[ Page 10543 ]

The House met at 2:09 p.m.

M. Coell: In Walnut Grove over the weekend, Saanich's Layritz Little League major girls team, aged 12 to 13, and senior girls team, aged 14 to 15, both won the provincial Little League championships. The major girls will go on to play in Victoria in a couple of weeks, and the senior team will represent the province in Windsor, Ontario. The member for Saanich South and I have kicked off their tournaments many a time. So on behalf of both of us, would the House please congratulate these young ladies.

Hon. D. Miller: Visiting in the gallery today is Dianne Schuett, who works for the Clerk of the House in New Hampshire. With Ms. Schuett is her mother Del Ericson and her sister Karen Ericson. Apparently they are having a wonderful time in Victoria. I would ask the House to please make them welcome.

D. Symons: In the gallery today we have a gentleman whose attendance this session has been just about as good as most of us down here on the floor. Sometimes I wonder whether this gentleman should be congratulated for his attendance or whether we should be concerned about him. Nevertheless, Campbell Achinson has been here time and again. I'd like the House to welcome him and thank him for attending.

S. Orcherton: I just looked up in the gallery and noticed that Councillor Bea Holland, from the city of Victoria, has joined us this afternoon. Councillor Holland and I and some other members of this assembly were recently at a very nice ceremony at Centennial Square, where the Minister of Small Business, Tourism and Culture announced that the B.C. Summer Games for the year 2000 will be held in Victoria. So I'd ask the House to make Councillor Holland welcome, and I extend my congratulations to the city of Victoria for this wonderful achievement.

Hon. D. Zirnhelt: Visiting us from Victoria is Barrie Tebrugge. Please make Barrie welcome.

W. Hartley: I am pleased to welcome some constituents in the gallery today: Susan Heard and Barb Gallant. I believe that Gemma Heard and Tegan Heard are accompanying them. I'd like the House to make them welcome.

The Speaker: I have an introduction. I'm pleased to welcome to this chamber some very special friends of mine, Rev. Bob MacRae and his wife Susan. I'd also like to introduce Councillor Bea Holland. Would the House please make these dear friends of mine welcome.

Oral Questions

NISGA'A TREATY AGREEMENT AND VALUE OF WATER RESERVATIONS

Hon. C. McGregor: It's my pleasure to have the opportunity to engage in a bit of a discussion around the Nisga'a agreement and those responsibilities that fall under my ministry.

In terms of water values, the member is right: there is no value that has actually been attached to the water rights that are attributed to the Nisga'a in this agreement. I can certainly take it upon myself, though, to talk with my staff and see if they can provide an approximate value for the member.

G. Campbell: The Nisga'a also have an unspecified water reservation for hydro power projects and storage under the final agreement. In section 118 of the "Lands and Resources" chapter of the Nisga'a agreement-in-principle, it's specified: "Prior to the final agreement, British Columbia will take such steps as are necessary to remove the B.C. Hydro water reservation on the Nass River." Can the minister tell us if B.C. Hydro has surrendered its water reservation on the Nass? If so, can she tell us what the cost of buying back that water would be if it were required by Hydro, after giving it up?

Hon. C. McGregor: To the best of my knowledge, B.C. Hydro has given up its water rights on the Nass River.

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

G. Campbell: Could the Minister of Environment tell me what the government estimates the potential costs will be for Hydro to buy back the water that it already had, if it needs it?

[2:15]

NISGA'A TREATY AGREEMENT AND VALUE OF TIMBER

Hon. D. Zirnhelt: Hon. Speaker, as you know, there are a number of ways of estimating the value of timber. To my knowledge, there was a wide range of estimates of the value of the timber. They ranged from $20-some million to $70 million, depending on the price. The $36 million that was in there was a negotiated value. It was the parties coming

[ Page 10544 ]

The Speaker: First supplementary, the member for Matsqui.

M. de Jong: That's not very helpful to the people of British Columbia, whose basic question is: how much?

I'll try this another way. I understand that there is a large discrepancy between what the government thinks the Nisga'a timber is worth and what some private experts believe that number is. That relates to the amount of wood actually in the area. Can the minister tell us this: how many cubic metres of merchantable timber are in the area of the Nass watershed that the Nisga'a will own after ratification of the treaty?

Hon. D. Zirnhelt: As I understand, it was the land with the trees on it that was valued by the accountants advising the teams. As I say, the value of the timber was in a range, and it would really depend on the market. There was a range, and we agreed on an average cost; that cost was $36 million. If there's additional information that can be provided, I'd be happy to do that.

G. Abbott: My question is also to the Minister of Forests. The notional value of the land and the forgone forest revenue estimates are both based on the amount and value of the wood that will be transferred to the Nisga'a. A lower annual allowable cut results in a lower estimate of land value and forgone revenues.

Can the Minister of Forests confirm that the AAC in the area in question dropped dramatically around the time of the Nisga'a AIP? And will he table the historical AAC for each of the areas where harvesting rates have been specified in the forest resources chapter of the Nisga'a final agreement?

Hon. D. Zirnhelt: Yes, I'd be pleased to table the historical AAC, but I'd like members to realize that this is an area that has in the past probably been overcut. In the past couple of decades, there has been an overcut in TFL 1. There's a lot of restoration work to be done there. The Nisga'a and the government agreed on what the AAC would be; it's agreed to be coming down.

What would the chief forester do? I can't speak for him; he has to make a determination. There will be determinations, and there will be negotiations over what that AAC will be in the future.

The Speaker: First supplementary, the member for Shuswap.

G. Abbott: Under sections 73 and 74 of the forest resources chapter, the Nisga'a will be eligible to apply for FRBC grants. Yet the Nisga'a won't pay a penny to either Forest Renewal B.C. or indeed the provincial treasury in stumpage, royalties or any other fee for timber harvested on Nisga'a lands. Can the Minister of Forests explain why the Nisga'a should be eligible for FRBC funding if they are not required to contribute to FRBC?

Hon. D. Zirnhelt: As I said, the dollars would be for restoration -- watershed restoration and so on. It was the point of the negotiations around this matter to ensure that the land was restored to its productive capacity and that the watersheds were restored, and on that basis they remain eligible. When it becomes private land, it's my understanding that the eligibility will be different. The whole intent was to ensure that the Nisga'a were comfortable that it was not a degraded resource that was turned over to them and that it was restored to its productive capacity, and I think that's fair. It's already been overcut badly. The fact that there may be a declining AAC has been taken into account, and we negotiated a fairly long transition period in the area to provide security for mills that are operating there.

FEDERAL ASSISTANCE FOR CROP FAILURES IN PEACE REGION

Hon. C. Evans: During the two-year rainy period in the Peace, we repeatedly tried to engage the federal government in responding in the fashion in which they did in Quebec with the ice storm and in Manitoba with the floods. My official correspondences with the minister have been three: two in writing, which I'll be glad to send to the member if he doesn't have them already, and one on the telephone from a hotel in Prince George -- in fact, on the day I was meeting with producers. I asked the federal minister directly: "If the province calls this a disaster tomorrow morning in the news. . . ." I've been calling it a disaster for six months. "If we call it a disaster in the newspaper, does that change the nature of your response?" And his answer was: "Disasters, to the federal government, only pay off on uninsurable losses." Since crops are insurable, he said the change would be zero. I was quite offended and startled to hear him tell a different story in the Peace last week. But the hon. member and his constituents know what we asked for last year and what his response was.

J. Weisgerber: My congratulations to the minister's staff for briefing him.

In fact, I was at a meeting with the federal Minister of Agriculture, and I was shocked to hear him say that British Columbia hadn't asked for assistance -- that the reason assistance was available for Quebec and Manitoba, for their disasters, was that those provinces had asked; British Columbia had not. Obviously the minister is aware of those comments by the federal minister. In essence, the federal minister said that this minister had done nothing to help provincial farmers. Has the minister responded to Ottawa, to Mr. Vanclief, since his comments in Dawson Creek last week?

Hon. C. Evans: The hon. member suggests that the federal minister has demeaned me somewhat in his comments and invites me to respond. My response was delivered in person last Saturday morning, at the Hotel Vancouver, where I met with the federal minister and informed him of the provincial position and what it had been for the last year, and that we are offended by his position. But more than that. . . .

Interjections.

[ Page 10545 ]

Hon. C. Evans: As soon as the official opposition is finished, I'll respond to the real opposition.

Interjections.

The Speaker: Members. . . .

Hon. C. Evans: Hon. Speaker, my struggle is not with the federal minister or the federal government; it is to restore the economy in the Peace. That has been the objective of this government -- from the Minister of Northern Development appointing a person to be responsible for the development of that economy, to attempting to marry the railroads, to the Minister of Environment extending the ag leases, to the Minister of Transportation spending $100 million on roads. I don't care what the hon. minister Vanclief does; we're going to make it work in the Peace.

Interjections.

The Speaker: Order, members.

WIDENING OF STANLEY PARK CAUSEWAY

Hon. H. Lali: I'm very, very disappointed with the decision that Mr. Wilson and the parks board have made. We were in negotiations with them on the particular issue that the hon. member has mentioned. We wanted to widen the causeway so that vehicles, pedestrians, cyclists, etc., could all travel in a safe and efficient manner. We were going to do a series of park improvements as a result of that as well. But I guess the parks board has left us no room on this particular issue. I know that the local MLA, the member for Vancouver-Burrard, has been working diligently on behalf of his constituents, who are telling him that we need to make the causeway wider and safer and do some improvements to the park. But the parks board has left us no position on that, except to just go ahead with the existing causeway and resurface accordingly, from curb to curb.

The Speaker: First supplementary, the member for West Vancouver-Capilano.

J. Dalton: In point of fact, on May 22, when the minister announced the rehab job, there was no reference to widening the causeway. In his July package, which I have a copy of, there's no reference to widening the causeway. It's only the member from Burrard who has told me personally that for safety reasons, he does favour the widening of the causeway. The parks board, of course, has foreclosed that option. My question to the Minister of Transportation and Highways is: can he tell us how he intends to improve traffic safety when he cannot widen that roadway?

Hon. H. Lali: The member takes a typically Liberal, hypocritical position. The member across the way has opposed every option that this government has put forward for the last several years. I would say that the member should go back and talk to Mr. Wilson, who was a Liberal candidate in the last election and was beaten by the member for Vancouver-Burrard. Now they're playing politics with this issue. I say to the member: quit playing politics and get on with the real issues.

Interjections.

The Speaker: Members will come to order.

Reports from Committees

Motion approved.

F. Gingell: Hon. Speaker, I ask leave of the House to suspend the rules to permit the moving of a motion to adopt the report.

Leave granted.

[2:30]

I move that the report be adopted.

Motion approved.

Tabling Documents

Hon. Speaker, I respectfully present the report on guarantees and indemnities authorized and issued for the fiscal year ended March 31, 1998.

I respectfully present the unclaimed money deposits report for the fiscal year ended March 31, 1998. This report was previously delivered to the Clerk of the Legislative Assembly in accordance with section 3 of the Unclaimed Money Act. No one's name in this chamber appears, hon. Speaker. [Laughter.]

I seek leave from the House for the Special Committee on Selection to meet today during House hours.

Leave granted.

[ Page 10546 ]

Motions without Notice

Leave granted.

REFERRAL OF AUDITOR GENERAL REPORTS
TO PUBLIC ACCOUNTS COMMITTEE

["That reports of the Auditor General of British Columbia deposited with the Speaker of the Legislative Assembly during a period of adjournment during the Third Session of the Thirty-sixth Parliament be deemed referred to the Select Standing Committee on Public Accounts."]

SELECT STANDING COMMITTEE ON FORESTS,
ENERGY,MINES AND PETROLEUM RESOURCES

["That in addition to the powers previously conferred upon the Select Standing Committee on Forests, Energy, Mines and Petroleum Resources the Committee be empowered:(a) to appoint of their number one, or more subcommittees and to refer to such subcommittees any of the matters referred to the Committee;

(b) to sit during a period in which the House is adjourned and during the recess after prorogation until the next following Session;

(c) to adjourn from place to place as may be convenient;

and shall report to the House as soon as possible, or following any adjournment, or at the next following Session, as the case may be; to deposit the original of its reports with the Clerk of the Legislative Assembly during a period of adjournment and upon resumption of the sittings of the House, the Chair shall present all reports to the Legislative Assembly."]

Petitions

Orders of the Day

The House in Committee of Supply; W. Hartley in the chair.

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

J. Weisgerber: I just want to take a few minutes to raise an issue that I have just become aware of. I want to thank the opposition Health critic for allowing me to raise the point at this time.

It's come to my attention that the community of Chetwynd, which normally has five physicians, is now down to two physicians, one of whom is leaving on holidays next week. We've gone from five physicians in Chetwynd to two, with one of them leaving on vacation next week. The two remaining physicians have apparently been unable to find anyone to come in and do a locum in the community. What we're facing in Chetwynd is a community normally serviced by five or six doctors being left with only one doctor. One can only imagine the amount of stress that is going to put on that remaining doctor. One always worries that you'll wind up with none in a situation like that.

I've gone back to look at the Dobbin report. While Ms. Dobbin hopes that as a result of her recommendations, locums will be more readily available, she has also made recommendations with respect to communities with two or fewer doctors and no hospital. Chetwynd has a hospital, although its services are quite significantly curtailed.

I'm wondering if the minister can give me any sense of what help the community might expect from the Ministry of Health in what is pretty clearly a crisis developing in that community.

Hon. P. Priddy: The situation currently in Chetwynd, I think, is a really difficult one. We have been working with the city of Chetwynd, and we do have a locum prepared to go in on September 1. I think there will be a two-week period when that locum will not be there, between one person leaving and them starting. I will say that in August it's particularly hard to find locums. In the short term, we will have a locum going in on September 1. The other kinds of solutions have to do with some of the things we've talked about, like funding medical students and more rural residencies that we pay for to give people experience in small communities. But we have managed to find a locum to go in.

J. Weisgerber: I appreciate the work that's being done, and I'm relieved to hear that a locum has been identified for September. However, that probably leaves a good portion of August -- two weeks in August, at least -- with only one doctor. I know that one reaction might be -- and I'm not suggesting that it's the minister's -- to say to the doctors: "Look, don't take holidays in July and August. That's a busy time; it's hard to find locums." But if a doctor has a young family, then I think all of us understand the family pressures to get some vacation time while school is out for summer holidays.

Again, I want to say that I appreciate the efforts the ministry has been making. Is there no way that we can find a locum to go in for that two-week period? I look at the Dobbin report, recommendations 6 and 6(a) particularly. If the minister doesn't have a copy, I can appreciate that. If the minister likes, I will read out the recommendations. What Ms. Dobbin says is that frequent locums, if they were available, should be provided by the local health authorities. In other words, the recommendation is that local health authorities work with the appropriate divisions of the ministry to achieve some equitable means of supporting physicians in northern isolation allowance communities with no hospital and one or two doctors.

Technically, I guess, Chetwynd doesn't meet that criterion, but it's a fine technical point. The reason I raise recom-

[ Page 10547 ]

Hon. P. Priddy: I'm prepared to look at anything that would be able to ease those two weeks. It doesn't seem, however, that the current. . . . From the people we've talked to. . . . We've canvassed all the new medical school graduates, etc., in terms of going in as a locum. At this stage this does not seem to be a money issue; it is about simply not being able to find a locum during that period of time. Students have just graduated; people are off on holidays. By the way, I wouldn't for a minute suggest that physicians with little kids shouldn't take summer holidays. They should; it's important that they do.

We will continue to try as hard as we can to find someone, but as I say, it is very difficult, and in all of the places we've canvassed so far there is no one for those two weeks.

[2:45]

S. Hawkins: I can certainly understand the concerns the member for Peace River South has. I think I raised it earlier in estimates that the town of Chetwynd. . . . I believe that Charlie Lasser, the mayor, told me that they've been through 75 doctors in the last four years. That number was incredible to me. I hope I have those statistics right. But that is the kind of pressure that a town goes through. Hopefully, we can find them some relief.

I want to talk about waiting lists for a little while this afternoon. It's interesting, because I think that in the opening remarks, the minister stood up and said: "Excessive waiting times. . . ." She said there were some exceptional cases. I want to show the minister this. These are just some of the letters and information that I have collected on waiting lists from patients in this province. This is about one-quarter of my file. If this is just exceptional, I would hate to see what the ordinary person goes through.

I want to spend a little bit of time on waiting lists, because I think it's something that is of foremost concern to patients across the province. I want to read some letters out, because I think it's important to bring patients' voices into this chamber. I don't think we should be dismissing patients' concerns. I know that the government put out a report in November and said that there were no problems with waiting lists in the province and that, in fact, patients were doing okay as far as wait lists were concerned. But we know that as soon as the government put out the November '97 report, there were many patients and groups around the province that dismissed that report. In fact, the BCMA head at that time called the report a cruel hoax.

For the minister's information, we received a lot of letters around that. The member for Okanagan-Boundary has a patient who wrote to him and sent me a copy. He said: "The NDP say there's no wait for surgery. I'm 76 years old. I saw" -- and he mentions his doctor in Penticton -- "in March, and I need both knees replaced. My surgery date is April, 1999, which is over a year away."

We have another one who wrote to the minister a month ago, and I got a copy. This lady says she is a staunch NDP supporter, has served 13 years on a local board and is chair of the health council and an original member of the regional health board. She had, until then -- the letter was written June 9 -- "a great respect for the difficulties encountered in the health system. Then," she says, "I had radical surgery for breast cancer three years ago and now have a lump in my throat." She first went to her doctor in Vernon on April 27 of this year. An ultrasound followed; a CAT scan was ordered. The first available date was July 8, which is several months down the road.

I know the member from Vernon is very concerned about CT scan waits in her riding. I don't know if she'll have the opportunity to stand up today and talk about it.

This lady felt, and perhaps her doctor felt, that she needed a CAT scan earlier. She did say she moved it up to June 1, but she had to drive to Kamloops from Enderby to get it. She said she received the results on June 8 and was told the chances of cancer recurrence is 50-50. Surgery is a must, but because of the long wait-lists, it's not a possibility until July. These are typical letters that I get. She says that waiting six weeks for test results and a further four to seven weeks for surgery at the hospital, which is her regional hospital, is not acceptable. She feels that government politics and cutbacks are playing Russian roulette with her life, and she says: "I don't feel this system should be acceptable to anyone. I'm rightly angry at a system that allows this to occur." And she demands change.

I could go through a lot of them. There was a report earlier this spring about a young man who needed hernia surgery and went back to Quebec, which was his home province. He's a B.C. resident, but his parents arranged for him to fly back to Quebec and have his surgery there because he couldn't get in anywhere here.

In response to the ministry's wait-list report done in November, the BCMA published another report in March. Lo and behold, that report showed that the wait-list waits -- and they actually regionalized the wait-list -- were almost double what the government report showed. So again, it makes me sad that the government and the BCMA can't work together. I understand that the BCMA has asked to share the information that the government has on how they compile their wait-list. They are very willing, and I understand that the new president, as well, is very willing to work with the ministry on wait-list numbers and wait-times, in addressing how they will be able to shorten the wait-list. But my information to date is that the government isn't willing to share that information with the BCMA.

So the BCMA commissioned their own study. They canvassed physicians, cardiologists, orthopedic surgeons and ophthalmologists across the province, and then they sorted out the wait-list by region. Again, their information was that patients were waiting at least double the time that the government reported. Well, that's concerning. Somewhere in there, I guess, is the truth. I would hate to think that the waiting lists are as long as the doctors are reporting in their report, but I understand that patients are confirming what the physicians are saying more than what the government is saying. I would hope that the minister would be able to work with the BCMA,

[ Page 10548 ]

It's disturbing to me, too, because I get a lot of calls from patients who are asking their physician when they're going to get the surgery. They find out that their surgery is going to be in. . . . You know, if it's something that's relatively simple, they don't know why they have to wait six months or a year. If it's orthopedic surgery -- say a joint replacement -- many patients are having to wait a year. So they write to the minister, and this is the kind of response the minister sends back. I'm quoting from a letter dated June 24, 1998, written to Ms. Barbara Krapec, who is the daughter of a patient in my riding. The writer of the letter writes to her: "Whether or not a patient is considered for emergency surgery or placed on a waiting list for surgery, his or her priority on the waiting list is determined by the physician providing his or her care. This is based on their assessment of the patient's medical condition, the degree of urgency of treatment and options available for timely care."

Well, it's very easy for the ministry and the minister to pass the buck and say that it's the doctor who decides. But you know what? I meet with physicians around the province, and they can only do with what resources they are given. If they are given only so much OR time, if they are given only so many hospital beds to work with and if they are given only so much funding for knee replacements or hip replacements or cancer treatments, that's all they can do. I think that it's very dismissive for the minister to be writing letters to patients, saying: "Hey, it's not our fault. Talk to your doctor." Well, you know what? I met with a group of physicians yesterday, and they're very concerned with that kind of language in letters from the ministry. What they tell me is that they are now doing more emergency and urgent surgery than elective surgery. The minister is absolutely right: in a way they do control the wait-lists, because they'll take the most emergent and urgent patients first, and the elective patients get bumped to the bottom of the list, over and over and over again. Those waits for elective surgery are getting longer and longer, because the more emergent patients are being done first.

I want to know from the minister what she is doing to address those concerns of patients, because we have had some very public outcries from patients and families. Just a couple of weeks ago the member for Shuswap stood up and addressed the concern of a constituent of his, Mrs. Jane Nicholson, who had been waiting a year for heart valve replacement surgery -- for cardiac surgery. Within a couple of days of the member for Shuswap raising the issue, the surgery was booked. But do you know what? She was bumped again, so she has now been waiting over a year for that cardiac surgery. That kind of surgery is ideally done within three months.

In fact, I don't know if it's just a coincidence, but the member for Shuswap stood up a year ago and raised the issue of Bob Goodgame, who, again, was a younger gentleman. I believe Mrs. Nicholson is in her early fifties. Mr. Goodgame is in his mid-forties, and he was raising a family. He had a disability from work. He wanted his cardiac surgery, he said, so that he could go back and be a productive member of society, pay taxes and live a good life -- and he had children to support. He waited a year. In fact, we raised the issue because he had his surgery booked for April 1 last year, and in a very cruel way, it was cancelled on April Fools' Day. You know what? Within a couple of days of raising the issue of Mr. Goodgame -- on, I believe it was a Tuesday or Wednesday -- he got his surgery on the Friday of that week.

I have to say that it saddens me. It's a patient's right to go public with these issues, but it seems to me that when a patient goes public, that's when they get their surgery. It saddens me, because I wonder and I question. . . . I always wonder whether or not I will take a patient's case public -- because they do move up the list. It frightens me because perhaps they have bumped someone else off the list. That scares me. If that is how we're running our health care system, so that we get the people who make all the noise out of the way. . . . I've seen that happen a couple of times, and that's why I really question whether. . . . It's a real struggle as to whether I should raise a patient's profile in the chamber here, because as soon as we get out in the hallway, the ministry wants the name of that person, and within a couple of days, that surgery is usually booked. That's great, but I wonder if someone else has been bumped out of the way for that patient. I don't think that's the way we should be managing a health care system.

I think that every one of us -- and some of the members opposite too -- has patients in their riding who have these kinds of concerns. I don't think there is anyone in the chamber who hasn't received a letter from a patient on a waiting list. To raise them in this chamber or to raise them publicly, and then to see their cases go forward. . . . That frightens me. I would like to raise every letter publicly, but I don't think that's how should we manage waiting lists in this province.

For the last couple of years I have challenged the Health minister -- the previous Health minister and certainly this one -- to come up with a plan for waiting lists in this province. That is a serious concern for patients in all of our ridings, in all of our health regions. Frankly, I don't think it's good enough to just deal with the issue when it arises in the media, splashes on the front page of a paper or becomes very public because a patient dies.

[3:00]

The ministry did an internal report and said: "Mr. Georgiou did not die on the waiting list." Well, he never had a chance to make the waiting list. But you know what? He died waiting. The semantics of whether you're on a waiting list or whether you're waiting. . . . I don't want to play those kinds of word games. The ministry and the minister have been engaging in those kinds of games, and I refuse to. Mr. Georgiou died waiting. No, he was not on the waiting list. He died waiting, and he died in the cardiac centre for excellence in this province. Mr. Georgiou was an urgent case.

I believe the report that was done internally by the ministry said that Mr. Georgiou wasn't even in the CCU, the coronary care unit -- I recall that very clearly -- in Kelowna General Hospital. You know what? I wonder if the person who wrote the report even knew that Kelowna General Hospital doesn't have a coronary care unit. There is a telemetry unit on the coronary ward. There was no room in intensive care for Mr. Georgiou, so he waited in Kelowna General Hospital, on the cardiac ward, in the telemetry unit. Let's be very clear: Kelowna General Hospital does not have a coro-

[ Page 10549 ]

When he finally got moved. . . . I know that the ministry has all that documentation, as do I. There were letters -- very good documentation -- and phone calls going back and forth between the hospital and St. Paul's, urgently asking that this gentleman be transferred to St. Paul's for his surgery. What a stress that puts on the family. His wife. . . . I'm going to ask the minister, hon. Chair, to comment on that case, because I think we're still trying to get the details of that case. Could she comment on whether she thinks he died on the waiting list or if he died waiting. . . ?

Hon. P. Priddy: I don't know the appropriateness, regardless of having all the documentation, of the minister making a judgment about whether somebody died on a waiting list or not. What I do know about these particular circumstances -- and I think it's been publicized enough that it's okay for me to comment on it -- is that the individual in question arrived at St. Paul's Hospital, was placed, I believe, in the ICU for two or three hours, and then was put back on a general ward. St. Paul's staff were carrying out more tests. He was assessed as a semi-urgent case, and during the time the tests were going on, he had a fatal heart attack. So I don't think. . . I don't know how far this advances us by talking about whether this individual and the tragedy in his family's lives was about whether he was or was not on the wait-list.

But I would say a couple of things. The member asked earlier about how wait-times are assessed. Yes, there was a difference between the report the ministry put out last November, as I understand it -- not being here, but as I understand it -- and the report the BCMA put out. I think that the difference between these two. . . . Probably both reports are accurate but count differently. The only way we are able to count a wait time is from the time the patient is actually referred to the hospital. We can only measure from the time the patient is referred to the hospital as a potential patient for surgery until the time the surgery is done. What the physicians are able to measure is from the time the family physician refers the patient to a surgeon. The person sees the surgeon, who says yea or nay, and then the person is referred to hospital.

We have actually written to the BCMA and offered to work with them in order to establish wait-times that are accurate and that do reflect real wait-times. At this stage we have no access to the data that lets us do anything but from the hospital referral on. But we are very anxious to work with the BCMA, if they will -- and I'm sure that they would want to work with us -- to help establish a wait-time that we can have at least some reasonable agreement about, so everybody is not out there with different numbers. It's confusing to patients. It must be fair and accurately reflect wait-times, because I've acknowledged that it is a problem in lots of areas.

While there is still a problem with wait-times -- and there's no question about that; I've never suggested otherwise -- we're now doing 12,000 more surgeries a year than we were doing three to four years ago. As the member knows, we have $22 million in new dollars for wait-times this year: $8.5 million for cardiac wait-times and the remaining for wait-times in other areas. So in this year's budget alone there's an additional $22 million for wait-times and 12,000 more surgeries than we were doing three to four years ago.

S. Hawkins: The reason I raised the issue of Mr. Georgiou in the House is that his wife requested me to. I think it does advance the issue greatly, because this epitomizes what's wrong with the system. This man died in the cardiac centre for excellence, waiting for urgent surgery. I would submit to the minister that he wasn't semi-urgent; he was urgent. Unfortunately, he was admitted to St. Paul's Hospital around Remembrance Day. Unfortunately, he kept getting bumped by patients who were even more urgent; that means they were emergency patients. What I'm hearing from cardiac surgeons, cardiologists and families around the province is that the only way they're getting their surgery is when they get so sick that they become an emergency or an urgent case. That's when they get their surgery.

This minister or the previous minister struck a cardiac panel to look at cardiac surgery around the province. I remember the minister's press release on May 15. There are tons of press releases on wait-lists here. But on May 15, earlier this year, the press release was very happy: "Well, we're doing a great job." But what the press release failed to report was that the median wait-list for cardiac surgeries has more than doubled since this government came to power. It was seven weeks in 1991; it's 16 weeks today. That's from the minister's own report, which was made public on Friday, May 15. Again, it's interesting, because the minister released that report on a Friday, before a weekend, hoping to slide it in and bury it in a weekend. But I don't think these kinds of important things can be buried. So the median wait-list has more than doubled since the NDP came into power in 1991. It was seven weeks; now it's 16 weeks.

The number of patients forced to wait longer than six months for cardiac surgery has tripled in this province. I don't think that's anything to be proud of. The wait-list for cardiac surgery, according to the minister's report, is the worst that it's ever been in history. A cardiac patient today has a 1-in-5 chance of getting their cardiac surgery within the recommended time frame. You have a 20 percent chance, if you're a patient on the wait-list, of getting your surgery within the recommended time frame. Patients who are very urgent, a very urgent cardiac patient. . . . If you're unlucky enough to be in that category, you have a 1-in-7 chance of getting that surgery done within the recommended 72-hour time frame. I don't think that's anything to be proud of.

There's a table in the report on page 7. That's disturbing too. The number of patients who have died waiting for urgent surgery is double the number normally expected. The table caption says that mortality increases by the urgency of the surgery. The very high mortality for the very urgent cases indicates the need for more timely surgery for those patients.

Then the minister was looking for another jurisdiction that maybe had worse statistics, to compare to B.C.'s. They decided to look at Ontario. But you know what? Lo and behold, in comparison, the death rate on the wait-list in B.C. is worse than in Ontario. That should be a wake-up call.

According to the minister's report, St. Paul's Hospital, the cardiac centre for excellence in our province, has the longest median wait, at more than 20 weeks. Now, I don't know if that's something to be proud of. That's our cardiac centre for excellence. And something I think we're all aware of and that we're finally starting to wake up to is that northern and rural patients wait at least five weeks longer than patients in the lower mainland and Victoria do. I think we always knew that there was inequity in waiting times between rural patients and urban patients, but this report certainly draws that line.

So there's a lot of disturbing things that the minister didn't tell the public in her press release. We did go through

[ Page 10550 ]

The minister has made it clear to the BCMA that they're willing to work with them on the waiting list issue. Well, I haven't seen a lot of planning on how that's going to be done. I have looked at other jurisdictions. I've looked at Ontario and what they've done with their cardiac surgery program. They've got a network; they're computerized. They have an information system that tracks patients on the waiting list. I don't see anything like that set up for B.C.

We're talking about accountability here. The minister talks about money that goes in every year to waiting lists. Every year she says they put in more and more money for waiting lists. But you know what? The facts bear out that every year the waiting lists are getting longer and longer. Maybe this is a project for the auditor general; perhaps the auditor general will do a value-for-money audit on waiting lists in the province -- if indeed the money that the ministry puts towards waiting lists actually gets there and if they are actually doing the job they're supposed to do in reducing the waiting lists. But we haven't seen that. We can only go by what the minister is saying: they're putting money in every year for waiting lists. We're finding that the waiting lists aren't going down; in fact, the waiting lists are getting longer.

Last November the then Minister of Health -- who is now the Minister of Finance -- said, first of all, that there was absolutely no problem with waiting lists. Then, when she recognized that waiting lists had gone from 300 to 500 patients within a span of about eight months, she said that was a spike. Well, I would put to the minister -- and to this minister -- that it's quite a spike of patients on that list. Then the minister put $1 million into the list at that time. We don't know if that actually did anything.

Again, I would put to the minister that it's a matter of accountability. You're putting more and more money all the time into reducing waiting lists. That's what the ministry has been saying in the last many -- I don't know how many -- years. It has been a very public issue. I think the minister and previous ministers have had to show that they're actually doing something. In very public announcements, they say: "We're putting this much money into the waiting lists. We're putting in $1 million here, $8.5 million here." This minister stands up and says: "We're putting $22 million into reducing wait-lists."

[3:15]

Hon. P. Priddy: The member has raised many issues. Let me respond to two or three of them. One of them is that when we released the cardiac-wait-time report, we tried to find a place that had worse or better statistics than we did. The only other place in the country that keeps cardiac statistics is the province of Ontario, although they count them somewhat differently. If we used exactly the same counting statistics as Ontario, there would still be some difference. Ontario reports a 0.6 percent wait-list mortality, and B.C. reports a 0.66 percent wait-list mortality. We compared it with the only other jurisdiction that actually happens to keep that data. In terms of wait-times accountability, what is going on to reduce times and whether all of the wait-times are increasing, the member is quite correct: we saw a significant increase in cardiac wait-times.

As a result of that, my predecessor did strike a cardiac panel. That cardiac panel was part of the press release that the member has. Anything we said was based entirely on that report, which had consensus by the cardiologists and cardiac surgeons who were on that committee.

Yes, there are surgeries for which the median wait-time has gone up, and there are some for which it has gone down. Of course, we hear far more about the ones where it has gone up than gone down. I've mentioned the one for cardiac surgery, which is probably the most notable, along with orthopedic surgery. But I would note that cataract surgery is down over last year. General surgery is about the same. Gynecology is down just a little bit. Urology is down more. Dental surgery is up a bit. There are some examples of the number of people waiting and the wait-times. So the member is correct: it's up in some areas, and particularly it was up in cardiac. The cardiac dollars are now approved and going out to the regions. The regions know what kinds of resources they're getting for that, and that is completed.

We have struck the same kind of orthopedic review panel, because we know that it's the area we hear the most about in terms of waiting times. Yes, there are differences across the province. There are also differences in terms of the number of surgeons providing surgery. One of the things. . . . As I mentioned to the member for Okanagan-Penticton last night, while it is not always possible in a community to refer to another surgeon -- and in some communities they work quite well together -- there is quite an astounding difference in some communities between the wait-times of surgeons who perform the same kinds of surgery. So there is always the option of the general practitioner referring to a surgeon with a shorter wait-time than another one. That's not always possible, but it is possible in a number of circumstances.

A third piece around accountability is the access-to-care committee that is being chaired by Mary Collins, which will be looking at the whole issue. It's called the Provincial Advisory Committee on Health Care Access, which, as I say, is being chaired by Mary Collins and will look at a number of areas, including accountability and being able to measure outcomes for the dollars that are being put into surgery wait-times.

S. Hawkins: I guess I got part of my question answered. The ministry is putting in money every year. I want to know what planning is being done around that money. The money goes in, and we don't see the outcomes as being that great, because every year the surgery waiting lists are longer and longer. Cardiac surgery is one I'm interested in, because it's a provincial program. There are only four cardiac surgery units in the province, so that's a resource that is limited. It's a provincial program; it is something that everyone in the province, presumably, should have access to. That is one that I'm particularly interested in today.

I know that in Ontario they have 13 -- I could be wrong -- centres. They had the same problem, where they were throwing in money. Their wait-lists were getting long. Doctors were having a horrendous time trying to find the first avail-

[ Page 10551 ]

As I mentioned before, the minister's own report in May indicates that rural and northern patients wait five weeks longer, on average, than patients in the urban areas. I have some statistics from my hospital from March 1997 to October 1997 -- about an eight-month period. At Kelowna General Hospital, we were holding cardiac patients for transfer. From January '96 to October '97, the average wait for outbound referral was 6.9 days -- almost seven days. From March '97 to October '97, that went up to 7.1 days. Of the 176 local cardiac patients referred out for either surgery or angioplasty, 36 waited ten days or longer; 13 patients waited 15 or more days for transfer; and five of the patients between March and October waited 20 days or longer. They were all going to St. Paul's Hospital. Frankly, from this hospital's statistics, it's not unusual to see patients wait up to a month in the hospital.

I visited one such patient in the hospital as well. They have -- as the minister knows -- something called resting angina, so they are in pain all the time, even when they're resting. Kelowna General Hospital, as I mentioned to the minister before, does not have a coronary care unit. We have a telemetry unit, where we keep these patients. It's pretty frightening for them.

The average wait time for surgical referral to St. Paul's Hospital in August of last year was 12.1 days, and that's been going up. Those are patients in hospital. They can't be discharged; they have resting angina. They need to get into a cardiac unit to get their surgery very soon. That's what I'm saying. It's getting to the point where patients have to be in an emergency state before they can get their surgery. Many of these patients are waiting 20 or 30 days. They're often very ill, and they're waiting two or three weeks in hospital.

I don't know what the reason for that is. I'm told that as long as there's a bed somewhere in a hospital, that's okay. Well, it's not okay, because these patients in the regions outside the lower mainland need to get closer to a cardiac unit to get their surgery. We seem to be discriminating on the basis of postal code here too. The further away you are from the four cardiac units in the province, which are supposed to serve all the patients in the province, the worse off you are in getting that service when you need it. If they do arrest or dissect or whatever in Kelowna, they are not going to have the outcome that they would have if they were in a hospital bed in the lower mainland and closer to cardiac surgeons or the cardiac surgery unit.

Again, I'm asking the minister if there is indeed some planning underway. It's very easy to say: "This is a doctor problem, because they control the waiting lists. Some of them have long waiting lists; some of them have a short waiting list. You should find the one with the short waiting list." Well, you know what? It's a provincial program. It's funded by tax dollars from everyone around the province. The ministry's responsibility is to make sure that people around the province have equitable access to that service. I am wondering if there is some project underway. I know that right now a lot of the surgeons carry their lists in their back pockets. How do we know who has a long surgical wait-list and who has a short one? We find out by physicians phoning around. That's a waste of two, three, four or even more hours of phoning around to find out who has a short waiting list and who has a long waiting list. I don't think that's a very effective way of running a provincial cardiac program, especially when millions and millions of tax dollars for patient services are at stake. I think there is a better way of doing it, and we have been challenging this government and this ministry to come up with that way -- and that is getting the services together, getting it computerized, making sure that physicians in the regions have access to those units and those positions and finding out who has the short and the long waiting lists without wasting six or eight hours phoning. I know that some of the cardiologists in the regions are doing that. Over two or three days, they'll spend two or three hours a day on the phone trying to find out who has operating room time and who has an opening. That is absolutely ridiculous; that is not a good use of time. What is the plan that this ministry is working on to make sure that we know we are using time effectively, that we are using surgeons' time effectively and that we are helping physicians and patients find the cardiac surgeons with the shortest wait-lists? How are we sharing that information within those four units, so that every patient across the province has equitable access to those services?

Hon. P. Priddy: Yes, we have looked at the Ontario model. We have been working with Ontario to see how much of that model might be replicable here and how much we might need to do differently. We do have a smaller database for other areas. I think that what the member says makes sense. As I say, we are working with Ontario.

Secondly, the cardiac review panel is continuing its work and is actually continuing to look at that way of developing a database on where the beds are and how long the wait times are, so that somebody doesn't have to spend that kind of time phoning around. It's not a good use of their own professional time, and it's not efficient or efficacious for the patient.

Thirdly, the Provincial Advisory Committee on Access to Health Care is also looking at the issue of how you can manage a provincial data bank. Do we do it by particular cardiac or surgical needs? The one the member has been speaking to is around cardiac surgery. Do we do that on a broader basis? I think the last piece to this is: how do we do the work with the regions? There are lots of ways the regions can also provide that kind of coordination around available beds in their areas.

[3:30]

Hon. P. Priddy: The plan from the cardiac review committee is due in October. I don't think this report will be only about wait times. It will be a report about a database and how we can gather that information better. I know that with the cooperation of cardiologists and cardiac surgeons, we are already beginning to see a bit of a better listing, and we will see a substantially better one, I think, as a result of that. The plan is due in October.

S. Hawkins: Will the minister make the plan public?

[ Page 10552 ]

S. Hawkins: It's not just cardiac patients who are affected; it's not just orthopedic patients who are affected. It's really sad when we see kids affected. Over the last year, I've been able to look at concerns of children, and I am very, very concerned. I met with the College of Dental Surgeons, and they are extremely concerned about the waiting lists for children's dental surgery. I spoke to the head of plastic and reconstructive surgery at Children's Hospital, and he is very concerned about children's plastic and reconstructive surgery as well.

There are a lot of reasons that they give us for the delays in surgeries for children, but this minister knows. . . .I know she has worked with children. I believe that's been her nursing background. I always worked with adults. Children grow and develop, and there are certain times in their growth and development when it's ideal or beneficial for them to have the surgery they need. When they're denied the surgery at that time, it either becomes more expensive later on or causes a great deal of concern in their growth and development as they mature.

I am very, very concerned with how long the waiting lists are for kids at Children's Hospital. In particular, it was interesting. . . . Last year and earlier this year, we saw cardiac surgeons writing to their patients and saying: "My office and I are spending more time explaining to patients why they can't have the surgery when they need it. I'm sending an open letter to all my patients to explain why this is happening." Well, now we've got the head of plastic and reconstructive surgery, Douglas Courtemanche, sending an open letter to parents of kids in his office that are waiting for surgery. It's very interesting, because he does say in his letter from earlier this year:

"Dear Parents:

"I'm writing to inform you of the current status of my practice as it relates to my waiting list for surgical care.

"As you may or may not be aware, there has been a slow and steady decrease in the amount of resources available to all of the practising surgeons in British Columbia, the surgeons at Children's Hospital and the division of plastic surgery. . . .

"At present, plastic surgery has two and a quarter days a week of blocked operating time at Children's Hospital and two days a month of blocked operating time for surgical day cares at Mount St. Joseph Hospital. The operating room time is shared by five surgeons.

"My own personal practice has a waiting list of 66 patients requiring surgical day care procedures at Children's Hospital. There are 69 patients requiring in-patient surgical care at Children's Hospital. There are 49 patients waiting for surgical day care procedures at Mount St. Joseph Hospital.

"In addition, there are 36 urgent cases. Four of these are day care procedures at Mount St. Joseph Hospital, nine [are] surgical day care procedures at Children's Hospital and 23 [are] in-patient surgical procedures at Children's Hospital. All of these should be completed within the next three months."

"There is not enough blocked operating room time available to complete the necessary surgery in the next three months. Because of the long surgical waiting list, it is not possible to treat patients on a first-come, first-serve basis. Most of the practice of pediatric plastic surgery deals with the management of congenital anomalies which affect growth and development and function. Many procedures must be done at a specific time during growth and development to achieve the optimal outcome. At present" -- again, very sad -- "it is no longer possible to achieve optimal outcomes for many patients because of the unavoidable delay in obtaining appropriate access to resources for surgery."

"I have reviewed all of the patients on my waiting list with the view to possibly referring patients elsewhere. I have found, however, that my practice is already extremely limited, and there were only three patients where referring them to a community plastic surgeon for care outside of the environment of Children's Hospital and the children's centre at Mount St. Joseph Hospital would have been appropriate."

When I talked to this doctor about the letter that had gone out, he said he'd never received so much attention. I think he met with three vice presidents of the hospital on this, and lo and behold they came up with more OR time for this physician because he said he had patients on his waiting lists that were urgent. I think the ministry knows that when it's kids, it will attract a lot of attention. Certainly, with an open letter to parents, very concerned parents were spending a lot of time phoning the office. The doctor felt that his staff were spending a heck of a lot of time doing that, so he just wrote down his concerns and sent that out to parents.

Parents started lobbying, I understand, and this doctor was able to find more OR times during the month of July to deal with his most urgent cases. He was asked to prioritize his urgents into "most urgent. . . ." He was taking holidays too. Apparently there was a maternity. One of his partners had a maternity leave that he helped cover, and he hadn't taken vacation for a heck of a long time, so he wanted some vacation this summer with his kids. But they found more OR time for the time being, so he prioritized his 36 or whatever into which ones had to be done and which ones could possibly wait until September.

I asked him if he was happy with that, and basically, I don't know how happy he was with it. He said it was a temporary solution and that this is an ongoing problem. The reason he got OR time for the summer -- they opened up a couple more ORs so he could do some of those urgent kids -- is because there was some noise made about this issue by parents.

My question to the minister is: what happens in the fall? Their waiting list has doubled in the last three years. There were some operating rooms freed up so he could deal with some of his most urgent patients, but what about all those other little kids that are waiting? What about all those little kids who need that surgery? This is an oral-maxillofacial surgeon, who deals with developmental difficulties -- cleft palates and those kinds of things -- in little kids. What is the solution for these kids who are relegated to long, long wait-lists? We found a temporary solution. What is the solution for these children who, once it becomes fall, are again in long lineups waiting for their surgery, which should ideally be done within the growth and development stage that's recommended?

Hon. P. Priddy: I think it may in part have been as a result of the situation that the member just described. But the

[ Page 10553 ]

Secondly, if you look outside the Children's Hospital just for a moment -- although that is certainly where a large amount, probably the majority, of plastics work with children is done, and it's certainly where the more complex dental work with children is done -- there is dental work done in other locations. I must admit that I am unable to break it down by age for the member, but when I look at, for instance, the wait-times around dental surgery, they are down by about 5 percent this year. The median wait-time for dental surgery is actually less than it has been, and 92 percent of those patients receive treatment in under six months. The median wait-time for plastic surgery is up a little bit -- about 0.4 percent -- and 87.3 percent of the patients receive surgery within six months.

I don't have an age breakdown between children and adults, but I do know that many dental surgeons will certainly make every effort -- and I expect that is the case with plastic surgeons as well -- to see children first.

C. Clark: I want to speak to this issue more specifically, if I can. I do have a constituent who has been. . . . I guess their son is a constituent as well, although he's only two years old. His name is Adrian Jackson, and his parents contacted me. He was born with a bilateral cleft palate, and as the minister will know, that is a fairly serious condition. He's not disfigured; he's had a number of surgeries already. I think he's had three so far.

He requires surgery because his speech and language development will be very seriously affected. As the minister can appreciate, it's at this age period when it's really important that he get the surgery very quickly. Six months in the life of a two-year-old means a lot. He was originally scheduled for his fourth surgery in November of 1997. That's when he should have had it. He was one of the patients that my colleague was referring to, whose case was so urgent that the doctor did a little fancy footwork and was able to move him up in the wait-list from a year to about six months. So he had his surgery this month, I think. This was his fourth surgery. His immediate problem has been addressed, but the long-term problem is still there.

He's just one child -- right? But he's like many other children in the system. He's going to require a lot more surgery over the next few years. He's going to require them in a timely fashion, so that his speech and language development won't be unduly affected. His parents are very concerned that they are going to have to continue to look at these long wait-lists. They kind of got lucky this time. Their son's case was considered by their surgeon to be urgent. But maybe they won't be so lucky next time, and maybe he will slip through the cracks.

The minister talked a little bit about how she has devoted some money to specific wait-lists. I'd ask the minister if any thought has been given to devoting money specifically to plastic surgery for children. In my view as Jane Citizen, Adrian Jackson is going to get surgery eventually. The question is whether he gets it later and it doesn't correct his problem as well, or whether he gets it sooner and has the opportunity to develop as fully and normally as any other kid. I put that to the minister and wait for her response.

Hon. P. Priddy: I appreciate the question. I want to wait for the hospital's review, so they can tell us where they are with both plastics and dental. Often, for kids with cleft palate, you've got both going on. I don't know how many teeth he has yet, but he's going to have more. So there's this combination of both dentistry and plastics going on at coordinated times.

[3:45]

C. Clark: I appreciate the minister's commitment to that. When she was the Minister for Children and Families, she did talk a lot about early intervention and how important that was. This is another kind of early intervention for this young boy and for children in this situation. So I appreciate the minister's commitment to do that. I'd ask, too, if her ministry would consider, as part of that dedicated funding, putting some goalposts in place. Would they look at putting in enough money, so that, for example, wait-lists might be reduced to a maximum of three months or six months or whatever is reasonable for the different kinds of surgeries? Then the public could track whether the ministry -- and the ministry could track it too -- is meeting its goals and commitments to reduce that waiting list on an ongoing basis.

Hon. P. Priddy: Yes, we will look at that, but not just in that particular area. I think that across the whole country, we are in the very early days of being able to identify -- and most people haven't in most areas -- some consistency in what would be an acceptable or standard wait-time. It has been done in a couple of areas. Of course, if I'm the mother of the child or if it's my grandchild, no wait time is an acceptable wait-time. We are in the early days of being able to apply some of those standards.

When we get the information from Children's, we'll look and see if there's any way of doing that, but we also need to be able to do that in the broader context. I think it would be helpful to be able to do that with some consistency across the country, so if you move, as we did, from Nova Scotia to British Columbia or from British Columbia to Ontario, then there are some standards and consistencies around the times you might have to wait for particular procedures.

C. Clark: Just one final question: could the minister confirm for us when she expects to receive the report from Children's and when her ministry has set a deadline for acting on the recommendations in the report?

Hon. P. Priddy: No, I'm afraid I cannot, because it was not one that we actually commissioned; it was the Children's Hospital themselves that said they were going to do that. We haven't had a date from them for when it will be finished, but I'll let you know when I know.

S. Hawkins: It's interesting. A lot of the members have patients waiting in their ridings, and a lot of the members are asking that the issues be addressed. When I do see short-term fixes. . . . Children's Hospital did open up an OR and allowed

[ Page 10554 ]

I have a letter to the Premier from one of the parents, Ian Johnson. He writes to the Premier: "I'm writing to you in your capacity as Minister Responsible for Youth to request your assistance in releasing funds from the taxes we have paid to ensure that our son, Thomas Savile Johnson, receives the health care he's entitled to." This kid is on Dr. Courtemanche's wait-list.

Unfortunately, it has seemed to me, in the last two years that I've been observing the way the minister and the ministry operate, that when it hits the fan is when we get some action from the ministry. That's too bad. We do now have funds going into Children's Hospital over the summer to deal with urgent stuff, but as Dr. Courtemanche tells me, that is not going to be the long-term solution; that's a short-term solution.

We will look forward to the report from Children's Hospital. It's interesting. It's really easy, I think, to stand up and sympathize with children -- it is. I mean, they're young and they're vulnerable. A lot of these kids have physical deformities. It's very sad. I know how heartrending it was for the member who just stood up. She went to visit this little boy on his second birthday. She has pictures from a little photo album that the parents gave her to show the members what kind of situation they have been placed in.

I have letters from another one, a little girl named Melissa. Melissa has had two surgeries to remove two hairy nevus, which are very large disfiguring moles, from her head and face. Melissa was told that she is number 200 on the wait-list. She'll have to wait another year or two for further surgery to repair the disfiguring scars. By that time, Melissa is going to be in kindergarten. I don't know if some of us can remember that far back, but kids can be really cruel. I remember kindergarten, because I couldn't speak a word of English and I know how cruel that is. Little Melissa has this disfiguring facial deformity. If she has to wait two years before she gets it fixed, and she's in kindergarten, I worry about how that's going to affect how she deals with other children when she gets into that kind of situation. I'm very concerned, because parents are being made to beg and suffer for surgery for their children under this government. Dr. Courtemanche's list is at 300, but that's just one practice of plastic surgeons.

Other parents are writing and saying that their kids need surgery for cleft palates and improving speech. Some of these children can't eat properly right now; they're eating soft foods rather than normal diets. There's all kinds of stuff. The minister was giving us waiting-list times and statistics up and down. I'd be the first to say that statistics can be manipulated. I know that; I studied statistics. It's easy to hone them into wherever you want them to fit. That's why, when I look at the minister's report and the BCMA report on waiting lists, I say that the truth is somewhere in between. I know that.

She recalled for us, just a short while ago, waiting lists for dental surgery. If I recall, she said that most of them are stable or going down, and only a couple of them are going up. When I met with the College of Dental Surgeons. . . . They're very concerned. What they said to me was -- this was in June of this year -- that the waiting lists grow. The diseases become more acute and spread, the pain and discomfort rises -- this is for children -- and helplessness and frustration mount, all because of limited access to operating rooms. They say that we have exceptionally high numbers of children in need of treatment, waiting to be admitted to Children's Hospital.

So we have health care providers not only for plastic surgery but for dental surgery, who are very concerned about children in this province. They're telling us that the waiting lists continue to grow. I don't know how the ministry tracks that, but I am concerned that perhaps we deal with these kinds of issues only when they hit the media and become a crisis. Perhaps the review at Children's Hospital may very well have been sparked by Dr. Courtemanche and some of his colleagues becoming more vocal. I will be very interested in seeing that report when it comes out. Will the minister make that report from Children's Hospital public?

Hon. P. Priddy: I would suggest that that would be for the Children's Hospital to do. Not wishing to speak for them, I don't know why they would not.

S. Hawkins: Will the minister recommend to Children's Hospital that perhaps that report should be made public, seeing as there are so many concerned parents writing to us as well as to the minister?

Hon. P. Priddy: Yes, I will.

S. Hawkins: If I can, I'd like to move on to the B.C. Ambulance Service. In the last year, we've seen correspondence back and forth from all kinds of patients and paramedics, and we've seen a lot of newspaper stories on the ambulance service in the province. Maybe I'll just start off generally. I understand that the B.C. Ambulance Service is moving to a model -- the Clawson model, I understand -- to be used by paramedic dispatchers. I'm wondering if the minister can tell us why they've decided to move to this model for dispatchers and what other provinces or jurisdictions use this model.

Hon. P. Priddy: I believe the member asked about the use of the medical priority dispatch system. It's in use in about 2,500 jurisdictions around the world. Probably the closest to us geographically is Edmonton, where, it's my understanding, it is being used.

A bit of what the member asked is about the rationale behind that. It really is about standardizing the process and allowing more effective monitoring and quality improvement of the way calls are dispatched. That's why we acquired what people call MPDS -- as you referred to it, the medical priority dispatch system. It is actually a worldwide standard in lots of places throughout major Canadian and U.S. cities. People moved to it, as I said, because there is a better opportunity for quality assurance and the continuous improvement in the dispatch system to ensure that we're trying to meet people's needs.

S. Hawkins: At the present time, I understand that the dispatch personnel have paramedic experience. I wonder what level of experience they have. Or am I wrong? Are there staff who are not trained paramedics that actually work in dispatch in the service right now?

Hon. P. Priddy: The member is asking about paramedics who are dispatchers, if I have the question correctly. The majority of dispatchers are paramedics, but that doesn't necessarily fall within the qualifications of being a dispatcher. But the majority of them are.

S. Hawkins: The reason I'm asking the questions is that I understand that the paramedics association -- CUPE, the

[ Page 10555 ]

[4:00]

S. Hawkins: Has the minister heard concerns around the implementation of this new model from the front-line workers in the B.C. Ambulance Service?

Hon. P. Priddy: Hon. Chair to the member, I may have tried to put words in her mouth; I didn't intend to do that.

Around the provincial medical priority dispatch system -- because I think her last question helped me to clarify -- what we've heard from front-line workers is that they want us to be able to trust their judgment, and we do trust their judgment. What did happen is that you get a dispatch call. The dispatcher listens to the information and, based on their professional judgment, makes a determination about how that call should be dispatched. What was added to this and what the medical priority dispatch system did -- as I say, not only is it used worldwide, but the successful results are worldwide -- is say: "Yes, your professional judgment is important, but here are some questions" -- I don't know if it's like a rolodex or flip chart -- "that you can ask to distil that information in a way that ensures that you're using the best content experience, plus your professional judgment, to make that dispatch."

S. Hawkins: I will keep apprised of that situation, because I do get letters from front-line workers concerned about the changeover. So we'll have to see how that plays out.

I want to talk about ambulances being delayed at hospitals. The minister knows that there was a very public outcry the Christmas before last, when a little girl in Maple Ridge, a two-year-old, died while being delayed -- the ambulance was being delayed. Out of that, there was an external review done. The report was made public on February 24, 1997. The review was called "External Review of Interface between Ambulances and Hospital Emergency Departments." It was a report to the Ministry of Health.

Following the publication of that report and in the last year. . . . It's interesting, because I'm hearing that some of the parties that made representations to the committee that did the review didn't find a lot of their concerns in the report. Some of their concerns had to do with the available beds in the hospital. I know that earlier in estimates, this minister did acknowledge that perhaps we did have a bit of a problem with beds in hospitals. As well, the authors of that review make it very clear that the ministry or the hospitals didn't always provide them with all the information they needed to make recommendations for this report.

Before Christmas I took the opportunity to visit two major hospitals, and I actually observed a shift at St. Paul's Hospital. The shift I was on was an evening shift, from about 6 p.m. to midnight or so, on the day after welfare Wednesday. You know, it's interesting. . . . When you're on the ground level and actually working with a triage nurse and following the physicians around, you get a feel for what they're doing. I know from my own observation that there were at least four or five patients backed up at several times in the evening. We talked about critical-care diversion earlier in estimates. During that evening, at least three or four times, the hospital emergency was on critical-care diversion.

It's interesting, because this emergency department, and certainly the one at Vancouver Hospital, took it upon themselves to start collecting some statistics about ambulance delays. At Vancouver Hospital, between January 3 and September 20 of last year. . . . These were actual delays that the paramedics would track themselves if they signed in, so these aren't exactly pure research. It's the ones who actually took the time to sign in and sign out, so we could track the delays. At Vancouver Hospital there were 862 delays, ranging from 11 minutes to four hours and 53 minutes. At least 156 calls were psych patients, and at least 84 of the calls were shortness of breath or chest pain -- more what I would consider serious patients who were being delayed.

At St. Paul's Hospital, the number of delays was 478. The delays ranged from ten minutes, which perhaps isn't a big deal, to five hours and 42 minutes, which is probably on the extreme end -- I hope. At least 30 of the calls were psych patients; at least 57 were shortness of breath and chest pain, and at least 52 calls were overdose-related. I recall, on the evening I observed the shift at St. Paul's emergency, that we had two cocaine overdoses.

[E. Walsh in the chair.]

This is serious stuff, and it comes on the heels of the report that was done last February and made public. There were all kinds of recommendations of changes to be made that would improve the system. Frankly, one of the heads of emergency in the lower mainland made it very clear to me that a very in-depth analysis he did on the availability of beds at his hospital didn't make it into this report on interface between ambulances and hospital emergency departments. We know that part of the reason that ambulances are delayed is that we can't get those patients into emergency, because the emergency patients can't get into a bed in the hospital. There's a backlog all the way down, and frankly, I don't think it's gotten any better in the last year.

In fact, I've gotten letters from patients over and over again, saying that they've had long waits in emergency. I have observed, in hospitals that I have visited around the province, patients sleeping in emergency for up to a week at a time, patients sleeping in cast rooms -- those are just light stretchers -- for two or three days at a time and patients sleeping in hallways. That is appalling. When we have our emergency system, our ambulance system, compromised because we can't deal with our emergency bed system and our hospital bed system, I think that's a situation that's totally unacceptable.

Now, the report made several recommendations, and again, I'm hoping the minister has some of the information around the recommendations that were made last February. It's over a year that the ministry has had to implement some of these recommendations.

The first recommendation was that the B.C. Ambulance Service implement computerized dispatch in region 2 at the earliest possible opportunity. I want the minister to update us

[ Page 10556 ]

Hon. P. Priddy: Perhaps I could just give a bit of an update on the Ambulance Service's response to the Vestrup report.

Let me begin with the question that you asked about the CAD system, the computer-assisted dispatch system. That will be integrated into the E-Comm system, so we're currently in the process of buying that. We expect it to cost about $9 million. So that's the CAD system -- approximately $9 million. It will be up and running when E-Comm is, so that's why we're in the process of acquiring it, as we speak.

We have defined response-time benchmarks in policy; that's been done. These are all recommendations, so I'm responding to the. . . . That was one of the recommendations -- that we define time benchmarks in policy. It may sound simple, but nevertheless, one of the recommendations was that all dispatch clocks be synchronized, and that has occurred. A target of 95 percent compliance with response-time recording has been achieved. A reporting mechanism, which was also recommended, has been initiated through publication of a quarterly quality-improvement report. Response times are included as part of this report.

B.C. Ambulance continues to work with representatives of regional health boards and working groups to formulate and refine operational policies. We actually have the Ministry of Health lower mainland emergency committee working; that has also been as a follow-up to Vestrup. The issue is, I think, in part as you have stated it. Two of the issues identified are psychiatric patients and ALC patients who are in beds that other people need to be using. As we mentioned, if you are able to have more supportive housing and a very aggressive case management plan, then you're less likely to end up with people who have mental health needs taking up acute-care beds in hospital.

When I look at how long ambulances stay in emergency departments before they are back out again -- and I'm just looking at a range across the lower mainland from Vancouver General to Eagle Ridge, so that sort of circle there, if you will -- the highest is 31 minutes and the lowest is 16 minutes in terms of their turnaround time.

S. Hawkins: I'm interested in the response times. I know that in the minister's press release last year, the minister was quoted as saying: "The B.C. Ambulance Service is responding to 85 percent of emergency calls in under nine minutes." On page 9 of the report, showing the emergency response time within nine minutes, it said that it was only 68.4 percent and has never exceeded 70.8 percent in the three years reported. I tried to bring this up last year as well. I'm wondering where the 85 percent figure in that report came from. Does the minister stand by what the last minister said about that? That certainly isn't what the report was saying. If indeed the response time is nine minutes for only 68.4 percent of the time, have we improved that in the last year?

[4:15]

S. Hawkins: That was the final report that was done and filed or made public on February 24, 1997, "External Review of Interface between Ambulances and Hospital Emergency Departments." That is a report from the ministry. If the minister checks that report, it's at about the middle of page 9.

Hon. P. Priddy: I'm not sure about the 85 percent, and I'm sure somebody here is busily checking that. The compliance time currently, being within the policy compliance time, is probably just over 70 percent. You know, it's an eight-minute response time that we consider to be policy. About 50 percent of those calls are answered in five minutes, so 50 percent of those are significantly below. But because some of these are brand-new initiatives, we're currently at only about 70 percent for the eight-minute compliance.

S. Hawkins: What the press release said and certainly what's in the report do not seem to match, and I'm interested. I understand what the minister said earlier about the monthly reporting of total response times. I'm wondering what information the ministry is finding out there. Is there a report being compiled around that? Will that report be made public?

Hon. P. Priddy: The first quality-improvement program report has been published and is public. The next one is just getting ready for the printers. Some of the issues identified when you asked. . . . Clearly these are not only for reporting but also for learning. Some of the issues that were noted in that first one were related to what people call chute time. Chute time is the amount of time it takes for the ambulance person to get to the ambulance station, into the ambulance and out the door. It measures that for those ambulance stations that do not have permanent staff in the station. The time it takes for paramedics to be in the ambulance and rolling on the call was one of the significant issues that was noted. That's related to response time. I think they noted one or two other issues related to response time, which I don't find in front of me, but the most significant one was the chute time.

S. Hawkins: Because of the restriction on time, I think, this afternoon. . . . There are a lot of questions I have about the recommendations in this report and where the ministry is with them 18 months after this report went out. If the minister will commit to giving me an update on what's happening in this report with respect to the recommendations, I'll go to a different line of questioning.

Hon. P. Priddy: Yes, we will do that.

S. Hawkins: I'll make a list of the commitments so far, so that the minister has. . . .

Interjection.

S. Hawkins: Okay.

It appears to me that this is not a new problem, because I have a briefing note, an FOI from '95-96. It's from the Ministry of Health, and it was for the use of the minister in estimates at that time. The issue it outlines on this briefing note is ambulance crews being detained by hospitals. The background, according to the minister's staff who wrote this briefing note at the time, was overutilization of emergency wards.

"Lack of in-patient beds has created regular backups in the emergency departments at the major hospitals in the GVRD and CRD. Ambulance crews are being required to stay with their patients on ambulance stretchers in hallways, in waiting rooms

[ Page 10557 ]

and, at times, in ambulances until a bed in the emergency department is free. This significantly restricts the BCAS's ability to effectively respond to emergencies and other calls. As an example, between September and December, 1994, at St. Paul's Hospital, ambulance crews were detained 70 times, with the wait time exceeding one-half hour. The average wait time was one hour and five minutes; the longest was four hours and 45 minutes; and 1.5 ambulances were tied up exceeding two hours."

What is also not a new issue is that we've been bringing it up every year. And every year, it seems to me, the delays are getting longer and more frequent, as I listed for St. Paul's Hospital. Instead of 70 delays, it's up to 478 delays; and instead of being delayed four hours and 45 minutes, at the longest, it's five hours and 42 minutes. At some point, we need to address this.

Hopefully, that report did give some key recommendations. Unfortunately, the bed problem wasn't addressed in that report, but I know that I will keep at the ministry to improve this service. It's very discouraging to get letters from patients and to hear news stories about people who didn't get the service when they needed it or got delayed service or died as a result of not getting the service. It's something, again, that we pay a lot of money for, and taxpayers and patients in the community want to know that they get the best bang for their buck.

I also want to talk just for a minute about rural ambulance service. I know that the members for Peace River North and Peace River South have been big advocates of improving ambulance service for the north. I believe that in estimates last year, one of those members asked about a review of the northern ambulance system. I wonder if that was done -- if the minister can confirm that they did that.

What I also hear about from the rural and northern areas is training. There is a huge lack of training and trained personnel for the ambulance service in those areas. I'm wondering what the ministry is doing to address those concerns.

Hon. P. Priddy: I just want to, if I could, tie off the last piece of the last question. I won't take up much time. While we are still unquestionably dealing. . . . As I said, the first quarterly report identified the problems both with patients with psychiatric needs and with ALC -- the sort of alternative-level care -- folks in hospital beds, which does block up emergency. I just want to comment again that there has been an overall decrease in the average number of minutes that ambulances spend at hospitals before they can go back out again, with the highest being 31 and the lowest being 16.7. There has been some change in lowering that.

In terms of training, there are two things. We have not undertaken -- and I'm not aware that we said we would -- an entire review of the northern ambulance service. But we certainly have done work with the member for Peace River South on air ambulances up there. I met with the member the other day to update him and let him know three things. One of them is that we now have a reciprocal agreement with Alberta for air ambulances. If someone from here cannot get in, we have a reciprocal agreement with Alberta.

Secondly. . . . This is actually the Ministry of Transportation that has done this, but it has been of assistance, or will be, in that area. The Ministry of Transportation has said that you can count the unpaved part at the end of Tumbler Ridge runway as runway space, which means that you can have a larger plane land there. We're renewing all of our contracts for air ambulances in October, and we will ensure that in letting that contract, there are air ambulances of an appropriate smaller size to be able to land at the Tumbler Ridge airport.

Around training, I just want to add that we have done an initial pilot paramedic level 1 program in Kelowna, actually, where 18 paramedics graduated last April. We will be expanding the program this year to include regional training centres in Kelowna, Dawson Creek, the Fraser Valley and Nanaimo.

[4:30]

An incident has come to my attention, which involves a sexual assault. My understanding is that AIDS treatment is available to victims of sexual assault for a 21-day series. This is available for residents of the province. I understand that in this particular incident, the individual was not a resident of British Columbia and had a great deal of difficulty accessing this treatment. If the minister could, would she tell the committee what the policy is around sexual assault HIV treatment for residents and non-residents of the province?

Hon. P. Priddy: I want to clarify the question, but I don't have someone here who can answer it at the moment. I want to be sure that I've got the right information, so that we can get it for you. Sorry, there was a bit of chatter going on, and I don't know if I heard all of it. This is someone who was the victim of a sexual assault, and there is concern about HIV. The normal treatment protocol, which I gather you indicated was a 21-day protocol, is available for women here but was denied to this woman because she was from out of province. I think it's a woman, because you're asking the question -- because of your critic portfolio. It actually could be a man.

It actually makes no sense to me whatsoever why that should be the case. I'm sorry, I don't have the right staff here, but we will have the answer for you tomorrow.

L. Stephens: It didn't make any sense to me either, because this individual is a resident of Canada, though not of this province. She's certainly not a resident of any other country and was simply here for a two-week holiday, so she would still be available under the Canada Health Act. This is an issue that we want to have clarified.

I know the minister knows that HIV is spreading rapidly, particularly in Vancouver. The downtown east side specifically has the highest rate of HIV infection in North America. I wonder if the minister could tell the committee what her ministry specifically is doing to help alleviate that kind of infection rate. We're all aware that this is spread primarily through intravenous drug use, and for the past year or so, the province has had a provincial AIDS strategy in place. Could the minister inform the committee what has been happening and whether or not this strategy is making any headway in the increasing incidence of HIV/AIDS?

Hon. P. Priddy: Just as I begin to respond to this question. . . . I think the member is asking primarily about the lower mainland or about Vancouver. The last time I looked at the statistics in my community, which is south of the Fraser -- as is the member's community, although I think the statistics were higher in mine -- there was a quite significant rise in the number of AIDS/HIV-positive people. You can almost see the

[ Page 10558 ]

But if we look at the Vancouver-Richmond area. . . . First, let's look at prevention. If we look primarily at the prevention projects, we do a prevention/intervention program with the Asian society. We do a project around AIDS services for the B.C. Coalition of People with Disabilities, because they're often very vulnerable for somewhat unique reasons that may not apply to everybody else. We're doing support kinds of prevention/intervention work with the Canadian Hemophilia Society, because HIV -- well, I guess I'm saying this for the record, because I know the member knows -- is spread across a very broad range of people depending on the method or the means or the way in which it was acquired. We are doing very significant needle exchange activity, which relates to HIV as well, with the Downtown Eastside Youth Activities Society, where we are running needle exchange programs.

I won't read them all, but I'll just read some that are kind of interesting. We're doing a housing project for people with AIDS, along with the McLaren Housing Society in Vancouver. There's a group that we fund for family and children support, which is actually called the Hummingbird Kids Society, which is for children who are HIV-positive and their families, but it is really focused on the children. We provide about $250,000 for intervention, prevention and education work with the Positive Women's Network Society, which, as I'm sure you will know, is the women's society that works with women who are AIDS/HIV-positive. We work with UBC, AIDS Vancouver and the National Congress of Black Women, which we fund to do some prevention/intervention as well.

I didn't read the whole list, but that is a spectrum of the prevention and intervention parts not so much in the downtown east side but in the Vancouver-Richmond area of the lower mainland. Those are important to have happen, because these are the people on the front lines doing the jobs all the time and they have the best sense of the work that needs to be done.

But in the shorter term -- maybe it's not shorter-term, but I sure want to think it is -- there are more active treatment supports, if you will, around needle exchange programs, the ongoing methadone program, which has expanded significantly to support people who have been heroin addicts. As a result of having that program, there are many people who may not develop HIV/AIDS because of the issues of intravenous drug use. So there's the more aggressive treatment part and then the intervention and prevention part.

L. Stephens: I'm sure the critic is going to talk about the methadone program that is under some controversy. The suggestion is that it is a pale imitation of what they do in the U.S., just across our border. That's an area that I'm not going to go into. I want to stick to the issue of women and particularly the downtown east side, and that means the aboriginal population.

The needle exchange program, I know, is something that the government has put a lot of effort and a considerable amount of resources into. But the issue here is the drug and alcohol abuse that goes hand in hand with HIV/AIDS. So when we talk about intervention and prevention programs, those are issues that simply have to be addressed. That means the resources that are available to the downtown east side, the detox centres, which we talked about yesterday. . . . I wonder what kind of coordination there is between the Ministry of Health and the Ministry for Children and Families, which, the minister informed me yesterday, delivers the alcohol and drug abuse programs. Surely there must be some kind of coordination. I really want to get a handle on who is responsible and how the management of drug and alcohol abuse and HIV/AIDS outreach is coordinated and managed, primarily in the downtown east side, to deal with these very critical issues that affect the people who live there.

I know that it's difficult, just because of the nature of the downtown east side, but I think that's where a lot of the infection spreads from. I'd like to know if the minister has a strategy that deals with those three issues, specifically in the downtown east side population.

Hon. P. Priddy: There is some coordination going on, and there will be more. We have a joint policy committee between the Ministry of Health and the Ministry for Children and Families. The importance of that close coordination is certainly one of the issues -- I mean, I've been in both places -- that people have identified with alcohol and drug abuse programs moving to Children and Families. I actually don't think we're quite there yet. We also have an interministry working group on HIV/AIDS that's chaired by Dr. Shaun Peck, who is the deputy provincial health officer. So there is that work between the ministries going on.

There's also work between our ministries jointly and the Vancouver health region, which has the direct responsibility -- they are the actual deliverers of some of those programs -- as well with Philip Owen, the mayor of Vancouver. I have met with him about this particular issue, because Vancouver has taken a very focused approach to trying to bring some resolution to the ways in which people might be able to be supported.

The other thing I'd say about the downtown east side is about helping. . . . I was going to say something, but it might sound disrespectful; I don't mean it to. Some of the thinking and some of the initiatives I took at Children and Families, which I know are being pursued by the current minister, are that you've also got to get some stuff out of the downtown east side. The more programs you can get in places like Prince George and other places, the fewer people you might have actually. . . . Virtually all of the services are in the downtown east side, and it becomes like a mecca for people. They go there because that's where all the services are. The more we can regionalize some of those services -- and the downtown east side would agree with this, by the way -- the less impact there will be on that particularly small area in terms of these issues. But there is a joint policy committee and the committee with Dr. Peck.

[4:45]

[ Page 10559 ]

Hon. P. Priddy: Without wanting to talk about some of the things I know from Children and Families. . . . One of the things that people in Prince George would say to you, among other things, is that it's really tough for moms and kids. It's really tough for moms to leave kids. That's a problem for women with addiction problems almost everywhere, but if you're in an urban area, you may have a lot more access to a day program. So that is a need I was quite concerned about.

If you're asking about the north and the things we will be doing for this coming year, we've already put out some support. We provide quite a significant amount of funding to the Prince George AIDS society, which does education intervention in the Prince George area -- public education, plus education of HIV and intravenous drug users. So it's both to the public and to consumers. You didn't ask about the Okanagan, so I'll pass on that for now.

Also, we fund a youth prevention program in the Cariboo in the north, with the Boys and Girls Club of Williams Lake and District. We work with the AIDS Prince Rupert Society and provide funding to them, to the Bulkley Valley AIDS Society and to the United Church Health Services in Hazelton. We also do some of that funding through the six aboriginal health councils, when you look at where support is for aboriginal people.

S. Hawkins: We have been talking about a provincial AIDS strategy for at least two years, since I've been the critic. Last year the minister stood up and gave me. . . . When I asked again for stuff to do estimates, nothing had been forthcoming. I got a document on community recommendations for action through 1999-2000, which was towards a provincial AIDS strategy but was really a list of recommendations that were brainstormed through a bunch of community groups that had been pulled together to help develop something that looked like a provincial AIDS strategy.

Well, this year I have a document called "Putting the Pieces Together: British Columbia's Strategic Plan for HIV and AIDS, 1998-2003." I understand that this is a draft. For two years I've been asking for an AIDS strategy or some kind of formulated plan to deal with the crisis -- and it is indeed a crisis in this province, because the downtown east side of Vancouver is known around the world as the HIV centre of the world. I don't think that's something to be proud of. This member stood in the House last year in July and called the situation in the downtown east side an epidemic, and the Vancouver-Richmond health board did indeed call it an epidemic in the fall. We again started hearing all this uproar about getting something together, getting an AIDS strategy together. I know that last fall the ministry put some money towards helping the problems in the downtown east side. But I understand that the people who sat down at the table to decide where that money was going to be allocated didn't include any of the actual people, like AIDS Vancouver or Positive Women's Network or any of those agencies, in sitting down and deciding where that money would be best spent to deal with that problem.

I'm concerned, because I see a lot of money going into the treatment, prevention and AIDS programs and being disbursed around the province. Then I hear stories about how some of this money is being spent, and it concerns me. In my own community of Kelowna -- and I'll use it as an example, because that's the area I represent -- there was a huge story in the paper several months ago about the AIDS group there, which had got provincial funding. It had an office in one area and had decided to take an office in another area, at the same time paying. . . . They already moved to a new office and were paying for the old office and hoping to sublet it. Those are taxpayer funds, public funds. Why would they be allowed to move from one office to another when the lease hadn't run out? I believe the lease in the old office is still in place for another year and a half or whatever, at a cost of $1,200 or $1,500 a month, and they're in a new place for around $3,000 a month. So now we're paying rent in two different areas.

All the AIDS groups around the province are crying for money. I was in Prince George, and I met with Mary Jackson and Olive Godwin, who are with AIDS Prince George. They had significant concerns about the money they get, how they feel it's not allocated fairly, how they feel. . . . They gave me a list of funding for groups around the province, rural and urban. They were comparing what they get with other groups. Then I look at the situation in my community, where the group there has funding, and how they're allowed to spend it.

I'm concerned because, first of all, I don't think the province has an AIDS strategy or plan; and if they do, I hope the ministry will agree to share it with us. I hope the minister will tell us that there's a business plan around the amount of money that's being spent on AIDS in the province. I know it's in the millions, and I know that the feds kicked in again -- or they said that they were going to continue to fund an AIDS strategy.

First of all, I want to know how the ministry apportions funding, because the figures are different throughout all the different communities; if they actually require auditing for the money that's being spent -- and I'm concerned that they don't when I hear stories like what happened in my town; and if indeed there is an AIDS strategy, whether there's a business plan for that strategy. I hope I'm not going to keep the auditor general very, very busy, but I suggest that maybe we should do a value-for-money audit around the AIDS/HIV spending we do in this province, because I don't think we're getting value for the bucks we spend when we have an HIV crisis going on in downtown Vancouver.

I can tell you that I was down there just before Christmas. I spent five days in Vancouver, three of those days meeting with HIV and AIDS provider groups. I spent an afternoon and evening with the aboriginal street nurse, spoke to Dr. O'Shaughnessy, had a meeting with him at St. Paul's Hospital. I did some shifts with the police, fire and ambulance there as well. Frankly, it's not just a downtown east side problem. The police stopped people from Kamloops and other places. They're coming down there, and they're taking those problems back to their communities. So it's more than just an isolated downtown east side problem; it is a provincial problem, and I'm hoping the ministry does have a provincial plan.

I know we had a provincial strategist; I believe his name was Moffat Clarke. He was seconded from the federal government, and I understand he's left, because I see an ad in the paper now for a director of provincial AIDS strategy. In this ad, the ministry is asking for somebody to manage the comprehensive provincial AIDS strategy. If we have that AIDS strategy, will the minister release it? If there's a business plan for that strategy -- there's millions of dollars being spent on that -- can she release that? Can she tell us how the money is being allocated around the province? We hear about inequities

[ Page 10560 ]

Hon. P. Priddy: The AIDS network plan is due to be presented to me in September, I think. The member is right. I would have much preferred to have come into this ministry, with it ready and prepared. We have had a series of circumstances with changing staff, with Moffat Clarke leaving and not having that position filled, and with a bit of a change in focus by the AIDS community regarding the way they want to go about this. You're right, you probably have the table of contents showing what pieces are included in that. That's probably the document that you were referring to, and it should be ready by September. I would have liked it to have been ready six months ago, but it wasn't. I've asked people to push that as hard as they can to make sure that we do it. The member is correct: there are fairly significant amounts of dollars going out if you look not only at what goes to the 40 community agencies throughout the province but also at what goes to methadone and those other kinds of programs. Those are my comments about the plan.

I think that is what you were reading from, but if not, I will give it to you. Were you reading from the table of contents for the framework plan, hon. member?

The Chair: Through the Chair.

Hon. P. Priddy: Sorry, my fault, hon. Chair.

It begins with introduction and then policy framework, roles and responsibilities and collaboration. Is that the one? I just want to make sure that we were referring to the same things. Those are the components that will be in there, including looking at the implementation that is tied to looking at programs and staff audits.

All of the dollars are financially audited; there must be an audited statement. All of the organizations are asked to say how they've met their outcomes. I've been around long enough -- not just in government, but almost 35 years working in organizations in the community -- and I know that an organization can have an audited statement that says: "This is what our outcomes were." But if you go look at it on the ground, it just might not be like that. As much as we can, our staff is out looking at those programs, asking for outcomes to talk about the people in the programs -- obviously not by name -- and what has actually happened to them as a result of the resources. This is particularly important when talking about resources of $200,000 to $250,000.

It's a lot harder for somebody who has a $16,000 grant to have enough staff to. . . . They have to do the audit anyway, but to do a whole bunch of documentation on that. . . . But there are people receiving significant amounts of dollars, and they have a responsibility to do that. I don't doubt that there is better work that we can do around program audits. I think the financial audits may be fine. I know you have referred to an organization in your community. I believe I know the one; at least my staff thinks it's the one that you've described. I don't know the circumstances. What I'm told is that they have expanded to provide support to a much broader range of clients. But their budget is substantial, in my opinion, compared to a number of others. So I would expect them to be able, in their reconstituted way, to provide us with a significant outcome audit in terms of whether the work is making a difference for people.

[5:00]

Frankly, that's why I'm asking: does the ministry have a business plan for the AIDS strategy? How is the funding allocated? It seems to me that there really hasn't been a lot of direction. Here we are, years into asking for an AIDS strategy, and the minister tells me that she will get one in October. I hope it really is a strategy; I hope there are some plans, goals, objectives and a business plan attached to that. That's what we'll be looking for. I hope I don't have to stand here next year and ask the very same questions again. It's getting a little mundane, a little redundant. Every year that I stand here asking those questions and they're not answered. . . . I get frightened for how things are actually run. I wonder if the minister can address that concern: how the money is allocated and whether there is a business plan for the millions of dollars that we spend on HIV/AIDS.

Hon. P. Priddy: Just one historical comment, if I might, and then I'll speak to the question that she asked. I don't know about all of these agencies, but many of these agencies previously had federal funding -- almost completely federal funding. When the federal government pulled their funding out of AIDS programs, we picked up what they had withdrawn. So there's a bit of historical context to this. To leave those agencies out there, with people dependent on them and with federal funding withdrawn, seemed not to be fair to the people who used that service in their communities. So some of that has come about simply historically in terms of the kinds of programs that those agencies were providing.

But above and beyond that, what we will be doing is much sounder, I think, than what we are currently doing. That's fair enough; that's why we're trying to move forward. When the AIDS framework plan is finished, if you combine that with the needs identified by the health authority, then that will help set those priorities around the province. While we do provide funding in every area of the province, in every region there are certainly some. . . . Well, some can be attributed simply to population, by the way, but there are still some other inequities. What we are currently doing in preparation for the framework plan being available is trying to look at those

[ Page 10561 ]

At this time we have divided money amongst all of the health regions. A significant amount of that is centralized either in the capital region or in the lower mainland, which, for understandable reasons, is where the population is. But we think people ought to be able to be supported closer to home. That's one of the things that the framework will look at: how you divide those dollars so you don't have everybody coming to Vancouver in order to receive the service. At this stage we're looking at it solely based on the need. The framework and the health authorities will allow us to do that, I think, in a more consistent and businesslike way.

S. Hawkins: I'm sure the minister will agree that the longer we wait to address these problems, the more expensive they will be at the back end. If we deal with them at the front end and we deal with them responsibly, it's not going to impact on our health care system as much as it will at the back end, when people are sicker and require treatment, hospitalization and everything else that follows the conditions a lot of these people end up in.

The provincial health officer did release a report today on injection drug use. We've been through that in estimates previously. In the press release that was issued today, he says: "Injection drug use is a serious public health issue that requires a new comprehensive strategy and collaborative effort. We must reduce the toll of deaths from drug overdose, HIV infection, hepatitis B and hepatitis C injection drug users. This report provides recommendations for a provincewide strategy to achieve this goal." We've been talking about injection drug use and all the problems that come with it -- substance abuse and the methadone program. We canvassed this in last year's estimates. It's interesting that the provincial health officer is now releasing a report and saying that it is an urgent issue and needs to be dealt with.

I wonder if the minister will respond to what's in the report and tell us what the ministry plans to do with this very urgent, very serious public health issue, so that we have some comfort that the ministry is actually taking this seriously.

I'm looking at one of the recommendations. The provincial health officer is asking for a 50 percent increase in detox services, residential care and counselling for non-heroin injection drug users. In the last few years we've talked especially about the downtown east side in Vancouver, where the burnout rate for this is great. We're very concerned about the lack of detox services there. When I was out with the aboriginal health street nurse, one of her major concerns was that there was no detox there for people who needed it.

I don't know how many times it needs to be said and how many reports it needs to be said in before. . . . The Minister of Health, the Minister for Children and Families, the Minister Responsible for Housing and all the others need to get together and really give this a serious look, so we're not paying for it in the back end. In the back end, we pay for it in overdoses that come to emergency, take up services and take up an ICU bed or a hospital bed. It becomes more expensive unless we deal with it at the front end. So I just want to know from the minister what their initial response is to the report and how they're planning to deal with this.

Hon. P. Priddy: Like others, I have just received the final report, so I'm not sure that I can stand here today and say that this is the response to all of it. But I can comment on some parts of it for you. One of the things that Dr. Millar recommended in his report is expanding supports for intravenous drug users and so on. The member will recall that just a few months, not long ago, we put $3 million in new dollars into the base of the Vancouver-Richmond health board budget to be directed specifically to people with HIV who are intravenous drug users. I try very hard never to say it as a label. So that's $3 million that's actually been added to the base. I would let the Minister for Children and Families certainly speak to any plans for an increase in detox centres or beds and so on, although I have alluded to them myself.

One of the things that Dr. Millar does talk about is the expansion of the methadone program, and that is something that we are committed to. That's something that the College of Physicians and Surgeons is committed to, because they've taken over part of this program from us. We have moved from fewer than 4,000 people receiving methadone to over 5,000 this year. Over the last few years, it's tripled in size. We've got 500 physicians actually, so that's a huge increase. I think it was 120 about three years ago, when this first became active.

One of the things we do know in terms of making a difference -- in two ways -- is around intravenous drug use. If you move from being a heroin addict to using methadone as a replacement, you reduce your risk of contacting HIV or hepatitis C through intravenous drug use. So people who move onto the methadone program immediately reduce their risk of that significantly, if indeed they haven't already acquired it.

Secondly, we have found -- which I think has been very successful in a short period of time -- that the mortality rate amongst heroin users is somewhere between 7 and 8 percent. For heroin users who use methadone, the mortality rate drops to 1 percent. So it has made a huge difference simply in terms of the mortality rate for those individuals. Those are just a couple of brief responses to Dr. Millar's report. I will certainly respond to it when I've had a chance to analyze it more thoroughly.

S. Hawkins: We will look forward to the ministry's response and any implementation of the recommendations that the provincial medical health officer lists there. I guess I should put the Attorney General on notice too. Had I thought of it earlier, I would have spoken about drug use in his estimates. I know that the provincial medical health officer and Dr. Blatherwick tell us that we have high rates, because we have the cocaine and heroin problem in the lower mainland. I know that they don't have the cocaine problem as much in Seattle. I like to compare two cities that are relatively close and the same size, and Seattle doesn't seem to have the IV drug user and HIV/AIDS problem that we do in Vancouver. We're told that the high use of heroin and the frequent use of cocaine are causing that problem. So perhaps next year in estimates I can ask the Attorney General what we're doing about controlling that drug problem, so we can reduce that risk for our residents in the lower mainland.

I want to talk about Pharmacare next. Also, before I forget, I want to ask the minister. . . . I had asked for business plans for the major programs in the ministry. I had written back in May, I think, asking for those business plans, and I received nothing. So I want to ask the minister if there are business plans for Pharmacare, for MSP, for the B.C. Ambulance Service -- for any of the major programs in the ministry -- and if she would agree to give us those business plans so we can scrutinize them.

[ Page 10562 ]

S. Hawkins: I wonder why we don't have business plans for those major program areas. If there are work plans, then, I wonder if the minister would commit to giving those to this member so we can see what the work plans look like. Maybe next year, if they are released to us, we can do a better job in estimates debate.

[5:15]

L. Reid: I'm pleased to enter the debate this afternoon on the estimates, the appropriations for the Ministry of Health. I want to spend a few minutes, if I might, on the vulnerable elderly in terms of their reactions within the Pharmacare program. I know the minister has kindly ensured that my written questions on the order paper did, in fact, receive an answer, and I am grateful for that. The dilemma is that the problem still exists, that the individuals. . . . And let's condense this discussion for the purposes of some answers as we proceed.

The first group I want to canvass in some detail is Alzheimer's patients and their requirement for a range of treatment within the formulary. Certainly the minister will know that one of the questions on the order paper was around Aricept, the drug therapy that is in use and has been approved in more than 25 countries -- and that number is only increasing -- and whether or not we can expect a timely answer to the question of when it will be available and funded in British Columbia.

The American Association for Geriatric Psychiatry -- their most recent document is, I believe, September 1997 -- talks about permitting choices consistent with the most appropriate medical care and the most tolerable and effective treatment for each individual patient. Again, I reference my remarks to the vulnerable elderly -- that they seem to be tolerant of that medication. It seems to be a good choice. The people in the trenches on a daily basis -- the geriatric psychiatrists who work with that population -- need to have access to that product. The individuals from the therapeutics initiative, if you will, don't have the same expertise. They certainly don't have the same contact with those patients on a regular basis. If 25 countries have looked at that and have moved on it, I would hope. . .I appeal to this minister to make a decision that's in the best interests of the vulnerable elderly. I know that the decision was to be revisited. I would simply ask if the minister can provide some guidance on that question.

Hon. P. Priddy: The only way I would see it being covered -- and I'm not saying it is or will be covered -- is. . . . While I would agree that -- at least from what I've read -- it's more tolerable, etc., I think that what we would have to see or what the therapeutics initiative would have to see is a bit more research done through controlled studies. They were not trying to say that it should never be done. What they were saying was that they didn't feel that there had been enough controlled studies done -- and the ones that were done were short-term studies -- or that there had been enough research done to suggest that there was a clear indication as to the long-term cost-effectiveness. So I don't think anybody has ruled it out, but my understanding is that the therapeutics initiative said: "We need some more information to come forward about the long-term effectiveness of this." I don't know if any other province is considering it; they weren't, the last I heard. We will continue to monitor the studies on it.

L. Reid: I appreciate the minister's response. Certainly it concerns me when one of the lead psychiatric institutions in the province, dealing with a geriatric population, was not consulted. I will put St. Vincent's -- the psychiatric part of St. Vincent's -- on the record in terms of individuals who do work with that population. If the ministry is truly keen on seeing some research results, perhaps contact could be made in that area. Also, perhaps a study could be initiated -- perhaps in concert with the ministry -- that would allow the minister and the ministry to have some comfort from the results.

The dilemma is that you need a controlled environment. If that controlled environment exists, those individuals would certainly be open to an offer of a study if the ministry was interested in moving forward on that question.

I know that all of us in all of our ridings have difficult questions around the treatment of the elderly, whether it's Alzheimer's treatment questions or dementia questions. All of those questions craft some difficulty, particularly when the formulary is restricted.

I appreciate what the minister is saying about British Columbia, but the bigger context is 25 countries. I would love to see British Columbia take the lead on this question -- to actually do some very fine things in terms of care for the retirement population we have in British Columbia, which is growing. As we all know, British Columbia is a wonderful place to live; people are coming here in their retirement years. We're getting a very large incidence of individuals suffering from different degrees of dementia and different degrees of Alzheimer's.

To suggest that Saskatchewan, as an example, is not as advanced as we are on this question really doesn't work for me. But I would be delighted to see British Columbia take the lead on this question. I would ask the minister to see if she can champion this cause and how she feels about doing so.

Hon. P. Priddy: Well, the member knows I like causes. We will continue to follow this, because I have read the same kinds of articles that the member has. But I do note that of the major hospitals, including St. Vincent's -- although I know that one of the people who has been quoted on this is from St. Vincent's. . . . Victoria General, Royal Jubilee, Vancouver Hospital, Burnaby Hospital, Royal Columbian, St. Paul's and St. Vincent's have chosen not to carry this drug in their pharmacies, because they do not believe that its efficacy has been shown. It's not only Pharmacare saying that; these hospitals, as well, have chosen not to carry it for that reason.

L. Reid: My apologies -- I'm not clear if I heard the minister mention St. Vincent's.

Interjection.

[ Page 10563 ]

Hon. P. Priddy: That's why I said, when I mentioned St. Vincent's, that I know there are some differences in what is said. My understanding of what has happened is not that they've asked us for it, but. . . . I'll stand corrected, but my understanding is that some of the people within the hospital -- the physicians, the gerontologists -- have asked the pharmacy to carry it, and the hospital and pharmacy have said no.

L. Reid: If nothing else, this discussion will certainly clarify that decision, or non-decision, that's been taken. Certainly the material I have says that the geriatric psychiatrists at St. Vincent's have requested that documentation. If there are now gerontologists who are saying no, that's a useful piece of information for the geriatric psychiatrists to have at their disposal. I think the minister and I have been in many conversations over the years, where we have talked about the cost of a hospital stay as opposed to effective drug therapies, drug interventions. This one has indeed been shown to improve functioning in many cases. That's what this is about: to get those people back in their communities doing some things, hopefully, with their spouses, their grandchildren and the like, in terms of keeping them out of hospital for longer periods of time. I trust that we can continue to revisit this decision.

The answer to the written question, I believe, suggested that there was some kind of review. The minister was probably not giving me a specific time line, but if I could ask her to narrow that down. . . . Will this product be reviewed this fall, or are we looking at next spring?

Hon. P. Priddy: No, I can't give her a date. I do not see a reason that the therapeutics initiative would review this, unless there was more data provided. If there are more short-term studies or certainly long-term studies being done on this, then the therapeutics initiative committee will review it.

L. Reid: The winter of 1998. . . . The information talks about: "New Medicines: The Best Value in Health Care." In terms of the cost of hospitalization compared to the cost of drug therapy programs, there are certainly gains to be made in the more effective use of drug therapy programs. I think the minister and I have agreed on that. Certainly it's my understanding that the auditor general is bringing down a report on reference-based pricing and the cost-benefit analysis around that. I believe it's actually gone to the ministry. Perhaps the minister could confirm that and let us know when that report will be released publicly.

Hon. P. Priddy: I don't have a copy of the report. I have been briefed by the auditor general on the report. I'm trying to remember what he said to me, because obviously it's his purview to release it. When I asked when he would be releasing it, I think he said this summer. That's obviously his decision, but I believe that's what I was told.

L. Reid: Certainly the discussion about reference-based pricing and where we've been as a society in terms of looking at drug costs. . . . The report of the auditor general, I trust, will contain some useful information. The minister will know that I've stood in this chamber many times asking for a cost-benefit analysis around the variety of decisions that have been taken regarding reference-based pricing. If indeed there is useful information in that report, I will be the first to welcome it into the discussion. It seems to me that we've often meandered through the discussion, without having access to decent factual information. My understanding continues to be that of the Canadian health care budget, where roughly 5 percent is put into drug therapies and drug initiatives. For the most part, those are very effective decisions that indeed increase quality of life and allow an individual's daily functioning to be at an optimum level. I support those things, because I think this is about having people move more readily in communities to access the amount of health care that's required -- but not putting hospitalization over an effective drug therapy.

I'm not clear whether the minister has made a comment in the last number of days through this process on the current position of this ministry regarding reference-based pricing. I'd be delighted if there was an update on that discussion topic.

Hon. P. Priddy: It's 15 percent, my deputy tells me, so that's that part.

The auditor general did not leave us any of his information, but I think that as in every auditor general report, there will be lots and lots of very useful information that we will be able to gain.

I thought it was actually a fairly positive report. We look forward to having the report and being able to review it and for others to review it at Public Accounts.

In terms of reference-based pricing, which you asked for an update on, the status around reference-based pricing is that we have found it to be very effective in terms of the purchasing of medications. We do not have evidence to the contrary -- that this has also not been effective for patients -- because there are other options available if a physician believes their patient is not able to take whatever drug is identified. We have been able to save, in the last year, $43 million as a result of reference-based pricing.

L. Reid: The Canadian Journal of Cardiology of 1997 makes some interesting comments regarding optimal patient care: "The best policy approach is not to restrict access to any form of therapy but to initiate programs that encourage partnership among government, industry, physicians, pharmacists and all health care professionals, in the interest of optimal patient care." I support that contention. I don't believe that many partnerships have been entered into between the industry and this government over the past number of years, and I would certainly hope that the contributions that pharmaceuticals and drug therapy interventions can make will be considered from a positive perspective, with a bit more conciliation than has been evident in the past. I do believe it is important that all the aspects come together to render some useful decisions.

[5:30]

Interjection.

L. Reid: The minister disagrees, but it is indeed a documented case where individuals were not welcome to come and meet with government and discuss their issues. This is the government of the day who should in fact have a policy that invites that kind of participation. This is about, first off, cost savings -- hopefully, having a more buoyant economy -- and

[ Page 10564 ]

I know that the welcome mat has not been put out. I trust that that's just a temporary oversight and that it would now be timely to look at some. . . . In fact, first off, the educational programs. The diabetes clinics that a number of drug companies offer around the province provide a very useful service that is about cost savings to the health care system. If those people are using their drug products effectively and appropriately, there are going to be fewer admissions and fewer hospital stays. So I would ask the minister to make some comment on that.

I will close with the comment that ensuring that components of the health care system are used efficiently and to the full benefit of all patients is the best solution. I believe that in the past the ministry has gone out of its way to deny access of some of the partners to the decision-making, and that has not been in the patients' best interests.

Hon. P. Priddy: It's probably not unfair for you to characterize it as not a relationship that Big Bird would necessarily approve of, in terms of collaboration and playing well together. On the other hand, they took us to court over reference-based pricing, and that's not always the best way to develop that relationship. But we. . . .

Interjection.

Hon. P. Priddy: No, I've moved on from that. It wasn't during my time. But I'll just say that that's the context of relationships sometimes.

But there are actually two or three initiatives. One of them has been around for a couple of years, and I think it is so good that I talk about it all the time. The Surrey-White Rock project is a partnership between the pharmaceutical company and health officials in that area for teaching seniors to use their medications correctly and so on. It's a partnership with the pharmaceuticals.

The therapeutics initiative committee has not met regularly at all in the last number of years with PMAC or with pharmaceutical manufacturers. We've arranged for that to begin to happen again, and there will be regular meetings between PMAC and the therapeutics initiative committee. I think we actually do have another partnership project coming up in the fall, with the pharmaceutical committee.

The other one, the seniors medication information line, is also a partnership with PMAC -- Pharmaceutical Manufacturers Association of Canada -- and UBC and the Ministry of Health. That's another partnership, and it's working extremely well. So now they'll have an opportunity to meet on an ongoing basis. In the months that I've been here, my deputy has spent significant amounts of time with representatives from PMAC, looking at ways in which we might move forward.

L. Reid: I thank the minister most sincerely for that comment. Certainly, since she and I have both been here -- since 1991 -- the dollars that Merck Frosst gave to the Children's Hospital in Vancouver and the projects that have been set up have been of benefit to the constituents in our communities. Whether it's the diabetics that Pfizer has been involved with or the Alzheimer's work that a number of other companies have been involved in, those are things that directly impact on constituents in our communities. I believe that the minister is sincere on this question and that we will continue to see some reasonable partnerships that are in the best interests of our constituents, so I thank the minister.

S. Hawkins: With regret, unfortunately, the auditor general's value-for-money audit isn't quite complete with respect to Pharmacare and reference-based pricing, so I guess we can look forward to bringing that up for next year's estimates and discussing the findings there. With respect to the reference-based pricing program, I am receiving a lot of complaints about the special authority form, and I think a lot of the members on this side of the House receive those complaints. I don't know what the turnover time is supposed to be, but I have letters in my file saying that turnover time can be six weeks to three months. For patients who are waiting for drugs, that is unacceptable. From the goodness of the hearts of physicians who have samples in their offices from drug companies and of pharmacists who will sometimes give the samples. . . . Unfortunately, most of the time they can't afford to do that, and patients have to buy what they need. It is a huge concern, so I hope the auditor general will address some of those concerns as well. I don't know if the minister has any comment on that, but that continues to be a huge concern.

The other concern was that earlier this year, when the budget was announced, it was left out -- the Finance minister failed to tell us -- that about a $200 increase was being sneaked into the Pharmacare deductible for families. I think that was cold comfort for families who are already paying a $600 deductible and then finding that they are going to be paying $200 more. The deductible is at $800. It's one thing for the Finance minister to say that they're going to give working families a modest tax cut of $45 that doesn't kick in until January, in another six months, and at the same time take $200 more out of their pockets for Pharmacare. I know there are huge concerns around that, because there are some members waiting to ask the minister questions about that.

At the same time that the Pharmacare program decided to do that, they also decided to delist, again, medications that affect the working poor. One of them was the remedy for head lice. They decided to delist Quellada. I know that the minister has received a lot of concerns about that from physicians and advocacy groups. I have one right here from Dr. Adilman, who's the clinic coordinator for the Vancouver Native Health Society. He says: "Virtually every patient we treat is unemployed and living on welfare. Our patients cannot afford these products. Something must be done to either reverse this action by Pharmacare, or steps must be taken to ensure that individuals on welfare will have these products fully covered."

If they are fully covered for welfare patients, that's great. But working families -- those poor families -- don't always have that luxury. Something like treatment for head lice. . . . That spreads very quickly in day cares and children's classrooms. So again, I question the wisdom of Pharmacare doing that.

Laxatives for the elderly were also delisted. Again, we're hitting the most vulnerable people. I got letters from families whose loved ones are in nursing homes, saying that now they're picking up the extra cost of that.

[ Page 10565 ]

Hon. P. Priddy: I'll do this quickly, because I know there are other members who want to ask questions and speak on this. Yes, the deductible was raised to $800. I'm not sure if anybody was trying to sneak it through. When I look at coverage across the country and I look at British Columbia. . . . In Ontario, people pay $964 for a deductible. Saskatchewan pays $850 every six months; that would be $1,700 for the year. Manitoba has an income-based system. I don't think this is in any way out of sync with what we see across the country. Somebody just passed me an article noting that in Quebec, people have to pay 25 percent of the total cost of their prescriptions for a significant period of time.

The other point I would make around the medication for head lice, not just Quellada, but around the fact that we have the best-funded, broadest-based Pharmacare system in the country, covering 24,000 drugs. . . . Around the funding of Quellada, there are three things. One of them is that this is not even an over-the-counter medication. This is a medication that does not need a prescription; it is found on the shelf. If you looked at getting a prescription for this, the public would be paying $26 for the doctor's visit, $8 for the lice medication and $7.55 for the prescription fee, which is a total of a little over $40 for something that costs $8 and that you can just buy off the shelf.

We can all say: "Well, there are always circumstances in which people cannot afford things." In some schools, parent groups do bulk-buying of that. Several of my colleagues didn't even know you could get this through a prescription. They've always just bought it for their children if that's been a necessity. This is not an on going prescription that you might have to take on a regular basis. In most of the experiences that I've had in our children's school careers, it's something you might have had to use once or twice.

S. Hawkins: It's interesting that when the government increases something, they always look at other jurisdictions and say: "We're better." Well, perhaps the other jurisdictions have lower unemployment and a better economy than we do. I know that working families are really suffering in this province, and that is the plan that this government decided to pick on when they increased the deductible from $600 to $800. That deductible has more than doubled since this NDP government got into power. The government has been raising that deductible every year. My comment to the government is: don't tell the people that you're doing them a favour and making the plan affordable when you're increasing it every year. That's what we hear this government saying -- that they're doing a good job and keeping prices under control.

Unfortunately, we probably won't get a chance to get into some of the other areas, like MSP and other health fees, where the health fees have gone up and up and up. Patients are paying more and more out of their pocket, and, frankly, they're telling me that the quality of health care in this province is going down -- not increasing -- as they're paying more for it. I have a problem with the minister comparing it to other jurisdictions and saying: "We're still doing a better job, even though we're charging people more and more out of their pocket every year." I have a problem with the amount of money that's being spent on health care and with very little accountability coming from the side where it's being spent.

The outcomes aren't getting better; they are getting worse -- from what we're tracking. People are writing to us, and certainly people from the Human Resources minister's riding have been writing to us. In fact, we had a meeting with a group of them just two weeks ago. Perhaps she should meet with them more often and listen to their concerns, instead of working against their concerns when we're actually raising issues of concern to them here in the House. If she wants to know which groups, I'll certainly put her in touch with them. I don't know how often she gets back there to meet with them, but we've certainly heard from concerned people in her riding about these kinds of issues.

The delisting of the lice medication and some of the other medications. . . . Well, that's fine -- comparing whether you get a prescription or not a prescription, over the counter or not, whether it's over the counter. . . . What we're saying is that when decisions like this are being made, they're being made against the most vulnerable. Again, a lot of people have written and questioned the wisdom of the government doing stuff like that -- and with absolutely no notice. Basically, it does draw the ire of patients and does concern people around the province.

I'll now defer to the member for Port Moody-Burnaby Mountain, because I know that she wants to get her question in.

Hon. P. Priddy: If the member for Port Moody-Burnaby Mountain will permit me, I'll just do this very quickly. First, the last time the deductible was increased was actually in 1994. Second, when we talk about targeting the working poor, I would remind the member that 30 percent of the people in this province are covered in some way by premium assistance. People on premium assistance did not have their deductible raised at all, so the working poor were indeed protected.

[5:45]

C. Clark: I want to just briefly touch on the same subject and to perhaps illustrate it with the case of a constituent of mine named Beth Granger. She has a family of five. They earn $19,000 a year, because her husband is the only working member of the family. So they really do qualify as the working poor. They have one child, Bradley, who's an insulin-dependent diabetic. Her challenge is that they don't quite qualify for premium assistance, but they're having difficulty affording the deductible and paying for the costs for this child. There doesn't appear to be any recognition in the system, that she's found, for the fact that she is trying to support a large family, one of whom has high medical needs, on her family's small income. I wonder if the minister could perhaps address for us some ways that she might be able to meet the challenge that's there, and tell us if the ministry recognizes the inequity that exists between the working poor and the availability of assistance with medical supplies for those people versus people who might do better on welfare or on income assistance and get help from the government. There seems to be an inequity there. She points out that if she was on welfare or some kind of income assistance, she wouldn't have the same kind of challenges in providing insulin for her son. I wonder if there's any recognition in the ministry that that's a problem.

[ Page 10566 ]

Hon. P. Priddy: A couple of things. If the member wants to talk with me or my staff after. . . . There's something that doesn't make sense about this. If we've made an error, we should correct it. I think a that family of two, with a gross income of $31,000 a year, qualifies for premium assistance. I don't know if it matters whether they're reflecting their gross or their net income, but if it's one person with five children, it makes no sense to me that they don't qualify for premium assistance. So I don't understand that part at all.

In terms of the insulin cost being covered, I know that through B.C. Benefits. . . . I'm not sure what level these folks would be at, but I would think it's a fairly high one, because of the child benefit that rolls through -- I assume times five -- for this family. If this mom is getting that, it should certainly help make some difference around the insulin as well. But the figures don't make sense to me, so if you'll talk to me afterwards. . . . Yes, there is a cutoff, but it's nothing that looks that low.

C. Clark: I have a copy of her letter, and I'll forward it through the Chair to the minister. I'll clarify with her what income numbers she's using, and I hope we can find some way to help her. So thank you very much.

S. Hawkins: It appears that we're running out of time. There are still some issues that are unresolved, and I will probably ask the minister to answer them. . . . I'll give some written questions to her, and perhaps we can resolve them in that way.

I'll just sum up before we pass the vote. I think there are a lot of outstanding issues in health care. In the last two years, we haven't seen the issues getting resolved to the satisfaction of patients around the province. We have extensively canvassed a lot of the issues this year. Unfortunately, we've run out of time, and we don't have time to canvass MSP, health fees and some of those issues.

I must reiterate my disappointment at not getting information from the ministry so that we can run these estimates more effectively. I wrote to the minister, and we asked for information. For the last two years, the commitments that have been put on the record. . . . The Minister of Health at that time, who's now the Minister of Finance, committed to getting me material, and those commitments have never materialized. I know that this minister has made a lot of commitments in these estimates, and I would hope that she will uphold those commitments. I really hope that she does. Perhaps next year, when we come to estimates and I get a chance to write for the information that we require, this minister will cooperate in trying to get us that information. We look forward to getting the information we asked for. I will get the minister some of the other questions that I hope she will endeavour to answer.

I want to thank the minister and her staff for the information we did receive, and we hope that the ministry does work towards resolving some of the very serious issues that we've raised year after year. We still see patients suffering as a result of the ministry not making a move towards resolving those issues. I will sit down and let the minister go on with the votes.

Hon. P. Priddy: I just want to make a brief reply, if I might. My House Leader says that I can take as much as ten or 20 seconds to do this.

I want to thank the members for their questions. Lots of people were strong advocates for the community. Those are fair questions to be raising, and I thank them for that.

I think we've been able to identify some issues that people have raised. In many ways, we've also been able to identify either that progress has been made or that people have heard those concerns in other estimates -- they've heard it from the public, from patients -- and that we are moving forward on those. We've indicated additional resources. . . . Certainly, when we talked about capital plans, we talked about a number of facilities for which capital planning was underway and a significant number of new beds as a result of that.

The two key issues we identified were to be able to move people through the mental health plan and through long term care strategies into more appropriate places that they'd rather be and that better suit their needs, in order for us to be able to make better use of our acute-care hospital beds. In the end, we identified lots of work to be done. It is hardly a perfect system, but I think we did recognize -- I certainly recognize -- my government's commitment for the last seven years to increasing the health care budget by $228 million next year.

When we look at how that work is being done and at what's happening in the rest of the country. . . . We look at neutral articles such as the one in Maclean's. It says that while there may be struggles, this province has the best health care system, with the best funding and the best patient outcomes. So while there's lots of work to be done, I'm proud of our government's achievement in that.

Vote 47 approved.

Vote 48: ministry operations, $7,110,515,000 -- approved.

Vote 49: vital statistics, $7,219,000 -- approved.

Vote 71: Forest Practices Board, $5,311,000 -- approved.

Vote 1: legislation, $32,051,000 -- approved.

Vote 2: auditor general, $6,923,000 -- approved.

Vote 3: child, youth and family advocate, $1,153,000 -- approved.

Vote 4: conflict-of-interest commissioner, $189,000 -- approved.

Vote 5: Elections B.C., $6,991,000 -- approved.

Vote 6: information and privacy commissioner, $2,460,000 -- approved.

Vote 7: ombudsman, $4,705,000 -- approved.

Hon. J. MacPhail: I move that the committee rise, report resolutions and ask leave to sit again.

[ Page 10567 ]

The House resumed; the Speaker in the chair.

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

Hon. J. MacPhail: 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 at 5:58 p.m.

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