1995 Legislative Session: 4th Session, 35th Parliament
HANSARD
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
WEDNESDAY, MAY 17, 1995
Afternoon Sitting
Volume 20, Number 4
[ Page 14359 ]
The House met at 2:06 p.m.
F. Gingell: My wife always used to complain that she was always known as Jennifer's mother. I know not whether the parents of Sandra have always been known as Sandra's mother and father, but I do wish to welcome into the House the parents of Sandra Throness, a Liberal researcher. And I ask the House to welcome Al and Maria Knak.
S. Hammell: I'd like the House to welcome Mr. Teather and 14 grade 10 students from William Beagle Junior Secondary School in Surrey. Could the House please make them welcome.
W. Hartley: In the members' gallery today we have some visitors from Great Britain. From Preston, England we have Harry and Marion Lee. They're in B.C. to celebrate the birth of their granddaughter, Savanna Robbins, in Maple Ridge. With them is Les Gardner, who is godfather to our daughter Wallis. Accompanying the group are the two most important people in my life: my wife, Alice, and my daughter Wallis. Please welcome them.
D. Symons: It's my pleasure to introduce today Patricia and Allan Morrison. It was my pleasure to know Allan in a former life, as a colleague in the teaching profession. I welcome him to this House. Would the House please make them welcome.
D. Lovick: In the gallery today is a very dear friend of mine, Mr. Stan McRae from Gabriola Island. Stan is one of those rare friends who is also aware of the fact that the best friend is the most critical, and he often gives me some very good advice. He and his partner, Maxine McRae, recently donated a chunk of their property to create the Gabriola Museum on the island. This wonderful, self-effacing man is here in the gallery today. I ask my friends to please make him most welcome.
MOTOR VEHICLE AMENDMENT ACT, 1995
Hon. J. Pement presented a message from His Honour the Lieutenant-Governor: a bill intituled Motor Vehicle Amendment Act, 1995.
Hon. J. Pement: I'm pleased to present this legislation that will reduce the $2 billion-a-year traffic accident problem we experience in British Columbia. Our strategy targets high-risk and bad drivers. Our traffic safety initiatives are speed-monitoring cameras, driving prohibitions, vehicle impoundment and enhanced probationary licensing for new drivers. We will be working and consulting with police detachments, local governments, traffic organizations and concerned citizens over the next six months before implementing these initiatives.
Because unsafe speed kills more than 100 people in British Columbia each year, we propose to introduce speed-monitoring cameras. Because drinking drivers cause one-third of all road fatalities, we propose an automatic 90-day prohibition for anyone caught drinking and driving. To make sure that these drivers stay off the road, we propose to impound the vehicles of anyone caught while prohibited or unlicensed. Finally, we propose tougher conditions for licensing new drivers, including a zero-alcohol limit during their prohibition and longer waiting periods before taking the road test, as well. These measures should save 100 lives in the first year, thousands of injuries and $350 million a year in health care costs, work loss and insurance claims. Therefore, Mr. Speaker, I move the bill be read a first time now.
Bill 25 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
MISCELLANEOUS STATUTES AMENDMENT ACT (No. 2), 1995
Hon. C. Gabelmann presented a message from His Honour the Lieutenant-Governor: a bill intituled Miscellaneous Statutes Amendment Act (No. 2), 1995.
Hon. C. Gabelmann: Hon. Speaker, I move the bill be read for the first time now.
I'm pleased to introduce Bill 24, the second Miscellaneous Statutes Amendment Act. This bill amends the following statutes: Court of Appeal Act, Evidence Act, Family Relations Act, Financial Disclosure Act, Labour Relations Code, Liquor Distribution Act, Motor Dealer Act, Motor Fuel Tax Act, Municipalities Enabling and Validating Act (No. 2), Special Accounts Appropriation and Control Act, Statute Revision Act, Trustee Act, Wildlife Act and Workers Compensation Act.
Bill 24 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
Hon. G. Clark: I'd just like to inform the House of our discussions with respect to the next couple of days of business in the House. We've had some discussions with opposition parties. Members know we were considering having tomorrow treated as a Friday. I've talked to the Reform Party and the Liberal Party. I haven't talked to all members of the House, and I apologize for that. We plan tomorrow to call the House, of course, at 10 o'clock as per the standing orders and to have, by agreement, question period at 10 o'clock. Then the government intends to call Motion 87 standing in the name of the Premier on the order paper for further debate on a very important matter, which I know the Speaker is familiar with.
COLUMBIA RIVER NEGOTIATIONS WITH BONNEVILLE POWER ADMINISTRATION
G. Campbell: On September 8, 1994, the Premier signed on behalf of all British Columbians a memorandum of negotiators' agreement with Bonneville Power. In October 1994 it was clear that the energy markets were dramatically shifting. On December 31, 1994, the Premier knew that no definitive agreements had been finalized with Bonneville Power. On April 24, 1995, the Minister of Employment and Investment knew that the negotiations were in serious trouble and that the dollars the government had expected would not flow.
[ Page 14360 ]
The Speaker: Your question, hon. member.
G. Campbell: Can the Deputy Premier tell the people of B.C. exactly when she was informed by the Minister of Employment and Investment that the deal with Bonneville Power Administration was in trouble?
Hon. E. Cull: I continue to be surprised at the line that the Leader of the Opposition is taking on this one. The position on this side is that a deal is a deal. I wish...
Interjections.
The Speaker: Order!
Hon. E. Cull: ...the opposition would get behind the people of British Columbia and be on the side of B.C. when it comes to this issue with Bonneville Power Administration.
Interjections.
The Speaker: Order, please, hon. members. It's very difficult for us to conduct question period in a responsible manner with the interjections that are taking place. I would ask members, in deference to those who are trying to hear questions and answers, to please allow this process to proceed with a minimum amount of interjections.
[2:15]
G. Campbell: It's a little bit much for this government to be claiming to be anti-American in view of the thousands of phone calls they make to their American consultants to tell them how to manage their bungling.
The question to the Deputy Premier is: when did you know that the negotiations with Bonneville Power Administration were in trouble? When you did know that? If you did know it on April 24, why don't you have any contingency plans in place as opposed to high-blown rhetoric? Why don't you, in fact...? Why didn't you have the answers yesterday for how you were going to deal with the loss of $250 million in your budget?
Hon. E. Cull: We on this side of the House are not anti-American; we are pro-British Columbian.
When it comes to dealing with our budget, I can tell the hon. member that we intend to be on target with our budget, as we have been in each and every year of this administration. We will have a surplus, we will maintain our three-year tax freeze, and we will ensure that we manage the finances of this province to stay on track.
M. de Jong: British Columbians have learned that they are out $250 million because the Minister of Employment doesn't know the difference between a negotiators' memorandum of agreement and a legally binding contract.
Interjections.
The Speaker: Order, hon. members. Order!
M. de Jong: Yesterday the minister said that he intends to challenge Bonneville Power Administration on the basis of his belief that the memorandum is "legally significant." What's really significant here is that we have a government that spent $250 million it doesn't have.
My question to that minister is: how can British Columbians have confidence in his ability to represent their interests in negotiations, when events to date prove quite conclusively that he's out of his depth, he's out of his league and he should be out of his job?
Hon. G. Clark: It's interesting to see the Liberals continually take the Bonneville Power Administration's position over that of the government of British Columbia. I think the people of British Columbia will be very interested in that position. I want members to know that if they had done any research at all, they would know that other utilities around the Pacific Northwest and elsewhere have been dealing with Bonneville Power Administration over the last few months, and they know there is a pattern of unscrupulous business practices by Bonneville Power Administration.
We have a memorandum of agreement with Bonneville Power Administration that obligates them to bargain in good faith to conclude the principles of the agreement that we reached. I challenge members opposite to get onside with the government as private power producers are, as other utilities are, to challenge this American company that's acting in bad faith, and to stand up for British Columbia for once -- to show some leadership, rise above their petty politics and stand on the side of British Columbians and against Bonneville Power Administration.
The Speaker: Supplemental, hon. member.
M. de Jong: The minister calls on British Columbians to join with him in a fight against Bonneville. I believe that British Columbians will come together to preserve their interests, but they will not be made to look a fool the way this minister has been made to look a fool. They want to know what remedies are available to them under this memorandum, and they don't trust the minister to tell them the truth on that question.
The minister said that he had a legal opinion. He then changed that to say that he was having a legal opinion prepared for him. My question to the minister is: does he have a legal opinion? Will he commit to releasing that legal opinion today, so that British Columbians will know what their position under that memorandum is before he goes off half-cocked and compromises British Columbia's interests some more.
Hon. G. Clark: At the last meeting of the chief negotiators, Bonneville informed us that they wanted to renege on the deal they made, notwithstanding that they signed their name on the paper, that they came up and had a press conference and praised the agreement. Just a couple of days ago, when they announced they wanted to renege, they said they would write a cheque to us right then for $250 million (Canadian), but that they wanted more for it. If we wanted to play politics with British Columbia, we could have said we'd take the money. We're not prepared to compromise this legacy of British Columbia for short-term cash. We said to them: "We don't care what you do. We're calling your bluff, and we're
[ Page 14361 ]
playing hardball with you." We're standing up to them as no previous government has, and we believe British Columbians want us to stand up for this legacy for ourselves and our future generations. The Liberals should get onside and support us in fighting this American company.
COLUMBIA RIVER NEGOTIATIONS AND COMMITMENTS TO KOOTENAY REGION
J. Weisgerber: My question is to the Minister of Energy, Mines and Petroleum Resources. This government deliberately misled British Columbians about the legality of the Columbia downstream benefits deal. The government deliberately misled British Columbians into believing that we had $250 million in cash from Bonneville, and further, this government committed a billion dollars to projects in the Kootenays on the basis of that agreement. Those commitments were deliberately misleading. They were irresponsible, and indeed they were mischievous as far as the people of the Kootenays were concerned. Will the minister confirm now that those projects will have to be put on hold until this Columbia deal can be resolved?
Interjections.
Hon. A. Edwards: If I may speak quietly and be heard, I will say again very clearly: this government made a commitment to the people in the basin of the Columbia River. We made a commitment that we mean. We will stand by that commitment.
The Speaker: Supplemental, hon. member.
J. Weisgerber: Will the minister then confirm that even if this government is unable to sell the downstream benefits in the United States, even if it is obliged to take the electricity back into Canada from the United States, it will go ahead and spend, in addition to that, $1 billion on new generating facilities in the Kootenays?
Hon. A. Edwards: We made a good agreement with the people of the Columbia Basin, and we intend to stand by it.
COLUMBIA RIVER TREATY BENEFITS AND 1995-96 BUDGET
F. Gingell: Yesterday the Minister of Finance said that I was very selective in what I report before she read excerpts from a letter written by the comptroller general. But it was the minister who was selective. The comptroller general had stated in an earlier letter dated October 26, 1994, that in his opinion "to account for the revenue as cash as received is contrary to the province's accrual accounting policy." Yesterday the auditor general reiterated his opinion on this matter when he said: "It's just wrong." Why did the minister go against the advice of her two most senior advisers and include the $250 million in this year's revenue budget?
Hon. E. Cull: The member continues to be selective. There were three letters that were written on the accounting treatment of this revenue. All three of those letters were provided to the opposition critic and to the third party, along with briefings from our comptroller general. Having looked at all three opinions, the comptroller general then issued a fourth letter outlining the advice that he gave to me, because the opinions were contradictory and could not be resolved. I read the words yesterday and, based on the advice of the comptroller general when we had to make final decisions about the budget, he indicated that the way to treat this was as revenue for 1995-96.
The Speaker: Supplemental, hon. member.
F. Gingell: Mr. Speaker, that letter is dated after the budget was issued. The letters they had from the auditor general and from the comptroller general both said it was inappropriate treatment, so the minister went shopping for another opinion.
The Minister of Finance has created a debt management plan based on surpluses that her government has yet to generate and on $5 billion from a deal that has yet to be finalized. This is what happens when puffery takes over and government is more concerned with propaganda than with accurate reporting and good fiscal management. Why did this minister tell the families in British Columbia that they have a debt management plan when they all knew that it was just smoke and mirrors?
Hon. E. Cull: I take considerable offence at the comments of this member maligning the comptroller general of this province and suggesting that our comptroller general would provide opinions that he did not stand behind.
Some Hon. Members: Shame!
Hon. E. Cull: I think the shame, hon. members, is on that side of the House for suggesting the comptroller general would in fact give an opinion that he did not stand behind.
Interjections.
The Speaker: Order, hon. members. Hon. members, with the greatest of respect, I think that we've reached a point where we have to decide whether we're going to conduct these questions and answers in a reasonable manner or lose complete parliamentary decorum in the process. I would hope that members would consider that we are dangerously close to losing our ability to show the credibility we all are responsible for.
Hon. E. Cull: The remainder of the member's questions with respect to the debt management plan shows that he simply doesn't understand the plan or estimates. The estimates that are tabled in the House are indeed estimates. All the revenue estimates are the best estimates that the government can make at the time based on the advice of the comptroller general; that's what's included in the estimates.
The debt management plan does not deal with dollars; it deals with the percentage of debt to GDP. That percentage will be maintained whether revenues are higher or lower than anticipated.
[ Page 14362 ]
COLUMBIA RIVER TREATY
G. Wilson: My question is to the Minister of Employment and Investment. At 10:30 on April 22 in Fairmont Hot Springs the annual Kootenay-Boundary conference was told -- with the Minister of Energy present, and I believe this minister, in addition to their legal counsel, Lidstone and Young -- that the government was preparing to provide the ten-year notice period for the cancellation of the Kootenay treaty. Could the minister confirm that that took place, and could the minister tell us whether or not that may have a bearing on a contract that was going to be 30 years in endurance?
Interjections.
The Speaker: Order, please.
The hon. minister.
Hon. G. Clark: I'll take the question on notice.
The Speaker: The question is taken on notice. The bell terminates question period.
The hon. Leader of the Official Opposition rises on a matter.
G. Campbell: I ask leave to move the following motion: whereas Bonneville Power Administration has backed out of the memorandum of negotiations agreement dated July 8, 1994; and whereas Bonneville's decision to withdraw from negotiations may seriously impact all British Columbians, and most particularly those residents of the Kootenays; therefore be it resolved this House do establish a special all-party task force, including independent members, whose mandate will be to investigate and develop a strategy that will ensure that British Columbians receive maximum benefit for the Columbia River Treaty legacy.
[2:30]
Interjections.
The Speaker: Order, please. Shall leave be granted?
Interjections.
The Speaker: I hear a no, hon. members.
Leave not granted.
Interjections.
The Speaker: Order! The opposition House Leader rises on a matter.
G. Farrell-Collins: I am shocked, and I guess the truth is out now as to who wants to work together for British Columbians and who wants to work for their own re-election.
Hon. Speaker, I ask leave, pursuant to standing order 35, to move adjournment of the House for an emergency debate, notice of which I've given you under practice recommendation No. 8.
As we all know, the Bonneville Power Administration announced that it would not be proceeding with an agreement between the province of British Columbia and the company for the return of downstream benefits. The collapse of the agreement creates a definite matter of urgent public importance to the people of the province. Failure to conclude this agreement leaves the province short by $250 million in this budget year. It also calls into serious question the veracity of the numbers in the budget we've already passed -- not spending, but revenues. Clearly the matter impacts severely not only on the people of the Kootenays but on the entire province.
We and the government have now tried on three separate occasions, under the standing orders, to bring this urgent matter before the House. It must be debated. It's only decent that the debate take place in this House and not be forced into the corridors outside these doors. Hon. Speaker, we believe a clear mandate is provided under standing order 35 for adjournment of the House in order to deal with a matter of urgent and pressing business.
Hon. G. Clark: Just briefly, Mr. Speaker, I believe you ruled on this very question and, of course, ruled appropriately. I've indicated to all members of the House before question period that we'll be debating this very question of Bonneville Power and trying to seek all-party support for the government's position with respect to dealing with Bonneville Power Administration tomorrow morning after question period at 10 o'clock. It seems to me that that's the appropriate course of action. It's on the order paper. I have indicated that I will be calling it tomorrow.
J. Weisgerber: Mr. Speaker, I do agree that you ruled on this yesterday. I think it's unfortunate that the government hasn't brought forward the estimates of the Minister of Energy, Mines and Petroleum Resources, which could have been called into this chamber this afternoon at 2:30 -- and perhaps still could be if, indeed, the government is genuine in wanting to advance this debate as early as possible.
W. Hurd: I believe this is a matter of urgent and pressing public importance to the people of the province, and it's important to note that the government motion, as I understand it, is not yet on the order paper, and will not be until tomorrow. Obviously it becomes a matter that should be dealt with in the House today. I am appalled, shocked and surprised that the Government House Leader would oppose...
Interjections.
The Speaker: Order, please.
W. Hurd: ...this motion for purely partisan reasons. I believe this is an important and pressing public matter which should be dealt with in the chamber today while people are here while we don't have a day before a long weekend, and I hope that this motion can go forward.
The Speaker: The Chair will consider the matter that has been presented and bring back a decision shortly.
[ Page 14363 ]
Hon. G. Clark: I call Committee of Supply. In Section A, I call the Ministry of Health and Ministry Responsible for Seniors, and in Section B, I call the Ministry of Aboriginal Affairs.
The House in Committee of Supply B; D. Lovick in the chair.
ESTIMATES: MINISTRY OF ABORIGINAL AFFAIRS
(continued)
On vote 10: minister's office, $322,041 (continued).
A. Warnke: After such a joyous atmosphere here during question period, I'm tempted to ask the question and really put the cat among the pigeons: sometimes a figure of $6 billion to resolve our land claims is tossed around -- is that equivalent to the downstream benefits we were supposed to get from Bonneville? But I'll avoid asking that question -- unless, of course, the minister wants to respond.
Interjections.
A. Warnke: It's interesting what kind of stimulus follows from Aboriginal Affairs, and I hope that all members continue this enthusiasm for the rest of the afternoon, because aboriginal affairs is indeed one of the most exciting issues of our time, so anyone who wants to participate.... I see there are all kinds of people who are ready and willing to get involved in this debate; I should encourage that. I see that the Minister of Social Services can hardly wait to get in here and talk about Aboriginal Affairs -- that's good to see, and I'm sure she'll have her opportunity.
There are a number of issues I want to explore in Aboriginal Affairs, and one concerns the Sechelt land claims. As the minister is fully aware, the Sechelt case is quite different from a number of the other models and cases throughout British Columbia insofar as a form of self-government has been established since 1987 under the federal and provincial acts. Now we see that with the current Treaty Commission process, the Sechelt band has filed the intent to negotiate, and I believe that it's at one of the most advanced stages, if not the most advanced, in negotiations. There are some aspects of the Sechelt self-government model that British Columbians are certainly very interested in. I would like to explore very briefly with the minister -- because we obviously don't want to belabour the whole of the Aboriginal Affairs estimates -- the present state of the Sechelt case. I invite the minister's descriptive remarks as to the current state of the Sechelt case.
Hon. J. Cashore: I think the hon. member is aware that the Sechelt negotiation, which is under the auspices of the B.C. Treaty Commission, is, as he says, a very special negotiation. In a way, it's the other half of the job that needs to be accomplished here, given that the work on self-government was accomplished previously.
The state of the negotiation is that this is the first negotiation under the B.C. Treaty Commission process to have entered the AIP stage -- at least, to be ready to enter the AIP stage. The Sechelt nation itself has been declared ready, and the government of British Columbia has been declared ready. It has been reported in the press in the Sechelt area that the government of British Columbia has its mandate to begin negotiations, and that there's some frustration that the federal government does not yet have its mandate to begin negotiations.
A. Warnke: One area I would also like to explore is one I touched on very briefly in another context. In some of the material released on the Sechelt land claim earlier this year, there was a reference to the financial component of the settlement. I made mention yesterday of the $60,000 estimated package value per capita, also taking into account that adjustment which equals $85,400 per capita. I'd like to get clarification on this from the minister. Are these just perhaps figures that are used as sort of an estimate, or is there something concrete in which these figures are presented?
Hon. J. Cashore: With regard to that question, the Sechelt have been unusual in comparison to other modern treaties in that they have produced a vision. That's a vision they have chosen to make public, for which I commend them. We don't in any way automatically accept their opening position. What they've put out there is an opening position, and it's stated in the context of a vision. It is commendable that they have done so. I don't think it should be construed by the public in any way, shape or form as anything that would describe the result of the negotiations.
I should also point out with regard to the Sechelt negotiation that I'm very, very impressed with the way in which the parties have worked to gain a very positive relationship with the third parties. The third parties -- representatives of various business groups, industries, labour and other interests in the area -- have been exemplary in the way they have entered into this process: genuinely seeking to be part of the solution and recognizing the opportunities that can come from an appropriate settlement.
I'd also just say that when I was at the meetings of the Union of B. C. Municipalities last September, I had appointments to meet with about 40 municipal delegations from around the province. One of the most delightful experiences I had was when the Sechelt band council showed up with the Sechelt municipal council to come and tell me that they didn't really have a problem that they wanted to discuss with me; they wanted me to know that they are an example of how a first nation and a municipality can work together cohesively and for the good of the area, while at the same time they can respect each other's vision for the future. As I say, I think it was exemplary. It has certainly helped to round out my understanding of what can be accomplished when parties come together. It's often in the context of hard-nosed negotiations, but there's a very basic feeling of respect for each other and of knowing what accomplishments can come out of it.
[2:45]
A. Warnke: There are some issues that the Sechelt have introduced with regard to the expansion of their land base and future land acquisition. There is an impression that the boundaries have been more or less established in the Sechelt case. That is not the case with many other bands and their intentions to promote their land claims. In the case of the Sechelt, the boundaries are pretty well established -- that's number one -- and therefore there is some question about land acquisition. I would like to have the minister respond to that.
[ Page 14364 ]
Actually, connected with this is the notion of subsurface ownership. I recognize that what the Sechelt have put forward is their opening position, but there is a concern here that if both the federal and provincial governments actually made a deal in 1987 in which they held control over the resources of the area, why is any consideration given to repealing the legislation as it affects Sechelt lands? I would like the minister to provide a response to those two issues.
Hon. J. Cashore: The self-government arrangement has to do with reserve land. They have tabled a position that would add land to that. That's the context of what we're going to be discussing at the table.
With regard to the question around repealing a decision in relation to subsurface rights, that is not a consideration that has come up for discussion, to my knowledge. It's difficult for me to speculate on that.
A. Warnke: Therefore the minister's answer is an interesting one, because he is.... I think the magic word here is "speculating." In other words, this is something to be negotiated down the road, and therefore it is certainly not the position of the British Columbia government to begin with any sort of concession on subsurface ownership. Is that correct?
Hon. J. Cashore: We haven't engaged in discussion with the Sechelt yet on this issue, but I think it is informative that one approach which I have referred to in this House with regard to the Nisga'a is where we have.... Recognizing that the settlement lands include reserve lands plus a modest expansion, we would see the subsurface rights going to the first nation in that situation, and we would not see subsurface rights going to the first nation outside their settlement area, which I think, again, is a very limited and confined area.
A. Warnke: Also there is the question of.... I suppose it revolves around the titles here of "certainty" and "finality." Again, what I've heard from a number of people is that -- and there is an impression, with regard to the Sechelt nation.... Wasn't there some sort of certainty and finality? Indeed, one story I heard.... I have not been able to confirm it; perhaps it's an apocryphal story; I haven't really been able to nail down its source. At the time of the negotiations -- I believe it was Minister Tom Siddon who was leading the federal government side -- there was supposed to have been the impression cast to the Sechelt people that when a treaty is established, as the one in 1987, it is final; it really cannot be renegotiated. My impression is that it was not final in 1987; there were clauses that still allowed the Sechelt to.... At least the way I read it, there was the opportunity there for the Sechelt to reopen the negotiations. But I would like -- since the concern is there -- for the minister to perhaps give some comment as to this whole question. Was the 1987 treaty final? I guess it really begs the question, too, as we proceed with dealing with the Sechelt: will we reach, or is it the objective to really reach, some sort of sense of finality or certainty? I recognize some of the comments that were made a few days ago by the minister -- that it's very difficult to cast something so strong as a final position that does not allow for some flexibility to readdress some anomalies that might be detected later that are not detected now. Nonetheless, in the Sechelt case, perhaps the minister could address the question of finality.
Hon. J. Cashore: My understanding is that the 1987 Sechelt agreement was a self-government agreement, and it was the subject of negotiations. I do not believe it is described as a treaty, but maybe that's an academic point. I would want the member to know that we will support the finality of that self-government agreement bridging into the treaty and achieving the finality that a treaty is able to achieve. I hasten to add, as this question of finality and certainty has come up before, that I would expect that the same type of finality and certainty.... It would behoove us -- as all three parties -- to have the same degree of certainty that you would find within contract law.
I use the example of the recent issue that has been in the news, where the federal government on behalf of the Musqueam negotiated arrangements many years ago with regard to residential leased land in the Southwest Marine Drive area. For the first part of that agreement, it was looking as though the aboriginal people had a bad deal, because they were only getting $300 a year for the leases. Then, all of a sudden, this date came when they could change that and, I think -- if the reports are correct -- they could be charging $15,000 a year. That's an incredible....
Interjection.
Hon. J. Cashore: I beg your pardon?
F. Gingell: It's $35,000.
Hon. J. Cashore: Some $35,000, or whatever it is. That makes my point even more strongly: all of a sudden, the benefit of the deal takes a major reversal. I think, in that case, non-aboriginal people would be saying that it is in their interest to be able to renegotiate. So in the interests of certainty and finality in contract law, they would want to be able to have some effect on that in relation to their own interests.
I believe that the commonsense principle here is that if there's a mutuality of interests, then this does happen. Hopefully it would never happen the way it does with hockey players. Nevertheless, from time to time and in certain instances, it would not be something where we would want to restrict or confine ourselves in a way that we wouldn't restrict or confine any other type of contract.
F. Gingell: The member for Delta South is much more reassured this morning with this particular minister in the role of Minister of Aboriginal Affairs. He's a pretty tough negotiator. Yesterday when I stood up and said I just have one question -- I asked one question -- he stood up and adjourned debate. Well, in fact, I had two questions, so I know that with him, a deal is a deal.
My question yesterday concerned the role of the Treaty Negotiation Advisory Committee, and I was referring specifically -- the minister will remember -- to Delta. The response I got from the minister was that the protocol exists, and that's what the arrangement is. So I take it that there's no intention or thought on behalf of the minister to expand the role of the advisory committee to get them closer to the table than they presently are -- and to have more open dialogue so that they are aware of all the issues which will concern their community that are being negotiated, and they'll learn about them early on, rather than later on.
[ Page 14365 ]
Hon. J. Cashore: As I recall, when I answered this question yesterday, I believe we were talking not about the Treaty Negotiation Advisory Committee but about the treaty advisory committee which is set up in relation to municipal and regional district interests. There is a lower mainland regional advisory committee, and it's chaired by Mayor Mark Sager. I met with Mayor Sager and his committee, which I believe -- I'm almost certain -- included a representative from Delta, and we discussed a number of mutual interests.
I want the hon. member to know that we are listening carefully, with a view to making the process work effectively. But also we do have in place a protocol whereby the municipalities, through their treaty advisory committees, are able to appoint an individual to sit as a member of the provincial team in negotiations. This goes further than any other such example in the history of modern treaty negotiations. At the same time, it's very important that we hear from people in Delta and elsewhere with regard to how we can be absolutely certain that this is working to ensure that the chief negotiator, when taking a mandate forward, is representing the interests of the people in that area. That's very important.
I should also add that Joanne Monaghan, the president of the UBCM, has taken a very positive leadership role, I think, in organizing an event later this month that will involve B.C. government people and the UBCM people. I believe there'll be a session there with some first nations representation -- again, to work on a provincewide basis as to how to address this very point. The impression that I get from the municipalities is that they are very much on board with regard to seeing that they have an opportunity to ensure that the process works well.
F. Gingell: I appreciate that open and clearly understandable response.
Has the minister included the amount in his budget this year for the purposes of helping to fund the costs of lower levels of government than the provincial government looking after their responsibilities in this area?
[3:00]
Hon. J. Cashore: The answer is yes. In this fiscal year we have two pilot projects; they are in Smithers and Prince George. On the basis of that experience we will be ascertaining ways to work in partnership with municipalities to budget for that capacity in the ongoing work beyond this fiscal year.
F. Gingell: While we're on the issue of money, the minister will appreciate that through what I believe was accidental or unintended, aboriginal bands are able to retain money assessed for school property taxes on property on reserve land that is leased to non-aboriginals. I wonder if the minister has any idea of the amount of money involved in that in a year -- either anticipated for '95 or for 1994 -- and whether there's any portion of his framework that they are working within that intends to change that arrangement.
Hon. J. Cashore: I think the hon. member is aware that there are two parallel pieces of legislation, one federal and one provincial. The provincial legislation is, I believe, called the Indian taxation enabling act; it's a process with time lines that enable the vacating of the tax field in order for that to take place, and it also involves service agreements. There have been some notorious instances recently, as a result of the federal government having signed off these agreements in an untimely manner, where certain matters have been left unresolved and have left the municipalities in an awkward position. I understand that those are getting sorted out. When I met with the federal minister two and a half weeks ago, I raised that issue with him.
With regard to the question about how much in 1995, I need to take that question on notice, because we would have to consult with the Ministry of Finance in order to get that answer. We'll seek to get it back before the end of estimates.
F. Gingell: My third question that I've included in there is the issue of whether you see it as an important part of your negotiating goals or targets to change that arrangement.
Hon. J. Cashore: Thank you for that question. That was the third point that I needed to make on that -- that the really important thing is when we are able to negotiate modern treaties. That should be much less complex; it should be a much smoother process with a great deal more clarity and certainty with regard to how first nations are able to participate in taxation, both in terms of providing services for their own people and in terms of those instances where there are non-aboriginal people on aboriginal land.
W. Hurd: I just have a brief series of questions with respect to the document that the minister was gracious enough to provide to the opposition -- "Crown Land Activities and Aboriginal Rights Policy Framework" -- and that was forwarded to my office. I thank the minister for that. I have just a couple of questions with respect to the test of consultation which is required before an activity on Crown land can proceed. There is one passage here that I was particularly hoping to get some elaboration from the minister on. It relates to section 7.2.4, where it says:
"Where the province has made repeated unsuccessful attempts to engage in consultation with first nations, legal advice should be sought from the Ministry of Attorney General. Non-participation itself does not give the province the legal justification to infringe an aboriginal right, but may limit legal remedies available to first nations."
I wonder if the minister could elaborate on what type of legal advice would be sought from the Ministry of Attorney General, and if he could possibly explain what limitation there might be on legal remedies available to first nations. What would they be sacrificing in the event that the province has been unsuccessful in efforts to engage in consultation?
Hon. J. Cashore: I may have not heard the entire question, so the hon. member may ask more aspects of it later.
If we were to be in a situation where we needed to consult with the Attorney General, it would be to find out what action we could take that would be within their understanding of the legal requirements. I would point out, though, that there was a case -- I guess it's a couple of years back now -- known as the Takla case. It's my recollection that in that instance the judge found that the government had done due diligence in seeking to consult, in making contact and in taking the appropriate steps; however, there was a time when the court recognized that it was reasonable and appropriate to proceed when the consultation had not really been concluded because of the lack of cooperation on the part of the first nation. So I think that there is.... Within the law we are
[ Page 14366 ]
getting at least the beginning of a body of law that supports the point that I made a few days ago that it's imperative, I think, for line ministries to be setting time lines in these processes.
W. Hurd: The manual clearly states that non-participation by an aboriginal group does not give the province the legal justification to infringe on an aboriginal right. That's what the policy states; but it adds that it may limit the legal remedies available to first nations. What specifically are we dealing with here? Are we talking about a restriction on their rights of litigation to sue the Ministry of Forests or the Ministry of Lands? I'm just looking for some sort of clarification from the minister -- since it does appear in his manual -- on how that non-participation may in fact translate into a reduction in the legal remedies available to them.
Hon. J. Cashore: I'll try to answer with an example. If they haven't responded in a reasonable time frame and in a reasonable way, they would be less likely to succeed in obtaining an injunction. If their plan was to go for an injunction similar to the 1988 injunction in the Sam Green case, they would be less likely to gain an injunction, having been approached through the appropriate procedures by the government in these present circumstances.
W. Hurd: The manual indicates that if conflicting interests cannot be resolved -- obviously that's between the Crown as owner of the land and a first nation -- the Crown may wish, in some circumstances, to attempt to justify the infringement on aboriginal rights. The example cited is in fishing and hunting, where it may be necessary for conservation to infringe on an aboriginal right. But there is a second category where it says it is less clear what range of justifications would be applicable to the issuance of Crown grants and tenures. Can the minister indicate to the committee whether his ministry is studying this area, to look at justifying an infringement in order to further the issuance of Crown grants and tenures? Since it does appear in the manual and he has indicated that he's not clear what range of justifications would be applicable.... I wonder if any work is being done in that area, given that there's a potential here to see the issuance of Crown grants and tenures held up by the mandate the Crown now has to identify where an aboriginal right exists. I wonder if he could elaborate on that.
Hon. J. Cashore: In a moment I'll give some of the guidelines that are within the aboriginal rights policy. I would also point out that we have the policy from the Ministry of Aboriginal Affairs, which is the policy that we make available to the line ministries. Within the line ministries, they then have to develop a policy to deal with specifics within their sphere of interest and responsibility. There is also an interministry committee of deputies and senior officials that reviews these situations to make sure that the process is working as well as it possibly can.
With regard to Crown grants, I want to read a portion from this policy, taking guidance from the Supreme Court of Canada decision on Sparrow. Among the questions which should be examined in this context are the following: can the infringement created by the proposed forest management activity be said to be necessary for the conservation and management of a natural resource to ensure public safety or to uphold a compelling or substantive public objective? Has the affected aboriginal group been treated in a way that ensures that their rights are taken seriously? Has there been as little infringement as possible proposed in order to achieve the desired result?
W. Hurd: I want to clarify one thing. Under this policy the ministries operate under, it is up to the Crown to identify the infringement on aboriginal right. The ministries are responsible for determining the specific nature of the infringement. Even if there's an absence of consultation with the band, if the band declines to offer anything in the way of concrete examples or information about the infringement, it is still up to the Crown to identify where the infringement occurs.
It's a troubling encumbrance on the Crown, because the minister acknowledges in section 7.2 that the province is currently faced with a lack of information on aboriginal rights, and few central mechanisms exist for compiling and making this type of information available on a shared basis. In the absence of a coordinated, central database or inventory for obtaining information on specific first nations rights and interests, there's a series of steps that are recommended.
I think the minister is acknowledging that this is a huge additional burden on the Crown during the pre-treaty process, where even in the absence of cooperation the Crown has to go out and identify the notion of infringement within a reasonable time frame. As I look back on my discussion with the minister in an earlier session during this set of estimates, we tried to talk about a reasonable time frame. Is the minister at all concerned that the mandate the Crown now has -- the requirement that it has to identify the infringement -- can in some cases represent an unacceptably long time frame, just because the Crown now has that obligation before it can possibly proceed with the issuance of a licence or application?
Hon. J. Cashore: It's really important to acknowledge in the context of this member's questions that we also sent him the forest policy, which does contain time frames in the text of the document we sent him. So there are time frames, and it's not really a correct characterization to say there are no time frames in these documents. That is patently not correct.
Also, the fact is, as the member points out, that the onus is on the Crown to do due diligence in ensuring that an aboriginal right is identified, where there is such a right. There is an onus to seek to do that. We have that responsibility. We didn't create the history that laid that responsibility on us, but it's a responsibility that was there.
[3:15]
Secondly, the fact is that in our array of tools to deal with these situations we have the ability to negotiate consultation agreements in the context of interim measures. This means that in that context, we are able to identify ways in which consultation is able to be effective in seeking to get a reasonable turnaround on these agreements.
The hon. member mentions, almost as though it was something we'd brought upon ourselves -- again, we are fulfilling legal requirements here -- the huge encumbrance on the Crown. We have to ask ourselves about the financial encumbrance on the Crown as compared to the financial encumbrance on the Crown if these matters were left to the courts, where we would be paying out enormous amounts on lawyers, legal fees and other procedures that probably wouldn't even come to resolution. We know that the courts
[ Page 14367 ]
have said -- at the end of the day, after they've made their limited findings -- that the parties should negotiate the definitions around some of these undefined rights.
W. Hurd: It's not just the burden on the Crown. It's the requirement that the licensee -- the applicant -- also has to consult. Can the minister first assure us that...? Where the applicant -- the licensee -- is required to undertake consultation with a first nation with respect to their management plans, is there any way that the applicant can access the ministry with respect to information about its work on identifying an infringement? Is this type of information shared on a regular basis?
Could the minister just take a moment to sort of deal with the time frames here? Where a licence comes forward, or where an applicant files the necessary application for a licence and is required to undertake a consultation with first nations -- assuming that consultation goes reasonably well -- is there then a concern that the ministry might be looking at having to identify an infringement because there hasn't been a lot of consultation between the ministry and the band? Are we seeing a meshing of the initiatives here? Or does one sort of trigger the other?
Is the licensee left with no idea of whether an infringement is actually taking place? Is the minister satisfied, if there is an infringement, that it's identified early enough in the process and that the applicant is aware of that potential infringement? It seems to me that we have a potential here to really see the time lines extended, despite the assurance of the minister that there are limits in this consultation process. That would be my first question.
My second question would relate to his assertion that if there isn't cooperation from the band, it may limit the legal remedies available -- and he has identified the injunction process, which might be more difficult for a band to pursue. Looking at the practicalities of that, is it not true that it usually happens the other way around; that the band will set up some sort of blockade or restriction on the land base, and then it will be up to the applicant to get an injunction? Can the minister cite any examples of where the bands have used the injunction process in the courts with respect to section 7.2.4? Those would be my two questions, hon. Chair.
Hon. J. Cashore: I believe I gave an example a few moments ago with the Takla case. I don't have the details of that case with me, but I believe that is an example that satisfies that question.
With regard to the question about limits, the hon. member referred to the fact that I had indicated that it would reduce the ability of a band to succeed in an injunction. It would also reduce the ability of the band to seek damages. It would reduce the ability of the band to have permits, licences or tenures set aside. So there's no question about that.
With regard to the hon. member having asked this question twice today and having asked it two or three days ago: yes, there are time limits; yes, there needs to be time limits; yes, time limits are stated in much of the policy; and yes, there needs to be continuing work in setting more time limits in some circumstances. In the forestry policy document, a copy of which the member has, in the implementation guidelines -- "Stage 1. Determining Whether There May Be Aboriginal Rights In the Proposed Forest Management Area" -- it says: "Approximately 20 days after notification." That's on page 4. There is another one here at stage 2, "Determining Whether Infringement of an Aboriginal Right May Occur": "Approximately 70 days after notification. . . ." And at stage 3, Where Infringement of an Aboriginal Right Is Likely," it says: "Approximately 90 days after notification. . . ." So there are time lines there, and yes, there's certainly a need for that in order to be able to expedite these.
I also want to say that I feel it behooves us to recognize in the context of this debate, as I pointed out yesterday, that when I was a Minister of Environment, long before the Delgamuukw case was a consideration in policy, one of the most frequent complaints in the lands branch was the backlog of referrals because of consultation processes that were required. This was endemic -- I don't know if endemic is the right word, but I'm going to use it -- in the administration prior to us becoming government, and it continues to be a concern: the number of referrals that require consultation with various entities, including municipalities and other interests. Consultation is not a new thing, but it is true under Delgamuukw, and another level of consultation is required. I don't intend to indicate that there aren't problems associated with it; there are. But I don't think we should necessarily accept the implication that in every instance where there's a delay, it's caused by the aboriginal situation.
W. Hurd: Just two final questions, then, and maybe I missed it on the minister's remarks. Can he confirm whether there are specific examples of the legal remedies available to first nations being reduced by a court decision as a result of an unwillingness to cooperate or a lack of action in cooperation? That would be my first question. My second would be: are the time limits that he identified for dealing with Crown land applications and forestry licences enforceable in court? When an applicant might be convinced that the time limits have been breached and an unreasonable delay in accessing the Crown tenure or the licence has clearly occurred, are these time frames subject to court interpretation? Would a legal right be available to the applicant who seeks to use Crown land for any purpose?
Hon. J. Cashore: I don't believe that there are specific examples with regard to remedies being reduced. I don't think we've been in a situation where that has been the case. We've been out there consulting and enabling the process to move along as a result of the consultation. I don't think that has actually come about, except in an instance such as the Takla case.
The hon. member is asking if time limits are enforced. In that instance, even where there weren't time limits, the court found that the band had had a more than reasonable opportunity to respond and hadn't done so; therefore the court moved that industrial activity should proceed. Even where there wasn't a time line, the court ruled on behalf of the development. The court was able to say that there was a reasonable opportunity for consultation on the part of the band, and that hadn't happened. We will get a copy of the Takla decision for the hon. member.
W. Hurd: I have just one final question. Could the minister tell us with respect to that decision whether the action was brought by the Crown or by the applicant who was seeking to access a licence that had been granted by the Crown?
[ Page 14368 ]
Hon. J. Cashore: We are not certain with regard to the answer to that right now, so we'll get that answer for the hon. member. I said before that that is a case that I'm recalling from memory, and it was quite some time ago. I do believe that the case does apply very directly to the issues that are being discussed, and we will get that for the hon. member.
J. Weisgerber: To pick up on the issue of consultation, it seems to me that the process has bogged down. In fact, it has dramatically impacted British Columbians across the province. The minister keeps referring to the limitations on a band's ability to take action in the face of an activity initiated by the Crown. It seems to me that the problem with consultation is, first of all, that the bands don't have the staffing capacity to deal with the deluge of consultation application requests that are being referred from various ministries -- from Forests; from Environment, Lands and Parks; from Energy, Mines and Petroleum Resources. They simply don't have enough people there to deal with all of these applications coming forward.
Staff in those ministries don't have any confidence that they are permitted to move forward if they don't have a response from a band. In my part of the world and around the province, we see people who are kept waiting on something as simple as an application for an agricultural lease on a relatively small piece of agricultural land. They may be kept waiting a year and a half or two years or longer, and the answer when they go to the ministry is always the same: "We haven't had a response from the band yet." The band has absolutely no interest in responding; there is nothing in it for the band to respond. The applications simply get shoved farther and farther down the stack of unresolved issues in the band office. It's a very genuine problem.
First of all, the ministries have to be empowered by the government to take action and understand that they're going to be supported in that action when there's no response from the bands. Could the minister respond? Surely he must be aware of the problems that surround this particular issue.
Hon. J. Cashore: I want the hon. member to know that I agree with what he's saying. We're into a whole process here, in that we are seeking to fulfil legal obligations. We're doing so, given the fact that we're all aware of the fiscal restraints we need to operate under in government today.
I know the hon. member knows, when talking about capacity-building -- whether it's the capacity of government or first nations, just to use an example -- that it was very difficult for the government he was a member of to find the capacity to enable adequate monitoring and enforcement through the conservation officer service. Yet I'm sure the members of the Social Credit cabinet as well as our cabinet would have said: "Yes, would that we could have the capacity we need to do those jobs adequately."
When it comes to the capacity that the hon. member is referring to among the first nations themselves and indeed among third parties and government, however, we are involved in capacity-building. We're involved in programs for joint training and access to government. We're involved in seeking to find ways to build the network of communication so that these parties can be interdependent in their way of accessing information and accessing one another.
We realize that it takes time to get it up and running, and we also realize that all parties are working under the constraints of the resources they have available to them. In some instances, we have to be identifying those areas where we really do need to improve the availability of resources to be able to deal with the situations.
[3:30]
[J. Doyle in the chair.]
We also need to recognize that the policy we have put in place is not the policy that creates the problem. It's the policy that is resolving the problem, and it is seeking to do so in a very new situation. The policy has two aspects to it, for instance, and the first aspect is to identify that which does not require consultation. That's a very important part of the policy, because prior to that being in place, it wasn't entirely clear to the staff of line ministries when they should and should not consult.
This has removed a whole stack of possible involvements off the desks of public servants simply by having a policy now that says where it does not require consultation. It's like coming home from work one day and seeing 75 phone messages on your desk, and being able to brush them off into the wastepaper basket -- because it's clear in this policy that those issues do not have to be consulted on.
That means there is a better opportunity now to focus on issues that do require consultation. Among those that do require consultation, it is my advice -- and I have said this to staff within our ministry and other ministries -- that even there you have to separate those that have the most need for a thorough process and those that need to be moved along very quickly. That kind of direction has to come from my level so that we address these issues where it is perceived that the aboriginal people are the cause of referrals being held up. Sometimes that is the case, but as I said a moment ago, that's not always the case. Sometimes it is the case that it's a referral that may have to do with some other aspect of governance altogether.
The fact is that in going this second route in some of those items where there does need to be consultation, we do have to consult with the advisers in the Attorney General's ministry to get their advice on what action we should take in certain circumstances.
As I said before in responding to questions from the previous speaker, there is policy, and time lines do exist within policy. I think we've moved very rapidly to be getting these processes in place and making them effective. That is not to deny in any way, shape or form the validity and the value of the point the hon. member is making, because he is making this point not only on the basis of his own experience, but also on the basis of his knowledge of the region he represents. We do need to hear about those issues that need to be addressed.
J. Weisgerber: To follow from where the minister has taken us is to.... Indeed, in many regions of the province, the economy -- the activity of the region -- is genuinely threatened by the slowdown in approval processes. In the gas and oil industry, it's seasonal; in the Peace, in the northern parts of the province, often there are very narrow windows for an activity to take place, whether it be logging, gas and oil
[ Page 14369 ]
extraction, or whatever, and those need to be.... The consultations, if they indeed take months, sometimes eliminate an opportunity entirely.
Again, there is very little opportunity -- very little reason, that I can see -- for the bands to respond, given all the other things that are going on with the tribal council, the band office and the demands that are made on very limited resources within the band government structure. There is very little motivation for them to deal with these referrals. Unfortunately, regional managers and approval agencies simply will not act until they get a response; either they advise people inquiring that they haven't had a response, or they refer the people making the inquiry directly to the band office.
I believe that at the very least, upon identifying those things which don't require a referral, there should be time lines that are sensitive to everybody's needs -- suggesting that if you don't get a response back, it should be deemed to be an indication that there is a lack of concern. I think we have to assume that if we send a request for comment and there is no comment, then it must be interpreted that there is, in fact, no concern. Failing that, I think there should be an obligation on the band to send a note, saying: "We're looking at this matter; we have concerns. It is just going to take us a bit more time, etc."
The other concern I have along these lines is that in most line ministry offices, the requirement to consult is considered to be a requirement to get consent. It's not simply a requirement to ask the band or tribal council if they have an objection; it essentially says: "Until you, the proponent, can get consent from the band, we're not going to give you permission, we're not going to mediate and we're not going to take a position." That is fundamentally, basically wrong. The government should hear from first nations; they should hear their concerns, examine them and then have the courage to go forward and make a decision without requiring consent.
I wonder if the minister would perhaps comment on that.
Hon. J. Cashore: The hon. member is absolutely right. I think the member is aware from his experience as the former Minister of Native Affairs that the circumstances have changed a lot in the last few years, given certain court decisions.
I think the hon. member would also know from his time that the government had real difficulties with capacity at that time also. Where he is referring to officials who equate consultation with the requirement for consent -- and therefore don't move unless there is consent -- I want to know about that; I want him to send me specifics about that. We want to be able to address that. First of all, we want to be able to address it through training programs we are developing and carrying out among line ministries. Those programs go beyond Victoria and into the field. We need to be getting specific examples of where the turnaround time is causing an unreasonable delay and where that is clearly tied to an aboriginal issue. We need the opportunity to hear about those specifically, because we very seriously do want to improve our policy in this, and we can only do that by making use of such cases in point.
The basic point that I hear the member making is that where.... First of all, I'm agreeing with his point about capacity. We need to improve our capacity by doing a kind of a triage, if you will, with regard to those cases that don't need consultation and can therefore be moved off the desk, those ones that need to have extensive consultations and those ones that don't need as much.
Also, we need to recognize that where the policy is not being carried out properly, that needs to be addressed; we need to identify where that's not happening. And we do need to look at issues of capacity.
Thirdly, we need to recognize that there are those instances that need a lot of attention. The interim measures policy is a means of addressing those issues in a way that brings people together in a relationship where they can deal in a consultative way on those issues where there is, I repeat, no moratorium and no veto, but where there is a serious need for consultation and where that can be facilitated through that type of an interim measure.
Lastly, it is true that in some instances we do have to -- as I said before -- consult with the Attorney General with regard to further action to take. That's not in many instances, but it is in some.
L. Hanson: I ask leave to make an introduction.
Leave granted.
L. Hanson: In the gallery at this moment we have 19 students from an independent school in my constituency -- the Vernon Christian School. They're accompanied by Doreen Fairweather, who is their teacher; Judy and Cliff Welfing; Joyce and Ralph Leyenhorst; and Curtis Raap. Will the House please join me in making them welcome.
J. Weisgerber: I'm encouraged to hear that the minister and the government appear to have recognized the problems that have developed in this area of consultation. I certainly will take the minister up on the offer, because I do hear regularly from constituents who have run into what they believe to be unreasonable delays and instructions, essentially, from ministry staff to go out and get consent from the band. "Don't bother me anymore until you've got this consent," is essentially the way it comes down. That leads to a whole set of other circumstances which perhaps we can pursue in a minute.
I wonder if, beyond the invitation -- which I accept is a genuine one to provide information -- the ministry has any plans to send out clarification, either directly or by way of line ministries. It's very clear to me, on the basis of recent conversations with senior staff in line ministries, that they don't understand what their options are, what kinds of decisions they can make. Understandably, they too delay in making decisions. I think it's really important that that kind of information go out.
I'm also looking at some information I received from the ministry in January. I've received a copy of something called the "Crown Land Activities and Aboriginal Rights Policy Framework," which is interesting, but it provides sections dealing with the Ministry of Environment, Lands and Parks. Another one is entitled "Guidelines for Pre-treaty Consultations with First Nations"; a third one -- Ministry of Forests -- is the Delgamuukw 2: implementation policy; a fourth is Transportation and Highways, "Consulting First Nations: A New Relationship"; the Energy, Mines and Petroleum Resources one is on consulting with first nations about mineral resources and
[ Page 14370 ]
energy activities; and the one from Agriculture is "Guidelines for Pre-treaty Consultations with First Nations." Looking through them, it appears that they were drafted by six different authors, and I expect that's probably the case. The difficulty that I'm leading up to is that an individual who is active in using Crown resources and lands probably would, in the course of their normal business activities -- a logger, a small rancher, someone who perhaps builds roads in the gas and oil fields -- wind up dealing with all of these ministries over the period of a month. It's incredibly confusing for them to go from ministry to ministry and find significantly and substantially different sets of guidelines and rules for dealing with similar issues. I think that, again, I'll wait to hear whether the government has, through the Ministry of Aboriginal Affairs, plans for more continuity in the way that ministry officials deal with the questions of consultation.
[3:45]
Hon. J. Cashore: It's absolutely essential that we achieve continuity. Again, I'm not saying this as a criticism of what the member or any other member has said, but it is awfully difficult to gain the benefit from hypothetical situations, or from hearing sort of general concerns, compared to what we can gain from having actual specific situations to analyze and identify clearly how we can learn from that specific situation in order to improve the process.
What the hon. member says about the different authors.... The fact is that each of these different operational guidelines for the various ministries is authored within that ministry, based on the framework of guidelines that come from the Ministry of Aboriginal Affairs. So the Ministry of Aboriginal Affairs has the overall policy. Each ministry has a responsibility for operational guidelines.
With regard to his point about clarification, that is the purpose of those guidelines. As I said before, we also are out there in the field with training, so that the people who are involved in delivering this policy are receiving training, where we can deal with some of the issues when there's misunderstanding with regard to what the task actually is.
With regard to the point the hon. member is making about third parties, that is a point we're very much involved in. We are working with third parties. We are hearing from third parties with regard to the kinds of information that would be helpful to them. We are preparing information documents to make available to them to help them access this policy in a way that they are able to understand it. And I believe, through the various consultation and advisory processes that we have set up with third parties, that that work is ongoing. But again, we do need to hear about the specific situations which we seek to address, and I do appreciate having those specific kinds of examples made available to us.
I think, though, that we need to recognize that the consultation which is going on is there in order to provide for the situation where ultimately there'll be more certainty in the regions -- and therefore more productive economies. That's what this is about. I think that, again, we're dealing in an era of a long time, of many generations when issues have not been dealt with. We are seeking to deal with these issues. We're seeking to do so not for ideological reasons but because of enlightened self-interest. If we don't deal with them in this day and generation and if we don't deal with them effectively, it's going to leave a major problem for future generations. And if we don't deal with these issues effectively now, we are going to be back into the very costly processes of having to leave it to the lawyers, leave it to the courts, and, as every member of this House knows, when that happens the results really are not satisfactory for anybody. I don't think that at the end of the day we're out for finding winners or losers; I think we're out for finding policies that will help us to get on and achieve that certainty and interdependence.
J. Weisgerber: I don't raise the question of winners and losers. I just raise the question of people wanting to get on with their lives. I think consultation has a role. We should give an opportunity to first nations and bands to advise when an activity is going to impact on wildlife, fishing opportunities or traditional or treaty rights, whatever they may be. I've no argument with that.
The minister asks for specifics. It's often difficult, as you might know, for someone dealing with various agencies and band councils to come forward, identify themselves and become the lightning rod for the kinds of things that happen in government as a result of specific complaints.
I can tell you, for example, that I was approached by a large number of individual owner-operators, small and medium-size contractors, who were deeply concerned with activities in the Peace region this year around consultation. The agencies were saying to people wanting permits for building roads to gas and oil leases, etc.... When the folks arrived at the band office, they were told that there were certain conditions in order to get the approval. They often involved the employment of specific individuals from the band or the employment of equipment owned by the band. It was very simple and very straightforward: "These folks have to be employed in your company, or your referral will go to the bottom of the pile. If indeed you are able to find your way to cooperate with us, then your referral will come to the top and be approved, and things will move forward."
Those folks were working as subcontractors to major oil companies. They were quite severely reprimanded by the companies they worked for, for raising that issue in a public way. They were advised that indeed the oil companies were prepared and understood that the way to get things done was to go along with those kinds of deals.
The effect of that was for contractors, constituents of mine, in some cases to have to lay off non-treaty aboriginal people who were already working for them in significant numbers, to make room for other individuals in their company. I could tell you the names of the people; I don't think it serves any great purpose.
It seems to me, though, from my experience in that case, that it's a practice -- at least in that part of the world, when related to gas and oil activity particularly -- that's quite common and quite widespread. I wound up calling the majority of major oil companies that work in and own properties in the region. I was advised that this routinely was the practice -- the accepted practice -- in the industry.
That was publicized. There were reports of that in the local Dawson Creek and Fort St. John papers for a number of weeks. I would be surprised if indeed the agencies of government didn't pass along that kind of information.
It's those kinds of concerns that I think, again, this question of consent versus consultation leads to. Perhaps the more exuberant use of that process then might be desirable.
[ Page 14371 ]
Hon. J. Cashore: The first part of the answer has to be based on policy. The second part has to deal with the situation that the hon. member outlines.
Based on policy, there is only a requirement for consultation -- nothing beyond that. There's no basis whatsoever in any government policy that would justify anyone from any party -- any individual representing any interest -- in stating that there's a hiring quota or requirement with regard to any relationship to the consultation process or, in relation to consent, with regard to receiving the necessary approvals to proceed. But I think the hon. member is also suggesting that there might actually be some consequences that none of us would have any control over if this were not the case.
I think that what all of us want to see are fair and equitable hiring practices anywhere in the province, no matter what the circumstances are, so that the people living in an area have a fair shot at getting jobs. I think we all stand up for that and none of us disagrees with that. But I want to assure the hon. member that government officials are not complicit in any type of an alleged incident and -- notwithstanding the comment the hon. member made at the beginning of his remarks about there being some people who are reluctant to be able to make their situation known -- I think I have to counter by saying that if inappropriate activities are going on, they have to be dealt with. They have to be dealt with in some way that we can deal with the specifics of the situation; again, I really have no basis for having any type of a framework of understanding as to whether this is real, or if it is real, whether it's only in a couple of very isolated instances. We simply don't have the information to be able to say that that's happening. The government is fulfilling its policy with regard to consultation. If this is happening, we have to find ways to be able to address it.
Now maybe the member can come and sit down with me in my office and talk to me about it, and maybe we can at least get some handles on what he's talking about here so we can try to address it. Obviously, he said that there are problems with giving the specifics about it; but it's awfully difficult to deal with something when there is a lack of those specifics that we need in order to be able to go to the nub of the problem.
If there is a problem, we need to understand it, and I would invite my colleague the Minister of Agriculture to come and join us, and we can sit down. I don't think it's a political issue. I think that it's an issue that.... We want to find out if there is any reality there and, if there is, to address it. I will reiterate: we expect fair hiring practices in every instance throughout the province. All of British Columbia should have fair access to jobs when they become available in a region.
Hon. D. Zirnhelt: I would like to thank the member for allowing me to get into this debate. I wanted to second some of the concerns. I have been just today dealing with some of these matters in respect to forestry referrals. In interviews with press today, I said that I had taken many steps to follow these through to substantiate them -- where they can be and where they seem to be sort of gone underground -- and see how you deal with them fairly.
I'm wondering if the minister has his ministry instructed to try to facilitate, say, a discussion -- maybe not necessarily about the specifics, but to try to bring together the first nations people, the government agencies who are responsible for the licensing referral procedures for permits and so on, and the contractors to talk about the notion of what is fair and what isn't fair in this case.
It's my feeling -- and what I counsel people to do; I don't know if your officials do that -- that we should be trying wherever we can to look at where there are new jobs; that we make those available on an incremental basis to restore imbalances of the past, unfairnesses of the past; or that we use attrition where it's possible, and if not, try to come to some understanding of how we can get communities where there is 80 percent unemployment up to something like the national or regional average, so that's seen as fairness.
I know that there are problems, that some people see any concessions or any kind of affirmative action as a pre-treaty provision. But I'd be interested to know if your ministry does actually encourage people to sit down in a non-threatening environment -- not the guy who might lose his job and the person who might pick up the job, but to try to get beyond that.... I know that your ministry's taxed in all these efforts, and this is all new to us. But I was wondering if you would take that approach, because I think the questions are legitimate. I deal with them, I follow up on them, and I find that in some cases, you can really fix the problem. For example, where there is somebody with an excavator who's been laid off, and the company has maybe bankrolled a band to start up a company with an excavator, the question is: why not -- if there's a willing seller -- assist the first nations in getting involved, where you're not displacing the machine and some of the employees who are working? It's not just the contractor; it's the employees of the contractor. You can have a willing seller if they're a contractor, but it's the employees -- and they're local people -- who often take it in the neck.
Hon. J. Cashore: In the context of the work of our aboriginal relations division of the ministry, that is exactly what is constantly being done in many instances throughout the province: addressing issues where we need to recognize that a difficulty has emerged in relationships between non-aboriginal and aboriginal people, usually in the context of dealing with a circumstance like this case in point. Yes, we do sit down together; we seek ways to promote understanding. Often that's in the context of the various levels of interim measures that I read into the record yesterday. Again, as I was saying about specifics before, the way the Minister of Agriculture has just described is maybe one of the more effective alternatives, I think, where parties don't want to come forward and start talking about a specific instance they experienced, but they can talk in a general way about how this issue can be addressed. Yes, that certainly is one of the ways we are able to talk about this concern.
[4:00]
J. Weisgerber: Let me be very clear: I support and encourage employment opportunities for aboriginal people all over British Columbia, particularly when there are activities in their communities. That's a given. I just don't think that the consultation process should be a lever that sees some person taken out of employment and somebody else put in. I don't think that's very productive. This issue came to me from people who I have known for a long time and who are genuine; I don't believe that 20 of them would get together and make up a story. I am willing, on the basis of the people and their approach, to accept that it's a genuine happening.
[ Page 14372 ]
I've talked with the senior company officials. Some have confirmed that it is, in fact, the practice; others have denied it officially but have, in fact, informally confirmed that it happens. The bands deny that it happens, and the government agencies -- very genuinely and sincerely, I think -- deny any complicity in it.
Let me just finish this, though, because I do believe that beyond the idea of sitting down together and trying to resolve this, if indeed there was a reasonable time frame whereby if you didn't get a response, the activity could proceed, and/or if indeed consultation was seen as listening to the concerns and not requiring consent, then it would diminish substantially the ability of the affected parties to engage in that kind of activity, which is significant use of leverage. I'm not sure that many of us would pass up the opportunity to use that kind of economic leverage if we were in the position of the bands. I believe the problem comes back to one of process.
I've tried to deal with this in an appropriate way as an MLA. I've met with the constituents; we've had a series of meetings; I've contacted the parties involved to try to confirm the practice; there's been publicity surrounding it. I think the next appropriate step is to come and raise it in debate here, assuming that the ministry has been made aware of those concerns by way of clipping services, etc.
Hon. J. Cashore: I want to reiterate: consultation does not require consent. I hear what the hon. member is saying. He is saying that in his area that message needs to be heard loud and clear. That point is well taken; it should be heard loud and clear. That is the message, and if I have to come up there and shout it from a rooftop in order to make the point, I will. But I think that working together, we can get this message through.
C. Tanner: I think that subject has been thoroughly canvassed, and it's time to change. I hope the minister is ready to go in another direction.
Mr. Minister, you mentioned about an hour and a half ago that you were at a municipal meeting in September in Whistler. At that meeting you gave a talk and a slide show of what is happening with land claims. After your presentation, which, incidentally, I quite appreciated, as did other people in the room.... In fact, Mr. Minister, in my view you should be doing more of that all around the province, and at every opportunity. I think it's absolutely essential.
After your presentation, you asked for questions, and you got a question from the mayor of Central Saanich, Mayor Box, and Councillor James. They asked you to assist them in any way you could in facilitating the agreement that was ongoing between the Central Saanich municipal council and one of the local bands. They've made some tentative agreements, but I don't think the agreement is finalized, and I've got a number of questions concerning that.
First, were you or any officials in your ministry able to help them?
Second, while the minister might say that that's not directly related to treaty negotiations, the fact of the matter is that it is the general public's view that it is all part of land claims negotiations, in that it's first nations asserting themselves. It does have some influence on what the minister, his government and this whole House are trying to accomplish in land claims.
Third, the minister also mentioned later on that he had been in Ottawa two and a half weeks ago, and he'd brought up the subject of compensation for the schooling tax raised on bands. Was he able to get any satisfaction from the federal Minister of Indian Affairs on compensation to Central Saanich and other municipalities with the same problem, in assisting them with their lack of taxation -- with regard to the ability of Indians to tax themselves?
Hon. J. Cashore: With regard to the first question -- "Did the government respond to their request for help?" -- the answer is yes. We paid for mediation and we were a participant. I have to say that the provincial government does not have culpability on this issue. But the provincial government, seeking to be a part of the solution, did provide mediation services. That's in relation to question 1.
With regard to question 2, it's more of an observation than a question. When this type of problem arises, it's seen as somehow a product of treaty-making negotiations. I appreciate the comment, because we really do need an opportunity to clarify this with the public. The hon. member asks that question out of years of experience with regard to the emergence of northern treaties and the Yukon treaty. The irony is that the treaty-making process is the way in which these issues that have festered for so many generations will be resolved. It's in settling modern treaties that we seek to get rid of these silly circumstances where you have to have taxpayer enabling acts, and the anomalies of the federal government and the Department of Indian Affairs and the way their trust arrangement results in occupying and vacating taxation fields. That is a very confusing set of circumstances.
What we are doing through treaties is seeking to remove the confusion, achieve the certainty and have one tax regime for all people that works for all people, where people pay for the services they receive, and where it's done on a fair and equitable basis. Therefore we seek to resolve that through treaties.
With regard to my discussions with Minister Irwin, I have met with him on several occasions. On several of those occasions, I have raised this issue with him with regard to situations in the province where the federal government, either by neglect of following through on its responsibility or as a result of a bureaucratic mistake in some instances, has caused problems for people in British Columbia. I have raised these issues with him and have asked him to deal with them, and I have discussed that specific issue with him.
With regard to whether that has resulted in satisfaction, I think the hon. member perhaps knows that Mayor Box is in Ottawa as we speak, and as far as I know, she is taking these issues up with the minister at the present time.
[D. Lovick in the chair.]
C. Tanner: I know I'm pushing my luck a little with the minster, because he's reaching beyond his jurisdiction in some respects, and I also appreciate the fact that Mayor Box is in Ottawa right now. But let's call a spade a spade, Mr. Minister. We know full well that the minister has more clout in Ottawa than any mayor in British Columbia -- and far be it from me to downgrade the mayor -- and consequently, his representations to the federal minister probably bear more fruit.
[ Page 14373 ]
When I started up this second question, I said I was pushing my luck, but did the minister have any indication from the federal minister that he was prepared to find compensation for those municipalities that had suffered more grievously than some others?
Hon. J. Cashore: I appreciate the hon. member's point, and we will continue to take it up with the federal minister. I can report only that he and his staff agreed to look into the matter. I did not get any guarantee of dealing with the shortfall and the compensation, so I continue to raise it with him and will raise it with him again the next time I see him.
C. Tanner: I have one last question for the benefit of the three municipalities in my constituency and the other 150 municipalities in the province. How many of these settlements have been made between municipalities and bands? To the best of my knowledge, it's something in the region of 40. At least, it was a year ago. How many have been settled, and how many are there to be settled?
Hon. J. Cashore: We will get that data for the hon. member.
A. Warnke: I won't go on at length, but what I want to do is to return to a document the member for Surrey-White Rock referred to earlier and seek some elaboration on that with regard to Crown lands. In particular, where I would like to express this once again in terms of a concrete example.
One area of concern I have -- and I've been in touch with the communities there -- is in the Williams Lake and Cariboo regions, regarding the ranching community. The leading issue for the ranching community is the aboriginal land title negotiations, insofar as the ranching community see the whole area in regard to range regions.
Interjection.
A. Warnke: Well, the way it's been expressed to me, it's a great threat to them, in that the ranchers there want access, and believe that to a large extent in the past they've had access, to Crown rangeland and private land, and there should therefore be continued access to Crown rangeland. One way to express this is that often when we think of Crown land in urban areas such as Vancouver -- and let's use that as an example as well.... When we think of the Justice Institute suddenly being relocated, the Crown land that is left behind is automatically part of -- or is certainly seen by the aboriginal community as being part of -- the land claims; therefore they should have access to Crown land, and there are negotiations that stem from it. In that particular case, it's interesting that as long as the Crown land was occupied by the Justice Institute, there wasn't a claim over it. But as soon as the Justice Institute is being removed, that land becomes available for negotiation.
Incidentally, not many people know this, but a lot of people are under the impression that in the United States a lot of federal land is somehow in perpetuity under the ownership of the federal government. I can think of similar examples; the island of Alcatraz comes immediately to mind. Once the prison at Alcatraz was relocated, aboriginals in California laid claim to the island of Alcatraz. So there are some similarities in the United States with what is happening in Canada.
In the grazing areas -- or what have been seen by the ranching community as grazing areas -- where they lease or have access to Crown land, it's very similar to Crown land in an urban area being occupied -- except, of course, the environment is a lot different. Sometimes urban people view Crown land one way and feel that in a rural area, Crown land isn't being utilized or occupied, when in fact the ranching community makes a strong argument that it has had access to Crown land for generations. They could lease Crown land. This is land that has been used for grazing, so in that context they should continue to enjoy the use of those lands for the purposes of grazing.
[4:15]
While I'm on that, when I think of the ranching community, it's not only for the purposes of raising cattle. The ranching community can be seen as far more encompassing than that. I would draw members' attention to the fact that in the ranching community there are such things as guest ranches, which would include tourism, back-country recreation, access to wildlife and fishing, and so on, where once again the grasslands of these areas are seen as part of that kind of activity.
At any rate, what I want to briefly pursue with the minister is the state of the ranching community and their concerns about land for the purposes of grazing -- or, for that matter, in a more expansionary view, for guest ranching and tourism and all the rest of it. I know I raised this concern last year, but the concerns still are expressed. Indeed, when it comes to the British Columbia Guest Ranchers' Association, they've made it clear too -- and maybe the minister might want to respond to this -- that they've been seeking recommendations in terms of establishing sensitive-development zones in the Cariboo-Chilcotin area. As well, they've advocated giving the Ministry of Tourism a legislative mandate to represent tourism resource interests in regional planning and policy development processes.
I'd like to just briefly explore the state of the ranching community in the context of the negotiations, especially in light of the document that was put out earlier this year entitled "Crown Land Activities and Aboriginal Rights Policy Framework." I would like the minister to perhaps respond by following up some of the questions and concerns I expressed last year at about this time. What sort of improvements, as the minister sees them, and what sort of efforts has the ministry taken to alleviate some of these concerns? Because somehow the concerns are still being expressed to me from the ranching community.
Hon. J. Cashore: I really do believe that we have canvassed this question in a variety of ways, with this one difference: the question is focusing on ranching and those who are involved in cattle-grazing, and often that grazing goes onto Crown land which is sometimes interface land with the forest. I want the hon. member to know that the principles of this government that I've read into the record.... I'm tempted to read them into the record again now, but it would be about the tenth or twelfth time during these estimates that I've read these principles into the record, so I'm not going to do it again. But I don't want to hear the member stand up and say that I refused to answer, because I answered it yesterday, three days ago and four days before that.
[ Page 14374 ]
I do want to say, in all seriousness, that the association which represents the ranchers and cattlemen is a very key and important player on the Treaty Negotiation Advisory Committee, and also in the regional advisory committees as they get up and running. I've had many personal conversations with the individual who heads that organization, and it's absolutely essential that when our negotiators go to the table they represent those people who have those interests that these ranchers and cattlemen are concerned about. There's no question about that.
We have pointed out, for the record, that we have not taken the position of the Liberal opposition, which is that there would be no land on the table against which there are leases and licences. In so doing, we feel that that would not be in keeping with the spirit of the agreement which was reached in setting up the B.C. Treaty Commission, and that indeed it would violate the opportunity to achieve modern treaties. Therefore we have not taken that position. But we do take the position at the table that we will defend the existing uses of that land in a very, very serious and determined way. As we have said before.... Our statement has been repeated again and again with regard to fair compensation in those very rare instances where that is required. So with regard to grazing, I make it very clear that the people who represent their interests are very much in the loop in terms of making their issues and concerns known to us, known in our mandate process and known in the review of our mandates as they are developed, because those go out before the regional advisory committees to seek their advice.
You know, hon. member, sometimes there's some question: how do we know they are seeking our advice? I just want you know that I met with one group representing one particular sector the other day. When that question came up, I was able to give them a list of ways in which we had accepted their advice. And they were very, very pleased with that. So the fact is that these advisory processes are important. They're working.
A. Warnke: I agree that there are a lot of principles that the minister has expressed in these debates. I paid very close attention to the minister's answers as well as the questions. The questions and the answers usually, unless I missed something, focused entirely on agriculture, agricultural lands, and so on. I appreciate that some of the principles the minister extended really apply to this area as well; but on the other hand, I did not hear anything specifically on grazing. This is the reason I was exploring this with the minister.
At the same time, here's, I think.... I'll try to get really at the nub of the issue here. As the minister has said to many questions, private land is not on the table. Nonetheless, there are those circumstances in which private land could be purchased in some sort of resolution after negotiation -- for which, of course, there would be compensation. I guess the concern still is raised; it certainly was put to me last year and to my former critic the year before. What if the aboriginal people still insist on access to private land?
How does the government make it very clear that it is not on the table -- that's number one -- and that the government will not purchase those kinds of private lands? Otherwise, there is a perception or impression that these are merely hoops and that, despite the statement that private land is not on the table, the government can still nonetheless purchase the land for settlement. All the literature just says the ranchers may be consulted, and nothing more, for a final deal.
I want to reassure the House and certainly the minister that I don't intend here to be fearmongering or anything like that. I just want to make it explicitly clear, I suppose, involving the complications here of the mixture of private land and conceptions of private properties in the negotiated settlement.... Essentially, I'm looking for some sort of clarification and something explicit that can actually reassure those who have been in the grazing and ranching business -- and, I suppose, the ranching business in a general sort of way.
I'm not going to belabour the point, so perhaps I'll put it into the context of this one question: what reassurance is there that ranchers' and grazers' concerns on grazing in designated protected areas, whether it's Crown lands reserved for grazing and for private lands...? What reassurance can the minister offer that these will not be negotiated out?
Hon. J. Cashore: I'm very happy to reassure the member that the terms and conditions of existing leases and licences on Crown land will be met. When I was making my comments on grazing before, that's exactly what I was referring to. We will follow that diligently.
A. Warnke: In the interests of expediting a few things, I believe there is another aspect with regard to gaming; but I see that my distinguished colleague in this area is with me, and I think he would like to put some questions forward.
The Chair: The member for.... I'm sorry, it's Surrey-Cloverdale. I haven't seen much of the member in this committee. My apologies for struggling with the name.
K. Jones: Sorry that you weren't able to see me so often. I've been in the other House. There have been very interesting debates in the other House as well.
Could the minister give us an outline of what is transpiring in the role of the ministry in relation to aboriginal gaming?
Hon. J. Cashore: Aboriginal gaming comes under the responsibilities of the Minister of Government Services. So what has transpired in the role of the Ministry of Aboriginal Affairs is that we have a very real interest in what happens in this area, and we consult with the minister, and our ministry consults with officials within the Ministry of Government Services.
K. Jones: The minister, I understand, has some staff on the implementation committee or team that is working under the auspices of a chair from Government Services. Could the minister tell us what direction that representation is bringing to those discussions?
Hon. J. Cashore: One person who is on the staff of the Ministry of Aboriginal Affairs is not working for us now and has been seconded over to the Ministry of Government Services to work on this file. The direction ultimately comes from the government.
K. Jones: The minister is saying -- I just want to clarify -- that the direction is coming from the government. You meant from Government Services, did you?
[4:30]
Hon. J. Cashore: Yes.
[ Page 14375 ]
K. Jones: Could the minister give us an indication of whether he has had representation from various aboriginal organizations in the areas of gaming or gambling with suggestions as to how they would participate in the expansion of gambling in British Columbia?
Hon. J. Cashore: Yes, there have been discussions; usually it's been my role to refer them to the minister when they've raised those issues with me. As the hon. member can appreciate, as you go out and about the province, meeting in different contexts, people come up to you and talk to you about issues that are on their minds. I am quite happy to discuss it with them, but I advise them that ultimately it's in the area of the Minister of Government Services, and I advise them to take their concern in that direction.
K. Jones: Could the minister give us some indication of the kind of direction that these requests are going in? What types of thinking are the aboriginal people bringing to the minister with regard to aboriginal gaming, or gaming of any form?
Hon. J. Cashore: A full spectrum of interests, all the way from bingo to huge casinos, saying sometimes that they want to get into it; and indeed I'd add to that spectrum first nations people who come and talk to me and say that they don't want any gambling at all -- they think it is not suitable for their area. As wide a spectrum of interests as you could possibly imagine comes to me from various people who come and talk to me, and I refer those people to the Minister of Government Services very happily.
K. Jones: As a man of the cloth, I thought you would probably be very interested in their concerns with regard to gambling. Certainly your church is known for its position in regard to opposition to gambling in this province. Perhaps the minister would be able to tell us if there is a strong percentage in favour of gambling by aboriginal peoples, or whether there is a strong movement against gambling by aboriginal peoples.
Hon. J. Cashore: I don't have the information to be able to answer that question with any accuracy based on the contacts that I've had, because I haven't done any scientific analysis on this. Those questions would have to fall within the purview of the Minister of Government Services. It's my sense -- this is just an opinion; it's not based on any type of study or anything -- that a significant number of first nations people feel that they don't have access to opportunities in the areas of different kinds of gaming, and because they are very interested in enhancing economic development in their areas, they would like to see that opportunity.
It's very difficult to answer the question in terms of how predominant the positions on one side or the other are, because you'll find a variety of opinions within aboriginal communities. A good example is the Kamloops band. The Kamloops band had a referendum. On first count, the referendum to allow gambling passed, I believe, by one vote. Then there was a recount, and on the recount it lost by one vote. That's a good illustration of just how much of a struggle this is for first nations themselves in trying to come to terms with this issue.
One of the benefits of treaties is that we try to move to a day when first nations are not always having to look to gambling or tobacco or storing toxic waste as a means of economic development, but are able to come more into being economically independent by having a greater variety of economic opportunities through building new relationships and partnerships.
K. Jones: I'm glad to see the caring and interest and sensitivity that the minister has toward this issue. It's very important, and it could be very devastating to the aboriginal people if it's not dealt with in the proper manner. Does the minister feel that this provides a form of economic development, as some aboriginal people have been saying?
Hon. J. Cashore: There are some examples from south of the border. I have heard of people going to one place -- I forget where it is in the States -- and they're talking about the members of a particular band receiving a great deal of money out of a casino. I haven't researched this, but I've heard it said that it's the largest casino in the United States. I don't know if that's true or not.
The fact is that on anything like this, you have to weigh the benefits and the costs. One of the things we know for sure -- and we've heard this coming out of Las Vegas -- is that there is a saturation point with regard to this being a rather silly way of trying to have any kind of economic development. That's my own personal feeling about it. But even for those who see it as some kind of gravy train -- and I'm not saying that in reference to first nations; I'm saying that in reference to everybody -- the facts don't add up; that just doesn't make sense. There is a saturation point. As an economic activity, yes, there are some who could point to where there have been some economic benefits in the way of jobs, in the way of being able to provide for certain opportunities in a carefully managed environment, and where it has produced some economic opportunity in some circumstances. Now, others would argue that it really is not a net benefit, because of social costs; that's an interesting debate in itself. But those are the parameters of the debate. To what extent is it a pure economic opportunity, and to what extent are there social costs that negate any economic benefit?
My own feeling is that we should be putting our eggs in a basket of productive, better job creation in other economic development activities, and therefore in some of the things that we see happening in the business community where there are real efforts being made on the part of first nations and non-first nations people to build business partnerships -- sometimes in anticipation of the post-treaty environment, but some actually happening prior to treaties getting going. In my view that's the better basket to put the eggs into.
K. Jones: Do you believe that there should be an aboriginal gaming commission?
Hon. J. Cashore: The answer is no.
K. Jones: In the area of trying to get economic development, what representations have you had from, say, the Osoyoos band? I believe they've made a fairly vocal decision with regard to gaming. Have you had a request to be onside with their proposal?
[ Page 14376 ]
Hon. J. Cashore: Hon. Chair, I met with the Osoyoos band council. I'm trying to recall; I think it was about a year ago. Perhaps it was last June; I can't say for sure. They were wanting at that time to have some direct negotiations with the government with regard to their desire to set up a casino on their land. I met with them, listened to them and said that at that time that our government was in the process of seeking to develop a policy in consultation with the First Nations Gaming Committee, and that that was a process that was underway. I also pointed out to them at that point in time that the Minister of Government Services was not meeting with individual bands with regard to one-offing this process, because that would create a totally unmanageable situation. We needed to get the policy in place first. So that was the message they heard from me and that was the meeting that took place.
Since that time, I'm also aware that there was some talk in the media about the Osoyoos band setting up a casino. I also understand that the head of the Assembly of First Nations, Ovide Mercredi, came out and counselled them not to go that route but to seek to do so within the context of the government responsibility to administer gaming. I believe there was something in the news again the other day about the Osoyoos band. I can tell you, hon. member, that I've just shared with you the extent of my knowledge of the Osoyoos band on this situation.
K. Jones: You mentioned the Kamloops band. I understand the Kamloops band actually have an operating bingo operation on their property -- actually, it's on land leased from the city, but they were running the bingo operation. They went for a high-stakes operation, and the government informed them that they could not proceed with that. Do you feel that they were treated properly with regard to that?
Hon. J. Cashore: I really can't say that I have the data to be able to form that kind of judgment. It's my understanding that I believe there was somebody charged coming out of one of those activities, but I may even be incorrect about that. I am really not in a position to judge whether they were treated fairly or not. I would expect, however, that insofar as the government was involved, the situation was handled -- I would assume, and it's certainly my understanding -- appropriately.
K. Jones: Is the minister aware of any gaming proposals in his own riding or in surrounding ridings in the lower mainland that he has immediate knowledge of?
Hon. J. Cashore: This is a very interesting question. In my riding there is one small Indian band -- the Kwayhquitlum band -- and it's on a reserve that you might say is a very small postage stamp of land, down on Colony Farm. They also have land at the north end of Colony Farm which they are seeking to develop for some economic development purposes. It's my understanding that the elected council, which consists of the chief and the councillors.... The name of the chief, which I know very well, just escapes me; it will come back to me in a minute. It's my understanding that the Department of Indian Affairs and Northern Development has suspended the funding of the band because the band council has been challenged by persons who have become members of the band through Bill C-31 and who, I understand, are living down in Tacoma. This is a really good example of the bizarre kinds of circumstances that we can find -- a problem for first nations and for everybody else -- under the anomalies of the federal Indian Act, which we want to get rid of through modern treaties.
But here we have this little band, which is trying to get into some economic development on their land, being stymied by this anomaly, and by these people down in the United States who have been given some credibility in the way in which they have been ascertained, by virtue of becoming registered through Bill C-31 in a process which I think is referred to as the custom process.... They have actually been able to convince the federal government that they should suspend the activities of the duly elected band council.
What I've heard -- and I can only tell you, hon. member, what I've read in the papers -- is that some casino outfit in the States has some relationship with these people down in the States. There was a news story saying they wanted to put a casino into that area, which is absolutely a crock. It's absolute nonsense; it will simply not ever, ever happen, and it won't be allowed to happen. What is really, I think, the more serious concern is the fact that the duly elected band has had its ability to carry on its affairs -- and it's doing a very good job -- curtailed.
[4:45]
K. Jones: It's interesting to hear of this one example that the minister is very familiar with, and the difficulties that are a result of that. Which organization would actually be preventing them from proceeding with this? You said they would be stopped, and that there would be no way that they would be allowed to proceed with a casino in that location. What would be the body that would be able to stop them?
Hon. J. Cashore: Ultimately, the chief of the band council and the band council would stop them. I have every confidence that they are going to be reinstated. This is a horrible injustice. They are adamant that their future is not in gambling, but in economic development that's of a more useful nature. They will have the complete support of the people of Coquitlam, who would be absolutely appalled at any such consideration; they would have my complete support -- which is considerable in the Coquitlam area, when you consider some of the things that have been accomplished there since I've been the MLA.
The fact is, hon. member, I have discussed this.... As a matter of fact, when I met with Minister Irwin two and a half weeks ago, that was the number one topic on the agenda, because this is such an incredible injustice. He is very concerned about the situation, and I have every confidence that he is going to do the right thing and that the duly elected band council will be reinstated.
The other organization that I would refer to is the province of British Columbia. The province of British Columbia won't stand for any such thing going into that area on the doorstep of Coquitlam.
K. Jones: Could the minister give us an idea of how he can convince aboriginal peoples who desire to have gaming operations in their area to turn their thinking to some alternative economic development process that would be satisfying to them, to make them feel that they were getting something that would give them a solid base for the economic development of their community?
[ Page 14377 ]
Hon. J. Cashore: I don't see it so much as my role to convince, because I have a great deal of respect for the ability that the people of first nations have to ascertain what's best for themselves. I don't think that the hon. member was trying to suggest that they don't. But one of the ways in which we seek to encourage first nations to address such issues as improving economic opportunities is through business partnerships such as the Burns Lake Native Development Corp., which is a singular success story in British Columbia, where an aboriginal corporation, having formed a partnership with Weldwood and West Fraser, is now directly employing 400 people, most of them non-aboriginal.
I think one of the ways that first nations are able to access these opportunities is to find out about them, helping us make those types of examples available to them, encouraging the type of thing that former Attorney General Brian Smith has been doing: holding seminars involving people of first nations and business people, so that they can talk about how they can get on with developing partnerships.
Also, I think we have to take a look at the whole issue of self-respect and self-esteem and how we seek to ensure, in the schooling that involves children of first nations and non-first nations, that there is a more appropriate outline of history, so that there can be a growing sense of satisfaction and appreciation with regard to the history of the people of first nations. There are a number of things we can do to try to address these. Again, I think the process we've entered into in the treaty-making context is what that's all about.
K. Jones: Your colleague the Minister of Government Services has taken a fairly strong position against the proposed aboriginal gaming position taken by the First Nations Gaming Committee. Do you feel that that's the right way to go about dealing with the aboriginal arrangements?
Hon. J. Cashore: Governments are elected to govern. When governments do due diligence in seeking a cooperative approach to addressing a policy issue, at some point they have to ascertain whether or not it's time to move on and fulfil the obligation government has to govern. That is what has happened in the context of the decision of the Minister of Government Services.
The Chair: Before I recognize the member for Surrey-Cloverdale, if I might.... We have had approximately 20 minutes of discussion on matters that fall, quite frankly, outside of the terms of reference of this ministry, as the minister has pointed out. I appreciate the fact -- as I'm sure all members do -- that the minister, recognizing that aboriginal gaming is conducted by aboriginal people, therefore feels, as Minister of Aboriginal Affairs, honour-bound to acknowledge that.
Beyond that, members, I have to advise that according to the estimates book, there is no provision whatsoever for anything to do with gaming, and we are out of order. Now I'm not -- I hasten to point out -- trying to say: "End the discussion at this point." But I do want to caution members of the committee that we are frankly out of order in this discussion, and I think 20 minutes is about enough. If the member has a point he wants to lead to in these ministry estimates, I would encourage him as gently as I can to please do so.
Having said that, the member for Surrey-Cloverdale continues.
K. Jones: I think your point is well taken. I'm trying to walk that line which separates this ministry and the Government Services ministry, recognizing that I have responsibilities to look after the interests in the gaming area on both sides of that line. As critic, my responsibility goes toward trying to address the interests of all the people involved in this issue. Therefore we are trying to look at it from the aboriginal side of it. I did not relate to the Government Services position or side of it; I just wanted to get what the minister felt with regard to those issues and what the aboriginal people he has had the opportunity to be in communication with were saying to him.
I think it's important that the people of British Columbia hear what the aboriginal people are saying in relation to their economic development. I understand that economic development is an item in the estimates, and therefore this does relate directly to that area. I'm not wanting to argue with you or anything like that, hon. Chair, but just recognize that this is economic development. That's how the aboriginal people see it, and therefore I think it is very pertinent at this time to address that fact.
I think we've had a very good cooperative dialogue on this, trying to get the minister's understanding of the issue and trying to see where the ministry direction is headed under these circumstances. It's a very difficult one for all of us. I think, primarily, it's a factor that has a great deal of interest for people, both aboriginal and non-aboriginal, in British Columbia.
Could the minister tell us what the ministry is doing with regard to land claims negotiations that might relate to an aspect of gambling?
Hon. J. Cashore: Very clearly our negotiators will not have a mandate to put gaming in the treaties; that is not on the list of the mandate topics that they will be dealing with.
I would like to say that after my brief mental block with regard to the name of the chief of the Kwayhquitlum band, it has come back to me, and it's George Chaffee. The word is admirable; he is a very admirable young man leading his people very effectively. In some ways, in Coquitlam we have a microcosm of the first nations situation for the whole province, with that tiny band trying to find a way into economic partnership with the rest of Coquitlam. Mr. Chaffee has participated with the public advisory committee on the future of Colony Farm, and he has participated in events with the school district in the opening of Kwayhquitlum school. Since the hon. member did mention activities in Coquitlam, I just wanted to put it on the record that George is doing a very fine job as chief in that area.
K. Jones: I'm really pleased that you have a person as admirable as Chief Chaffee leading. Does the minister note that that tends to be an exception in your dealings with regard to the aboriginal peoples -- that this particular chief is showing greater, more admirable talents, capability or direction than others in the province?
Hon. J. Cashore: Just as it is in government or among MLAs -- we have a variety of personalities and qualities -- I think it's no different when it comes to first nations. I would have to say that in the time that I've been in the Legislature, whether people are on this side of the House or that side of the House, I've come to have a great admiration and appreciation
[ Page 14378 ]
for my colleagues. That's not a comment on their level of ability; it's just an admiration and appreciation. And I think that's all one can say with regard to any other entity, whether it's the chiefs of first nations.... I do want to say that both with the first nations and the third parties, since I've been in this job I've developed some friendships with some people that it's been very good to be in contact with. But maybe one of the really good things about all of it is that we're all subject to being very complex individuals.
Interjection.
K. Jones: Obviously the minister has one backbencher who considers the minister to be admirable in being able to respond to that. I think the minister was exceptionally fair and careful in making his response to that statement. He could have been in a lot of hot water if he'd handled it differently.
The question of gambling on first nations lands, as you've said, is not part of the agenda of the negotiators. You're stating that that is the case in all treaty provisions, both those that exist and those that are coming forward. Is that the government policy position?
[5:00]
Hon. J. Cashore: Yes.
K. Jones: Does that mean that lands that are proposed or extended in the claim from the existing reserve lands would possibly be considered as items where gambling could occur, or could be proposed to occur, and would that be acceptable to the minister?
Hon. J. Cashore: In all instances it's the position of the province that the Criminal Code would apply and any questions of expansion would go through the process that the government is putting in place, and definitely not through the treaties.
K. Jones: If it's not through the treaty process, by what method is it going to be negotiated when they are negotiating for land that is beyond the current reserve land?
Hon. J. Cashore: You'll have to ask the Minister of Government Services.
K. Jones: I'm afraid the Minister of Government Services doesn't really have an idea of what's going to happen with regard to that, because that isn't within his mandate, either. I think that those lands beyond where there is expansion -- that is, claimed lands -- are actually within your ministry's process, and therefore would have to be answered under your estimates.
Hon. J. Cashore: Perhaps I didn't hear the question clearly the first time. If the hon. member is saying that when there's a treaty settlement and some land will be added to the Indian reserve land that would form an additional amount to the land base.... Whenever I comment on this, I hasten to add that this would be a very limited amount of the percentage of the original land claim. As I have said before, in exchanging the certainty of treaty rights for aboriginal rights, this would no longer be Indian reserve land. It's our position that it would be land that would become the equivalent to fee simple and it would be subject to the laws of general application of the province. So the policy that is forthcoming from government with regard to gambling would obtain in these circumstances.
K. Jones: Just to clarify that, if an aboriginal band had a claim on a piece of property in the downtown Vancouver area -- the Vancouver waterfront area, for instance -- and there happened to be a casino at that location, would that give them the title and claim for that casino?
Hon. J. Cashore: That would be private property, therefore it wouldn't be land such as the member describes.
K. Jones: Consider that the land might be owned by the federal government and would therefore be negotiable property, either on the waterfront, over water, or shore property owned through various ownerships of the federal government. That land, I presume, would still be considered negotiable in the land treaty settlement. Is that correct?
Hon. J. Cashore: Even in that very hypothetical circumstance, federal government land would be subject to the laws of general application. That wouldn't make a difference at all.
K. Jones: Could the minister clarify? The laws of general application mean all of the responsibilities of federal, provincial and municipal laws of British Columbia. Is that correct?
Hon. J. Cashore: In this particular instance, I'm referring to the laws of general application of British Columbia, which has jurisdiction when it comes to gambling.
K. Jones: Could the minister tell us what laws of general application there are in British Columbia with regard to gambling at the present time?
Hon. J. Cashore: That question should really be addressed to the Attorney General. I don't think I can be expected to bring information with me to estimates with regard to how many laws of general application there are. We can try to help you find that by contacting the Ministry of Attorney General, but I think the hon. member is capable of doing that himself.
K. Jones: Perhaps I can help. Perhaps the minister isn't aware that there aren't any laws of general application in the province with regard to gambling. There is no act with regard to casinos and things like that; therefore the minister would not be able to use the laws of general application in this case.
Hon. J. Cashore: There's the Criminal Code, and there's the B.C. Lottery Corporation. Those are both within the framework of the laws of two jurisdictions.
K. Jones: In both cases I don't think you'll find that there's any application relating to the situation that we were describing and that you were saying would be under the control of the laws of application. We'll leave it at that. The situation is one that is of great concern to people throughout British Columbia in that there seems to be very limited knowledge or limited government capability in dealing with the question of aboriginal gambling. We need some really clear, supportive direction and a more open process.
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The people of British Columbia still don't know why the Minister of Government Services shut down aboriginal gaming negotiations with the first nations committee. The public has never been aware of any aspect of the negotiations. The Minister of Aboriginal Affairs should see that the public is aware and that the aboriginal people are properly represented in the public's eyes as being open and honest in the negotiations process. Currently that image is not out there.
The position taken by his colleague the Minister of Government Services indicates that there has been an action taken, yet nobody really knows why that action has taken place. I would certainly ask the Minister of Aboriginal Affairs to bring forward a more open process that would more fairly represent the area in the ministry that he represents today.
Hon. J. Cashore: I have listened very carefully to the hon. member's comments, and I thank him for his comments.
A. Warnke: I have one question to follow up on from my colleague from Surrey-Cloverdale, and it's in response to the member's question that the minister apparently had not acquired any scientific impression as to opinions among aboriginals regarding gaming. I want to broaden that. Perhaps I'm under a totally misleading impression. I was under the impression that there had been an opinion or some sort of survey taken among the aboriginal community on not only gaming but a variety of issues: justice, self-government, economic development and that sort of thing. I want to have the minister confirm whether an opinion survey has been conducted in the past among aboriginals. Failing that -- if the answer is no -- is the minister contemplating conducting an opinion survey within the next year?
Hon. J. Cashore: No to both questions.
A. Warnke: Just for the record, too: is the ministry depending on some other ministry conducting an opinion survey among aboriginals? Just as a point of clarification, I'll ask the one question, and that will be sufficient for my purposes. I'm just wondering whether in fact any surveys are being conducted by any other ministry or department -- that is, a survey among aboriginal peoples or a survey of British Columbians that would include aboriginal peoples in the sample -- and particularly any sort of questions with regard to services, views about economic sustenance, title and self-government.
Hon. J. Cashore: I am not aware of any survey that would fit into that described by the question. But we all know that from time to time there is opinion research, and in that opinion research we can expect, insofar as aboriginal people are part of the general population, that they would be included in that. To my knowledge, I don't know of any such research being considered that would be targeted to the aboriginal population.
But when you stop to think about it, it might be a good idea. So I'm not saying that it could never happen, but I am certainly not aware of that having happened. There may be some point at which that would serve a useful purpose.
A. Warnke: I appreciate the remarks of the minister, because I suppose there is some concern as well whether in fact the members of the aboriginal community really reflect what the aboriginal leadership is expressing. Maybe it would be to the benefit of all involved. Obviously, the minister has made it very clear that it has not been conducted, or there are no plans to do so -- unless, of course, the minister changes his mind. I'd perhaps encourage that -- to give that some sort of consideration. So I'm really pleased with the minister's remarks. One can only reflect on some of the events around the Charlottetown accord, where once again there was some concern whether the general membership of the aboriginal community reflected what the leadership was expressing.
Incidently, one question on that had been raised to me as well. This actually was put to me by someone of the group -- we did just briefly discuss them -- the Union of British Columbia Indian Chiefs. I recall such a member putting to me something like that question, too: when aboriginal leaders get together to negotiate, who actually selects the aboriginal leadership? What is the process of selecting the aboriginal leadership?
[5:15]
I suppose along this line as well is this: how do we know that the leadership that are involved in negotiation actually reflect the perspectives, attitudes and so on of the rank and file or of the general membership of the community they're representing? Would the minister care to comment on that?
Hon. J. Cashore: The whole negotiation process is open to the first nations communities as well. Also, as I outlined yesterday, the ratification process ensures that they have very clearly defined input, as agreed upon in the treaty considerations.
The Chair: Minister.... I'm sorry -- the member for Richmond-Steveston.
A. Warnke: Well, thank you, hon. Chair. It's always nice to be exalted a little from time to time. Maybe it even provides some incentive. At any rate, hon. Chair, we shall leave that for the future to determine.
I hope the minister doesn't mind, but I would like to put a number of questions together, sort of in bullet form, beginning with just a couple on health care in this context, and on education and social services. I'll lump a number of questions together that I would like to pursue. In particular, with regard to aboriginal health care, we discussed a year ago some of the obstacles to equitable service. I guess that it's very appropriate, a year later, to reflect on the progress or development of where aboriginal health care has evolved. We've discussed some obstacles in the past. Perhaps the minister would like to address some of those obstacles and whether there has, in fact, been some sort of progress. I would also like the minister to comment on the fact that aboriginals are somewhat underrepresented -- remarkably so -- in the health care professions. As my second question, I would appreciate it if the minister would comment on the current state of aboriginal representation in health care programs, and whether in fact there are any significant changes as he sees them.
Hon. J. Cashore: I think the hon. member may be aware that about 25 years ago, there was a concerted effort to enable people of first nations to get into the legal profession. Universities were involved in that, as well as a number of other entities. As a matter of fact, if we look at the results of that
[ Page 14380 ]
program, I think that by any measurement, it was very successful. There are now a number of people of first nations who are in the legal profession, and in many instances they are able to be involved in advising their people with regard to treaty negotiations. Ed John, for instance, is a graduate lawyer, and so is David Joe, one of the negotiators with the Champagne-Aishihik. So is Chief Joe Mathias. I'm sure there are a great many other examples.
With regard to the point the hon. member is making about the health care professions, I think that by addressing that issue and seeking to encourage training institutions and other processes with the cooperation of the federal and provincial governments and the first nations, it also can be achieved. I do know that there are considerations of trying to achieve that kind of goal in health care professions that have been actively discussed -- if not, in fact, programs in place. If there are programs in place, I don't have the portfolio or the information to be able to give an update on that, but I'm very interested in it.
On the issue the hon. member is raising here, I want to assure him that our ministry is in very close contact with the Ministry of Health, as the ministry is seeking ways of having greater community input into the delivery of health care services. In so doing, there is -- again, through the Ministry of Health -- a direct reference to the first nations. The fact is that there are some areas in the province where there are first nations health care facilities, such as up on the Nass. That's a major factor with regard to the process the government is going through in delivering those services. Again, the Minister of Health is better able to answer some of these questions, and I will also say that he is very knowledgeable -- and, I think, very well counselled by people of first nations who are on his staff, as well as by others who are involved in this area.
I do think that one of the concerns that undergirds the question that the hon. member is dealing with is the appalling statistics that we have to recognize are out there. It's a situation that clearly has to be changed -- appalling statistics with regard to rates of poverty, teenage pregnancy, infant mortality and so on and so forth. There's no question that in seeking to achieve a new and honourable relationship that we need, in that context, to be developing treaties that are going to enable us -- through the attendant result of self-esteem, self-respect and self-determination -- to address those things. I know of a great many examples of positive role models in the aboriginal community who have had a tremendous impact on others of a younger age who have been coming along. Some very close personal friends of ours who have taken their place within the health care professions have been aided in doing so by having positive role models that they were able to recognize in seeking that goal.
A. Warnke: I do appreciate the minister's answer because while I'm tied up in here, I cannot address the Minister of Health in the other place. So I thought I would take the liberty to some extent to raise that point to put on the record -- essentially the current state. I appreciate the minister's answers.
Similarly, with regard to education I have addressed a few questions to the minister there and I'll be doing so in the area of social services to the Minister of Social Services. Therefore I will not follow those kinds of questions here for the minister. In the area of justice, similarly, I have put my questions to the Attorney General.
But there is one area here that I suppose still falls somewhat under the purview of the minister. It's sort of a justice question and yet it's a specific example. What I'm really looking for is not any sort of legal answer. I'm wondering, I guess, what the minister is doing to correct the situation. I'll briefly describe the situation; I think the minister might be aware of it.
It's a case involving a Prince George man who, I believe, has expressed complaints to the minister -- and certainly to the Premier -- about enforcing a fee for collecting pine mushrooms. I believe the minister has responded in a letter of March 27. I apologize that I did not provide advance notice of this particular letter. But I'm not so much concerned about the specific case; I'm sure the minister will look after it. I believe the minister's response was that there is no agreement between the provincial government and the first nations that allows them to make demands or place limitations with regard to fees for collecting pine mushrooms, and so on. In a very general sense, I'm wondering whether the minister has any comment about a number of people who have apparently been caught in this kind of situation of paying a fee or being forced to pay a fee, and whether there has been anything done to correct this situation. I have not had the opportunity to explore this with the Attorney General. I'm not so sure it's really that important, and I'm pleased the minister did respond to this specific case. I'm just wondering what efforts the minister has taken to correct the situation, given that aboriginals here obviously had some sort of impression that they could attempt to enforce such a law -- or a law as they saw it -- which has been seen by non-aboriginals as enforcing something without due process or without conforming to the laws of Canada.
Hon. J. Cashore: I don't think the situation the hon. member describes is endemic. But it's serious, and I want him to know that in no way, shape or form is that activity condoned. It's a unilateral action, it's illegal, there's no basis for doing it, the parties shouldn't pay it, and if they refer the issue to government their advice is not to be influenced by that. So it's just simply absolutely wrong, there's no basis for it whatsoever, and we do not in any way, shape or form condone that activity.
To go back to the hon. member's earlier point, I was reminded of the recent National Aboriginal Awards that took place in Vancouver. There was a thoracic surgeon from Comox -- an Inuit who was born in Sachs Harbour. There's a very positive role model right there, and we hope to see more people going into health professions. There was also another award recipient -- a registered nurse, I think, from Manitoba -- who is doing very significant work in the area of drug and alcohol counselling. When I attended that ceremony, I read very carefully the lists of names of all the people from the aboriginal community that had been nominated to receive awards. There were several from British Columbia -- a very distinguished and accomplished people.
A. Warnke: Just another quick one. I appreciate the answer that the minister has provided, and I will also make sure that certain individuals get that.
There's another area that's sort of related. There are some concerns about demands to end tobacco quotas. I'm wondering whether the minister would care to comment on that. I guess the ministry is trying to find some sort of balance
[ Page 14381 ]
between an appropriate quota system on tobacco and at the same time trying to deal with preventing smugglers from abusing the system. Perhaps it's kind of improper to ask this question, but I'm wondering if the minister would like to respond to this and provide some sort of view as to where the minister sees the whole tobacco controversy going -- in particular, I suppose, as it relates to taxation.
Obviously we want to see some significant changes on taxation. Indeed, if I may comment quickly on where taxation is going, I'm rather optimistic that the taxes related to aboriginals will significantly change, because many aboriginals have expressed to me that they can hardly wait to see the day when they pay taxes, and there will be one taxation standard across the country. This seems to be a very strong symbol of becoming part of the main fabric of Canadian society. Indeed, many aboriginals have said: "Yes, the taxation system is just as repugnant to us as to anyone." We certainly know that it's repugnant to many non-aboriginals, but it's all to come at the tail end of the negotiations. If I may express some optimism about where we're going in the future, I really think that taxation is not going to be one of the major stumbling blocks; it may actually be one of the areas where there will be some quick agreement between aboriginals and non-aboriginals. But perhaps I'm just too optimistic.
But back to the main question that I want to pose to the minister.
[5:30]
Hon. J. Cashore: I appreciate the optimism; I share that optimism. I think that when we get into the area of exchanging aboriginal rights for treaty rights and the certainty.... To get rid of the kind of nonsense that has emerged over 125 years and longer with regard to a relationship that hasn't worked well.... And then, with the Indian Act -- which is just totally archaic and unworkable in the context of having an effective partnership relationship -- we have to get rid of section 87; we have to make sure that aboriginal lands are not tax havens and that the way to have a vibrant and healthy economy is to enter the mainstream economy and let that mainstream economy, as much as possible, be a place where aboriginal fashion and culture is used in a way in which it's tastefully a part of their commercial development. By all means, I think we have to look to that process to deal with those issues.
With regard to the interim situation, where do we go between here and having treaties? It's complex and difficult. As I think the hon. member pointed out, it's primarily in the area of the Minister of Finance. We work with the Ministry of Finance on this issue, and consult on it very carefully. We're seeking to find ways to improve the situation and to try to avoid inappropriate uses of this anomaly in the federal Indian Act.
J. Weisgerber: Indeed, the minister's comments, I think, are worth everyone paying attention to. I do believe that we should all be looking at treaty-making in British Columbia as a way to achieve true equality for aboriginal people, to move out from under the Indian Act and all of the difficulties that are so readily apparent with that system and with the administration under the Indian Act. I couldn't agree more. I think that the true test of our ability as governments and as treaty-makers will be whether or not we achieve equality: equality of opportunity, equality of responsibility and equality of obligation. Those are terms that we use perhaps glibly, because indeed they have very serious implications on all sides. To say we're going to achieve equal opportunity is easy to say and difficult to achieve; therein lies the challenge of the treaty-making process. The transition to equal obligations and responsibility is probably no less daunting. I think we in British Columbia are presented with a marvellous opportunity. It has been a significant factor, an impediment in British Columbia -- the fact that we were the only major jurisdiction south of 60 that wasn't a treaty region. And so it was the need to make treaties that saw us -- while I was Minister of Native Affairs -- for the first time in 130-odd years recognize that there was the responsibility of a role to play for British Columbia and an issue to be resolved.
I think that I'm as much convinced today as I ever was of the need to resolve treaties, and to do it in a fair and reasonable way. I think it's important also for us to recognize that one of the many benefits that we can achieve through treaty-making is this question of certainty. If there is a single issue that I hear as I travel around the province.... As I talk about native land claims, native issues, aboriginal affairs and the implications, it is probably one of the single most common concerns raised. Will there in fact be certainty? Will we be able to finally put this issue behind us? Will we be able to put the issue to rest? I have to say to people that I have every confidence that under the constitution these treaties will be protected from arbitrary change by either the federal or provincial governments. The questions are: "What kind of protection will there be against demands to reopen the treaty negotiations from the band or tribal council -- from the aboriginal community? How do you have protection for one? What kind of protection do we have on the other side of the coin?"
Hon. J. Cashore: I'm not sure if the hon. member was in the room earlier when I dealt with a similar question. We have to ensure certainty and finality to the greatest extent possible, but we should not do that to the extent that it's a disservice to British Columbians.
To give an example, I did cite as an analogy -- it's not a perfect analogy, but I think it makes my point -- the situation with the Musqueam. The federal government negotiated a deal on behalf of the Musqueam that resulted in the lands out there on Marine Drive being available for housing on a leased basis. For the first 25 years of that agreement, the annual fee was $300 per resident. I'm advised by the official opposition Finance critic that now that a certain point in that agreement has been reached, the first nation is able to increase those lease costs to up to $30,000 for a year.
An Hon. Member: It's 15 percent of the assessed value.
Hon. J. Cashore: That's 15 percent of the assessed value -- thank you. It could be argued that that was an agreement where it was in the interests of the non-aboriginal people to have recourse to open it up. What I'm saying here is that to the very best of human ability, we need to negotiate treaties that have certainty and finality; but we have to recognize that circumstances do change. Where there is a case of mutual interest among the parties, there should be a means whereby the parties, on the basis of mutual self-interest, would be able to address an issue at some point in the future. I do not see that as being something that we should be fearful of; it's quite normal and understandable in contract law. I don't think it
[ Page 14382 ]
would make it any different than the issues that would achieve certainty in any other type of negotiation, whether it's with a corporation or with some other entity in our society.
Yes, I accept the principle of certainty and finality, but we cannot take that to such an extreme that it precludes us from being able to reasonably deal with future circumstances that we cannot always foresee. Would that our forefathers and foremothers had foreseen some of the situations that we're having to deal with now that weren't dealt with adequately at that time. We've got to do it well, but we can't go to the extent that there's no way that it could not be addressed on the basis of mutual interests.
J. Weisgerber: I think there's probably some validity in that approach. Given the concern that exists that there must be some fairly specific processes or triggers in place that would allow for that -- if indeed what we're talking about is reopening the treaties for negotiations; if indeed we're talking about adjustments, changes in rates or changes in thresholds -- that may well be something that can and should be built in.
One of the things that is a difficult issue and has been difficult for some time is the decision in British Columbia -- after more than a century -- to enter into land claims negotiations. I believe that one of the most compelling arguments was the lack of treaties. It was a compelling argument in northern Quebec, in the Northwest Territories, in the Yukon and in British Columbia. I believe it was the fact that we were somehow different that was the compelling argument -- probably the overriding element in whatever legal decisions the government now uses. I'm wondering how the minister is able to square that with the reopening of negotiations in the Treaty 8 area. It has always been a troublesome area, because the northeast part of the province has very much followed the practice of Canadian governments in colonization and settlement. It's a unique area, and I wonder if the minister could give me some sense of how my constituents and those in Peace River North might anticipate this issue being dealt with, also recognizing that part of this equation is the interesting -- and I think somewhat innovative -- decision by McLeod Lake to decide that rather than pursue a treaty negotiation, they would negotiate adherence to Treaty 8.
Hon. J. Cashore: With regard to Treaty 8 -- and in the context of finality -- it's very important to point out that it was the B.C. Treaty Commission that accepted Treaty 8 into the Treaty Commission process. Let's remember that the B.C. Treaty Commission process came out of the recommendations of the task force report that this hon. member had a role in getting started. It is only self-government that is being negotiated in the Treaty 8 negotiation; it's the unfinished business of negotiating self-government. I think that the Treaty Commission ascertained that that fit in with the criteria, and that it was no more or no less than being able to honour the kinds of considerations that were available to the Sechelt in being able to come to a self-government agreement. So the Treaty Commission process is an avenue through which Treaty 8 can deal with the unfinished business of self-government. It is not opening up the land question, the resource question, within Treaty 8.
With regard to the McLeod Lake question, I would like to suggest that we deal with that when we come back to estimates. I'm going to have to, for personal reasons, ask for an opportunity to adjourn the House now, but we will come back to the McLeod Lake questions which the hon. member has raised.
I just want to say one final comment with regard to the certainty that there will be dispute resolution processes built into treaties to ensure that, where issues come up, they can be dealt with without having to impact the treaty itself. In other words, the treaty will produce dispute resolution instruments so that, should disputes arise, the parties can resolve them in that way.
With that, I move the committee now rise, report progress and ask leave to sit again.
Motion approved.
[5:45]
The House resumed; the Speaker in the chair.
Committee of Supply B, having reported progress, was granted leave to sit again.
Committee of Supply A, having reported progress, was granted leave to sit again.
The Speaker: Before the motion to adjourn, hon. members, I would like to read my ruling. This morning the official opposition House Leader sent the Speaker a written notice of intention to move an adjournment motion pursuant to standing order 35 to debate a matter of urgent public importance, namely the withdrawal of the Bonneville Power Administration from the Columbia River Treaty.
The Chair has given serious consideration to the hon. member's notice and his submission to the House under standing order 35. I conclude that the matter raised by the hon. member is identical to that raised by the member for Surrey-White Rock yesterday in his submission to move a motion pursuant to standing order 35. For the reasons outlined yesterday in my ruling on the same matter, I find that the member's application cannot succeed. Moreover, I refer members to standing order 35(10)(d), which clearly provides that "the motion must not anticipate a matter which has been previously appointed for consideration by the House, or with respect to which a notice of motion has been previously given and not withdrawn."
The House is reminded that motion 87, which appeared on the notice of motions in the Votes and Proceedings dated May 16, 1995, deals with the withdrawal of the Bonneville Power Administration from the Columbia River Treaty. The same subject matter is that which the member for Fort Langley-Aldergrove proposes to raise under standing order 35. The member's proposal under standing order 35 anticipates the matter in which a notice of motion has been given. Therefore, on all these grounds, I find that the matter raised does not meet the requirements of standing order 35.
Hon. G. Clark moved adjournment of the House.
Motion approved.
The House adjourned at 5:48 p.m.
[ Page 14383 ]
The House in Committee of Supply A; L. Krog in the chair.
The committee met at 2:40 p.m.
ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 42: minister's office, $461,000 (continued).
L. Reid: I look forward again to engaging in debate on the estimates for the Ministry of Health. As per yesterday's discussion, we'll probably proceed for the next 45 minutes to an hour on provincial programs. I'd like to begin with the British Columbia Transplant Society.
I recently had the opportunity to meet with individuals from the Transplant Society. As the minister is well aware, I've had ongoing dealings with the British Columbia Eye Bank and with the other tissue collection agency in the province. It seems to me that the good work being done by the B.C. Transplant Society is today not replicated by the Eye Bank. There seems to be tremendous confusion, tremendous disorganization and some lack of administration in that agency. I have no direct knowledge of what is happening with the other tissue collection agency.
The line of questioning I'd like to proceed with this afternoon relates to tissue collection -- the harvesting of tissue, the harvesting of organs, the harvesting of corneas -- and whether or not it's possible to put these into one central agency. Oftentimes more than one we're dealing with the same donor; oftentimes organ or cornea or tissue is collected from a single donor. It seems to me it's possible to streamline the administration and collection processes.
There is a great deal of work to be done around that process. I would ask the minister to give some guidance in terms of how best to proceed with the issue of tissue collection -- whether it be solid organ, skin tissue or cornea. This is one instance where we could have some agreement that one agency could coordinate these services. I would ask the minister to comment.
Hon. P. Ramsey: Again, I think one of the things the member opposite and I will find ourselves in agreement on is that we need to enhance tissue collection and organ donation in the province. There's an unmet demand, particularly in a couple of areas -- corneal transplant services and kidney transplants are the most obvious ones.
That's why we have embarked on a number of initiatives that I hope will improve both the willingness of British Columbians to come forth and identify themselves as organ donors and make sure that their wishes are acted upon at the appropriate time. There are several things I should say. Both the Eye Bank of B.C. and the B.C. Transplant Society are working to develop strategies and programs to do that. I think I saw the member with a packet of material that outlines many of the initiatives that they're working on. They have a detailed strategy for making sure that physicians working with those who have indicated they want to be organ donors, or their families.... I think it is crucial that the wishes of the person are acted upon.
[2:45]
I agree with the member that a large part of it lies with the work of the B.C. Transplant Society and hospitals around the province. They must ensure that there are appropriate procedures in place so that physicians are comfortable about, and have a procedure for, approaching next of kin and making sure that the wishes of the deceased are acted upon. That's part of what I think needs to be done.
I also agree with the member that we need to have one focus for donation in the province, whether it's tissue or solid organ. That is clearly the responsibility of the B.C. Transplant Society. Along with that is the development of a central organ donor registry so that we have a way of quickly and accurately identifying British Columbians who have volunteered to become organ donors.
L. Reid: I appreciate the minister's comments. I know the minister is aware that Austria, Belgium, Spain -- all those countries -- have donation rates, if you will, that exceed British Columbia's. I certainly don't take away from the minister's comments, but I would ask him to come back to the issue of organization. I think he and I would agree that the B.C. Transplant Society is taking some leadership on this question of organizing what needs to happen.
I don't have the same amount of comfort around the Eye Bank of B.C. at all, and I'm wondering why we would continue to expend resources to create three separate organizational structures. That's in huge contrast to your comments over four hours of debate yesterday, hon. minister, in terms of whether it makes sense to consolidate those services. In this case, I would strongly make the case that it would be an absolutely common sense direction, because typically we're dealing with a donor or a family who has been visited by two or three tissue harvesters. There's something not tasteful and not gracious about that, no matter how well it's done. It makes the province look disorganized; it makes that aspect of the medical delivery system look disorganized. Frankly, I would concur that it is disorganized at that level, and I would certainly agree with the minister when he talks about needing to consolidate. But I am trusting that other than just agreement here today, we can actually have some commitment, some leadership and some political will to put that process into some kind of consensus building or leadership discussion, where that can happen.
I know the minister is probably aware that the B.C. Renal Council, chaired by David Babiuk, is looking at following people from dialysis all the way to transplant. That makes great sense to me. I don't see that happening in some of these other agencies. It makes good sense to coordinate that service to provide a continuum. Again, not to take away from the minister's comments, but that's not the issue. It's whether or not you're prepared to take some leadership and create a system or a decision-making structure that allows, hopefully, single donors to be visited only once -- to have one provincial program for organ tissue, and corneal transplant. Perhaps I could ask the minister to comment.
Hon. P. Ramsey: Maybe I wasn't clear enough in my first answer. We are asking the B.C. Transplant Society to assume leadership for all donations in the province, and that includes
[ Page 14384 ]
corneal. They may well contract with others, but they are going to have central responsibility. I think the situation that the member identifies is one of the issues that clearly needs to be addressed.
My sense of the whole situation in organ donation -- maybe the member opposite feels the same -- is that after the initial burst of enthusiasm around organ and tissue donation in the seventies and eighties, when these procedures were first coming into use, there was great enthusiasm around organ donation, and, indeed, commitment to the program and organization of the program have fallen a bit. We need to get that back up. There are too many people waiting on lists.
While our rate of tissue and organ donation compares favourably with some other jurisdictions in Canada, there are clearly, as the member notes, other jurisdictions where we can do better in identifying and harvesting tissues and organs and in making sure that donors have their wishes respected. I think she points to part of that issue, which is to make sure that the patient and family deal with as few people as possible. There are obviously other aspects to it including the central registry, standardized procedures and a lot of education that needs to be done in hospitals around the province.
L. Reid: This time the minister's comments warm my heart, because I do believe this can be done extremely well. I think we have the capability. The goal today for transplants in British Columbia.... The actual number currently available is 15 to 19 organs or tissues or corneas per million; the goal is 20 to 25, so we're not looking at even doubling it. We're looking to bring it up five or six per million, which certainly seems doable.
The other conversation I had with the Transplant Society was around promoting the live kidney donor portion of the program. Currently 20 percent of the population is prepared to give a kidney for donation. They would like very much to raise that to 40 or 45 percent. In terms of that particular aspect of live organ donors, will your television advertising touch on that concept at all?
Hon. P. Ramsey: Promotion of the living-donor program is part of the strategy of the B.C. Transplant Society. I have done no TV commercials that would focus on that particular part of it. I think, more importantly, what we're trying to do is raise the overall issue for British Columbians. As they look into it, the options are going to be presented to them. When they call the number or contact the B.C. Transplant Society or deal with their local physician or hospital, they'll see the range of options in front of them. Just from the reaction to the advertisements we have done and the work of the Transplant Society to date, hundreds and hundreds of British Columbians have called and said: "So how do I become a donor?" I think, as the work of the B.C. Transplant Society unfolds with the $500,000 that the Premier and I committed to improving that back in March, that we will see increased rates of commitment to organ donation by British Columbians and decreased wait-lists and wait-times for those waiting for organ and tissue donations.
L. Reid: Another aspect I want to touch on is the finances around transplant. There seems to be a great myth out there that it's still horrifically expensive. Again, if I could ask the minister to look at the advertising that's being prepared and to perhaps have some ability to communicate the message effectively. I truly appreciate the discussions I had with the B.C. Transplant Society about there being significant costs in the past, $200,000 to $300,000 per organ transplant was somehow touted as being the normal cost. They tell us today that that has dropped approximately 50 percent. Now the cost of implanting a heart is $50,000; the cost of implanting a liver, $55,000; and a pancreas, $33,000. They have broken it out very, very carefully; they have measured well. They also do quality of life. They check back after five years, ten years.... I believe it's after seven years in terms of the life of the B.C. Transplant Society.
The point I make, particularly around dialysis treatment.... They again tell me that is $50,000 a year, yet post-operative medication for a liver transplant is roughly $5,000. We are not making good economic decisions when we choose to keep people on dialysis for years at a time. According to this documentation, we are doing that for the most part because there are not sufficient organs available. We are costing the province and the health system a great deal of money because we are not organizing well how best to collect that tissue.
Again, this information suggests that in 1994 there were 152 transplants carried out. That leaves 300 people on a wait-list. That is a significant sum of money if indeed those folks are charging the system anywhere near $50,000 a year to be dialysed. First of all, that level of disorganization is not about patient care; it is not about quality of life; and it's certainly not about prudent decision-making if indeed there are ways to spend fewer dollars and give someone a better quality of life. Perhaps the minister can touch on how best to tackle those wait-lists beyond the television advertising program that is currently in place.
Hon. P. Ramsey: I just want to say that I couldn't have done a better summary of why we have committed $500,000 to the organ donation program than the member opposite. I would only add that the figures she quotes on the cost of actual transplants are last year's. The new rates are going to be even lower. Right now the estimated cost per transplant for a kidney will be just over $14,000 in the coming year. To then save the $40,000 or $50,000 a year as well as have the enhanced quality of life from receiving a kidney transplant is phenomenal. These are not, in most cases, highly expensive procedures anymore, particularly when we talk about kidney donations. The cost savings are clear, as are the improvements in quality of life.
Part of the reason why rates are coming down is because of more experience, and the length of stay is declining, as well. We are getting quite good at making this a normal part of medical treatment for an increasing number of British Columbians, I must confess, though, that it doesn't seem normal at times. I think we've touched on the basic things we need to do to enhance organ donation. Clearly broad public awareness is part of it, and the advertising and very public TV campaign we embarked on back in March should be part of it.
One of the things that happened in the early part of the organ donor movement a decade or more ago was the involvement of service clubs and other volunteer agencies in
[ Page 14385 ]
promoting organ donation and in urging members of their groups or their communities to become donors. I think we need to do some work to reanimate that sort of movement, that sense that we are all one community. As with blood donation, this is a contribution or a part of what we can do for the broader health of our community. I think that needs to be there.
The other thing we need to do, though, is what the B.C. Transplant Society is proposing to do -- that is, work with individual practitioners around the province who can raise this matter with their patients when they come to see them and, most importantly, then with hospitals. As the member suggests, we do not have too many cases now, and we need to make sure that we have some standardized procedures for approaching next of kin in making sure the wishes of organ donors are respected.
The final thing I'd say is that we need to look at what we are funding -- and that's the development of a central registry of organ donors -- so we do indeed have one place to go. The last bit that I'd add to the discussion on this is that one of the things that I'm considering, or at least looking at, as we look at new ID for CareCards is whether we can in some way, not just by a sticker, incorporate into a central database that's linked to the B.C. Transplant Society information on which British Columbians have indicated their willingness to become organ donors.
L. Reid: Again, my thanks to the minister for those comments. I very much welcome a card that identifies people accurately and allows us, hopefully, to carry some information on those cards that will be useful for programs such as this. I appreciate the minister's comments on the central registry. My concern is that unless there is a coordinated effort across all hospitals, we're not going to make it. This would be another situation where some leadership from the ministry would go a long way to ensuring that on every hospital admission form, there was the question, "Have you considered being an organ donor?" so that there's actually something to follow up.
I've had many meetings with the folks in the Vancouver Hospital over the future of the Eye Bank. For the most part, individuals are never asked, and they certainly saw the necessity to have somebody pose that question. It went many, many places to decide who the best person should be and came all the way back.
[3:00]
In terms of actually having useful data, it would be wonderful to see Vancouver Hospital do it. But if they're the only referral hospital or tertiary care centre that does it, there are eight or nine other missed opportunities in the province. So if there is some way for the ministry to provide some direction on having all the referral centres in the province take some approach that's consistent.... I would ask the minister to respond to having a question on the admission form, because, I mean, you have a wonderful audience there that certainly could be asked. Perhaps the minister could kindly comment.
Hon. P. Ramsey: One of the advantages of having a central registry, hon. member, is that identification of donors will become a routine provision. The how is going to be very simple. We'll have a centralized, computerized database of who has decided to be an organ donor identified by personal health number. Simply by keying in the number at registration, whether the person is conscious or unconscious and whether the person is accompanied by next of kin or not, the information is available to the hospital. So the identification doesn't rely on searching through wallets or trying to contact next of kin, in the case where somebody may have suffered a severe trauma that may be terminal, and hospital staff are trying to identify whether the person has said he or she wishes to be a donor. It can be done automatically through the database that we're developing. That gets rid of the situation you described, where caregivers are running around saying: "Who's the next of kin? Do we have any ID that identifies what's going on here? How do we deal with this?"
[G. Brewin in the chair.]
L. Reid: Hon. minister, I appreciate fully how the data comes out of the system; I want to know how it gets in. Who is responsible for asking whether you or I will be an organ donor? Is there some sort of consistent approach for people in hospitals and for the average British Columbian? Are you sending them something? Are they responding? Are we consistently asking the population at large? How are you getting the information to put into the computer to generate it?
Hon. P. Ramsey: I don't think it's enough to say that the responsibility is this person.... It's going to be a huge range of people. I don't know how you first became an organ donor. I did when I went in to renew my driver's licence years and years ago. They had this little pamphlet that said: "If you want to do this, stick this on your driver's licence." That's going to continue. In the new identification system, people will be presented information when they apply for new ID. When people apply for a CareCard, that information is included in the packet, and that will continue. That's one route.
General public advertising of the sort that you've seen is another route. The B.C. Transplant Society is planning for a fair bit more public awareness. In addition, various foundations that are involved with health conditions will be assisting in the promotion of organ donation, such as the Kidney Foundation, the Canadian Diabetes Association, the Heart and Stroke Foundation of Canada, the B.C. Lung Association and the Canadian Liver Foundation -- there must be a foundation for every organ. They're all going to be involved in trying to persuade as many British Columbians as possible to become donors.
I think there's a role that even the media can play. For example, I've been following with interest the series in the Vancouver Sun on waiting for a heart transplant. I think it gave the general public an awareness of what it means to wait for a transplant. It may make them think again about whether they wish to become a donor. In a way, it's above and beyond all that. I think there may be a general need to do some of the work that the member has talked about in letting people know that this is now a routine, cost-effective procedure. This isn't medical science.... It isn't medical experimentation anymore. I hope it's medical science and something that can become part of normal practice.
Because it's an issue I grapple with, I would invite the member to comment how we could deal with people who are, for a variety of reasons, reluctant -- and not necessarily for religious reasons. Sometimes there are a variety of misperceptions about what organ donation and transplant is. People say:
[ Page 14386 ]
"Good ad. I recognize it's something I should do; but I'm not going to." It's the same sort of barrier the Red Cross Society has to overcome in getting people to volunteer to be blood donors or bone marrow donors. There are a variety of strategies those organizations use, which in part rely on people's sense of wishing to participate and their sense of generosity, but there are clearly some barriers to overcome. If the member opposite has any great insights into how we overcome some of those sometimes difficult psychological barriers to becoming a donor, I would surely welcome her advice.
L. Reid: I appreciate the dialogue; I know we can arrive at some kind of solution. What I heard you say in terms of my request for a consistent approach was that we can probably expect that British Columbians will be asked at least twice in their lifetime....
Hon. P. Ramsey: Oh, more than that.
L. Reid: Well, consistently across the board: when they get a driver's licence; when they get a CareCard. We know that's not going to pose the question to them annually, because most of those are three or five years. So they are going to get asked at least twice. To extend the discussion a little further, most of us, when we talk about communications and advertising and getting the message across, talk about the frequency of the message. I wonder if the ministry has given any thought to utilizing some of the other corporations and agencies of government that are currently available. I will make special reference to the Power Smart program. They will tell you that the reason it is successful is that every month when you get your bill, you get the message. Has the ministry considered putting in a heart smart card with people's hydro bills and things they receive monthly...
An Hon. Member: Or ICBC.
L. Reid: ICBC bills -- anything that government is responsible for billing people for has a Crown corporation or an agency. Can he ensure that the message gets out frequently? I appreciate what the minister said about CareCards and licence renewals, and I applaud the fact that those two agencies are going to continue to take up the slack on ensuring that that message gets out. But I think perhaps we can look at expanding the number of deliverers of the message -- something that comes into your home on a monthly basis. I know the minister will probably agree that something like the Power Smart program has been successful because the companies are very, very skilful at creating awareness for it. This, I think, is of equal value and equal merit. It is certainly a better deal for the province if some dollars could be spent on ensuring message frequency by perhaps inserting a card into the envelope. I would ask the minister to kindly comment.
Hon. P. Ramsey: I thank the member opposite for her suggestions. I think she's accurate in saying that you get at least two every year.
I wouldn't underestimate the work that some of the other agencies are going to be doing. The Kidney Foundation of Canada has just informed us that their latest fundraising drive sent out 500,000 folders and organ-donor stickers. That's not an insignificant number. The other foundations are doing similar work.
Neither would I underestimate the impact of involving doctors' offices, hospitals, clinics and community health services in the long-term implementation of the registry. They'll have a vital role. The goal is to have the information there at a variety of sites. A lot of it is going to be folders in doctors' offices or clinics, delivered with fundraising letters from foundations, or direct mail-ins from the B.C. Transplant Society.
I do welcome the member's suggestion that we look at an inclusion of information with hydro bills or other broad government mailings. I think that's worth looking into, and I'll ask staff to do that.
L. Reid: Certainly I would concur with the minister that organ donation is a shared responsibility. I think the fact that those other groups are doing an absolutely superb job is wonderful. I would never, ever take away from the work that they're doing.
I know the minister will agree that out of 3.7 million people in this province, a mailing of 500,000 still leaves many, many missed opportunities. If there are ways to look at organ donation as a package, and ways to canvass the province very consistently, I would absolutely welcome that.
I have one or two questions regarding what appears to be a moratorium by the Canadian Pediatric Society. It's one of those very delicate, very emotional questions, because it looks at infants who are born without a brainstem. It looks at infants who are born needing some organ, not being able to access that level of organ transplant, if you will. Somehow the moratorium is still in place and does not allow the harvest of that tissue. I don't know if the minister is aware of that. That was certainly raised to me on two separate occasions in the last couple of months. I am not knowledgable in great depth on this topic, but I simply think that perhaps over time you could do some work on that. I understand completely the sensitivity around it. I can tell you of parents with newborns who are awaiting some organ, understanding fully that hospitals choose to have children as close to two years of age as possible to be considered for transplant, and hopefully as close to ten kilograms as possible.
Within the broader question of a shortage of organs, there seems to be a very specific question about infant organ and tissue available for transplant, that is somehow tied to this moratorium on organ-donor infants. If the ministry could do some work on that, I would certainly appreciate it. Again, I understand the sensitivity around the situation. If the minister would comment.
Hon. P. Ramsey: I think we are in agreement that this is a very delicate issue. It involves a lot of the attachment of parents; it involves some ethical questions as well. I have asked staff whether "moratorium" is the right word; they are not sure. I will endeavour to get some information back to the member about what the state is. It clearly is a hard thing to deal with. It does involve whole issues about when one says: "If this life is over, can the end of this life assist somebody else to continue to live?" That is a delicate one.
It may be -- and this is one thing I will ask staff to look into -- that this relates to some national policies or national standards as well. Then it is beyond the ability to deal with it independently in this province. I will ask staff to look into that and get back to both you and me.
[ Page 14387 ]
L. Reid: I thank the minister for his comments. It seems the University of Alberta has a neonate program that certainly welcomes children and new moms from British Columbia, and I welcome that. I am not convinced that every province needs to have every freestanding resource there is. Certainly we can see some of these delivery systems as packages and share some of these resources. I am wondering in terms of the future B.C. Children's Hospital if are we looking to replicate that neonate program. Are we looking to continue to seek their guidance and insight?
Hon. P. Ramsey: I appreciate the opposite member's understanding of the complexities of providing some of these procedures that are indeed rare. We may have two or three institutions in the entire continent that deal with a particular condition. As far as qualifications or standards for doing kidney transplants on infants are concerned, staff have informed me that the B.C. Children's Hospital and the Alberta Hospital are identical. We already replicate that.
We were also talking briefly about what we do in the case of very specialized operations -- heart transplants, for instance. Right now in this province we send patients to Loma Linda in California, and so does Alberta.
[3:15]
As the member may notice, a couple of places in the continent specialize and have a very high success rate in those procedures. It's obviously cost-effective to make use of that resource, rather than duplicating it here, and it also insures high quality of carrying out these procedures.
L. Reid: Again, I thank the minister for his comments. I certainly concur that it's a mighty complex issue and brings to mind the situation with baby Diego and the kidney transplant, and the complexities around liver transplants on little tiny souls as well. Has the ministry had any discussions in terms of having that kind of expertise available in British Columbia or within a Canadian province?
Hon. P. Ramsey: The member opposite refers to a situation I became aware of and was somewhat involved in personally, working with the family through their options and seeking good advice from the B.C. Transplant Society and others about how to deal with them. As the member knows, the decision at the end of the day was that the services required were simply not available anywhere in this country and that we should look elsewhere.
There have been ongoing discussions between the Hospital for Sick Children in Toronto and other major referral centres in the country. The decision to date has been not to replicate the under ten kilogram -- very, very low weight infants -- transplant program in this country. The analysis still is that it is probably more effective, both for quality and cost, to use those resources available in other centres on the continent.
L. Reid: I certainly thank the minister for his comments. He will recall that approximately this time last year, during the Health estimates, we got into a debate around presumed consent. Certainly we both had issues around regard for individuals' autonomy and human rights and other issues of equal complexity.
What I want to say in terms of this set of materials available from the B.C. Transplant Society is that they have now moved to the wording "breaking barriers to organ donation by mutual consent," and I would applaud them. I think a lot of thought has gone into this particular approach, and that kind of tastefulness, if you will, and timeliness around this topic will only be to the good. Indeed, I think individuals will feel less pressured in terms of family members when considering organ donation. So again, I think the materials that they have prepared are absolutely outstanding.
I would also like to take a moment to commend Evelyn Carroll, who is the chair of the board of trustees for the B.C. Transplant Society. Both she and Loretta O'Connor gave me a fabulous tour and a sense of how vital they believe the work to be. We can only applaud their work, because I think it is absolutely fabulous that they are prepared to give that kind of time, effort and commitment to it.
In terms of the next step and what happens in other institutions around the province, the minister is aware that a number of agencies are creating ethics committees. Certainly the ethics committees will not restrict their work just to organ tissue and corneal tissue transplant, but will engage in a whole range of services that are available or not available to different British Columbians, based on criteria that's probably yet to be established -- how a person presents, whether or not they are a viable recipient for a particular procedure and whether or not it's a good investment in terms of their health care and in terms of the province.
Perhaps the minister could just give me a thumbnail sketch of where the progress has been made in terms of ethics committees. Is there one established in the majority of hospitals in this province, and will that ever be a public process?
Hon. P. Ramsey: First of all, I just want to say to the member opposite that I share her enthusiasm for the work of the Transplant Society, and I know how excited they were when.... I think what they felt was perhaps years of having this as a back-burner issue, when the Premier and I said: "Let's make it a front-burner issue and recognize that we've got too many people waiting too long on wait-lists for organ transplants in this province, and we need to take coordinated and urgent steps to rectify that."
As far as ethics committees go, there are a couple of things. First, most hospitals do have one now, particularly those that are going to do complex procedures. Second, there is public involvement in them now, and that should continue in the future.
As the member may know, I have an advisory committee on ethical issues that reports directly to me. One of the things I've tasked them with is going out and working with regional health councils and community health boards about the establishment of ethics committees more broadly for health decision-makers. As the member opposite says, the work of those committees clearly involves both the medical efficacy of a procedure, its impact on the totality of one's life and also the consideration of effectiveness in terms of use of public resources. So they have a big job in front of them, and I think the more widely we get that sort of work done, the better.
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L. Reid: If I can simply ask the minister to clarify further for my information. . . . When I asked about public process and public involvement, you responded positively. What does that public participation look like? Are you appointing lay members to that committee?
Hon. P. Ramsey: My understanding is that the great majority of ethics committees in hospitals consist of more than medical personnel and hospital administrators. They usually involve members of the general public -- sometimes from the clergy and sometimes other members of the public. The advisory committee, to me, on ethical issues contains people with medical backgrounds, those with philosophical and ethical backgrounds who teach ethics and biomedical ethics in universities and, as well, -- what's the third category? -- philosophers -- Lord help us.
L. Reid: We could use some here.
Hon. P. Ramsey: I have attended a couple of their meetings. As the member opposite says, perhaps we should let them come and give us a seminar on how to engage in the full range of discussions on the complex issues.
L. Reid: To continue the discussion, I have had individuals who have been seeking a particular service in a particular institution, and I am sure there are other MLAs in the province who have too. I won't cite particular examples; however, I'm happy to share that with you after the debate. These are cases where people have been seeking a particular service and have been turned down. Their question to me has been: do they have any recourse to something like an ethics committee? Is there any appeal process?
What I have done up to this point is simply send them back for another medical opinion, because I do not believe the process encourages that kind of dialogue. I would appreciate the minister's comments and guidance on that question. It may be that the structure will never accommodate that level of exchange, or it may be that we're evolving to that level of exchange. I would simply ask how best to direct these constituents at this time -- if, indeed, that's a possibility?
Hon. P. Ramsey: Hon. member, the primary responsibility for that, beyond that of an individual medical practitioner, rests with the College of Physicians and Surgeons. Clearly they have the responsibility to say whether this is within accepted medical practice. So that is one avenue for directing individuals, and I must say that my office in Prince George has done some of that, as well. First, obviously, back to the medical practitioner or to another practitioner, but then, second, to the college.
L. Reid: To clarify, the ethics committee will probably not have a role in terms of receiving or hearing from individuals. They would simply suggest that those individuals go forward to the College of Physicians and Surgeons. If there was an issue, the College of Physicians and Surgeons would perhaps have a direct communication with the ethics committee. If the minister could comment.
Hon. P. Ramsey: As the member opposite deduced correctly, the primary communication would be from the practitioner or individual to the college, and either back to that individual or practitioner and the institution where he or she works. It would not be with a local ethics committee.
I've also just been informed that the situation is more complex than either of us suspected. The College of Physicians and Surgeons of B.C. has its own ethics committee to deal with these very, very difficult issues.
L. Reid: I knew that.
Hon. P. Ramsey: I did, too, at the back of my mind somewhere.
They, like all of us sometimes, wrestle with problems, such as babies born without a brainstem. They find themselves with as many questions -- perhaps more questions than answers -- as all of us do.
L. Reid: One additional question in this area. The only reason I'm asking for some sense of the public's participation in the process is to take this matter to the next level. I know parents who delivered a very significantly impaired baby. In some cases, they were invited to participate in the discussion; in others, they were not. The person who I will absolutely commend in this process is Dr. Michael Whitfield from B.C. Children's Hospital. He truly supports the view that it's a decision that needs to be reached by all concerned. He wants people to be part of these quality-of-life issues.
There are other scenarios where parents have not been part of the process. Perhaps the ethics committee is further down that road, but that is where two of the parents who have come to me believed their issues could best be addressed. How many surgeries should newborns have before they're four hours old? They want to be part of that process. This is not at all to take away from the expertise of the medical community; this is to have parents share some of that decision-making. To me, that's the finest way for parents to proceed. These are not simple issues; they're absolutely complex. In the case of Dr. Michael Whitfield, he's achieved that very fine balance, which I think is rare.
[3:30]
Does the ministry have any thoughts on how we can achieve this balance in different centres? I will concede that the B.C. Children's Hospital is the place, and they're doing an excellent job, but often these babies are born in different sites around the province. Decisions are made before they reach the B.C. Children's Hospital for treatment, and parents would very much like to be involved in those decisions. Could the minister comment?
Hon. P. Ramsey: I thank the member opposite for her comments about the really sensitive way that staff at the B.C. Children's Hospital deal with this issue. Obviously a parent or guardian has to give consent for procedures. If I understand the member correctly, her question is: to what extent does the practitioner involve the family in the consideration of every option and really try to sensitize the family to.... As the member says, what happens if you have six operations in the first four hours of life? What does that mean for quality of life? How does that influence your decisions around the case?
[ Page 14389 ]
I wish I believed that there is a standard way to do this. I don't think a committee is the answer. An ethics committee may well have a role to play at an institution in sensitizing physicians to approach the task of involving the family more sensitively, but as the member opposite knows, physicians, like other human beings, have a range of how they carry out their practices; they may be ethical and medically appropriate, but they still have a range of how they carry them out. I think the task is probably slower; it will be evolving over time as these issues come to the fore and the ethics committees sensitize the staff at hospitals about how to deal sensitively with families. I would also submit that patients and families themselves are increasingly demanding that they be consulted more. I think the days are past when the appropriate patient-physician relationship was deity and supplicant. I don't think many patients accept that any more; they demand a greater say. Clearly I think that is to the good and will involve families more deeply as time goes on in decisions in cases such as the member has presented.
L. Reid: I thank the minister for his comments. In terms of questions around rehabilitation, the Vancouver Region: Acute Care and Rehabilitation Services Study makes some interesting recommendations. But if we could spend just a few moments on some of the global issues around rehab -- and I don't mind if the minister wishes to address this on another day -- and perhaps frame the discussion from community-based physio and occupational therapy, all the way to services such as Pearson Hospital. I would be the first to admit that a range of services are required, that there are a lot of services along that continuum. I guess for me it's a question of how best to coordinate some of those services and what may still be missing along that continuum.
If I might I'll make reference to a particular case the minister and I have corresponded on: the case of Elliot Murphy, the little guy at Sunny Hill Hospital who now finds himself in a facility whose mandate is changing. When I was employed there many, many moons ago, in the early eighties, it was definitely a residential care facility. There was no doubt about that. It's moving to a facility that is responsible for stabilizing patients and for putting them into some type of transitional phase. I don't take any issue with that at all, but it seems to me that there have to be places which can receive the individuals who will now move through Sunny Hill Hospital and other rehab residential facilities in the province. I acknowledge the minister's comment that the mandate for Sunny Hill Hospital has changed. Again, I take no issue with that. My concern stems from the fact that there doesn't appear, at least on the surface, to be appropriate receiving facilities for those children. I would make the same claim for individuals leaving Pearson Hospital. Certainly it's a vastly different population, but there seem to be a number of issues that their families are raising about the most appropriate placement. If we can spend a few minutes today addressing some of those issues.
On a very positive note, the correspondence that you have sent back in terms of exploring a sub-acute care facility -- a group home placement for significantly head-injured people -- I took as very positive. My request was to have the ministry exam the viability, the costs and all of those issues and come back to the table. I welcome that. I think that's exactly what should happen in this particular case.
But I also know that in my using Elliot Murphy as an example, there are 80 other children in this province who need a place. Their parents, I know, have been in touch with you, because they have been in touch with me, concerning issues around head-injured young people, 12 to 14 years of age, who find themselves on geriatric wards. I respect the urgency their parents have to see them placed with similarly aged peers. I think this has to be something that is looked at as a family issue. I am not making the claim that 80 of those children are in inappropriate placements, but the individuals who have come forward have such alarming stories about how difficult it is for their families to continue to function. What they are really looking for is some kind of prescribed physio occupational residential setting that will provide those services to them without exposing the other children in their family to a roomful of 90-year-olds, which brings attendant problems of psychogeriatric care and all those other issues. We will perhaps touch on those next week when we discuss corporate programs.
In terms of today's need, could the minister comment on where that discussion sits in terms of a subacute care facility? Most families are defining subacute care facility as an aesthetically pleasing group-home setting that offers a range of services, where the residents can be with similarly aged peers. That speaks to me. I would welcome the minister's comments.
Hon. P. Ramsey: This is an issue that the member is knowledgable about, has worked in and knows some of the individual cases, as I do. I want to say that I share the member opposite's view on this issue that we need better integration and coordination. I don't know whether she is aware that for the last year there has been an ongoing team working on what we are calling a rehabilitation services action plan. It started in March of 1994 and has been doing community consultation and work with providers, advocates and families. Its goals are clear: we want to see consensus, a vision and some guiding principles for a provincial system. I emphasize system, not provincial bits and pieces.
We are asking them to produce a framework for the planning and decision-making used by all stakeholders, including the Ministry of Health, to get a provincial rehabilitation system in place. Then comes a clear action plan that says: "These are priority things you need to do; this is the order in which you ought to approach them." We then provide this information to the ministers and to regional health boards and community health councils, as they do the work of providing rehabilitation services for residents of their own regions and communities.
I think they have done a lot of good work to date. They have had about half a dozen extensive regional workshops around the province in the last year, which have attracted close to 400 people -- consumers, care providers and other members of the community interested in the issue. The reaction of those people has been generally positive. I am looking forward to receiving that plan in the very near future. Their original deadline was the end of April. Talking to staff, I understand it has slipped -- that seems to happen regularly -- but it would obviously be a document that would be available both to you and to the general public. It would obviously reflect the input of families and care providers.
I must say that the member and I both recognize that the world has changed for various institutions when we think about long-term caring for somebody. The ministry has been
[ Page 14390 ]
taking action over the last few years to make sure that the situation that the member describes -- the ten-year-olds in with the 80-year-olds -- doesn't happen, but it may still occur. I am unaware of any right now, although I surely have received letters from people who are worried about that inappropriate placement. There is a need for more residential facilities that I believe, with the proper supports and care providers available, can take care of cases like Elliot's.
L. Reid: In terms of something like Sunny Hill Hospital and the minister commenting that the mandate has changed, perhaps you could just clarify the current mandate. That may eliminate my need for further questions.
Hon. P. Ramsey: The member may know some nuances that I'm unaware of. My understanding of the current role of Sunny Hill is that it is clearly focused on rehabilitation rather than residential. Their goal is to provide the rehabilitation their clients require and also to do the outreach to the regions in order to provide those rehab services not just on-site, but also in coordination with other care providers in different regions.
I recently visited a facility at Kamloops that works very closely with Sunny Hill to provide chairs and other devices that are needed for rehabilitation. That's where I draw the demarcation: Sunny Hill's role is in rehabilitation; we should no longer see it as a long-term residence. The challenge is to find long-term residence sites that are respectful both of the needs of the individual and of the wishes of the family.
L. Reid: I was concerned when the minister rose and said that the mandate had changed, because I think that lacks some recognition of the folks who are currently residing in Sunny Hill Hospital. It is changing, and in fact, for the ministry, it may have changed. But for the little guys who are there, until there is an appropriate place for them, the message that goes back to their parents is: "We no longer deliver that type of service, so you are no longer an appropriate placement in this setting." As the minister is aware, that was the situation around Elliot Murphy.
Certainly over the past year the mandate of Sunny Hill Hospital probably did change. I don't believe the evolutionary aspects of that were considered for the existing residents. A new place was not found for them in the community and still has not been found for them in the community. The message going back is that they're no longer appropriate.
[3:45]
Again, I know the minister agrees that this is an intensely emotional issue for this family and for all families who have head-injured individuals. The need to find an appropriate place comes with intense urgency and intense frustration. Oftentimes the knowledge and the information are simply not there, in terms of where best to look.
[L. Krog in the chair.]
I certainly don't mind at all when the minister states that the mandate has changed. I think it makes perfect sense for the individuals coming into that setting, because they know what they are coming into. For the folks who are residing there, it's a definite catch-22. They have no other place to go at the moment, yet they don't fit there. I think so much of the emotion that these families need to survive is being expended on this level of worry, this level of concern, about what happens next. I'm speaking for families that are still there, not just Elliot Murphy's family. They need to hear somehow, through some forum, that decisions will be taken that don't remove them from the exercise and that still see them as recipients along the continuum. The road may be changing direction slightly, and that service may be shifting and evolving, but closing the door simply sent, I believe, the wrong message. To hear that you're no longer appropriate when you have no place else to go has caused great concern and unnecessary concern.
I think the support that hasn't been there for the families is something we can only hope to improve upon next time out, because there will continue to be head injuries in this province. There will continue to be head-injury survivors in this province, and what I want to see us do is look at the family as a package. Certainly my concerns over the last number of weeks in working with this family and with individuals in other parts of the province have been around situations such as the Insurance Corporation of British Columbia, which will cite regulations and bylaws as to why they can't support the family or why they can't offer counselling services to the parent? I come back to the citation that says those services are only available to the victim. I would suggest to you today that the entire family is traumatized when something like that happens, and to have individuals continually citing rules and regulations and denying that there's a need.... Those families are not seeing government as being supportive.
We can certainly get into an elongated debate as to whether it's Social Services or Health or ICBC or WCB, but the bottom line is that most people look at those agencies as government. They see them under the umbrella of government. And if there are ways to make those agencies more responsive and react in a more timely fashion and model some more appropriate behaviours, that is what these families would like to see. I would welcome that. I would ask the minister to exert some influence in terms of ensuring that the family is seen as a unit. If I can ask the minister to comment.
Hon. P. Ramsey: I agree with the member opposite that at times it seems there are too many agencies involved -- ICBC, WCB, Ministry of Social Services, Ministry of Health -- and that's one of the reasons why the work on the action plan is so important: to figure out where all those pieces are, how they all fit together and what the priority actions are.
One of the things we have to recognize is that the care plans that are developed for the kids at Sunny Hill are done with the interest of the child at heart. They are looking at what the needs of the individual are; they're not going to place the person in a facility or situation in which needs are not being met.
I think one of the difficulties very often -- and I don't know all the details around some of the consultations that are going on in terms of Elliot -- is to demonstrate clearly to the family that appropriate supports are there and to discuss what supports are needed in a residential or other facility. I haven't met anybody who works with these kids and doesn't have that as the goal. But we must also say that the long-term plan for many, many of these individuals is to find placements
[ Page 14391 ]
under Services for Community Living or some other arrangement, which says that we're not sure that a hospital is the right place for the individual or for the family. That's a decision, as the member knows, that is widely accepted.
A lot of the movement toward Services for Community Living came from families and advocates for individuals themselves. This is not something imposed from above through some cost-saving measure. At times it may, at the end of the tally sheet, have proven to be more expensive than to provide some of the supports in a community residential setting rather than in an institutional setting. I submit it's still the right thing to do for the individual.
So I've surely urged people at Sunny Hill and in my ministry to work sensitively with these families and their children in order to make sure that the care plans are well understood and that the needed level of care is there. I have also said very clearly that we ought to be saying as clearly as we can that when hospital facilities are needed, they should be there. When other venues are more appropriate for delivery of care, we should provide those as well.
L. Reid: I do believe the minister and I agree. I certainly know that it's a highly charged time for all these families. There are ways to convey the message more clearly and more directly over care plans. Certainly with my background as a special ed teacher, the necessity for a team plan and for a team meeting to bring all the players onside is absolutely evident. It works well.
I think these issues are even more complex, particularly around Elliot. This little guy's been in a coma for more than a year and a half. I would applaud this family. I think they're doing a remarkable job of beating their way through the maze and, hopefully, coming out with something that is appropriate for their child. I would suggest that we're probably halfway along that road. I trust that when the report comes back to you about subacute care, it will look to quality-of-life issues.
Certainly I would be the last one to stand and tell you that a hospital is always the most appropriate placement. I don't have the background to do that, and, frankly, I don't believe that. In terms of how best to evolve these discussions and how best to communicate the message, we can only hope to improve every single time. As long as there's some assurance for this family and for other families that the goal is to involve them in decision-making and to treat the family as a unit, I will happily await the outcome of that report.
In terms of programs available in the community and supports for individuals who currently reside at Pearson Hospital, again, I've spent a number of days with individuals in that residence who have similar concerns about how the transition will occur or has occurred from what that facility used to be and how they see it changing. If the minister could comment on whether that mandate is also in an evolutionary process, I would appreciate that.
Hon. P. Ramsey: I just wanted to check with staff and make sure that my understanding was accurate. My understanding is that Pearson is essentially a residence for long-term care and that there are no plans to change that role. There may be individuals within Pearson who would be looking at a more appropriate place in the community, and we'll be working with them to facilitate that. There's no plan that I'm aware of to change the general role of Pearson.
L. Reid: My thanks to the minister. I'm absolutely happy to take that message back. For whatever reason, there seems to be some confusion around the future of that organization.
An Hon. Member: We're not sure where it's coming from.
L. Reid: I just receive this information and pass it on to you.
In terms of physiotherapy and occupational therapy, there are questions around those services previously being hospital-based, and now there being fewer opportunities for out-patients to receive those services from hospitals. Again, in terms of a delivery change in that service, whatever is best practice is absolutely fine, but in terms of getting to that best-practice stage it seems that there are a lot of individuals who previously were able to access that service and are not able to now. Certainly one of the considerations is financial. When that service was provided on an out-patient basis, it was part of their ongoing treatment. Now when they're required to secure that service in the community, once they've had a certain number of visits, there is a cost attached to that.
The individuals who come to me perceive their treatment as a package. They started it in hospital, and they wish to continue it. Some of them will tell you that they expected to complete it as a course of treatment within that institution. Could the minister comment in terms of whether all out-patient physio and occupational services in the province are being downsized? Has that focus been changed? Can patients who are discharged expect to receive a certain amount of hospital-based service in the future?
Hon. P. Ramsey: Like the member opposite, I have heard these concerns, particularly from physiotherapists in private practice who feel at times that the hospitals are downsizing. Actually, I've heard it from hospital workers as well, who feel that physiotherapy services are being eliminated. There is no plan to do that. Any reduction or elimination of a service requires ministry approval, and we are not interested in eliminating out-patient or in-patient physio and occupational therapy.
We have tried to reinforce it. For example, with the health accord a laid-off physiotherapist would be registered and have to seek another job. One of the conditions of the health accord is that a transfer to private practice doesn't cut it as satisfying those concerns. I'm aware of a couple of layoffs in physiotherapy in hospitals. We're saying very clearly that that is a service hospitals should be providing on an out-patient, as well as an in-patient, basis. In the current budget letter to hospitals this year, we're asking for their support in making sure that they maintain out-patient rehabilitation services.
[ Page 14392 ]
L. Reid: The maintenance of those programs is certainly not in question. The size of those programs, if you will, is what I'm questioning. It seems that service is being downsized. I have not heard this concern at all from, as you have stated, physios in private practice. These concerns have come to me from patients who tell me -- and I know, from copied correspondence, that they've told you, too -- that they were not able to receive that service from the hospital. They didn't suggest that the service had been eliminated. They simply said that they could never get an appointment; it was never available.
[4:00]
In terms of funding from the ministry.... Appreciating that they must all offer that service, what does the service look like? Is it full-time or part-time? Has it been reduced in any way?
Hon. P. Ramsey: I have a couple of figures here. We've pretty much stayed away from figures in our debate so far. The 1994-95 budget increases physiotherapy in a variety of settings. Hospitals, as you know, received a relatively small budget increase last year -- 1.2 or 1.3 percent. Some received top-ups from the $50 million fund, but they were relatively small. Community physiotherapy services, through health units and others, received an increase of 13 percent. We were clearly saying that we wanted to make sure that sort of service was available.
We negotiated a new agreement with physiotherapists under the supplemental practitioner part of the Medical Services Commission. I listened very clearly to their concerns that their budgets were not adequate to fit demand. We increased budgets for private practice physiotherapists by 18.4 percent. There are a variety of sites where it is available. There may be an individual who runs into difficulty, particularly in smaller communities where the options may not be as great. But we have clearly said that we recognize the value of physiotherapy and other rehabilitation services. We have provided funding increases for them.
L. Reid: I understand from the minister's comments that the percentage increase has been larger for community-based physio, so indeed it would make sense that some of the services that were previously offered in hospitals have been shifted into the community. I hear the minister say that these patients should have no difficulty securing the service. It may not be in the hospital. They may now find it in the community, but it should still be there in equal numbers. Would the minister confirm or deny?
Hon. P. Ramsey: I am getting good advice from my colleagues that the appropriate and quick answer is a prompt denial. I am not sure I am going to take that advice.
Hon. member, as we moved through reducing beds in hospitals and getting more efficiencies in institutions, I surely heard great concern among physiotherapists and some other services provided in hospitals. They thought they were easy targets, and that hospitals would be looking at shutting them down, moving that service out and hopefully relying on someplace else. As I said before, we have clearly said: "No, you don't get to eliminate or reduce these programs." Our budget letters have reinforced that message and said: "We expect you to continue to provide that service. Yes, we expect you to provide it efficiently. Your budgets are not what you would love in all cases. We recognize that some out-patient services in particular might be more appropriately provided by community physiotherapy, and we will give a larger increase there." As I said, I will make sure that private practice physiotherapists are an integral part of health services in their communities.
[G. Brewin in the chair.]
V. Anderson: I'm pleased to come in for a few minutes and give my colleague a break. I first of all want to ask about Pearson Hospital, which is in my riding. We hear from time to time a great many concerns about the future of Pearson Hospital -- whether it is going to be downsized or eventually moved out. I know there is a connection between it and G.F. Strong Rehabilitation Centre. I was wondering if the minister would respond about Pearson Centre -- its present situation and prognosis for at least the foreseeable future.
Hon. P. Ramsey: As I was just saying to your colleague, neither I nor my staff are aware of any plans to change the role of Pearson. It provides a valuable service. Its focus is on residential long-term care, and that will remain its focus of care. The only thing I can see that might have engendered some of this concern would be the Lovelace report and the regionalization which will clearly place both G.F. Strong and Pearson under the governance of the Vancouver Health Board. There are no plans to change the mandate or role of Pearson.
V. Anderson: As it comes under the Vancouver Health Board, is there any stipulation within the mandate that those programs must be maintained, or will they have freedom within their budget to alter those programs or phase them out within that programming? Is the security we had from the minister now dissipated once it went over to the regional board?
Hon. P. Ramsey: I recognize that there is a concern around regionalization. Change brings fear and uncertainty. The reality is that regional health boards are not going to have the mandate to say: "There are great aspects of care that we are simply not going to provide." That's not on. We have tried to ensure that through a number of ways: through specifying in core service documents and others what the expectations are for the delivery of services in regions across the province; by saying to regional boards and community health councils that they must present to the ministry a plan for delivery of services and for structuring those services before we turn over operational authority; and by saying clearly to organizations that offer specialized services, such as the B.C. Rehabilitation Society through G. F. Strong and Pearson Hospital, that where they have a mandate that stretches well beyond their region, they'll be funded for that mandate even though they're serving people who may not be from your riding or from the Vancouver region.
V. Anderson: One of the focuses, again, has been trying to.... Many of those who live in Pearson are looking forward to the opportunity to move out into living on their own.
What is the plan to enable them to do so? Is that a plan that will come from the ministry or is it a future plan that will come through the regional board? How is the funding available to enable them to get out into independent -- in some cases shared -- living?
Hon. P. Ramsey: The responsibility for doing that work will rest with the board. We will be asking them to do it. I see boards across the province looking at how they provide the right mix of institutional-based care and residential care.
[ Page 14393 ]
V. Anderson: I might ask then, because in many cases this is a question of suitable housing availability, if the Ministry of Health, the Ministry of Social Services and the Ministry of Housing, Recreation and Consumer Services cooperate in order that the variety of needs involved with these persons as they try to move into independent living.... Is there a coordinated approach? I know that in the past it's often been the case of going to one ministry and they refer you to the other one, and they refer you back again. That's been very frustrating when you have enough difficulties to contend with in the first place.
Hon. P. Ramsey: First I want to assure the member opposite that both at ministry level and at staff level my ministry and the Ministry of Housing, Recreation and Consumer Services do work closely together to meet the needs for residential housing of people who are at Pearson, for mental health consumers or for others.
I must say, though, that one of the challenges we both face, the Minister of Housing and myself, is the very limited resources that we have right now. I mean, the federal Liberal government has just about walked away entirely from housing programs. In this province we have put in additional funds to make sure we are building social housing and the sort of supported housing that the member and I are talking about. But I tell you, as we see the withdrawal of federal government support from this area of social programming and others, it makes it increasingly difficult to make sure that we are meeting all the priority needs.
V. Anderson: In meeting with the residents' association of the Pearson Centre, particularly in the riding, there has been ongoing discussion on the kind of balance of management of the centre by the residents and the staff. I know over recent times there has been a great deal.... When I first became involved with Pearson many years ago, there was really no involvement of the residents in management. That has changed drastically so that they are involved in management.
I wonder if the minister could talk more about Pearson and other hospitals where people who are in long term care can be involved in feeling that they have some ownership and some say in the ongoing management of the institution -- Pearson being a good example in that regard.
Hon. P. Ramsey: The situation the member describes at Pearson is not only common but, as far as I can tell, almost universal in the province. Just ask if you can think of a long term care facility that doesn't have a residents' committee. The answer is no; you can't think of any.
Over the years this has become part of the expectation of service -- participation in decisions on services provided in such facilities. So what the member sees at Pearson Hospital is typical of what's going on around the province. I must say, as I've met with residency councils in my travels to facilities, some are working better than others. Sometimes it depends on personality, relations with staff or a variety of things. But the intent to involve residents in decisions about their care is universal in long term care facilities.
V. Anderson: Another area that comes in relation to Pearson Hospital was the experiment begun just about a year ago with B.C. Transit for a special kind of pick up and delivery service, which made it possible for them to get from that centre to downtown and to different places. Do you have any information on how that cooperation between the centre and B.C. Transit has worked out and whether that kind of program will be made available in a similar fashion to other centres?
Hon. P. Ramsey: You've got us. I don't have any specific information on the Pearson Hospital experiment. I would say, though, that this idea of a coordinated infrastructure for transportation for those with severe handicaps is something that has migrated even as far north as Prince George. We just took delivery in Prince George, through B.C. Transit, of several of the newer-model buses, where you can actually bring them down for wheelchair access. They're devising a transportation network for those living in residences for the handicapped, which combines HandyDART and general public transport to make sure that they have increased mobility in their community. So the sort of work that the member has seen at Pearson Hospital and the cooperation between a health facility and B.C. Transit is happening in other parts of the province, as well. I must, at the end, say that I don't have the specific figures.
V. Anderson: I'll move away from that topic for a moment to another area in which I have some interest, and that's in the interdenominational programs or services that are related to the Health Ministry. I know that in the initial stage there was a great deal of fear that the interdenominational church and other society programs were not going to be given the opportunity to be fully part of the program, but I know that there has been some agreement between the minister and those associations. Could the minister elaborate on that agreement, and what is the state of it at this present time?
Hon. P. Ramsey: The member is right. There is a firm agreement between myself as Minister of Health and the association which represents denominational facilities in the province. The agreement provides for affiliation between those facilities and the regional health boards that will be responsible for funding them. It clearly says that we need to recognize the denominational ownership and the quality of care provided in those facilities. It also recognizes very clearly the responsibility of the regional health board and community health council for overseeing supports and admin for them. I'd be glad to provide the member with a copy of the document; it's a public document which details the responsibilities of both parties. Regional health boards across the province, as they work on their health plans for delivery of services, must deal with denominational facilities within the bounds of that agreement.
V. Anderson: I look forward to getting a copy of that; I would appreciate that very much. I've had a chance to meet with some of them, so I'm aware of the concerns they've had and also aware that they are thankful that this kind of document was coming forward. I want to say that, from my point of view, I appreciate the development which took place. Within that, I still hear some uncertainty and concern about how this is going to be handled because of the variety of concerns that regional health boards have and the kind of pressure that's going to be on them for prioritization of those services.
[4:15]
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One of the concerns I hear -- not only in the health area but also in social services and other areas -- is the pressure being put on volunteer boards which have been operating in many cases with non-union staff. The pressure being put on them for union staff coming into many of these facilities also puts a pressure on the kind of management and other issues that volunteer boards haven't had to deal with in the past. It's an area they're not experienced in dealing with and a kind of pressure that many are not sure they wish to undertake. That is a concern as this process develops, because moving into a non-union facility is not the same as a part of the hospital which has been operating under a board working primarily with union situations. I'm wondering if you can comment on this, because it is complicated and has added a great deal of pressure to many of the people I've talked to.
Hon. P. Ramsey: If you have specific correspondence from specific institutions, I'd be pleased to review it and get a response prepared to them. I must say that I'm unaware of any pressure from regional boards for "privatization" of services. I'm not quite sure what that means. There are some private health providers in the province, but I see no push from regional health boards to privatize the sort of facilities you're talking about.
Similarly, I see no pressure -- no real pressure at any rate -- to force the unionization of staff. That is simply not on. The work that Mr. Dorsey is doing for the Minister of Labour, as a commissioner under Bill 48, respects the fact that there will be a mix of union and non-union providers in the province. I'm at a bit of a loss to address the issues, because in neither of those cases is privatization or forced unionization a policy or initiative of this government or of the regional health boards.
V. Anderson: I think that is an encouraging statement for the people whom I've talked to, because there has been an uncertainty in this area from the very beginning and a concern that there were outside pressures being brought to bear which would hamper their particular programs in operating in the manner which they felt there was the freedom to do that. I think it's important that there be some clarity in this. If I have the opportunity, I will follow up on that and bring some more information to you. It's that fear and uncertainty back there, which in some ways has held these people back from wanting to be involved.
I'd also like to comment briefly on my experience in my own particular area with the development of the local regional health unit. I've had the opportunity to attend a fair number of the community meetings and also to get the minutes from the community meeting in our own area. One of the ongoing concerns has been the attempt to really involve the people of the community. There have been a few key people who have been fairly consistent in being at the meetings. But almost inevitably, at the meetings of the local community areas where I've been present, there have been more regional people than community people actually involved. There were people from the planning stage, the promoting stage and the developing stage. Each time there were new community people there, and the ones who had been there previously weren't there. You came away each time with the feeling that there's no real community involvement here, and that's been going on fairly consistently. I think that's a concern.
It's one thing to bring together a regional board or a regional council where you have a dozen or 15 people, whatever, who are committed to operate at that level. It's a different thing to bring together a group of people in the local community who are there to get information, and not many of them are there really wanting to participate on a regular basis. I'm wondering if it is unique to my area -- but I doubt it, from what I'm hearing in other areas -- that the further it goes down into the community, the more difficult it is for people to feel they really have a handle on what's being involved.
I'm wondering if the minister could comment on that. There's a feeling that it's being put in from the top down, and that whether the community people get involved or not, it's still going to happen. If they stay away from the meetings, it's still going to happen, and it's still going to go on, and yet the theory of it is that it really belongs to them.
Hon. P. Ramsey: People may turn up at a community meeting to discuss health issues or the community health council for any number of reasons. Some of them may be care providers; some of them may be practitioners of one sort; some may be concerned with treatment of a particular condition that they have or that a member of their family has. There's a huge range of issues. People do show up, and they do get involved. Some decide to stay involved, and some decide not to stay involved. I think that's fairly common in any sort of community development.
But the people who have been working around the province to make sure that the voice of the broad community is heard on community health councils and regional health boards have attracted a fair range of participation, and the people have stayed involved. In most cases where they have sought nominations or interest from people coming forward to do the really hard and time-consuming work of making decisions in community health councils or regional health boards, they've had far more nominations and interest, and more people wishing to serve their community in that way, than they could possibly accommodate. As a result, the appointments to those councils and boards have reflected well on their communities, both in the expertise they bring to it, their past interest in the health system and the wide range of the community that they represent.
What the member describes.... I was thinking of the experience in my own community, where after a long bit of work, the steering committee for the community health council presented through the paper its document on the direction it wanted to go with a health plan, and then it went out and held a variety of public meetings to present that to various neighbourhoods in the city. They got different people at all of them, but they got a few of the ones who stick around and work further on advisory committees and do other work. Others went away satisfied that these people were listening carefully to them, and maybe some of them were dissatisfied.
As far as the mix of interests or involvement, I find this fairly normal for community development. I also think the members should recognize that in most situations I'm aware of, there has been a good core of folks who have stayed involved in the community process, and they see it as important to the health of people in their communities.
V. Anderson: One of the realities I found in visiting the municipal associations during some of their meetings around the province was that municipal members from the smaller
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communities seemed to be happier with what was going on in health councils than people in the urban areas. That was fairly consistent, except that in Victoria, they have a health system of their own that has been community based for years, so they seem to have another approach to it. In the lower mainland, one of the distinctions I found was that it was the same people from the rural communities on most of the boards anyway. They could almost have a meeting on the street, because in a small community you meet everybody on a regular basis at the school, the hockey rink or the curling rink. There's much closer interaction with people you already know.
In an urban centre there is not that knowledge and daily experience. The only time you'll meet many of the people is on this particular committee; there's no other time you're going to interact with them. The process there is different from the process in the rural area.
Also, the concern there has been the crossover between the boundaries. I know there was a concern in our own particular community. Some had assessed their situation and recommended that they should belong to the west group rather than the east group. They ended up in the east group against their will. The feeling grew quite quickly with them that it didn't really matter what they said, because someone beyond them was going to tell them what was going to happen anyway. That's an unfortunate circumstance to have developed at the very beginning, because they began to feel that what they were saying was really not that significant. I feed that back, because it is important for people to have confidence in the development of the system.
Of course, the concern that we have in the urban Vancouver area was over changes within hospital organization and the amalgamation of hospitals. In our particular area there was a sensitivity to begin with, because of the loss of Shaughnessy Hospital, which was right on our doorstep. We have heard recently about a movement within the area toward three kinds of hospital organizations rather than one big amalgamation. We're getting press reports on this, but not a great deal of detailed information. Could you comment?
Hon. P. Ramsey: The member opposite raises a number of issues. One thing I've found, both in rural areas and urban areas, is that those coming forward to sit on community health councils and regional health boards have very often been involved in governance positions in the health system before. The last time I tallied it up, some 30 percent of those sitting on CHCs and RHBs had prior board experience in some sort of health organization. That bodes well for the experience they're going to bring to the new governance system.
There may indeed be more concern about this among councillors, particularly in urban areas. I know that the regional health boards in the urban areas of the province are working hard to do even more community development and community involvement as a result of that. They recognize that you're not going to run into everybody at the hardware store, as you might in a smaller community. They're making efforts to involve as many people as possible.
As far as the boundaries issue, the decision, as you know, rested with the steering committee at the regional health board. I think they did their best, given the diversity of opinions they were faced with. It may not have satisfied every individual. I think, on the whole, that they seem to have got it approximately right.
[4:30]
Finally, as far as the organization of the large acute care facilities in Vancouver, there has been some action in the last little while. As you know, Marguerite Ford's steering group originally proposed a one-hospital board model. Mr. Lovelace's report then proposed a three-clustered hospital board model, one of which would include the B.C. Children's Hospital, the B.C. Women's Hospital and Sunny Hill Hospital for Children. Another would include Vancouver Hospital, the B.C. Rehabilitation Society and some others. The third would contain the denominational facilities, about which we spoke earlier. The report of Mr. Lovelace to myself and the regional health board is a public document. You're welcome to read all 120 pages of it and get as much detail as you wish.
F. Gingell: It's time for the annual discussion on the issue of stammering, and they're all ready for us this year.
I'm really pleased that the government has seen fit to fund $60,000 for 15 adults to go to ISTAR, the training program in Edmonton. That, in the total scheme of things, is very, very small. The issue -- the minister will remember -- that we discussed last year was the closing down of opportunities for speech therapy for adults within the province as hospitals, in dealing with budgets that allow for out-patient services, were cutting therapy. Victoria, of course, was the big example -- at Gorge Road. I was wondering if the minister could respond to this issue.
Hon. P. Ramsey: Just to dwell on the hon. member's pre-emption of the good news on dealing with this issue, take credit, hon. member, for raising this issue and for identifying a resource that we, in this province, should explore. We will assess it's effectiveness and cost-efficiency and use it as a base for further development in this area if, in the assessment of the professionals in this province, it proves to be both effective and efficient. Yes, we're looking at a $60,000 pilot project. It will probably involve, as the member said, a small number of folks. Perhaps 15 or so adults will be subsidized for their work at the Institute for Stuttering Treatment and Research at the University of Alberta in Edmonton. I see that as the start of what needs to be done, and I think the initiative will grow over the years.
As for speech therapy, I asked staff whether we were funding fewer of them, because my recollection from every budget document that I've signed off on this is that, if anything, we're having more. There have been, in various regions in various years, difficulties in recruiting speech therapists in the public system. Some of them prefer a private practice. We continue to hire, and there's been no diminishment of the numbers of speech therapists that work for the Ministry of Health. In fact, I can think of several health regions where we've hired more in the last 12 to 18 months.
F. Gingell: My understanding of the issue concerned the reduction of services where in-patient services at hospitals were being used by out-patients. Gorge Road in Victoria was an example where there were speech therapists on staff who were available to out-patients who all of a sudden were no longer available. I think that happened in other places. I find it hard to think why anyone would be an in-patient because they stammer -- they need speech therapy -- but that was the way it worked. There were programs continuing, in my
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understanding, at Lions Gate Hospital, but they were available only to residents of the lower mainland. So the vision I had was that the services were shrinking.
You'll remember also, Mr. Minister, that last year we discussed the issue of funds that were allocated by the Ministry of Education for speech therapy in schools. We know that schools do not necessarily spend the money the way that it's been allocated. They did when I was on the school board, of course, but they don't necessarily these days.
Hon. P. Ramsey: You wouldn't want us to check, Fred?
F. Gingell: But in those days, you see, we didn't have special grants. We used to tax. We used to decide how much to tax, and we used to spend the money. Times have changed.
But you were going to follow up on the issue of speech therapy within schools. I wonder if you have any response on that issue.
Hon. P. Ramsey: To return just briefly to the Gorge Road situation, you have me at a disadvantage. The staff person I had hoped to have around when we got talking about the acute care system is not with us today. Linda and I have been trying to work out a schedule of events to spare the taxpayer the cost of having the entire executive of the Ministry of Health in the audience every day. I will try to get you that answer, if we can actually quantify any reduction in speech therapy provided through the Ministry of Health. I know that the preferred venue for provision of that service in many communities is through a health unit rather than an institution-based service. As I say, my impression is clearly that we have not reduced, but have hired.
The other thing, as far as speech therapy in schools goes, is that the Ministry of Education gives the Ministry of Health about $1.7 million a year to do public health service in schools. Part of that would be speech therapy. Of course, they also hire their own. The minister and I have had conversations about ensuring that they spend the money where it's allocated. I know he's concerned about it and takes all measures.
I must say that -- my impression may fit yours -- at times boards do find ways of circumventing those directives, even now. But I know the minister is aware of the issue and attempts to make sure that funds are spent on the purposes for which they're allocated.
F. Gingell: When I think about the valuable resource of having a speech therapist within a community, I think of a community like my own in Tsawwassen, where there's a population of 20,000-22,000, and of Ladner, a community of similar size. If any speech therapy there was being funded through this process, it would seem a pity that it was available only to school children. There's just so many hours in the day, so many days in the week, so many weeks in the year. Whether that resource is being used in its most effective manner, of course, deals with the issue of crossing over ministry boundary lines. This is why we in government believe we shouldn't have any ministers, you see. We won't have these problems of differentiating between ministers. Don't quote me on that.
Perhaps you could give some thought to the issue of making those resources available for all members of the community, not just those who necessarily qualify under one ministry or the other.
Hon. P. Ramsey: This discussion is indeed getting familiar, from our discussion of it last year, hon. member. I'm not sure if I suggested it at that time, but I would suggest at this time that I hope you put these questions to the Minister of Education when you had him in front of you as well. I think that is where part of the flexibility can lie. Clearly speech therapists that are employed by schools don't necessarily end their job during summer break. Some of them do a good deal of work and carry on therapy with school-age children during the summer, as well as through public health units, which tend to deal with preschool.
My only answer to you at this point.... I think I pretty much have to stop there. In some communities the communication and liaison go relatively well, and kids receive a relatively seamless set of services. In others, there seem to be some disconnections and dislocations that don't serve the individuals well. I'm not sure the solution is the elimination of all ministries or the creation of a superministry, or whether at the end of the day one of the solutions is to make sure that decision-making on how those services are allocated is as close to the community as possible. I must say I don't think it's too tenuous a tie to say that's one of the advantages I see in empowering community health councils to do that delivery of services. I think we have a far better chance of actually getting coordination if it's a local government's body on health and a local government's body on education, and if it's their administrators and staff working it out rather than asking two senior staff in Victoria to figure out how to coordinate it for Delta.
F. Gingell: This minister and I are two proponents of an exercise I call POMAR, program outcome measurement and reporting. I don't know why, but I can't get anyone else to go along with this acronym that I created.
It would seem to me that while this ministry is starting a new program in sending some adults to the University of Alberta, it might be a very appropriate time to make sure that we have some benchmarks, some criteria and some means of measuring the results, that we understand exactly what we are trying to accomplish and that we make those understood before the program goes too far.
I see, in fact, that the first program is finishing this week. The three-week period went from May 1 to May 19, so we will soon be welcoming the first group back, which will be five individuals, I presume. I am sure you don't have that number at your fingertips; I will be most impressed if you do. Perhaps the minister at some later point in the estimates could advise me how many went on that first program and speak to the issue of program outcome measurements.
Hon. P. Ramsey: I don't have the number at my fingertips. I am sorry about that, hon. member. I will ask staff to provide you with the criteria that we are using for evaluation of the effectiveness of the program.
F. Gingell: We had a discussion last year on the issue of speech therapy being included in the normal fee-for-service. I came to the conclusion last year that you were going to take this issue up with the Medical Services Commission. As I said last year, and I would like to repeat, the issue of speech therapy is clearly a health issue. It is not an education issue, although education plays its role, as in many other health issues. In my mind, it clearly is a health issue. When we talk about preventive medicine and preventive things that we can
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do and get a return on, helping stammerers get over their stammer has tremendous economic advantages to the province. People who stammer tend to be economically disadvantaged. They tend to have other social problems just because of the frustration of being unable to express oneself. So I'm wondering if anything has happened since the discussion of last year relative to speech therapy being considered as a fee-for-service that will be covered by the Medical Services Plan.
[4:45]
Hon. P. Ramsey: I do remember our discussion on that, and I do know that staff reviewed the debates in Hansard closely and were following up on a number of issues. I find myself at a bit of a disadvantage. As I said earlier to your colleague from Vancouver-Langara, your critic and I were trying to go through this in an orderly way to keep all of my staff from being here. I don't have the staff from the Medical Services Commission with me today. So you may want to drop in at an appropriate time later in these estimates to discuss the issue of coverage of speech therapy through MSC. I suspect there was some discussion; we have not included it at this point.
F. Gingell: That has covered that matter as far as the questions I have are concerned. It would be interesting to discuss some of the things we didn't.
I was wondering if the minister would tell me whether it's normal practice to unappoint, retract or fire members of community health councils. Has much of this happened?
Hon. P. Ramsey: Very little of it has happened. The only instances I'm aware of were where we've made an appointment in error.
F. Gingell: So are you going to tell me the appointment of Mr. Duckworth in Delta was an error?
Hon. P. Ramsey: I will tell you that the two nominees put forward by the community health council to replace the community members on that council were appointed. Mr. Duckworth's nomination came by another route. We only had two spots. I felt it was appropriate that they remain filled by the nominees that were made by the council for those community positions.
F. Gingell: I am pleased that the minister knows a lot more about this than I do. All I know is that Mr. Duckworth was most pleased to be appointed, attended his first meeting and wanted to contribute, and all of a sudden he got a letter out of the blue telling him that he had been unappointed. And he was disappointed that he was unappointed.
So do I just leave the matter here? It seems to me that there's more to this than.... But once you've made the appointment, surely there would be efficiencies within your organization -- which wouldn't do such things.
Hon. P. Ramsey: I don't want to elaborate on it too much more. We did indeed have two vacancies there. We asked the community health council to recommend people, who were on the steering committee or had been nominated to fill community positions, to fill them. We appointed those, and in error another nominee went forward separately, got signed and got appointed. It was only in retrospect that the ministry suddenly realized we'd appointed three people to two positions.
Please convey my apologies to the gentleman. I recognize that he wished to serve his community in that capacity. It was a regrettable error. I think that at the end of the day it got sorted out appropriately.
D. Schreck: I'd just like to take a few moments to deal with an issue that has caused some concern in my community, and that is the letter the minister sent out to recently seniors' groups throughout the province, in which the minister removed some uncertainty about potentially using an income or means test for the Pharmacare program.
I know the president of the North Vancouver Silver Harbour Society was extremely concerned when speculation arose that such changes to the program could occur, and enormous comfort was had when the minister sent out the letter. However, I'm aware that prior to that clarification, a series of consultations took place -- I'm not sure if they were around the province or all held on the lower mainland -- along the lines of if there could be an income or means test or some sort of ability-to-pay principle for Pharmacare.
Sources within the seniors' community alleged to me that those consultations were the direct result of a demand by the B.C. Pharmacy Association for active consideration of that option. Could the minister please comment on whether those consultations arose from demands by the B.C. Pharmacy Association?
Hon. P. Ramsey: The member has identified an issue that has been of great concern to seniors and others who are looking at possibilities for restructuring the program. Nearly two years ago the Pharmacare Review Panel recommended that ability to pay be considered as one option for restructuring. The member is accurate in identifying the genesis of the consultations that took place last fall. After a number of discussions with the B.C. Pharmacy Association on initiatives that this government had taken to restructure the program, including the low-cost alternative program, the therapeutics initiative and the development of the PharmaNet program, they said that as part of their participation in PharmaNet, they wanted to see the whole issue of ability to pay revisited.
We undertook the consultation and held a number of meetings and information sessions. At the end of the day the results were clear. There were alternatives for restructuring the Pharmacare program that made a lot more sense, in terms of making sure that the right therapeutic drugs were in the right hands at the right time, than restructuring around ability to pay. At the end of the day that alternative was rejected. A letter was sent out to the organizations that had been consulted. We're getting on with the job of making sure we have a cost-effective Pharmacare program which will provide therapeutic drugs to people in B.C.
D. Schreck: I particularly welcome the support of the official opposition critic for the position taken by the minister.
I know that amongst my constituents there is some confusion when we talk about this ability-to-pay notion. Many say that well-off people should pay more. I know that one of the several reviews that were done over the last five or six years
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on this concept actually did a public opinion survey, asking people if they supported ability to pay. It's sort of like asking: do you like apple pie? What I find interesting is that when that question is asked in some of the research, it frequently lacks a number. Amongst my constituents, I get a much different reaction if I put two different questions. If I ask whether those who are better off should contribute more towards the cost of their drugs, most people will say yes. If I ask whether families with family incomes over $20,000 should pay the first $600 or $700 of their drug bill and 20 percent thereafter -- perhaps more than $2,000 a year toward their drug costs -- they say: "What are you talking about? Absolutely not."
Could the minister confirm that the options which were reviewed during recent months and in discussions with the B.C. Pharmacy Association concerned major deductibles and co-insurance for families in the $20,000 range as opposed to those in the six-figure range?
Hon. P. Ramsey: One of the reasons that we undertook the consultation was to address the situation that the member mentions. While the Pharmacare Review Panel had talked about ability to pay in terms of principle, it was time to take a hard look at what it would actually mean in terms of the resources of the Pharmacare program and the redistribution of social benefits.
The Pharmacare program, therefore, developed a number of actual models of what ability to pay might look like without adding to the budget for Pharmacare. Indeed, as the member says, when people are presented with the reality of what it might mean, they are not impressed. In terms of family income, one model had a cutoff of around $18,000 or $20,000. You could well be faced with a $500 deductible and a 30 percent co-pay on top of that. People said that wouldn't work for them. They said that the cutoffs simply wouldn't work and that we should look at doing more effective things to make this a cost-effective program for British Columbians.
D. Schreck: I would like to congratulate the minister on having done the due diligence, although I recognize that part of that raised anxiety to what I think is a regrettable stage for seniors was done not at the minister's initiative but at the demands of the B.C. Pharmacy Association. I have been particularly concerned about some of the articles written in the Tablet, in which the executive director of that society who has his own political ambitions, having declared himself as a candidate for a Liberal nomination in my constituency, is using that platform in health care to campaign for essentially destroying Pharmacare for seniors. I urge the minister to maintain his firm position in rejecting that attack on Pharmacare for seniors.
L. Reid: I'm pleased to continue some discussion on the Vancouver Region: Acute Care and Rehabilitation Services Study. I want the minister to pay particular attention to recommendation 3, which states:
"A shared services corporation should be established to initially include shareholders, recognizing the RHBs of Vancouver, North Shore, Burnaby, Richmond and the three-clustered hospital boards. The purpose of this corporation would be to develop shared services that would enhance the efficiency and quality of services for members of the corporation."
In that that speaks very strongly to constituent MLAs for the lower mainland, I would ask the minister to expand on what he perceives to be possible shared services under that mandate.
Hon. P. Ramsey: First of all, let me say that this is one of the recommendations that the report came up with which I think was welcomed by the Vancouver Health Board and some others as identifying clearly where some efficiencies could be made in sharing services in areas that didn't impact on the decision-making around clinical care. The only caveat that I would add to it is that I think the word "corporation" was an unfortunate choice. I don't think there's any desire on the part of the Vancouver Health Board to contract with some private corporation for provision of services. In my discussions with that board, they have used a shared services society or organization or some other structure.
Some of the initial things that I know they're looking at could be around laundry or food services, laboratory services that might be rationalized and then some of the more straight administrative functions -- payroll, human resources. There are a large number of services that the regional health board in Vancouver feels can be profitably amalgamated to get efficiencies into the system. Some of the initial analysis suggested that the figure might be a savings of as much as $30 million in administration and support services. I'm going to ask my deputy to take one more question, and I'm going to take a short break.
L. Reid: I share the minister's sense that perhaps "corporation" is not the word that should be included in this recommendation. My fear was that this would become a freestanding corporation. It makes no reference here to this as an opportunity to contract out those services and purchase them from a corporation. The way I read this recommendation, it says a shared services corporation will be created, and I think that will be established. If the minister when he returns, or his representative, could lay to rest any fear that this will result in another freestanding corporation, another arm of government, that was my concern when I read the recommendation. If, indeed, that's not the case, I welcome the response.
L. McFarlane: If I understand the minister's view on this correctly, it is that he is not looking for a corporate structure here, and neither is the regional health board. The objective, if I understand the Lovelace report, in using the language that was used was to clearly identify that they felt that some element of organizational structure of sufficient administrative strength was required to achieve the economies that were looked for, and that a very loose amalgamation would be insufficient to find the kind of economies that were being sought. It was clearly understood, however, that people participating in it would be the main service providers in the region. In other words, this would be a wholly owned subsidiary, if you like, of the existing organizational structures in the region. It would not be some external third party, nor would it be an arm of government.
[5:00]
L. Reid: I appreciate the comments. I don't take any issue with the intention around creating this new structure. Its mandate, in what both the minister and deputy minister have shared, is sound decision-making in terms of how best to proceed. My concern is around whether we will see an additional freestanding corporation, once this debate is concluded, that somehow has the ability to acquire and dispose of property and all those other bits and pieces that tend to come along with the term "corporation." If that is emphatically not the
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case -- if this is going to be a committee structure, a composite of those regional health boards, and if these will be individuals who come together, and this is not about creating a corporation -- I would welcome that comment.
L. McFarlane: I'm reluctant to go beyond a certain point in characterizing the intentions of the regional board. As the hon. member is aware, part of the intention of this process is that regional boards will assume the responsibility for decision-making in their own regions and that the Ministry of Health is relinquishing the ability and the desire to make those decisions when they belong locally. I think our role at this point is to explain the extent that we understand the thinking that has evolved in Vancouver, and as I understand it, it is consistent with what you've said.
There is not a desire to create a separate corporate structure that would introduce additional costs, additional assets or additional externally based factors. What is looked for here certainly is -- and this is an important distinction -- more than a loose confederation of people who would sit around a table and from time to time possibly agree that something could be done. I think there's a desire that the structure would have enough decision-making authority within the facilities, which are the owners of it, that it would be capable of achieving economies past the level of size we have seen to date.
L. Reid: Again, I appreciate the deputy minister's comments in terms of what he would like this to look like and what has been tentatively agreed to in terms of a structure. Because I'm not favouring burgeoning bureaucratic structures around the regional health boards, I would like some confirmation that under this recommendation -- and I appreciate fully that it's simply a recommendation at this stage -- we are not going to see yet another administrative structure, this time referred to as a shared services corporation.
L. McFarlane: I think the correct answer is that what we expect to see, what we would hope to see and what the regional board is working toward is empowering existing resources already in Vancouver: personnel with sufficient authority that they can achieve economies that will not be accomplished by either a committee or some loose federation. There will be management authority. They're not looking for a corporate model in terms of assets or external controls, but they are certainly looking to a management reporting structure that vests enough authority in some single structure and that the structure has the ability to achieve economies. As I understand the thinking of the regional board, they fully envisage that this would be a structure of the existing authorities and existing purchasers, not some external group brought in from outside.
L. Reid: Simply put, you will not be creating a corporation around shared services in the lower mainland? Yes or no.
Hon. P. Ramsey: I wish I had been here for the earlier debate. I mean, look -- a corporation? If you mean incorporated under the business legislation of the province, I don't think the Vancouver Health Board is interested in that. As far as its relation to the health board, I think most of the people I've talked to on the health board see it as a subsidiary operation of its mandate, run as it will run other facilities and other services.
L. Reid: Hopefully I may clarify this with the minister. My concern is over the use of the word "corporation." The point I made earlier was that I did not wish to see another corporation having the ability to acquire or dispose of property and be a freestanding entity, separate and distinct from the regional health boards.
I am taking issue with the use of the word "corporation." It pleases me that you and I are defining it similarly, but the response I've heard from you and your colleague simply suggests that the door is still open for them to create a corporation. Again, I respect the notion that this is still at the recommendation stage, but I need some assurances that this is not about allowing the growth of corporations around the delivery of health care. If it's simply the term that is causing concern and there is some sense that that will not happen, that's all I need to hear.
Hon. P. Ramsey: I think you can consider that you've heard it. We're not interested in the privatization that the term, I think, sometimes connotes. What we are looking at is a body that may have a fair bit of autonomy but is a subsidiary of the regional health board and does not function independently of it.
L. Reid: My thanks to the minister. I appreciate the clarification.
I reference recommendation 5 of this same report, the Vancouver Region: Acute Care and Rehabilitation Services Study, the final report of March 1995: "A research and education standing committee or committees should be established consisting of representation from various academic institutions and the proposed role of these committees would be to provide advice to the VRHB on issues relating to research and education activities." The minister and I have been in discussions previously on this topic of measurement and defining best practice and the need that the official opposition has to see some health targets in place in this province, so that we have some ability to gauge our successes along the way. Could the minister expand on the recommendation in terms of what he wishes to see flow from such a recommendation? Will this planning, this expectation of measurement, be attached to every regional health board in the province, because I appreciate that this refers to the lower mainland? Is there a similar expectation for measurement, best practice, and for performance reviews, and will it be placed on all the regional health boards?
Hon. P. Ramsey: Hon. member, I think you may have misinterpreted the intent of this particular recommendation. The facilities in Vancouver are major teaching and research institutions for the province. What has been proposed in this recommendation is that the Vancouver Health Board has a standing committee that pulls together all those research and teaching functions performed in the Vancouver institutions so that the importance and continuity of those functions is recognized and planned for.
I am sure the member is aware that there's a Council of University Teaching Hospitals. I am sure the member is also aware that nurses and other health professionals are also trained at the Vancouver centres under the auspices of a variety of post-secondary institutions. What this recommendation says is that the Vancouver regional health board needs
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to take conscientiously the establishment of a standing committee, a body to deal with issues arising from its role as a centre of teaching and research in the province.
L. Reid: I thank the minister for his comments, but what I am asking for is an extension in the expansion of those services. I think the minister is aware that the teaching function of our institutions does not occur just in the lower mainland.
The family practice unit at Prince George Regional Hospital is a very good example. There are teaching sites around this province. My question to the minister was whether or not the same expectation around measurement will occur in the other centres. I think it is a good recommendation, but I don't wish to see it curtailed solely to the lower mainland.
It seems to me that Kelowna, the new centres for the cancer agency, Prince George Regional and a number of provincial referral hospitals will have the same responsibility to deliver teaching programs. Certainly there are students, both physicians and nurses, in programs today. I don't anticipate that changing. Again, having a strong need to see some research and evaluation and some performance reviews in place, is it the minister's intention to see this type of recommendation appear as part of the working statement for all of the 20 regional health boards?
Hon. P. Ramsey: I must say that I think that the Vancouver region is unique in the extent of teaching and research that occur in it. As the major region that does tertiary services and does some of the one-site services in the province -- some of which we've been talking about earlier today -- they have a unique mix of teaching and research activities going on. It was because of that that those involved in teaching and research within the region made this strong recommendation to Mr. Lovelace and to the regional health board and myself that we acknowledge that role and formally establish a standing committee to deal with it.
I want to distinguish, though. When the member talks about doing outcome measurements and getting, as I've sometimes said, more science into medical science, I'm not sure that this committee is going to have that as its primary focus. It may well be coordinating or making sure that the research is accommodated within the facilities. But I would suggest that some of the work that's being done under the auspices of the Medical Services Commission around clinical practice guidelines and some of the work that's being done by committees within the ministry that brings together peer group hospitals to talk about best practices in delivery of services -- maybe locuses for that sort of work -- will have far greater impact on what services are delivered and how than the work of a committee like this.
Having said that, I think the member is right that in many other regions of the province, you do have physicians being trained, nurses being trained and other health professionals being trained. Regional health boards and community health councils there will also, in their planning, have to take account of those functions -- non-health service functions, but important functions -- that are carried out within their regions and institutions. Whether that results in standing committees of the magnitude that's proposed here or in some other mechanism, I think we need to allow regional health boards the flexibility to decide how they are going to be doing that.
L. Reid: To take the discussion perhaps one step further, certainly I support the contention of the minister that it will happen. It may just happen in a variety of different ways around the province in terms of evaluation. In terms of some checks and balances in the system, the process as I understand it today would allow this research and education standing committee to report to the regional health board or boards in their entireties serving the lower mainland. Certainly that is allowed for in the previous recommendation, which talks about Richmond and the North Shore and the like. Perhaps a lower mainland focus would be reasonable. At that point, what will be the reporting function of the regional health board or boards to the Ministry of Health? Will there be some ability to coordinate and collect that data around best practice? That is where I am heading with this line of questioning. Who at the end of the day will take some responsibility for evaluating these programs?
Hon. P. Ramsey: One of the things we are doing with the restructuring of governments is making sure the ministry's role as standard-setter and provider of measurements is maintained. Indeed, that will increasingly become its focus of activity rather than direct delivery of services and planning for direct delivery of services. At the end of the day, the responsibility remains with the ministry to make sure that information on organization and best practice is both collected and disseminated as widely as possible, that we have proper measurements in place and that we are measuring effectiveness well.
L. Reid: The minister has stated many times in the past that these 20 regional health boards are at very different stages in their development and evolution. If that is the case -- and I certainly accept the notion -- I need some assurances in terms of checks and balances in the system and in terms of performance reviews.
[5:15]
Is it the intention of the ministry to conduct a performance review on the progress of each of these 20 regional health boards or simply to receive the information in terms of them delivering programs and reporting back? How can the public be assured that there are some framework and some standards that are indeed being met by these varieties of boards around the province? That is an issue that continually comes back to the table in terms of giving authority and responsibility to different regions of the province to deliver these programs. Are they indeed meeting the standard? The public is not clear today what the standard is or how best to evaluate that. Will it be something that comes back to the ministry? How might that be done?
Hon. P. Ramsey: The member is right; regional health boards are at various stages of development. Most of them are now working on two sets of plans that are important before we as a ministry say to them: "Here's your authority to actually run services." One of those is a health plan to identify what the health needs are in a region and how it intends to meet them. The other is a management plan that speaks to the structure of the organization they intend to set up by amalgamating existing structures within their region. That's why the work that we've been discussing in the report of Mr. Lovelace was done: to enable the Vancouver Health Board to get on with its job of producing a management plan for health services in the Vancouver region.
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So the initial check, hon. member, is that this ministry is not prepared to sign off on those health plans and management plans until we're sure that they do meet standards for service delivery and that they do ensure that continuity of service delivery is maintained and that high quality services are being delivered. The ministry will continue in the future to monitor and to require reports from regional health boards on services that they deliver and will continue to serve in that monitoring and evaluation function.
L. Reid: I appreciate the minister's comments that he's not prepared to sign off the plan. I don't know if that alters practice at all. Because the plan has not been signed off, I would assume that those services would still be delivered in those communities. Otherwise it's not appropriate to have the patient wondering about the status of the plan and whether it's been signed off. In the interim, the services are still being delivered up to the point where the plan is ready to be signed off.
My question is: how does the evaluation work leading up to the plan, both pre-plan and postplan? What you've said is that once the document has been signed, somehow they have convinced the ministry that they are complying to a certain standard of delivery. What happens pre-plan? How are those services being evaluated and how is any kind of evaluation being put in place today?
Hon. P. Ramsey: This is getting a bit abstract. Let me just say this to the member opposite. Facilities around this province must meet accreditation standards; they must meet guidelines that are proposed by the ministry; they must satisfy licensing requirements. There's a wide range of requirements placed on them. All those are in place and remain in place.
L. Reid: I don't believe this is abstract at all; I think this is the crux of how best to deliver services in the province. Certainly I appreciate the minister's comments that the accreditation, etc., etc., is in place. That is not what I am questioning at all. I'm looking to the point where the range of services for individual regions may be two or three years to the point where you will sign that off, given that all these regional health boards are not at the same place today. We both agree on that point. They are at differing stages in their development.
I know that this ministry intends to sign them all off in a year's time, October 1996. That has certainly been the understanding. The question, both looking out today, May '95, and getting us to October '96 -- and beyond if indeed there are regions that are not ready to be signed off in October 1996 -- is: what would the ministry response around evaluation be at that point?
I know those other pins are still in place, and I'm not suggesting that they be removed or eliminated in any way. But I have concerns about a broader evaluative framework. If everybody is doing it a little differently, there's no ability to take any kind of consistent measure. Right now we're comparing apples and oranges. We could be comparing many, many, many things a year from now. Certainly the discussion we had on the Cancer Agency looked at consistency and uniformity of practice, so you have something tangible at the end of the day that you could measure.
I mean, this may become abstract because there's no plan in place. There's no framework for measurement. It seems to me that we haven't been happy with the existing structures -- accreditation, etc., etc. -- because of some of the missed opportunities around evaluation. We have both had discussions in the past that said it needs to be more sophisticated and to have a clearer direction. We need to ensure that we are comparing apples to apples. I'm not convinced, from what you've said in terms of October as the sign-off date, that somehow we'll magically have a new evaluative structure in place.
Certainly I'm not directing this just to the Ministry of Health. It's a common theme throughout government. However...
An Hon. Member: This government.
Hon. P. Ramsey: In the private sector, too, by the way.
L. Reid: ...my concern today is health care, hon. minister.
It seems to me that some focus can be put on evaluation to ensure that the taxpayer is getting the best possible return. We haven't believed that from the existing structures. We know we're partway down that road, but we're not all the way down the road. I need some sense from this minister today that indeed there will be some consistent approach to evaluation around health care.
I can tell you that all the public is interested in is what they're spending today and what they're getting for that. They're not going to be put off a whole lot longer by: "Well, everybody's at a different stage, and we're not clear what we're going to be doing yet. We don't know what it's going to look like." I accept that as valid, but that cannot be the final answer. I would ask the minister to comment.
Hon. P. Ramsey: I assure the member that I do not consider regionalization of governance and service delivery to be the final answer in assuring quality of health care. This is an ongoing issue which will involve the regional health boards and the ministry -- and other essential agencies as well, such as the Medical Services Commission, the College of Physicians and Surgeons and others. It is an ongoing piece of work.
I must also say that to imply that somehow the shape of what health care is going to look like and how governance structures are going to appear in the province is still lost in the fog ignores the reality that in community after community, people are close to presenting -- or already have presented -- to their communities and signed off on health plans or management plans and are getting on with the job of figuring out how to get more dollars into service delivery and away from some of the duplication of effort we have seen in the past. That is there; that is happening.
If there is uncertainty about it, I would suggest, hon. member, that it is the uncertainty caused by comments -- I'm not sure; perhaps by herself or perhaps by members of her caucus -- that I have surely read in the press that suggest that the whole effort towards regionalization in this province is not something they feel should be supported and that we should revert to some sort of pilot project, and sit on the side of the road and wait while the train passes us by, budget cuts from
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the federal government come in and our system is no longer affordable. That indeed, I think, is causing some uncertainty out there.
Clearly, everybody who is involved in community health councils and regional health boards has a set of implementation plans in place. They are working with the ministry staff and others on transition teams to prepare their plans, and they are ready to go.
The Chair: I recognize the hon. member for Vancouver-Kingsway.
Hon. G. Clark: I have been demoted, I think, from the executive council, but that's okay.
I am delighted to speak in these estimates very briefly, because I do want to commend the minister for obviously doing an outstanding job in general, particularly in dealing with my constituents. I just want to raise, for the record, three issues that I have had the privilege of working on with the ministry, and the minister in particular, which I think are of real value to my constituents.
The first is working to resolve an issue at the Italian Cultural Centre in terms of providing some funding. I had some involvement with the capital side, but obviously the big commitment was on the operating side for what I think fits with Closer to Home, which is to sponsor the intermediate care facility at the Italian Cultural Centre. There is still some debate going on in terms of some contribution from a particular society in that regard, but the essential elements remain. It's under construction, and it's very good news.
At the end of the day, as people get older and need certain types of care, I think it is increasingly important. I think everybody recognizes that it makes sense, and it's part of government policy to ensure that people can stay closer to their community whenever possible. When people are forced to move as they get older, especially if they are not well, it does indeed shorten their lives. So I think this Closer to Home concept is really worthwhile, and the Italian Cultural Centre project is a large one. I know these are difficult financial times, so I just want to thank the ministry on behalf of my constituents. I think that's helpful.
The second one is the Three Links project. The Three Links project, if anybody's familiar with my constituency -- and I don't imagine they are in detail, as I am, having lived there all my life and continue to live there.... But a few blocks from my home on either corner of 22nd and Earls, or where Renfrew turns into Earls, there is a three-links project on each side. One is a seniors' home, and the other is an intermediate care home. What is now happening is that funding is close to happening -- or we hope it's happening. We're working with the ministry and the minister on funding for a long term care facility at the same site.
That again, along the lines I just mentioned, is a perfect progression of people living in the community, moving as they get older into a seniors' home in the community, then if they require it, moving across the road to an intermediate care facility and being able to stay there in a long term care facility. I can't tell you how many times constituents who live in the intermediate care facility are forced to move to a long term care facility in Surrey or Richmond or somewhere else. That is, of course, very traumatic for them and for their families -- and very difficult.
I really commend the ministry again on their work on this, because I do think that is in keeping with our philosophy, in keeping with the government's direction and in keeping with what people want and expect. I know these are difficult times for funding, so we certainly appreciate your support.
Lastly -- and in some ways this is more significant because in some ways it is a more vexing problem -- there's the issue of methadone distribution. In my constituency at about 15th and Commercial Drive, across the street from Clark Park, there is a pharmacist, and there was a doctor who, to put it politely, specialized in methadone treatment. We had the very difficult situation of, in some cases, 100 or 200 people lining up in the morning for their methadone. That caused certain challenges for the community. Obviously we wanted to make sure that methadone was available for those on maintenance programs so that they could live productive lives, but there were all kinds of problems associated with that facility, and it was very difficult to deal with.
Very recently another pharmacy specializing in methadone distribution -- in fact, distributing methadone almost exclusively -- opened up near Joyce and Kingsway in my constituency. I have the dubious distinction of having two of these facilities. Obviously we want to be careful not to stigmatize people on this program who are attempting to live productive lives, but there were serious, serious problems, with the volume of patients of a particular type, the attraction in the neighbourhood of a criminal element and the difficulty of the community having to deal with it.
[5:30]
I visited the home of one of my constituents near Clark Park. For my benefit, the neighbours had just done a sweep of the park and handed me about 40 or 50 hypodermic needles that they had picked up in the park that morning. These were the result of an illicit drug trade that had been attracted to the area, in part because of the predominance of the methadone dispensing there. There are all kinds of problems with this. I think my constituents took an extremely enlightened position, one which I don't think we would find in many other communities. They said to me: "Look, we know that people need this, and we're not interested in just moving this to another community. We're not interested in victimizing the victims. Can you help us? This is a family neighbourhood, and this is causing serious problems and dislocation."
What happened then, under the minister's leadership.... Particularly, I have to pay tribute to Mike Corbeil, the head of the Pharmacare program, who engaged in a process of examining how we could fix this problem without just moving it around. There was an intense dialogue with pharmacists, etc. One of the solutions the neighbourhood came up with, which was, in a way, what we ended up adopting, was that if every pharmacist had to carry methadone and the number of methadone patients per pharmacy was limited, then it wouldn't be a pervasive problem in one or two neighbourhoods. Methadone would be dispensed like any other prescription drug. It would be dispersed throughout the community, and it wouldn't be a big problem.
In a way, that was a grass-roots response. The minister worked with the ministry staff and met with neighbours -- I think that must be a first. They actually went in and talked to people. They talked to the pharmacists, and we now have a solution which limits the number in the existing program to 70 in the pharmacies that are predominantly methadone. I think
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this seriously impacts on their business, which I think is good. But also, he'll say that if they want to do other business, the 70 patients can seek the drug there. Then he says that other pharmacists can take up to 30 at any other pharmacy, so we don't have a preponderance of methadone-dispensing pharmacies in one or two neighbourhoods.
On behalf of my constituents, I just want to pay tribute to the ministry and the minister today on the Italian Cultural Centre Society problem -- an issue of funding, which was dealt with -- and on the Three Links issue, which I think is very important. I look forward to that; I think the community does, too.
Perhaps most importantly today, I want to say that solving this methadone question -- and we don't pretend this is a solution entirely, but a huge step forward for my community.... I think for people who are attempting to live productive lives and for people generally, this is a good, pragmatic solution which really helps immensely. I know I've had nothing but positive feedback from the neighbourhood.
I'm pleased to have been part of the solution to those three, but I think today it's important to recognize the staff in the ministry and the leadership the minister has shown to try to get on with helping people in constituencies. I'm pleased to take my part in the debate simply to say that.
Hon. P. Ramsey: I just wanted to thank the member for Vancouver-Kingsway for his words about some of the good work that we've been able to do.
One of the initiatives actually started by my predecessor in this position was to look at the issue of long-term care in a different light, get away from bouncing from facility to facility and make multi-level care the standard in designing new facilities so that people could age in place. We want to make sure that we are not disrupting their lives by shuttling them from facility to facility.
Through the good work of the Italian Cultural Centre Society and Three Links, we have initiatives in place that will meet some of the growing need in this member's riding.
There are clearly other issues like this around the province. There is, as the member states, a need for this which calls on this government -- and I think any government -- to fund it and to say: "There are some structures that simply must be built; it is appropriate to incur debt in doing them; it serves the long-term needs of our community." This government is committed to doing that. I think the growing population of seniors in this province -- it's now at 13 percent, and it will be 18 percent within a very few years -- should look very carefully at the commitment of parties to continuing the work of building needed health facilities. For our part, this government is committed to doing that work.
On the methadone program, I'd like to join my colleague in congratulating staff in the ministry, who did an excellent job of working with the community. When we poked into this as a result of some of the concerns of the member's constituents, we found that indeed one owner-operator running five pharmacies was dispensing 51 percent of all methadone prescriptions in the province. It was a program that clearly badly needed to be revised and revisited. We have established maximum methadone clients per pharmacy, we've established some new standardized dosages and we've also managed to save a fair bit of money by moving to a per-client charge per month rather than a dispensing fee and markup which had, quite frankly, made it a cash cow to some people who wished to milk it in the past. So I join the member in adding my thanks to the staff of the ministry who did the good work in making necessary changes to that program.
With that, hon. Chair, I move that the committee rise, report progress and ask leave to sit again.
Motion approved.
The committee rose at 5:36 p.m.
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