1994 Legislative Session: 3rd Session, 35th Parliament
HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
TUESDAY, JUNE 28, 1994
Morning Sitting
Volume 16, Number 25
[ Page 12397 ]
The House met at 10:02 a.m.
Prayers.
Hon. D. Marzari: Hon. Speaker, I call debate on the Health estimates.
The House in Committee of Supply B; D. Lovick in the chair.
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 42: minister's office, $436,943 (continued).
L. Reid: When we concluded debate on the Health estimates on Friday, June 24, the question I had posed concerned appointments to the regional councils and boards. I asked if it was your intention to exclude all medical practitioners from those 21 regions and from the approximately 90 health councils in the province. Your comment was that, yes, that is the intention. You then promptly adjourned debate. I'd like to spend some time this morning clarifying that, because it seems to me that we're going to have some difficulties if we have no expertise and no medical background from any of those individuals. You certainly seemed to suggest that. Perhaps you could walk us through that process for a few moments this morning. Then I'm prepared to ask some questions pertaining to that.
Hon. P. Ramsey: I welcome the opportunity to discuss in some detail the establishment of governance models that will start to empower broad communities of this province to make their own decisions about health services.
I'll just start with one comment. The member talks about no expertise and no medical knowledge on CHCs or regional health boards. I point out to her that it's currently the situation with every hospital board in the province.
L. Reid: For my clarification, hon. minister: are you prepared to confirm today that no nurse and no practitioner will sit on any regional board or any council in British Columbia?
Hon. P. Ramsey: The conflict-of-interest guidelines we've been working on as we developed these councils and boards have indeed been, as the member says, to exclude those who have a pecuniary interest in the health system. That's not just direct employees; it also involves physicians who provide service to the broad community and others who might contract with CHCs and RHBs.
We said very clearly at the same time, hon. member, that we must find good ways of involving the expertise that health care providers represent in the decisions that boards make. That must be done. In the case of physicians, that's traditionally been done in hospitals through medical committees. The equivalent of that clearly must be there at the community health council level and/or the regional health board level, depending on which one is responsible for the actual running of institutions. Similarly, there is a great and expanding need for involvement of care providers, nurses, lab technicians and others involved in direct line services in advising governance bodies on what impact those governing bodies' decisions will have on the health needs of patients.
So this a two-part process, hon. member. It's not as if this is government and that is not. We're saying very clearly that both are essential. First, we need councils and boards that are seen by the public as free from the influence of direct pecuniary interest as they make their decisions. Second, we need to have the best possible advice given to those boards, and that must come from health professionals and others involved in the health system.
L. Reid: Is there some difference, then, in terms of who was appointed to these boards and who will be elected to these boards come 1996? Will some of the appointees perhaps be practitioners or nursing professionals in the field?
Hon. P. Ramsey: No, I see no difference in the conflict guidelines from the situation now, where we're appointing people on an interim basis prior to the 1996 elections.
L. Reid: Perhaps I may extend this discussion by way of an example. Let's say a nurse from the Kimberley hospital was appointed in Salmon Arm or in Cranbrook. Does that scenario exist today? Are we saying that as long as you're not involved in your own region or your own council, you could be a member of another CHC or regional health board? Is that the discussion today?
Hon. P. Ramsey: We've tried to avoid those situations. I find it difficult to have one set of rules for the interior of the province, where communities and community health councils might be at some distance from one another, and another set for urban situations, where the boundaries of councils or regions will be streets, not a stretch of timberland. So the answer is that in all cases we have attempted to avoid any perception of pecuniary interest on the part of board members.
L. Reid: Minister, have you not today appointed nurses in the West Kootenays as members of the regional health boards or community health councils?
Hon. P. Ramsey: The question puzzles me. There are no community health councils or regional health boards in the Kootenays, west or east. There are steering committees working toward the establishment of those councils in the Kootenays, west and east. We have said very clearly to health providers who wish to serve on the steering committees and planning groups: "Come on in; we need your advice." But I have appointed no nurses that I'm aware of to any community health council or regional health board in the Kootenays, west or east, and no such councils have been designated.
L. Reid: There certainly seems to be some confusion surrounding that, and I will bring some documentation into this debate later today. It certainly appears that a number of nurses have been appointed by your ministry outside the realm of a steering committee. If there is a conflict there, I would be interested in delving into it in more detail, perhaps later this afternoon.
As for individuals who have a medical background being part of the steering committees and the regional boards, I would like you to spend a moment on what leads up to the election process. You have said many times that the election will first occur in 1996. Will the appointments that occur now
[ Page 12398 ]
carry us through to 1996 or will there be some interim process in which people will be appointed for differing amounts of time? Would the minister kindly comment.
Hon. P. Ramsey: First, I just want to reinforce the division between the membership and composition of planning groups and steering committees, and the designated community health councils and regional health boards. With the first, the planning groups and steering committees, we've said clearly to everybody in the province -- health care providers included: "Please get involved in planning a governance and delivery system for health services in your community and in your region." We have welcomed and encouraged the participation of nurses and other health professionals. With the second, the community health councils and regional health boards, eight community health councils have been designated so far. We said that we think conflict of interest should be avoided both in appearance and in actuality. That leads us to a search. Nobody with pecuniary interests from the broad health system ought to be sitting on a community health council or regional board.
The specific question the member asks is whether all appointments to community health councils would run from the date of appointment to '96, or whether there might be some stagger to them. We have attempted to stagger the initial groups of appointments. Some would be for one year, some for two, and some might be to the election date in '96. The purpose is to allow those who wish to, to test whether they want to continue public service on a community health council or regional board or step aside. It also provides for some continuity with the longer-term appointments while you get some changes with some of the shorter-term appointments -- if that is the wish of the people who have been appointed.
L. Reid: I thank the minister for his comments. I would come back and ask the minister to confirm that he hasn't appointed any nurses to the Salmon Arm community health council. Fact or fiction?
Hon. P. Ramsey: There is no Salmon Arm community health council.
[10:15]
L. Reid: In a private member's statement on Friday, we touched on the issue of the Eye Bank in the province and the availability of corneal tissues for transplant. There seems to be some real questions surrounding that in terms of British Columbians being on the wait-list for upwards of three years and sometimes closer to four years. Your parliamentary secretary responded that it was never appropriate to purchase tissue. That was never the issue. The issue is: how does your ministry intend to solve the current dilemma? There seems to be inefficiency and a lack of commitment to ensuring that all available tissue is secured from the patient's family and goes forward for implantation.
I speak specifically of corneal transplants today, but all recipients who are on a wait-list for all manner of tissue need to hear some direction and vision from you, as the Minister of Health, to bring some kind of solution to the question. The corneal tissue issue must have a solution. What impact can your ministry have on the coordination around the Eye Bank, ensuring that all the health care facilities under your jurisdiction do in fact have an appropriate plan to make that tissue available?
That is a series of questions to you, hon. minister, but I know the issue is on the minds of many British Columbians today who are sitting on wait-lists and have been told that it's simply a matter of the tissue not being available. What kinds of strategies do you have in place so we can rectify that problem?
Hon. P. Ramsey: First, I should point out that the member for North Vancouver-Lonsdale is a very capable member of this assembly but is not my parliamentary secretary. The member for Comox Valley is serving as my parliamentary secretary, though I'm very glad that the member opposite enjoyed the debate with the member for North Vancouver-Lonsdale over the issue of corneal transplants.
The member, in her statement on Friday and again here today, raises a very serious issue. The wait-lists for transplants, particularly for corneas, is continuing to grow in this province. My ministry and the B.C. Transplant Society are working on creating.... Well, let's try to analyze the problem, hon. member. First, what can we do to increase the number of donations that are coming in? I happen to agree fully with the member for North Vancouver-Lonsdale, who said very clearly that paying for organ and tissue donation is not a principle that we should adopt in this province or in this country. Having said that, I think more needs to be done in making sure that people know they can donate. Organ donation forms and stickers are now available, as the member knows, for placement on both drivers' licences and on CareCards. There's an ongoing attempt to make sure people of the province are aware of the need for donations and to make sure that they see this as an option as they look at both their CareCards and drivers' licences.
We're now working with the B.C. Transplant Society to develop a computerized registry of organ and tissue donors so that when there is an opportunity to acquire a tissue donation, those who are doing that can rapidly find out if that tissue is available. There may be a number of other options for change, but those are the two that I would point out to the member now: first, increased public awareness and, second, developing a computerized donor registry so that we're not wasting tissues or organs that could be available for transplant.
L. Reid: I appreciate the minister's comments about organ donors being listed on a driver's licence, but frankly that's only a focus for discussion because, unless the family is aware of that, oftentimes the tissue or organ does not go forward for transplantation. That is a concern for us today.
I also appreciate the minister's comments on the B.C. Transplant Society and the registry, but it's not helpful to the people who have waited three years and will probably wait another year. Perhaps some time lines, some sense of when we may have a solution to this dilemma, some sense that your ministry is taking charge of coordinating that delivery system within hospitals today and not that this registry may be working at some future point.... What can you say to the British Columbians who are waiting today? I certainly have a number of letters that I know you have from people who have waited upwards of three years. What is the answer for them today? To simply say that at some point we're going to have a B.C. transplant registry will not reassure them that their issue is in fact being addressed.
Hon. P. Ramsey: Hon. member, I recognize that, like many other issues, this is something that needs to be addressed with some care and planning. I'm sure the member is aware of that. In my opening remarks on the subject, I indicated that it's not just drivers' licences, it's also CareCards. If you get a new CareCard in the mail, you will find with it a form to fill out to indicate that you wish to
[ Page 12399 ]
become or be considered as a donor. Everybody in the province receives one or both of those documents: CareCards and drivers' licences. So we are making this issue well known to everybody in the province.
The second issue is: how can we make sure that the wish of those who have indicated that they're interested in donating organs or tissue is, upon their demise, respected and acted upon? A computerized donor registry is, I believe, the right method to make sure that everybody can get that information in a timely fashion, when the organs or tissue can be of use.
There is a third issue here, which would be the legislative options that this body would have to act on. Reviewing those options right now, the most obvious one would be to propose legislation that assumes consent and says that everyone is an organ or tissue donor, unless specifically indicating otherwise. That would be an interesting debate. It is something that should be considered and reviewed carefully before being introduced into this assembly. Many British Columbians might see that as a fairly draconian measure. The current system we have says that if you volunteer, your choice will be respected. The flip side of that system is that you have to opt out, or you're assumed to be a donor. I'm not sure that all British Columbians would be comfortable with that. I do think it is an issue that needs to be raised and debated publicly.
L. Reid: We have certainly gone back and forth now in terms of the CareCard and driver's licence notification. The issue I have around both of those documents is that they're often not considered binding. Is it your position that once a patient has indicated that they want to be a donor...? Often what happens, as physicians in this province have told me, is that the family overrules what is on the CareCard or the licence. That is an issue. You made the point, hon. minister, that it is your intention to respect the wishes of the deceased. Is it binding when they have voluntarily indicated their willingness to donate tissue and organs? Is the message you send to British Columbia hospitals, coroners, etc., that if that documentation is there, that decision can be overruled?
Hon. P. Ramsey: My understanding of the legalities is that a signed donor card is a legal and binding document, but I am greatly concerned about saying that.... I would ask the member to consider what might happen should health professionals be seen to be overruling the wishes of those in attendance at the death of a relative and culling tissue or organs against the express wishes of the immediate family. I can see this causing considerable distress, and may potentially develop in fewer people volunteering or stepping forward as organ donors, rather than more. I see that as very problematic. The legalities, I believe, are that a signed organ donor card is legal and authorizes the culling of tissue. But I would ask the member to recognize the emotional complexities of a health professional acting contrary to the wishes of the immediate family upon the decease of a family member.
L. Reid: My dilemma today is that there are tremendous emotional complexities regarding individuals awaiting this tissue. I don't want to suggest that the family doesn't have all the rights and responsibilities.... But the question was specifically that if you or I were to fill out a donor card -- have it attached to our CareCard or our licence -- would our wishes to be respected? Where the confusion happens -- and you have just alluded to supporting the ongoing confusion -- is that the card is not binding. If there is some question about the fact that you or I may have volunteered to be an organ donor, then our last wishes will not be respected. Is there any way for this ministry to address the fact that somebody's last wishes should be respected?
Hon. P. Ramsey: I think we may have pursued this about as far as we can. I think we're in agreement that we need to make sure that British Columbians are increasingly aware of the need for organ and tissue donations, and of the increased wait-list for transplants -- particularly for corneas -- that is growing and requires the increased donation of organs and tissues. I also think we're in agreement that we must enhance our ability to make sure that people who have legally indicated their desire to donate organs or tissue have their wish respected. I would suggest that as people are looking at their end of life, increasingly they discuss their wishes with their family and those who they expect to be near them or involved in decisions after their decease. I believe that is happening.
[10:30]
The question that we're raising here, though, which I think is a point of contention, is whether or not it is sound public policy to say that regardless of the emotional situation that's going on at the time of decease, the wishes of a family should be clearly overridden by the health professionals in attendance -- regardless of what's going on, and regardless of whether or not they're able to explain to the family that this was the wish of the deceased, that it's clearly indicated and that it's legally doable. Should they override objections of the family if persuasion and explanation do not work? I'm reluctant to take that step, hon. member, and I would ask whether that is something that.... I think we should recognize that rather than creating some very unpleasant situations for health professionals and for families, the process of educating everybody in society about the need for tissue and organ transplants is probably a more profitable way of ensuring that the level of tissues and organs available for transplant rises.
L. Reid: In conclusion, does the minister ever envision a point in time when there will be sufficient education around this issue so that perhaps this government can move to the question -- the debate -- of presumed consent around organ donation? I appreciate that it's a package; it must go hand in hand with the educational aspects. But the technical aspects of ensuring that the entire province is blanketed in order to ensure that every single useful donation can be utilized.... There are ways to move to at least a debate on presumed consent in this chamber. The minister alluded to that earlier on and wondered, in terms of weighting them, whether people should be given the option to continue to volunteer, or whether we can presume that unless they remove themselves from the process, they are giving consent for the donation of their organs or tissue. I'm thinking that we're not going to win it if we simply state that education is the only avenue. I support that; the teacher in me supports that. I think it's important. Certainly it would never be my desire to cause undue harm to a family. You have a lot of concerns around respecting the wishes of the family; I have a lot of concerns around respecting a person's last wish. If it is their last wish to ensure that that happens, can you as minister see some future date and framework for when we can have a debate in this chamber on presumed consent?
Hon. P. Ramsey: I think we will be moving into that, hon. member. I do think that, generally, the idea of donating tissue or organs after you're deceased is becoming increasingly accepted by the general population of the province --
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probably because people have been increasingly involved in experiences surrounding that decision.
My preference is to push ahead with the voluntary donation of organs and tissue. We have a fairly good record. B.C. has ranked consistently first or second per capita in organ donation in Canada. We obviously need to take better steps to coordinate the agencies involved in organ donation and the use of donated organs and tissue. We need to establish clearly that those who have volunteered the donation of organs or tissue have that wish respected. Those are the initial steps.
It is time for those of us involved in health policy to start raising the issue of assumed consent more publicly as we talk to groups outside this chamber, and raise it as an issue not just with groups directly involved in transplants, because they know the issue, but with the general population. I would suggest, hon. member, that as we review legislative options, this debate will take a couple of years before we are ready to bring forth legislative changes.
L. Reid: I thank the minister for his comments.
Ministry documentation suggests that by the year 2010, 25 percent of our population will be over the age of 65. It leads me to a discussion of freestanding hospices in this province and their designation under continuing care. It seems that there is some confusion around funding. A number of communities across this province are looking to create a freestanding hospice -- i.e., one that is separate and distinct in operation from the hospital. They may share laundry, kitchen and administrative structures, but they want very much to provide a sense of community. They want very much to provide something for these folks in their dying days that is not a hospital setting.
I have toured palliative care units in this province that are attached to hospitals. I have had many individuals suggest to me that they are dying, but they are not sick. They don't wish to be institutionalized if they have three or four months left to live. They want to be in some kind of different surrounding. I have a lot of empathy for that position. I respect where they are coming from.
I am wondering if the minister can discuss the funding aspects of freestanding hospices, how that works in this province and whether or not there is sufficient information on that. My understanding is that a number of those situations are funded through continuing care. If the minister could shed some light on that, I would be very appreciative.
Hon. P. Ramsey: I think the member has raised a very important issue. As I have toured institutions and talked to those who are currently in palliative care units, I too have found that many of them would indeed prefer a non-institutional setting -- though they wish, of course, to have the option to return to that institutional setting if the services provided there are needed.
But the issue that the member raises is a straight one of funding, and I don't want to dodge it. In our health system, which is faced with a diversity of needs and demands for the services, how do we get money into those institutions? My understanding is that currently hospice services are largely funded through association with hospitals, and that their funding comes through hospitals.
I am aware that there have been a couple of proposals in this year since I took over as minister. I have asked those societies who are looking at establishing a freestanding facility for palliative care or hospice care to look at applying regionally for Closer to Home funds. We have allocated about $42 million this year. It is clear to me that if the same care can be provided in a hospice setting rather than a hospital setting, if the wishes of the patient would be served in a hospice setting and if, indeed, some cost efficiencies can be gained by making that option available to people facing the end of life, then regional steering committees looking at allocation of Closer to Home funds should consider that very carefully.
L. Reid: Certainly the Seaton commission made mention of freestanding hospices and moving towards palliative care. I appreciate the minister's comments on the $42 million, and certainly I respect the minister's comment in terms of patients in this province having some choices around the type of care that they desire. I know as well that certainly there will be situations where people must be able to move freely back and forth between the hospital setting -- perhaps for pain management or drug therapy -- and the community. But oftentimes there are situations that exist -- and the May Gutteridge Community Home is one example -- where that kind of care is provided by physicians who visit the patients in those settings. I would ask the minister for some comment, other than that about the $42 million.
Let's take the new Prince George Hospice; I believe it's on Clapperton Street. I understand that the land was purchased and that there is some variance required at the present time; there is some bottleneck, if you will -- and the funding issues have not been resolved. I know that there are a lot of municipalities in this province looking to the Prince George example for some kind of guidance, and frankly, Richmond is one of them. Richmond hopes to put in place a hospice scenario. Can the minister kindly comment on the steps that Prince George still needs to go through to get final approval and final funding? In terms of accreditation, how does the hospice in Prince George fit into the overall scheme of health care facilities in the province?
Hon. P. Ramsey: I'm very pleased that the member opposite is aware of the good work of the hospice society in Prince George.
L. Reid: I visited it.
Hon. P. Ramsey: You visited their facility. I have as well, and I really commend them for the work they are doing; they have a good team in place. What I'm most impressed about by the team in Prince George is their desire to work with existing care providers, physicians and others who provide care in people's homes, as well as those who provide care in the hospital in Prince George, and to figure out how the freestanding hospice can be part of a range of options available to somebody facing the end of life.
As I understand at present what has happened, hon. member, in May the hospice society presented to me and the ministry a costing of operations for the freestanding hospice and also applied for licensing as a community care facility. Both of those issues are under active consideration by the ministry right now. In discussion with the group in Prince George, I also have suggested informally that they work with the hospital in applying for Closer to Home funds available in the northern interior region.
L. Reid: Hon. minister, will the designation "hospice" ever be available to those facilities? I now understand -- and certainly you have just corroborated -- that "continuing care facility" is indeed the current designation. A lot of individuals are very tied to the name "hospice." Certainly
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the movers and shakers looking at creating hospice situations around the province want to know if "hospice" will become a recognized term through your ministry and if they can have that title accorded to them.
Hon. P. Ramsey: If I understand the member's question, it is: is continuing care an adequate designation?
L. Reid: They want to call it a hospice.
Hon. P. Ramsey: Well, they can be called a hospice. Licensing requirements might designate them under a particular classification, but they can surely choose a title. I do not see that as an issue.
What I see as the larger issue is making sure that, in talking about hospice and palliative care, we don't start attaching that care to one sort of institution. There are a variety of places for that sort of care -- call it hospice care or hospice/palliative care. It can be and probably should be available in an acute care institution. But some people's preference is for it to be in their own homes; that's surely other people's preference. The third option is in some sort of alternative facility. That is the option that I know community groups are exploring with hospitals in their communities and with my ministry.
L. Reid: Not to take away from the minister's comments in terms of a range of services and choices being available to British Columbians -- I don't take issue with that -- the question specifically was whether hospice would become a designation. If you're saying they'll continue to filter in under continuing care, I will accept that answer. But certainly the wish of those involved is that the term "hospice" be officially recognized -- not to take away from palliative care or hospital services, but simply for some recognition. I'll allow the minister to ponder that.
[10:45]
In terms of the costs of palliative care in this province, it certainly seems to be -- and again, the example is the May Gutteridge Home -- that we look at upwards of $195 a day, a substantially reduced cost over what it costs to be in hospital in this province. Are we going to look at a funding formula for that? Now, I'm not sure if that daily cost is an allowable expense to the Ministry of Health under continuing care, or if indeed there are cost-sharing arrangements that need to be addressed before new hospices, if you will, or new palliative care centres can come into existence.
Hon. P. Ramsey: First, I thank the member opposite for raising the issue of the specific designation of the name. That's an issue that I hadn't heard perhaps as clearly as I should have and that I should be looking at addressing.
The other thing I'll say here, as for funding, is to make very clear what we're doing here. We have a limited resource. We have combined home care and the hospital care budget under one division of the ministry now, to make sure that the options for delivering a set of services are considered by the same agency or branch of the ministry, as options are evaluated for cost and approved for funding. We are far from the point where we can attach specific dollars to a specific patient-care day in hospice. I have seen a couple of proposals; we have not gone the next step in saying that this is a standard for that sort of care.
L. Reid: Hon. minister, I am not exactly clear on your most recent answer. I am not asking for designation for individual facilities. I am wondering if there's going to be a framework in terms of.... Let's say Prince George is going to charge X dollars. Will there be a delineation between what the Ministry of Health is prepared to pay and what the patient pays? Is there discussion about any kind of cost-sharing?
Hon. P. Ramsey: To my knowledge, the discussions between members of my ministry and the Prince George association and others has been in terms of looking at budgets proposed for particular services delivered. To my knowledge, there has been no discussion of some sort of a day charge for hospice facilities. The member raises a number of issues that, to my knowledge, have not broken out of those discussions yet.
L. Reid: Another emotionally complex issue is that of euthanasia. A lot of questions come to me as the Health critic in terms of where the government is headed with this, and what kinds of plans and discussions are underway. I don't intend to belabour the point, but perhaps the minister could give us a status report on where the discussion currently sits.
Hon. P. Ramsey: We are dealing with some interesting issues this morning. As you know, this issue has recently been brought to great public attention in this province by the case of Sue Rodriguez and by the Supreme Court's ruling on interpretation of present criminal law affecting physician-assisted suicide. I have requested of the Hon. Alan Rock, the Minister of Justice and Attorney General of Canada, that the laws respecting euthanasia and physician-assisted suicide be reviewed. My stance is that I believe that those laws should respect the last wishes of people who have a terminal illness and are looking at end-of-life situations. It's clear to me that in the case of Ms. Rodriguez the laws did not do that.
As the member recognizes, this is a very complex issue. When we referred this issue to the Special Advisory Panel on Ethical Issues in Health Care, they came back with a report on euthanasia and physician-assisted suicide, which I released in early April. The ethics committee was only able to reach consensus on two issues: that we need to improve education about palliative measures and/or techniques and access to palliative care programs, and that it is ethical for physicians to allow death to occur when death is imminent and it is medically inappropriate to continue efforts to keep the patient alive. On the issue of taking the next step -- active involvement in the end of life -- the committee, as I think perhaps the population of the province, is split.
This issue is now before a committee of the Senate of Canada, which is going to be holding hearings on amendments to the Criminal Code and provisions affecting euthanasia and physician-assisted suicide. I would encourage all members of this Legislature who are interested in this issue to make their views known, as I have, to that committee. I would urge all British Columbians who are interested in this issue to make their views known as well. I know that the committee plans to hold hearings and consult broadly. I understand that it does plan to recommend whether or not changes to federal legislation should be made in the next year.
L. Reid: I thank the minister for his comments.
In terms of individuals receiving support at home, I have a number of questions this morning regarding the home oxygen program. Apparently a number of companies are currently involved in that service; ARS Vitalaire is one. I have extensive documentation on a number of issues around that. I wonder if the minister could kindly comment on where that program sits now. If there's specific information
[ Page 12402 ]
relating to that particular company, I would welcome that. I also want some questions answered regarding continuing care -- whether that program is shifting to a different delivery system within the ministry and who will be assuming responsibility for the home oxygen program.
Hon. P. Ramsey: The home oxygen program is obviously a very valuable service to those who require that sort of service in their homes, and I'm very pleased that we've been able to ensure that the service is there. I don't foresee any great changes in the program. It is currently widely available and is designated as part of Pharmacare. The Pharmacare Review Panel recommended that it be placed elsewhere in the ministry, and we're considering our response to that recommendation. But I expect the program to go on, whether it's within Pharmacare or within continuing care, as a service that is paid for by the province and available to people who require it.
L. Reid: You've just stated that the Pharmacare Review Panel recommended a change in the program. Could you perhaps indicate where they suggested it and the rationale for that?
Hon. P. Ramsey: I believe the Pharmacare Review Panel suggested that it should be amalgamated with other continuing care programs, and that recommendation is being reviewed. There is an entirely separate issue that I'm sure the member is aware of, and that's whether the contracts for it are properly designated as continuing care or whether some other vehicle should be used for letting contracts to suppliers of home oxygen.
L. Reid: You've just the made the point that you'll consider moving it to continuing care. Could you perhaps provide the rationale for that? I'm not clear as to what that was.
Hon. P. Ramsey: I believe the rationale of the Pharmacare Review Panel was that Pharmacare deals largely with therapeutic drugs, and a number of other programs have been added to it over time. Since the clientele for continuing care and for receiving home oxygen is similar and there's a fair bit overlap, it was felt that it might be more appropriately administered through continuing care. Quite frankly, I don't see where it's administered as a major issue, as long as the program itself continues to provide good service.
L. Reid: If there is no rationale for why it needs to change, is there perhaps a cost savings around moving the program? Has that been a consideration?
Hon. P. Ramsey: I think the cost efficiencies that have been attained in the program have been through the contracting process for delivery of home oxygen. The question of where it is administered is a separate issue. I believe one court decision suggested that continuing care was a more appropriate place for home oxygen. The Pharmacare panel seconded that view in terms of where sets of services are coordinated and administered.
L. Reid: So you're convinced today that the same quality will reside in the program. I had some concerns about Pharmacare because oxygen is not typically considered a drug, and certainly that was your comment earlier on. If you can assure me, though, that the same quality will be available in the program, I would be interested in your comment.
Hon. P. Ramsey: I can assure the member that the same quality will be maintained for the program.
L. Reid: For a number of suppliers, there seems to be some discussion regarding Bill 38, which I know is before us. Do you anticipate any changes under sections 1.1 and 1.2, I believe, of Bill 38? Will that impact on the discussion we have just had in terms of continuing to provide this program?
Hon. P. Ramsey: This might be more appropriately carried on in debate on Bill 38, actually. Bill 38 provides the ministry with the ability -- an ability which the court ruling said was not as clear as it might be -- to designate programs as continuing-care programs. That will not change the quality of the service that is provided.
L. Fox: I'm pleased to take part in these estimates. I have a number of questions specifically around issues in my constituency -- and the Health minister's constituency as well, I believe, as we share the same health facilities in the city of Prince George.
First, on Thursday of last week the minister announced a new panel to do a review of PGRH. Could the minister give us some specifics as to the terms of reference of that review panel? There's some question, certainly in my mind and I know in the minds of residents of Prince George, about this whole process.
Hon. P. Ramsey: Yes, I was pleased to announce last Thursday the establishment of a study team to advise me on several aspects of the operation of Prince George Regional Hospital. I apologize if the member opposite did not get a copy of the news release that announced that, because the terms of reference were incorporated in it. I will try to reconstruct them as accurately as I can.
The first priority was to look at the immediate financial requirements of Prince George Regional Hospital in the current fiscal year and to make recommendations to me and to my ministry. Obviously the member is as aware as I am of great community concern that the same level of services be maintained for the areas served by Prince George Regional Hospital. I share those concerns. I want to make sure that Prince George Regional Hospital takes all the initiatives that it needs to in terms of coordinating with other agencies, making use of funds that are available through the Closer to Home fund, coordinating well with community hospitals from surrounding communities and doing a number of other things. At the end of the day, the people of Prince George need to be assured that services are going to be maintained at Prince George Regional Hospital. I've asked this committee to advise me on funding requirements to make sure that services are maintained.
The second issue is a little broader. As the member opposite knows, in the fall of 1993 the Cranston study on the operation of hospitals and other facilities in the northern interior health unit was reported out. That study made a substantial number of recommendations -- over 130, I think -- and I suspect that over half of them involved the operation of Prince George Regional Hospital. After that study, the hospital itself produced a strategic plan for improving its operations over the next several years, and it incorporated many of the recommendations from the Cranston report. Therefore the second major task of the study team is to look
[ Page 12403 ]
at how the hospital has implemented the recommendations of the '93 report and advanced its work on the strategic plan.
[11:00]
The third issue they're asked to report to me on is a clear definition of what the regional role for the hospital in Prince George should be. As you know, hon. member, there's been a good deal of discussion about what a regional role consists of, and identification of its regional role is a priority in the strategic plan for the hospital. It needs to be addressed as we set up a regional health board, one of whose primary responsibilities will be to ensure high-quality acute care services to the people of the central interior.
L. Fox: Perhaps the minister could tell me what the qualifications of these four individuals are -- besides the fact that they all appear to be supporters of the NDP -- in terms of making these very objective explorations into the problems at PGRH. It would appear to me that the minister is looking for a report that allows him to provide some bridge funding. I wouldn't necessarily disagree with that, if that is the objective of this whole study team. Obviously there are some real needs in that hospital. But in talking to the board members and to administration, it appears to me that one of the main constraints on this hospital, which we talked about at some length Thursday, is the effect of the health care accord -- some $500,000 over the next year. The impact of the accord on the Vanderhoof hospital is $125,000, which is a real problem for them in balancing their budget.
The Prince George Regional Hospital used to be a regional hospital, which was relied on by pretty much all of northern British Columbia. We can no longer do that. I draw the minister's attention to the fact that all four of these individuals are from Prince George. It used to be a regional hospital, but more and more it's becoming a community hospital.
We had a case in point this weekend where a young boy in Vanderhoof broke his leg just below the hip. He's been lying in the bed in Vanderhoof until now, not being accepted into Prince George in order to see an orthopedic surgeon to have his leg pinned. Because of the downgrading of that hospital, he cannot be referred there for the necessary surgery. We saw a situation not too long ago when a lady from Burns Lake travelled to Prince George to have a gall bladder operation. She had to continue on to Quesnel in order to have the surgery, and by that time it had ruptured. Her health was in extreme danger. Once again, Prince George Regional Hospital could no longer provide regional service.
If this study team is going to be of real value to the northern part of the province, it should have more than just Prince George people on it, with some expertise that understands the delivery of health care in rural and central British Columbia. It should be able to address and explore why these kinds of problems occur on a more than uncommon basis. In fact, it's the common situation -- a doctor in Vanderhoof spent three and a half to four hours, which is valuable time, on the telephone trying to get his patient into the Prince George hospital in order to have that necessary surgery. At the same time, the ministry is screaming at the smaller rural hospitals to cut down their patient-days, when in fact there is a patient sitting in that hospital for three days who can't get services in what used to be an automatic process at the neighbouring, supposedly regional, hospital. There is much speculation, not only among the health care deliverers of Prince George but also among the residents, that that hospital no longer carries a regional status and is in fact a community hospital rather than a regional hospital.
Hon. P. Ramsey: First, let me say very clearly that I think the time to engage in rhetoric about the services at Prince George Regional Hospital has passed. I'm a little distressed that the member opposite continues to sing the song that this is somehow not a regional hospital anymore. Any look at the specialties that are available at Prince George Regional Hospital and at the set of services it delivers would surely convince the member that this is a regional hospital that serves the northern interior of this province very well. In fact, hon. member, the Cranston study of last fall found very clearly that compared to other regional hospitals, a very high percentage of services required by people in the central interior for acute secondary-level services are provided through Prince George Regional Hospital. They said some 90 percent of all required surgical procedures were provided within the region, either at the community hospital or at the regional hospital. I invite the member to compare that with other regions of the province and to draw his own conclusions about whether or not the set of services provided proves that Prince George Regional Hospital is indeed regional. I would assert that it clearly is.
Having said that, I do not mean to minimize the stresses that Prince George Regional Hospital has been under. I would point out to the hon. member that we have increased funding for Prince George Regional Hospital, as we have in the past. The hon. member and I were both present at a ceremony yesterday opening a new psychiatric ward at Prince George Regional Hospital. The chair of the board acknowledged, among other things -- and I wish the member opposite might acknowledge it as well -- the provision of $971,000 for operating that facility to make sure that we have good mental health services for the people.
Interjection.
Hon. P. Ramsey: I see the member raising his finger and saying: "One facility; one service." I think the hon. member is also aware that very recently -- just in the last couple of months -- I was pleased to note that Prince George Regional Hospital and two other regional hospitals at Kelowna and Kamloops would be involved in providing advanced imaging technology through a mobile MRI facility that would travel between those regional hospitals. That's another new service. I think the member was also present when we opened some new diagnostic equipment last fall. To somehow assert that the story of Prince George Regional Hospital is less and less is simply contrary to the facts.
Let me say also that there have been continual assertions that somehow the set of specialties available at Prince George Regional Hospital is declining. With the exception of neurosurgery, which is a very hard discipline to recruit to -- and I regret that the neurosurgeon who practised in Prince George has chosen for personal reasons to locate elsewhere -- I am absolutely confident that we can recruit the specialists needed to ensure that Prince George provides all specialties on a 24-hour basis to the people of the community.
With that, I think I'll take my place. There is much else that I could say, and perhaps would wish to say, on this topic, but I may have another chance.
L. Fox: I'm disappointed that the minister would take the position he did, particularly with respect to this study team. He didn't address that concern at all. If he truly envisions Prince George Regional Hospital maintaining that status, why wouldn't he then look at a more regional concept in terms of the members on this study team rather than four
[ Page 12404 ]
sympathetic government individuals? There's no question that this study is a political initiative.
As the House may be aware, a new society has been struck in Prince George, a non-political body which intends to be a vocal point and a focal point for all the concern in the Prince George region. I think this was a move to try to take away from that concern. Also, the council had considered recently -- about two weeks ago -- doing a study of its own. Obviously this now takes the focus away from those independent bodies and tries to make a show that government really is concerned and trying to do something.
The minister should be well aware that the medical staff in Prince George do not share his opinion that that facility can continue to be a regional facility. In fact, only recently one of the medical staff called and talked to a doctor out in Vanderhoof, asking if there wasn't a possibility that they could refer some perinatal care out there, because there was no longer any guarantee that they were going to have the staff available to do C-sections on an emergency basis. The minister should inform himself that that is the kind of discussion happening between the medical professionals in those communities. They're really concerned that they will not be able to deliver the service in Prince George Regional Hospital, so they're looking at developing alternatives.
Why is that happening? Quite clearly, the constraints on that hospital are such, notwithstanding the fact that we've just opened a new psychiatric wing and the minister has guaranteed to fund it.... I don't believe that's all new funding. We had that wing in the hospital before, albeit it was archaic and certainly not efficient; we did fund that particular service before.
So let me just say this: if the minister is going to stand there with his head in the sand and continue to suggest that all's well in Prince George Regional Hospital, he is not facing straightforwardly the problems at that hospital. He knows full well that one of the major problems in creating a shortfall at that hospital is the health care accord. That is one of the major problems facing all rural hospitals in British Columbia.
Hon. P. Ramsey: I'm not going to reopen the debate on the accord. The member opposite and I and others in this chamber had a good discussion of the merits of the accord last week. I invite the member to refresh his memory on the positions taken by members of the House by reading Hansard if he wishes to revisit that debate. I don't intend to reopen that at this time.
Let me just say a couple of things in response. First, the member doubts that the funding for the new psychiatric wing is new money. I suggest that he ought to talk to the board of the Prince George Regional Hospital. They have no doubts. That's $971,000 of new money this year for an initiative that's been planned for some time. I welcome its addition to Prince George, as it was badly needed. Second, the member might also wish to ask the Prince George Regional Hospital board how much money was incorporated into their budgets to do exactly what this member is talking about in terms of recruiting and retaining qualified specialists. I think he'll find that the answer is over a quarter of a million dollars, to make sure that we have the specialists available in Prince George to provide service.
Finally, though, hon. member, I must say that your view of the study team is remarkable. I have no idea what the politics of the chair of the nursing program at UNBC is. I welcome Dr. Hardy's participation on the study team. To say that Ms. Anne Martin, who has been involved in health issues in Prince George for years -- including the Healthy Communities initiative and the establishment of a child development centre -- is somehow unqualified to sit on this strikes me as ludicrous. We have a good team in place. They will be hearing thoroughly from others.
I might also inform the member opposite that the chair of the community society that he refers to has asked whether he can sit as a member of the study team -- a request that is being considered now. I might also inform the member that in conversations with the mayor of Prince George, His Worship John Backhouse, I asked how he saw the committee he established and his relationship with it. His view was that his committee ought to be reporting to this study team.
[11:15]
So, hon. member, this team will be acting promptly to advise me and make recommendations on immediate financial needs. This is a problem that is being fixed. They will be acting comprehensively to address the regional role of Prince George Regional Hospital and assure the people of Prince George and area that high-quality services will be provided through that facility.
L. Fox: I'm not going to get into a long debate about the political biases of the study team; I think I've already made that point. The minister knows full well that that is the case.
It's unfortunate that he's only looking at it with a Prince George focus. That tells me and the people in the rural parts of British Columbia who depend on the Prince George Regional Hospital that its downsizing to a community hospital is going to inevitably take place. He's not concerned about the attitudes of the people in Burns Lake, Vanderhoof, Fort St. James, Dawson Creek and Mackenzie. They rely on that service and on the expertise that used to be offered at the Prince George hospital, but it's no longer affordable.
This government has done its best to pick a fight with the specialists that were in Prince George, and they created a lot of the difficulties. True, I'm sure the neurosurgeon would have moved to greener pastures in time anyway; we've had that problem historically. But more and more over the last few years we've seen that the quality of life that can be achieved in the northern and rural parts of the province has been desirable to those professionals. We've seen a lessening of that transition where doctors and professionals move out of the rural parts of the province into the more urban parts.
There's no question in my mind that the difficulties with the Prince George hospital -- the lack of surgery times and opportunities because of the constraints placed on that hospital -- were part and parcel of his decision to leave Prince George. I'm not saying that it was the primary reason, but I'm sure it was part of the decision that caused him to look elsewhere.
If we do not have a truly regional study of this hospital by individuals who understand the funding and delivery of health care in areas other than Prince George, this will be nothing but a political exercise by this minister. It will allow him some leeway to provide bridge funding on a one-time basis until all of these problems go to this new volunteer regional health board and are faced and solved by them. That is the number one concern in my region and in my constituency, and unfortunately I haven't heard anything from the minister here this morning that would convince me that this mess in that region is going to be improved over the long term.
Hon. P. Ramsey: You might say that the alarm of the member opposite seems to rise in proportion with his fear that it might actually work. We have a study team in place that is going to be making recommendations on the immediate financial needs of that facility, and I will be acting
[ Page 12405 ]
on their recommendations, hon. member. I don't know how I can state it any more clearly. We are clearly acting to address the needs of people in Prince George and the area and to allay their concerns that services are not going to be available. We've said to the study team that one of its primarily roles is to meet with health care providers in the broad region served by the hospital and recommend a process for ensuring a regional role for the hospital within the new emerging regional health board. That's one of its prime functions, hon. member.
Finally, let's just address very briefly the issue of attracting and retaining specialist services. As the hon. member said, this is an ongoing issue for those of us who live outside the major urban centres. Quite frankly, the concerns in Prince George were exacerbated for the last year or so by the fact that some specialists had chosen to opt out of medicare and extra-bill their patients. That created a dynamic that was perhaps unhealthy for patients in Prince George. We have now reached an agreement with the BCMA to ensure that extra billing ceases, and I think that is good news for the people of the region.
We're also taking clearer steps to make sure that there is a more equitable distribution of specialist services around the province. As a result of the cooperative agreement that we have with the BCMA on this and other issues, we are moving forward on permanent measures for physician supply and distribution in this province. That, I think, is good news for the region of the province that this member and myself represent.
L. Fox: I have one final question on this topic. Maybe the minister can give me some advice as to what I should tell the parents of this young boy who has been waiting for two and a half days to have surgery. He is sitting there with a broken leg and can't have it set because he can't get into the Prince George Regional Hospital. What would the minister have me tell his parents? Would he have me tell them that all's well in Prince George Regional Hospital and that we still have a regional hospital capable of meeting the needs of northern British Columbia? Is that what the minister would have me tell the parents of this young boy? Or would the minister have me tell him to jump in a bus and go to Vancouver, or some other hospital where he might get some services?
A call has been placed to the minister's office over this particular case, and it has yet to receive an answer. Every day that goes by could lengthen this young boy's recovery time, because this operation would be more complicated. What would the minister have me tell parents in this kind of situation?
Hon. P. Ramsey: First, hon. member, I hope you would express my sincere sympathy to the parents of the boy for the situation in which they and their family find themselves. I do not find that an acceptable level of service. We'll be working to make sure that that particular circumstance is addressed and, as I think I've said very clearly, that Prince George Regional Hospital continues to fulfil its role as a provider of high-quality acute services for people in the central interior.
L. Reid: I have some questions regarding protocols for information that's shared with members of this chamber. Specifically, what protocols have you put in place for individual MLAs responding to and receiving information from your ministry?
Hon. P. Ramsey: Would the member be a little more specific? I'm not sure what she's referring to.
L. Reid: I have made a number of requests to your ministry that have certainly not been forthcoming. There are some issues of policy and platform that are truly in your jurisdiction, but when simple statistical background information is sought, why is that not shared more readily? It seems to me, from what I have been asked on the telephone a number of times, that the policy would somehow be different if I were a government MLA. I have some concerns about that, and I have some questions that I would seek your guidance on.
Hon. P. Ramsey: As the member opposite knows, we have freedom-of-information legislation in this province that provides everybody with broad access to information to government and to information held by government. My view is very clear that anything available through those routes should be available to members of this chamber, regardless of their political affiliation, without the necessity of going through a formal process -- except, of course, where information that might well be subject to confidentiality provisions is asked for.
L. Reid: I appreciate the minister's comments, but I'll walk the minister back to January 14 when my staff and I were told that any requests would have to be routed through your office. I can suggest to this minister that there doesn't seem to be such paranoia in other ministries of this government. I can also tell this minister that freedom-of-information requests have gone in, and we are yet to receive them. This past Friday, June 27, we were notified that a 30-day extension for the information I had requested was now protocol. The FOI request has been outstanding for 30 days, and the ministry is asking for another 30 days. I have some serious questions about that when this is supposed to be an open process. We are in debates on the estimates, and the background information is unavailable to myself as the critic. That's not the open and honest government you promised the people of British Columbia.
Hon. P. Ramsey: I stated very clearly what I believe the policy should be and what the ministry seeks to accommodate, and I resent the implication that we're dealing with an environment in which information is deliberately withheld. I must say to the hon. member that there's a difference between asking for information and going fishing. Quite frankly, too often it seems to me that we have seen from the Liberal opposition, on this issue at least, a fair bit of fishing. A request for 180 audits -- some 15,000 pages or so of audits, some of quite inconsequential matters -- strikes me as something that's designed not to elicit information that might be useful in debate but simply to amass volumes out of which one might find the occasional finny beast swimming around.
I suggest, hon. member, if you wish to acquire specific information, let me know. But....
Interjection.
Hon. P. Ramsey: I suggest, hon. member, that we'd better be very careful about the sorts of questions that are asked, then. Too often, if they are very broad, obviously the ministry must comply, but that is an expense to this ministry and to government. So be very sure about the questions you are asking and make sure the information you are seeking is
[ Page 12406 ]
indeed information you wish to use, rather than simply for bookcases you wish to fill.
L. Reid: Surely this minister can appreciate and take into consideration that pushing individual legislators through the hoops is a cost to the system. For myself as the critic to request audits during an estimates debate certainly makes sense. That is the only avenue I have as the critic to receive that information. That is a very appropriate request.
[11:30]
You have made the comment that indeed your ministry must comply. Frankly, if it's not delivered in a timely fashion and they comply six months or 30 days from now, this estimates debate will be over. You will not have satisfied the requirement; it will be useless information at that point. It seems to me that I do have a recognizable concern here and that you have not addressed it.
Hon. P. Ramsey: Let me just say again that I've outlined my belief that information must be available in a timely fashion. It's incumbent upon those who seek it for this chamber to present the demand or request for information in a fashion that is also focused on some of the information already available. I understand that, on some issues, people in my ministry have had extensive consultations with staff of the Liberal caucus to ask them to narrow requests or accept information in a readily available form. Right now, I've been informed, in dealing with the requests for additional costs and getting requests granted, the ministry has hired some 15 additional staff. This is not a negligible expense to the operations of this ministry. I would ask the member to make very sure that when she or her staff asks for particular information, we have it in something that can be readily provided. I want to make sure that it is readily provided.
L. Reid: I'm somewhat astonished that 15 people have been hired and no material has been produced for the official opposition. I find that an alarming comment by the Minister of Health.
In debate on Friday we discussed the status of the regional health councils across this province, and the minister responded that if I wanted a checklist, that information would be available. I indicated that it would be a good starting point, because no other details had been made available. I would ask the minister to please indicate when I might expect that, so it may be considered a useful and timely piece of information.
Hon. P. Ramsey: If you wish to receive that this afternoon, you can acquire it.
L. Reid: Thank you, hon. minister; I will expect it in debate this afternoon.
I want to move to a discussion of administrators in this province, because the discussion always seems to be that somehow hospitals are not running as leanly as they might. That doesn't seem to bear out in discussions I have had with hospital administrators. They believe they are running their operations to the bone, if you will, in a lot of respects. As the minister has noted previously, we have discussed the accord in some detail. I'm not asking him to revisit that, but I'm interested in comments the minister might make in terms of advice to hospital administrators on how they can continue to downsize their operations. I have a lot of empathy with a number of administrators in hospitals which I have spent a great deal of time in over the last couple of years. They believe that their decision-making structures and administrative structures are cleanly delineated and are not excessive in any way, shape or form. Perhaps the minister could comment.
Hon. P. Ramsey: There is a whole range of areas that hospitals are being asked to address. We have said very clearly to hospitals that we want to work with them to establish teams that draw from my ministry and from hospitals to establish good practice in various aspects of hospital operation and to work with hospitals to make sure those good practices are implemented broadly within hospitals of various sizes in the community.
Let me give the hon. member a couple of broad parameters. As I've said -- and, I think, as the member knows -- consistently between 25 and 30 percent of patients who are admitted to acute care hospitals do not belong there. We have had studies of hospitals in B.C. that have confirmed those figures. Clearly that's an issue that those involved with patient care need to address. Consistently, about 20 percent of lab tests and imaging tests ordered in hospitals are redundant. After nursing, this is usually the largest single clinical department in the hospital. There are clear clinical areas that hospital administrators, working with professional medical staff and others, need to address.
I believe there is a lot of ground to be made up -- both on the administrative side in terms of amalgamating and streamlining administration, and on the patient-care side.
L. Reid: Certainly I think the minister would concur that British Columbia hospitals are among the most efficient in Canada. In fact, B.C. is below the national average for operating expenditures per capita, for operating expenditures per patient per day and for administrative expenditures. Yet it seems that we always come back to somehow suggesting that hospitals are not administratively sound and that in fact they are not delivering in as cost-effective and cost-efficient a manner as they can.
I appreciate the minister's comments on administrators bringing to bear on the clinical delivery systems, but certainly the basic tenor of the discussion has been that somehow administrators are at fault. I would suggest that that is not the case, based on the fact that they are the most efficient in Canada. It seems to me that individuals always hit on the fact that administrators are not efficient. That is not my understanding of hospital administrators in this province. Could the minister comment on his remarks?
Hon. P. Ramsey: I regret if my comments on the necessity of finding ways of operating hospitals more efficiently left that impression. Indeed, when I spoke to the hospital administrators' association of this province, I praised them. I said very clearly that they are helping to lead the way in developing hospital procedures for a health care system in Canada that will serve the twenty-first century, and I believe that. I do not believe that the hospital administrators are somehow either incompetent or inefficient. What the member says, I second. I find them, on the contrary, very highly trained and dedicated individuals who work very hard to make sure their hospitals are meeting the needs of the people they serve.
Having said that, what is the problem? The problem is the lack in the system that we have right now. With the best will in the world, most hospital administrators do not look outside the walls of their institution to see how the same set of care that they are providing inside might be provided either in conjunction with community services or displaced to community or home setting. It's not their fault; it's the fault of the system itself, and the fact that it's fragmented. We
[ Page 12407 ]
need to develop a system that allows those charged with delivering health services to look broadly at where those services are delivered in hospitals, clinics and homes, and to decide the best and most efficient option for the quality of care and the efficiency of the system.
L. Reid: In that we have canvassed hospitals in this province partnering with other hospitals for service such as laundry, kitchen, etc., I won't belabour that point. I would simply ask an additional question in terms of the steps your ministry has taken in streamlining administrative costs and what positive impact that has had. If we are asking hospitals to do that, I would be very interested to know what steps the ministry has taken in terms of reducing its own administrative costs.
Interjections.
Hon. P. Ramsey: It's good to hear a debate going on in this chamber among the members present.
Let me respond very clearly. Since September, work has gone on in the streamlining and restructuring of operations of the Ministry of Health. One of the things that has worked best is taking what used to be separate divisions within the ministry responsible for community and hospital services and combining them into one. For those looking at the operations of the ministry and the health system, we're saying that these functions should be combined and considered jointly out in the regions and communities. We're doing it here in our own organization. In the process of restructuring, we reduced the number of divisions within the ministry and the number of assistant deputy ministers from six to four; we reduced the number of senior managers at the executive director level by 25 percent. So we have taken some of the initiatives within our own ministry that we are asking people in the health field to take as well.
Also, we've attempted to do this in the least disconcerting way to staff as possible. Any change of this magnitude and impact will obviously be of concern to employees, so we've taken a number of initiatives to ensure that employees are fairly and openly dealt with, that they have the opportunity for input and design of the new branches, and that they understand clearly how reporting relationships are shifting within the ministry.
L. Reid: Could the minister tell us if British Columbians have derived a benefit, a cost saving, from the changes you've just outlined? What might that benefit be?
Hon. P. Ramsey: It is at least $1 million a year, and that's just in compensation for senior managers. For instance, if you look at the budget for regional services this year, I believe you will find a decrease in administrative expenses within that division of some 5 percent.
L. Reid: I have a number of questions on wait-lists in the province. Since December 1992, cardiac surgery wait-lists have definitely increased. There are a number of individual cases in this province that individuals in your ministry have responded to. A number of individuals on the caseload today are considered very viable candidates for cardiac surgery, and some of them have been waiting a year and a half and approaching two years. I can appreciate that the minister is working toward some kind of preventative care model in this province, but the individuals on the wait-list are taking a lot of services to support them while they wait. There are individuals who are having heart attacks while they wait, which is a huge cost to the system. I know the minister has the documentation, because it was simply copied to me. I know you are aware of a number of cases. I certainly don't intend to belabour the point in debate, but if necessary I can put those individuals onto the record. So what steps has your ministry taken to date to ensure that wait-lists, and particulary the cardiac wait-list, receive some response?
Hon. P. Ramsey: Actually, hon. member, if you check Hansard from last week, I read into the record some rather detailed figures on cardiac wait-lists in the period from 1991-92 to the present. For your edification, I'll read them again. Wait-lists for cardiac services in '91-92 had approximately 800 cases; the wait-list in April 1994 was approximately 320. They've stayed in the range of around 300 for the last year or so. The average waiting time for cardiac surgery is now eight to nine weeks. I recognize that any wait is distressing. I think the member recognizes that emergency cases are dealt with promptly. I know it's distressing to try to draw that line between what's an emergency and what's elective when you're dealing with a condition that is as potentially life-threatening as cardiac surgery. We have done a number of things to deal with the cardiac surgery issue, including establishing the Provincial Advisory Committee on Cardiac Care; making sure they have the right clinical indications for when cardiac surgery is required; and developing a comprehensive cardiac registry to actively monitor how those services are being obtained and used by the people of British Columbia.
[11:45]
The wait-lists and waiting times vary significantly between the 16 cardiac surgeons in the province. I think the member is aware of that. They also vary between hospitals. The patients are advised of those variations so they can make informed choices about their care and access to services. But I must quarrel with the member's overall assumption that these waiting lists have gone up markedly in the past three years. The figures I've just tabled suggest the reverse.
L. Reid: From the minister's comments, he's suggesting between eight and nine weeks. How do you reconcile that with the people who are waiting closer to two years? Those individuals exist today. I appreciated the minister's comment that the 16 surgeons perhaps have a different time line. But surely the difference between eight weeks and two years is significant enough for the ministry to address my concern.
Hon. P. Ramsey: I'd be very interested in seeing those cases. I'm unaware of cases where elective time for cardiac surgery has been greater than two years. If you have such evidence, I'd be glad to look at it and see what the cause of it has been.
L. Reid: The hon. minister does have this documentation as well, because individuals in his ministry did respond to particular cases that I have before me today. I'm happy to share that with the minister, because these individuals have been waiting a great deal of time -- closer to two years than to eight weeks.
In terms of diagnostic services, there seems to be a tremendous variation in the number of people waiting for CAT scans and MRIs in this province. Would the minister be prepared to confirm that the MRI wait-list today, on average, is about three and a half months? Is that still the status quo?
Hon. P. Ramsey: Just to return very briefly to the cardiac surgery issue, hon. member, I recognize that you may indeed have a case or two where somebody has waited an extended
[ Page 12408 ]
period of time. But I would ask you in return: let us not try to panic the people of British Columbia by suggesting that services, particularly for situations as serious as those requiring cardiac surgery, are not available. Let us not suggest that we haven't been dealing with waiting lists and attempting to bring them down. Let us not suggest that the serious need has not been recognized and is not being addressed. I am unaware of cases over two years. If you have such, I'd be interested in seeing it.
As for the MRI wait-list, your general assertion about waiting times strikes me as accurate. I need to review some of the detailed information.
L. Reid: I also have extensive documentation with me today on individuals on the wait-list for hip- and knee-replacement surgery. They tell me that the wait-list is approximately five months, and they also tell me that there are approximately 902 British Columbians waiting for replacement surgery as of April 1. Could the minister kindly confirm those numbers?
Hon. P. Ramsey: The member asked about wait-lists for joint-replacement surgery for hips and knees. Waiting times for elective -- and I emphasize elective -- hip- and knee-replacement surgery averages six months or less. It is an area that I think we need to do a good deal of work on to ensure that budgets for prosthesis are appropriate, and that these operations are not being performed in inappropriate circumstances. We're going to be asking some of the joint panels that we're working with to look at this situation and establish guidelines to make sure that these services are being provided when appropriate.
This service is now available in 25 hospitals around British Columbia. The waiting times vary quite a bit, from a low of three weeks to a high of around 40 weeks. Many hospitals seem to be in the 11-to-15-week average waiting time.
L. Reid: I would ask the minister to address what steps he has taken to reduce these waiting lists. I was somewhat intrigued by the phrase "inappropriate circumstances." I can't imagine any British Columbian asking for inappropriate hip or knee surgery. If exceptions do exist, I will accept that, but I have some serious concerns surrounding that as a blanket statement.
I would also ask the minister to comment on his justification that surgery for those individuals is considered elective. At the end of the day, the taxpayer is still paying. They are paying for home support; qualify of life is in question. We're looking at a whole array of costs because we're not able to get those individuals into hospital to have that looked at. We also have people who are off work awaiting that surgery, in a number of instances, and that cannot be the best value for the taxpayer in this province. Could the minister kindly comment?
Hon. P. Ramsey: Surely the goal of this ministry and this government is to make sure that people receive the health services they require in a timely manner, and that is as true of hip- and knee-replacement surgery as other services. But I would point out to the hon. member that this area of surgery is recognized across this country as needing some scrutiny in terms of guidelines for use of that surgery. That's not true just of this province, therefore I expect that the Medical Services Commission will be looking into that area to establish some clear clinical guidelines. This is not saying -- and I hope the member is not hearing me say -- that surgery should not be provided when needed. It is saying: "Let's look very carefully at the criteria for this particular procedure."
L. Reid: Perhaps the minister could respond to the second part of the question, which was about elective surgery. As for the individuals who are on the wait-list, even though someone has deemed that surgery to be elective, the taxpayers are still paying for them to receive at-home support and all the other services they need because they're not able to get into a hospital.
I have some real concerns around the elective designation. I think we slough off the problem when we suggest that it's only elective. If you're in pain every day, it's not elective. A number of individuals have come to me saying that they're not able to work, that they have no quality of life and that they are being told that the wait-list is four, five or six months. Why is that in the best interests of your ministry and why is it in the best interests of the taxpayer? I'm not convinced that that's a rational response.
Hon. P. Ramsey: I would surely not wish to be heard saying that those who require that sort of surgery should return to work or should not have access to it for other reasons. That's not my import, and I hope the member doesn't hear me saying that. The conditions that require this surgery are very often progressive and degenerative. Quite frankly, the point at which surgery becomes the preferred medical option seems to vary from surgeon to surgeon and from facility to facility. We need to ensure that we have better clinical guidelines in place for managing this situation, which are broadly applicable for this set of services, as well as for many others. That does not diminish the necessity for making sure that those who require the surgery on an emergent basis receive it promptly.
L. Reid: I am still attempting to get to the notion of how "elective" is determined. It seems to me -- and a number of patients have indicated to both you and me -- that hospitals seems to have a quota, and once they reach that, everybody else becomes elective. I have some questions about that, and it has been covered extensively in the press in the last two and a half years in terms of hospitals saying that synthetic joints are not in large supply in some hospitals. They simply get to the end of their quota, if you will, and that surgery is no longer available. Everyone else then becomes elective. Is that something that this ministry has addressed and can rectify?
Hon. P. Ramsey: I am not sure how best to address this. There are a variety of issues here. First, we need to make sure that the surgery is being performed when it's needed. And that's going to require a good deal of work between those who are responsible for governing health care institutions and those who deliver the service in them -- physicians and surgeons. Second, the member raises the issue of budgets for what I think one of the hon. members referred to as the "hardware of orthopedic surgery," and that's a concern I personally have. Hospitals allocate their budgets in various ways for surgical procedures, and they need to take account of how that internal allocation is being done. The third issue is that these are not procedures without their risks, trauma and consequences for those who undergo them. Those who decide to authorize these procedures must weigh very carefully the consequences of the operation versus the potential benefit to the individual. That task has to be done sensitively, but it also has to be done in a comprehensive
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manner, not assuming that we have one solution that's going to fix all.
With that, I would move that the committee rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; the Speaker in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Hon. P. Ramsey moved adjournment of the House.
Motion approved.
The House adjourned at 11:58 a.m.
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