we can talk about in this chamber.
I thank the hon. member for raising this issue, because it's a broad issue that crosses all party boundaries, and I'm thrilled that he has raised the issue this morning. I hope that his remarks will redouble the efforts of all of us in this chamber to commit ourselves to the elimination of poverty in our society, to the elimination of violence and to the enhancement of programs that recognize the necessity of protecting our communities through looking after the citizens, the young in particular.
A. Warnke: I want to thank the member for Parksville-Qualicum for his remarks, and to elaborate on one point that he has raised: that unemployment and poverty are a cause of crime and violence. I think there is merit in that argument, so I'll acknowledge that.
At the same time, I think it's extremely important to understand that even in affluent communities -- such as Richmond, where I live -- there isn't necessarily a direct correlation between poverty and violence and crime. As a matter of fact, it is instructive to note that a number of young people who are involved in breaking and entering and other crimes do not necessarily come from the most impoverished parts of our communities. This is the reason I emphasize very strongly that we have to look back and understand that the fragmenting of social structure actually contributes to the community being more vulnerable to crime and violence. We need the emphasis on community, for the breakdown of the community facilitates crime.
Let us take a look at young people. Some young people who are engaged in crime and violence find that the temptations are too great, because they're on the path of success and they want it all now. They are too willing to try to score the big win and achieve success now.
I want to emphasize that for crime control we have to begin with a sense of the community, and advocate more of, let's say, community service orders. We have to advocate restitution for the victim. Victim restitution schemes are, I believe, a very progressive way to go, so as to not just focus on the offender but to also relate what the nature of the crime is between the offender and the victim. Too often we ignore the victim. Too often we ignore the victim, and I think it's extremely important to understand that the victim is a centre of our community as well. We have to pay more attention to the victim, but we also have to focus on more deterrents to crime and organize communities in such a way as to pre-empt crime from breaking out. Sentencing is a penalty, surely, but it also should be therapeutic insofar as that sentencing should not be simply a matter of putting in time; there needs to be some supervision.
I see my time has worn out, but I do invite all members to think seriously on this subject. Once again, I also thank the person who made a reply, the member for Parksville-Qualicum.
D. Lovick: I wonder if the House might grant me leave to make an introduction.
Leave Granted.
D. Lovick: About three weeks ago I made what I like to refer to as a provisional introduction. I welcomed some 53 students from Woodlands Secondary School along with their teacher, Mr. Bush, and three adults to the chamber. There was only one problem: they weren't here. I'm happy to report that they are here today. I welcome them, and I would ask the House to please join me in making them welcome.
G. Brewin: It gives me some pleasure today to take a different tack from other issues on the floor this
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morning, and to talk about recognition of historical events that are happening this year in our community of Victoria, the capital city.
There has been an impression that Victoria is and always has been a city whose delicate, prim sensibilities are easily shattered, a city where there is a tea cosy on every pot. Nothing, especially in the early days, could be further from the truth. Early Victoria was a gritty, boisterous, dirty, frontier town. The characters who made Victoria home were tough, hard-working, ambitious, visionary pioneers. I'd like to think we're still like that a bit. Some of them were not averse to boldly airing their disputes in public or to doing a few dastardly deeds. We can thank these pioneers and the generations of dedicated, diligent and conscientious Victorians for the attractive, clean and vibrant city we have today.
Although downtown Victoria east of the harbour was once an open glade of oak trees with several swampy areas, it was hardly deserted. The Songhees peoples, who now call themselves Lekwammen, lived from Cowichan Head at the north end of Cordova Bay to Perry Bay, west of Albert Head. The Songhees played an important role in the local economy and politics from the fur trade era to the early days of the city. In the early history of Victoria, native people represented the majority of the population. These lands were not only the home of most of the local Songhees peoples but also the seasonal trading resort or visiting grounds for thousands of native peoples from the coastal area between what is now Alaska and the state of Washington.
The early economy of Victoria depended on native trade and labour -- still, it is the history of the new settler about which we know more. I am glad to say that this is changing and work is being done to provide more concrete recognition of the contribution and history of the Songhees peoples. We're looking forward to that.
On March 16, 1843, the Hudson's Bay Co. accepted James Douglas's choice and commenced the establishment of Fort Victoria. We acknowledged the 150th anniversary earlier this year. With the gold rush starting in 1858, Victoria began to boom. This led to new problems: miners would come in from San Francisco, to winter in Victoria, and the population would swell considerably. There were major problems with issues like prostitution and no infrastructure -- open gutters in the street and all manner of effluent flowing therein. As these obstacles increased, there was more pressure on the colonial legislature to incorporate the city of Victoria to raise moneys to deal with these issues. In 1862 the act of incorporation occurred, and the newborn town saw its first election two weeks later.
The first mayor was Thomas Harris. He was a 300-pound butcher and described as Falstaffian; he was known for being a jolly, generous sportsperson. The cricket team, however, didn't much want him, so he took up another sport for which he had a passion -- he was a jockey. However, when he took the mayor's chair for the first time, the chair collapsed under him. The city continued to prosper, however. The first city council concentrated on cleaning up the town and getting rid of the dirty streets.
Victoria is known for another major personality: a man named Mifflin Gibbs. He was the first black city councillor. An American, he came to Canada in the late 1840s and became very much a part of our community. He observed the following: "The business portion here is generally owned by old fogies who are destitute of Yankee enterprise." He ran Lester and Gibbs, dealers in groceries, provisions, boots and shoes. Within a few years he became wealthy enough to hire a servant and build a fine house on five acres in James Bay. Gibbs felt the sting of prejudice, however. At a benefit concert, Gibbs and other black citizens -- sitting in the dress circle -- were taunted bitterly. They were hissed at, onions were thrown, and eventually some flour was also thrown. This was too much to handle, and punches started to fly. But Gibbs survived to serve several terms on Victoria city council, and we're very proud of the work he did there. When he resigned, he moved back to the States in 1870.
Later on, Victorians were shocked to discover that they were not being united to the mainland of British Columbia, but were going to be annexed by it. This did not sit well. In fact, the Governor would be Frederick Seymour -- British Columbia's Governor, not Vancouver Island's Governor. Also, there was nothing in the act stating where the capital should be. With the collapse of the gold rush, Victoria was in a severe depression. The city needed an economic base that a capital could provide, but there was already a capital in New Westminster and Seymour was it's Governor. Seymour postponed making the decision for two years in the hope that the Legislature would vote in favour of New Westminster, thus allowing him to appear to be honouring the wishes of the people rather than his own preference. His strategy backfired, for Dr. Helmcken, the former Governor Douglas of Vancouver Island and other Victorians had time to organize their support.
The question arose in the Legislature on April 2, 1868. I have to confess that the Victoria crew, keen to have Victoria named, was not above a little skulduggery. William Hales Franklyn, the member for Nanaimo, was the spokesman for New Westminster. He was known to favour a wee drop of whiskey and was quite myopic, unfortunately. The Victoria contingent hosted him to a few drams before his speech -- an event, of course, that doesn't happen today. He stumbled through the first page, got lost and repeated himself. He removed his spectacles and laid them on the table. A Victoria supporter reached over and popped out the lenses. The member was now totally at sea. Helmcken then moved a recess. The Victoria supporters completed the job by taking Franklyn to the bar and hosting him to a few more nips. Victoria supporters won the day, and Seymour agreed that Victoria would be named the capital on May 24, 1868.
To mark the anniversary of Victoria becoming the capital, on May 24 this year the city will host an open house at city hall and an afternoon of entertainment at Centennial Square immediately following the parade. All members who are here are welcome to join the festivities.
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The first parliament buildings were erected in the 1860s. They were a collection of half-timbered cottages, which the Victoria Gazette described as resembling a mixed style of architecture -- the latest fashion of Chinese pagoda, Swiss cottage and Italian villa. It went on to say they were perhaps Elizabethan. The buildings were dubbed the "birdcages."
Originally, Douglas intended the buildings to be located on Government Street between Bastion and Yates....
Deputy Speaker: I regret to remind the hon. member that her time has expired.
L. Fox: By agreement, we're splitting the time, so I will attempt to keep my comments very brief. When we look at the future, it's always good to reflect on our past, and I think the member for Victoria-Beacon Hill has caused us to do that.
There were a couple of minor omissions in that presentation, and I thought I would bring them to the floor. When we're considering the capital of British Columbia, we should reflect back to what the first capital of the province was. In fact, it was the community of Fort St. James within my riding -- the oldest community in the province, and indeed, the first capital of British Columbia when it was called New Caledonia.
[10:30]
There is no question in my mind that the leaders of the day in Victoria had taken some rather unique initiatives to assure themselves that Victoria would become the new capital of British Columbia. We have to respect that kind of commitment by community leaders and the kind of commitment that is presently displayed within all communities by their leaders and by the people who work hard behind the scenes to improve the economic benefits of their respective communities. Oftentimes we all take that for granted. We recognize the elected individuals, but we don't recognize the input and contribution made to the growth and well-being of that community by the non-elected communities and the many societies that have helped British Columbia to become the kind of community that we enjoy today.
I welcome this very brief opportunity to respond, and I did want to point out that Fort St. James, which is in the riding of Prince George-Omineca, was the first capital of British Columbia.
K. Jones: Although Surrey-Cloverdale doesn't have a capital of British Columbia within it, just adjoining it is the other capital of British Columbia, which is Fort Langley. We need to recognize that also as a very important part of the history of British Columbia.
I'd like to say a few words about these centennials that we're celebrating. It seems we used to celebrate 100th anniversaries. That used to be an important factor. It used to be 200th anniversaries, as in the case of the United States. It seems now, as set by the example of the federal government, that we're minting medals for 125th anniversaries. We seem to be finding more and more excuses to have an anniversary rather than have a significant event that provides the basis for such a celebration.
With this one we're celebrating Fort Victoria's 150th anniversary, the 125th birthday of Victoria's establishment as a capital, and the 100th anniversary of the parliament buildings. The 100th anniversary of the parliament buildings is probably an appropriate thing to do. We seem to be adding a few extra things in there to try to broaden it, and I think that's a factor that loses some of the significance of other celebrations that have been held at the time.
Also, an area that needs to be recognized when we're recognizing the establishment of Fort Victoria is the basis under which Fort Victoria was established. The Songhees were actually forced from the lands where they farmed and had their village. In fact, the Songhees people thought the cattle of the settlers of Victoria were part of their range area, and when they took one for food it got the ire of the administrators of Fort Victoria, who took a shot....
Deputy Speaker: Hon. member, I regret to advise you that your time has expired.
K. Jones: Let me just finish this.
Deputy Speaker: I'm sorry, hon. member, but....
K. Jones: They took a shot at the chief's home and destroyed it.
Deputy Speaker: Thank you, hon. member.
The member for Victoria-Beacon Hill concludes.
G. Brewin: It's a pleasure to hear the remarks from my colleagues for Prince George-Omineca and Surrey-Cloverdale. I think it goes to say two things. One, we all have a sense of humour, and I think it's very important to remember that, and to honour it as well. Two, this is indeed a vibrant province. We have a history that is worth knowing, celebrating and honouring. That's part of what we're doing this year. Some special events have occurred, and we wish to acknowledge them, because if we don't spend some time thinking about the past, then we have some wrong sense of ourselves -- that we suddenly emerged complete and whole today, and that is not the case. We are the sum and substance of our communities, our families and our history. I think it's important to spend time dealing with and considering what that is.
This is a very special building for all of us. I think we need to recognize again not just what happens here, and what has happened in the past, but the symbolism and the energy that is part of what put these buildings together. We're looking forward to June 7, when we will honour that occasion.
Then, throughout the summer, there will be other events. I particularly want to draw the members' attention to a number of aboriginal peoples' events in this area that will be of significant interest as we look at treaties and a special mapping project about where they lived, how they lived, their relationship to each other and their longevity in this part of British Columbia. I
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think it will be beneficial for all of us to know more about this history. So you'll be hearing more about the events this year, and I would encourage everyone to join in all of that.
U. Dosanjh: If you recall, on May 22, 1992, we had a discussion in this chamber on the issue of the Chinese head tax and the exclusion act. There was a unanimous motion passed by this House urging the federal government to deal with the issue of the Chinese head tax and the exclusion act and provide an adequate redress. I regret to inform the House -- if the House is not already aware -- that the Prime Minister and the government of Canada have not dealt with that issue. The Prime Minister, who is presently away from the country, indicated at the beginning of his term that this issue would be dealt with and dealt with quickly. It seems to me that he has only a few days left in his political life as the Prime Minister of the country, and this issue remains unresolved.
Let me briefly recapitulate some of the events. In the 1860s the British Columbia legislature attempted to impose a head tax on Chinese immigrants. Subsequently, in 1885, British Columbians and other Canadians succeeded in urging the federal government to impose a head tax on Chinese immigrants to Canada. That was done in 1885, starting with $50 per head and then increasing to $500 per immigrant coming into the country. That was repealed in 1923, but it was replaced with the Chinese exclusion act, which excluded or banned Chinese immigrants from this country. Therefore, between 1923 and 1947, when that act was repealed, only about 50 or so Chinese immigrants came to this country. What obviously transpired was that all of those immigrants who had contributed to the building of the Canadian Pacific Railway and the building of this province and the country could not be rejoined with their families and their children, and they suffered as a result of that particular act. In 1949, other prohibitions and discriminations were repealed -- for example, no voting rights and no entry into the professions.
This is a very important issue for all Canadians, not just Chinese Canadians. For example, the 1923 exclusion act was enacted on July 1, 1923. What goes through the minds of those Chinese Canadians, descendants of those pioneers -- Canadian pioneers -- who paid a head tax to come into this country and build this province and this country, on July 1 when we celebrate Canada Day? What goes through their minds -- that our country Canada was not fair to them at that time? I think it's important for us as Canadians and us as British Columbians to send that message again to Ottawa so that this issue can be dealt with very appropriately and expeditiously.
During that period between 1885 and 1923, almost $23 million was paid as head tax. That's almost $1 billion in today's dollars, and that's a lot of money. Money is not the object, but the amount of money that was paid at that time indicates the enormity of this problem, because $500 was two years' wages for a Canadian in 1923. For someone to come to this country from China after paying $500 meant that the family in China was left deeply in debt, so they could not be reunited and had to suffer isolation for years.
All of those issues have to be dealt with, and they can only be dealt with if the federal government of the day takes this issue seriously, consults with the Chinese community across the country and deals with it appropriately and immediately.
V. Anderson: I rise to express appreciation to the hon. member for Vancouver-Kensington for raising this issue again before us and keeping it at the forefront of our thinking.
It is well that we continue to look back on our history, because it's the basis of our future. Probably, though, most of the time when we look back on our history we look back to say thanks to those people who gave us the opportunities that are ours. The people to whom the hon. member refers are part of that history, for many of the Chinese people who came to this country built the groundwork that has provided the history of benefit to all of us. However, when we look back we often overlook the ill parts of what we or our ancestors have accomplished. We like to take credit for the successes, but we like to ignore the mistakes. It's important that we look back and be aware of our errors -- some of them done quite consciously and others unconsciously.
I come from a community where confession is very important, because with confession comes the opportunity to change, to acknowledge the mistakes and to correct them. True, it is a very symbolic gesture to recognize and try to repay in some way the financial implications of the head tax. But the symbol goes far beyond the financial implications, as the member has also mentioned. It recognizes the children and grandchildren of those who were punished in those days. It recognizes that these children have carried that hate, that uncertainty, that guilt and that anger with them through the generations. It is hard for them to even feel accepted in our own time, unless we go back and accept the heritage from which they come in all of its strengths.
The hon. member for Vancouver-Kensington has acknowledged that it was only in 1949 that many of the prohibitions were removed within Canada. But even as late as the 1960s, there was what in immigration circles was called the Asian triangle. Immigration of people to this country was still hampered, even as late as the late 1960s, by that particular oppression. Even today we hear regularly that our immigration policies do not allow people from other parts of the world to have relatives even come to visit them for birthdays, anniversaries and some special days.
[10:45]
Hon. Speaker, we need to look back and acknowledge the mistakes we have made and apologize -- apologize in symbolic and very important ways -- to the people against whom we have made those mistakes, and indicate to them that we apologize not only for the actions of our ancestors but for the actions we still undertake in our day. This reminder today will help us
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look at ourselves in the mirror and change our present actions. That will be the really symbolic recognition that we have learned from the past and are willing to change in the future.
U. Dosanjh: I will be very brief in conclusion. I want to ask every member of this House, and anyone out there who's listening to and watching this statement, to urge the Prime Minister and government of this country to deal with this issue immediately -- before Brian Mulroney goes, because he promised that this issue would be dealt with. It's a non-partisan issue. It's important for all of us to send the message to deal with this issue to Ottawa.
SEXISM
J. Tyabji: Today I've chosen to speak on the issue of sexism, with some very specific examples. One reason I chose to speak on this is that in the last few months we've seen some very interesting examples throughout the province where institutionalized discrimination still exists, and sexism as a mind-set that is denied by the group of people who have been perpetuating it in the past.
In the last few months I've met with women from around the province -- whether at women's trade shows, with female dentists or with a grade 12 playwright in the Fraser Valley -- who are finding that when they offer their perspective of the world.... I'm not talking about women who have got in that position because of an affirmative action; they've got there through a lot of courage, determination and hard work. When they try to get through the glass ceiling, not only do they hit it, but as they hit it and proclaim, "Here is the glass ceiling that I've hit," it is used as an excuse to undermine what they've been trying to achieve in the first place. As we've seen in the past, insidious references are made: a women is aggressive but a man is assertive; a woman who says, "I'm being treated unfairly," is doing so as a justification for some kind of gender weakness rather than in recognition of the fact that discrimination exists.
The very specific example that I'd like to bring forward today is what we see in the University of Victoria political science department. I'd like to preface my remarks by saying that I'm a graduate of the political science department of the University of Victoria, so I've been there. I've seen it and very much understand the reports that have come forward. In this example, there was a climate committee in the political science department that reported some of the systemic discrimination that exists and put forward some very serious concerns in as an innocuous a way as possible, I would say, and recommendations to prevent that kind of systemic discrimination from being perpetrated by the people who put it there in the first place. One would think that an educational environment where the minds of the students are being to a large extent directed and fed by the faculty would be the kind of environment where we would say: "Here is an opportunity to direct all of these students towards the progressive vision of society that many of us hold and certainly the principles that are espoused verbally and in writing by this faculty."
Instead, when the report of the climate committee came forward and said, to protect the people who perhaps had perpetrated this discrimination, here are the problems, the issues that need to be dealt with and our recommendations for dealing with this, they were attacked. They were attacked by the faculty they were making the recommendations to, in the kind of letter that says: "It is our belief that there have been no incidents whatsoever of the behaviours described, and we can only conclude that the implication that such behaviours are regular occurrences is completely without foundation and therefore totally unacceptable." Surely we can't believe that there is absolutely no basis whatsoever for any kind of gender discrimination in a faculty where there are no senior female faculty members and virtually no attention given in the past to the gender equity or race equity issues that we as a society have had to grapple with.
I find it really unfortunate that the government hasn't become involved to some extent, because this government has stated repeatedly that it is committed to gender equity. Yet the Minister of Women's Equality hasn't even bothered to contact the faculty who are waging a very serious battle, with a lot of courage, in trying to change systemic discrimination and coming forward with positive recommendations, under extremely strong pressure to not do so -- in fact, pressure to be quiet and to retract their statements; if they retract their statements, then perhaps there'd be some room to move.
Whether we sit here as an assembly and say that there is this discrimination or not, we can surely recognize it. It runs contrary to the existing laws of the land to harass somebody when they bring forward a charge of discrimination. Every Canadian has the right to come forward and say they believe they are being unfairly treated, without then being threatened. I find it bizarre in the extreme that supposedly mature tenured faculty members are feeling so threatened by this report that they feel they have to threaten legal action as a method of recourse against the people who brought this forward. Even if they didn't believe the recommendations, even if they said to themselves, "We sit here in absolute, complete gender equity of mind and racial equity of mind," surely to goodness they don't think they can achieve anything constructive by then threatening to sue the people who are saying they believe there are some problems.
One thing I'd like to state on behalf of the House is that we must recognize that if we are seeking the truth of the matter, the truth exists and is there for all to see, even if only person is willing to come forward and speak it. If there is only one person who will move forward and say that there is a problem, it is still the truth, even if it turns out that the majority of faculty or the majority of some of the students might feel threatened by it to the extent of trying to put it down to some kind of gender imbalance in terms of perception.
Hon. Speaker, I look forward to the message that comes forward from the government side, because the Minister of Advanced Education was in the dining
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room when I was meeting with some of the representatives from the faculty and he...
D. Schreck: Point of order. Dealing with gossip in the parliamentary dining room and turning members' statements into partisan statements are clearly out of order, hon. Speaker.
Deputy Speaker: Thank you, hon. member. The member will please proceed.
J. Tyabji: I guess I must have struck a nerve. My point is that when the Minister of Advanced Education had an opportunity to speak directly with the women who have been fighting this battle on their own, without any contact from the government, he left the room without coming forward, even though he was invited to speak with them.
I'm looking forward to the government's response to this because all of us must step forward and recognize the problem and battle this issue head-on. We won't make any progress if we look for a lot of excuses as to why in this particular instance this is not an acceptable way of dealing with it, or say that perhaps we shouldn't talk about it, because we don't feel comfortable about it or because there's an entrenched system in place and that this an unacceptable way to take it on.
At that, I defer to whoever will be responding.
J. MacPhail: The member for Okanagan East raises a very serious issue. It is an issue that's before us in the public eye. She raised some very serious points concerning the dispute at the University of Victoria. I am pleased to see that the university administration considers the matter as serious as do we on the government side and as does the member on the opposite side. From media reports we all know that the university will have a report out within a few days investigating this matter. It has taken on a very serious tenor.
I want to deal in some general terms with the issue that the member opposite has raised. Dealing on a daily basis with the issue of discrimination on the basis of gender makes one feel very uncomfortable. I believe that women in every walk of life face this. It is discomfiting. It affects our personal lives, our health, our ability to earn a livelihood and, more to the point, it affects our families. It's nice to be able to discuss them out in the open and receive comfort from a collective will to correct these problems.
But, hon. Speaker, it does require a collective will to correct inherent, systemic discrimination on the basis of gender. I might say that it requires solid affirmative action. One cannot deny that there are historical injustices that have perpetuated the way we do business from day one. From day one, women have been treated as lesser than men. It requires some strong action to correct that. It requires public investigations when there are charges of harassment, yes; but it also requires that we treat women with equality in all aspects of life.
I'm pleased to see, actually, that those of us who have had an opportunity to be in this job for about 18 months now have matured and realized that it is a serious issue. I recall the first days of excitement in this House when I joined with 18 other women to become a Member of the Legislative Assembly. I was terrified. I knew what I was going to have to face as a single parent of a young child, and I was so delighted to have both my male and my female colleagues assist me in dealing with these issues. The member opposite, on the other side, said in an interview: "Hey, no problem. It isn't a problem being a woman in this business." I'm glad to see that she has matured from that state. I'll tell you how it made me feel when she said that. I thought: am I in a different world? Am I facing different issues than this woman opposite? Now she has matured and realizes that there is systemic discrimination, and I'm pleased about that. Maybe it's just opportune that she gets to raise these issues right now; maybe she isn't truly feeling the issue from the heart of a woman, and there's another agenda here. I'm hopeful that that isn't the case.
Our government has proposed initiative after initiative to deal with the issue of systemic discrimination against women. The member opposite rises and accuses us of horrible quotas. Now maybe she realizes that the issue of dealing with affirmative action to right historical wrongs is exactly what's needed. I hope that from now on she will join with us in righting the economic wrongs that women face.
J. Tyabji: I find it appalling that the government bench, rather than be constructive, has decided to sling mud on an issue of this importance. First of all, since my position has been so badly distorted, perhaps I can clarify for those listening that from the beginning I have had the political maturity to recognize that we must fight all forms of discrimination, including reverse discrimination, which I see this government repeatedly putting in place. Women can make it on their own as long as the barriers are removed. That has been my position from the beginning.
This government talks about collective will to fight discrimination. Where have they been? Where's the Minister of Women's Equality in this issue? Why is it that the women in the faculty of political science are fighting this battle on their own? When I bring it forward, I'm accused of political opportunism, which I believe to be typical of this government. Where were they, for example, when issues were brought forward of women around the province.... We had a situation with Robyn Allan, for example, where for the first time, somebody going for a position of prominence.... Her driving record was brought forward, not the job that she could do, and the government caved in on that issue. This government has repeatedly refused to meet the public relations battle with regard to women in the system.
Systemic discrimination does exist. The speech from the previous speaker proves it, rather than recognizing that we need to go to the source of the problem, that there are issues that need to be dealt with. I've got the report that she was talking about right here. Rather than deal with the issue, which was the allegations of sexism and racism, the report says that there was an impasse, that these people are fighting and that we have to figure out how to stop them from fighting. Today we
[ Page 6294 ]
find that the male faculty are calling for a $200,000 investigation, which will be paid for by the university at a time when that money could be used much more productively to advance the education of the students within the system.
I find it absolutely appalling that once again the government has missed the point. At no point has anyone on the official opposition side said that it is an easy route for a woman in politics.
J. MacPhail: Yes, you did, Judi.
J. Tyabji: What I said -- and I encourage the member to go back to the press clippings -- is that we remove the barriers, the discrimination. That's the approach we take. I would be happy to enlighten this member further on the kind of systemic discrimination that I recognize.
One thing I would like to say in closing is that the only reason I ended up in political science in the first place that when I wanted to pursue astronomy I was discouraged by my physics professor in high school, to the extent that I had to drop the course and did not pursue science. I was told that women didn't have as much ability in that area as men. I ended up in political science, going through arts at the University of Victoria and understanding the kind of system that existed, which I recognized from day one, unlike government members have suggested.
[11:00]
I hope that the government will learn something from this and realize that there are problems in our own back yard that need to be dealt with in other than the kinds of ways they've approached them in the past.
Hon. M. Sihota: I call Committee of Supply.
The House in Committee of Supply B; D. Streifel in the chair.
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 47: minister's office, $419,400 (continued).
Hon. M. Sihota: I take this opportunity to rise in debate and discuss a number of issues as they relate to the Ministry of Health. Before I do that, I will allow the hon. member for Fort Langley-Aldergrove to take his place in debate.
G. Farrell-Collins: I'm just requesting leave of the House to make an introduction, if I may.
Leave granted.
G. Farrell-Collins: I ask the House to make welcome Mr. De Jong, a teacher at Credo Christian High School in Langley, and 60 students who are here visiting us today. They have had an excellent tour, and are here now to follow the wonderfully exciting debates on the Ministry of Health. Would the House please make them welcome.
L. Reid: I too ask leave to make an introduction.
Leave granted.
L. Reid: I would ask the House to make welcome the members of the Nimpkish band council who are on the steps of the Legislature today. They are here in terms of urgent medical priority. They have a member of their band who needs radiation therapy immediately. I would ask the House to make welcome George Speck, the assistant manager of the Nimpkish band; Pearl Alfred, the mother of Lorie Alfred; and Lorie's brother, Ernest Speck. They are here because they very much wish to have these issues addressed during Health estimates this morning.
Hon. M. Sihota: The Minister of Health is on her way and is expected to arrive in the House to allow for the continuation of the Ministry of Health estimates. Since the estimates commenced, I have not had occasion to be able to speak on health-related issues.
Interjection.
Hon. M. Sihota: In fact -- as the hon. member may well know -- I know a lot about health care, particularly because I have a major hospital in my riding. Occasionally some of us take advantage of the opportunity to speak in the House so as to send a note or two about local health issues to representatives in our constituencies.
I just want to canvass a couple of things with regard to health issues in my own constituency. This government, through the initiatives that it has taken over the past 18 months, has placed an emphasis on community care and preventive care. Certainly in the riding of Esquimalt-Metchosin, there is ample evidence of the success of those initiatives taken by the provincial government. Historically we have had a great need for services, both for seniors and preventive health care in our community. I know, for example, that the Liberal Health critic, to her credit, has come to my riding and taken a look at the services that are offered by the Esquimalt Wellness Centre. It is an outstanding agency in terms of the preventive work that it does on the health care side for seniors, the kinds of educational services it provides seniors and the kind of leadership role it plays in taking steps that, in my view, are necessary to encourage people to stay at home longer and to better look after their needs, whether they be nutritional or more serious concerns with regard to in-home care.
The services of the Esquimalt Wellness Centre were, of course, in jeopardy last year. Through a lot of work over the first, I would say, six months of the mandate of this government we were able to maintain the Esquimalt Wellness Centre as an essential preventive and educational program within the community for health care needs. It is augmented in our constituency by the outstanding resources of the CRD health clinic, which
[ Page 6295 ]
sits on Fraser Street in Esquimalt. It provides in-home care and nursing services for residents within the Esquimalt community to make sure they remain closer to home and in the community as opposed to finding themselves in the hands of institutional care.
I may also say that there are growing needs in terms of additional health care requirements in the Western Communities in my riding. I know that for some time the CRD, through the Priory in Langford, has been working to secure some capital expenditures to upgrade the services that are provided at the Priory. The Priory is a long term care facility that provides care for residents of the Western Communities within the Western Communities.
I remember, from the time I first became involved in political activity in the mid-eighties, that there's always been a demand for additional long term care facilities in the Western Communities. In my view, a lot of the -- if I can put it this way -- pioneers of the community have expressed a legitimate and sincere desire to have long term care needs attended to in the Western Communities.
I would hope, hon. Speaker, that some time during this year the Minister of Health will see fit to approve funding for additional capital requirements to expand the repertoire of services that we offer to the citizens of the Western Communities. I know that my colleague from Malahat-Juan de Fuca and I have heard from our constituents, and I would hope that with the kind of success we've had in Esquimalt, which has seen -- if I can use this word -- a healthy level of cooperation between the CRD and the Ministry of Health, the same will continue to apply in the case of the Priory in Langford. There's a critical need for it in our community and, hopefully, a need that will be met in the years ahead.
I also want to take the opportunity to talk a little bit about dental programs and dental services. Certainly the announcement made by the Minister of Social Services and the Minister of Health with regard to dental programs for children and families on social assistance has been a move that I know has been well received in my constituency.
I note that the Minister of Health has returned. I was tempted to talk about experiences in our own household and some of the views that my wife -- she's a registered nurse -- has with respect to the administration at Victoria General Hospital, but I won't succumb to the temptation. I will point out to the minister that I did take a minute to talk about the services provided in Esquimalt through the CRD, at the CRD health centre, which is much appreciated in our constituency; the Esquimalt Wellness Centre; and our hope that in the months ahead we will see some capital funding come through with regard to the Priory in Langford.
L. Reid: I want to bring to the attention of the House today the Nimpkish band council's letter of yesterday, May 13, 1993:
"The Nimpkish band has found itself once again confronted with inadequate medical care. Our band confronted this issue in 1979 when one of our members died.... We had hoped to never again have to face a similar crisis, but it seems this is not to be. One of our band members, Lorie Alfred, was recently diagnosed to have a brain tumour. She was told that surgery was not a viable option. She required radiation treatment immediately. This fact has been confirmed by all the doctors Lorie has seen. The longer Lorie waits, the greater the risk that she can't be treated.
"We have been told that Lorie Alfred will not receive the immediate care she needs because there are many ahead of her waiting for radiation treatment. Apparently, at the Vancouver cancer centre there can be as many as 200 to 300 cancer patients waiting to receive radiation treatment and, as a consequence, the centre is referring patients to the Victoria cancer centre. The Victoria centre also has a long waiting list. We have been told that people have died waiting for treatment.
"The Nimpkish band will not tolerate such treatment of a band member and are appalled at the treatment received by cancer patients in this province. If Lorie cannot receive treatment here in B.C., then we believe efforts should be made to see that Lorie Alfred receives treatment wherever it is available. We believe that adequate medical care is a...duty owed us and other aboriginal people, and as such we demand that this particular case be acted on immediately."
It's written by Lawrence Ambers for the Nimpkish band council. This is the group that I introduced earlier in debate, and I think their issue must be addressed. They make the case very eloquently that this is not just their particular case but that of all individuals who sit on wait-lists in the province of British Columbia.
I will refer particularly to the Health Special Account Act. When Brenda Parkes came to the steps of this Legislature some time back and asked that 50 percent of lottery funds in this province go to urgent medical priorities, we understood that that would happen. I believe the health special account has been diluted to the extent that it is not effective in addressing urgent medical priorities. The health special account consists of 50 percent of lottery funds in the province of British Columbia and looks at issues of health promotion, consultation and education. We don't take any issue with that; our issue today is priority.
Earlier in debate the Minister of Labour suggested that this government will emphasize community care. I am suggesting that preventive care is being emphasized at the expense of urgent medical need in this province. It is not appropriate to have individuals on a wait-list, and it is even less appropriate to have a rationale that says: "It's unfortunate that you're on the wait-list. There is nothing we can do about it." We've run the gamut of blaming the previous administration, and of suggesting that indeed the wait-list is less now since this government has been in office. That is not acceptable. For anybody who is dying, it would be scant comfort, if any, to know that there are people on the wait-list ahead of you and your number will eventually come up. It's unacceptable for cancer treatment in this province. We have a commitment and an obligation to understand urgent medical priority and to make the system accessible -- not just be seen to be accessible -- to all people.
I know my colleague from Vancouver-Langara will be touching on aboriginal health issues. I can tell you
[ Page 6296 ]
that this is not just an aboriginal health issue. This is an issue of public right and of human rights for everyone. If we're going to stand behind the Canada Health Act and talk about universality of health care in this province, we have to ensure that universality is extended to all individuals. I can submit for the record the discussion that the Minister of Health and I had some days back when we talked about a difference in treatment if you happen to be on a WCB wait-list. The minister said that that is not the responsibility of the Ministry of Health. I accept that, but at the end of the day the general public believes there are ways to be treated differently in B.C. It's simply a matter of knowing how to play the system. If we stand behind universality of health care, that is unacceptable. There needs to be a much more personalized response when people's families are coming to the steps of this Legislature to ask for intervention. We have to ensure that there is equal treatment across the board.
At the end of the day this is about priority and fairness; this is about believing that the system can be responsive. If it's not, there has to be a better answer than" "Sorry, there are other people on the list."
We have to do some things in this province about training. What have we done in the last 18 months in terms of training radiation oncologists? What has happened in terms of a partnership with the Ministry of Advanced Education? This is an urgent health care priority in this province. I need to hear today what this ministry has done. I have heard already that the wait-list has been reduced since this minister took office. I need to know that all the people on that list believe that their health care is a primary objective.
Again, I draw the minister's attention to the Health Special Account Act. Fifty percent of lottery funds in B.C., in excess of $100 million, could address the surgical wait-list in this province and where we're headed in terms of treatment of cancer patients. Those dollars must be directed where they can do the most good.
I don't take issue with the minister's comments on health promotion. I do believe we will see a benefit over time, but I don't believe that we can disregard current needs for a benefit two or three generations from now. I await the minister's comment.
[11:15]
Hon. E. Cull: I'm very happy to be able to stand and speak to this particular issue. It is one that we have talked about earlier, but it's a very important issue. The people from the Nimpkish band out in front of the buildings this morning provide us with a real-life situation to focus our minds on issues that are often very complex. When you deal with them in the abstract, in terms of waiting lists, training programs or providing new equipment, it's easy to lose sight of the fact that there's a human face in all of this. The waiting lists are made up of people who are frightened and worried about their health and who are looking for treatment.
One of the things that appalled this government when we were sitting in opposition was the lack of attention to the general issue of wait-lists that was current in the Ministry of Health at that time. The problem with wait-lists is that they don't appear overnight. They don't just suddenly arrive on your doorstep one morning. They build up gradually over time because of decisions that have been made or have not been made. To address wait-lists takes the same kind of attention.
With something like radiation therapy the elements of the solution involve physical facilities. Are there enough pieces of equipment to provide radiation therapy? That's one element of the problem. Are there enough trained people to operate the available equipment? Is there enough money to provide the salaries and operating costs of that equipment? You've got several things to work on if you're going to bring those waiting lists down. Everyone will accept, I think, that if the problem is that there isn't enough equipment, then that takes a bit of time to put into place.
There were some decisions made in the past that proved to be incorrect. They weren't made in the last 18 months; they weren't even made in the last two or three years. They were made some time ago when specialists believed that radiation therapy was going to be used less in the future. So the planning for the physical capacity of our cancer treatment centres failed to recognize the growing need for radiation therapy. It has recently been recognized that there was an error made at the time in terms of the planning. As a result there are plans in the works, and, in fact, construction is underway for new cancer clinics in Surrey and Kelowna and for an expansion of the Victoria clinic. There has been additional equipment purchased for the existing clinics. There have been upgrades of the equipment to improve the physical capacity. So that's one aspect of dealing with this problem.
The other aspect is that if you have enough machines and equipment, do you have enough of the right people to be able to operate them? That, too, is part of the problem. Radiation oncologists, because it is a physician's position, take many years to train. If we were to identify at any point that we need ten, 15 or 40 more of these types of individuals in this province, we need a very long lead time if we're going to deal with training. This leaves virtually no other alternative but recruitment, so we are recruiting aggressively and internationally to bring in radiation oncologists to work at the cancer agencies in this province. There's also the area of radiation technologists. Their training period is shorter. In the last year we have increased the capacity of our institutions to get more radiation oncologists trained so they can go to work.
We've dealt with the facilities and the staff, but what about the third element: operating budgets? Last year, as part of the health lottery account fund, we increased the funding to the Cancer Agency by over 9 percent. Their budget is about $70 to $75 million. I don't have the precise amount, but we were looking at pretty close to a $7 million increase last year. This year we've increased it by 6 percent or $4.2 million. Those are just the operating costs; I'm not talking about any of the capital costs, which of course are part of the first element of this problem that I identified.
Five more physicians' positions have been approved for the cancer agency in the last year. So in terms of the
[ Page 6297 ]
different parts of the problem -- facilities, trained personnel and operating budgets -- in the year and a half that this government has been in power, we have moved on all those items. The questions anyone can ask are: Have we done it well enough? Have we done it fast enough? Have we done as much as we should have? Should the budgets have been increased more? Should we have announced more expansion of the facilities? Those are the items that we have to be held accountable for.
As I said yesterday to the member for Prince George-Omineca, if the government was failing to pay attention to waiting lists, if we had not put any priority on this, if we had not.... You suggest that we've prioritized prevention over this particular treatment. We haven't, because I always use the rule of thumb that if the budget is increasing by 4 percent overall, you can tell where the priorities in the budget are by those areas that are increasing faster than the average because that indicates a shift of resources into that area. In both of our budget years, we have funded the cancer agency at a higher rate than other hospitals and at a higher rate than the average funding in the ministry. It is among the highest rates of any program area in the ministry. So we've clearly indicated a priority there, notwithstanding the general priorities about shifting to more community-based services and prevention. We recognize the importance of waiting lists.
As I said to the member for Prince George-Omineca when we were discussing this issue yesterday, if we were doing nothing about this and if we had not devoted any additional resources to it, then I think the opposition members should be absolutely howling on it. We would howl; we did howl when we were sitting in your chairs.
We have made some progress. It's not enough, it's not fast enough, and we need to do more. But we have devoted our attention to this by looking at all aspects of the problem, and we have started to reduce the waiting lists for cancer radiation therapy. We have recognized the seriousness of that particular element by providing contracts with Washington State, so that we can use other resources while we are waiting to get ours up and running.
The question of equity raised by the member is a really important one, because when the royal commission looked at our health care system, they told us we had one of the best in the world, but there were some serious flaws that had to be addressed. One of the most serious flaws was equity. They said that we are not equally healthy -- we know that -- and we do not have equal access to health care services in this province. The philosophy of equity that is inherent in our system is not, in practicality, always there. And that is one of the principles that our New Directions strategy is determined to address. Our New Directions strategy has been out in the public arena for three and a half months. Equity is one of the major issues that the particular strategies we've identified are intended to address. That, again, is going to take some time, but I assure the member that the equity of the system concerns me deeply. We are trying to make sure that the system reflects those equity issues.
I want to deal with the particular case that has come to our attention. Right now the parents of this young girl are meeting with Dr. Neil Fatin, who is not only a member of the Ministry of Health staff but also our appointee to the Cancer Agency -- he's someone with considerable knowledge on this -- to make sure that she has been treated fairly by our system and that we haven't failed to examine any alternative that would be available to her. I want to let the members know the history of this person, because there is an implication that no treatment is yet available for her or that she has been on the waiting list for months. I will just give the information that we have from her physician with respect to her treatment history.
The biopsy was done on April 8. The patient was referred on April 15 and taken as a new patient on April 20, and a requisition for the therapy was made on April 20. The work around the mould room was done on April 23, three days later. The simulator, which has to be adjusted individually for every patient to make sure that the radiation therapy goes to the correct part of the body, was done on April 27. The plan for her treatment was developed and was ready by May 13. The final check of the plan, the simulator and all of the arrangements have been done, and treatments start for this individual on May 27.
I'm not a doctor or an expert. I'm a mother. As a mother, if I looked at April 8 through May 27, I would say that it needs to be hurried up. But when I look at the time that has elapsed, the two or three days between each of these steps in the sequence don't seem totally unreasonable. It does take time to do radiation therapy. It's not like getting a prescription and taking a pill. There is far more to it. While as a mother I would agonize every second that passed after April 8 when the biopsy was done, if we look at this particular time line and the fact that treatment is due to start on May 27, we are not dealing with an absolutely horrible wait. I was of the opinion, when I first started to look into this issue, that we were talking about months and months and someone who still did not have a clear date.
I bring that particular case to the attention of the members, because I know we are all concerned with this young woman. It is a human face on a problem that troubles all of us in this Legislature. I think it is important that we deal with her and make sure that she has been treated to the best of the ability of our system, and as fairly and expeditiously as possible. That doesn't deny the fact that we have to deal with this issue in a concerted way, directing resources to it and finding out where the backlogs are in the system, so that we can continue to make progress on reducing waiting lists in this province.
L. Reid: I welcome to the gallery the Alfreds, the family we are now discussing. The issue is bigger than this particular case. I agree with the minister that this young woman will now receive treatment. The uncertainty and hesitation out there is that if they didn't come to Victoria and bring this issue to the government in such a visible way, would they, along with the other 300 people, continue to sit on a wait-list for a length of time such that treatment is no longer
[ Page 6298 ]
viable? This young women is taking cortisone daily to reduce the swelling of the brain tissue. She's not alone.
I appreciate the walk through all the things that this ministry has done, but the minister, moments ago on the steps of this Legislature, said that it's not a money issue. If that is the case, why are these people not being sent for treatment wherever it is available? I was there when the minister made the comments. Are you prepared now to stand by that comment -- "It's not a money issue" -- and address the 300 people on the wait-list? I appreciate that the other proposals you have put in place will take some time; I understand that. But at the end of the day, if your words were factual that this is not a money issue, there is no reason in the world to have anyone on a wait-list for cancer. This is not a wait-list for elective surgery. It doesn't really matter in elective surgery if you get it this week or six months from now. This is an urgent medical priority, and I applaud the Alfred family for coming, because I think their concern is whether or not anyone else is going to have difficulty and uncertainty around an urgent medical issue in their family.
[11:30]
Interjection.
L. Reid: Yes. If it is your family, you are going to be very committed. But in terms of the Ministry of Health, I think we have to be committed to the 300 people on that wait-list and their families, and where they're going to receive treatment.
If it's not money, when can these individuals expect to receive service from this Ministry of Health? Frankly, it is their tax dollars that are funding this system. They are finding fault with the sense of priority currently in place in this system. They don't believe their needs are being addressed. They will not be fobbed off by more consultation and more education and the shift to community care. It's not their reality today, and I think that's what we need to be addressing. I await your comments.
Hon. E. Cull: As much as anyone, I would like to take credit for getting the treatment for this young woman, but I can't do that. In fact, this treatment plan was in place before the family arrived here today. So when you ask, "Do people have come to Victoria and stand on the steps of the Legislature to have the treatment plan that I just read to the members?" the answer is no. In fact, that treatment plan was put together by the family doctor and the people at the Cancer Agency.
In regard to waiting lists and why people sometimes come to the Legislature -- or, more commonly, write to me or call my office -- they get frustrated with the waiting list, and they hope that something can be done to change their frustration and get treatment quicker. We are able to deal with that with many waiting list issues, particularly with general surgery. This is not as applicable with radiation therapy, but with general surgery -- and general surgery waiting lists continue to be a concern -- you will often find that the waiting list is related either to a particular physician or a particular hospital.
This year we have been working on a surgical registry which will function like the cardiac registry functions, which did have a dramatic impact on cardiac surgery. We've talked about this quite a bit. The cardiac surgery waiting list has dropped to 288 patients this March from 402 patients last March and from 714 patients the March before. So the introduction of the cardiac surgery registry, which provides information to physicians, has had a tremendous impact on those wait-lists.
We're now working on the same system for the surgical registry. It's a little more complicated because there are different kinds of surgery and it's not as simple as just dealing with the more limited number of cardiac surgeons. The surgical waiting list registry will help patients and their doctors become aware of where there is capacity elsewhere in the system. So you can sometimes go to another hospital or go to another physician who does not have a wait-list or has a much shorter wait-list. It's very much an information system, and I think the member would probably agree. In thinking through how cases are diagnosed, how treatment plans are determined and how referrals are made, most of it happens within a fairly narrow confinement of doctors and specialists who know and work with one another.
We're dealing with a monstrous system, and if doctors had better information about what was available outside of their immediate sphere of knowledge, they might be able to direct their patients to care that is just as good but would be much faster. So that's what the surgical registry is all about. The system does work well at doing that.
When the minister gets involved, it's often because the patient hasn't had that connection made for them somewhere else in the system, either by their doctor or the hospital. People don't often come and deal directly with ministry staff. If they're not getting satisfaction from their physician in terms of getting a good answer about why they're waiting so long, or they are told that the wait-list just can't be changed, they go directly to the minister's office, and we get our staff involved trying to make those connections for them in the interim.
Once we get a surgical registry in place, that will improve the situation yet again for general surgery. One doesn't need to bring political pressure to have these things occur, but sometimes the involvement of the ministry in the whole question of the waiting list does assist getting the information to the right places. So we need to do that more than just on a case-by-case basis but in a systematic way, and that's what the registry will address.
You asked me whether we would commit more money to this problem to reduce the waiting list.
Interjection.
Hon. E. Cull: The member is correcting what I've been saying to her. She said that I said that money was
[ Page 6299 ]
not a problem. Money is not the factor that is creating the waiting lists right now with radiation therapy.
I will go back to what I said a few minutes ago about there being three elements to the problem. Have we got enough capacity? No, we're building more capacity. Have we got enough trained people? It looks like we're getting there with the radiation technologists, but the oncologists are still in short supply. Have we got enough money, given the other two, to operate everything that we have there in terms of capacity? We do have enough money to operate the existing facilities. Through the latest information the Cancer Agency has on staffing resources, if there is a way to expand their hours of operation and put on additional shifts, and if there is a feasibility to expand our capacity on a temporary basis through additional contracts with Washington State, then the answer to your question is yes, we will look at that. We will consider that, because waiting lists are a priority with this government.
L. Reid: Does the minister have plans to use lottery dollars for urgent medical priorities in this province?
Hon. E. Cull: Yes, we do. All of the dollars we received last year went to urgent priorities, and all of the dollars that we will receive this year will go to the same kinds of urgent priorities. I don't know whether we will be adding anything to the list, because the list of things that were covered last year, in terms of waiting lists -- AIDS treatment, some of the very specialized areas of concern.... I just had my staff pass me some of the things that we did with the money last year: cardiac programs, such as open-heart surgeries and angioplasty; computerized tomography -- that's CT; MRI operating costs; cancer programs; AIDS drugs; renal dialysis; bone marrow transplants; vaccines and immunizations; alcohol and drug abuse programs; and continuing enhancement of the mammography screening program. Those are some of the things that we devoted lottery funds to last year. I would suggest that that's probably a pretty reasonable list of high-priority items, and we would continue to put lottery funds to those items.
L. Fox: Given that yesterday I raised the issue of this family coming from Alert Bay and the concerns of the family and the band, I just wanted to say to the House how pleased I was with the concern shown by the minister and her staff for this particular issue and for this family. In fact, I just received a note from one of the ministry staff saying that they had concluded their meeting, and it was a very satisfactory conclusion, I understand. So I am extremely appreciative of that. I am sure the family is, as well.
On the issue of waiting lists....
Hon. E. Cull: My staff is reporting to you faster than they're reporting to me, hon. member.
The Chair: Hon. members, debate would be aided if it were carried out through the Chair.
L. Fox: Hon. Chair, perhaps the rationale for that is that there was some dialogue between the ministry staff and my secretary immediately after I raised the issue yesterday in the House. I'm sure that the interest shown by my secretary to her staff is the reason why I got the note.
However, let me just get back to the issue at hand. When we discussed this yesterday, we talked about at what point we refer people outside of the province for treatment given the waiting lists something and given there are individuals who have difficulty achieving the necessary care. I'm wondering when those decisions are made and who might make them. The minister laid out the program for this particular young lady earlier. Being a parent and somebody who has gone through the process, May 16 to May 27 sounds like a reasonable time frame, but that's 11 days. We all know how quickly cancer multiplies, particularly this type of cancer and located where it is. I have some difficulty accepting that 11 days is reasonable. I'm wondering if there isn't some opportunity for determination at some point whether this particular patient should be sent outside of the province for treatment and who might make that determination.
Hon. E. Cull: People are all in the same place there, but the determination would be made by the specialists who are involved in the treatment of any patient and the cancer agency that would be working with them. They would determine what facilities were available outside of the province, what kind of treatment there is and whether it was suitable that this person should travel for it. Some cancer patients are so sick that travelling would not be an appropriate solution for them. The people who know most about cancer and its treatment are the ones who make those decisions.
L. Fox: Is there a sum of funds unallocated within an agency for other things that are available for this kind of an emergency situation, or is this just part of the global budget provided to those agencies?
Hon. E. Cull: We've actually negotiated contracts with institutions in Washington State to provide treatment. We're buying that service that we don't have here from the surplus capacity that exists in Washington State. I'm not sure whether it's an amount of time, a number of treatments or exactly how the contract has been worked out, but the contracts exist. The capacity and the ability to refer patients is there, so the decision is made looking at individual cases to determine whether they go there or have some other kind of treatment or plan here in British Columbia. It's not like there's a fund that we have to go to when you want to send somebody. The service has already been purchased to provide an extra capacity to our system; it's there for us to use.
L. Fox: I have one further comment with respect to this. As the minister suggested earlier, this particular incident with this family from Alert Bay obviously put a face to an issue and brought it a lot closer to home than if we hadn't had this kind of circumstance before us. I'm wondering whether or not there's any ongoing monitoring of waiting lists, what kind of people are on those waiting lists and what the prognoses of those
[ Page 6300 ]
particular patients are for the minister's constant review.
Hon. E. Cull: With respect to waiting lists and the number of people who are on them, yes, that is monitored on a constant basis. It is available for my review and is certainly the subject of a lot of work on the part of my staff in making sure that we become aware when waiting list patterns change dramatically, particularly if they're going up, and that we start to get at why they're going up, what can be done to address it and whether it's just a temporary situation or there's really something else at work.
With respect to the prognosis of all of the individuals on there, I don't have access to that information. The Cancer Agency, though, in managing their waiting lists would have access to the status of all of their patients, because they have to make decisions all the time about the urgency of treatment, whether there might be referrals and all of the other things that we've talked about. I don't have that.
[11:45]
But I did check this morning with Dr. Fatin with respect to fatalities. He's on the Cancer Agency board and I would expect that he would be quite aware of these things. He is not aware of any during a wait-list period. That is the information I have in terms of what he is personally aware of in his capacity as a board member and a Ministry of Health employee.
L. Fox: Just one final question. I'm trying to enter into this questioning area because I have great concern that other people on the waiting list might see the initiative by this particular group today as something that's necessary to achieve a treatment. My question is: can we, and she as the minister, be satisfied that all the right priorities are in place to ensure people get the treatment necessary at the earliest opportunity -- or as close as possible to the most desirable time?
Hon. E. Cull: I share your concern that watching the coverage of this -- which will undoubtedly be on tonight's news -- may lead people to believe that they can queue-jump if they come to Victoria and appear in front of the parliament buildings. It's very important for all of us, in commenting on this issue, to be responsible on that particular point and make it very clear that this woman's treatment plan was determined and set prior to the minister getting involved today, because if we give a message to the people of this province that if you can somehow lobby the minister's office, you can move yourself up in the queue, we will be in serious trouble.
My commitment is to make sure that people are treated fairly. When I or people from my office get involved, it's to ensure that somehow the system hasn't failed them in some way, that someone has looked at all the alternatives and hasn't missed an opportunity that exists or that something hasn't got lost in the system and is stuck sitting on someone's desk and not being dealt with. Part of the role of my office is to ensure that the system doesn't have bottlenecks in it and when those bottlenecks are identified, we break them up and do whatever is necessary to make the system run more smoothly.
It's one of the interesting challenges of being a minister -- of any portfolio, I would imagine; I have experience in only one, but I'm sure it applies to all of them -- that until some problems emerge, sometimes you don't know where your administrative systems are failing you, because unless there is.... When things are going along well, they're quiet; sometimes when things aren't going along well, people are too accepting of that and don't let you know. It's important that problems are brought to the attention of political leaders, but it's also important that political leaders act in a very fair way.
My determination with this particular case, or with any cases that come to me, is to ensure that the person has been treated fairly, that we've put all available resources to work to help them and that we've listened to creative ideas that may be outside the bounds of normal bureaucratic procedure and said: "Maybe we should try that approach." Maybe the idea that comes from an individual, a patient or their family is worthy, such as the issue that you brought to my attention with Mr. Kingsley. That's a case which, looked at on its facts, doesn't fit into the policies of the ministry. Part of my job and the job of my staff is to say: "Why doesn't it fit into the policies of the ministry? Maybe the policies should be changed." As we become aware of individual situations, we question administrative practice. Some of the administrative practice may have been there for decades, and no one ever questioned it before. Part of our job is to do that.
It's also part of the overall job to periodically review all administrative practice, not only when a problem comes forward but looking at how you manage your ministry. We do that. Administrative functions are part of the job of this minister. My frustration is that with 8,000 full and part-time FTEs, and more pieces of the ministry than you can count, I haven't yet been able to examine each and every part of the ministry in the kind of detail that I think is needed. We've been working through it systematically. You and I talked yesterday about areas that still need to be looked at. The commitment I have is to continue to do that in as fair a way as possible.
L. Fox: Notwithstanding my earlier comment with respect to the visit by these people, I want to suggest, just for the record, how much I appreciate them getting in touch with me and making their concern known to all of us. It really did bring me back to focus on the waiting list and the importance of emergent treatment in cases such as theirs. I really commend that group of people from Alert Bay for making this long trek to Victoria to make us aware and to bring our attention back to those specifics.
In hopes that this will continue on Monday, I will at this time defer to the critic.
V. Anderson: One clarification on the last bit of the discussion, and I'm sure the people watching would want the same clarification. I understood the minister to say that backup services for radiation treatment are available in the state of Washington. Could you clarify how people on waiting lists would access those backup
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services? From your comments earlier, I'm sure it's a question they would be raise, and it might prevent them from phoning you as a result of the discussion today.
Hon. E. Cull: Anything that would prevent that flood of phone calls would be very valuable. The Cancer Agency makes those decisions in consultation with the specialist involved.
V. Anderson: Perhaps it was just timing that this particular case came forward today. We might discuss the aboriginal opportunities with relation to the health department for the next little while. As I look at the description in the Health estimates, I find two references to aboriginal concerns. One is under community health services, which says simply that they include services for aboriginal persons. Would the minister briefly highlight the main concerns within her ministry and the opportunities for aboriginal purposes that are priorities at the present time?
Hon. E. Cull: I just need a point of clarification. Specifically, what was the area that you were focusing on there: community care or continuing care?
V. Anderson: My first question was on the community health services, but I would be interested in the other services as well.
Interjection.
V. Anderson: All of them, yes, if we could touch on them briefly as we go.
Hon. E. Cull: I was sitting here scribbling a note to myself, trying to think of all the different parts of the ministry. Actually, I've discovered I've got a printed list of everything that we are doing; let me just run over some of the things. We've just consolidated two native health areas in the Ministry of Health. Within the alcohol and drug programs -- the member will know ADP was separate from the Ministry of Health until November 1991 -- we've just consolidated the alcohol and drug aboriginal program with the native health branch in the ministry to form one branch on native health issues. The native health branch has been doing consultations with the native communities, finding out what they need and then helping them put their programs together either by working with other parts of the ministry or providing them with particular grants to develop the programs that are really very sensitive to the cultural needs of their communities. We also have a bursary program for natives so that they can become trained in the health care professions because aboriginal people who are in there may be able to assist us in providing better services to first nations people.
In the alcohol and drug area, an aboriginal advisory committee was struck last year to make decisions about the distribution of $5 million to aboriginal people in the area of alcohol and drug treatment and violence against women. This particular committee can make distribution decisions on other available money. There has been money provided through the health promotion office to native communities wanting to do Healthy Communities initiatives. One of the members of our Seniors' Advisory Council -- through the office for seniors -- is a first nations person. There has been $1,180,000 provided for aboriginal sexual abuse intervention. One of our most successful programs, I believe, is the pregnancy outreach program dealing with substance abuse issues during pregnancy and targeting women who may have high-risk pregnancies. Nine programs are operated or located through the friendship centres. With respect to urban natives, we've been doing a fair amount of work in the area of AIDS prevention and needle exchange programs. One-time funding was also available through the B.C. Health Research Foundation for research issues related to aboriginal health, and there are contracts under the Medical Services Plan for physicians in the native health branch. Very briefly, those are a number of the things that we're doing in that area.
There are obviously other services that are provided to first nations people that we can't track because we don't keep a record of the race of, say, people who are receiving services through a hospital or through some particular programs that are available to the general public. We don't do that. One of the things we have just recently started working on with the Minister of Aboriginal Affairs is the creation of a permanent advisory committee on aboriginal health issues. That has evolved over the year from the existing aboriginal advisory committee struck to deal with alcohol and drug programs. The group has transformed itself into the B.C. Aboriginal Health Advisory Council, and we're now working with the ministry to ensure that we have a committee that is representative and acceptable to first nations people, to give us ongoing advice on aboriginal health.
V. Anderson: I thank the minister for that brief overview of some of the programs that are being undertaken. Might I ask if she could explain a little more about the bursary program and how many people are using it? Is it available in particular areas?
[12:00]
Hon. E. Cull: I think we do have that information here, but I don't have it at my fingertips. If he'd like to continue with some other questions, we should be able to find it.
V. Anderson: Thank you. I was going to ask about the friendship centre programs. She mentioned one program with regard to high risk working through friendship centres. Are there other health promotion programs that you work through the friendship centres, or is that the only one at this point?
Hon. E. Cull: I mentioned the nine pregnancy outreach programs that are operated through various friendship centres. Some of the money that was distributed under alcohol and drug programs through the aboriginal advisory committee also went to friendship centres, and I can give you some examples here. The Mission Indian Friendship Centre received funding to hire an elders' coordinator to organize programs for the elders, to create community involvement and aware-
[ Page 6302 ]
ness, and to reconnect youth to traditional and cultural values and strengthened dysfunctional families. There was another program for the same friendship centre. I'm just looking at the list to see if other friendship centres were involved in the projects approved under the.... That's the family violence program. If we have a look at some of the alcohol and drug ones.... Oh, I'm not sure I can pronounce the name of this friendship centre. We challenge Hansard to spell it correctly. Dze L K'ant Friendship Centre has received funding to do cultural healing workshops for all members of an urban aboriginal community in the Smithers area, and to hire an assistant to the alcohol and drug council to ensure that this program does preventive educational work within the community as well as counselling. So there's an example from the alcohol and drug program. There seems to be additional money available for.... No, this is not under family violence; sorry, I've got the wrong program here. But that's an example of some of the things that are done there. Under family violence, the same friendship centre has money for some of the women's wellness programs.
Is this the kind of information you're looking for, member? I can provide some additional information if we just keep working through here. Fort St. John Friendship Centre received funding for an on-site counsellor for adult education; the Fort Nelson Friendship Centre received money to hire a local facilitator to provide workshops to make the native community and others aware of the codependency that exists in relation to issues for their own protection.
With respect to the native bursary program, the most up-to-date statistics I have, I'm afraid, are 1991-1992, which is a little out of date unfortunately. There were bursaries provided to nursing, social work, sexual abuse counselling, long-term aides, pre-medicine, bachelor of science, health care aid, medical office assistants and drug and alcohol counselling. Those were all of the areas that were funded in that particular year. In that year, the amount of money that covered those particular cases went to 25 students, and it was $96,723. Last year it was increased to $135,942. Given a few more minutes, I'm sure I can tell you what the increase has been this year. But I think there's a fairly representative group of health professions. You might be interested in knowing that the communities that have been assisted are also all over the province: Alert Bay, Prince Rupert, Merritt, Port Alberni, Victoria, Hazelton, Williams Lake, Skidegate, Kitimat, Pouce Coupe, Smithers, Penticton, Vancouver, Courtenay, Campbell River, Mount Currie, Terrace, Nanaimo, Sooke, Port Coquitlam, Port McNeill, Canim Lake and Armstrong. Not too many places have been left out of that list.
V. Anderson: Yes, I'm interested in that. Travelling in the province with the Aboriginal Affairs committee, I discovered that there were very few people in the communities we visited who were aware of the First Citizens' Fund bursary program. So I'm wondering what kind of cooperation there is between the ministries in order to make this information available so that people know there are a variety of sources, apparently, for educational support: probably under Advanced Education as well as Health and the First Citizens' Fund. What kind of cooperation is there between the ministries to integrate the information going out on the availability of these programs?
Hon. E. Cull: A number of things are happening in that regard. One is through the Health human resources initiatives that we're preparing as part of the New Directions strategy. We are working with other ministries -- particularly Advanced Education but also in this case, obviously, Aboriginal Affairs -- to make sure that the human resource plans we're developing are sensitive to the need for more first nations' people to be trained.
It is my hope that the aboriginal advisory committee on health issues will start to be able not only to provide us with good advice as to how we should be restructuring our programs but also to serve as a point of information for first nations to learn about what's available. The native health branch did that reasonably well in the past, but we think we can improve upon that. I think you might appreciate that it's a bit of a trouble. You want to provide a single entry point for first nations' people into the Ministry of Health so that they can find their way through the bureaucracy, but on the other hand you don't want to funnel them only into one place, because, like you and me, they should be able to get services throughout. So we're trying to strike an appropriate balance there.
V. Anderson: You mentioned some of the urban native programs. I'm thinking of Vancouver and Victoria, which probably have the largest urban native populations; but of course this is true in Prince George, Prince Rupert and all of the urban communities around the province. You mentioned AIDS and the needles program. Are there other programs that are particularly geared to the province's urban population?
Hon. E. Cull: About half of the money that has been approved by the aboriginal advisory committee goes off-reserve, and a fair amount of that would of course be going to urban native populations. There is quite a number of projects approved for the lower mainland area, which would obviously include the urban population in Vancouver. I don't know whether you want me to read through them all or whether you would just like to receive some of the printed material we have on the distribution of those projects. We work with the Vancouver Native Health Society and other groups in the Vancouver area to deal with the particular needs of urban natives living in the city.
V. Anderson: In Vancouver, Victoria and other urban areas, is the minister working with defined contracts that have specific tasks, or are those areas given grants to do general health work? Are they specific tasks or general health?
Hon. E. Cull: All of this money is contract money. It defines the product that's going to be provided for the money given to the various agencies.
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V. Anderson: You indicated that about half of the money is going to urban areas and the other half is going to on-reserve programs. Could you comment on the differences between the nature of those programs? Are there any significant data? Or are there just contracts? Or are there types of programs that are more relevant on reserve than are known in the urban area?
Hon. E. Cull: The programs would vary somewhat. The off-reserve programs are not all urban. The major difference is that when you're dealing with the on-reserve programs, you're dealing with a community that lives together in one location and you have a band community. You're dealing almost entirely, if not totally, with a first nations population. So you're dealing with a different set of circumstances.
[F. Garden in the chair.]
When you're dealing with urban people, they may be scattered around. While there's a certain concentration in downtown Vancouver, there is also a large first nations population that's scattered. Therefore it's more difficult to be able to provide those services.
Hon. member, I'm going to ask if you're just going to continue to put the questions to my staff. I need to consult with the opposition critic for a second on a note that she has just passed me.
V. Anderson: Hon. Chair, are we using the opportunity for the staff to reply in this House as we do in the other house?
The Chair: No, we won't be doing that. If there's a reply, it will be from a Member of the Legislative Assembly.
V. Anderson: When the minister comes back, I would like to ask her about the area of health related to traditional native health practices and supporting the traditional native health programs. We know historically that was not always done, so we'd be interested in what's happening at the present time. What's being done in that particular area?
D. Lovick: We have much to learn.
V. Anderson: Yes, we have much to learn. I guess that at the present moment, the major learning we've done in that regard is that we have learned at last that we have much to learn and that they have much to contribute to us.
The minister has returned, so I'll get an opportunity for her to respond.
Hon. E. Cull: I understand that you were dealing with the matter of traditional healing practices. We did have a contract last year with a traditional healer to learn more about this area and to give information to the ministry. What we have been trying to do is to integrate the concept of traditional healing into our other programs. If you look at the material I offered to send you with respect to the various programs we've funded under the alcohol and drug and the family violence programs, you'll find that the specifics are very much in line with traditional healing. They take a very holistic approach to the issues the native communities are struggling with. It looks considerably different from the kinds of treatment programs that we may be funding through the non-native community. There are a number of programs that take this approach, and we respect the traditional practices as much as possible in our funding decisions.
V. Anderson: Are these the traditional kinds of contracts you have to renew every year, so you spend half the time each year worrying about whether you renew them and there is no long-term planning? Or are the contracts moving into the area where there is two- or three-year planning so there can be some consistency in planning and reliability in programming? In health, that would seem to me to be very important.
Hon. E. Cull: I don't believe that we do have any core funding, but I could be wrong on that. I am not able to ascertain it. We are dealing primarily with contracts that do have to be renewed on an annual basis. I accept the comments you make about the problems that approach provides.
On the other hand, I know that in the short time that I've been in this portfolio, I have seen many cases where we have evaluated services, and have been very glad that the contract was coming up for renewal so that we could cease to fund a contract. I'm not talking specifically about aboriginal health; I'm just talking generally about the areas in which we do a lot of contract funding. It is important that we have the ability to deal with those areas which are just not providing the services according to the contract or according to the needs of the community.
[12:15]
V. Anderson: Having spent most of my life on the other side -- dealing with groups that are trying to get contracts -- I realize the validity of evaluation on a regular basis. I also think there's a stronger message on the other side: that evaluation could be built within the contract itself, so even if it is a three-year contract, there still would be evaluation within it.
As we are particularly encouraging the aboriginal community to develop new programs, it would seem to me that they need to have some ongoing assurance -- over a period of two or three years, at least -- that this program can grow and meet the needs, and could be evaluated and changed or corrected within the program as part of its growth, rather than being static.
If we're dealing with the first nations in the economic development, I think we are finding that along with the contracting there is almost a requirement for ongoing consultation. I wonder whether in this area there might be consultation built in as part of the contract to make these more valid for community groups. I think that consultation within the contract could be very important.
Hon. E. Cull: The member makes some very good points. As I said, we have just recently restructured our first nations health groups in the ministry so that we now have one aboriginal health policy branch. It has a
[ Page 6304 ]
section that is devoted to evaluation and development, so that we're addressing the very matters which the member has pointed out to us.
With respect to the ongoing funding, I accept the issue that the member raises. It does create difficulties. I think we should be able to address that, in some measure, through the kinds of evaluation initiatives that we're now putting into place.
V. Anderson: The minister mentioned specific programs about alcohol and other drug situations within the aboriginal community, as within the non-aboriginal community. Are there specific programs that are related to the family-style, community-style of care giving, particularly around alcohol programs, fetal alcohol syndrome and AIDS, which involve a certain kind of community responsibility and opportunity and is different in the aboriginal community than in other communities.
Hon. E. Cull: Absolutely. In fact, I think that you'd find most of the projects we have funded in alcohol and drug that come under the aboriginal advisory committee take that holistic community family approach. The concept of healing that first nations people have is not just an individual healing issue; it's a healing of the whole community. You'll find that many of the initiatives put forward to us and funded by us involve the whole community changing their attitudes with respect to substance abuse.
V. Anderson: In the areas of justice and social services, I think a great deal of change has been required within our systems because they didn't fit into their systems. As we mentioned earlier, there was a great deal of learning on our part to be responsive to what they were bringing. Because of our unawareness of how to operate with credibility in their systems, there was, either by design or not, a lot of discrimination as they interacted between the systems. Is the same difficulty felt within the health system -- that there is discrimination because of the way our systems operate? What particular process is being taken to overcome that?
Hon. E. Cull: I think it's fair to say that the same problems do exist, whether to a lesser extent or not, I don't know. I can think of a number of cases that have come to my attention, where first nations people have felt they did not receive fair treatment at a hospital or in another part of the health care system. Many feel it's simply related to their culture.
Since we know discrimination exists throughout our society, I would be absolutely surprised if it didn't also exist in parts of the health care system. We're attempting to address this in a number of ways. One of the most effective ways is to have more health care providers who are first nations people so that the bursary and training programs become very effective. The more people from different cultures we have working in health care, the more likely it is that the institutions they work in will be sensitive to those cultures. Because a lot of the community-based health care provided to first nations people is done by first nations, there is that cultural sensitivity there.
I'm also advised that more and more hospitals have become aware of traditional healing and are now permitting traditional healers to be present in the hospital, in the same way that we would have chaplains or religious people available to us in hospital if we felt it was needed to assist in our holistic healing and comfort.
V. Anderson: One of the topics this week was midwives. Do you see the midwife program tying in with aboriginal healing and health and birthing processes?
Hon. E. Cull: As you are no doubt aware, the Health Professions Council said that the whole area of native midwifery was beyond their ability to get into, given the constraints that were upon them, I guess. It's an area we want to explore. I think it's an absolutely natural addition to the type of holistic healing that first nations people have practiced traditionally for centuries.
V. Anderson: I'm sure others would ask this next question as well. We've mentioned health workers in the field who are of aboriginal heritage. How many aboriginal persons do you have in responsible positions here in the direct administration of your ministry?
Hon. E. Cull: We don't keep statistics on people by race, but I can tell you that four of the six in the aboriginal health branch of the ministry are of aboriginal ancestry.
V. Anderson: The aboriginal people of the M�tis have been expressing themselves in a greater way and trying to establish their own centres and programs in cooperation with the other aboriginal programs. Are there any particular programs that you're aware of that the M�tis have come into in a formal sense with regard to health programming?
Hon. E. Cull: The M�tis people have been funded through the aboriginal advisory committee's allocation of funds on a number of projects. I'm not sure exactly how many, but there have been several projects in that area.
V. Anderson: The minister also mentioned the programs that were being developed in the area of research. Could she indicate the kinds of programs undertaken and the kinds of groups that at this point are accessing them?
Hon. E. Cull: I'm trying to recall what the Health Research Foundation demonstration projects were. The only two that I can remember off the top are the heart disease projects and the diabetes projects. I'm not sure what else was in there, but I might be able to find those for you in the next few minutes.
V. Anderson: We could go on about the aboriginal matters indefinitely, but I know there are some time constraints and limits. At least we have opened up some of the scope
[ Page 6305 ]
of the program and some of the areas of priority the ministry has undertaken.
I would like to shift from that for a few moments. It's related in one sense, though, because it has come up very often in this particular case. That's the area of alcohol and drug rehabilitation within her ministry. I've had experience with the alcohol and drug program and community programs when they were under Health, and then under Labour, and then when they came back to Health with all of the disruptions that took place. I've been hearing lately that with the change in the ministry there is also now some reorganization of alcohol and drug rehabilitation programs within the ministry. Could the ministry explain a little bit of what's happening in that regard?
Hon. E. Cull: I'm going to have to ask the member for more clarification on that. I know we've been receiving cooperation from the opposition in terms of the subjects, and you did indicate alcohol and drug today. Unfortunately, my person is ill. If you could give me a more specific question, we might be able to address that for you.
V. Anderson: The concern I've raised has come to me from out in the community. Apparently they have been hearing rumours that there is some shifting of alcohol and drug rehabilitation programs within the ministry. I'm wondering whether this is an increase in the importance of these programs or if they are being shifted to be a subministry under another area. That uneasiness and concern that they've been through over a number of years is now surfacing again.
Hon. E. Cull: What you may be referring to, particularly when you talk about the stories that are floating around in the community, has to do with the fact that in the last number of months, we have integrated alcohol and drug programs back into the Ministry of Health. As you pointed out, they ping-ponged backwards and forwards there for a bit. When they came back last year, they just sat there as a part of the ministry that wasn't integrated anywhere. We now have brought it into the community and family health programs. That's administrative. It also means that for the vote purposes in the estimates, it's wrapped into the vote that's there. But it doesn't mean that there's been any policy decisions to downplay rehab services over prevention or ADP over other things. We continue to try to work on a number of different fronts with respect to treatment and prevention for people who are substance abusers and to enhance those programs within the means of our 4 percent budget increase.
V. Anderson: I don't know whether the minister wants to follow this a little further today or not, but a year ago we were concerned about some of the teenage programs, that I and others had been associated with that were closed down or had contracts cancelled because the minister was then undertaking to replace these programs, ostensibly for ones that were happening throughout the whole of the province and were available in a large number of areas. I don't know whether she wants to deal with that this week. We could leave it until next week and deal with it again at that time -- whichever you prefer.
[12:30]
Hon. E. Cull: I'd be happy to get the details of that, but the assessment programs were in place before Peak House was scaled back. Those services are in various parts of the province. We did talk about it last year; I don't believe a lot has changed. Peak House is continuing to provide services in Vancouver and residential treatment but not provincewide assessment programs.
V. Anderson: You mentioned provincewide assessment programs. What about provincewide treatment programs as far as youth are concerned? Are those available throughout the province now?
Hon. E. Cull: I'm sorry, I don't have a list of all the residential treatment programs for youth around the province, so I can't give you a full answer on that.
V. Anderson: Fine, I'll move on from that. I have one question that was put to me to do with a person who's in Pearson Hospital, which is in my own riding in the Vancouver area -- I use that as an illustration. This person is in a family situation in which the husband has income that makes them independent. The wife is in Pearson's long term care program and is not able to be cared for at home. Since it comes back against the family income, the increase in rates has put great pressure upon them. Not being seniors, they don't fall into the normal category of support systems you've discussed here. I'd ask if the minister might respond to that concern.
Hon. E. Cull: We did deal with this at length twice earlier in the estimates, although not the particular twist on non-seniors. But the same thing applies: we calculate the rates based on couple income and individual income, and give them the best rate. So it doesn't matter whether you're over 65 or not. In fact, people who are under 65 have other deductions: $3,000 for a spouse, $3,000 for being disabled -- which of course they would be, otherwise they wouldn't be in the long term care facility, in most cases anyway -- and they may also have dependents, which would give them another $3,000. So in many cases a much higher income would have to apply before the higher rates would even start to come into play.
V. Anderson: I appreciate that, because the minister's response probably indicates that the information which these people need is not necessarily getting to them. They're going by what they hear from the newspapers and are frightened by that. So there's an indication of a means of flow of information. What process is there for providing information to the people who might have need of it -- apart from what they've read in the newspaper headlines, which is not that helpful sometimes?
Hon. E. Cull: A very detailed letter was sent to all patients and their families, there is a 1-800 line, and our continuing care managers are working on a case-by-
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case basis with the facilities to make sure that they understand the tremendous flexibility that we're willing to apply in these cases.
L. Reid: I'm aware that the minister is more than aware of the situation at the hospital in Victoria over the last number of days in terms of wait-lists in emergency. In that we began this discussion this afternoon talking about wait-lists, I'm not going to reflect on that particular case at all. I simply want some guidance in terms of how wait-lists are tabulated in the province, and specifically, how emergency wait-lists will be addressed. I don't believe it's just a situation for Victoria; I believe it is a provincewide problem, hon. minister. I think there is an issue surrounding the RJH emergency and I know that you are working on that at the present time. In terms of the provincewide problem, I will ask the minister to address issues surrounding emergency rooms. There seems to be much concern, particularly in the city of Vancouver, with the closure of the Shaughnessy emergency room. If that goes forward, those individuals -- and certainly constituents of Vancouver -- believe they will have half a million people trying to receive service from the emergency room at Vancouver General and from the emergency room at St. Paul's. It's a horrific number of individuals. I think the minister is commenting on the University Hospital, but I am conscious of the travel difficulties with the University Hospital and that that is not anyone's first choice if it is indeed an extreme emergency.
So in terms of wait-lists that surround emergency rooms in the province, what kinds of initiatives are in place to see if we can reduce that? At the end of the day, I think the backlog occurs in emergency because there aren't sufficient beds in the hospital to accommodate those individuals. The minister has often spoken about hospitals getting a budget and then allocating the most appropriate use of those dollars. If the issue is budgeting for hospitals, and if people are not able to access a hospital through the emergency room because there's simply no place to put them within the physical plant, what is the answer to that?
Hon. E. Cull: With respect to the situation in Victoria, I have asked for a report so that we don't leap to conclusions about what actually took place. I have heard -- only through the media -- that the hospital said that being six feet further into the hospital wouldn't have made any difference in this particular case, but I think it's important to hear from both the hospital and the Ambulance Service.
With people who present themselves at emergency rooms, there isn't a wait-list per se. That's the whole nature of emergencies. People are triaged as they arrive at the emergency room and are dealt with in order of urgency. Sometimes people are not able to immediately move into a bed in the hospital. In some cases, that has to do with hospital discharge planning, which certainly can be improved in many cases. In some cases it has to do with -- as I believe was partly the case in the Victoria situation -- an unusually high number of emergencies showing up in a particular period of time. The practical reality is that we can't build a system for the peak periods. We have to build a system to handle the average flow, and then make sure we have enough flexibility in our system to be able to deal with those emergencies as they come along.
L. Reid: I appreciate the minister's comments. To make this discussion more specific to Vancouver, what is the response to the individuals who will now be seeking services from VGH and St. Paul's? I believe we are talking about at least half a million people within the city of Vancouver. Those same individuals don't see a lot of value in travelling to University Hospital on the campus of the University of British Columbia.
Hon. E. Cull: Besides VGH and St. Paul's, there is the UBC site -- the University Hospital -- which has an emergency room, and will continue to do so. There are also the Royal Columbian and Burnaby hospitals. I'm not sure about Mount St. Joseph and St. Vincent's; I don't know if those two have emergency rooms or not. So there are more than just the two. In the city of Vancouver the Ambulance Service is able to radio ahead to find the hospital that has the least clogged emergency room.
L. Reid: I appreciate the minister's comments, but my particular concern is people who do not arrive at emergency through the ambulance route. A number of individuals present themselves at emergency, particularly in downtown Vancouver, where we have a very transient population. We have individuals who, for whatever reason, would not be in an ambulance but would simply be presenting themselves through a number of different ways. They are not going to be able to seek service at University Hospital. If transportation is an issue for them, and if it's not an immediate requirement that they be in an ambulance but they are still going to present themselves at emergency, the other hospitals that you mentioned -- Burnaby and New West -- are going to be no more viable than the downtown core.
The issue, for those folks certainly, is that the density in that area of Vancouver -- half a million people -- is tremendous. In your opinion, is there enough capability within emergency at VGH and St. Paul's to handle that volume of people?
Hon. E. Cull: I believe there is.
L. Reid: I'll tie the next item to the previous one in terms of bed space available in hospitals once people access a hospital through an emergency room. We've talked numerous times through this estimates process and over the last 18 months about the 2.75 beds per 1,000. We've discussed age and size of community as having some bearing on any kind of determination. From my reading of the estimates, there is approximately $14 million in the new hospital budget to distribute to institutions, and again, they looked at three factors: community growth above the provincial average; community utilization below provincial targets; and community already getting new health moneys through other allocations. All of those are addressed in terms of whether or not the 2.75 beds per 1,000 is a reasonable amount or whether it's fairly
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arbitrary and needs to be reconciled with the unique needs of each community.
I would be interested in communities where there are particularly high utilization rates and in some of the factors behind those utilization rates. When my colleague from Vancouver-Langara and I talk about drug and alcohol treatment, that's certainly one of the issues surrounding utilization rates. I appreciate the minister's comments on where we've gone in trying to have drug and alcohol patients treated outside a hospital setting. I applaud that, and I honestly think it is the way to proceed. But in terms of utilization and the $14 million put towards the budget, where can we expect to see some drops in utilization or perhaps more dollars to particular regions in the province to allow for increased utilization, which may or may not occur as a result of age or location within a centre?
The Chair: The member for Surrey-White Rock rises on which matter?
W. Hurd: I would ask leave to make an introduction.
Leave granted.
W. Hurd: I'm please to introduce 33 grade 5 students and several adult chaperons from Jessie Lee Elementary School in my riding. I would certainly appreciate it if the House would make them welcome.
L. Reid: If I might reframe the question, we were discussing 2.75 beds per 1,000, and talking about a $14 million allocation under hospitals, to look at the determinants of whether or not there is going to be increased utilization in a number of different communities. We talked about provincial growth above the provincial average, about community utilization below provincial targets and about communities who may indeed receive health dollars through other sources -- whether it's a hospital foundation or community fund-raising. My question is: what factors will be in place to determine which hospitals receive any portion of that $14 million?
Hon. E. Cull: With the B.C Health Association and the others we consulted with around the funding formula, we looked at those hospitals that had the highest growth rates in their communities where we were not recognizing a growth in utilization per se. In fact, we want to see utilization come down virtually everywhere. But what we're looking at is the fact that those populations are growing very quickly, and so the demand on their system needs to keep pace with the growth of their population.
L. Reid: The voted expenditure for the minister's office shows a 14 percent increase over last year. How do you account for that?
Hon. E. Cull: I should bring in my office staff to help answer that question. We've added another person, and that's where the growth is: 8 percent translates to $32,000. We've added another clerical position to the office to bring our full component this year to 9; we had 8 last year.
There's been a dramatic increase in the work done out of this office. In 1990, for example, the office of the Minister of Health received 10,000 pieces of correspondence; in 1992, it received 20,000; in the first three months of this year, it received 11,000. Obviously there is a lot more work being done out of the office. In terms of the number of meetings that I have personally attended -- which of course requires scheduling arrangements and all the backup work in the office -- in 1992, there were 561 meetings; in the first three months of this year, there were 184. We have become an incredibly busy office and deal with a lot of issues there. We receive phone calls daily: between 300 and 600 calls a day and 95,000 on an yearly average. There are 14,000 faxes sent and received on a yearly average. Considering that we are dealing with one-third of the provincial budget, it is a very active and busy office and requires the additional staff just so people can work hours that are reasonable and we don't have to pay a lot of overtime by having people stay and work extra hours. If you've got that much extra work, it's better to bring in another full-time person.
[12:45]
L. Reid: I'll just make one comment: I trust that this new clerical person will ensure that both opposition Health critics receive press releases long before they reach Prince George, which has not been the case the last number of days.
In terms of strategic and support services, one of the line items makes particular reference to the fact that, notwithstanding the overall reduction in the budget, total salaries in this subvote go from $22 million to $28 million, an increase of around 27 percent; travel increases to $784,000, an increase of about 25 percent; and office and business expenses go up to $3.6 million, an increase of about 38 percent. From the comments you've just read into the record, in terms of the busyness of the office, is there any way to streamline any of the processes that are currently in place so that, hopefully, we can see some cost-benefit analysis of increased staff and a budget reduction in terms of providing services in a more efficient and cost-effective manner to British Columbians?
Hon. E. Cull: If the percentages that the member just read were an actual reflection of the increase in dollars that were being spent on any of those areas, they would indeed be somewhat alarming. They are actually representative of the increase in funding, but they're accounting changes that have been made as a result of directions from the auditor or the other people who give advice -- I'm not sure which -- on how best to do this kind of accounting. We actually had money for travel and for other administrative things that in the past were not all in that vote. Some of that money was in other votes because it was tied more to the program than to the vote. What we've done is clean that up so the money now is all in one vote. You can see how the increase is occurring from year to year. With travel, for example, the actual increase in travel costs this year is 4 percent.
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L. Reid: I appreciate the minister's comments that those dollars have now been consolidated. But we're certainly not spending any less on some of those issues. If indeed it's an important and prudent decision for the minister to travel to address some of the difficulties in the health care system, perhaps there are some ways to streamline that process. I hope that's the case.
In terms of community health services, the subvote includes prevention, promotion, community-based health care, aboriginal services and funding for construction of new facilities. This is the difference or the change over last year: it's a new, consolidated subvote. Formerly it did consist of two subvotes: community and family health and community care services. My comments suggest that it represents a difference of $185 million, which appears to be around 14 percent. Ministry officials say that community health care expenditures are up only 8 percent. Where will this come to rest? Will it be 8 percent or will it be closer to 14 percent in terms of the amalgamation of the subvote on community and family health and community care services?
Hon. E. Cull: I'd have to have a look at that. Are we comparing actual costs to the budget this year or are we comparing estimates to the budget this year? It depends on how you look at it. I know for a fact that the overall increase from what was spent last year to what will be spent this year is 8 percent. That's what I think is important. What was budgeted last year, whether it was met or not met, for whatever reason, doesn't mean an awful lot to the people out there. They want to know what services they had.
I understand that we're going to be continuing this fascinating debate at a later date. So, hon. Chair, I will now move that the committee rise, report progress and ask leave to sit again.
The Chair: Just before I put the question, I note that several young people have just arrived in the House. I haven't had a chance to introduce them all, but I hope they are enjoying their stay in Victoria and the proceedings they're observing at the moment.
The motion before the House is that the committee rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; E. Barnes in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Hon. A. Hagen: Hon. Speaker, it being Friday, I move the House do now adjourn until Monday and wish everyone a very pleasant weekend.
Motion approved.
The House adjourned at 12:51 p.m.
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