[ Page 10195 ]

The House met at 2:07 p.m.

Prayers.

J. Cashore: In the gallery today we have two residents of Coquitlam: Joe and Ria Smeets. Would the House please join me in making them welcome.

Hon. M. Farnworth: I have the great pleasure today of announcing the arrival into the province on Thursday evening of my new niece, who is the daughter of my brother Robert and his wife Loni. She came into the world at nine pounds, and her name is Ryann Hannah Farnworth. I would ask the House to please welcome her to British Columbia.

I. Chong: Joining us today are two students from Royal Roads University, who are here to watch question period. They are Tom Hickman and Bryan Mathews. I would ask the House to please make them welcome.

P. Calendino: I will have to make this announcement in bilingual mode, as usual. In the gallery are two very good friends of mine who are businessmen. One resides in Burnaby North and the other resides in East Vancouver. They are Michele Castagno and Michele Di Trolio. With them is their nephew Mario Di Trolio, who has come from Italy to vacation here for four or five weeks. He is a recent graduate in economics, and he likes this country so much that he is going to come back to our province and register in graduate studies at one of our universities very soon. In Italian, with your permission, hon. Speaker: A nome di tutti i deputati di questa Camera vorrei dare il benvenuto al signor Mario Di Trolio, appena laureato dall'università di Salerno in Italia, qui in vacanza per qualche settimana. I would like the House to make them all welcome.

Oral Questions

PROPOSED GAMING LAW CHANGES AND RIGHT TO SUE CROWN

Hon. M. Farnworth: Apart from the fact that the question is out of order because there is legislation before the House, the fact of the matter is that citizens do have that right in this province and this country. Regardless of what legislation takes place, that right is still there through the constitution.

The Speaker: Hon. members, just for the record, it is indeed the case that a bill has been introduced for discussion, but the detail of it is subject to. . . . Some discussion can happen around the general topic but not around the detail.

First supplementary, the member for West Vancouver-Garibaldi.

T. Nebbeling: Well, the minister's answer was short. My problem with the answer, first of all, is that while Robin Hood stole from the rich, right now I think we see this government involved in taking from the poor.

Let me get this straight, Madam Speaker, and then I'll speak to the bill. We have a group of citizens who believe that they have been ripped off by this government since 1986. The NDP know today that they're on the wrong side of this issue, so they change the law and grant themselves immunity. I have a very simple question for the minister: does he believe that government should be subject to the same law as we are, or does he believe that this government is above the law?

Hon. M. Farnworth: For the last 12 years, since 1986 -- since the regulations governing gaming came into place -- gaming has operated in this province, and the regime under which it has operated has been accepted by charities, by government and by citizens right across the province. There was a lawsuit filed that called into question the way in which the Gaming Commission potentially was constructed and some of the decisions that were made. That is currently under appeal. Right now there is nothing that stops any individual from taking the province to court on constitutional matters -- on the constitutionality of whether or not certain fees or licences should have been issued. Nothing in that has changed. What will potentially change is the ability of individuals to recover or take money from taxpayers, based on a technicality.

G. Campbell: During Dave Barrett's government, the NDP introduced the Crown Proceeding Act, which gave people the right to sue the Crown. Attorney General Alec Macdonald stood in the House and said: "We seek to abolish in British Columbia a relic of the medieval age when the King could do no wrong." To the Minister of Employment and Investment: how can he possibly defend an amendment which is eminently wrong -- an amendment which denies citizens their rights to access the courts?

[2:15]

The Speaker: First supplementary, the Leader of the Official Opposition.

G. Campbell: Let's be clear, hon. Speaker: what the court said was that governments had broken the Criminal Code of Canada. Former Attorney General Alec Macdonald also said the system where "the subject had to go on bended knee to ministers of the Crown to seek the right to sue the Crown has no place in modern jurisprudence." Let me try the Attorney General. Why is the Attorney General turning back the clock to deny citizens one of their most fundamental rights by stripping away their access to the courts?

Hon. U. Dosanjh: As my colleague has explained, there was an error made in the establishment of the Gaming Commission in 1986. The court in British Columbia said to us early

[ Page 10196 ]

Secondly, yes, there are actions before the courts -- on which I can't comment. But it is important for people to recognize that if the government can be sued for $140 million to $200 million, so can the charities for $1.4 billion to $2 billion. We as a responsible government and I as the responsible Attorney General want to make sure that if the taxpayers are protected by protecting the government's treasury, so are the charities -- no one person in British Columbia would be able to stand up and sue the charities to return all of the moneys back to government.

The Speaker: Second supplementary, the Leader of the Official Opposition.

G. Campbell: The government broke the law -- you broke the law. And an Attorney General is responsible for upholding the law, not for fixing it when it makes that better for him. The Attorney General is responsible for the administration of justice in this province. How can he, of all people, sit there and support an amendment which will deny people's access to justice?

Interjections.

The Speaker: Order, please.

Hon. U. Dosanjh: I said before that it is important to recognize that the court in British Columbia has said that from 1986 onwards, the government has been in violation of the Criminal Code. I as the Attorney General want to make sure that we rectify that retroactively to 1986, and we have done that. In the process of doing that, we have done two things. No one would be able to sue the government for $110 million or so in fees that the government received for administering the scheme and the like.

As well, if someone could stand up and sue the government, so could the charities be sued. If you have received the proceeds of gaming -- which was inherently recognized by the court to be illegal as a scheme in the first place -- whatever you have received can be asked to be returned, just as it can be from the government. I want to make sure and the government wants to make sure that there is a foolproof method of protecting the charities, so no one could stand up against any charity -- not just all of the charities -- or against the government and say that that money should be paid back.

G. Farrell-Collins: The Attorney General misses a point. It wasn't the charities that were accused and are in court for breaking the law; it's the government that has been in court for breaking the law.

On Friday we witnessed one of the most disgraceful in a long line of acts by this NDP government. If it wasn't bad enough that the government took the money from the charities in the first place, now they're going to stop them from getting it back -- a new low in B.C. politics. There's only one thing you could do that would be lower: if you took the money and funnelled it into your political party. That would be worse.

Can the minister of justice, the Attorney General of this province, tell us how he's advancing the right to justice of the citizens of British Columbia by bringing in this kind of amendment?

Hon. U. Dosanjh: First of all, as my colleague the Minister of Employment and Investment has already said, on the constitutional question anyone has the right to sue. On the technical administrative issue, what we have said is this: as a principle of law, one should understand that any proceeds from an illegal scheme -- be they proceeds to the government by way of licensing fees or be they proceeds to the charities by way of the proceeds of charities -- could be held to be illegally obtained, and kept. It is important for us as a government to make sure that that scheme is stable, that it is legal and that no one. . . .

Today we have someone who is suing the government. There are four million British Columbians. Tomorrow one of them could decide to sue a charity or a number of charities. These members would then stand up and say to the Attorney General: "Why didn't you foresee this? Why didn't you do anything about it?" We're doing it now. They should stop talking about it, and let's get on with the business of the House.

The Speaker: First supplementary, Opposition House Leader.

G. Farrell-Collins: So far it's only the government that's advocating this legislation. I haven't heard one charity in British Columbia stand up and say that this is the best thing that could ever happen to them. Can the Attorney General tell us: of the hundreds and thousands of charities in British Columbia, how many, and what percentage, have stood up and said to him: "Please bring in this legislation"?

Interjections.

The Speaker: Members. . . .

Hon. M. Farnworth: I guess the Red Cross might have something to say about that.

PREMIER'S OFFICE AND MLA'S CONSTITUENCY ASSISTANT

I want to ask the Premier a question. The Premier spent over a week trying to avoid answering questions about the conduct of the member for Comox Valley. That member said that she met with officials in the Premier's Office to discuss the phony letters written by her CA. Can the Premier tell us the date that his office discovered what the conduct of the member for Comox Valley was, about the phony letters, and what he did to inform that member's constituents, who had been misled by her?

Hon. G. Clark: I'm delighted to answer questions on this matter, although I don't have the specific dates the member referred to. I think they were canvassed in the House -- or at least I read them in the newspaper, and therefore they must be true, of course. I'm delighted to answer about the member for Comox Valley. I want to be absolutely clear. The member's constituency assistant wrote a letter -- not under his name; under a pseudonym -- that was drawn to the attention of the member for Comox Valley. She discussed that with my staff, and she immediately took the appropriate action and dismissed the individual.

Interjections.

[ Page 10197 ]

Hon. G. Clark: It's a tempest in a teapot, and the members opposite are determined to try to divert attention from their inept performance in this House by going after the member. The member for Comox Valley acted entirely appropriately in dealing with her staff and dismissed the individual immediately. That's the end of the matter as far as I'm concerned.

Hon. H. Lali: I'd like to make a statement to respond to a question taken on notice on June 25 from the member for Peace River South.

The Speaker: Proceed, member.

TURNING LANES FOR HIGHWAY 97 NORTH INTERSECTION

Tabling Documents

The Speaker: There is another report here, from the Speaker. I have the honour to present the fifth annual report of the information and privacy commissioner for the period April 1, 1997, to March 31, 1998.

Orders of the Day

The House in Committee of Supply; E. Walsh in the chair.

[2:30]

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)

S. Hawkins: When we left off on Friday, I thought I was finished on the millennium bug, but I did have the opportunity to speak to a consultant from Silicon Valley over the weekend. Actually, he's now in San Diego. Because there are less than 500 days left to fix the problem, I'm wondering who the consultants are that the ministry has hired to help with the problem and when they started their work.

Hon. P. Priddy: The firms that we have been working with. . . . First, we've been working with Cipher Systems, which has been the central consulting company for us. We have also done specific projects around the year 2000 with IBM. As I think I mentioned on Friday, or whenever we last spoke about this, we have been leading the country in terms of our work. Along with the other provinces, we are now engaging DMR Consulting to work across the country with us and with the other provinces.

S. Hawkins: Does the minister feel that there will be enough technical support, with less than 500 days left till the millennium, to fix the problems that will be apparent?

Hon. P. Priddy: We believe that to be the case. We've been working within the ministry on the year 2000 project for over two years now, and we have quite a large working group with the regions to ensure that they have the technical support they need.

S. Hawkins: I note that with concern. Some of the other provinces perhaps aren't up to speed. Looking at Quebec, only 15 to 20 percent of the debugging work that was necessary had been done as of April. Apparently, Quebec says the total bill for dealing with their needs will be almost $200 million. I'm wondering how much money the ministry has set aside in B.C. to deal with this problem.

Hon. P. Priddy: If I understand the question correctly -- I think we did visit this once before -- the amount for the Ministry of Health internally is $11 million in terms of the total cost. The assessments from the regions are in the process of coming in. We will be able to cost those when the final assessments are returned to us.

S. Hawkins: Would the minister commit to giving us those assessments when they come in?

Hon. P. Priddy: Yes.

S. Hawkins: Is the minister comfortable enough to guarantee that not one patient will be harmed on New Year's Eve 1999 because of the millennium bug?

Hon. P. Priddy: I'm satisfied that all of the work that can possibly be done -- within the ministry, with suppliers, with technologists and within the regions -- will be done.

S. Hawkins: Am I to understand, then, that the minister isn't able to give a guarantee about safe patient care for New Year's Eve 1999?

Hon. P. Priddy: What I have said is that all the work that can be done will be done. Can any of us guarantee anything? No, I think that's probably unlikely. But I am confident that all of the technological issues. . . . All of that work with the consulting companies, the ministry and the suppliers, who have every bit as much interest in the health of patients as we do, will be done, and we will successfully transverse New Year's Eve.

S. Hawkins: I think the minister committed earlier to keeping the opposition informed of the progress that's being made. Certainly when the budgets or assessments from the health authorities come in, the opposition would appreciate those.

As well, just to clean up from last week, we talked about severance resulting from regionalization. The minister said

[ Page 10198 ]

Hon. P. Priddy: The total severance cost paid out since Better Teamwork, Better Care is indeed $6 million.

S. Hawkins: When I asked last week, the minister said it was $6 million in the last budget year. That was the answer that was on the record. Is the minister changing that now?

Hon. P. Priddy: No, that is the cost since the beginning of Better Teamwork, Better Care. I'm not aware of anything in the first three months of this fiscal year.

S. Hawkins: I will keep updated on that.

The next area I would like to explore is communications and advertising in the Ministry of Health. Can the minister tell us what the communications budget is and, out of that, what the advertising budget is for the Ministry of Health?

Hon. P. Priddy: We're just bringing another staff member in. I didn't hear the second part of the member's question; I heard the first part. If she could just repeat it, that would be helpful.

S. Hawkins: Certainly. Out of the communications budget -- if that is indeed where it is -- how much is the advertising budget for the Ministry of Health?

Hon. P. Priddy: I'm wondering if it's possible for the member to move on to a different area. It will take us. . . . We have most of our staff here, but since we haven't. . . . It's hard to predict. The staff person is on the way, but if we can move into a different questioning area, that would be very helpful.

S. Hawkins: I'm interested in talking about earthquake preparedness and seismic issues, then, if the Ministry of Health has staff to deal with that.

[2:45]

S. Hawkins: I would like to canvass both.

Hon. P. Priddy: If more information is required, I'm sure we can get it.

There are a couple of things that are happening. One of them, of course, is that when we do renovations or when new capital projects are approved, if they're not a sort of build-from-start, brand-new project, then seismic upgrading is done at that time. Secondly, since the total responsibility has been turned over to health authorities, we are now working with the regions to develop a plan for seismic upgrading needs across the province, region by region.

S. Hawkins: Thank you for that information. I was going to ask if the ministry had inspected the hospitals, if there were inspections done to determine their structural integrity in the eventuality of an earthquake -- particularly lower mainland, coastal and interior hospitals. Can the minister elaborate as to whether any of those surveys have been done and if we indeed have some information on that?

Hon. P. Priddy: The ministry itself has not gone out to do that; the health authorities have a responsibility to do that. They'll put forward -- and they'll continue to put forward -- their seismic requirements, both in the regional plans that are being developed for this issue and in their capital plans.

S. Hawkins: That's kind of difficult to know, then. I wonder if the ministry knows if the regions are going ahead and doing that -- if inspections and surveys have actually been completed to determine whether hospitals in earthquake zones are structurally safe -- and if not, what work they have to do to make them safe.

Hon. P. Priddy: There are two things, really. One of them is that the hospitals -- certainly the lower mainland hospitals, as the member has mentioned -- if they are of either recent or current construction, are certainly up to code in terms of seismic upgrading. My understanding from staff is that all of the hospitals in the lower mainland are up to code. I think there are two or three exceptions. The regions will be taking that into account in their capital plan, and we are prepared to act on that.

S. Hawkins: What is the time frame for the upgrades? The minister is telling us that some of the hospitals aren't up to par, that there were some surveys done and that they're not completed in all the regions that might be affected. What time frame is the ministry giving itself to ensure that the surveys are done, to see if the buildings measure up? Secondly, what is the time frame for making those improvements, so we have safe hospitals in the case of a major disaster? That is the place people are going to be taken if they're injured.

Hon. P. Priddy: There are plans underway to remedy that for the one exception that I'm aware of in the lower mainland, beginning this year. Secondly, when I look at some of the other hospitals that are not in the lower mainland but may also be in that zone. . . . The hospitals that occur to me are either in the process of being rebuilt or are being built -- brand-new. Those plans are actually in place, and the money to do that is committed. In terms of anything else that is assessed by regions, we will look at what their assessment is and then move as quickly as possible to do that. Primarily for the hospitals in the more earthquake-prevalent zones, we believe that that work is underway.

S. Hawkins: To get back to the question I asked: what time frame has the ministry given itself to ensure that the hospitals have reported in and the work is completed? Does the ministry have a plan for that?

Hon. P. Priddy: I can't give the member a specific date. Let me use an example. Port Alberni, for instance, is a reasonably coastal community, if you will, that has a new hospital being built. I can't tell the member the exact date that hospital will be finished, nor can I for some of these other facilities. What I am saying is that the work on these is currently underway, so as soon as those new hospitals and projects are finished, then the seismic upgrading has obviously been done, because they are being built to code. For the ones that are not part of new projects or something that's currently being built, we'll act as soon as we can on those, given our capital budgets.

[ Page 10199 ]

Hon. P. Priddy: I couldn't speak for each and every staff member, but I would for sure say to you that staff in places like Port Alberni are more than aware that their hospitals do not meet the code. That's the reason they're getting a new hospital. As the new hospital is being built, they're aware that we've addressed that issue in their new structure.

S. Hawkins: For the hospitals that don't meet the standard. . . . Again, the minister is assuming that staff working in these hospitals know that their hospital doesn't meet seismic standards. I can tell you that I wouldn't know from working in a hospital if my hospital met the standards or not. I think that's something that is determined once the survey is done and once the ministry informs the hospitals. Certainly I can assure the minister, too, that I know that Port Alberni knows that they don't meet the code. That hospital has been in the news for the last four or five years, and that hospital is late being built. I don't know how many times the announcement was made for that hospital to be built. They don't even meet Fire Code, but we'll get into that later.

I'm wondering: for staff who are working in hospitals that don't meet the code -- and we'll assume they know that the hospital doesn't meet the code -- can the minister tell me if staff have been trained to deal with the eventuality that in a time of crisis their facility might no longer exist? What kind of training have we given them to deal with the hundreds of patients that will be in the hospital at the time of the quake and the injured that might be coming to that facility in the event of a quake?

Hon. P. Priddy: All hospitals are required to have an emergency preparedness plan in order to meet their accreditation. I think there was an audit done some time ago that said there were some hospitals that did not meet that requirement as well as they should have. In point of fact, the ministry has worked with those hospitals to ensure that it's the case. . . . In that emergency preparedness plan, it is also a responsibility to look at the issue of staff response in that kind of an emergency, such as an earthquake. It's our expectation that health authorities and hospitals have the responsibility to do that. I wouldn't be able to guarantee that all staff have had training but that's the expectation. We will do another audit to ensure that it has happened.

S. Hawkins: The minister is referring to an audit that was done before. Is that audit public information?

Hon. P. Priddy: That's part of an auditor general's report; therefore it is public.

S. Hawkins: I assume, then, that the minister is referring to the earthquake preparedness report that the auditor general released in December of '97. Let me quote from that report, because it's the reason I'm asking these questions. I was quite concerned when I read this report. On page 9, the heading is: "The ability of the health care sector to respond is of concern." Under there, the auditor general's team says: "Of the key support functions, medical -- the responsibility assigned to the Ministry of Health -- is the one of most concern to us. There is not a systemwide plan for emergency preparation and response. This is particularly worrisome, as those hospitals who responded to our survey expressed a pessimistic view of their ability to provide adequate out-patient and care services after an earthquake."

That's why I'm asking the minister if staff have been trained for the eventuality that there may be an earthquake. We would have hoped that the ministry has identified those hospitals that aren't up to par. Are the staff trained to deal with that eventuality? Knowing how quick the government is to announce capital projects, but how slow it is to actually carry them through, I doubt that we're going to be seeing too many hospitals built in the next little while. So we would hope that the ministry would at least have a plan, for those that aren't upgraded, that the staff are trained and that there's a contingency plan in existence to move patients to working facilities in that eventuality.

[3:00]

S. Hawkins: Well, I don't think I'm getting answers to my questions. I guess what I'm understanding from the answers is: "We're still planning. Staff don't have the training. There are hospitals out there that aren't upgraded. We haven't identified them, and who knows when they'll be done." I guess I'm just as concerned as I was in December; I am concerned today that there isn't a lot of movement on the auditor general's recommendations. But I could be wrong about that.

I wonder if the minister or the ministry's emergency preparedness team have planned a safe location where emergency supplies will be stored, perhaps to deal with the treatment of patients in case of an earthquake, because we know we will need those kinds of supplies when we treat emergencies and triage patients. Is there at least something like that set up now -- a safe location where we've stored emergency supplies?

Hon. P. Priddy: Two things, hon. Chair, if I might. In case of that kind of disaster, in particular if we're talking about an earthquake, there are some places that are clearly more at risk than others. Those hospitals would then draw on two things. They would draw on the support of other hospitals and on the federal government's emergency preparedness program as well.

Secondly, in order to be accredited, hospitals have a responsibility to prove that the staff in their hospitals have training. They must do that in order to meet the accreditation standards. So any hospital holding an accreditation must have been able to prove to the accreditation team that their staff was trained.

S. Hawkins: I just want to bring to the minister's attention the fact that the liquor distribution branch stores have all been seismically upgraded. It's interesting, because I remember that in other estimates, especially in Education, we asked

[ Page 10200 ]

Getting into the details of the report, "Planning for Response" -- I'm on page 131 of the report -- the auditor general's team says: "The Ministry of Health. . .should give immediate attention to reviewing and, where appropriate, strengthening the ability of the health system to respond to a major earthquake. . . ." The minister tells me that they've set up a committee now to look at that. It says: "All ministries assigned key support functions should complete, without delay, plans detailing how they will carry out their assigned responsibilities after a major earthquake. . . ." Has the team gotten so far as to devise that plan?

Hon. P. Priddy: We received the report, as people know, in December 1997 -- just at the end of last year. Our staff have been actively working since then. I don't know if they've got as far as defining roles and responsibilities. I do know that they've looked at the 1992 plan, where the auditor general found that significant upgrades could be made, and they've taken that into account. Whether they've gotten to roles and responsibilities yet, I don't know.

S. Hawkins: The auditor general has a whole list of responsibilities that apply to the Ministry of Health. Another key one, I think, is to "develop a new communication strategy to ensure that the provincial response plan is known and understood by local authorities and response agencies. . . ." Is the ministry working on a communications strategy, or do they have one in place?

Hon. P. Priddy: Yes, we are.

S. Hawkins: There is also a recommendation about amending the emergency program management regulation, with respect to updating the B.C. earthquake response plan. I wonder if the minister can tell us what kinds of recommendations they have made for amending that regulation.

Hon. P. Priddy: Maybe the member could provide us with the name of the regulation, because staff here seem to think that it's the Attorney General's, not ours. But we could be mistaken, so we would be prepared to double-check.

S. Hawkins: It's called the emergency program management regulation. It probably is in the Attorney General's purview, but I would think that the Ministry of Health, in updating their plan, would have some input into amending that regulation too. Is the ministry not involved in that?

Hon. P. Priddy: Yes, we are. Because a fair bit of this falls within the Attorney General ministry, and some within ours and within other ministries as well, there is a cross-ministry committee to ensure that the input from each ministry is used as required.

S. Hawkins: Another one that I think is key, as well, is to "develop and issue a current emergency public information plan." I wonder if the ministry is involved in working on that as well.

Hon. P. Priddy: Yes, we are part of working on that with PEP. I think there was just recently a preparedness event that took place.

S. Hawkins: I'm also wondering if there have been any tests of any plans. Or are there any plans to do a test to see how prepared our emergency response system is right now?

Hon. P. Priddy: There has been one smaller one, I think, with PEP, but the last major test was a year and a half ago. We are in the process of planning more.

S. Hawkins: I'm wondering if the ministry, then, has a time frame that they've set for themselves for developing this earthquake preparedness plan and the communications strategy, and for getting it out to the public. Does the minister have time lines for a plan? When can we expect that plan?

Hon. P. Priddy: In terms of the larger pieces that the member is referring to, our commitment to the auditor general is to have a plan in place within 12 months of his report.

S. Hawkins: I had some concerns around information not received from the ministry when I asked for it. Part of that information was around business plans. I wrote to the minister in mid-May or late May, I believe it was, asking for business plans. I believe my colleague from Okanagan-Penticton, who sits on the Public Accounts Committee, has some questions around that issue.

R. Thorpe: I'd like to start by asking the minister this question: does the ministry issue an annual report each year?

Hon. P. Priddy: The ministry should issue one each year. However, I do realize that this year -- quite soon -- we will actually be tabling two: one for '95-96, one for '96-97. My belief is that they should be tabled annually.

R. Thorpe: In other words, the last one that was tabled in the House is the '94-95 report. I wonder, minister, if you could just take a moment and tell us why we would be so far behind. I believe you just said it was your goal or wish that we should file. . . . What systems or actions have you put in place to assure this House -- and, more important, British Columbians -- that annual reports will be filed on a timely basis?

Hon. P. Priddy: The first thing is that I'm ensuring that both the '95-96 and '96-97 reports are tabled in the next few days or a week. Secondly, I have given directions to the ministry that annual reports will be tabled on an annual basis. I expect to be tabling the first one from me by the next session.

R. Thorpe: I'm just wondering, because the '95-96. . . . Those reports obviously must be ready if you're going to table them in the next few days. I wonder if we could get a commitment from the minister that perhaps they could be tabled tomorrow in the House, because obviously that's historical information. Could the minister commit to tabling those documents in the House tomorrow?

Hon. P. Priddy: Perhaps they could be tabled tomorrow. I'll work to ensure that they get to the House as quickly as possible.

R. Thorpe: I and the members here -- and members of the government side, I'm sure -- look forward to reviewing those reports later tomorrow afternoon.

But more importantly, or as important, my next line of questioning has to do with. . . . At a Public Accounts meeting

[ Page 10201 ]

[3:15]

R. Thorpe: Are those public documents?

Hon. P. Priddy: Many of those are public documents and have actually been quite widely used publicly. We don't publish the business plan for each and every division of the ministry, but there's no reason that the public could not apply to get it.

R. Thorpe: If I understand what the minister is saying -- that there is an overall strategic vision of where we're going or are attempting to go. . . . In our business planning for the Ministry of Health and the various programs that you would probably have subplans for, do you state targets? Are you working towards quantifiable, measurable targets as part of a performance management process?

Hon. P. Priddy: We do. Let me talk about two ways in which we do that -- one much more difficult than others. Certainly there are some things for which it's fairly easy -- I don't know about easy, but it's a least clearer -- to do those kinds of performance outcomes, if you will, or targets, around things like capital planning, meeting your budget and those sorts of things, which are at least quantifiable. I think the things that are a bit harder are the issues around personal outcome, patient outcome and so on. We do, wherever we can, make an effort to do that, hon. member. For instance, we will often talk about one of the performance outcomes as seeing X number of people more a year in a particular part of the ministry. One that I'm currently working on is increasing immunizations by a certain percentage -- we're still working on that -- particularly in aboriginal communities. We certainly do those performance outcomes where we can. The part of performance outcomes that's always harder is that although you've seen 100 patients, you have to do the follow-through to know what the actual outcomes were for them. I do know that Maclean's magazine -- I don't know where they did all their research -- felt that not only our budgets but our outcomes were better than any place in Canada.

R. Thorpe: Of course, we heard the Premier earlier today when he stated that it was in the paper; therefore it must be right. Now I guess what the Health minister is saying is that it was in Maclean's, so therefore it must be right, it must be true. But you know what? I bet you they didn't measure how good it could be or how good it should be. It may be the best in Canada -- and I have no idea what they did, and I don't want to get into another discussion, which I'm sure we're going to have later -- but that's not what I happen to be hearing in my part of British Columbia. Perhaps Maclean's didn't research the South Okanagan.

What would be the key -- the top five -- objectives that you want to achieve and that are in your business plan this year?

The Chair: I'll remind the members to please direct their comments through the Chair.

Hon. P. Priddy: The deputy and I did two lists, and they match. That's a good thing. Let me do this in two ways, if I can, one around principle and one around specific initiatives. Some of the principles that underlie the five initiatives I would pick would be access, quality, necessity -- are these required services for people? -- and affordability. Under quality, things like safety would be included in there. Moving on, then, to what I would pick as five specific initiatives, I would choose wait times. For me, wait times include emergency departments. Much of what happens around wait times is based on what happens in emergency rooms, which is based on who's in the beds that people are requiring. So there are wait times, mental health, expenditure management, children's health -- our tobacco reduction strategy is only one part of that -- and community support, in which I include things like home care and the kinds of support people need in their communities. Many of these are linked together. If you can get support at home, you may not be in emergency; you may not be in a bed that is needed by someone else. There are lots of linkages between these, but these are the five I'd select.

R. Thorpe: I thank the minister for that. I know that some of my colleagues are going to spend quite a bit of time on wait-lists, and I think they're going to spend quite a bit of time on mental health and children and community support. So let me just zero in here, if I could, on the expenditure management issue. We have the broad line that one of the five key, specific initiatives is expenditure management. Could the minister now take that key initiative and give us an idea of how that is implemented, managed and monitored?

Hon. P. Priddy: I wonder if the member can help me a bit here. Are you looking for specific examples, or do you want a broad statement?

R. Thorpe: I'll try to be a little bit more specific for the minister. I'm just following up on the five key, specific initiatives that you talked about. Now, what I want to try to do. . . . My colleagues are going to talk about many of the others, and I doubt that anyone other than perhaps me is going to talk in detail on expenditure management at this point in time. Now that we have that broad category, I want to take it and see how you manage that through your various programs. Maybe we could pick a couple of programs, and we could be specific. Since I've got the budget here, how would you manage that in Pharmacare, for argument's sake, and regional funding for acute care? There are two examples, if the minister could just give us some detail on that.

Hon. P. Priddy: Let me deal with acute care first, if I may. There are a number of checks and balances in place. If I can do it chronologically from the beginning of the year, every health region receives a binder such as this, which says how people expect the budget to be prepared: the categories, how they're to look at that, etc. This is the first year they've received such extensive information. We also have a funding methodology committee, which provides advice to the ministry around budget allocation, looking at areas of need and how the budget should be allocated across the province. Actually, I should have said the funding methodology committee first, then this information to the regions. The regions, then, on a monthly basis, submit their expenditures to us. We don't have to wait until the end of the year but are able to see that on a monthly basis and are able to monitor and manage that. We have

[ Page 10202 ]

As regards Pharmacare, I'll give you what's here, and then I probably will make another comment or two.

Why do I always do this with you? Then I get the nudge from my staff saying: "How come you took longer answering his question?" It's because you're such a nice guy. It must be that -- right? -- just your personality.

We receive a breakdown on a monthly basis of all the eight plans that exist under Pharmacare. That's how we manage that on a month-to-month basis around the management reports. But the other ways we manage from an expenditure perspective within Pharmacare are, for instance, the use of the therapeutics initiative committee and the use of the pharmaco-economics committee. It doesn't just come to the ministry from a drug company, and we say: "Okay, we'll fund that one too. It seems okay. Nice literature." It goes through the therapeutics initiative committee and the pharmaco-economics committee, who say: "Is this a drug that has had the trials to prove that it's therapeutically good for people, that it's economically good for people and for the Pharmacare system?" -- and so on. So in part, you do the management that way as well.

The other way is that we have a number of drugs that have been reference-base-priced, as well as generic drugs. From a business management perspective, I think those have saved significant money for Pharmacare.

R. Thorpe: If I could just ask a couple questions of the minister on Pharmacare. You mentioned eight plans. Back to the business planning side of the ministry on the subject of Pharmacare. . . .

Hon. Chair, I'm just wondering if we could have a little bit less noise over on the other side of the House while we deal with this serious issue.

The Chair: Hon. members, if we could just have a little bit of quiet. . . .

R. Thorpe: Would there be business plans or strategic plans for each one of the various eight plans within Pharmacare?

[3:30]

R. Thorpe: We hear about the rising cost of new pharmaceuticals and about new drugs coming out every day. We can't keep up with it, not only in British Columbia but around the world. I'd like to ask the minister two things. First, what kind of programs do we have to work with the various suppliers of medications to ensure that we as British Columbians are receiving the best possible medications we can, taking into account the affordability issue? Secondly, as the world appears to be changing so fast, do we have any pilot projects where we're working with suppliers on some kind of a joint venture-type effort to reduce the overall cost yet provide better health care for British Columbians? Do we have those?

Hon. P. Priddy: Actually there are. . . . Oh good. I'm so glad the member for White Rock is here, because the project I'm going to mention first is actually in his riding. I'm sure he will know all about it, naturally.

We do have a project in White Rock with PMAC, which is the Pharmaceutical Manufacturers Association of Canada. I have a whole page on it, but let me just tell you a little bit about it. It's a project working with White Rock seniors around the utilization of drugs. Often, for seniors, part of the difficulties they sometimes get into is around how they take drugs and how they understand the issues of taking drugs. This project has actually been quite successful. This one started, I think, in July of '95, so it has been going on quite awhile and has been very successful. That's one example of where we're doing that with the drug companies.

We have two or three other initiatives that aren't quite signed yet, and we have some other trial projects, as well, that we will be doing with pharmaceutical companies. They are partners.

R. Thorpe: Thanks to the minister for that information. With respect to Pharmacare and some comments that the minister mentioned the other day -- probably last week -- what are you doing within Pharmacare to establish and implement a best-practices program?

Hon. P. Priddy: I think there are four pieces, and if I miss, my folks will help me.

One of them is that we pay the College of Physicians and Surgeons to monitor triplicate prescriptions, which is obviously about monitoring practice.

Secondly, we pay the therapeutic initiatives committee to do the work around the efficacy the drugs. They send out a newsletter to physicians, talking about the medications -- their use and the best way to use them.

Thirdly, PharmaNet is probably one of the largest ways to monitor best practice, if you will, because PharmaNet allows the pharmacist to know if a drug interaction could happen, which they wouldn't have available. . . . I'm told that it's one of the best databases in the world.

There's a fourth one; I missed it. In terms of the prescribing of betaferon, which is certainly used a lot by people with multiple sclerosis, we have a panel of physicians who advise us around best practice for betaferon and when it's best used.

R. Thorpe: With respect to the database the minister just mentioned, do we consider or have we ever considered advising British Columbians who receive what I think is almost a half a billion dollars -- $470 million -- of assistance with their medication how much they have received from the province with respect to medications?

Hon. P. Priddy: I'm informed that the cost breakdown, including what the patient has paid, the dispensing fee and what the province's share might be, is either on the container or on the printout that you get from the pharmacist. We don't routinely send them out, but you can request from your pharmacist a pharmaceutical profile for yourself, which, if you've misplaced that information, will give you the whole profile.

R. Thorpe: I believe that the estimates process is to solicit information and, from to time, to give back information. As a user of medication for my own health concerns, I'm appreciative. What I'm getting at, because we are talking here about

[ Page 10203 ]

With respect to acute care, you talked about the funding methodology, the binder of how-to-do and. . . . Does the deputy need some medication?

Interjection.

R. Thorpe: He said: "Just what we need -- another project."

And regional funding. . . . Would a binder for the South Okanagan region, such as you have there, be available to us so we could go through and understand it better, instead of asking questions in isolation? I ask: would that be available, minister?

Hon. P. Priddy: It's public information. Your entire health authority has it. So of course.

R. Thorpe: With respect to the how-to-do binder, if I can, what kind of measurable goals. . . ? What would be the three key measurable goals we're trying to achieve in the next year as we implement this complex and multi-year program?

Hon. P. Priddy: Let me try this, and if it doesn't answer the member's question, you can tell me.

One of the things that you would find in this binder around expectation and outcome for the regions is the whole piece around performance monitoring, which is what you're asking about. For us it's reporting expectations as well. Within that, I can just highlight some for you. There's a whole list, and you're welcome to have it. One of them is to actually demonstrate progress towards regionalization objectives; identify potential risks and required action in relation to those risks, which would be a plan to address those; and ensure that policy requirements are met. That may just sound like words, but we do need to be very clear, particularly during devolving to regions, that there are certain policy requirements that nevertheless are met, regardless of where you live in the province of British Columbia. One of the things that we. . . . I think we raised this last week. Within this monitoring and reporting, we expect the health authorities to report to their communities on the outcome and the work that they're doing.

From a business perspective -- both business and policy, I suppose -- we expect them to look at both short-term and long-term trends in their particular communities, show comparative performance and create incentives for good performance -- the whole performance of the health system that they're responsible for. There are others here, but if it's something different. . . . I suppose the ones I would add, though, are a bit more technical. They're around data collection or statistical collection and measurements that we expect of the regions: the development of aggregate population, financial service and personnel indicators, and routine monitoring, plus detailed audits and reviews.

R. Thorpe: I do thank the minister for her answers, and I do look forward to getting the binder and going through it in detail and following up on some of the points. But I'm not going to do that today.

On regionalization, though, one of the other issues you talked about in the business. . .was the principle of access. How do we in the regional. . . ? I don't mean to make light of the how-to-do binder. From the client's perspective, how do we rate the accessibility factor?

[3:45]

The other way we would get that from the community, though, is that every health authority has advisory committees that represent various components, if you will, of that community, and their responsibility as an advisory committee is to give that information back to the health authority, whether that's around seniors, aboriginal people or whatever. So that's also part of how you get a patient response.

R. Thorpe: I realize that we're going through the implementation of regionalization at this point in time. Do you do any random research follow-up with clients at the hospital or within the regional health. . . ?

Hon. P. Priddy: For the most part, hon. member, that is done through the health authorities, who do indeed do that. They do it with home care or home support. They do it and the hospital does it, so a number of services do that random survey and follow-up in terms of the service that people have received.

We have just recently been giving some consideration to doing some of that ourselves -- to be able to do a quality assessment and a report-carding.

R. Thorpe: I would ask, again going back to the comments last week on best practices, which is a program and a methodology that I personally endorse. . . . I think it's important that we establish some of those key practices and not only that we ask the regions to do that but also, for our own independent verification, that we have a program. I would look forward to hearing at some time in the future how we're going to do that.

With respect to children, you just mentioned a specific initiative. Would we have within our strategic plan an objective on childhood immunization? Do we know where we are today, and do we have a target?

Hon. P. Priddy: As the member may know, we have a joint responsibility around immunization, but because the health officer reports to me, we certainly have a policy responsibility. Yes, there are markers, and we know that there are parts of the province and parts of cities where we fall well below what I consider to be any kind of acceptable mark for immunization. We know that in aboriginal communities, and

[ Page 10204 ]

For awhile, throughout the country, we saw immunization rates actually drop where there shouldn't have been any reason to do that, given the accessibility to it. So we said to ourselves that in those communities where we fall far below, we will actually have a marker, if you will, or a benchmark to say: "We will get to this percentage of immunization for aboriginal children or for children who live in communities where we know that that doesn't happen regularly enough for them."

R. Thorpe: I would like to assure the minister that whatever I and my colleagues can do to assist in that area, we'd be pleased to do it. Children are special to all of us and should be very much a number one priority.

With respect, though, to the fact that you know of some areas of our communities where we have shortcomings and where we're not measuring up to our own goals and perhaps the minister's personal goals, can I therefore conclude that we have a listing by community and that we do know the levels of immunization for children in British Columbia today? Does such a list exist?

Hon. P. Priddy: I'm not sure you could always do it by specific community. You can certainly do it by region, and in some places you can do it by specific community.

R. Thorpe: I don't want to go through and dig all that out. But if the minister could commit to providing that detailed list to me, I would very much appreciate that. Would the minister do that?

Hon. P. Priddy: Absolutely.

R. Thorpe: With respect to expenditure management and funding methodology, I just want to spend a few minutes on this and ask questions. I'm going to use my particular area of British Columbia as the example. When we go through and look at the funding methodology for providing our Okanagan-Similkameen regional health board with $232 million -- I know it's subject to change, but in round figures it's $232 million -- do we use a broad-stroke approach, or do we look at the demographics of the various communities?

Hon. P. Priddy: To allocate new dollars, we do use a population-demographic formula to do that, but not on existing dollars.

R. Thorpe: It's always useful to ask questions, because you never really know what answer you're going to get. I wonder if the minister could explain to me what new dollars are.

Hon. P. Priddy: Any incremental dollars at all.

R. Thorpe: Again using my regional health board. . . . I'm going from sheets that were provided by the ministry dated April 16, 1998, so I'm assuming that, broad-stroke, they're fairly accurate. We went from $230 million to $232 million. Would the $2 million then be subject to an application of new or current demographics? Is that what we're saying? If that is the case, could the minister explain how we go through that?

Hon. P. Priddy: The money in Okanagan-Similkameen as well as the rest of the lift, if you will, for the regions was. . . . Yes, there was a population-demographic formula used for the entire amount of that lift. But people will have considered things like an aging population or communities that have a whole lot of younger children in them and so on.

R. Thorpe: I guess what we're doing here is applying a one-size-fits-all approach to all parts of British Columbia on the base amount. Would that be correct?

Hon. P. Priddy: No, it's not a one-size-fits-all. . . . I mean, the formula is a population-demographic one, but local health authority people look at whether you have more of an aging population in your area or somebody else has. . . . You know, aboriginal communities may have particular demographics that are very different, so those are taken into account on a local health authority basis.

R. Thorpe: But what troubles me, and what I don't understand -- and perhaps the minister can give me some more information to help me understand -- is that if you live in a particular part of the province that has a higher-than-average seniors population, and if the funding is only adjusted on the incremental base, you can never catch up. How are those kinds of inequities ever adjusted? How does that take place?

Hon. P. Priddy: I appreciate the question about how you do catch-up. But all of the increments over the last five years, which are several hundreds of millions of dollars throughout the province, have been based on the needs of a particular area -- on both population and demographics. Over the last five years, those several hundreds of millions of dollars have not been one-size-fits-all, but based on what the particular needs of that health authority are.

R. Thorpe: I thank the minister for that. I'll wait and go into some details in other areas with respect to that when we get to them. I'm just trying to mesh theory with the reality that apparently takes place in my community.

The fact that we're moving to an annual business plan and that in the next few days we're going to have tabled in this House two of the outstanding annual reports. . . . What kind of an ongoing report card to British Columbians are we going to have with respect to the things we're trying to achieve within the health care system in the province?

[4:00]

R. Thorpe: Do we know at this point in time -- perhaps not all of the items that would be on that report card -- what the ministry believes the key indicators would be for that report card? Could the minister share those with us?

Hon. P. Priddy: I'll just name a few, if I could, for the member. One of them would be simply how healthy British Columbians are, looking at the issues of mortality and morbidity. A second one is looking at the issues of access. Clearly,

[ Page 10205 ]

R. Thorpe: I assume that that would be a provincial report card. Has any thought been given to also doing regional report cards?

Hon. P. Priddy: Yes, hon. Chair, and we will be working with the regions to collect that information. So it will be available not only provincially but also regionally.

R. Thorpe: I just want to thank the minister for answering my questions. I look forward to receiving some of the material we talked about. I'll turn it back to my colleague.

S. Hawkins: I thank the member for doing that part as well. I'll be interested in seeing the annual reports. The minister is probably well aware that the auditor general did have some concerns. I believe there was a value-for-money audit done on downsizing Riverview, which I brought up in the House before, and on mental health services. I believe it was the auditor general's feeling that the annual reports didn't always give the information that was needed to assess what the ministry was doing. That was certainly the case in the value-for-money audit that the auditor general had done in mental health. I hope the ministry's annual reports won't be just a rubber stamp of words but, rather, will give us some detail on the programs and on the progress that the ministry has made over the last several years.

I should mention at this time, too, as I've mentioned before, that it is disappointing to not have those reports. This House holds the government accountable for the programs, the services and the quality of health care that patients and people in this province receive. When we don't have that kind of information. . . . Frankly, I can tell you that I'm disappointed. I've written to the minister and asked for all kinds of reports, and I've gotten nothing. We could have saved a lot of time so far in these estimates, on the kinds of questions that the member for Okanagan-Penticton had to ask, if we had indeed received some of the information that was asked for from the minister.

But we'll plow ahead. We want to go on now to some regional health issues. I believe the member for Surrey-White Rock has some concerns that he wishes to raise.

Hon. P. Priddy: I'm happy to go on to that, if the member likes. Our communications staff is here. If the member wants to return to the communications questions, we can do that.

S. Hawkins: I think I started off asking. . . . Yes, I will deal with the communications stuff, if the staff is here. I want to know what the communications budget is for the Ministry of Health and how much of that is allocated to advertising.

Hon. P. Priddy: The communications budget is $3.6 million. The advertising part of that is $2.1 million.

S. Hawkins: I'm sorry; I had trouble hearing. I thought I heard $2.6 million and then $2.1 million. Is that correct?

[E. Gillespie in the chair.]

Hon. P. Priddy: The total communications budget is $3.6 million. The advertising portion of that is $2.1 million.

S. Hawkins: Can the minister tell us what different areas the communications. . . ? I guess there's $1.5 million in communications. What does that cover, as far as Health ministry communications?

Hon. P. Priddy: The total is $3.6 million, just so I can be clear. The $2.1 million is. . . . I didn't know if I heard the member say $5 million. The total is $3.6 million.

Let me give you some examples of that. Tobacco public awareness would fall into that category. Our work on the information around organ donors and organ donor cards is part of that. Part of that was the hepatitis C look back, where we had to put out public information and advertise for people. Those are some examples of what would fall within that category.

S. Hawkins: I appreciate that. What I was asking was. . . . If the advertising is $2.1 million, and there's $1.5 million left in the communications budget, how is that allocated? How many staff and what kinds of value are we getting for that money?

Hon. P. Priddy: Of the remaining budget, $1.209 million of that is staff salary and benefits. That is 21 FTEs.

S. Hawkins: For the advertising part of the budget, what guidelines or policies are in place to guide the ministry in what kinds of advertising they do?

Hon. P. Priddy: If you will, the principles that underlie that are around public education and awareness. That's why, around the advertising, I gave some of the earlier examples of the tobacco reduction strategy, organ donors and hepatitis C.

S. Hawkins: What is the ministry's policy, then, on negative advertising?

Hon. P. Priddy: Perhaps the member could give me an example of negative advertising.

S. Hawkins: I would certainly like to do that. I hope the minister is aware that we hear a lot of concerns about the ministry spending money on advertising, and we learn it's now $2.1 million in the new budget year. A lot of patients call and write to me, and I have seen editorials in the paper, with respect to ministry advertising -- and certainly with respect to all ministry advertising. They say: "Spend that money" -- especially from the Ministry of Health -- "on health care and not on ads." It's one thing to say that there are public service and public awareness ads, which is fine. I agree with that too. I think organ donor ads are great, because we know what kind of concerns there are about the lack of donors. So getting that message out is great.

But you know, when I see ads and certainly whenever the ministry does do ads with respect to, well, issues that perhaps are better left to interviews rather than ads. . . . I'm thinking back, and I have ads in front of me on the doctors' dispute with the ministry. You know, I've got this ad: "Health funding will increase $228 million in B.C. this year. The dispute with the B.C. Medical Association is over doctors' incomes, not health care funding." I'm wondering what kind of a public service or public awareness that is. The minister has the chance to do interviews. We've seen the increase in public funding for health care in the papers and stuff. Frankly, when patients are waiting on waiting lists and are concerned about

[ Page 10206 ]

I recall the auditor general's report with respect to ministry advertising. He estimates that the government spends $2-3 million a month -- perhaps $25 million. That's just an estimate -- I'm sure it's probably well above that; that's what the auditor general is estimating -- with very little accountability for where that money is going. Couldn't that money be better spent? What I'm saying to the minister is that I do get letters telling me to talk to the minister about this -- that the money should be better spent on patient services and patient treatment, rather than self-serving advertising by the ministry or negative advertising that doesn't serve anybody. I want the minister to comment on that.

Hon. P. Priddy: I think the things that I read out to the member a moment ago make up the largest total by far -- almost 90, 95 or 100 percent of the advertising budget.

On the advertisements that the member refers to, while I also get calls and letters -- I may get the kind the member gets, but I get different ones as well. . . . When the public is frightened by what they hear about what's happening in the medical system, they certainly have the right to make their own judgment about that, but we have a responsibility to also provide accurate information. Yes, the minister could do interviews, but I would suggest that it is probably not the most watched or best way necessarily to get information out to the broadest range of people. The public does have the right to have accurate information about their health care system in order to make their own determination about the state of it.

S. Hawkins: The one thing we can agree on is that the public does have the right to accurate information. That's why it's sometimes misleading to see some of the ads that the ministry puts out, because I think they're just as one-sided as the ads that the other side puts out. Again, I don't know if it's the best use of health care dollars to do the kind of negative advertising in which the ministries, and certainly this ministry, engaged themselves.

[4:15]

Again, as far as the ministry guidelines are concerned, public education and public awareness are two good goals to have. But I would suggest that. . . . Gosh, I don't know how to say this in a polite way. I'll have to think about it for a minute. But I don't think that fighting wars through the paper is the way to go. I mean, if the ministry is doing a good job of providing health care services across the province, they don't need to advertise. Patients will know that the ministry is doing a good job. Patients will know that they're getting the treatment they need when they need it. Patients will know that they don't have to wait a long time. Patients will know that they won't be denied services. You don't have to advertise that you're doing a great job and putting this much more into funding and everything's okay now because you've got these wonderful ads in the paper, when we know that patients are being denied services in different parts of the province. Waiting lists are the longest for orthopedic surgery, for example, for patients in the north. We know that, and no matter what advertising the minister does, that's not going to change.

Some of the budget. . . . I can tell you, $2.1 million is a lot of money. It's a lot of money to me, and I'm sure that if you asked any patient, that is a heck of a lot of money. I think it's disgraceful to do advertising like what we've seen in the last few months for a budget of $2.1 million. When we see ads like that, that's when we get patients phoning us and writing us, telling us: "At a time when we have to wait long periods of time and endure bed closures and see health care in our regions screaming for, say, long term care beds, why is this happening? Why is the ministry engaging in advertising like this?" So I bring that to the minister's attention, and I hope. . . . Obviously we're monitoring that. Over the next year we'll see if public education and public awareness are actually the two goals that are being followed when the ministry advertises.

At this time, unless the minister wants to comment, I will turn the floor over to the member for Surrey-White Rock.

G. Hogg: Well, appreciating that this year's estimates are to some degree based on the financial actuals of last year and recognizing that there are 52 health authorities in the province, I'd be interested in finding out if there is some estimate with respect to how many of those authorities came in on budget and how many were over budget in '97-98.

Hon. P. Priddy: The great majority of those 52 came in either on budget or with a small surplus. Some came in with a deficit. It's information that I'm not sure we have with us, but we'll get it to the member. But the majority came in on budget or with a surplus.

G. Hogg: I'd be most interested in finding out perhaps the five that had the greatest overexpenditure, that were the furthest over budget, and the areas that they were in if that's at all possible. Secondly, with respect to those that did have the shortfalls, how were the shortfalls accounted for or taken care of?

Hon. P. Priddy: We don't, as a matter of practice, fund deficit budgets. There is the odd case where people make a legitimate argument for the reason that they have been over budget for that year, in which case they can do one of two things. Many health authorities, although not all, will have a working capital, if you will. So it's money they have on reserve. They can either use that or include it in their next year's budget, but they're still expected to manage it.

G. Hogg: With respect to Surrey Memorial Hospital, which I think has been carrying about a $5.8 million deficit for a number of years, I wonder whether it is written off or whether it starts to accumulate -- how in fact its deficit is managed.

Hon. P. Priddy: While we are talking about health authority budgets, this is an individual facility, so it's up to that health authority how it manages that within its budget. But

[ Page 10207 ]

G. Hogg: Do we have the amount of the infusion of one-time funds? How much was infused to turn the deficit into a surplus?

Hon. P. Priddy: We will have to check that. We don't have with us facility-by-facility. . . . My staff will get it and give it to the member.

G. Hogg: Perhaps when searching that, they can also look at. . . . It's my understanding that Surrey Memorial has been carrying a deficit for a number of years. In my time on the regional health board, I was aware of the deficits that Surrey Memorial was carrying. In many cases, there were one-time infusions. I wonder whether or not the base that will go to the authority will allow the base for Surrey Memorial to be brought up. Or will they continually be in a position of seeking one-time infusions year after year in order to get to the position where they can function within the framework provided?

Hon. P. Priddy: We have not done that to date, but the budgets are still coming in. We still have a few budgets to come. When those budgets are assessed, I will take that into consideration.

G. Hogg: I appreciate that you don't have the details and specifics, but I want to ask a couple of those and perhaps get the information at another point in time.

I know that the issue of severances for CEOs has been canvassed and discussed previously. With respect to the hospital in Surrey-White Rock, Peace Arch District Hospital, there were also a number of persons who left the employ of the hospital who were not CEOs but were at other director levels. I wonder if we can find some details with respect to the severance packages that were provided for those and how in fact those were funded.

Hon. P. Priddy: Yes, we will get that information for the member. My staff has made a note of it. Secondly, I think those were primarily administrative positions that were eliminated. Nevertheless, as a result, there are savings to the health care system as well. We'll get the member the specific information.

G. Hogg: With respect to capital purchases which may occur in any of the specific hospitals. . . . If I can, I'll use Peace Arch District Hospital as a reference point, which has a very active foundation and a very active auxiliary, which has been able to do very well with respect to their fundraising. Are there some limitations with respect to any of the capital purchases that this hospital may choose to make? Do they have to have some type of approval for those and for the operating costs through the regional board? What type of latitude does a foundation have in terms of making capital purchases for a specific area or a specific hospital?

Hon. P. Priddy: Certainly a foundation can buy any equipment that it chooses to buy. But if there are operating costs attached, then there must be some support and approval from the health authority to be able to operate it. So if there are operating costs attached, they must have worked with the health authority to get that agreement ahead of time.

G. Hogg: With respect, then, you're saying that a foundation is free to go ahead and make the capital purchases it chooses. However, if those are encumbered by some operating costs, then there would have to be approval from the regional board to allow the operating costs to be paid. If in fact the independence that is allowed for the capital purchase is. . . . If they are able to also provide funding for the operating costs for set periods of time, would that allow them to accommodate that type of process as well?

Hon. P. Priddy: While there may be exceptions -- which I can't think of -- for the most part that would not be the case. While a hospital foundation may believe that it has the money to operate it indefinitely, our experience is that that's not very likely to be the case. At some stage, then, if the foundation were unable to provide the operating costs for whatever financial reasons, people would certainly expect the ministry to be able to pick that up. So our general position is not to get into supporting capital if people say: "Oh, we can provide the operating money for it."

G. Hogg: With respect to areas such as South Surrey-White Rock where we have large population growth taking place, there's been some discussion over the past number of years with respect to funding formulas and allocations of resources based on some type of growth formula in order to ensure that the inequities of growth are starting to be managed and dealt with. Can the minister provide us with any further information with respect to how those formulas might be progressing, what their status is and what we're looking at in terms of that?

[4:30]

G. Wilson: My question to the minister. . . . If I can get the minister to visualize Texada Island for a moment, which is right across from Powell River and separated by a ferry ride, it is currently trying to resolve a situation with respect to the maintenance of their clinic. The minister will be aware, I think, that we have worked a long way toward getting resolution to financial arrangements for a physician; I think we're very close to having things wrapped up. Of course, this is a community that would very much like to make sure that the medical services provided for their community are maintained. However, it seems there is an unresolved matter, and I think it has to do with the ongoing operation of the clinic itself -- that is, the cost of the clinic itself. We've run into a difficult situation, where it would appear the ministry's position is that these rural clinics are going to have to be picked up out of the general costs of the CHC -- or RHB in this case. Those costs are going to have to be borne out of a general budget, and yet there was nothing provided for that clinic in that original budget.

[ Page 10208 ]

Hon. P. Priddy: As the member knows, we have reached an arrangement around the alternative plan, and we have reached some agreement about funding nursing for the health clinic as well. I think the member's correct: we've made a fair bit of progress toward resolving this. I don't have an immediate answer for the member. In many cases, the work in the community clinic is funded by the physician as part of the practice. This is a somewhat different circumstance. We don't say to community clinics that they you have to fund it all, because it normally works in a different kind of way. So while we have agreed to the physician's salary and the nursing service, my understanding of it -- and I haven't had this conversation with the member except a bit in writing -- is that the community clinic seems to see itself as needing an additional amount of dollars in order to cover the operating costs of the clinic. This is actually one of the better-funded clinics that we have this kind of arrangement with, but I'm still committed to working with the member to see if we can get resolution to this.

G. Wilson: I'm delighted to hear that. I don't think that Texada is the only place in the province that has this kind of problem. It's a problem we perhaps need to try to draft some basic guidelines or policy on in order for us to try and overcome in the long term what the community sees as an inequality between the services provided to the larger centres and those that are provided to rural ones separated by lack of transportation or, as in this case, by Malaspina Strait, which is crossed by the ferry.

For the last number of years, as the minister is aware, the islanders themselves have subsidized that clinic to the tune of about $45,000 a year. I understand that with the report coming out of the work with the northern doctors, there's a $20,000 potential nursing subsidy, which means we're really looking at a rather minuscule amount of money in the scheme of things. If we're looking at something in the neighbourhood of $25,000 in the larger scheme of government expenditures on health care, I think the minister would recognize that to be a relatively small amount of money. Yet to the people of Texada, it makes the difference of being able to actually get a physician there, have that clinic operate on a long-term basis and provide security and stability to that community. So I am pleased to hear that the minister would be prepared to continue to work on this. It strikes me that there must be some way for us to get our heads together to be able to find that outstanding $25,000.

The difficulty is that we're running into some time problems here, because in order for offers to be acted on and contracts to be signed and so on. . . . We're running into a bit of a time crunch. I wonder if the minister might tell me if she has ideas as to how we might proceed on that outstanding $25,000.

Hon. P. Priddy: I don't have a particular solution currently. What I need to check on -- and I'm sure the member knows more about it; it's his community -- is what position the health authority has taken on this. I appreciate the time frame you're working under, and I'll direct my staff to work very quickly with you on this.

G. Wilson: I'm very pleased with what I'm hearing. I know the health authority is certainly 100 percent on board. We've worked very closely together.

I would like to say, just for the record, how much I've appreciated the work that has been done with Ministry of Health staff on this question, because this is an anomaly -- there's no question -- and it is something that is going to require a certain amount of ongoing attention.

If I could just draw the minister's attention to two other items with respect to Texada, then, the other is the matter of in-home care. We run into a difficult problem in the rural area when we have clinic facilities there and people who require ongoing treatment because they're seniors, they're retired, and they therefore need to have ongoing care. Texada is again in a unique situation in the sense that people cannot ordinarily travel for those services, and it's hard to get people to come to the island for the provision of those services unless they reside on the island.

I wonder if I might get some comment from the minister with respect to how we deal with these anomalous situations in isolated communities, especially coastal communities, where the provision of those services becomes more expensive by virtue of needing to put people into that position -- therefore they have to live there -- even though the amount of time that they would ordinarily spend would be the same as if they were in a larger community. In other words, there's an associated cost of having to reside in that area.

Hon. P. Priddy: It's hard for very small communities, and the member knows that. In this case, it's an isolated area that may not need full-time staff, but there doesn't seem to be any other way to get people there. I don't have any magic or immediate answers for this. I don't know if the regional health care team that is responsible for your area has been doing some work on this or not. If they have not, I will direct the staff to do that. You're right; it works very differently in different communities. If it's home support, sometimes the person will choose to live in a smaller community. If it's home nursing, then the community probably isn't big enough to support someone to do that. I mean, it is really difficult, and you'll find different answers for different communities. If it's of any help to the member, I'll direct the regional team in your area to work with you on this.

G. Wilson: That would be excellent. I'd certainly offer my office as a way of trying to set up meetings, if that's needed. It may not be. I'm sure we have a very active team with respect to the health authority in Powell River and a very progressive group.

The minister did touch on the other part of the question, and that was on home nursing. I was also talking about home support. The home nursing situation in a rural community like Texada is extremely difficult, because it is a relatively small community. There are two primary settlements, I guess you would say: Vananda, as you come off the ferry. . . . I don't know if the minister has ever been to Texada, but if the minister hasn't, I would suggest that it might be an excellent place to go this summer. There's a wonderful little campsite with a very nice little beach, and there are no phones. You can get away; it's perfect.

Having said that, there is Vananda and then there is Gillies Bay, each one on opposite ends of the island. Those are the two primary centres. Many people in the rural community outside of those live even further afield. So it does become extremely difficult when you need home nursing because of

[ Page 10209 ]

I do appreciate the minister's suggestion that she would send a team there. I would like to thank her, and I look forward to working with the ministry to make sure the community of Texada is properly served. I'd also like to thank the member for Okanagan West for the opportunity to raise these issues.

[4:45]

I don't think it serves patients in the province well for the government and the physicians to be having this kind of war. I think the minister would agree with me that it's not a great situation right now, at a time when we know that there are problems in health care and that we all need to work together. I think working together should be the key here. But we see this huge division and this rift forming between the Ministry of Health -- the government -- and the physicians in the province. I can tell you that it's not a healthy situation.

This is an issue that I get a lot of correspondence on. When the ad wars started happening, I got even more. In the last few months we've seen the rural and northern health crises, and part of the issue there was the availability of physicians in the province -- and certainly physicians in rural areas. Frankly, patients are concerned when the ministry and the doctors have, very publicly, the kinds of media fights and the kinds of stories that we've been seeing in the last six months or year. Patients are concerned. They think that the ministry should be working with health care providers. I'm wondering if the minister can brief us on the ministry's and government's position with respect to working with the physicians to get some kind of resolve and some kind of healthy working relationship, instead of the war of words we've been seeing in the last year.

Hon. P. Priddy: I think the member is correct. Any such public discourse causes patients to worry. I would suggest that there has probably been a lot of public discourse, and if there's a war, it means there are two parties involved.

My personal commitment, since I have been here. . . . By the way, I think we need to be clear about this. I meet with physicians all the time from all kinds of different specialities -- individuals, my own physician. I don't think it's about individual physicians or a group of physicians. If we were to be frank, the public discourse has been between the organization that represents physicians, the public and perhaps the ministry or the government. I do want to reinforce that my individual contacts with individual physicians or groups of physicians have actually been quite positive.

I met early on with the BCMA. I think people know that my particular style is to work with people, wherever that's possible, to acknowledge where we have common ground. My last conversation with the current president of BCMA -- who I met with right after his election or appointment, whatever the process was -- was about ways we could move forward. We agreed that we might disagree on some areas but that we would move forward in a positive way and find opportunities to work together wherever we could. They actually offered specific examples of where they would be pleased to support the government on some current initiatives.

I think this is something we see across the country in all provinces. It means that everybody involved -- whether it's people in government, people in opposition, individuals physicians, the organization that represents physicians or the patients themselves -- has a responsibility to make sure that that relationship goes forward as well as it can. Will we disagree? I expect we will, but I think we can disagree in ways that are not harmful to the health care system and do not induce fear in patients.

S. Hawkins: I think what's happening is that we are seeing some harm to the health care system. Because of the disposition of the physicians and the relationship between them and the ministry, we see these RAD days starting, reduced activity days. I can tell you very clearly that I'm not a supporter of those. I'm not a supporter of anything that denies health care to patients. This is one issue that certainly does that, and I think that is a result of the ministry and the physicians' group not coming to agreement or not finding resolve for those kinds of issues.

The minister says that it's not individual doctors and it's not groups of doctors; it's the BCMA. Well, the BCMA is made up of those individuals and groups of doctors. From what I understand, those physicians are more united across the province than they've ever been, so the minister has to be talking about the majority of physicians in the province when she talks about the BCMA.

I am not happy to see that relationship. The minister tells us that she meets with the doctors and that she wants to work with them. I think that more than once in question period, when I have posed questions to the minister, there have been very accusatory types of comments, in my perception, coming from the minister and the government. I don't think that kind of discourse is healthy for patients, for health care workers or for front-line workers across the province.

Frankly, in reality we are experiencing a brain drain in Canada. We know that physicians are very mobile. I fear -- and patients fear -- that a lot of these workers will vote with their feet and walk out of the province. Certainly we have seen that over the last five months in the dispute with the northern doctors. We see towns in northern and rural B.C. that are now depleted of physicians. I don't think it's healthy to have that kind of relationship. Frankly, when I see an article like this that says, "Doctors Plan Media Fight Over Health Funding in B.C.," I wonder what measures the minister is taking to work on these issues so that we don't have to see this war, which will apparently escalate later this summer and into the fall.

I also have to wonder. . . . If the physicians are planning a media war, which I think is what they're saying here, is the ministry going to match that dollar for dollar too? That's what we have been seeing, and I don't think that is good use of health care dollars. I've said that before. We've seen a group put in an ad; then the ministry puts in an ad. The ministry's ads, unfortunately, come from our tax dollars -- dollars that should be spent on patient services. The physicians' money, I

[ Page 10210 ]

Interjection.

S. Hawkins: The member for Bulkley Valley-Stikine finally raises his voice. In his part of northern B.C., I can tell you that there are serious health issues and serious issues with respect to physician recruitment. I wish he would stand up, for a change, and speak for patients in that part of the province. I haven't seen him do that once this session -- not once this session. What I am saying is: stand up and stick up for those patients; stand up and stick up for those physicians in your area, who want working conditions. . . . They want to work with this government.

This minister says that the head of the BCMA wants to work with her. Is the minister going to take steps -- and what steps is she going to take -- to work with the physicians so we don't see this media fight and we don't see the ministry match, dollar for dollar, the media campaign that the physicians are going to start later this fall?

Hon. P. Priddy: I don't think it's particularly useful for patients or health care in the province to have physicians involved in a million-dollar campaign that I think will simply instil more fear and anxiety in patients. That's what the member has said, as well, and I agree with her. I would certainly call on. . . . I guess I would ask physicians to rethink a particular strategy that spends $1 million doing that.

Yes, the president of the BCMA did say he wanted to work with us, as I indicated I wanted to work with him. We have found at least a couple of ways to do that. If the member is asking, as I believe she is, what I can do, as the minister, to prevent this million-dollar media war campaign by the BCMA, I'm not sure what I can do. If the answer is that you write a cheque, then I'm not particularly in the position to be able to do that.

I've stated this before: this is the only province in the country that has had a health care budget increase for each of seven years. It's the only place in the country. We have the most number of physicians per capita, and we fund the largest health care cost per capita in the country. Do we have areas of concern? Yes. I think that some of those can be worked out with physicians. Some may require resources, but what I've heard so far from the organization involved. . . . For me to be able to get them not to do that, which would be to fulfil all the issues they have, is simply not financially possible at this time. I'm not even sure if all of it would necessarily be in the best interest of the overall health care system in the province. But they have raised some issues that I think are important and that we will continue to work on together.

S. Hawkins: Is the minister concerned at all that physicians will leave the province, leave rural areas where patients need that kind of medical care, because of the so-called war between the ministry and the physicians?

Hon. P. Priddy: I would always be concerned if there were physicians either leaving rural or remote areas or leaving the province. The actual numbers -- the most recent numbers, and they are quite current -- would suggest two things. One is that we have more physicians who have come into the province in the last five years than have left the province. In point of fact, in British Columbia the population per physician is 510, and the national average is 545. We do have more physicians per capita than the national average -- than any place in the country. I'm concerned when any one physician makes a decision to take her or his skills either outside the province or outside the community they're currently practising in, but it is their choice to do that.

S. Hawkins: You're absolutely right: that's their choice to make. A lot of them have walked. We know -- from the facts that I have, and I've said it several times -- that as of May there were 86 fewer physicians in rural areas than four years ago. We know that from January to the end of May, at least another eight physicians left rural areas as a result of the crisis. I don't think it's helpful to have the kind of relationship that the ministry has with the physicians. The minister says that it's just over funding and those kinds of issues. I think it goes deeper than that; I think there is a lot of rhetoric -- perhaps on both sides -- and there is a perception on both sides that the other is the enemy. I don't understand that. I've heard the minister stand in this House and really put down this group of people. I really don't understand that.

I'll tell you that what I hear from physicians -- and certainly from patients -- is that there is a really negative response to the ministry on this kind of discourse. When the minister says that she and her government are doing everything they can. . . . I recall a meeting -- in April or May, I believe -- of the BCMA. Not one NDP member came to that meeting the physicians held here. That is absolutely not helpful. They brought their membership here -- 75 of them -- to meet with a matching MLA, and to have not one NDP MLA or the minister attend that meeting. . . . That is the kind of action that's going to create a deeper rift.

[5:00]

I think the minister can agree that there are very challenging issues in health care. Physicians are just as interested in helping resolve some of those as the ministry and the members in the opposition are. Frankly, when we meet with the physicians, there are certainly areas that can be worked on. It's not unreasonable to expect our health care leaders and the Ministry of Health to reach out to these people and see if there's something that can be done.

Again, I am very concerned about these RADs, reduced activity days, and their impact on patients and patient care and waiting lists. I think it's not getting better; it's getting worse. The longer the ministry lets this feud go on. . . . I think the minister should take a lesson from what happened up north. For five months patients were without service in their own communities. I don't think that was a proper way to deal with the issue, and we'll get into that when we talk about the rural northern health care crisis. I guess I have to ask the minister what her plan is then, because it sounds like maybe she's waiting for the doctors to take the first step and back away from their media fight. I think both sides have drawn

[ Page 10211 ]

Hon. P. Priddy: Hon. Chair, if people are going to speak of rural health care later, I won't respond to those points now. I'll wait until the appropriate time.

I agree that health care leaders have a responsibility, and that includes all health care leaders. I have never expected the BCMA to "take the first step," which is why I met with the president of the BCMA almost immediately after I became minister. I have met with the current president as well.

There are clear areas of disagreement, and we're not sitting back simply waiting to see what physicians do. That's why we have done things like put $9 million more into cardiac surgery and procedures. Cardiac surgeons have said that's a huge issue for them; that's why we've put $8.5 million into that. That's not sitting back and waiting; that's addressing one of the really important issues that they've raised. They raised the issue, as well, about orthopedic surgery, and that's why we've struck exactly the same kind of review panel for orthopedic surgery as we did for cardiac care, with the kind of outcome we've seen with cardiac care, which was $8.5 million. So we are taking action on a number of issues that are of concern to the physicians and which the BCMA has stated are concerns to them. We've taken some action, as well, on some of the continuing medical education issues that people have raised. We're certainly not sitting back waiting for the BCMA to either change its mind or do whatever. We're working on the issues that we're able to, and we're moving them forward as quickly as we can.

I think if you were to ask the physicians in the north, regardless of whether they're in urban or rural areas -- and regardless of whether or not everybody is totally pleased with the Dobbin report -- those physicians would tell you that they have had incredibly open access to the staff in my office and to me. So I am quite willing to work with physicians.

S. Hawkins: I didn't hear an answer to my question, but I'll try. . . . I just want to respond to something the minister said. That was with respect to putting $8.5 million into cardiac surgery. I wonder who the minister or the ministry officials talk to when they make a decision like that. I understand that it was done but that there was no matching budget for the anaesthetists. So if there's going to be extra surgery done. . . . Apparently there wasn't budgeting for the anaesthetists' time within this waiting-list time. There seems to be a lot of things the ministry wants to do and is trying to do. But what I'm saying is: talk to the groups that are actually going to be doing the surgery, the procedures, and managing those waiting lists and work with them.

Here's another issue -- that is, the whole waiting list issue. The ministry put out their report in November. The BCMA and a lot of patients, I have to tell you, didn't believe the ministry. BCMA did their own report and released that in February or March, I believe it was, and there was a huge disparity between the numbers. They were almost double the waiting-list times that the ministry and the BCMA gave. When I spoke to the physicians and asked, "How can we fix this?" they told me that they have been trying to sit down with the ministry to actually get the ministry's numbers. The ministry has access to wait times through data in hospitals and in ministry offices. What is stopping the ministry from working with the physicians on the waiting-list issue?

It's nice to make this huge, wonderful announcement about $8.5 million more for cardiac surgery, but it's discouraging when we hear the next day that the anaesthetists aren't going to participate because there is no funding to match the time that they're going to spend on these extra surgeries. I have to wonder if the ministry is thinking that through. Or is the $8.5 million for both the cardiac surgery and the anaesthetists, so it's actually fewer procedures than the ministry is announcing? I'm hoping for the ministry to forge a better relationship with this group. They are a group that has a huge influence on our health care system. The ministry knows that, and patients know that. It's not helpful not to work with them.

I heard Granger Avery, past president of the BCMA, tell the minister -- and he certainly told me -- that he is willing to work with the minister on the waiting-list issue. They have absolutely no access to data through the ministry -- none. So, again, these are the people who are managing the wait-lists, and I don't think we're doing a great job on wait-lists. Unless we start working together, we're not going to get there.

The question I asked the minister last time, before I sat down, was: if there is going to be this big media fight, is the ministry's plan to match dollar for dollar the media war that the doctors are going to start? And where is this money going to come from?

Hon. P. Priddy: Since we haven't even seen a media war -- just some stories about it -- I don't think I'm going to speculate on what the ministry will or won't do if that occurs.

I do want to correct some information, though, if I might. The number of procedures announced, at the time the $8.5 million was announced, was correct. What was incorrect was that there was no money in there for anaesthetists. There is indeed money in there to fund anaesthetists. The anaesthetists have refused to provide those surgeries because of another disagreement they have. We're negotiating with them and hope to have that sorted out quite soon. But there was money for anaesthetists budgeted in that $8.5 million.

S. Hawkins: I will be watching. Unless the ministry and the physicians sit down this summer and work something out, from what I understand and certainly from what the physicians have been telling the media, there is going to be an escalation in their media fight with the government. I want to tell you very clearly that I think it's wrongheaded for the ministry to be spouting the kind of rhetoric -- from the minister, from the Premier and certainly from members opposite -- that alienates this group. Like I said before, it is a group that does have quite a bit of influence -- certainly enough influence to get their members to take reduced activity days, which will affect patient care. It has already affected OR times and waiting lists, and it has impacted on hospital emergencies. I don't think that's in the best interests of patients, and I hope the minister agrees with me.

I will be watching to see what happens in the next few months. I certainly will be watching to see how the ministry responds, because in the past -- and I always look at past performance for future indications -- the ministry has been matching the ads. Frankly, I don't think that's a good use of health care dollars, and patients don't think so either.

At this time, I want to go back to regional budgets. I'll start with the Okanagan-Similkameen. I think the member for Okanagan-Penticton did touch on that a bit, and the member for Surrey-White Rock did speak to the minister about some of the budget shortfalls in the different regions. I understand that the Okanagan-Similkameen region has about a $2 million deficit. In order to meet that deficit. . . .

Actually, the CEO wrote a letter to the member for Okanagan-Penticton, which he shared with me. I know that

[ Page 10212 ]

I know -- and the minister knows -- that there are huge concerns about the impact on acute care. We've seen bed closures. At least, in my community we've seen huge bed closures at the Kelowna General Hospital. It's almost laughable hearing the last minister stand up and say that there have been no bed closures and that some of the summer closures are normal closures. But I can tell you that every year I've lived in Kelowna, there have been bed closures at our hospital. We've got fewer beds than we did five years ago. We're seeing that over and over again. We've got the longest wait-list in the province for long-term care. I know the ministry came through with 60 more funded beds, but there is still a huge need.

There was a story in our paper about two months ago, and the headline reads: "Cash Cure Needed -- Health Region Says It Needs Extra $7 Million." "The Okanagan-Similkameen health region needs a funding increase of $7 million this year if it is to maintain services at current levels. . . ." That's not very encouraging, either, because that tells me that in order for the region to balance their budget and provide services at current levels, they need to find savings somewhere. Hopefully, it won't be through patient care, but I'm afraid some of it is going to be patient care services. They need another $7 million just to maintain services. That is quite a concern, I guess. The chair of the board, Pendharkar, said: "Part of the problem is that hospitals have been forced to care for extra patients, because there are precious few beds available in long term care facilities." We've known that and have raised that issue in the last few years in this Legislature. Again, the ministry did come through with funding for long term care beds. But we know that this need is still there; we know it's a huge need. I wonder if the minister would comment.

[5:15]

When I talk about Kelowna General Hospital, I guess the other thing is that we have a new cancer centre there. Apparently there was a study done, and the cancer centre is going to impact a lot more on the hospital than was initially thought. Again, we are grateful for the cancer centre, because that means patients can be treated closer to home. But the cancer centre is going to draw a lot of resources from the hospital. I want to know what the minister's thoughts are on how this region in particular is managing with a $2 million deficit. They say they need $7 million more. We've got the longest long term care wait-list in the province -- I believe there are 200 on the list -- and a regional health board that tells us we're in a financial crisis.

The Chair: Member, would you like to repeat your question?

S. Hawkins: I want the minister to comment on the situation in this region, where they're facing a $2 million deficit. They're asking for $7 million more just to maintain services at the current level. We have a regional health board that tells us we're in a financial crisis, and I know that we're not the only regional health board in the province saying that. We've got the longest long term care waiting list in the province; I believe there are 200 people waiting. It impacts on our hospitals, on our nursing services in the community -- on a lot of patient care. I want the minister to comment on that situation.

Hon. P. Priddy: I am aware that this board has submitted, I think, a $2.2 million or $2.3 million projected deficit. The health authority budgets are only just in -- well, most of them are in; we still have a few to go. The ministry will go through those budgets, make an assessment about those budgets and work with people, wherever it might be possible, around some of the pressures they've identified. The $7 million may be a projection of what people need to do or feel they wish to do, but the projected deficit is $2.2 million or $2.3 million. When all of our budgets are reviewed, we'll work with the regions on whatever pressure points we're able to.

B. Barisoff: I've just a few questions along the same line as my colleague from Okanagan West. The funding for long term care services in the Okanagan-Similkameen region is at a crisis level. The demographics of the area show that the number of people aged 65 and over continues to grow. We're probably in the neighbourhood of 365 beds short. We're using acute-care beds at $585 a day. I'm just wondering what steps the minister is taking to address this major crisis in the Okanagan-Similkameen area.

Hon. P. Priddy: I expect, within the health authority budget, that they have identified, as many regions have, the need for long term care, continuing-care beds and multilevel-care beds in your region. That will be taken into account when the budget estimates from the health authority are reviewed, and where we are able to help with those pressures, we will do so.

I think there is a real struggle in the province; there's no question about this. It's a bit like education. People, both elderly people and people with young children, move into an area, and it's often not possible to keep up with capital expansion at the same rate as people can simply move from one place to the other. I don't think there's any question about the need for beds throughout the province, given the demographic shifts that there have recently been and that there will continue to be as we see an aging population.

The other piece of this, though, is that while there's no question that there's a need for long term care beds -- continuing-care -- there's also a need for us to look much more creatively at the kind of support that's offered to elders in the community, so that it doesn't immediately become an

[ Page 10213 ]

B. Barisoff: The Okanagan-Similkameen has the highest per capita group aged 65 and over, yet we have probably one of the lowest funding levels for long term care in the province. It's not a new problem; it's not something that just happened yesterday or overnight. This is an ongoing problem in the Okanagan. Seniors have been moving there for many years, and yet we still have the lowest level of funding for long term care. Along with my colleague from Okanagan West, I guess what I'd like to ask the minister is: how are we going to correct this obvious inequity in funding between what happens in the rest of British Columbia and what happens, in particular, in the Okanagan-Similkameen?

Hon. P. Priddy: I was just trying to confirm some information with my staff. I think the member is correct that he probably has one of the longest wait-lists in terms of long term care. I don't know about the formula in terms of why, given the number of people, that funding formula is so low. It's actually one of the arguments Surrey makes on a fairly regular basis.

There's a couple of things. I would not even propose to have an answer that says to you, "Well, we'll just catch up right away," because there are not the financial resources to do that. But I would say to the member that there is a continuing-care review going on that is taking into account parts of the province that may have a higher number of people in that category and have a lower population ratio to deal with it. I mean, it's looking at a whole variety of features of continuing care, but it will look at that as well. As a result of that, it may be that there are adjustments to formulas that need to be made in this particular area. As well, I want to reinforce for the member that I have heard his concerns, and when the budget is looked at, we will very carefully take into account the need for additional resources for that area.

B. Barisoff: There has been some discussion about the benefits of moving to population-based formulas, something along the lines of the school districts, which do consider the differences in rural areas. I just wonder whether the ministry has given this any thought. Is something like this is in the cards or being talked about, or is anything like that is actually happening?

Hon. P. Priddy: Yes, we have looked at this, and we continue to do so. There is a committee that did look at a different kind of methodology, a population-demographic base for the entire health budget, which is what the member is asking about. Yes, we continue to do work in that area. But in my own education experience, doing that did not significantly benefit the community I came from, even though we were quite certain that it would. So in doing that, I think we have to very carefully consider that if you are going to take. . . . If you have all of the money you wish to spend and can leave everybody where they currently are so that everybody gets the same amount as they do now but lots of people get more, that would probably work beautifully. But if you're going to take the existing dollars and do it on a population-demographic base, there are health authorities that will get less. That is not a particularly easy situation, either to deliver that message to a health authority or to be an MLA who's from that particular health authority. So there are a lot of challenges involved in doing that with the existing budget. But I still think it is the direction we need to move in, and my direction to my staff has been to continue that work.

B. Barisoff: I guess I agree with the minister and the fact that when you come from a growing area like the Okanagan, it definitely would be of benefit. Why we have the concern is that we have the lowest level of funding for long term care. Just so the minister knows, it is at a crisis situation right now. We are in the neighbourhood of 365 beds short. I think the ministry has allotted 65 beds in the last little while. I just wonder whether the last announcement for 60 new beds for long term care for the Okanagan-Similkameen. . . . Is that just operational dollars, or are there some capital dollars with that too?

Hon. P. Priddy: I'm sorry, hon. Chair. I was checking some information. Could the member repeat his question for me?

B. Barisoff: It's always good to get up and talk again about the crisis situation in the Okanagan in long term care facilities. The question I had was about the recent announcement about the 60 additional long term care beds in Okanagan-Similkameen. Was that just operational dollars that was given there, or was there some capital funding to go along with that? I'd just like to clarify that.

Hon. P. Priddy: There actually hasn't been any public announcement of the beds that the member refers to. I think there is an indication of the ministry's commitment to working with the health authority on the real challenges that they're having in that geographic area in the area of long term care, but there has been no particular announcement about it that I'm aware of or that my staff is aware of as yet. So I think the question is one that will be better answered after the budget process.

[5:30]

I've got just a couple of questions more, here, relating to the Okanagan-Similkameen district. One I got was from Dr. John Dimma from my area. It's addressed to whom it may concern. It has come to his attention that there is no 1-800 number for the B.C. Cancer Agency's centre in Kelowna. There is a 1-800 number for the one in Vancouver. He has patients complaining about the fact that there is no 1-800 number for the Kelowna cancer clinic. I was just wondering whether that's something that could be addressed -- whether it is happening or if there is one.

Hon. P. Priddy: That's not something I know anything about. But we will have staff check, and I will report back to you before estimates are over.

B. Barisoff: One other question that I got came from locals from my area. The Society of Obstetricians and Gynecologists of Canada, along with the Society of Rural Physicians and the College of Family Physicians have just recently published a position paper on the issue of rural maternity care. The report concludes that women who reside in rural communities should receive high-quality maternity care and that rural hospitals should, within a regionalized

[ Page 10214 ]

Hon. P. Priddy: We are aware of the report. We're in discussion with the B.C. reproductive care program at Women's Hospital. We'll be looking at the implications of that. It's a personal opinion, but I think the closer to home that a woman and her family are able to give birth, then the healthier it is for everybody. I don't want to see women having to go any further away than is necessary. The discussion that instigated the paper is that there have been some suggestions in other places that if hospitals do less than X number of births a year, then perhaps they should not be doing that. I take that report very seriously, because I take being able to give birth close to home very seriously. We will be continuing our discussions and looking at recommendations both with the reproductive care program and with the obstetricians.

B. Barisoff: I welcome those comments, because those are my sentiments exactly. The fact is that I feel very strongly that that should take place closer to home. Coming from a constituency that has two smaller hospitals that pride themselves in the services they give South Okanagan General and the Grand Forks hospital -- I would ask that the minister make sure that these kinds of things are always considered and that we are able to have maternities continue in these smaller hospitals. I guess my question to the minister is: would she give assurance to the constituents of Okanagan-Boundary that the maternity care in the two small hospitals will be maintained? I know that it's one of the things that is of the utmost importance to them.

Hon. P. Priddy: As I said earlier, I think that wherever possible, the closer to home a woman and her family are able to give birth, the better. The only piece that was part of both the discussion paper and part of what has elicited this is: as long as that is safe care. I know that the member would agree with me about that.

B. Barisoff: This will be my last comment. Yes, I do agree wholeheartedly with the fact that it must be safe care. I do know that for years and years both of those hospitals have given very competent and safe care to maternity patients. I guess that I just wouldn't want to see us, in a funding crunch or whatever else, start to funnel patients into the bigger hospitals and lose the kind of uniqueness that we have in the small rural communities. I thank the minister for her answers.

S. Hawkins: I'll be continuing with issues in the Okanagan-Similkameen. That health region was the only one that didn't have abortion services, which is a core provincial service. The health board has now made a decision that. . . . Well, I think they always, hopefully, were of the mind that they would provide this service somewhere in the region, and they've made a decision that it's going to be at the Kelowna General Hospital. Given the fact that there were bomb threats and threatening letters sent to providers of that service, I'm wondering what kinds of measures the ministry is taking to work with this region to make sure that patients are safe, that health care workers are safe and that the service providers will be safe in the facility that's going to be undertaking this service.

Hon. P. Priddy: The questions that the member raises around safety are extremely important, particularly in the climate that we currently see in this province and in some of the incidents we've seen of threatening of health care providers. I called the chair of the board the day after the board took the decision and I said that I supported their taking that position and also realized it was a difficult decision in a difficult climate. So I acknowledged that.

We've been working extensively with the hospital there, primarily with the B.C. Women's Hospital and Everywoman's Health Centre, as well, who have extensive experience around the issues of security risks -- security risks to patients, to health care providers and to the person providing the service. There has been a lot of work done in person between the Women's Hospital and the hospital in Kelowna -- at least, that was indicated to me by the CEO at the hospital when I spoke with him. We are also prepared, as we have in Vernon and other places, to have people who have had the experience actually go into the community and work with the staff. They often feel better hearing from staff who've been put in that position, as opposed to reading a paper or having somebody say to you: "This is what you should do." To actually be able to talk with staff who themselves have faced those risks about how they've dealt with that provides a much more. . . . I don't know if it's reassuring or not, hon. Chair, but at least it's more empirical information, if you will, for people.

We are prepared to send staff in -- send others in, not our own staff; it would be people who do the work every day -- to do that kind of training. We will do whatever is necessary to ensure that women are not threatened and that health care providers are not threatened and are not at risk. I will be quite honest, though: in this province, we know that sometimes people are.

S. Hawkins: Yes, certainly in the area I represent, there's a lot of cause for concern, given the kind of events that have happened in the past. Part of the reason, I understand, that the health board didn't provide that service before was that there was no funding for it. I'm wondering: given the fact that the region says that they are in a deficit situation, where is this funding coming from, and when is it going to come through?

Hon. P. Priddy: Two things, hon. Chair. When core services were identified and money was transferred to the regions, that was identified as a core service. We have assured the folks in Kelowna that the resources will be available for them.

S. Hawkins: It's not clear to me. Is the minister telling me that it has to come out of the existing budget, then, because it was transferred as a core service?

Hon. P. Priddy: Typically, that is what I would say, but in this case, we have assured Kelowna that there will be additional resources.

S. Hawkins: Does the minister have any idea how much funding that's going to require?

Hon. P. Priddy: I did know, actually, because I'd had several discussions with people up there. I don't have it off the top of my head, but I'll get it for the member either tonight or in the morning.

S. Hawkins: Thank you. I recall that Vancouver Hospital asked for bubble-zone protection, and I think they were one of the first hospital facilities in the province to ask for that. Is that something the ministry is considering under the legislation? Have they received that?

[ Page 10215 ]

Yes, that is an item of consideration. With bubble-zone legislation, as you may know, you have to be able to demonstrate that indeed there are concerns, so you can't just put a bubble zone around some place because you think that there might be. With Vancouver Hospital there certainly have been some ongoing incidents, and my understanding is that that is under consideration by the Attorney General ministry.

S. Hawkins: Some of the other regions have also indicated concerns, and one of them is the Central Cariboo-Chilcotin health council. As early as a month ago they had sought a meeting with the minister to discuss their budget. I think I heard the minister saying that for the regions that were in deficit positions, the ministry was meeting with them to go over their shortfalls and how they were going to address them. Can the minister tell me if this region has had a meeting with the minister and what has been done to address their concerns?

Hon. P. Priddy: A couple of things. . . . I want to be sure that I was not unclear earlier. What happens is that when all the budgets are in -- as just about all of them are, except for a few -- the ministry goes over the budgets with everybody, not just with people who have submitted deficit budgets. They go over everybody's budgets with them. Obviously for those people who have deficit budgets, we try to work on pressure points, and we try to ensure with those people who don't have deficits that they haven't missed some piece that might lead them to difficulties. Those meetings will not happen until all of the budgets are in and have been assessed by the ministry.

As yet I have not met with the Central Cariboo-Chilcotin health council, although I've met with a number of health councils. The MLA from the Cariboo-Chilcotin area is a vigorous lobbyist on behalf of his constituency, and undoubtedly I will be seeing him very soon.

S. Hawkins: I guess I'm concerned. It's already into the second quarter of the budget, and I wonder why the budgets are late getting in. Why are the regional authorities submitting their budgets so late, when we're already into the operating year?

Hon. P. Priddy: I think that in the future we will see budgets come in earlier. This is the first year that the health authorities have done their budgets in this way, with all of the services integrated. I think it's simply taking people longer, because it's the first time. I expect that in the future it will be much earlier.

S. Hawkins: I will wait to hear what the ministry has done to address the regions that have deficits. Did I hear earlier that there were only five regions that were concerned about deficits? Is that what I heard?

Hon. P. Priddy: I think those are numbers I used when I said that in 1997-98 there were only five out of the 52 health authorities that had. . . . Actually, I didn't say five, because we didn't know. I think it was the member from White Rock who was asking and who said: " Tell me the top five." I think that what I said at the time was that out of the 52 health authorities, the vast majority of them submitted balanced or surplus budgets in 1997-98. Then I think the member from White Rock said: " Can you tell us the top five?" So that was not my number.

S. Hawkins: Thank you, because I think I've counted more than five, in the letters that I have received, where there have been crunches in funding. The Central Vancouver Island health region has a deficit of about $1.5 million. They are in dire straits. I understand that the North Coast community health council, in its attempt to submit a balanced budget for this year. . . . The hospital announced that it will cancel all elective surgeries for ten Fridays. This is in addition to the 24 RAD days that the doctors are planning, and certainly with all the long waiting lists. . . .

My question to the minister is: what is the ministry doing to address those kinds of concerns, when one way to balance the budget is to provide less patient services? Certainly in the area of wait-lists I don't think that's a reasonable thing to do to patients.

[5:45]

Whenever anybody is asked to submit a. . . . We do ask regions or health authorities to submit balanced budgets. We do ask them what they would have to do, what actions or steps they would have to take, in order to do that, and we expect them to do so. But I also said that when the budgets come in, assessments are done of where the pressure points are. Wherever we can, we help out with those pressure points. I think we've heard some examples -- from opposition MLAs, actually -- of where we've been able to do that in their areas over the last year or two. The fact that someone has submitted a balanced budget and has said: "In order to achieve this, we will have to do those ten things. . . ." It may be that they have to do those ten things. It may be that they only have to do five of them, or it may be that they don't have to do any of them. It will be based upon the assessment of those budgets when all of them are submitted and assessed by ministry staff.

S. Hawkins: I can tell you that in the last few years the budget shortfalls and deficits have certainly resulted in fewer patient services and longer wait-lists, and the ministry is going to have to deal with that. We can pass this responsibility onto the health authorities, but I think they're getting the message too. They're beginning to realize what they have responsibility for, and certainly they're not very happy about the positions they're put in with carrying a deficit of $1.5 million or $2 million. We heard that Surrey Memorial Hospital has a $5.8 million deficit. Frankly, to balance the budgets, they're having to cut services. I don't think that's right.

I'm just going to address an issue of the Comox-Strathcona regional hospital district, because I promised to bring it up. I know that the minister is advised of this. They are not happy with the funding formula and the funding method used to fund health care services. They don't feel it's equitable, and they passed a resolution at their April 29, 1998, meeting:

"Whereas the funding method used to fund health care services is not equitable, and whereas services, facilities and equipment cannot meet the needs of our patients due to inadequate staffing levels, therefore be it resolved that the auditor general complete a full review of funding formulas the Ministry of Health currently uses in the allocation of our health care dollars, and further that this letter be sent to the Union of British Columbia Municipalities and all regional districts in British Columbia, requesting their support on this resolution."

[ Page 10216 ]

Hon. P. Priddy: I believe it's the regional health district that the member is referring to. I am aware of the resolution. Unless I've misunderstood the question, let me go back to my earlier comments on population-based funding. I have not yet talked to a health authority that doesn't say to me: "Please do population-based funding. We'll be better off." Well, not every health authority will be, although we all think we'll be. I said it from Surrey long enough that it's part of my mantra, but in point of fact, when you look at population-based funding, there are many, many health authorities that are not better off as a result of population-based or population-and-demographic-based funding. I still think it is the way to go, so I still have my staff working on the formula, but I think we have to be able to find a way that it does not disadvantage other health authorities.

S. Hawkins: It's the same with the Simon Fraser health region. They're posting a $3.9 million deficit. It's interesting. They said that even if the region were to receive an $11.6 million boost from the government, the budget would not cover new programming or significant program expansion. Obviously they've identified the needs in their area. They also cite pressures in hospital funding, health care facilities, acute care, continuing care, mental health programs and public health programs.

I had a question from the North Peace health council. For the second year in a row, they are going to submit a budget deficit of more than $218,000. Their wait for eye surgery already exceeds a year. They have 80 patients waiting for long term care. It's interesting. Where does the minister think the cuts should come from to balance these budgets?

The Chair: Noting the hour, minister.

Hon. P. Priddy: As I've said, I think every region has things that they want to do and new programs they want to do, and I must admit, I would very much like for them to be able to do them. The health budget is a third of the provincial budget, and I don't think we are in a position where we have another billion dollars to put in the system -- as much as we all might like to be able to -- for all of the new programs that we know would benefit people.

Over the last few years, if you look at all of the health authorities and areas, the system overall has operated at a surplus. There are regions that, for a variety of reasons, have additional challenges because of population growth, and those are the ones that we will work with before we see any budget cuts happen. That will happen during the assessment and looking at where the pressure points are.

Seeing the time, I move that the committee rise, report progress and ask leave to sit again.

Motion approved.

The House resumed; the Speaker in the chair.

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

Hon. P. Priddy: I move that the House at its rising stand recessed until 6:35 p.m. and thereafter sit until adjournment.

Motion approved.

The House recessed from 5:55 p.m. to 6:37 p.m.

[The Speaker in the chair.]

Hon. P. Priddy: I call Committee of Supply.

The House in Committee of Supply; E. Walsh in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS
(continued)

S. Hawkins: Before the break, we were talking about the budget crunches that the regions and certainly some of the hospitals around the province are under, and I'll bring to the minister's attention just a few others that are of concern. I hear from the folks up in Terrace a lot. They're certainly in a budget crunch and have found it difficult indeed to have their health needs met. First, I'm concerned about Mills Memorial Hospital there. I understand they are facing some real challenges, and I'm wondering if the minister has met representatives of Mills Memorial and what the ministry is doing to help them out.

Hon. P. Priddy: I am aware of the situation at Mills Memorial, and our staff has actually been working very closely with them. We have sent a support team of staff to work with their staff, and I have had a conference call with people there, including the mayor. Again, we'll be looking at their situation when the budget comes in.

S. Hawkins: The hospital, and certainly the region, is in need of better psychiatric care, as well, they say. They need to provide more and to do a better job. At the hospital in particular, their ICU services a regional area, and so they feel they provide a regional service, but that's not recognized by the province. I'm wondering if the minister has addressed that concern with Mills Memorial.

Hon. P. Priddy: I've had the discussion with people up there about the fact that they see themselves used as a regional support facility and feel they are not funded for that, although they are funded for all the services that they do provide. That is part of the ongoing discussion and part of what my staff team is working with them on. I don't see this necessarily as part of the budget assessment, but we're also looking at whether we can do more joint work in planning within that whole region in order to allocate some of those resources better or to enable other places to provide the service. I actually see that as being sorted out in a different way.

S. Hawkins: The minister knows I'm particularly concerned about hospitals in that region, because it is northern and rural health care that's concerned. I guess I get very concerned when I read stories that Mills Memorial Hospital cancelled elective surgery for a week and turned off its CT scanner for two weeks in an emergency effort to save money. They expected to save about $30,000 by doing that. But the minister must agree that when they turn that off and cancel elective surgeries, it's patients that pay. Certainly waiting lists -- again, getting back on that issue -- are longest in the north and rural areas, especially in that region, and patients there

[ Page 10217 ]

Hon. P. Priddy: I think that closing services like that for reasons that are not deemed necessary. . . . The ministry might perhaps have a different opinion than is held locally. The understanding I have from staff is that that occurred, in part, because the physician was absent on holidays.

S. Hawkins: Is the minister asking me if the physician was absent and if that's why they cancelled elective surgery?

Hon. P. Priddy: No, I wasn't asking the question; I was saying that that was the information, in part, that I have from staff: that it was due to a physician being on holidays.

S. Hawkins: That certainly is not the information I had at the time, and it's certainly not the information that's reported in the story in their paper. The story in their paper specifically said that the measures were announced last week, after the hospital's financial health took a sudden turn for the worse, and in order to improve the hospital's financial health, they had to cancel elective surgery and turn the CT scanner off. They said that cancelling a week of elective surgery, in this case during the week of the spring break, is identical to what the hospital already does at Christmas. They had to reduce their activity in order to meet the budget crunch. That is the information I have.

[6:45]

Hon. P. Priddy: In regards to Kitimat, I think there are a couple of issues. One of them is that the region has been looking at whether there are services currently provided in Kitimat that can be provided in Terrace. I know that they have had some challenges around ensuring that they have enough. . . . I'm more aware of the psychiatrist part. My regional staff team has been working -- on an extremely close basis, both with the MLA and with the hospital -- on how you provide enough work to be able to retain the physicians but do that in a cost-effective way. Those conversations with Kitimat are ongoing as well.

S. Hawkins: I have another story regarding Mills Memorial. The acting health council chair -- Peggy Julseth is, I think, the name -- said the operating room closure and the two-week CT scanner shutdown will help the hospital meet its year-end budget target. So that was the information I had.

There seems to be quite a disparity in the funding in the areas, between Terrace, Prince Rupert, Kitimat and greater Trail. I tend to get correspondence at any given time from the different areas, quite concerned that they are not getting the funding they deserve. Again, Mills Memorial feels like they provide a regional service but aren't funded for that service. They serve a population of 31,517 -- that's their 1998 population -- and they have a budget of about $11.2 million. They compare themselves, I guess, with Prince Rupert, which has a population of about 10,000 or 11,000 fewer and has relatively the same budget -- $11.1 million.

I am wondering if the minister can tell us how the two are funded and what kind of services are different from what they are providing. The only thing I can see that is quite different. . . . Both have an ICU. Mills Memorial has some psychiatry. They both have med-surg. The only thing different, I believe, is that Prince Rupert has a CCU as well. But the populations are. . . . The Prince Rupert population definitely is about 10,000 or 11,000 fewer, with almost the same budget. So how are those decisions made?

Hon. P. Priddy: There are two things. One of them, as we've spoken of earlier, is that the increments over the last five years in terms of funding between the two would have been funded on the basis of need, if you will, or population and demographics, which may have been different.

I think that the challenge here -- we've had this discussion, and perhaps we'll have it again, around funding formulas -- is that the base that people began with five years ago, when the incremental was done on population demographics. . . . The bases were probably different at the time, which means that they haven't kept pace at the same rate. I think that -- and I'm sure we'll discuss it at another time -- is the question around whether you redistribute based totally on population demographics.

S. Hawkins: If the minister recognizes that problem, that issue, then how is the ministry working to correct that disparity?

Hon. P. Priddy: One of the things we continue to look at, as I said earlier, was whether we should actually take the available dollars and distribute them solely on the basis of population demographics. I don't know, by the way, what that would mean either to Prince Rupert or to Mills Memorial; I don't have the list in front of me. But I don't know, without looking, whether indeed that would actually make the difference that the health authority would need in terms of Mills Memorial. We will continue to look at that, because it is still my view that that is probably the most equitable way to do that.

S. Hawkins: Does the ministry actually have. . . ? Are there efforts being made, is there planning being done, to work on that disparity, or is it something that's just come up and the ministry is just starting to look at it?

Hon. P. Priddy: The funding methodology committee, which I think has been struggling with this for about a year now, will be making some recommendations to me quite soon about the next steps we could take on this to try and begin to reduce the disparity, without going to a particular health

[ Page 10218 ]

The other thing that makes a difference in a small way, is that you can begin to make up some of the disparity where there is an acknowledged one. The money that is not included in the normal lift -- the money around critical care beds, mostly tertiary services -- is in addition to what the health authority actually gets for their budget. So as that is allocated around the province, that reduces some disparity.

S. Hawkins: I also would like to point out that there are concerns about cuts to Penticton Regional Hospital. I know that the member for Okanagan-Penticton raised that. The nurses were quite concerned as well. I think there were some concerns that were quite publicly made. I wonder if the minister has sat down with anyone at that hospital to see, again, how the cuts are made. Or is this part of the budget process, where the regions will be dealing with the minister once their budgets are all in?

Hon. P. Priddy: I personally have not sat down with the hospital, but my ministry staff certainly is in contact with the hospital. I think it's important from a ministry perspective to look at the fact that we're funding health authorities; we're not funding. . . . I mean, we give the health authorities dollars to fund individual facilities. While I have talked with people from some hospitals, I certainly haven't from Penticton. But the health authority up there did receive a $2.5 million lift this year -- almost $2.6 million -- which was part of our $228 million increase to the health care budget. So in point of fact, it has, as each year, received an increase.

S. Hawkins: The minister knows that the increase goes to things like inflation, wage increases and that stuff too. I understand that the ministry used to have a policy -- the minister can tell me if that's still in place -- that in striking a balanced budget, services weren't to be compromised. It seems to me that in trying to strike that balanced budget, more and more hospitals and regions are cutting services. Can the minister tell me if that is still a policy the ministry has?

Hon. P. Priddy: Two things, I guess, and one of them is that it indeed is the case. But unless the health authority could demonstrate that they were providing the services in a different kind of way -- for instance, providing out-patient psychiatric support that meets the patients' needs, as opposed to, you know, two or three additional psychiatric beds. . . . While I recognize that in general much of the budget in any system goes to salaries, benefits and so on, I would remind the House that health care workers -- at least so far, certainly in the acute-care sector -- have settled for zero, zero and 2 percent. So I don't see a great deal of the budgets being eaten up by a zero percent increase.

S. Hawkins: Well, maybe we should get into the history of the health labour accord, if the minister wants to get into that, and we'll see how much of that ate up the health care budgets. The reason we can't afford health care today is because of the mistakes the NDP made in the last five years on the health labour accord and the renewal just before the election. So I can tell the minister that a lot of the regions I hear from certainly credit the NDP for the rising cost attributed to the health labour accord and for the fact that today we're sitting in the kind of crunch we're sitting in.

Now I'm moving on to Nanaimo Regional General Hospital, because they have to find $1.5 million in savings to balance their budget. This is an article from last month, June 19, 1998: ". . .the hospital's chief operating officer said the decision this week to close two operating rooms and 11 overflow beds for two weeks will result in about $78,000 in savings. It's not known where the other $1.4 million will be found." This hospital makes a point of saying that while some B.C. hospitals temporarily close their operating rooms in the summer to accommodate holidays, staff vacation time and the like, it's not been normal practice for Nanaimo Regional General Hospital. " 'Obviously we are given orders to balance the budget. No one wants to reduce services,' " the chief operating officer is quoted as saying. "The temporary closures," it says, "will have an impact on the hospital's 2,700-name-long waiting list for surgery. About 140 procedures that could have been performed in that time frame won't be completed. It will increase the waiting time for surgery for another two to three weeks."

That's what I'm asking the minister. Last year it was reported that this hospital had a waiting list of around 2,000; today that number has jumped to 2,700. In order to balance their budget now, they're saying they have to close operating rooms and cancel surgery again. This is going to add another two to three weeks to an already long wait-list for surgery. You know, I wonder if the minister is aware that they're doing this to balance the budget and if she's supportive of operating rooms closing and of extending the wait-list in this case.

[7:00]

The wait-list data is difficult to get from Central Vancouver Island; it doesn't seem to have a central storage for data. I think their data is from the physicians' waiting lists, so we don't actually have a double confirmation of that from the region. But I don't think there's any question that Nanaimo is in the same position as Similkameen and some other areas, where we've seen rapid growth in the last few years. We're doing what we can -- which is why there was that large amount of cash last year -- to do as much catch-up as we can as quickly as we can, within a balanced budget.

S. Hawkins: Yes, I do remember the hospital getting a lift; it was after a review that was done. I don't know if their baseline funding ever moved, but I know they had been getting a lift almost every year for the last four years, and then there was a review done. This hospital has been reviewed eight times. I'm wondering if the ministry and the minister are not concerned, after eight reviews, why there are still thousands of patients stuck on the long wait-list for surgery and why the hospital is now in a budget crunch again, looking to cut $1.5 million of its budget in the funding crunch they're facing.

Hon. P. Priddy: I did just check the number, although the member has certainly spoken of it as well. The adjustment for Nanaimo Regional General Hospital last year was $4.1 million. It did indeed go into their base. At the time, which wasn't all that long ago, the hospital indicated that they would be quite solvent with that, and they did not predict that that would create any problems for them in the future. They felt that they could deal well within that amount.

[ Page 10219 ]

Hon. P. Priddy: I'm seeking some direction, or at least some information, from staff behind me. Sorry for the delay.

The regional team -- because we have regional teams in a number of parts of the province -- is working with that health authority around any issues raised in the review, including support to the administrative team. When the $4.1 million went in, we also put in a CT scanner -- and my understanding is that the wait-list for that is almost nothing at this stage -- and a new ambulatory care unit. As a result of that, they've been able to do about 2,000 more surgical procedures. We also have a letter from the board saying that with those dollars they would be able to meet all of the needs of people in their community.

S. Hawkins: Well, what they say and what actually happens are two different things now, aren't they? They may have given you a letter before, but what they're saying now is that they're cutting. Given the fact that the regional authority budgets are just coming into the ministry for review and they are having to balance their budgets and are already proceeding with cuts to services, what direction is the minister going to give the health authorities and the hospitals right now with respect to cutting patient services?

Hon. P. Priddy: Two things. One of them is that we have told all health authorities that there is to be no reduction in patient services -- certainly until their budgets have been assessed. There would be no reason for anybody to be taking any action at this stage. That's the direction from myself and from senior staff in the ministry.

Secondly, I think if a health authority sees a certain amount as being able to meet all of their needs and nine or ten months later they're in a deficit position again, then I expect that the health authority, the Health ministry and the regional team need to have a hard look at why this has occurred. Are there ways that those dollars can be used better, more efficiently and more efficaciously? As I say, the indication less than a year ago was that this would meet the community's needs. If, nine months later, people are saying that they are in a deficit position, I need to know, as Health minister, what has changed in that community or what was wrong with the original projection made by the health authority.

S. Hawkins: There's the million-dollar question. As the minister knows, this isn't the only region that's facing a deficit. There are at least five or six I've counted that are facing a deficit. With respect to her comments, they needn't proceed with the cuts until the budgets have been reviewed by the ministry. This hospital closed down their operating rooms for 12 working days starting June 27, so that has happened already. That's happened, as far as we know, and that's affected patient care and waiting lists. That's why I'm asking the minister what direction she is giving to the health authorities with respect to cuts to patient care because of the budget crunch and having to balance their budgets.

Hon. P. Priddy: That is indeed the instruction we have given to health authorities. I'm not sure about this particular instance. Do I understand the member to say that Nanaimo has never done summer shutdowns before?

Interjection.

Hon. P. Priddy: Okay. I will have my staff do a double-check on that. It is fairly common practice in almost every hospital that exists in the province that they do summer shutdowns. I need to have my staff investigate whether they've instituted a regular summer shutdown or whether indeed they are doing this in response to their budget. I will have my staff investigate that and report back to the House.

S. Hawkins: I appreciate the minister getting us that information.

With respect to summer shutdowns, I want to know what the minister thinks of summer shutdowns and Christmas closures. Waiting lists are getting longer, and I understand that part of it is to accommodate vacation time not only for nurses and OR staff and physicians but for everyone else and their vacation hours. Because waiting lists are getting so long and because OR time is so scarce, I know that many, many hospitals are saying that if they had the money, they would run over the summer.

When I was a head nurse, I know I used to pay a lot of overtime in the summer. I don't know if it really paid, because at the end of the day, summertime was a time when we had all our major head injuries and accidents and what have you. We'd have to bring in staff on overtime and open extra beds to accommodate the tourists and everyone else that were coming through. I don't know if there's a huge savings there. I am sure there is enough, because the hospitals still do that.

At a time when waiting lists are long and when physicians and staff are willing to work those summer hours to accommodate some of the treatments, I'm wondering what the minister's view is on the reduced activity days that hospitals take.

Hon. P. Priddy: When you have long wait times for some kinds of surgery, I guess you want to get the best use out of the ORs that you can. One of the challenges we find ourselves in is that hospital budgets, perhaps with the exception of Nanaimo, have historically been based on both Christmas shutdowns and summer shutdowns. If all hospitals were to stay open over Christmas break and summer break, I don't know if we could meet the economic need that quickly.

I would suggest that even if hospitals were able to do that, there are probably a couple of other factors at play. I know that the member knows this, and so do people in the House who have young children, but for some people, that is the only time they can take holidays. For nurses, for health care staff, for physicians with young families, summer is the time that they want to be off. And yes, they'd like to be off at Christmas or whatever their special holiday is as well. So I think that part of this does meet the needs of people who need to have summer holidays because of their particular life circumstances, and I think we ought to accommodate that. If there are people who are prepared to work -- for instance, over the complete Christmas break -- we couldn't do that for every hospital, but I would be interested to hear from people who might have that solution.

S. Hawkins: I know that when we're scheduling vacation in the summer, everybody can't get away, and so not every-

[ Page 10220 ]

Hon. P. Priddy: I think what we see with reduced activity days is, if you will, a reduction in services. When you look at how hospitals organize or reorganize their time, we have hospitals that may be closed over a summer break -- not over a summer, but for a week or whatever in the summer -- or at Christmas. We also have hospitals that every year allocate their time so that they are doing more and more service; they are not reducing service. RAD days reduce service. Hospitals reorganize their time so that they indeed are doing more services each year.

[7:15]

So again, I pose the question to the minister, because I find it an interesting analogy that's been posed. The hospitals have an allowable amount, an available amount, that they can spend, and they do their summer closures and have their reduced activity days in the summer and at Christmas to save money. The doctors have an available amount that the ministry says they will pay for services. Does the minister say that these should be infinite services that are provided within this available amount? Or can the minister tell me, again, what is the difference between a reduced activity day that the doctors are talking and a reduced activity day that a hospital takes to stay within their available amount?

Hon. P. Priddy: A couple of things. One of the differences is that physicians have -- albeit they are currently dissatisfied with it -- a contract with the government to comanage services. Do I think people should provide infinite services for free? No, I don't. But as part of that contract, there is an agreement to prorate services after people have. . . . If people cannot comanage within that budget or the allowable amount, then there is a proration beyond that. That was agreed to by both parties.

In some ways, I think the physicians' RAD days are different, because they are doing this outside of a contract that they have agreed, with the ministry, to go forward with. A physician's RAD day, reduced activity day, is one where the physician has chosen not to work on that day. Hospitals are providing more and more and more surgeries every year -- almost 12,000 more surgeries in the last three to four years. That shows that indeed hospitals are performing more procedures. A hospital's closure is about organizing their time differently, not about simply not working on that day.

S. Hawkins: Does the doctors' contract with the ministry state that the doctors have to work seven days a week?

Hon. P. Priddy: No, it does not.

S. Hawkins: So the minister agrees that the doctors can work whatever hours they want, for whatever they bill and for whatever services they provide.

Hon. P. Priddy: Any individual physician is able to work any hours that she or he chooses to do, as long as they do not withdraw services from their patients. They can choose their work hours. As they state, they are independent business people and therefore can choose the hours they work. But given that there is an agreement on the part of the provincial organization with the government, the spirit and content of that is such that there is a commitment -- a moral commitment and other kinds of commitments -- to ensure that patients in this province do not have services withdrawn from them.

S. Hawkins: The minister knows as well as I do that when doctors do take the day off, it's not really a day off. They're still on-call, some of them, for their patients. There certainly are arrangements made through emergency departments and other places. It's not a total abandonment of the system -- the way I understand it, anyway. I'm also interested, because the doctors see this as keeping within an available amount. They are not bound by hours, and I would suggest to the minister that with the contract they signed -- crazy as it is; I don't know what advice they got when they signed the proration agreement -- the more services they provide, the more they're prorated. They're actually penalized, if you will; they're clawed back if they work longer hours. The way I understand it, the more services they provide and the more they go over budget, the more they're clawed back. Again, I heard the minister say that she didn't think they could or should provide an infinite amount of service. Given the fact that they do have an amount they can bill and they're still looking after patients -- I know a lot of them are -- on the days that they have reduced their activity. . . . Actually, the days when they reduce their activity, they are in their offices catching up on paperwork and doing other kinds of stuff. I can tell you that in my experience, at least in the community that I represent, I know that they're still active in the hospital and in their offices.

It's interesting, too -- and perhaps the minister is aware of this -- that the hospitals are working with the doctors. They want advance notice of the reduced activity days so they can tie into those and save even more money. Is the minister aware of that?

Hon. P. Priddy: Yes.

S. Hawkins: What does the minister think of the hospitals asking the doctors to give them advance notice so that they can shut down and save even more money?

Hon. P. Priddy: As long as we're dealing with RAD days -- and I certainly would prefer not to be. . . . I don't mean in terms of the discussion; I mean in terms of their occurrence. It would seem somewhat foolish for a hospital to have all of

[ Page 10221 ]

S. Hawkins: I totally agree. Actually, I think that for a lot of the hospitals, it's almost a blessing in disguise. They are already in deficit positions, and when they see the RAD days coming, it's a chance for them to reduce staff -- to shut down the OR and save money as well. We've created a real dilemma here. As I was saying earlier, I hope that the ministry and the BCMA -- the two sides -- really make an effort, sit down and work this out. I can tell you that it's not to the benefit of patients. I think that in the next year we'll certainly see some of the results of that.

I have an interesting letter, if I can share parts of it with you. The lady who wrote the letter is a patient at the Royal Inland Hospital. It went to the minister's office as well. It was forwarded to me by the member for Kamloops-North Thompson. She had the unfortunate experience of losing a baby the day after the baby was born. The mom had eclampsia, and the baby was birthed by C-section and subsequently passed away. She sat down and wrote a four-page letter to the member for Kamloops-North Thompson. It's quite a striking letter.

She feels that she saw some very real deterioration in the health care system at that hospital. She says that she saw understaffing. She says: "Nurses, doctors and health care workers are having their caseloads maximized. . .too many patients and too little health care personnel." She felt that because of the crunch in beds, there was very little privacy. For a mom who had just lost a baby, she felt that she was put in a very busy ward. She had to room with another mom and a new baby and was surrounded by that mother's family and friends. She said that she therefore had no provision for privacy for grieving, as well as for her medical condition. She felt that compassion and consideration were being stripped from health care as well.

She talks about the options for moving. They were able, they said, to move her somewhere else. She said she was sent from the maternity ward to the geriatric ward. She roomed in with an elderly patient who, she said, had coughing fits and was defecating in the bed, and had an elderly man placed in front of her room for a long duration -- again, no time for privacy, no time for grieving or rest. She really felt that the services were lacking, and she said that if it weren't for her husband, who spent a lot of time at her bedside, she would have been left alone, for the most part, to care for herself. So she sees a real issue of understaffing, the way our hospitals are being run now, with the kinds of pressures and challenges that are posed to hospitals.

She said that she also witnessed small things -- I don't know if they're that small -- like equipment malfunction. She said that a nurse had to go get three blood pressure monitors before she could get one that worked, that could take her blood pressure. Again, the minister knows what eclampsia is. This is a mom that had eclampsia through pregnancy. Little things like blankets. . . . She said that all the blankets had holes in them; she asked for another blanket to stay warm, and that one had a hole in it too.

These aren't unusual letters. I get several of these a year. I think it takes a bit for a patient to sit down and write a letter like that and say how concerned they are with the kinds of conditions and experiences they had in the hospital. I think a lot of them are so glad to get home that they just don't take the time to write. I know that a lot of them appreciate the staff that look after them, and they don't really want to complain. But I get maybe half a dozen or eight or ten that are very serious, like this one, and I get very concerned. I wonder if the minister has any comments about that.

Hon. P. Priddy: I do recall the letter, actually, that the member refers to. I think there are two things. One of them is that I would agree that this is a mom who should have been able to have a place where she could grieve. Ideally, she should certainly not have been placed in a room with a mom with a new baby that was perfectly healthy. I think that's very difficult. I mean, it's hard enough to cope with this kind of tragedy, but to be placed with someone who has a new baby and whose new baby is okay is incredibly difficult. That is hardly coming even close to an ideal placement for a mom in that situation. I would certainly agree that there should have been a placement -- even in a surgical unit, maybe -- that would have provided some more privacy for this mother, who should not have been placed with other brand-new, excited moms. So I would not argue with its being inappropriate placement at all.

[7:30]

S. Hawkins: I would hope that most patients would have an acceptable experience. But I know that in the last year and a half when I've toured the province -- I've toured probably the majority of the major hospitals, anyway, in the province -- I've started to see the results of what some of the funding challenges and cutbacks have done. I'm very concerned, because. . . . Again, in this letter -- and I didn't read all of it -- the mother was worried about cleanliness. I know through some of the hospitals that they do have that challenge of keeping things fairly clean. I expect a hospital to be a very clean place, so it makes me a little nervous when I find they have trouble meeting that end of their commitment.

Frankly, the more hospitals I go to -- and I think we'll get into some of the bed issues as well. . . . I think we're seeing a real crunch in beds, and certainly at the Royal Inland Hospital. I toured that hospital and was there again last summer, or maybe it was just a few months ago. I know that they're having trouble providing beds in maternity and general wards. Gosh, we were just talking about Nanaimo Regional General Hospital, and the day I was there -- I think I was accused by the former Minister of Health of doing a secret tour; it was not secret at all -- there were patients who had been lying on stretchers in the cast room for three days and patients that had been sleeping in emergency. These are ill people, and we have no place to put them. Frankly, I would hope that most patients' experience in hospital would be pleasant, but we are hearing more and more often that there are patients who are not having that pleasant experience -- if you can call a stay in a hospital pleasant.

I was also wanting to ask about the Campbell River and District Hospital. Somebody sent me a concern about under-

[ Page 10222 ]

Hon. P. Priddy: Perhaps we could get more information from the member outside the House, because MSP doesn't actually fund hospitals. So I'm not clearly understanding how that could be the case. What MSP does is respond to billings for diagnostic services. We don't fund hospital services, and therefore we don't cut hospital services.

S. Hawkins: I will get that and pass it on to the minister. Apparently it's to do with paying for diagnostics. I think the hospital was cut back $100,000. I will put that aside and get that for you.

One more thing is to do with the capital health region. The CEO of the region, Ken Fyke, was picked as the new boss of the blood agency. Around the time he was appointed, there was discussion on whether he was going to be replaced with a full-time person or whether he was going to keep the job at the blood agency and work half-time with the region. Can the minister update us on what happened there?

Hon. P. Priddy: At the time Mr. Fyke was appointed to the Canadian Blood Agency, I was assured by the capital health region, which agreed to this, that there would be no additional administrative cost whatsoever to this arrangement. We have been monitoring this, and so far that has turned out to be the case.

S. Hawkins: I understand that there would be no additional cost. Is there job-sharing going on, then? Is there a half-time administrator, with Mr. Fyke still doing the job half-time?

Hon. P. Priddy: My understanding currently is that Mr. Fyke has, for the most part, been able to carry out his responsibilities on about a half-time basis, if not more. He has been supported by quite a strong executive team. He will be leaving full-time September 1 on a paid secondment, and the health region has not made a decision to date about how or if he will be replaced.

S. Hawkins: Is the minister actually saying that the region has saved money? Apparently the blood agency was paying for about 60 percent of his salary, the region was going to pay about 40 percent, and he was going to work half-time. Has the region actually saved money as a result of him only being there halftime?

Hon. P. Priddy: I don't know if it's 50-50 or 60-40, or what it has been over the last few months since his appointment. I'll check on that and report back to the member.

S. Hawkins: Thank you. I would appreciate that.

I have a couple more questions. This one is with respect to the Eric Martin Pavilion. I think this was quite a public story just a short while ago -- in May, actually. The reporter, who actually got into the Eric Martin Pavilion, was quite horrified, I think. He saw a lot of overcrowding, he said. There were 83 beds and 101 patients that day. He said patients were eating on the floor in the dining room. I don't know if that's something that's normally done there; it sounds pretty disgusting. The wards were mixing male and female patients, so they were rooming together. The chief of psychiatry was quoted as saying that the problem of overcrowding usually subsided after a couple of days, but not anymore. It was not a pretty picture. Can the minister update us on the situation at the Eric Martin Pavilion?

I have just a little more information. About a month ago it was reported that they decommissioned four beds which had never been funded. They had actually opened four beds, because they obviously saw that need, and about a month ago they decommissioned those beds because there was no funding for them. The story basically says that at a time when everyone involved with mental illness agrees that Victoria needs more hospital spaces, the Eric Martin Pavilion is decommissioning four beds. If someone needs to be admitted for a lengthy stay, the staff try to move them to regular wards, but apparently it's a real juggling act trying to fit everybody together. I'm wondering if the minister can update us on what's happening there and what's been done to help that situation.

Hon. P. Priddy: I have met with staff from Eric Martin about this particular issue. I'm not sure if these are four of the ten, but I believe they are. The health authority made a decision about three or four months ago to fund ten new beds from the mental health dollars within the health authority budget. So those were ten new beds that they decided to fund. I don't know if these four beds that they've "decommissioned" are part of those ten or not.

I'm not sure if I heard the member say that there were women and men in the same room. Did I hear the member say that? Okay. The member would be correct; that is certainly not a situation we would want to see under any circumstances.

I think that there are some short-term things and some long-term things around Eric Martin and actually around a number of other psychiatric support services in the province. Over the past six years, funding for mental health in the capital region has doubled. Actually, I know that in my region the largest increase has been for mental health services. But to go back to Eric Martin, I think that the long-term solution is going to be around the mental health plan, because there are some people who are currently in-patients, if you will, who with good support could be able to live reasonably independently in the community.

Eric Martin has done a very interesting pilot project. They've done it with nurses, but I think you could do it with other trained staff as well. They see people on a daily basis at Eric Martin, either just for the people to have the opportunity to make contact with other people or to take medication and so on. If the person does not return for their next appointment -- whether that be the next day -- then they actually have someone go out and find that person, because that is one of the most common dilemmas in the mental health system: people fail to show up for appointments. There's no mechanism to follow up with them. Therefore these are the folks who sort of get lost in the mental health system. One of the solutions is going to be being able to provide support in the community for those people who need some additional support. They probably don't need to be in-patients, but there's no sort of in-between alternative for them.

The second piece is that we've actually approved 400 new supported-housing units this year -- 200 outside the lower mainland, with some of those to come to Vancouver Island. That again will enable people to have a place to live and therefore, with support, to be able to function in the community.

[ Page 10223 ]

[7:45]

Again, the facility only has 83 beds and serves a population of 330,000. The facility opened in 1971, so obviously it's not new. It had 100 beds, and at that time the region apparently had a population of 205,000. The Canadian Psychiatric Association apparently recommends a ratio of 50 beds per 100,000 people, so it falls short of the recommendations. Eric Martin gives Victoria about 25 beds per 100,000 -- half the beds that are needed.

It's interesting that the article quotes Dr. Donald Milliken, who's chief of psychiatry for the capital health region. He says he doesn't think that the mentally ill are that well served in Victoria. They're not treated as well as they once were. He's quoted as saying: "I provide good care. But I will say I very frequently have patients who, 20 years ago, I would have admitted to hospital." He says that it's impossible to admit these people until they are having a severe psychotic episode, and he also says that 95 percent of all admissions come through the emergency ward. He rarely has elective admissions anymore. I think that's critical; I think that's pretty striking.

Also, there is a question of whether -- I don't know if the facts shows it -- Victoria has a greater-than-average proportion of mentally ill people. That's what we're led to understand. The doctors believe that it is because if you are living on the streets, it's warmer here than in Vancouver and certainly than in other places in Canada. So we seem to have a higher proportion of mentally ill in the capital, and apparently the community supports just aren't there, either, for people with mental illness.

I'll be interested to see what the minister does with this situation. Certainly, when we get to mental health, we can discuss what kinds of measures the ministry is taking to address some of the concerns with respect to funding for these kinds of things. Does the minister have any comments on what I just read?

Hon. P. Priddy: It seems to me that when the member moves to the discussion of the mental health plan, we will be able to have a fuller discussion about this -- about the components of the mental health plan, about the fact that that plan was developed because we know that there are not the community services that people need. We know there are more people self-identifying as needing assistance; we also know that the sooner you can treat people after the first break, the more likely it is that we increase the incidence of recovery. So I think we'd probably have a fuller discussion of that under the mental health plan.

S. Hawkins: I also want to raise an issue from Smithers. They built a psychiatric holding room -- they spent more than $30,000 on that -- for patients with severe mental health problems. The Bulkley Valley District Hospital administrator says that the room has never been used, because the government hasn't given approval to open it. I'm just wondering if the minister can update us on that.

Hon. P. Priddy: My understanding is that we have given capital money for the changes that are needed for what is called an observation unit; that the standards for observation units, which we have been redoing, are actually now complete; and that the hospital will be able to take the program money, I believe, from the new mental health dollars.

S. Hawkins: In the Central Vancouver Island health region, there is a home for mentally ill seniors that is empty. They renovated the home on Tunnah Road, at a cost of more than $400,000, but the region says it doesn't have the $200,000 necessary to provide 24-hour staffing. Again, I'm wondering if the minister, because we still haven't got the implementation framework for the mental health plan. . . . Is there consideration for this home for mentally ill seniors to be up and operational?

Hon. P. Priddy: My understanding of this facility is that this is indeed, if you will, a designated Riverview downsizing facility. When the downsizing was on pause and the mental health plan was being developed, this is a facility that I think got caught in that time period.

I realize that the capital renovations have been made. The region has a variety of options around this, but when the mental health plan kicks in -- which will be very soon -- the region would have the option of using mental health dollars for operating dollars for this facility.

S. Hawkins: There seems to be a real concern about either no beds for the mentally ill or the mentally ill taking up beds in hospital that are traditionally used for acute-care, medical or surgical patients.

It's interesting. I have a letter here from a psychiatrist that was written to the member for Vancouver-Langara. He writes that he is a psychiatrist at one of the large hospitals in the lower mainland. He recently had four patients within a one-week period who were all urgent psychiatric cases requiring psychiatric admission. He said that three of these patients were suicide attempts and one was a patient with psychosis. He says that he tried to no avail to get these patients admitted to the psych ward at St. Paul's Hospital, but the bed situation did not allow this. There were no beds available, because of overcrowding, not to mention that there were often between six and ten patients in the emergency department requiring psychiatric beds. As a result, all of these patients had to be admitted off-service onto medical floors, where they received suboptimal psychiatric care. He's concerned, as I am, that this costs taxpayers thousands of dollars. It's probably not the best place for them, and it's probably not best for patients who are put with patients in that condition.

Again, I'll be interested, once we get to the mental health plan area, to ask the minister if they've finally got an implementation framework and their spending priorities for mental health this year. I understand that $10 million has been allocated out of that plan for this year. We're into the second quarter of the budget year, and we haven't heard. Meanwhile, we're still hearing stories about the need.

This letter was written about three or four months ago. I wonder if the minister has comments about that, because I

[ Page 10224 ]

Hon. P. Priddy: I don't think anybody would question that we have a need for more psychiatric support services, or we wouldn't even have engaged in the development of the mental health plan. I think we might have a broader opportunity to canvass these issues when the member addresses the larger area of the mental health plan.

S. Hawkins: At this time, I want to deal with some of the other kinds of shortages at hospitals. I'm particularly concerned about two of our major hospitals that are referral centres for provincial programs -- that is, Vancouver Hospital and St. Paul's Hospital, in the lower mainland. In the last year, I understand, both hospitals have asked the government to provide more funding for ICU space.

Maybe I'll go over one hospital at a time. I'll start with Vancouver Hospital. Apparently, they have 18 ICU beds. They have four or five CCU-ICU beds at the UBC site and 18 at the VGH site. Their occupancy rate is close to 100 percent. In 1994 they saw 113 patients, and in 1997 they saw 161 patients in that unit. So the number of patients per month went up to 61, from 54, due to multitrauma and head-injury conditions. They've had an increase in length of stay, and they attribute that to various reasons: increased severity, new treatments which prolong life. . . . They have an approximate budget of $10 million, and $850,000 of that is for physician compensation for five internists. I understand that they have asked the ministry for more beds. They're asking for two more beds and 8.4 FTE nurses, at a cost of $1.28 million.

At the time that I toured the unit, it wasn't looking very hopeful. But I am asking the minister to comment on this, because when I went in early March, they told me they had been busy right since Christmas. The nurse manager told me it was a daily puzzle: they were always looking for staff and always looking for a place to put people. At that time, they were worried about going into the summer period -- which we're into already -- and they said they were going to be facing a difficult time going into summer. In fact, the day before I visited, they had a trauma patient coming, and there was no room. They could have transferred someone to the UBC site. Unfortunately, the trauma patient expired, and they didn't have to make that arrangement. The day I visited, they had admitted a head injury patient to PAR -- the post-anaesthetic recovery unit -- the night before, and they should have come to ICU.

[8:00]

I can tell the minister that this isn't the only hospital that's told me they have had to admit patients to PAR. I can tell you, I get very concerned about that. Kelowna General Hospital has told me that, through emergency, they've had to put patients in PAR because that's the only place there is monitoring. Some hospitals have told me they've had to cancel surgery because they have nowhere to put patients coming out of surgery, because they've got ICU patients being monitored in the post-anaesthetic recovery unit.

So, first of all, I want to ask the minister: what has been done on behalf of Vancouver Hospital to help them get the extra critical-care beds they say they need?

Hon. P. Priddy: We have in our budget $3.37 million for critical-care beds. We are very aware of the situation at Vancouver Hospital and have spoken with people there -- I have personally and my ministry staff have on a regular basis. We have a critical-care committee that is looking at that $3.37 million in terms of allocation. Those decisions should be made -- the minimum would be a week; I don't think it'll be quite that quick -- in somewhere between four and six weeks.

S. Hawkins: I should have gone over the situation at St. Paul's Hospital as well. I can tell you that when I went to tour the hospitals, they were not very hopeful that the ministry was listening or even thinking of helping them with this problem. In St. Paul's Hospital, the intensive care unit has space for 19 beds. It's funded for 15; it's funded for, I believe, 11 ventilators and four step-downs. In its tertiary care, they basically say they have no room to move anywhere. They need. . . . I'm concerned about these two units, because they do provide a provincial service as well. They say half of their beds are filled at any given time with patients from outside the Vancouver-Richmond region. I know that doctors from the periphery spend hours on the phone trying to find beds in these units. It's getting to be more and more difficult.

They also have a proposal in to the minister, and they're looking for more beds. Again, are they in the same situation as Vancouver Hospital? They want to open four more beds. Physically, there is space. Obviously they need the funding for staff and equipment. Can the minister give an indication of whether there's any hope for these units getting the extra space they're asking for?

Hon. P. Priddy: Yes, indeed there is hope. While it's always hard for people to. . . . I don't question what the member has heard about people in those hospitals saying that they're not hopeful at all. In point of fact, Dr. Peter Dodek, who is the head of critical care at St. Paul's Hospital, is on the critical care review team that's reviewing the budget and allocating those critical-care beds.

S. Hawkins: I also want to point out that the hospitals felt that they had a very acute nursing shortage in critical care. They were paying high overtime, obviously. I'm sure it results in sick time as well, because if you're working your staff overtime, I'm sure they can't work on overdrive too long. They end up incurring sick costs as well. I know we've been hearing about this nursing shortage for the last couple of years; I know I've talked about it for the last couple of years and asked what is being done to address that need. Certainly in the critical-care areas, it's critical, if I can say that. Is the ministry doing anything to respond to that need for critical-care nurses, and for nurses in general, regarding the nursing shortage?

Hon. P. Priddy: Because we've heard the same kinds of comments, of course, there has been a group underway since January -- with us, the HAABC and representatives from hospitals in the lower mainland -- to look at this particular issue. That group did do some data collection and analysis. In spite of what we hear anecdotally, they didn't identify an immediate critical-care need, but they certainly identified that there is work to be done in that area. What we're currently doing is. . . . Actually, we've asked the HAABC to do this with us. They will coordinate discussions about industry training needs with BCIT and the Ministry of Advanced Education, Training and Technology. That meeting has either just happened or is just about to. We'll be doing that with them as well. The HAABC will also be working with the BCNU to seek their input and to look at issues they might raise. Also -- these are just immediate actions -- hospitals will be reviewing their own staff complements as they deem appropriate.

[ Page 10225 ]

S. Hawkins: Every unit that I went to has told me that they've got a high need for critical-care nurses. It seems to be a provincewide phenomenon. So it's interesting that the ministry is just becoming aware of that.

The IC nursing unit at VGH tells me that the age of nurses is getting older, so the average age of nurses is now 35 to 40. They're not having a lot of young nurses come through the unit. The turnover is low, but there are not that many nurses training in ICU. So they need to make sure that when the nurses do turn over, they have people with adequate training. I can tell the minister that when I was head-nursing, I was in charge of a neuro-intensive care unit. It's very expensive to train an ICU nurse; it does impact the hospital budget. So if we train them and then we don't provide enough nurses in critical care -- we work them overtime, until they're sick -- it just perpetuates the problem. It doesn't get any better.

I recall watching a report on BCTV about a month or so ago. Recruiters from the States were up here, and they were recruiting some of our highly trained nurses. The nurses were citing working conditions at some of the hospitals in the lower mainland as one of the factors that was taking them to the United States. So we do have to be cognizant of the fact that when we staff our units, we staff them properly and try to keep them staffed with the appropriate level of nurses. I can tell you that in some of the places I've toured, they have pulled nurses off the wards to look after patients in emergency or in the critical-care units. Again, if you're working in a critical-care area, that puts a lot of stress on the nurse responsible, because you know that the nurse working next to you doesn't have that expertise. You have your own patients to look after, plus that mind-set that you've got to look after that one too. So it does make it very difficult.

I also want to ask the minister about the problem with physicians from outside the lower mainland, and perhaps with physicians from the lower mainland as well. When they need to get a patient into the units that serve a provincial purpose, which are the cardiac units and the ICUs, certainly, at VGH and St. Paul's -- I hear this all the time -- they often spend countless hours trying to find an available bed. The frustration is just so evident when you talk to these physicians. At the end of the day, I think the patient suffers, because they wait longer before they get the bed they need.

I know that Ontario has a system called CritiCall; I think that's what it's called. Basically, the physicians can plug in, and they find the first available bed and talk to the unit director. Is the ministry aware of that problem? Are they moving in that direction, trying to expedite patient referrals from the periphery into a provincial unit like the ICU at VGH or at St. Paul's?

Hon. P. Priddy: Yes, we are aware of the Ontario program. We have looked at that. My understanding of the Ontario program is that it's primarily cardiovascular, but I'm sure it could work for an expanded range of services. We actually are looking at it here. We're trying to look at how much of that might be portable -- you know, that would work here -- and how much of it might actually have to be designed here in B.C. Would you look only at cardiovascular, or would you look at a wider range than that? I don't know if it's a challenge, but one of the things Ontario did some work sorting out was around working with physicians. So if you dial the 1-800 number and say you need a critical-care bed for somebody who's just had a cardiovascular or cerebrovascular accident or whatever, then you take that critical-care bed. They don't say: "Here are six choices for this." I gather that they did some work with physicians in order to be able to work in that model. But yes, we are looking at what could work here.

S. Hawkins: I'm also seeing a phenomenon in the last couple of years that's particularly disconcerting as well. It's called critical-care diversion. Is the minister aware of that?

Hon. P. Priddy: Yes, we are aware of it. It is one of the things that has been reviewed by the emergency-room services committee and it is under ongoing review.

S. Hawkins: It's happening not only at hospitals in the lower mainland and at the hospitals I call our provincial centres, Vancouver General and St. Paul's, but it's also happening at peripheral hospitals like mine. On July 3, there was an article in the paper, and I think it concerned a lot of patients, because I got calls after that. It was Vancouver Hospital reporting that they were on critical-care diversion, and they were calling. . . . It says: "Inadequate staffing and more patients, especially elderly ones, have resulted in what both the nurses' union and officials at Vancouver General Hospital are calling a crisis situation in the emergency room." On Thursday of that week, the day prior to July 3, the hospital president said there were no critical-care beds at either the hospital's 12th Avenue site or at its UBC facility. There were also six psychiatric patients waiting in emergency, with no beds available for them. I guess I have to be concerned. Where do the trauma patients go when they happen, say, outside the lower mainland? I mean, we count on a lot of those specialized services in the lower mainland, and we count on these ICUs to be our resources for severe and critical types of injuries.

I can tell you that when I did my shift at St. Paul's emergency just before Christmas, it was interesting watching the triage nurse. As soon as we were full and there was an ambulance waiting in the bay and patients on stretchers waiting in the hallway, the nurse would flag critical-care diversion. That means they couldn't take any more; that was it. The hospital beds were full, the ICUs were full, and the emergency room was full. Then she'd have to take it down, because maybe an hour later Vancouver Hospital would be on critical-care diversion. When both hospitals are on critical-care diversion, it cancels both of them. That means they have to take what comes through the door.

I guess all that -- the beds issue, the overcrowding in emergency, the mental health issue -- has impacted on the hospitals and their staff. You know, it's very disturbing to see headlines like this on July 3, just a week and a half ago, saying: " 'Crisis' Looms at Hospital." Again, the hospital president is quoted as saying:

"We can no longer accept additional ambulances coming to the hospital with more patients, because we don't have the facilities to care for more. Every night there are patients waiting in the emergency department who aren't placed until the next

[ Page 10226 ]

day. Some elective neuro- and orthopedic surgeries at the hospital are cancelled today" -- which was July 3 -- "because beds are overloaded. Those beds become occupied for emergency patients, and they're no longer available for elective cases."

Hon. P. Priddy: I think the first question was: did the hospital notify us? Yes, they did. They also notified St. Paul's, which indeed helped out in this particular situation. One of the things that has occurred at VH that I think is remediable is the fact that in the Vancouver-Richmond health board two facilities were actually closed. The contracts were terminated at both Trout Lake Manor and Lakeside Place. What that means is that it has caused a significant backup at Vancouver Hospital of people who really require alternate levels of care -- who don't need to be in hospital at all but are occupying hospital beds. As we've all talked about, that's what happens to the backup: beds are filled with people who should more reasonably be in other places. This backs up the emergency, which leads to the situation the member has described.

We expect, by fall, that the region will be back up to their 165 funded beds instead of the 25 they currently have, which will provide significant relief at Vancouver Hospital for those people who truly require alternate levels of care, not an acute-care bed.

S. Hawkins: Can the minister tell us how many patients are bed-blocking at VH, due to this problem?

Hon. P. Priddy: If we are referring to this particular group of people, VH identifies 60 patients who need alternate levels of care rather than acute-care beds. It is possible that there will be some people in their discharge planning unit that could also require that.

S. Hawkins: The minister knows as well as I do that this isn't a new problem. It has been brought up for the last several years by myself and by the Health critic before me. It's cold comfort to hear that the problem is going to be relieved this fall. We keep hearing that every year that we stand here -- that the ministry is working on it and that the problem is going to be alleviated. In fact, I submit to the minister that the problem is getting worse. In the last couple of years, I think I've seen more beds blocked, more waiting lists and longer lineups for an alternate level of care -- and more acute patients being displaced because of that.

Does the ministry have a plan? Or is this, again, a fly-by-the-seat-of-your-pants type of thing -- as the problems arise, they'll be dealt with, as in what's happening at VH?

Hon. P. Priddy: Two things. One of them is that we do anticipate that there will be 142 additional beds opening. . . . I'll be happy to call the member and tell her when. It should be in September, God willing and the creek don't rise!

That was a specific situation in Vancouver, where two places were closed, and so on. I would certainly agree with the member that while we're dealing with that. . . . You don't deal with it provincially in a one-off kind of way by waiting for two facilities to have a contract terminated or whatever. That is the reason we've undertaken a fairly extensive continuing-care and longterm care review in the province -- an entire review of continuing care, with a number of people with expertise in the area looking not only at the need for continuing-care beds or alternate-level care beds but at how we can use our facilities better and at what kinds of community supports aren't there for people. It's a very comprehensive look at continuing-care and longterm care needs in the province.

S. Hawkins: I recall how that review came about. I recall that last year some very significant problems were revealed at a place called Skeleem Village in the Cowichan Valley. It's been a year since that review was put in place, and I'm wondering when we'll finally get the results of that review. I think patients are waiting to hear what's happening with the continuing-care and licensing issue.

Hon. P. Priddy: I think maybe I need to describe this a bit differently. The strategy we've currently undertaken in the review is of long-term care. Some people call that continuing care, multilevel care or alternate-level care. That has been underway for about three months.

I think what the member is referring to is a review that the previous minister ordered, in part as a result of the incident concerning the Community Care Facilities Licensing Act that the member mentioned. There's a difference between these two.

S. Hawkins: The review that the minister is talking about now, with respect to bed-blockers and. . . . When did it start, and when is the minister going to have the results of that?

Hon. P. Priddy: The review was announced in February and was begun about four weeks after that. They are to have a report to me by September. It's quite a broad committee, with a list of many people with expertise in long-term care and gerontology, and it's chaired by Barbara Burke, who I think is the vice-president of patient services at St. Paul's.

S. Hawkins: I don't know if I heard when we would expect the results of that.

Hon. P. Priddy: The committee is to report out to me in the fall.

S. Hawkins: The minister's going to be very busy in the fall, when she gets all of those reports on her desk.

I want to reiterate how concerned I am about this critical-care diversion that's happening more and more often. I just happened to check my hospital on the same day that the Vancouver Hospital reported that they were experiencing this. Lo and behold, on July 3, 4 and 5, our hospital, Kelowna General, was also in critical-care diversion. It begs the question: where do these patients go? If our hospital is on critical-care diversion, Vancouver Hospital is on diversion as well, and St. Paul's is full, it makes it awfully difficult to provide services for patients who are critically ill in other parts of the province. Again, just to let the minister know, it's not a phenomenon that's happening just in the lower mainland; it's happening around the province and with more frequency. I will certainly be following that issue very, very carefully in the following months and probably bringing it up again next year.

With respect to nurses, because we did talk a bit about the nursing shortage, I had a very good discussion with the nurses' association and a meeting with RNABC. They gave a list of issues, and I'm sure the minister is aware of a lot of

[ Page 10227 ]

They felt that they needed more front-line staff. Again, they felt that there was a shortage of long term care beds, and we've discussed that briefly. They foresee a nursing shortage in the next several years, because the average age of a nurse is increasing and we're not seeing a lot of new nurses coming into the workforce. They're very, very concerned about respite care; they see severe cutbacks there. I promised them that I would make their issues known to the minister, so I'm just going to read from the list. They feel that there is a high need for respite for families, especially families of head-injured patients. I think we can all agree that funding for the head-injured is quite challenging and insufficient. It's a huge challenge looking after those patients.

[8:30]

The other thing, and I raised it before in this House with this minister, is nurses that work in corrections. I know that that's under the Attorney General's purview, but I think the Health minister should be concerned as well. We are talking about health care personnel, and nurses are very concerned about working in the area of corrections and not having, perhaps, the support or the security or the feeling of safety they would like to have. I know that they have lobbied the minister and asked for her help on this issue. I'm wondering if she has talked to the Attorney General and if she has done anything on behalf of the nurses, especially the nurses at the Burnaby Correctional Centre who were suspended. They do feel that their safety is compromised.

Hon. P. Priddy: Yes, I have talked with the Attorney General on more than one occasion, as well as with the BCNU on more than one occasion. My understanding from the Attorney General is two things. One of them is that he has had done an overall review of this. What I have asked him to do is ensure that nurses are safe in the meantime. Without, of course, the benefit of seeing the Attorney General's report, I would agree that as described to me by the nurses in Burnaby, it is not an acceptable, safe environment.

As to the RNABC, I appreciate the member stating their concerns. The RNABC has certainly stated them to me on the several occasions that we have met. My ministry staff is working with them.

S. Hawkins: Does the minister know what the status is on posting a guard for the nurses that work at the Burnaby Correctional Centre? They did ask for one. I know they asked for the minister's support for that. Has anything been resolved there?

Hon. P. Priddy: My understanding was that work was underway, but I would need to check with the Attorney General and let you know in the morning.

S. Hawkins: I would hope that something has happened in that regard.

Another issue that came up last summer -- and I think there's still a threat. . . .

Interjections.

S. Hawkins: It's getting very noisy in here. I can hardly think.

The Chair: I'll ask the members in the chamber if they would like to. . . .

Interjections.

The Chair: Members, could we have some order, please.

S. Hawkins: Thank you.

There was a concern about the northern nursing program at UNBC. Given the fact that we have personnel in the north and that it's very hard to recruit. . . . I believe that the nursing program at UNBC offers that experience in northern nursing; that's what they teach. I wonder if the minister has heard about this and what she has to say about the continuance of the post-RN program, I think it is, at UNBC.

Hon. P. Priddy: I am aware of the UNBC program. When we've been looking at additional training for nurses who are working in rural and remote areas, we looked at what UNBC was offering. We are prepared to look at that again. We've also looked, though, at a specially designed curriculum that is offered by. . . . I don't remember the nurse's name, but it was designed by a woman at the University College of the Cariboo in Kamloops and was very specifically designed for rural and remote areas. It seemed to me, with the information I had, that it was actually more specialized than the postgrad program at UNBC. But in our commitment to the Dobbin recommendations that we look at human resources, I certainly didn't interpret that to be only physicians. Therefore we will be reviewing not only UNBC but also the curriculum at the University College of the Cariboo, and we will be working with BCIT around curricula as well.

J. Dalton: I have two or three questions about the North Shore health board that I would like to ask. As the minister and her officials will know, there is currently an interim board of nine. Are there any plans to top that up to the required 15? If so, when might that happen?

[R. Kasper in the chair.]

Hon. P. Priddy: Fifteen isn't a requirement; it is a maximum. But, in point of fact, there are some plans. There are

[ Page 10228 ]

J. Dalton: Well, I certainly agree with the minister's comment about the makeup of the current board. I talk to the chair quite regularly, and from the reports we're getting, they're doing a first-rate job. Will the minister be relying, then -- given her comments just now -- on the advice of the current interim board as to topping it up, as I put it? Or will that be external in nature?

Hon. P. Priddy: Unless there's been a misunderstanding, it's not an interim board; that is the board, although it may get larger. My preference would certainly be -- and that's what I have asked for from board members -- that recommendations about who those additions might be will come forward from the board, who know their community better.

J. Dalton: Fair enough. It may be a bit of a misdescription to describe that as an interim board. I was thinking back, of course, to when the previous board was fired and we went through quite a period of time with nothing. Then, happily, you appointed a good public administrator, who is now, of course, the chair of this board, interim or otherwise. As I say, it is doing a good job. We'll wait to see the outcome of that.

Another issue, with regard to the meetings of the board. . . . I am informed that there have been discussions with ministry officials about whether they will have to strictly comply with the open-board requirements in the act or whether they can hold more -- for the want of a better term -- in-camera board meetings and have effective public accountability meetings on a less regular basis. I can say, from a personal perspective. . . . I attended quite a few of the old board meetings. They met publicly twice a month. Quite frankly, even though I'm a firm advocate of openness and accountability, I think that was overkill. That may, in part, be why we no longer have that board in place -- who knows? Can the minister advise the committee as to this issue of whether this board will have to comply strictly with the open-board process or whether they will be able to rely more on their good common sense and business sense, and conduct their meetings according to their wishes?

Hon. P. Priddy: I believe that what the act says is that meetings should be in public except when it's necessary or appropriate to conduct other kinds of meetings. There's no particular standard that says that you must have two public board meetings a month. Certainly in the communities that I'm familiar with, given all the work that boards have to do, what you've just described would seem to me to be. . . . I'm sure there's no such thing as overly accessible. It would seem to me that for a very busy board, twice a month for public meetings is probably not necessary. As I say, there is no particular standard, but health authorities are expected to have a combination of whatever meetings they have to have in camera in order to accomplish certain kinds of work that legitimately fall in that way and to have some public meetings that meet the public accountability standard. But there isn't anything that says people have to do what you've described.

J. Dalton: I would certainly agree -- at least with that general sentiment -- and I know the board would. . . . In fact, it's interesting that in the latter stages of the previous board, before it was dismissed, they actually cut back their public meetings to once a month. I think they realized they were getting overwhelmed. It was my observation that too often you had the special interest groups attending those regular meetings, and I don't think the board's business was being properly attended to.

I would certainly encourage ministry officials and the minister. . . . If they're getting what I think is good advice and suggestions from the North Shore board, they would be well advised to follow them. I think that this is a good board, and I think that they've got a very good business sense of what the health needs of the North Shore are. Certainly if they suggest that the meetings should be not less public but less onerous from the point of view of trying to accomplish their tasks, which I know they will do. . . .

There's one other issue that I would like to address. I understand that Inge Schamborzki was offered a position in the Health ministry, a position more or less comparable to the one that she was dismissed from. Can the minister advise us as to whether that is true? If so, why was Dr. Schamborzki not more or less encouraged to take that position? As the minister will know, we're looking at a severance package of 18 months plus all the benefits, plus Dr. Schamborzki still has a computer and a fax machine at home that belong to the North Shore health board. She will have those and who knows what else for the duration of her 18 months' severance. We've been talking at length to our critic about accountability and guidance from the ministry for health boards and how they spend our money. I think the North Shore, quite frankly, is an example of where money has been misspent.

[8:45]

Hon. P. Priddy: I believe that the first question the member asked was whether the individual in question was offered a position within the ministry, and I think he also asked if she refused it. The answer is yes. Under the contract that she signed, which was some time ago, she is allowed to do that. Under the new contracts, if the individual turns down a job that is offered, then that is the end of the effort that is made, and the person is terminated. That is not the case in her circumstance, but that is the case in all of the new contracts.

She does indeed -- you're quite right -- still have a computer that belongs to the North Shore board. She pays all the transmission charges on that. I'm uncertain about the date of return, but obviously it will be returned to the board.

J. Dalton: This will probably be my final question or comment, although I'm certainly pleased to hear that at least for all subsequent contracts. . . . We've all learned an expensive lesson. I know enough about mitigation of damages in wrongful dismissal cases that, at least from the admittedly limited background that I have about the Schamborzki case. . . . Quite frankly, I think Dr. Schamborzki should have been compelled to accept the offer and not worry about the "wording in the contract," because the taxpayers' money is at risk here and is still at risk in this case. It's fine that we've closed the barn door after the horse has escaped, but that doesn't do the good taxpayers of this province any good.

I was listening quite intently the other day when we started the estimates, when the critic, quite rightly, was asking the minister for guidelines as to what health boards are or are not to do. I know that my colleague from Seymour has a whole stack of stuff in his desk -- expenses and things that were incurred during the employment period of Dr. Scham-

[ Page 10229 ]

D. Jarvis: I would like to ask the minister if she could tell me how their system is set up. When the previous CEO was Lynnette Best, who was laid off in September of '97, we had to pay a severance fee in excess of $76,000. The year before that, we had a severance fee of approximately $130,000 to $150,000 for Mr. Smith. How the minister could allow the head of the North Shore board, Dr. Schamborzki, to rewrite her contract to give her $160,000 a year, I think, and then write into her contract that in the event that she was asked to leave at any time, she would receive severance of approximately $13,000-plus a month for the next 18 months. . . . That is clearly an abuse of the situation, and why this. . . .

Interjection.

D. Jarvis: Even your own members are shocked -- and then you look at the expenses. I think our critic from Kelowna went over a few of them, and I've gone over additional ones. She was down in San Francisco every quarter in one year. She was in Montreal and in the eastern provinces. . . .

An Hon. Member: Has she been to China?

D. Jarvis: No, she never went to China, but she went to Montreal. She went to Winnipeg. She went to the Maritimes. She went to San Francisco three times in less than four months, Orlando, Florida. . . . She was just continually travelling and using the taxpayers' money. I was wondering if the minister could tell me how the ministry could allow things like this to happen.

Hon. P. Priddy: All expenses for CEOs are to be approved by the health authority. Health authority boards have guidelines, and I expect them to take the kind of leadership they should in monitoring those expenses and in having those trips preapproved so that people are not submitting expenses after the fact. We all have to do that before we have approval to go anywhere. All of us, including us as elected officials, have to have that kind of approval. I expect a strong health authority to take that kind of leadership and to ensure that expenses are not out of line. That clearly has not happened in the past, and I expect this board -- which, as your colleague mentioned, is a very strong board -- to be able to do exactly that.

D. Jarvis: I assume, therefore, that there were no checks prior to you taking this position. Are these the new rules that are now before the boards -- that they have to be approved by your office? Clearly, in three years, the North Shore health board has gone through close to $500,000 in severance fees alone, just for three CEOs.

Hon. P. Priddy: I was just trying to help define whether the member was asking: had severance guidelines only been in place since I was here? Or was it: had expense guidelines only been in place since I was here? Actually, the answer is probably neither one. The contract guidelines, particularly around severance, actually came about as a result of at least one of the incidents that the member referred to and other incidents around the province. Those have been in place, I think, since December 1996. So around the severance piece's contract, those guidelines have been in place. Contracts signed since that time would have the new guidelines in them.

In terms of expense guidelines -- and again, we canvassed HEABC and the ministry at some length on either Thursday night or Friday -- the ministry has circulated those through HEABC and ourselves to all the health authorities, and they have those. The expense guidelines have been in place for some time. What we have found are circumstances where boards have not necessarily administered those as rigorously or vigorously as they could have. Or if things were done without board approval, then it wasn't sanctioned that it happened. I expect health authorities to take stronger leadership than that.

D. Jarvis: I thank the minister for her comments. I just want to reiterate that we are talking about this computer thing. I know it sounds like a picayune thing, as the CEO still has it, and she has been out of the job for almost half a year now. But I'm from the old school. If you can't do a job properly, you get tossed out and shouldn't expect these high severance pay fees that are paid to these people. That's completely an abuse of the privilege they were given by being hired.

I'm leading up to the fact that -- as I say, it's kind of a picky, picayune thing -- she still has this computer and fax machine. I think someone should drive over tomorrow, pick it up and take it out of the house. She's getting over $13,000 a month; certainly she can afford her own lease on it. Besides, this same CEO had been ousted out of the Vancouver General three years before this and got a very healthy severance pay, so it's rather habit-forming. I'm not sure if you answered the member for West Vancouver-Capilano about this. You were going to look into the computer aspect and make a decision then whether to take it out of her hands.

Hon. P. Priddy: I will be very pleased to pass your comments on to the chair of the board. I mean, it's not the ministry's computer; it's the health authority's computer.

D. Jarvis: It's the taxpayers'.

Hon. P. Priddy: Well, okay, it's the taxpayers' computer, through the health authority. What I think I said to the member is that I don't know precisely what the due date is on this. But I'm quite pleased to pass those comments on to the chair of the health authority, who might very well take action on them immediately. I would say, hon. member, without any. . . . I'll preface it by saying it's no particular bias of mine, but in cases where people in that kind of position have been terminated, it is not uncommon to provide that kind of equipment for a certain period of time after for the purpose of "job hunt." I'm not suggesting that I agree with it; I'm just saying it's not uncommon to see it.

Interjection.

D. Jarvis: Just quickly. . . . Like our friend from the Peace River just said: "Not in the circles that I go around in does that happen." If I get paid $13,500 a month for the next 18 months because I wasn't capable of doing my job properly, I wouldn't expect to have all the facilities to go with it, such as faxes and things. On that, unless the minister wants to answer me, I will conclude my remarks.

[ Page 10230 ]

Can the minister provide to me, first of all, an explanation of why some of these problems might be occurring -- diversion presumably to other hospitals in the region, the frequent cancellation of surgery and the difficulty of the emergency being used as essentially a holding area until other arrangements can be found?

[9:00]

Secondly, around diversion. . . . I don't know these particular circumstances, but often within a region -- and I know we're seeing some things happen in the north like this -- in order to best use regional resources, sometimes patients are diverted to another hospital that may be able to just as well serve their needs. But I'm unfamiliar with the Shuswap hospital, so if you could provide us with that information, we'll do a check for you.

S. Hawkins: Earlier I said we were going to get into bed closures, and then we got into some of the constituency issues. I just want to speak for a minute about the problem that the member for Shuswap raises.

It brings to mind, unfortunately, the lady that passed away in emergency here in Victoria, which was reported earlier this year -- an 81-year-old who was taken there by her family. She sat dying in her wheelchair in an emergency ward waiting room while other so-called more urgent patients were given treatment ahead of her. I think it's a very traumatic experience for the family. The lady's name was Beatrice Salmon. I think the minister might recall that she had to wait three hours for help. In fact, I believe their family member had already expired in her chair by the time emergency got to her. Again, it speaks to how busy the emergency wards are and what kinds of resources they feel they have to deal with these kinds of problems.

The story about this woman who died in emergency, waiting for a doctor to see her. . . . Dr. Ernie Higgs of the capital health region said that a full review of that was underway. He did say that the emergency that evening was particularly busy with a shooting victim, a stabbing victim and two critically ill children at the same time that this lady was waiting. We do hear of these kinds of incidents, and it's very traumatic, like I said, for the families. Unfortunately, we're hearing about plugged-up emergencies and waits. This is a very unusual situation, but again, it speaks to the kinds of situations that we're hearing about with more frequency, and it's quite disturbing.

I wonder if the minister is aware of the "Acute Medical Beds" report. It was a retrospective study conducted by Dr. Miles Kilshaw. It was with respect to how medical beds are used in B.C. Is the minister familiar with that study?

Hon. P. Priddy: I am aware of the report but not particularly familiar with it. I believe this was done about three years ago by the research network group for acute care. I don't have a lot of detail about it.

S. Hawkins: Yes, it was. It was conducted in '94-95. The reason I bring it up is because there were a lot of recommendations in that study. It was released last year, I think, on March 11, '97; that's the information I have. Basically it showed an inappropriate use of the medical beds audited during that year. The study did use an American tool to measure utilization, so that was one of the things pointed out. It was retrospective, and the assessment of the non-medical reviewers disagreed with the judgment of the attending doctors as much as one-third of the time, so those might be some of the flaws in the study. Even with those flaws, it showed that hospitals like the one in the area that I represent, Kelowna General Hospital, have reduced their utilizations by nearly 10 percent since the study was done.

One thing that's really key about that study on acute medical beds and how they're used is that it points to the lack of out-patient and community supports and those kinds of services that cause discharge delays from hospitals. I know the minister has touched on some of the recommendations from this study. I should have discussed this at that time, but I just found my file under another file. If I can just go through some of the recommendations. . . . I know the minister has answered some of the questions, but I do have some other details that I would like to address.

The first recommendation from this study to the Ministry of Health is that the ministry initiate a vigorous analysis of the relative costs of potential alternative levels of care. When we were talking about bed blockers and what have you, the minister told me that the ministry has undertaken to study the different levels of care, and I'm sure that they are doing an analysis of the relative costs. I'm wondering if the group that is studying that has terms of reference for that analysis. Can the minister confirm that they have those, and what they are?

Hon. P. Priddy: Yes, the continuing-care review committee does have terms of reference, which the member would be more than welcome to have. There is a national study being undertaken about relative costs, and we will be using information from that.

S. Hawkins: We would appreciate the terms of reference. If the minister can get those to us, we'd appreciate that.

Is the study that the minister's staff or team is conducting in conjunction with the national study, and who is doing the study provincially?

Hon. P. Priddy: I'm not sure if I've lost part of the question. The people who were doing the review here in

[ Page 10231 ]

We have a physician from the northwest represented. We have Sophie Pierre, whom some people may know, from the Kootenays, also representing, obviously, some aboriginal concerns. There is someone from Kelowna. I can't read her last name, but I'll work on it in a minute, because you might want to know. It's Penny Lane from Kelowna. There are people from the South Fraser as well as people from the HEU and the BCNU; Martha Donnelly from UBC; and Geri Hinton from our own seniors program. It's quite a wide range of people who are sitting on the committee. There's someone from Housing, because housing is one of the issues, of course, that's critical for people who are aging, or elders; and Adela Moore, who represents seniors' perspectives.

S. Hawkins: What alternate levels of care are being examined by this team?

Hon. P. Priddy: What's being looked at, for the most part, is. . . . I was going to say that for the most part, it's comprehensive, but that's not quite what I mean. It is comprehensive, and for the most part it is almost anything that is not acute care. So continuing care, community care, home support as a service but also other kinds of more informal support in the home, home nursing. . . . I mean, we consider anything that is not around acute care to be included in that review in terms of the range of the levels of care.

S. Hawkins: The recommendation was to do a rigorous analysis of the relative costs of potential alternate levels of care. How are the costs of the various levels being measured up by this committee, and how are these estimated costs then being validated?

Hon. P. Priddy: I don't remember saying that this committee was doing a rigorous analysis of costs. It certainly is doing a comprehensive assessment of the continuing-care system in British Columbia. It is the national study that is undertaking the relative cost issues in continuing care.

S. Hawkins: I understand that the first recommendation of this report was that the ministry do a rigorous cost analysis of the cost of potential alternate levels of care. Is the minister saying that this recommendation hasn't been followed through in any form?

Hon. P. Priddy: I'm not aware that the recommendation has been carried out in the way that the member reads it from the report. We do know that this work is being done at a federal level, or as a national piece of work. I think that while there does have to be some review of relative costs of care, recommended in the report from three years ago, I don't think there's any question that people have some sense of relative costs of care, certainly compared to what would be an inappropriate use of a medical bed. That would likely be the highest-cost care for the outcome wanted for that individual. I do know that as a result of the study, there was a significant literature review done on relative costs of care. In point of fact, the literature review was not conclusive in any way.

S. Hawkins: Although the study was retrospective, and by now it's at least three years old, it was quite significant in pointing out that almost 50 percent of beds in some places were taken up by patients who were not appropriate for those acute-care beds. One of the key recommendations coming out of this study was that there would be some kind of analysis of the relative costs of alternate levels of care as compared to acute care. I think we can both agree that it probably will be cheaper to look after the patients in another setting, rather than a hospital setting. I'm wondering if the ministry, then, has any intention of following through with this recommendation in this study.

[9:15]

My staff tells me something that I find a bit puzzling, and I can only think of some circumstances where it would apply. Obviously that's part of what the national study will get at. I'm told that not in. . . . While I think you and I by instinct would agree that it's likely to be less for the majority of people, there are circumstances in which it might actually not be a lesser cost of care. Without having done the literature review myself, my sense is that it might be around geriatric people with very aggressive behaviours and so on, where you're talking about very particular environments and staffing levels. That will be very comprehensive nationally. I don't think we need to do our own here.

S. Hawkins: I don't think you'll know until you get all the information on whether it'll be cheaper, more expensive or whatever. All I know right now is that there are inappropriate admissions to acute-care beds. That's driving up the cost for hospitals and driving up waiting-list numbers and everything else that impacts on the hospital with respect to that.

As well, in this study it was recommended that incentives be aligned with the need for utilization review and management. The reviewers pointed out that this might include specific designation of a proportion of hospital funding for utilization management and reconsideration of current policies restricting certain insured services to certain specific settings. I'm wondering if the ministry has dealt with that recommendation -- if that recommendation is being followed or has been followed -- and what insured services are being reconsidered for restriction to certain specific settings.

Hon. P. Priddy: The rewarding, if you will, of utilization management initiatives is acknowledged in the funding formula.

S. Hawkins: I also asked what insured services are being reconsidered for restriction to certain specific settings. Is there any work done around that?

Hon. P. Priddy: Just for my own clarification, could I ask whether the member is referring to hospital insured services or medical insured services or. . . ? Maybe just help me a bit more with the question. We don't have the report in front of us.

S. Hawkins: I believe they were talking about hospital insured services. I'm sure you have the report at your disposal. It's a public document. I think I got it on the day of the press release.

Hon. P. Priddy: I'm not sure if this report is referring to restricting hospital services to, for instance, only having cer-

[ Page 10232 ]

It would be helpful for us, if the member is going to go through the entire report, if she could just read out the recommendations for us. I'm not suggesting that we don't have the report at all. Given its age, we don't have it with us. We weren't necessarily expecting to deal with it in these estimates. I'm not unhappy to do so, but if you could at least read out the entire recommendation, it may help my staff to respond.

S. Hawkins: I summarized it for myself, so it'll take me a few minutes to go through and find it. I'm kind of concerned, because I'm wondering, if the minister is not familiar with the report. . . . I think the report is very, very important, and I don't know if I'm getting the kind of feedback that tells me that the report has actually been acted on. I'm concerned about that, because this report did deal with. . . . This was a study conducted for the advisory committee on clinical resource management. Part of what the ministry was trying to achieve in the last few years was to put better utilization practices into place, to review what was going on, to be more efficient and to plan for the future. I'm a little concerned that maybe the study has been shelved, and none of the recommendations have really been followed through on.

It was also recommended that a major provincial initiative be launched to provide guidance to the hospital community in utilization management, access to the tools and techniques available in the process. . . . I wonder if that initiative has been launched. This was released in the first week of March of last year. I didn't have the resources to deal with this in estimates last year; certainly I didn't think the minister would be able to answer those kinds of questions, given the kinds of recommendations that appeared in this study. It has been over a year, and there are some very significant recommendations in the study for reviewing acute medical situations and utilization. I'm getting concerned about the kinds of answers I'm getting -- that perhaps the recommendations haven't really been acted on.

Hon. P. Priddy: There are recommendations in that report that have been acted on, and there are also a number of other things the ministry has done that may not respond to a particular recommendation but are about dealing with the appropriate utilization of beds. While I will take the time to read out some of the things that have taken place as a result of some of the recommendations in the study, I would again point out that it's three to four years old, and it was, in itself, retrospective. While I think it made some important recommendations, it is easier for the ministry to not only speak to those recommendations but also talk in general about what has been done about utilization, which is really what the report is about.

But let me just touch for a moment on some of the things that were done after the Advisory Committee on Clinical Resource Management tabled its report on medical bed utilization. There is a Joint Industry-Ministry Committee on Utilization Management. There are utilization management training and pilot projects taking place in the province. There are annual surveys of CT and nuclear medicine installations in British Columbia -- the staffing, the workloads, the costs, etc. There has been the development of a detailed database called Purrfect, which is able to track utilization trends or rates by specific types of cases, length of stay, referral patterns and so on. It's on CD-ROM, and it's available to all the health authorities. They use it. So there are things that have come about as a result of the report.

S. Hawkins: The study information was old, and it was admitted right in the report that it was done for '94-95 information. It was a retrospective study. But what is significant is that it was the first time we actually had an analysis such as this and the first time we actually had hard evidence to show that beds were being utilized by inappropriate patients. That was very significant in this study. What was really important in this study was that they pointed to a lot of gaps in the system, and they gave the ministry recommendations on what to do for the future and for utilization management -- making sure that admissions were appropriate or at least tracking the ones that weren't.

I am happy to hear that there are some utilization management things happening across the province, but I am concerned that some of the specific recommendations in the report with respect to admissions to hospitals are not being followed.

There was another important recommendation, I feel, in the report. They recommended that some kind of process should be established in each hospital to review the indications for admissions and hospital stays. They said that consideration should be given to implementing one or more decision-support tools that are available. Again, I'm asking the minister how many hospitals are using decision-support tools to achieve this goal. Does the ministry have decision-support tools? Are the hospitals using the same ones? I think it's important to start tracking prospective data now, in order that we get the best bang for the buck that we spend on health care in this province.

[9:30]

There's also another decision-support tool called the medical bed assessment tool -- I think that's what it's called. How would we live if we had no acronyms to talk about? That is a decision-support tool around the use of medical beds.

S. Hawkins: I wonder if the hospitals, with the help of the ministry, are currently using criteria to determine the appropriateness of a hospital admission or of the length of stay for a patient. Has the ministry given any direction to hospitals, given the findings in this report, for those two areas?

Hon. P. Priddy: We were just having a discussion about who the report was actually prepared for. Sorry to keep you waiting.

One of the ways in which this happens most effectively is with the Joint Industry-Ministry Committee on Utilization Management, because they actually provide support and feedback to the hospitals about appropriate utilization. So yes, that direction does happen.

[E. Walsh in the chair.]

S. Hawkins: The reason I'm interested in the appropriateness of hospital admission, and the length of stay as well, is

[ Page 10233 ]

Hon. P. Priddy: It's one of those questions that you try to find a way to answer. I would not suggest to anyone that a high proportion of the surgery done in this province is unnecessary. Is there surgery that there may be another solution for? I think there probably is. But would I suggest that a high proportion of surgery is unnecessary? No, I would not.

S. Hawkins: I think the previous minister also said, if I recall correctly, that 30 percent of medical care being funded by her ministry in the province was unnecessary. Is this minister of that opinion?

Hon. P. Priddy: Hon. Chair, I have no idea what percentage of medical care might or might not be necessary in this province or any other place. Do I think that there's probably some medical care that is not necessary? Yes, I do. Do I think it's 30 percent? I would certainly hope it is not, because this is all care that is being recommended and prescribed by physicians, who I'm sure would not be overrecommending services in that proportion. I always think that there's an amount of surgery or medical care that may be unnecessary, but I certainly don't think it's the largest amount of surgical care, and I certainly don't want to believe that it's 30 percent of medical care.

S. Hawkins: In order to help emergency departments, the study did recommend -- and I think it was also the recommendation in the ambulance review done about the same time last year -- that hospitals establish a means of supporting the most appropriate decisions possible in their local environment in directing patients to the emergency department to best help meet their needs. Possible options that I can think of include setting up quick response teams and appointing a medical triage officer or nurse reviewer. Whichever mechanisms are pursued, the individual or team obviously has to be quite knowledgeable of the alternatives and available resources in the community, and personal and social care in the community as well. I'm wondering if this recommendation has been followed through and which hospitals are using this.

Hon. P. Priddy: The answer is yes, there have been a number of initiatives by emergency rooms to do so.

S. Hawkins: What kinds of solutions, then? Was it a team? Was it a nurse triage officer? What was the measure, and where has it been implemented? Which major hospitals have implemented this?

Hon. P. Priddy: I think at the time of the report, of course, that this was not accurate. Currently there is not a major hospital in the lower mainland that does not have a triage nurse in charge of doing the triage work. There are quick response teams for both mental health and medical care in most of the major hospitals, I think. Those are all things that have been put in place since the report.

S. Hawkins: I'm aware of the nursing triage staff person. It's interesting, because we had them anyway, before the ambulance review and before this study came out. When I was talking to the triage nurses in the hospitals where I've had the opportunity to observe them, they say that nothing has changed. Basically, you're still funnelling people through. There's still a backup. There's physically no space in the emergency department for the patient. We're finding, in some places, that ambulances are just dropping off patients because they have to get to another call. I wonder if the minister has had any reports back on how well this is working.

Hon. P. Priddy: Through our Lower Mainland Emergency Services Committee, we have had reports back that it's working very well, actually. That does not take away from the fact that there are real challenges in emergency departments because of all of the issues that we have talked about. The reports that we've had back from the people who sit on the Lower Mainland Emergency Services Committee are that it's working very well.

S. Hawkins: That's interesting, because I have some quotes from some of the people that work at the major hospitals. It's public information. It was reported in the Province on May 14. The headline was "Emergency in Emergency." The physician who is the head of emergency at the Royal Columbian says: "We're past the crisis point now. The emergency is full because it's the entrance to the hospital. It's the only place the overflow can come when the hospital is full." With respect to the ambulance review, Dr. Jeff Coleman, who is the VP of medical affairs at Vancouver Hospital, said that the government report "didn't address the root causes of the emergency waiting" -- one of which is that "there are no beds to put patients in." That was a quote from just this year.

The physician at St. Paul's emergency said: "We have no places to off-load patients. Given the resources the hospital has to deal with, the hospital staff can't deal with the patients fast enough." It just goes on and on. I've got lists of quotes from last year.

In the past year, what I'm hearing is that it's actually got worse. So it's interesting that the minister is hearing that it's got better. I'm not only hearing from personal experience, from visiting these places, but they're going public. Those are quotes from newspapers.

I'm wondering. . . .The minister says the program is in place to help triage and move these people through and decide if they're appropriate admissions, and to try to clear the emergency room or clear the beds in the hospitals. If she indeed believes they're working when we have public quotes and public information from the front-line workers that keep telling us that it's getting worse. . . . Is the minister hearing from the front-line workers? Where is she hearing that it's getting better? All the evidence that we have suggests that it's getting worse.

[9:45]

What triage doesn't deal with and what first response doesn't deal with are the larger issues we've talked about, which are (a) why we have a mental health plan, and (b) why

[ Page 10234 ]

What they need -- and I agree with the member -- is more beds to be able to have that quick flow into a hospital bed, if that's what the patient needs, once you've triaged in emergency. The emergency services committee on which the individual from Royal Columbian sits does agree with us and certainly would acknowledge, as we would, that alternate-level care beds are a large part of the solution to this problem, as are mental health beds. That's a huge piece that has to be dealt with, but that doesn't mean triage is not working and that doesn't mean quick response isn't working.

S. Hawkins: Just to be a devil's advocate, I'll disagree with the minister. I think that in order to get all of this working, you do need those community supports and community resources, so you can get the people plugged into the right resources when they come in. But when she talks about triage and quick response working. . . . I'll give the minister an incident.

I got a phone call at the end of February or early March. It disturbed me to hear that there was a cardiac patient -- this was just a few months ago -- who was taken to Burnaby Hospital and was waiting in the hallway in emergency. And again, ambulances were backed up. The paramedics tried to get the attention of the triage nurse or the attention of anybody in emergency. If triage was working, I think they would have identified this patient as fairly critical. The emergency room was so busy and the triage nurse apparently couldn't give the attention this patient required, so this ambulance had to call another ambulance to do drug protocol. I think the minister understands what I'm saying. The paramedics that took this patient to emergency weren't advanced life support paramedics. So to have another ambulance come to the emergency department for that emergency and give drug protocol to a patient who is lying there tells me that the triage and the quick response aren't always working. So I am concerned, because I am hearing those kinds of stories. I wonder if I can get the minister's comments on that. I'm hearing that more and more often. I don't know if the minister is being shielded from that information; I hope not. I certainly am not. I get that information given to me quite readily. Unfortunately, patients do suffer in that regard, and I was very disturbed to hear that. I don't know how often that's happening, but that's an incident that really concerned me. Here we have a cardiac patient who is in the emergency and another ambulance has to come to assist that patient, instead of the patient getting the attention they need from the physicians in emergency.

Hon. P. Priddy: I don't actually think I get shielded from very much. I talk to nurses who work in emergency and to people who work in the health care system. Partly I do it as a minister, and partly I do it because I know those people on a personal level. So I do try and take my advice from wherever I get it, not only from staff in my ministry but from the contacts I have in the health care community. I think the member agrees with that and probably has made that point in a different way -- that people who work on the front line all the time are the people who know best what's happening on a day-to-day basis, whether it's in health care or in any other field.

I think the situation the member has described is an unfortunate one. It should have been able to be dealt with in emergency. She's of course correct that another ALS-trained person or a team was called to be able to administer cardiac drugs. I'm not for a minute suggesting that because there's a triage nurse in every lower mainland and large hospital and a quick response team in every hospital, suddenly everything is working well. Does it work all the time? No. I wouldn't for a minute stand here and try and say that. But is it better than when we had no triage nurses at all? We followed up on that, and there are, and yes, it is better as a result of that. Is it better because there are quick response teams in place? Yes, it is better.

The thing that will improve the system the most -- and I said this a moment ago -- is being able to free up beds occupied by people who don't need to be in those particular beds -- they need more appropriate care -- so that there is a place for those people to go where the triage people and the quick response people can do the good work they can do. I don't know this, but I expect that in the situation the member described. . . . Sometimes emergency just gets really busy anyway, but part of it is the backup, in not being able to get people through and into a hospital bed. That's why we've taken on the mental health plan and the continuing-care review. I said that it was one of my primary commitments as the minister to reduce wait times. Reducing wait times is about that issue we've talked about, which is freeing up hospital beds.

S. Hawkins: I'm willing to give up the painful extraction, in trying to get through these recommendations, if the minister will agree to look at this report and tell me what recommendations have been followed through to the extent they have and what work needs to be done on the recommendations in this report. If the minister is willing to do this, and noting the hour, I'm willing to give this up and move on to something new tomorrow.

Hon. P. Priddy: I'm happy to make sure that I have reviewed the report. I'm happy to ensure that we give feedback on the recommendations either that we have taken up or the ones we have not. There may be ones that for whatever reason the ministry is choosing not to take up, and we will indicate those to the member as well.

Seeing the time. . . . I don't know if it's another major piece that the member wanted to move on to. You're finished with that section. I know we have six minutes left, and I realize that most people would rather spend that six minutes moving onto another issue, but it's probably not long enough to do a really big piece. So perhaps I could move that the committee rise, report progress and ask leave to sit again,

Motion approved.

The House resumed; the Speaker in the chair.

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

Hon. P. Priddy: Hon. Speaker, I move, quite early, that the House do now adjourn.

Motion approved.

The House adjourned at 9:56 p.m.

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