1998/99 Legislative Session: 3rd Session, 36th Parliament
HANSARD

The following electronic version is for informational purposes only.
The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, JUNE 29, 1999

Volume 16, Number 15

[ Page 14067 ]

The House met at 2:07 p.m.

Hon. G. Clark: Seated in the gallery today are the legislative interns assigned to the government caucus. Tomorrow is their last day, and on behalf of all members of our caucus, I want to thank Paola Baca, Jitesh Mistry and Shaila Seshia for their hard work in the research department. Jitesh is going back to SFU to finish his master's thesis; Shaila has been accepted to do a PhD with the University of Sussex and leaves for the U.K. in September; Paola will return to work for caucus in a few weeks.

On behalf of both sides of the House, I know that we very much appreciate and value the interns who work for our respective caucuses. They are invariably outstanding individuals with high standing in their universities or colleges. They do superb work for us, and we hope they enjoy it. We know that we enjoy their company and their pleasure.

Would the House please join with me in welcoming them today and wishing them well in their future endeavours.

G. Farrell-Collins: I want to extend our thanks to the interns who've worked with us over the last number of months. It's always exciting to see them when they come in the first of the year -- and a little intimidating when your read their CVs. I think most members in caucus would struggle pretty hard to keep up with them. They're very bright and fun to work with and really create a good environment, and they add a lot of value to what we do as the opposition -- and, I know, to what the government caucus does in government.

We wish our interns well. They've done a great job with us so far. Some are off to school, some are off to be married, and some are still figuring out what they're going to do -- not unlike many students in British Columbia. On behalf of our side, we'd like to thank the interns who worked with us and the interns who worked with the government, and we look forward to next year's group.

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Hon. J. Kwan: I have the delight of introducing two frequent visitors to the gallery. One is John Ranta, mayor of Cache Creek and president of the UBCM. Along with him is Richard Taylor, executive director of the UBCM, who has worked extensively with my ministry on a number of issues including a bill that I'll be introducing today. Would the House please make them welcome.

T. Nebbeling: On behalf of the B.C. Liberal caucus, I too would like to welcome the two familiar faces, Mayor Ranta and Mr. Taylor of the UBCM. I know that they have to wait another hour before they know exactly what is in the new bill that will be introduced this afternoon, but in the meantime I'd like to once again welcome them to the House.

Hon. A. Petter: It's my great pleasure today to introduce, for the benefit of the House, the winners of the 1999 Queen Elizabeth II British Columbia Centennial scholarship. This prestigious scholarship is the government's highest scholastic award. It was established in 1971 to commemorate the Queen's visit during our centennial celebrations. The major award is a substantial one worth $20,000, and there are two secondary awards worth $4,000 each. They support British Columbia graduates who are taking postgraduate studies in Commonwealth countries.

The major winner is Noelle Gallagher, who is with us today -- a truly exceptional English literature graduate from the University of British Columbia. She'll be pursuing her doctorate in English literature at the University of York in the United Kingdom. The secondary winners are David Jensen, a science graduate from the University of Victoria who'll be pursuing his doctorate in conservation biology at Oxford University and Janet Downie, who unfortunately can't be with us today. She is an English literature graduate from the University of Victoria who will be pursuing her doctorate in Byzantine and medieval studies at the University of London. Perhaps she thought the Legislature was too much like her studies, hon. Speaker.

In any event, I would like to ask the House to join me in congratulating these winners and in welcoming Noelle Gallagher -- who is here with her mother Deborah and her father Richard -- as well as David Jensen -- who is accompanied to the Legislature by his partner Robin Jarvis -- in recognition of their accomplishments and their future success.

M. de Jong: Six special guests are here from Jaffray. Tom, Tyler, Brittany, Chris and Matt Molenaar are shepherding their father Peter around Victoria today. I hope my colleagues will make them all welcome.

Hon. D. Streifel: I have two introductions today. The first one is on behalf of my special assistant, Chloe Burgess. Her friend Dr. Michael Temelini is here from Montreal and visiting friends in the building. I understand that Michael is an individual who appreciates a salmon when it's cooked well, so he's come to the right place -- maybe a little early for the season, but we'll see.

The other introduction is a little bit special for me. This is the first opportunity I've had to introduce my MP to the House in Victoria. Grant McNally, MP for Dewdney-Alouette, is here in the gallery with his father-in-law. I wish the House would bid my guests welcome.

J. van Dongen: I'm pleased to welcome Ed and Mary Froese, two constituents from Yarrow, to the Legislature today.

[ Page 14068 ]

[1415]

Secondly, if I might, I would like to acknowledge some of the same people that the Attorney General has acknowledged around adult guardianship, particularly as it relates to this ministry. In that light, I would acknowledge and ask people to welcome Margaret Neylan, chair of the Seniors Advisory Council, which provides advice to my ministry -- it's a very fine council; Joe Scaletta, the director of the elderly outreach program; Elizabeth Laharne, the seniors representative at the office for seniors -- I've just discovered she is a graduate of the same nursing school that I went to; and Lou Drage, chair of the Mount Arrowsmith Elder Abuse Prevention Committee. Just to add to that, if I might, Andrew Kellet is a very frequent visitor who provides good advice to my constituency office from Surrey mental health services, and two other people are here as part of that group.

One thing this legislation did was say that everybody, including people with a mental handicap, is presumed to be capable. So I would like to introduce a friend of mine, Al Etmanski, who's the father of a very capable daughter, Elizabeth Etmanski, and my friend Linda Derkach, who's the mother of a very capable friend of mine, Elaine Derkach. I'd ask the House to make them welcome.

W. Hartley: In the galleries today we have six young visitors. They're the 789 Girl Scouts Company, and they're from Bothell, Washington. They're here with their scout leader, Ms. E. Pechacek, and some other adults. Would members please welcome them.

J. Reid: It's my pleasure today to have my husband Keith Reid sitting in the gallery. I'd ask that the House make him welcome.

Hon. A. Petter: In the gallery today, along with others, are six members of the Parliamentary Players, an acting troupe that I think members are familiar with. They help to interpret B.C. history to visitors of the Legislature throughout the summer. This program will communicate the important role of the parliament buildings and provide an educational work experience for talented young artists who have been studying in British Columbia. I'd like to introduce them and let members know what roles they'll be playing. Cherie McMaster from Calgary will be playing Queen Victoria -- a rather different interpretation than the one we saw yesterday, I dare say. Cara Dick from Kelowna is playing Nellie Cashman; Jeffrey Fisher from Vernon is playing Sir James Douglas; Adam Sawatsky from Victoria is playing Francis Rattenbury; John Bolton from Vancouver will be playing stonemason Hamish MacKinnon; and David Brown from Victoria is playing Amor de Cosmos. These young actors help make the experience of visiting the parliament buildings a more pleasurable one. I'd ask members of the House to join me in making them very welcome.

The Speaker: And to all those who were not introduced -- welcome.

Introduction of Bills

LOCAL GOVERNMENT STATUTES AMENDMENT ACT, 1999

Hon. J. Kwan: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. J. Kwan: I'm pleased to present the Local Government Statutes Amendment Act, 1999. Bill 88 is part of the ongoing Municipal Act reform initiative, which is designed to modernize our system of local government to ensure that it meets the needs of British Columbians as we enter the twenty-first century. It is designed to empower local governments, cut excessive red tape and strengthen local government accountability. The legislation gives municipalities broad service powers and regulatory powers which will allow them to focus on delivering quality public services to their communities without having to constantly come to Victoria for approvals. As part of our long-term plan to streamline local government legislation, Bill 88 will consolidate 100 separate sections of the Municipal Act related to service powers into one.

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Bill 88 also includes stronger disclosure requirements for local election contributions. These requirements will now apply to nomination campaigns, as well as general elections. With this legislation, local governments will take on greater responsibility and the greater accountability that goes along with it.

I want to thank UBCM president, Mayor John Ranta, the UBCM executive and everyone who participated in the consultations of the Municipal Act reform that led to this bill being introduced today. I'm very pleased that Mayor John Ranta -- president Ranta -- has joined us in the gallery today for the introduction of this bill, along with Richard Taylor. I'd also like to recognize my staff, who have worked extensively in bringing this package together.

Hon. Speaker, I move that the bill be placed on orders of the day for second reading at the next sitting of the House after today.

[ Page 14069 ]

ADULT GUARDIANSHIP STATUTES AMENDMENT ACT, 1999

Hon. U. Dosanjh: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. U. Dosanjh: I am pleased to introduce the Adult Guardianship Statutes Amendment Act, 1999. This act enables partial proclamation of the four statutes known collectively as the adult guardianship legislation. The effective date for this partial proclamation is February 28, 2000. These technical amendments provide the needed links between the new adult guardianship system and the existing legislation until such time as the balance of the new guardianship system is brought into force. The adult guardianship legislation was passed in 1993.

The portions of the four acts comprising the legislation that we're bringing into force will create the representation agreement, which is a new legal document for adults to plan for their future, clarify health care decision-making when adults are incapable of making their own health care decisions, promote the coordination of support and assistance for abused and neglected adults and provide new tools to assist adults who cannot seek help, modernize the law establishing the public trustee and convert it to the new public guardian and trustee office.

Thousands of hours of volunteer effort and community government partnership led to the development of this legislation, and that partnership has continued to this day. I want to recognize the people in communities throughout British Columbia who have made a significant contribution to the development of community response networks, representation agreements and guidelines on various aspects of the legislation.

Hon. Speaker, I move that this bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 92 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

UNCLAIMED PROPERTY ACT

Hon. J. MacPhail: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. J. MacPhail: It's my pleasure to introduce the long-awaited Unclaimed Property Act. This act is designed to reunite owners with their unclaimed property. This act will replace the Unclaimed Money Act, which has become outdated and ineffective. The Unclaimed Property Act strengthens the requirements that all holders of unclaimed property, including business organizations, make reasonable efforts to locate and notify rightful owners.

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This proposed legislation balances the concerns of the business community with the interests of the consumer. The goal of the legislation will be met without undue regulation of business activity in this province. A regulatory impact statement has been prepared for this proposal.

Hon. Speaker, I move that the bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 91 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

JOB CREATION IN B.C.

Under the government's Power for Jobs scheme, the Premier promised three aluminum smelters and over 6,000 new jobs for British Columbians. He even dared the media to print the good news about the three -- count them: three -- aluminum smelters. My question is for the Premier. Can the Premier tell us whatever happened to this assignment? Whatever happened to the 6,000 jobs? And don't tell us that the dog ate your aluminum smelters.

Hon. G. Clark: I'm delighted to answer this question. British Columbia has created 36,000 new jobs in the last 12 months, hon. Speaker, and I never hear the opposition talk about that. I never hear them talking about Louisiana-Pacific investing in the north of British Columbia, creating jobs. I never hear them talk about Telus, the largest company in Alberta, moving their head office to Vancouver. I never hear them talk about Tembec, from Ontario, buying Crestbrook and investing in value-added in British Columbia. I never even hear the member from Kelowna, who owns shares, talking about Western Star Trucks making a commitment to thousands of jobs in Kelowna. I never hear the member for Abbotsford talking about 800 jobs in Abbotsford at Conair. I never hear them talking about B.C. OnLine and MDA investing in high-tech and creating jobs in British Columbia.

[ Page 14070 ]

The Speaker: Minister, finish up.

Hon. G. Clark: I'll wait for my next grade, hon. Speaker. But I want to tell the members that there are eight aluminum companies negotiating with the province of British Columbia. . . .

Interjections.

Hon. G. Clark: I love it when they do this, hon. Speaker, because they're going to look like such fools when they see. . . . We had staff in London last week, and they have rated. . .

The Speaker: Premier. . . .

Hon. G. Clark: . . .almost uniformly, British Columbia as the best place in the world for a new greenfield aluminum smelter. There will be an aluminum smelter in this province.

Interjections.

The Speaker: Members, come to order.

I recognize the member for Vancouver-Little Mountain, for a first supplementary.

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Hon. Speaker, we've gone through the government's press releases over the last couple of years. In fact, the Premier promised 84,966 jobs with only. . . . I think it's about ten or 12 press releases -- only the big ones. On those very projects that he promised the 84,000 jobs, it turns out that we've actually lost 12,348 jobs on those assignments. Power for Jobs was supposed to generate 4,200 jobs. We're only a little over 4,000 jobs short. Highland Valley Copper was supposed to produce 1,200 jobs. Instead, the Premier has lost 1,100 jobs.

Now, any grade 3 student who had failed to hand in all those assignments at this point would be up for a failure. Can the Premier tell us if he intends to hand in those assignments, or is he intending to drop out over the summer months?

Hon. G. Clark: Hon. Speaker, I started a list. Let's do some more. The film industry -- a billion dollars this year. What about Weyerhaeuser? They want to invest $3.6 billion in British Columbia companies. Is that not a sign of faith in the B.C. economy? What about the public sector projects? They're opposed to SkyTrain; we know that. SkyTrain starts construction in July. Those are good, decent jobs right here in British Columbia. I haven't heard them on the new trade and convention centre. We're working hard to bring that project in -- an $800 million project in downtown Vancouver and thousands of spinoff jobs as we get more conventions in Vancouver.

The Speaker: Time, Premier.

Hon. G. Clark: I've only begun. Tourism is up in this province.

The Speaker: Premier. . . .

Hon. G. Clark: Small business taxes are down.

The Speaker: Mr. Premier. . . .

Hon. G. Clark: The Lions Gate Bridge is under construction. Hon. Speaker, if they would just open their eyes for a minute, they'd see that there are bright spots in the B.C. economy.

The Speaker: Premier, please take your seat.

Hon. G. Clark: It's starting to turn around, and thousands of jobs are being created.

G. Plant: Well, like the teacher said: Mr. Premier, all these excuses, and you still don't hand in your assignments. Way back in 1997 and 1998 the Premier created all kinds of hype and fanfare. He announced that B.C. was on the shortlist for a Nike factory. We were going to get 5,000 new jobs in British Columbia. Well, the Premier hasn't handed in that assignment either. If we're not going to get the assignment, maybe we could get the rough notes. Maybe we could get the outline. So my question is: will the Premier for once just do it?

Hon. G. Clark: How many more do they want, hon. Speaker? How about the IBM Pacific Development Centre -- a partnership with the province? That's 800 new high-tech jobs in Burnaby because of a partnership with the provincial government. Retail sales -- I never heard them -- were up 1.3 percent in British Columbia last month and down everywhere else in Canada. What about the high-tech community? The high-tech community is growing at 25 percent a year.

We are in negotiations with a number of companies in partnerships with the provincial government. We're in negotiations with Nike. There's no question about it. They have not come to a conclusion. I love it when they laugh, hon. Speaker.

Interjections.

The Speaker: Members, the Premier is just finishing. Let him finish his remarks. Members, come to order.

Hon. G. Clark: They don't want to hear the good news. They want to spread doom and gloom. Commodity prices for lumber are at record levels in the United States. Forest companies are making money. People are going back to work. Pulp prices are coming up in this province.

The Speaker: Thank you, Premier.

Hon. G. Clark: There are lots of positive signs that we've finally turned the corner. Jobs are starting to come up, and the economy is recovering. There will be more announcements about partnerships between this government and private industry to create jobs in the coming days and weeks.

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[ Page 14071 ]

On June 14, 1999, this NDP government issued a news release under the headline "Timber Sale Offer Creates Two Jobs." Count them -- two jobs. Hold the presses. The government that promised 40,000 new forestry jobs has created two. How does the Premier explain the fact that this historic, groundbreaking announcement about two new jobs was so blatantly ignored by those cynical people in the press gallery?

Hon. G. Clark: Hon. Speaker, I know it's the end of the session, so they're desperate for questions. They're desperate for questions.

Listen to the list of initiatives that I just enumerated: Lousiana-Pacific, Weyerhaeuser's faith, Tembec's investment, IBM's investment, MacDonald Dettwiler's investment and all the public sector projects from the Lions Gate Bridge to SkyTrain to the new trade and convention centre. They opposed every single one of them. They have not put forward one positive suggestion about how to improve the economy. They are desperate for failure. They're happy if there are problems in British Columbia. But they're the minority. People in this province are looking for leadership.

Interjections.

Hon. G. Clark: That's right. And they're not getting it from that lot over there. They promise us more for everything, but their suggestions don't add up, and people see through them. They know that we live in the most magnificent province in the most magnificent country in the world, and things are looking up. Things are turning up. If we stay the course, they'll be very depressed, because things are finally turning around in our province.

The Speaker: First supplementary, the member for Matsqui.

M. de Jong: Well, the only people that are going to be depressed are the people sitting beside the Premier, if he decides to show up for another term in September. Those are the people that are going to be depressed.

Look, they're his announcements. I've tried to calculate, based on the existing evidence, just how long it would take the NDP to fulfil its forest job creation promises.

Interjections.

M. de Jong: It may happen, and undoubtedly there will be an announcement. I can see it now: "Premier's log, star date 2995.5. Job targets reached. Victory is ours." How can this Premier continually stand in this House -- when he does stand in this House -- and expect to have any credibility, when he has promised British Columbians that he's going to create in excess of 50,000 and what we've seen is an actual loss of 13,000 jobs?

Hon. G. Clark: Hon. Speaker, I don't know what he's talking about. The facts are clear: 17,000 net new jobs in the last 12 months. That is not insignificant, and all the signs are finally positive: lumber at $400 (U.S.), workers going back to work, forest industry making money, new investments. . . . Why is that? This side of the House cut costs, and we cut red tape. We cut stumpage fees. We worked with the industry, and it's working.

They're unhappy every time the number of jobs is. . .

The Speaker: Premier, please finish up.

Hon. G. Clark: . . .improved in this province.

The Speaker: Please finish up.

Hon. G. Clark: So I look forward to them. . . . They can laugh all they want. Things are turning in British Columbia. These are real jobs; these are real initiatives. . .

The Speaker: Thank you, Premier.

Hon. G. Clark: . . .and they're paying dividends for our province.

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TOURISM PROMOTION FOR NORTHEASTERN B.C.

Hon. I. Waddell: Well, hon. Speaker, I can tell the member that tourists are coming to British Columbia, to every region. Tourism is booming in British Columbia. It's a $9 billion industry.

With respect to that concern, the hon. member, who's a valued member of this House and who has raised this point before about northeastern British Columbia. . . . I raised it with Tourism B.C., which is an arm's-length agency doing marketing, and they put an extra $100,000 into marketing for the north. If it's insufficient or if it's not targeted where it should go, then I'd be pleased to take that up with Tourism British Columbia. The member can come along with me, and we can sort it out so that we get those visitors. I agree with him -- that's a very important area for getting visitors to B.C.

Tabling Documents

[ Page 14072 ]

Orders of the Day

Introduction of Bills

SUPPLY ACT (No. 2), 1999

Hon. J. MacPhail: I move that the bill be introduced and read a first time now.

Motion approved.

Hon. J. MacPhail: This supply bill is introduced to provide supply for the continuation of government programs while the debate on the government's estimates for 1999-2000 continues. The first interim supply for this fiscal year, granted by the Legislative Assembly, was for one-quarter of the tabled estimates for voted expenses. This funding will be exhausted by June 30, 1999. Therefore a second interim supply is required to provide for the continuation of government programs.

Therefore, in moving introduction and first reading of this bill, I ask that it be considered as urgent under standing order 81 and be permitted to advance through all stages this day.

The Speaker: An interim supply bill falls into the category of a bill which, by precedent in this House, has been permitted to advance through all stages in one day, and I so rule today.

Bill 90, Supply Act (No. 2), 1999, read a first time and ordered to proceed to second reading forthwith.

The Speaker: Hon. members, I would ask that you remain in your seats for a few moments while the bill is being circulated by the Sergeant-at-Arms staff. Then we'll continue.

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SUPPLY ACT (No. 2), 1999
(second reading)

This supply bill is in the general form of previous supply bills. The bill requests one-twelfth of the voted expenses as presented in the 1999-2000 estimates, to provide for the general programs of the government while the estimates debate is completed.

G. Farrell-Collins: This is the second supply bill for this fiscal year. I can't think of a year since 1992 where we haven't had two interim supply bills through the early part of the session. Each year I am hopeful that the government is actually going to bring the House in a little earlier, get to work a little earlier and have a fiscal plan and a legislative plan to move this stuff forward in a reasonable time. Year after year, I'm disappointed. This year is no exception.

Despite the fact that this House came in several times over the last year. . . . We adjourned last summer at the end of July, came back in December for second reading of the Nisga'a debate and then came back in January to complete the Nisga'a debate. We only sat for a month -- three weeks, actually -- until the government pulled the plug. We left the Legislature and then didn't come back again until the very end of March, right at the end of the fiscal year, to bring in the government's budget and to get interim supply for the next three months.

At any one of the opportunities along there, the government could have -- if it hadn't been in complete disarray -- brought in the budget earlier. It could have brought in the budget in February; it could have brought in the budget earlier in March. Indeed, a previous administration -- same party, but a different administration -- in 1992 brought the House in about mid-March. In fact, that was a pattern for some time. Under its new leader, this government seems to try to bring the House in absolutely as late as possible in order to get supply for the three months that follow. Every year it seems that despite the best attempts of the opposition, we end up here at the end of June with another supply bill. This year it happens to be for an additional month.

The fact of the matter is that the Legislature has virtually completed the estimates process, with the exception of a portion of the health care estimates and the Premier's estimates. We tried to start our evening sittings a little earlier this year, to have a bit more order in the way that the Legislature dealt with the supply, and to a certain extent that worked. But I must say that we could have completed the estimates process much, much earlier. The government came back in March and continued with committee stage of the Nisga'a bill. At that point in time, the budget had been introduced. Had the budget speech progressed and the government then moved the estimates process forward, we could have been well underway in the estimates long before now. In fact, we would have probably completed them by now, because we could have moved them into Committee A; we could have started the work there.

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We talked earlier today -- in question period, in fact -- about the government's job creation record and some of the announcements they've made over the last number of years in an effort to attract jobs to British Columbia. I know that when people are looking to invest, they look to see what kind of a government they're going to have to deal with. In British Columbia they look at a government that has failed year after year to get its supply through on time. They look at a government that year after year comes in with a scattered legislative agenda, a government that's in disarray, a government that

[ Page 14073 ]

The fact that we sit here in this Legislature year after year and deal with our budget in the way that we deal with it is, I think, entirely inappropriate. We should have a fixed budget day for the province of British Columbia so that people know when the budget is coming in. We should have a plan to deal with the estimates that will get them completed in the time required. Interim supply should not be used by the government just as it pleases because it can't get its act together sufficiently to get its legislative agenda through.

The problem, too, with this is that we're again being asked to grant the government more money -- one-twelfth of this year's budget -- when we all know that the government failed in this year's budget to deal with the problems that are arresting people in British Columbia and that are hurting families right across this province. The downturn in the economy continues. We're still in recession in B.C., despite the amazing revisionist theories of the Premier, whom we heard less than half an hour ago talking about how everything's wonderful in British Columbia and everything's turned around and everything's back on the rise. That's clearly not the case.

Housing starts are at a record low. Since we've been keeping track, they've never been lower than they are now; in 50 years, housing starts per capita have never been this low. Retail sales are off substantially from last year. The Premier picks one month and says that they've gone up. It's ridiculous to use that kind of comparison. To think that the Premier bases his philosophy and his plan for British Columbia on statistics like that. If he's that selective with his statistics, it's no wonder that he doesn't understand what's happening in British Columbia right now. It's no wonder that we're in the problems that we're in right now, because that's the way the government views the economy and the way the Premier views the economy.

For the Premier to stand up and ask for more supply, for more money, from the Legislature of British Columbia when he has yet to prove himself worthy of those funds is unfortunate. The Premier has once again delayed his estimates to the very end of the estimates process so that he need not be accountable for the work -- or lack of work -- that's gone on in his office and the lack of vision that's been exhibited by his office on the economy. He leaves it till the last so he doesn't have to defend it. That's part of the reason why we're sitting here today having to debate a supply bill once again.

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The province of Alberta is one example. It's interesting to see what's happened in Alberta over the last couple of years, because the people in Alberta are starting to reap the benefits. . .

H. Giesbrecht: Of their gaming policy.

G. Farrell-Collins: . . .of their government getting its economy in order.

The member for Skeena says it's because of their gaming policy. Well, I thought that the government of British Columbia had decided against an aggressive expansion of gaming, but it appears that the member for Skeena wasn't at that caucus meeting. Or is it just that policy changes so fast on that side of the House from caucus meeting to caucus meeting that if you miss one, you don't know exactly what's happening? Maybe the member for Skeena could get up to speed on what's happening with his caucus, or maybe this is the precursor of the fact that the government has changed its plans yet again. We know -- or at least we were told -- that there was an emergency caucus meeting of the NDP today to deal with something. Maybe they've changed their gaming policy again, and we're going to see that.

In Alberta, if you look at the trends that have taken place there over time, you see that in the last couple of years the people of Alberta are starting to reap the benefits. In fact, spending on health care in Alberta is substantially higher than it was before the cutbacks were ever initiated -- substantially higher. In fact, they cut back, I think, about $400 million in health care spending, and now health care spending is about $1.2 billion more than it was at the height of the cuts. So in fact health care spending in Alberta has gone up dramatically and is forecast to go up dramatically over the next number of years. Indeed, spending in Alberta on education is going up as well. Health care spending in Alberta has gone up well beyond what the cuts were initially, well beyond what they were before. . . .

Interjection.

G. Farrell-Collins: The minister asks me if we're going to get their MPs to run for us as well. Well, we might get one of her former cabinet colleagues to run for us: Ms. Pement, a former cabinet member of the NDP, has joined the opposition to the NDP and is now part of our party. Who knows? She just may choose to run, and the people in her community just may choose to back her, and she could become part of the opposition to the government and part of a new plan.

It's people from right across the political spectrum that are uniting to oppose this government. That's why they're at 16 percent in the polls; that's why the Premier has a 78 percent disapproval rating -- a record level for a leader in British Columbia since they've been polling. I know that the Minister of Finance may be uncomfortable with that -- to find out that when she walks out of this building, there's really only she and part of her caucus that still supports the Premier and that the rest of the province doesn't -- but that's the reality of it.

So if you look at what's happened in Alberta over the last couple of years. . . . Prior to their cutbacks in health care, they

[ Page 14074 ]

[1500]

Interjection.

G. Farrell-Collins: All of that money is going back into their health care and education system. They're reaping the benefits of good fiscal management.

The member for Skeena asked me how many. . . .

Interjection.

The Speaker: The member for Skeena will have a chance to enter the debate, should he wish to do so. In the meantime, interruptions are not helpful. The member continues.

G. Farrell-Collins: I await the day that the member for Skeena actually gets up in this House and enters into the debate. I think that what happened in 1992, when he got here, was that one of his colleagues played a trick on him and Krazy Glued his seat to the chair. He hasn't been able to get up in the last seven years. They probably should have used the Krazy Glue for another part of his anatomy. Then we wouldn't have had to listen to him and his heckling over the last seven years. But we'll wait and see what he does with that.

Interjection.

G. Farrell-Collins: My colleague from Peace River North raises the fact that the Albertans tend not to fly their patients to British Columbia for health care, whereas there seems to be a number of health care patients in British Columbia who end up in Edmonton and Calgary hospitals in order to get health care. So I don't know what the true story is there. But I'm sure that the member for Skeena will get up and engage in the debate and help us with those figures.

Interjections.

The Speaker: Hon. members will come to order. The member for Vancouver-Little Mountain has the floor.

G. Farrell-Collins: The Finance minister had her chance. I thought she would have got up and said more to justify the supply, but perhaps she won't.

If you look at what has happened in Alberta, their health care and education spending is at record levels. It's climbing dramatically at the same time as their debt service costs are dropping.

I did hear the member for Skeena talk about the hospitals that closed in Alberta, but I didn't hear him talk about the hospitals that were closed in Saskatchewan by the NDP government. It seems to me that another social democratic government. . . . I'm not sure that this one's got very much social democracy left, in the NDP; it's more like a big-labour party. But certainly the social democratic government in Saskatchewan has done similar things. They're supposed to be left of centre. They in fact had to deal with some tough times in Saskatchewan. But they balanced their budget year after year, six years in a row. They've been paying down their debt, and they're putting more money into health care and education.

So it doesn't matter whether you're a left-of-centre party, an extreme-left party or a right-of-centre party. It doesn't seem to matter in other parts of Canada. They're all trying to get their finances in order and all trying to present a reasonable fiscal approach to managing the people's finances.

In British Columbia we seem to be off in some never-never land, with the Premier hallucinating about all sorts of jobs. He thinks that all you have to do to create a job is to have a press release or a photo op, and therefore the jobs exist. If you announce that there are going to be 6,000 jobs in the aluminum sector, then they exist. He doesn't understand that making the announcement and the photo op is only the first part of it. You've actually got to create the jobs. You've actually got to have the businesses come to British Columbia, invest, expand, hire people and create jobs; that's what it takes. It doesn't just take a photo op; it doesn't just take a press release. It takes hard work. It takes creating an economic climate that fosters business and allows for business to create jobs, to create opportunities for people in your province.

All other provinces have figured that out -- all the other nine provinces, whether they're the NDP government in Saskatchewan, a Conservative government in Alberta or Liberal governments in places like New Brunswick or Nova Scotia or wherever. They have all realized that in order to have a prosperous economy, in order to create jobs and in order to give people opportunity, you have to get your fiscal house in order.

It's very interesting to see, once again, that this government is back here asking for more money -- asking for more cash -- to get them through. . . .

[1505]

G. Farrell-Collins: "How much more?" my colleague asks. I think they're asking for about $1.7 billion for the next month.

If the government were spending that money wisely, if they actually had a credible budget and a credible fiscal plan, I'm sure all members of the House would be enthusiastic in supporting this request for supply. But as we've gone through the estimates process, whether it be in Forests or Finance or you name it -- whichever ministry; we're now doing Health -- we hear of litany after litany of failures. We hear about programs that aren't delivering what they promised.

An Hon. Member: Oil and gas is down 15 percent.

G. Farrell-Collins: My colleague tells me that oil and gas is down 15 percent. We know that the job creation record of the government has been abysmal. We know that the health care system continues to have crisis after crisis. I think it was

[ Page 14075 ]

I have sat in this House for seven years now. This is actually the eighth time I've had to sit in this chamber and listen to the health care estimates, and after seven or eight years, it's the same issues that are coming forward. It's wait-lists that aren't getting any shorter. It's money that's not being spent appropriately. It's people having to fly out of the province to get health care from that demon province, Alberta. It's people having to go down to the United States to get health care -- although I think there's a little less of that than there used to be. But it seems that there is no credible plan to move these issues forward. Year after year we grapple with them.

Education is the same thing. The Premier thinks that all you have to do is create a photo op and you've solved the problem. We saw one a couple of weeks ago, where the Premier was trying to tell us that the government was going to get rid of portables. We've been hearing that announcement since 1990, before the first time this government was elected. I think we've got twice as many portables now as we had in 1992. The Premier says: "We've got a problem with portables. I know how to solve it. Let's have a photo op." So what they do is go and find a portable, they take it and attach it to a school, and then they put the Premier in the seat of a truck, so he can drive the portable away. The problem's gone, according to the government. It's over; they've solved the problem.

They deal with portables the same way they deal with job creation. You have a photo op. You have an announcement. You get the Premier to stand up and read off the list of announcements. And we're all supposed to believe that the jobs have been created. We're all supposed to believe that the portables have disappeared. We're all supposed to believe that the wait-lists are gone. The Minister of Health has stood up in the House -- how many times? How many times has she stood up in front of a podium? How many times has she stood up in front of a television camera? How many press releases have she and her predecessors -- the three or four other Health ministers we've had in this province in the last seven or eight years -- put out, saying: "Here, we're injecting new money into the health care system. We're going to eliminate wait-lists"? It's eight years later, and the wait-lists are longer, not shorter.

So the government came up with a new angle. They've gone into the high-tech sector. The government has come up with a wait-list web site. British Columbians can get on the web site and find shorter waiting lists and plan their route to better health. We find out now that according to the government's own web site, there are over 2,000 new people on the wait-lists. Either there is something wrong with the web site or with the way it's being reported, or the government hasn't been reporting the problem accurately over the last number of years. I don't know which one of those it is, but any one of them is a problem. If it's the first one -- that the web site is inaccurate -- then they're not telling people the truth about the state of the wait-lists in the province. If the information that is being reported there to them is inaccurate, then they've got a reporting problem. If the web site is actually accurate, that means that they haven't been reporting the information accurately in the past. They've been misleading British Columbians in the past about the real state of wait-lists.

Maybe the new high-technology trick the government is trying with the web site is going to solve the problem. Maybe it's highlighting further problems, and maybe it's actually going to finally tell British Columbians the truth about what the government has done in the last number of years.

If we on this side of the House felt that those problems were being dealt with and that those problems were moving forward, we'd all be enthusiastic about granting further supply to the government, because it would be stopping those problems. It would be correcting those problems. It would be improving the state of the economy, the state of health care and the state of education in the province of British Columbia. But clearly that hasn't been happening. I must tell you the frustration that I as a member of the opposition sense, year after year, standing up in this House and asking the government almost the very same questions, highlighting the same problems for this government and dealing with interim supply debates.

[1510]

It reaches a point where the only recourse that is available to the people who speak to us and speak through us is an election. It's the only thing that is going to finally settle the matter. It is the only thing that is going to finally clear the air. It is the only thing that is going to change the direction of this government -- by replacing this government. The people of British Columbia are bitterly disappointed with the performance of the New Democrats over the last eight years. They are bitterly disappointed with the way they've been misled, with the way they've been promised things only to find out that there was never an intention of delivering in the first place. They are bitterly disappointed with turning the news on every night and hearing the latest gimmick that the Premier has thought up to get himself on the 6 o'clock news, knowing full well that there is about as much fact in that as there is in turning on the television and watching Bart Simpson make a promise. That's about how much reality there is.

It's hard to tell anymore where the comedy starts on the news, where the tragedy starts on the news and where the government's announcements fit in. They're blurring. They're pretty much the same. The Premier stands up every day. . . . We saw the one I highlighted, with the school; we're going to see another one, I'm sure, tomorrow. The Premier announced today that there are going to be more aluminum smelter announcements in the weeks to come, and I'm sure there will be. I'm sure before the next election. . . . He said today that it's eight aluminum companies now. It's not three anymore; it's eight aluminum companies that are thinking about investing here in British Columbia.

[ Page 14076 ]

When the Premier and the Minister of Finance come and ask us for more money, it's our duty to ask the government why they need this money and if they've changed their ways. If they need this money, then perhaps they're going to enlighten us and tell us that they've changed their ways, that they've got a better plan than the one they've been working on for the last eight years and that in fact they're going to try and turn the corner and change the way British Columbia works. But we see that the Premier is still in dreamland. He still is under some illusion that what he has been doing for the last three years has worked.

I don't know how he continues to delude himself. Maybe he sifts through the tea leaves of economic news and pulls out the one little kernel of statistical plus and says: "Hey! Retail sales went up a half a percentage point last month. Everything's fine." He's ignoring the fact that retail sales are off dramatically over last year.

An Hon. Member: Housing starts are at a 40-year low.

G. Farrell-Collins: My colleague reminds me again that housing starts are at. . . . Actually, I think it's a 50-year low. I think that since we've been keeping track, it's at a 50-year low.

[1515]

They don't get it. I don't think that anything we could possibly say here in this Legislature is going to see that they get it this year as opposed to other years. In fact, I expect that they'll go ahead and do exactly the same thing. If this administration, heaven forbid, happens to last another eight or nine months and we're forced to see the 2000-2001 budget, I expect that it will reflect the fact that the government has still not figured it out. So I don't see much point in standing up here, yelling at this government and trying to correct the government's ways and to pass on the recommendations of British Columbians to this government -- as we've done year after year -- when they continue to reject it year after year.

I think that the sooner we can get over the business of this government, get rid of this government and have an election and get a new government in place, we'll all be a lot better off.

The Speaker: Seeing no further speakers, I recognize the Minister of Finance to close debate.

Hon. J. MacPhail: It's an interesting exercise to pursue the choices that people make during a budget. We've made our choices perfectly clear, and the choices are much different from those that governments in other provinces have made.

It is simply ridiculous to compare health care or education spending in Alberta as an example to hold up to this government in some way. If we had actually followed the example of Alberta, we would be sitting here with a $500 million surplus based on this year's budget. If we had made the choices around gaming revenue that Alberta has made, we would be sitting here with a $1 billion surplus. It is simply ridiculous. . . . Maybe it isn't ridiculous. Maybe this opposition is actually going the way of the members that it's trying to recruit. Maybe it is going to actually change its name. Maybe we'll be standing up and asking for a private member's bill to have the Liberal name changed to Reform, to actually reflect what they really stand for.

Anyway, we are here to determine supply. It is straightforward, and I would move that the bill be read a second time now.

Motion approved.

Bill 90, Supply Act (No. 2), 1999, read a second time and referred to a Committee of the Whole House for consideration forthwith.

SUPPLY ACT (No. 2), 1999

Section 1 approved.

Preamble approved.

Title approved.

Hon. J. MacPhail: I move that the committee rise and report the bill complete without amendment.

[1520]

YEAS -- 38
Evans	Zirnhelt	McGregor
Kwan	G. Wilson	Hammell
Boone	Streifel	Pullinger
Lali	Orcherton	Stevenson
Calendino	Walsh	Randall
Gillespie	Robertson	Cashore
Conroy	Priddy	Petter
Miller	G. Clark	Dosanjh
MacPhail	Sihota	Lovick
Ramsey	Farnworth	Waddell
Hartley	Smallwood	Sawicki
Bowbrick	Kasper	Doyle
Goodacre		Janssen

[ Page 14077 ]

The House resumed; the Speaker in the chair.

Bill 90, Supply Act. (No. 2), 1999, reported complete without amendment, read a third time and passed.

[1525]

Tabling Documents

Hon. J. MacPhail: In this chamber, I call Committee of Supply. For the information of the members, we'll be debating the estimates of the Ministry of Health. In Committee A, I call Committee of the Whole to debate the bills as agreed.

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

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

[1530]

Also, in the context of that, when she does respond, if there are any overruns for this year, if she could also elaborate on the factor that was cited as a reason for the cost overrun. . . . That is the issue of fluctuating currency. Again, that caught me by surprise when I read the letter that I received from the minister's office. As I say, thinking that the entire project was a B.C. build and B.C. labour and B.C. materials, fluctuating currency seemed a bit odd in that context.

I also spoke to the minister before the break about some constituency concerns that have been raised in my riding, in particular about a senior who was not able to receive home care support when he returned from surgery. At that time I did not give the name of the constituent, which I'm prepared to do, because the constituent is quite happy for the minister to know. It is a Mr. Hall, who lives in Oak Bay. It was his neighbour, Mr. Peter Holloway, I believe, who had contacted our office and indicated his concern for his neighbour. Were it not for the concern of Mr. Holloway, the neighbour, Mr. Hall's situation could have been much more tragic.

In conclusion on that particular file, Mr. Hall then sent me a letter. As I say, his suggestion as a result of his experience was that every doctor and surgeon must ask each patient whether they live alone and "Will you need help? If so, what kind?" so that the doctor can assist in arranging it if that is the case. So I just leave that for the minister, as well, so that she's aware of those concerns of seniors which I represent -- many in the riding that I represent.

The other issue I also want to provide to the minister is another constituent. Again this has to do with wait-lists. I know that the wait-list issue has arisen, but it continues to plague the people in the riding that I represent. Ms. Julie Keyes waited so long for surgery for kidney stones that apparently it's very likely that she may now have some permanent kidney damage. So in the context of that, hon. Chair, I'd like to ask the minister: can she advise whether the wait-list for surgery in that area has improved or if there is still a substantial backlog in kidney surgery?

[1535]

In terms of Royal Jubilee Hospital, my understanding is that the original project was $83.5 million. I think what we referred to last year -- or at least in the letter that you received -- was an additional cost of $5.941 million due to contaminated soil, asbestos, etc., which was the cost overrun referred to in the letter. You asked if there had been any other cost overruns -- additional costs approved since the original amount. There has been one. In June this year, just recently, $3.7 million was approved to cover the lowest tendered cost.

I. Chong: To the minister's last remarks about the additional cost of $3.7 million, would she be able to clarify that, perhaps, in the context of the lowest. . . ? What I'm looking for is: was it a cost that was paid out that actually did not receive any tangible benefit? If it was just to satisfy a legal requirement, I would be curious to find that out.

Hon. P. Priddy: What happened in this circumstance -- and it could happen either higher or lower in others. . . . When a project is put on the capital plan and approved, there's an estimated cost for that. In this case the estimated cost was $83.5 million. When the tender came in, the lowest tender was $3.7 million over the $83.5 million that had originally been estimated.

I. Chong: I would surmise from that comment that the budget would therefore have to have been revised from its

[ Page 14078 ]

The difficulty, of course, as the minister must be aware, is that when you have moving targets in terms of your budget because of extras and adjustments to tenders, etc., then it's very difficult for people to really get a handle on whether the project has come in on budget -- which is something, I'm sure, that every ministry wants to have happen in its capital projects. So I would just like a final confirmation, if at all possible, of the final budget projection -- the target amount that we will be measuring to when the project is complete.

Hon. P. Priddy: The final target will be $101.6 million.

I. Chong: I'd like to move on to another issue here in the capital health region. That is, about a month ago a press release was issued on a weekend, announcing additional spending that was coming to the capital health region. As a result of that, obviously, I was called and asked to comment on it -- not only from constituents but also from members of the media. I was quite surprised to have to respond to $116 million extra that was being provided to the capital health region. Lo and behold, I realized later that in fact it is the additional amounts that are included in the current year's budget, the '99-2000 budget. It was not additional moneys over and above what has been allocated for this budget but in fact is the budgeted amount, which is an increase over last year's spending.

[1540]

What I've discovered or what has been brought to my attention is that the extra $116 million for the capital health region in this year's current budget in fact was moneys for programs that were initiated last year, in '98-99. So this extra $116 million is to cover last year's programs and in fact will not improve or increase health care services for the current year. This is what I've been told by people who work in the health care field. I'm wondering if the minister can provide some further clarification on that. I'm not absolutely sure if it's $116 million or $161 million; I may have my figures transposed on that. But I know it is in that range.

Hon. P. Priddy: Sorry; we don't have all our press releases here. If you have one and could pass it across to us, I'd be grateful, because $116 million -- at least in the information in front of me, presented by staff -- isn't a number that we have.

In point of fact, the capital health region did receive an overall budget increase of 3.7 percent. Whatever programs they were running last year would have been annualized in their base last year. So this is additional money this year. Their total operating budget is $476,835,325, which is almost a 3.5 percent change. So I would need to look at the press release -- I'm sorry -- to understand. But they do have new money. It's not only to sustain the programs that were begun last year. They do indeed have additional resources this year -- about $16 million, actually.

I. Chong: I apologize to the minister. I don't have that press release here, but it was about a month ago. The answer that the minister has given is fine, in terms of that particular press release. But my understanding, of course, was that the additional increase this year was based on programs that were announced for the capital health region to provide or to be expanded or enhanced. I'm not exactly sure, other than the fact that I have spoken to people in the health care industry who have said: "Really, that extra money isn't going to allow us to do anything extra, other than what we're required to do." If the idea is to increase funding for health care services, one would logically expect that it would be to provide new services, not to pay for the services that are required as a result of announcements from the previous year. That's where the question lies. I'll leave it for the minister to ponder; and if she wishes to respond to me, that's fine.

In another area, again in my constituency, last year I asked about the Queen Alexandra Hospital for Children, the Queen Alexandra Foundation for Children and the ongoing signing of the agreement. This is a very short answer that the minister can provide: has the agreement finally been signed last year? It was to be very soon; it's now ten months later. I'm assuming that the agreement with the Queen Alexandra Hospital has been signed -- with the capital health region -- and that there were no difficulties or problems encountered with that.

[1545]

I. Chong: Then perhaps the minister could provide me with some details -- if not now, then perhaps by way of a written response -- as to what the delays are, preventing or precluding the agreement from the proper signatories. The reason I ask is that it began, I believe, two years ago, prior to this minister assuming responsibility for the Ministry of Health. When the Miriam Gropper report was released, we were told that all the recommendations had been accepted by the Ministry of Health and that it would be signed very shortly. So last year -- it had been a year since then -- I asked if it would be signed very shortly, and the minister replied yes.

It just causes one to raise the question: if it's all agreed to and everything is fine, why aren't we signing this document? If there are other issues to be dealt with, there would also be further costs, I would imagine, to revise, amend or alter the agreement. We're looking at additional legal costs or consultants' fees. I don't know to what extent, financially, but that's a concern. We know there are very few, scarce health care dollars. Certainly we want them to be spent for the patients and not for a continuum of legal services. So if the minister is able to provide that at a later date, I will accept that.

I'm anxious to move on to another issue as well. There is a group called Citizens Concerned About Aphasia. They've contacted me, as I know they've contacted other members in

[ Page 14079 ]

Hon. P. Priddy: If I can just go back to QA for a moment, we will get you that information. Again, I would prefer to get it for you before estimates are over. I agree that last year we thought it was all optimistic and should be signed soon. Of course it's puzzling a year later, when it is still not signed. So the member's question is a fair one, and we will get that information for her.

In terms of funding for people with aphasia, we are not aware at this time that we have received a provincial proposal. As I say, we're not aware. I have people saying no. You know, we can always be proven wrong, but at this time we're not aware that we have received a proposal for funding for people with aphasia. They may have received proposals at regional health levels. In fact, I don't doubt that they have, because I know the issue is primarily for adults who've had CVAs and have lost speech as a result of that, although it certainly could include other people as well. I would expect that those have been made at a regional level.

[1550]

I. Chong: Regrettably, I believe that the regional health board -- the capital health region here -- has not included it within their plan. Again, due to funding commitments and requirements, it's not yet being considered. But I raise it on the basis of whether the ministry as a whole is looking into this area. We've seen the ministry move into areas of funding for midwifery. We've seen the ministry moving in the area of alternative medicine. It may be something that requires the ministry to take the lead on, versus people going to all the regional boards to solicit support for and understanding of this.

So in that context, I ask whether the ministry itself is looking at this or whether it's low on the priority list at this time. I'll let the minister answer.

Hon. P. Priddy: No, we are not looking at it provincially at this time. I think the examples that the member uses around midwifery or traditional Chinese medicine are about professionals incorporated in a college providing a service. If we were to take it on at a provincial level and say to all regional health boards, "You must fund programs for adults with aphasia," then we could quickly lengthen that list to services for people who are hearing impaired or mobility impaired. That list starts to grow.

I think that the regional health boards need to make that decision. I mean, they need to put it in their plan and submit that plan to the ministry -- fair enough. But there may be some health authorities that don't have a high number of adults and may not choose to put their dollars there, even though they still have adults who need it. There may be areas like the capital region and others, with a high proportion of seniors, which would wish to include it. So we're not looking at providing provincial funding to do that, but we'll certainly look at anything that comes from a regional plan.

While I'm on my feet, hon. Speaker, I seek leave to make an introduction.

Leave granted.

Hon. P. Priddy: I notice in the gallery two colleagues who are, I'm sure, here to watch the Health estimates, because they have a profound interest in the health care profession. They are Chris Allnutt and Mike Old from the HEU. I'd ask the House to make them welcome.

I. Chong: I thank her for her clarification on that issue. I think it's important that those who would review the Hansard after this date or who are watching now understand the process by which certain forms of health care services are not funded. I think that clarification may help those who want to pursue this issue a little more.

Before I move on to a few other constituency areas. . . . This does not actually fall within my constituency, but as the sort of greater Victoria MLA in the opposition benches, I feel that I need to ask a very quick question to the minister. It's whether or not another major project in the capital health region, the replacement of Mount St. Mary Hospital at the Fairfield Health Centre. . . . Again, can the minister advise whether we are on time on that -- I think the date expected for completion is March 2002 -- and whether we are also on budget at this time?

Hon. P. Priddy: The most recent information I have is that they are both on time and on budget.

I. Chong: The issue of home support, which we've touched on very briefly in discussing some constituency concerns, has been very much heightened in terms of awareness in the last three or four months. The capital health region board went through a contract-restructuring process about four months ago; I know that the minister is well aware of that. I know that there have been difficulties in contract restructuring in the Ministry for Children and Families, for example, where the whole process was halted.

[1555]

[ Page 14080 ]

I'm wondering whether there's any direction that the Ministry of Health staff place on the regional health boards in the area of contract restructuring, whether there is a valid business plan that has to support contract restructuring and what cost savings are looked at -- in essence, whether a thorough review before this kind of project is undertaken. It's simply because in the area of home care support, people are very much tied to their home care support providers. Any change sometimes causes severe stress on those who rely on continuity and familiar faces. I'm wondering if the minister can provide a little more clarification on what occurred.

Hon. P. Priddy: We have said to the health authorities that if they need to do that kind of restructuring, they can and should. But they need to do it based on, probably, two or three factors. One of them is that, yes, they do have to have a business plan to go forward with that. Secondly, I think that they must bear in mind the kind of quality home support that is offered to people and that because we are a medicare system, if you will, they have to be very conscious of the not-for-profit components of the home support system.

I have met with a number of people from Victoria, particularly people with disabilities, who've been concerned that the restructuring may, for them. . . . They are less concerned about the process of restructuring than the fact that if you're a person who needs a significant amount of assistance with the activities of daily living and you've had the same home support worker for a year or two or three years -- whatever that is. . . . If suddenly someone says, "You're going to have someone new," that's very frightening for people. I think that our work with people with disabilities in Victoria -- last time I checked, which was a couple of weeks ago -- is going reasonably well towards meeting the needs of people with disabilities who have those concerns.

I. Chong: I just want to say for the record that I've found the name of the other agency. The two agencies that were not included in terms of providing contract services were Island Community Home Support Services Society and Fernwood Home Support Services Society, both of which use a complement of volunteers, I believe, as well as paid staff. I think it was distressing to those employees, many of whom were not organized employees and had been working for many years, to no longer be able to continue to work for their society and have to find alternate work through an organized labour structure in the other nine contracted agencies that did receive it.

[P. Calendino in the chair.]

[1600]

I did want to comment, if I might go back for a moment, that I understand from the ministry that we have written to health authorities -- I'm going back to aphasia for a moment -- to inform them that speech language services, which is really what you're talking about, for adults suffering from aphasia are important measures for them to be considering when they look at services in their area. We've not gone beyond that, but we have written that recommendation and reminder to them.

I. Chong: I will certainly take the minister up on the suggestion she made that we contact the capital health board. Someone may have done so; I'm not sure if they've had difficulty. If we've had difficulty retrieving that information, then perhaps I will oblige myself to use the services of her ministry staff to assist me in obtaining that information. I would certainly also hope that it would not have to go through FOI; these things should be made public. We're talking about individuals and their care providers. I think they should be entitled to know.

I have two other issues I'd like to quickly canvass, which are specific to this region. I know it may be outside the purview of the Ministry of Health, but I place it on the floor for her to perhaps comment on. That is the CRD clean air bylaw that was introduced recently. I know it comes from the regional district, although the capital health region medical officer, Dr. Stanwick, is very much a proponent of this. I'm sure he has quite a bit of involvement; that's where the link is, as I see it. At the last reading of this, I understand that the enforcement has become very difficult and that the regional district -- in conjunction with the CHR, I guess -- is looking to get a ruling from the B.C. Supreme Court on this issue of enforcement.

Can the minister advise whether there is money coming out of her ministry to help fund the legal court case, or is this strictly in the regional health board's budget that they should have provided for in their business plan?

Hon. P. Priddy: We will, of course, always check when we say these things, but to the best of our knowledge, no, there are no dollars coming from the ministry to do that. While you are correct that this is sort of a broader issue, as it relates to health authorities or health facilities, if you will, and enforcement of the regulations, I do note that they have made some exceptions. And I actually support the exceptions that were made. Enforcement in those areas is probably the least of the difficulties that they'll have.

[1605]

[ Page 14081 ]

The final issue I'd like to ask the minister about is an area that I've canvassed in the estimates of the Ministry of Agriculture, the Ministry of Forests and the Ministry of Environment, and finally it has landed here in the Ministry of Health. I'm sure the minister is quite aware of the issue I'm going to raise: that is, the aerial spraying for the gypsy moth. I raise it because not only has it been an environmental concern for those who would oppose this; it's been a health concern as well. Seeing that interministerial discussions need to take place. . . . I know the Agriculture ministry and the Environment ministry are looking at this.

But again, the medical health officer, Dr. Stanwick, has stepped into the fray here and has said that he would be monitoring the effects of this. I'm wondering whether the ministry itself would take any -- I wouldn't say lead -- authority or responsibility in looking into the possible health effects, above and beyond the local health officer. Certainly if you were to ask the health authority in the Richmond area, they feel that there are health risks. So if you're going to compare region to region, you're going to get different medical officers providing a different assessment of the risk of the aerial spraying. If that is the situation, then there surely must be some collaborative effort from the ministry to ensure, once and for all, that the health risks are settled and determined. I'm wondering if the minister can provide any clarification on that from her ministry.

Hon. P. Priddy: There is not any current plan to do additional research or additional observation beyond what has been indicated in the CRD.

However, we have a provincial medical health officer, Dr. Perry Kendall. If people wanted additional assistance above and beyond what they felt they could do locally, then the appropriate thing would be to raise that with him. I met with him -- I don't know -- a week or so ago. He didn't raise that with me, particularly, as an issue at the time or say that we'd received any requests to do that. I'll check back and see if we have. That would be the appropriate route -- for Dr. Stanwick to say to the provincial medical health officer, "We might need this help beyond that" -- and then we'd look at it.

I. Chong: Just a quick follow-up, then. Would it be correct to conclude that if the provincial medical health officer. . . ? His decision, I guess, would be final and would override those of the regional medical officers. Would it be correct to conclude that?

Hon. P. Priddy: I suppose that in extreme circumstances the provincial medical health officer could override a local medical health officer, but it's very hard to imagine the circumstances in which that might happen.

[1610]

I. Chong: I would just like to thank the minister and her staff for having been as helpful as they have. I know that -- duly noted -- her staff has recorded information that I've requested, and I'm sure that I'll get that in due time. Those are all the questions that I have, related to the constituencies that I represent. Certainly I'll be watching the debates as the critic continues, to see where questions of a general nature may arise, and I may take the opportunity to again deliberate with the minister. But at this point I'm very grateful for the help and assistance I've received.

Hon. P. Priddy: In our efforts not to have outstanding questions, I have additional information that a memorandum of understanding has been developed jointly between the capital health region and QA -- back to Queen Alexandra again. It is now with QA for signing and confirms the framework for the working relationship. Once the CHR completes the regional services planning exercise they've initiated, it will be further formalized, probably in some form of lease agreement.

T. Nebbeling: First of all, I would like to introduce what I would like to speak about today and question the minister for a little while about. That is the fact that the Sea to Sky community health council from time to time has spoken to the minister about the really serious problem of underfunding, based on certain criteria that I think I would like to canvass today.

It is not unknown to the minister that the Sea to Sky country -- from Squamish up to Pemberton, D'Arcy and Birken -- has experienced an enormous growth. As a matter of fact, it is seen as one of the largest growth areas in the province. In spite of that, of course, the funding for patient care in the Sea to Sky corridor has not seen parallel growth to accommodate what is needed.

This has created a fair amount of serious problems in the past, and I think the minister is aware of the fact that not so long ago the government actually had to come in with an additional loan to keep the operation of the Sea to Sky health facilities in full operation. This money was provided at the end of the book year, I think. Because of the inability of the Sea to Sky community health council. . .the funding was actually waived and was transferred to the next year. This kind of thing has been going on now for a year or two and, of course, is not sustainable in the long run. A health council has to have the ability to plan for the programs that they are involved with and for the staffing they need to provide the health care in their jurisdiction.

The first question that I would like to ask the minister is: one of the problems that arises from year to year is that the acute funding allocation is considerably lower than what the community health council sees as a reasonable or needed amount of money. Can the minister give me a quick rundown

[ Page 14082 ]

[1615]

Ministry of Health staff met about two weeks ago with Sea to Sky staff and agreed to review a number of issues -- some of which you have identified, hon. member, and which were identified by the CHC -- including whether the increase this year of just over 2 percent actually does keep pace with the funding formula. The funding formula is the same across the province. We don't have a different funding formula for different regions. I don't have in front of me your population growth and whether the increase has kept pace with that or not. I can't answer that question. You're right: we have provided some additional dollars during the year.

What I would prefer to do. . . . I guess that's part of what our staff will try to work out with Sea to Sky. We did put $600,000 into Squamish General Hospital and another $400,000. . . . But it's a difficult way to try to run a health authority; I know that. I've been in one that has tried to run the same way, and it's hard. It's much easier when you can establish a base that is enough for people to actually be able to provide services without running a deficit. I'm sure that you know that the increase this year was just over 2 percent. The issues you've identified are ones raised by your CHC two weeks ago, and they're working on them with our Ministry of Health staff.

T. Nebbeling: What I would be interested in as an answer is how the formula of the acute-care funding model really works and what is incorporated in the calculations to come up with a number that, in the opinion of the bureaucracy, is reflective of what is happening -- in particular, in my case, in the Sea to Sky corridor, but it obviously applies to every other region in the province. That's what I was looking for, and I hope the minister can give me the criteria for the acute-care funding formula.

The other point, of course, is that the minister just mentioned that there is a base funding for everybody, but it is supposed to be equal throughout the province. Not so long ago, during a small debate on health, it was pointed out to the minister that the base funding per patient in the Sea to Sky corridor is considerably lower than anywhere in the province. I believe the average is. . . . I'm not going to say the average, but I know that in Pemberton the funding per patient is $192, which is considerably lower than the numbers for available funding that I hear are in other rural areas in available funding.

First of all, the funding formula itself. I would like to hear from the minister about what exactly is considered to be a cost factor to come to a determination of why the increase for the acute care has been, I think, $63,000 -- which is not 2 percent, as the minister said but is only 1.2 percent.

[1620]

Let me first tell you who does it, because it's not only people in the Ministry of Health. It is a committee that is made up of all four of the health care unions, a selected number -- and they differ -- of CEOs from health authorities and Ministry of Health staff. So it's not something that's done solely within the bureaucracy; it is done by people who are working in the field.

Anyway, the formula. . . . People estimate population growth by age cohorts, if you will. They translate that population growth into in-patient cases, calculate this growth on a proportion of total provincial growth in particular cases and then give the health authority a share of increased funding equal to their proportion, for that health authority, of the provincial growth.

T. Nebbeling: If it is a known fact, because the sense is that the growth in the Sea To Sky corridor has been established at a 34.7 percent rate, then can the minister explain to me why the increase in funding for acute funding and in-patients is. . . ? You know, I don't know on what basis, but clearly it does not reflect the increase in the population, as I just mentioned. We have a 1.2 percent increase in funding and a 34.7 percent increase in population. Where do the minister or the ministry or the team, which accumulates all the data to come to the determination, incorporate this number? If they do, how can they indeed come up with a 1.2 percent increase in funding for in-patients?

Hon. P. Priddy: I just want to ask a question of clarification, if I might, and then make a response. I want to be clear. The member was saying there was a 37 percent increase in population last year.

T. Nebbeling: These are the official numbers: 34.2 percent, not 34.7 percent, between 1994 and 1998-99. So it's in the last four years. The total increase over these last four years has been 21 percent, of which, then, this year 1.2 percent is the increase. The imbalance between the growth in the corridor and the funding has been blatant in the past, but it's even more blatant this particular year. That is why I was very interested in knowing what the criteria are for the Sea to Sky corridor or for any other district. If the minister wants to get. . . .

Interjection.

T. Nebbeling: I don't think the minister's going to be able to give me the answer, so maybe if I ask some other questions, that will make it easier for me to understand why this discrepancy.

Are day surgery, cancer care, palliative care and emergency volumes also considered in the total package that then makes up the consideration of funding for the district, or are they all excluded from that formula?

[1625]

[ Page 14083 ]

The other piece is that people are funded for the work they do, as opposed to just the population. When people choose to go to Lions Gate, then the dollars go to Lions Gate because that's where the work is being done.

T. Nebbeling: An interesting statement that the minister makes is that, yes, we do incorporate tertiary care in the funding. These are the elements that I just mentioned. It is interesting to see that for the Sea to Sky corridor, the funding for tertiary care was zero. Again, clearly, none of these services -- and I've got the budget here from the Ministry of Health -- that are now provided by the community health council are being covered in any way, shape or form; hence we have a problem.

It was two years ago that the community health council was created in Whistler, Pemberton, Squamish and Birken. Since that time, this health council has really striven to participate in the ministry program, Better Teamwork, Better Care. Within the guidelines of the program -- or within the spirit of the program, I should say -- for the last two years they have introduced, in the health care profession in the Sea to Sky corridor, a number of treatments and care that were just not available prior to the community health council's creation. That there is clearly a cost with this activity is again not recognized, so that's really where the problem lies.

I feel that the recognition that the population in the Sea to Sky corridor has blossomed -- mushroomed, whatever you want to call it. . . . At the same time, the health care providers have had the need to provide services that, prior to the community health council, were just not available in the Sea to Sky corridor. At that time, sure, many people did have to go to North Vancouver or Vancouver to get services. So there clearly is a need for an immediate review of what is happening there and to get that health council and the health care in a shape that is responsible. I don't think anybody in the Sea to Sky corridor is expecting bags of money to make life easy. That's not the case. But it is really a wrong system where we are no longer focusing on how much health care we need to provide but on how much health care we can afford right now. It is just a very simple change in principle, but it is a principle that I think is very dangerous and is hurting people.

The minister made the point that if you don't provide the proper health care services, then indeed you send people to Lions Gate Hospital or Vancouver Hospital. It's true; but again, over the last two years a number of things have been happening in Squamish in particular that have given a lot of people a sense of comfort -- to have the treatment in Squamish. Caesarean sections, up to a year ago or two years ago, had to go to Vancouver, because we just didn't have the surgeons available to provide these kinds of services. Patients were not comfortable staying in the corridor because the services were not available. Today they are. As a consequence of that, the number of in-patients in the Squamish hospital has gone up by about 10 percent. Again, there is no recognition in the acute-care funding allocation model that reflects that increase in patients. Can the minister give me a comment on that?

[1630]

The other thing I would add to that is I will make a commitment that we will review the diagnostic and treatment dollars with your health council, because I do think that we might. . . . We meant to do it separately, but there is something that needs to be done about that. That's why the zero for tertiary.

T. Nebbeling: We always learn, and I'm always happy to learn, but it was a little trickier for me. When I spoke about day surgery not being funded, cancer care not being funded -- I mentioned this earlier on -- palliative care not being funded, the minister said, actually, that we do fund tertiary care. I thought she meant as her response that indeed these issues are covered by tertiary care. That's why I said: "Well, there is zero funding available for that." Nevertheless, the point is that these kinds of services are often out-patient services and therefore not being considered when the formula for acute-care funding is being considered. It is based, as the minister just said, on in-patient beds. So there are a lot of services provided that just somehow miss the boat of getting the proper funding.

I was going on the issue of the Squamish hospital now providing services such as Caesareans, hernias and a number of other issues, because they have staff surgeons. The minister, earlier on, made the point that traditionally many people from that area went to Lions Gate Hospital. That is no longer the case. It is proven that a 10 percent increase in patient load is a reality. This is not reflected in the acute-care funding allocation model, as it has been presented as part of the package that we received for this year's funding. How is the minister going to deal with that?

The numbers used by the committee to establish the criteria and the proper funding for the Sea to Sky health community council are based on 1997-98. That was two years ago. In those two years we have seen the creation of the community health council. We have seen a fair number of services added to the package that are now provided in the Sea to Sky corridor. As a consequence of that, we see fewer people going to the city to have services done. If I take the minister's words that were said earlier, we are actually channelling funding towards hospitals in the city for services done in Squamish right now.

I would like to ask the minister if she will correct that immediately. We just cannot let that go on for another year. Is the minister considering any steps to take care of that particular issue?

[ Page 14084 ]

[1635]

Interjection.

Hon. P. Priddy: Well, I'm told one year.

Interjection.

Hon. P. Priddy: Well, I'll come back to that part in a minute then, because people are telling me something different here.

Day surgeries, by the way, are one of the things that are looked at. They're not excluded -- so I'm told -- from the way the calculations are done. I don't know of any way to have the data any more up to date than what CIHI provides, which I'm told is only a year behind.

T. Nebbeling: I can understand that, in general, it must be problematic to use up-to-date information to calculate how funding will be channelled towards the various councils to accommodate the increases and the needs of an area. However, it has been documented well enough over the last number of years that very considerable growth has caused some serious trouble. As a matter of fact, it was recognized, when the whole Sea to Sky council was being created and when it was reviewed, that in '94-95 the base created for the funding we deal with today. . . . Squamish General Hospital was actually underfunded by $150,000 to $300,000. That has never really been rectified. We have had, from time to time, some emergency funding thrown in to deal with: "Are we going to keep the hospital open or not?" But the base funding has never changed, and that's part of the problem.

I'd like to hear from the minister if, at this stage, there's any serious consideration of bringing that base formula up to the level that that particular area needs, so that the funding that will then be calculated, based on that new base, will reflect the needs of the whole area more. I may sound a little bit like an old record, but I think it is fundamentally important that I really get this message through to the minister. I know that very dedicated staff throughout the Sea to Sky corridor have tried to get this message through a number of times. I've seen it in written form; I've heard it verbally presented to the ministry. Everybody always understands and recognizes that there is a problem, but then when it comes to action, it really is a problem, because there is no action. Hence we have this rather small increase this year that does not reflect what is happening in this corridor.

Now, in comparison -- and I don't really want to get into comparing how other areas get more funding than this particular one -- one that really stood out for me was the Sunshine Coast. When I see the Sea to Sky corridor, with all its growth, getting a 1.2 percent increase for acute, in-patient care -- and that increase reflects $63,217 -- and when I see the Sunshine Coast, which I doubt will have an influx of growth as we do, having an increase of $524,000, which is almost 7 percent, I really question how that calculation has happened and what numbers it's based on. If I look at the weighted cases, there is no justification for an increase of that nature. Maybe the minister or her staff, through the minister, can tell me how the Sunshine Coast can justify 7 percent -- the Sunshine Coast alone; that's not Powell River -- adding up to $524,000 when an area right next to it with much-recognized growth is being sent home with 1.2 percent.

[1640]

I have probably three comments. I want to go back to the data -- how old it is; you say two years, and we say one year. I think it's actually probably somewhere in the middle, now that I look at this note. We get our data from the Canadian Institute for Health Information in September or October of the year that closed in March. So we get 1998-99 data in September of '99, and that's used for the 1999-2000 funding. It's used for planning the following year. As I say, we get the data in September of 1999, and it's used to plan 1999-2000 funding, so it's not quite two years behind.

There are a number of health authorities around the province -- and I've been quite frank about that -- that have not had adjustments to their base. I could provide you with a variety of examples where, while we have tried with new dollars to keep pace, some health authorities started out with a base that many of us would probably agree wasn't a large enough base. So we're working to try and adjust those bases as we can and not to put new money out on that same formula as the base was adjusted on.

We will continue to look at that with the Sea to Sky as well, and we will look at the diagnostic and treatment centre and see if we can find a solution for that which would put additional dollars into that council.

T. Nebbeling: Just to be correct on the information, because I don't want to use wrong information or give the minister wrong information, the data used for the conclusions that I shared with you today is for '97-98. Based on what the minister just said -- that the data is collected in October of one year for the following year -- I would say to the minister that this data was collected in October 1997, which is almost two years. So this is not the latest data. The book here -- '98 -- is finished in March. So this is two years. For that reason, maybe we have the discrepancy between the number that should be there and which is there. That is most probably the reason why we have a discrepancy between how many people use the facilities now in the Sea to Sky corridor and those going out of town. I would like to make sure that the minister is aware that there is a year in between, for calculation.

Just on the D and T, maybe the minister can give me some of her thoughts on how the whole situation with the emergency clinic in Whistler is going to be dealt with. As the minister is aware, the amount of people going through that clinic is phenomenal. The estimated use of that emergency clinic for B.C. residents has been exceeded by 3,000 people a year. The data was far too low, in the calculations of how many people would go to that emergency centre. As a consequence, again we have the same problem: it creates a strain on the whole Sea to Sky corridor. Has the minister any thoughts on how that problem could be rectified in the very foreseeable future, as somehow the funding for that centre is just not working. It's having a very negative impact on the other facilities in the Sea to Sky corridor, be it care centres for senior citizens or the Squamish diagnostic centre. Has the minister any thoughts on that one?

[ Page 14085 ]

[1645]

In terms of the diagnostic and treatment centres, I can't tell you at this stage -- nor, I guess, would I be the best person to do that -- exactly how it will be resolved. But I have made a commitment to you in the House here to review it. We are in discussion with your health council about it. You will be able to have fairly accurate numbers, I assume, because the numbers won't be as old, because you know how many people are currently going through your diagnostic and treatment centres. We are actually working with the health council there -- I guess as we are in other places -- to make sure that the information gets reported in a consistent kind of way. We have some discrepancies between figures that are quoted and figures that are given to the ministry. Often figures quoted are higher than the ones given to the ministry. So if we have higher figures, then we have a better number to work on, which advantages you.

T. Nebbeling: I'd like to thank the minister for her answers. I truly hope that we're going to see some action. I know it is difficult to sit on your side. Everybody has issues that they feel they have to deal with. I'm realistic enough there. But I think the uniqueness of the Sea to Sky corridor and the community health council's issues. . . . It really does not just expect a solution; it demands a solution. Like I said earlier on, in the Sea to Sky corridor today, it is not how much health care we can give; it is how much health care we can give with the money we have. That is fundamentally wrong. So I hope that during the coming months, now that we're closing the House soon, we're going to see some dialogue with the community health council in the Sea to Sky corridor, leading to a solution that will make things a bit better.

B. Penner: I could ask the minister some questions relating to reductions in home support services in the Fraser Valley, but I already did that when we debated interim supply a few months ago here in the Legislature. I think the minister is well aware of the concerns in the Fraser Valley regarding reduction in home support services and how they've adversely affected the seniors, in particular, in our communities, who rely on those services.

I'd like to ask the minister just a few brief questions about the correspondence unit in her ministry. From time to time, I've been concerned that it takes what appears to be an inordinate amount of time to get replies from various ministers in this government. I think the average is three to six months for a response to any letter, whether or not it's marked as urgent. The record response time, in terms of quickness, occurred a couple of weeks ago, when I got a letter back in ten days from the Minister for Children and Families. I guess that that was because there was a possible media exposure to the issue. The ministry took that matter seriously. That had to do with the suspension of a social worker, who was speaking to the media.

However, in the past year I've become increasingly concerned about the response time from the Minister of Health's office about a couple of issues raised last year during estimates debate here in the chamber. I have in my hand a letter dated May 28, 1999, that provides me with an answer to a question I asked ten months earlier, on July 24, 1998. Along with my colleagues, I have received quite a number of these letters, shortly before the minister's estimates started. I'm just curious why it takes up to ten months to receive a response.

[1650]

Hon. P. Priddy: Undoubtedly there are times when correspondence takes far too long. The letters you're referring to are letters from last year's estimates that should have been done much faster than they were. As you notice, we're trying very hard not to take any questions on notice, if you will, and trying to get back to people with answers as they raise them. We realized last year that there were literally hundreds. . . . Well, I don't know about hundreds, but there must have been a least a hundred letters on questions that we didn't answer in estimates. I don't consider that to be the best way to do that. So as you'll notice, we're trying very hard not to do it this year.

Other than the fact that the estimates letters took far too long, somebody is checking for me the average turnaround time for letters in our correspondence unit. I don't quite know yet what they are, but I will get that to you. I too have been concerned, and my office staff would confirm that. Some letters actually do turn around very quickly. Then I'll get a letter that's taken two or three months to turn around.

My position would be that if we do not think we can answer a letter quickly because it's more complex, we at least send people an initial letter saying: "This is who is looking after this." It may take a while to get people the information. We can always do better, and we will.

B. Penner: Just a final comment: one thing I've noticed -- it's perhaps not empirical but certainly anecdotal -- is that it doesn't seem to matter whether the letter is marked urgent and the letter is faxed, in terms of the response time. I know for myself that I'm quite careful about what letters I deem to be urgent in nature, and I use that designation selectively. Notwithstanding that, it doesn't seem to have any bearing on the response time to those letters.

With that, I'll turn the floor over to our Health critic.

C. Hansen: I want to turn to an ongoing issue that's been in the news in the Comox Valley, and that's Glacier View Lodge. There was a court decision that came down very recently that talked about the ministry's intention with regard to compulsory amalgamations. I'm wondering if the minister could explain to the House what the ministry's policy is today vis-à-vis the compulsory amalgamation provisions in the Health Authorities Act.

[ Page 14086 ]

There has been no change in the legislation. I do not currently envision using, or saying to a health authority that they have to use, that part of the legislation. But the legislation has not been changed.

C. Hansen: I appreciate the fact that it is before the courts as a result of the appeal. So I am trying to approach this in a generic sense, in terms of overall policy and not interfere per se with those issues that are before the courts.

But the ramifications of the messages that are being sent out are, I think, quite far-reaching. I know that last week the minister put out a press release regarding the need for community care facilities to be built -- long term and intermediate care homes -- and the need for. . . . I know she's talked many times during these last two days about the need for partnerships with either the not-for-profit organizations or the for-profit organizations with regard to the construction of those facilities.

Yet the very provisions of this legislation are sending out a signal that basically says that any facilities that are being built by not-for-profit organizations continue to be under threat. I know of organizations that made decisions not to proceed with proposing long term care facilities in their communities, because of the very threat that is contained in the legislation: they may be subject to expropriation at some point in the future.

As I understand it, the minister has indicated that those provisions will not be used. I'm wondering: if they're not going to be used, why would they not be removed, so that those organizations don't feel that this threat is hanging over their heads?

[1655]

The reason for leaving it in the legislation is that I still think there are extreme circumstances where, for instance, you may have patients at risk. You may need the ability to be able to put a public trustee into that environment in order to protect patients and would need to use that piece of the legislation to do so. But I will take your point. If that's putting out a negative message, then we have a responsibility to people to get out a different one.

C. Hansen: Certainly the provisions for putting in a trustee are there, outside of the actual compulsory amalgamation provisions. To remove the compulsory amalgamation provisions does not limit the ministry's ability to put in a trustee, should that ever become necessary in the case of a facility.

I gather that this particular statement is not accurate. I'll read the minister this statement, because it pretends to be a statement of government policy: ". . .that the government will not now or at any time in the future force amalgamation of health facilities in this province." What the minister was saying earlier is that they want the provision to stay, and I gather that's because they may feel that it is necessary to use those provisions in the future.

Hon. P. Priddy: As I said earlier. . . . You've read that. I don't know if it was a quote of mine, but it likely was, and I know that I've said it. I don't envision a circumstance where I would use that. Nevertheless, this is the Ministry of Health, and I'm the Minister of Health. I think that in the end, in terms of my accountability to the public for patient safety, that needs to remain in the legislation. That's where it is.

[1700]

I'm just going to read directly from the judgment. Actually, I'll read the whole thing, so that I'm not taking this out of context:

"The minister can make an amalgamation order swiftly and without advance notice, so this situation fits within the 'brief' category referred to in Borowski" -- which is another case that was referred to. "But I have the sworn assurance of Ms. McNeil, a responsible senior official of the ministry, that, so far as is known, it will not recur. Neither Glacier View nor other not-for-profit health care providers are at risk of compulsory amalgamation."

Hon. P. Priddy: That's correct.

C. Hansen: There's one other clause which is important, and I'll read the entire section: "Mr. Groberman, while contending that this case is moot, very properly noted that the present position of the minister concerning compulsory amalgamation cannot be regarded as a commitment for the indefinite future." Again, is that a proper reflection of where the ministry is coming from?

Hon. P. Priddy: It's certainly correct that that is my commitment. I'm not sure that anybody can make a commitment for future ministers or future governments, much as we all might like to. But that certainly is my position as minister currently.

C. Hansen: I took the minister's earlier comments as an undertaking to at least review the ramifications of the compulsory amalgamation provisions and the effect that they may be having on not-for-profit organizations.

The minister is nodding. Certainly from the feedback that I've had, I think that would be an important review to under

[ Page 14087 ]

While we're on the subject of the Comox Valley, I want to ask specifically about the Comox Valley community health council. My understanding is that it is probably one of the few, if not the only, CHCs where they have both a CEO of an acute-care hospital and a CEO of the community health council as two separate. . . . I think in most CHCs that position is combined into one and the same person. Now, I understand that St. Joseph's General Hospital in Comox is a denominational hospital and that this has an impact on why it is structured this way. But I'm wondering if this is the only case in the province where there are two bodies -- two different people -- in those roles and whether or not there is a less expensive way to administer a community health council.

[1705]

C. Hansen: I was wondering if the ministry has explored any other models for administration. If you look at Prince George -- the Northern Interior regional health board, for example -- it's somewhat of a hybrid between the regional health board model as we know it in other parts of the province and the CHC model, in that the Northern Interior regional health board has three very distinct geographic components within it. I'm wondering, now that we've been through the Better Teamwork, Better Care transition, whether there has been any review of the model in the rest of the province, where there are very distinct CHCs and very distinct regional health board models -- whether or not there's an opportunity to look at hybrids in other parts of the province, as we have in Prince George.

Hon. P. Priddy: Are people prepared to look at hybrids? I expect that we are, because people will look at what works in different parts of the province. This was put in place in 1997, I guess. It's fair to give it some opportunity to settle in and to see if it works. But we do have a commitment in our strategic plan to review all of the models -- all of that -- next year. That may be a time to relook at that.

C. Hansen: Again with regard to the Comox Valley community health council, in response to an inquiry that we made of the ministry, the minister wrote back to us in April regarding the contract that is in place for the CEO of the community health council. What I found quite surprising was that it is set up as a fee-for-service contract on a per-diem basis. Usually that would imply that this is not a full-time position. I'm wondering if the minister could tell us whether or not this CEO position on the community health council is in fact a full-time responsibility.

Hon. P. Priddy: Yes, it is a full-time responsibility. The community health council chose to deal with the CEO in the way that you've described, as a contract.

C. Hansen: I was wondering if there has been any direction given by the ministry with regard to structuring an employment arrangement on this basis. I'm certainly not aware of any other full-time responsibility in the province on a per-diem basis that passes the test under the Income Tax Act as to what constitutes an employment relationship and what can constitute a fee-for-service arrangement.

Hon. P. Priddy: We would not be likely to direct a CHC or an RHB about the kind of relationship that they have with the person they have employed. Our concern is the total amount of the compensation and that it fits within the HEABC guidelines. HEABC, the Health Employers Association of B.C., does have guidelines for executive compensation. They are there to provide advice either to CHCs or to RHBs. Our concern would be about the total amount of the compensation.

[1710]

My understanding is that in the Comox Valley, the local citizens have now raised enough money for the purchase of a new CT scanner. They've had that in place for some time now, I believe. There are new statistics that have been generated by the use of the CT scanner in Campbell River that show that the majority of individuals who are using the CT scanner in Campbell River in fact come from the Comox Valley or south. Now that that kind of data is coming in on the actual experience of that equipment in Campbell River, is it time for the ministry to take another look at the allocation of the operating dollars?

What the residents in the Comox Valley that I have talked to are arguing for is not to move the CT scanner from Campbell River or not to move all of the operating dollars. But if the residents of the Comox Valley have the funds to put in place their CT scanner -- which would be completely funded as far as installation goes -- would it not make sense to divide operating dollars between the two facilities, perhaps with a technician that can move between the two facilities, rather than having all of the patients from Comox Valley and south travelling north to Campbell River for that diagnostic treatment?

Hon. P. Priddy: We have had this come up before, where either communities have been left money or there have been bequests or whatever to actually purchase a piece of equipment. I'm told by staff that the fixed cost of any CT scanner -- just to have it and keep it operating -- is about $250,000 a year. That's about as much as we're currently spending in Campbell River. To have another CT scanner, there would still be, I'm told, a basic cost of $250,000 to keep another one running, even if you weren't using it the same number of hours. On that basis, then, there would be other parts of the province that would have a stronger argument for a CT scanner and the $250,000 just to keep it open for the year.

C. Hansen: I guess what these residents were arguing for is that the operating dollars that were there be split between

[ Page 14088 ]

Hon. P. Priddy: I realize that there are some new statistics in. We look at those new statistics, as we have for other places on Vancouver Island and throughout the province. We'll continue to do that and make decisions based on it. But I'm informed that just the maintenance contract alone on a CT scanner, regardless of how long you operate it, is about $110,000 per unit. While on the surface it seems reasonable to say that you could just divide the dollars in half, I don't think it would work that way if each unit has a base maintenance cost, regardless of use, of $110,000.

C. Hansen: I gather that one of the big changes that has happened since last year is that the community health council in the Comox Valley has now come out in support of setting up this CT scanner in the Comox Valley. I gather that before, there wasn't that kind of consensus within the valley. I'm just wondering if that would be a factor in the minister's decision as to whether to look at moving forward with the initiative of the Comox Valley residents.

Hon. P. Priddy: We don't have the regional staff here, but the senior staff that are here were not particularly aware of the fact that people didn't want one in the Comox Valley. Given the other factors I've talked about, would that play a role? Not likely.

[1715]

Hon. P. Priddy: My understanding is that, through whatever human error happens, that press release was put out before those people had been confirmed as board members.

C. Hansen: I want to jump across the water to the Cariboo, specifically the issues surrounding the nursing station at Tatla Lake. The federal government has pulled out their funding for the nursing station, and I think they have taken a few complaints with regard to the amount of timing that was good. I think the criticism that the federal government is taking in terms of the lead time is certainly justified. But now it appears that the federal government is in fact pulling out. They've extended the deadline for funding for that nursing station to September of this year. But there's still an enormous sense of uncertainty as to what's going to transpire once the federal funding for that nursing station ends. I'm wondering if the minister could give us some reassurance that the residents around Tatla Lake are going to be able to continue to receive the health care that they've become accustomed to.

Hon. P. Priddy: Although we are still in discussion about how that will happen -- whether that will happen on a contractual basis with the Red Cross or how that might happen -- yes, I can assure people that the services will be there.

C. Hansen: I'm familiar with the nursing stations that the Red Cross operates, and I gather that they provide a very excellent service around this province in a lot of small communities. Certainly there has been a lot of talk about the role of nurse practitioners, and my understanding is that in British Columbia, the Ministry of Health itself and the regional health authorities do not currently engage nurse practitioners, but the Red Cross does in several of these nursing stations. I'm wondering if any consideration has been given to the level of nursing that would be provided at a nursing station like Tatla Lake in future.

Hon. P. Priddy: People do use the phrase "nurse practitioner" in a variety of different ways throughout the province. That's one of the things, of course, that we are looking at with the RNABC and the nurses' union. But as it pertains to the Red Cross using nurse practitioners, any service that we would contract to have there would be able to provide -- if that's your question -- the same level, intensity or experience of care that they're currently accustomed to.

[1720]

Hon. P. Priddy: There will still be two nurses in the area. As the member may know, aboriginal people from Redstone or from the band currently draw their services from Tatla. There will be a nurse on reserve, funded by the federal government. So the aboriginal people, who are in significant numbers, who've drawn their services from there will have their own nurse. There will be at least one nurse that remains in the nursing station to cover those people who are not aboriginal.

C. Hansen: I'm not sure that that's the answer some of the residents are going to be looking for, but certainly in terms of. . . . Is there any initiative towards the kind of coordination that might go on between those two nursing stations? Is that part of the discussion? I gather that the nursing station developed on the reserve by the band would be some distance away, for one, and would be funded, I assume, by the federal government through the band administration. I'm wondering what kind of relationship is being developed between those two nursing stations to ensure that people are properly served.

[ Page 14089 ]

C. Hansen: I have two remaining questions on this subject, and maybe I'll try to roll them into one for expediency. First of all, will the community health council be expected to fund this nursing station out of their own existing budget, or will they actually see an increase in their budget to reflect the specific costs of the Tatla Lake nursing station?

My second question -- which I'll lump into it, although it's a slightly different subject. . . . I understand that the nursing station is really provided for two types of treatment. One includes public health care, which, I gather, in most parts of the province would be funded at least in part through Children and Families. I'm wondering if Children and Families becomes a component in this funding arrangement as well.

Hon. P. Priddy: We already fund one of those nursing positions. There will have to be some additional dollars put in for administration and overhead and some of those kinds of things that may currently be covered by the federal government. But we already fund one of those positions out of the alternative payment plan.

In terms of the public health component -- which, you're right, is primarily Children and Families, and a little bit of it is ours -- those discussions are still going on with the CHSS, and we hope to be able to resolve those. Particularly in the north and particularly in those communities, the whole idea of public health and prevention and immunization is absolutely critical -- to make sure that we maintain those standards.

[1725]

The most frequently received concern in my office is around waiting lists. In the past year in the Shuswap-North Okanagan area -- I'm referring specifically to constituents in the Shuswap -- the most frequent concern is around the wait time for orthopedic surgery. I understand that that may in fact get a little bit worse. Others would know this better than me, but I think the orthopedic surgeon in Vernon is departing, and that may create even more of a gap in the system.

The letters I receive are concerns that there are waits of a year or more for hip surgery and very substantial waits, again, for knee surgery -- at least 12 months. Obviously we hope to shorten that, as people tell me that the quality of their life is sharply depreciated in situations where they are in constant pain and can't work and so on. Again, I apologize to the minister; she may have dealt with this earlier in the context of North Okanagan. But is there any way in which we can reasonably, practically, reduce the wait time for things like orthopedic surgeries and cardiac surgeries?

Hon. P. Priddy: We have had this discussion with others of your colleagues, but I'm actually pleased to answer your questions. If it's permissible to you, I would prefer to do it after the dinner hour. My understanding is that the committee has to report, and the Lieutenant-Governor is here. I think that your critic and acting House Leader has agreed to that.

So in that case, I would move that we rise, report progress and ask leave to sit again.

Motion approved.

The House resumed; the Speaker in the chair.

Committee of Supply B, having reported progress, was granted leave to sit again.

[1730]

Bill 71, Finance and Corporate Relations Statutes Amendment Act, 1999, reported complete with amendment to be considered at the next sitting of the House after today.

Bill 76, Health Statutes Amendment Act, 1999, read a third time and passed.

Bill 81, Regulatory Impact Statement Act, read a third time and passed.

The Speaker: Hon. members may be aware that His Honour the Lieutenant-Governor will be here for royal assent in about 15 minutes. I'm going to suggest that we take a break for ten minutes, and then we'll ring the bells to call members back to be present for the royal assent.

The House recessed from 5:32 p.m. to 5:43 p.m.

[The Speaker in the chair.]

His Honour the Lieutenant-Governor entered the chamber and took his place in the chair.

Law Clerk:

Forest Land Reserve Amendment Act, 1999

Range Amendment Act, 1999

Tuition Fee Freeze Act

Fire Services Amendment Act, 1999

[ Page 14090 ]

Miscellaneous Statutes Amendment Act, 1999

Wildlife Amendment Act, 1999

Securities Amendment Act, 1999

Labour Statutes Amendment Act, 1999

Attorney General Statutes Amendment Act, 1999

Strata Property Amendment Act, 1999

Forest Amendment Act, 1999

Education Statutes Amendment Act, 1999

Agricultural Land Commission Amendment Act, 1999

Private Post-Secondary Education Amendment Act, 1999

Health Statutes Amendment Act, 1999

Land Reserve Commission Act

Regulatory Impact Statement Act

Park Amendment Act, 1999

In Her Majesty's name, His Honour the Lieutenant-Governor doth assent to these acts.

[1745]

In Her Majesty's name, His Honour the Lieutenant-Governor doth thank Her Majesty's loyal subjects, accept their benevolence and assent to this act.

Hon. G. Gardom (Lieutenant-Governor): Madam Speaker and hon. members, in a couple of days we'll all be celebrating Canada's birthday -- 132 years young -- so every best wish to it and to you. Madam Speaker, if it's at all possible for you to arrange a few weeks off for the legislative rainmaker, I'm sure that every British Columbian would be delighted.

His Honour the Lieutenant-Governor retired from the chamber.

[The Speaker in the chair.]

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 from 5:49 p.m. to 6:36 p.m.

[The Speaker in the chair.]

Hon. D. Streifel: I call Committee of Supply. For the information of the members, we'll be examining the estimates of the Ministry of Health.

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

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

G. Abbott: Rather than have the vote pass, perhaps I'll get up and repeat the questions I provided to the minister before the dinner hour, in anticipation that she might respond. Perhaps we can just begin with the first issue, which is the problem of wait-lists and to some extent cardiac wait-lists, but particularly -- I don't know whether it's something that's characteristic of other areas in the province -- the orthopedic wait-lists and the problems caused by that. Perhaps I'll first ask the minister whether, from discussions over the dinner hour, there's anything she can add in the way of rays of hope with respect to orthopedic wait-lists.

Hon. P. Priddy: As the member has noted, of course, this is an issue that's raised by many of his colleagues and, actually, by many of my colleagues. But as it relates to your particular health region, I know there's been a recent announcement by an orthopedic surgeon, I think, to leave that area and move to North Dakota or wherever. That has been anticipated, and I know that there are efforts underway by the CEO to recruit another surgeon.

I do know that the North Okanagan health region, in partnership with the Workers Compensation Board, began an expedited surgical program on May 11 -- just this last month. It's estimated that 300 cases of orthopedic day surgery will be provided annually for WCB clients, because those are some of the people who are waiting in your area -- which will actually improve access to orthopedic day surgery for all patients.

[1840]

G. Abbott: Do we have an objective in terms of reductions in orthopedic surgery wait-lists for either the Shuswap-North Okanagan particularly or the province generally? What, in short, can the people who write to me anticipate in terms of the objectives of the government over the next year in terms of orthopedic wait-lists?

Hon. P. Priddy: What the people can expect is that the orthopedic panel, which I think I talked about with one of your other colleagues, hon. member, will be looking at the same thing that the cardiac care panel looked at, which is: what would be an acceptable median wait time? Now, we all know that no wait time feels. . . . If we're the person or it's our family, no wait time feels acceptable. But we don't have anything across the country -- in B.C. or anywhere else in the country -- that says that this would be an appropriate median wait time for a particular kind of orthopedic surgery. What we would expect from the orthopedic panel are some benchmarks in terms of the time that we need to strive for, as we've done with children's surgery. So people can expect to see that.

We will evaluate the impact that the additional 20 percent of hip and knee surgeries are having on the wait times, and

[ Page 14091 ]

G. Abbott: I thank the minister for that explanation.

The second issue is with respect to the ambulance service out of the village of Chase. That ambulance service actually serves quite a large rural region, including west to Pritchard, east to Sorrento and then north to the north Shuswap. It's a pretty substantial area. The concern that has been raised by the North Shuswap Health Care Society is around the ability of the Chase ambulance service to respond to that. They had particular concerns, and I know that these were forwarded to the minister in a letter of May 1, 1999. The minister may well have responded to that by now. I don't know.

The particular concern they had was with respect to the original three full-time staff members. One person left for Kamloops. Apparently that full-time position has not been filled, so there are concerns around that. Again, I don't know whether the minister, in consultation with the critic, is proposing to deal with ambulance issues as a separate part of these estimates. If in fact that's the case, I'd be happy to leave the response from the minister to that point in time. Maybe I can get some indication on that point.

Hon. P. Priddy: That letter has come to the ministry. The discussions currently occurring, as we look at staffing, are that -- as I'm told -- the workload in that particular area does not, if you will, meet the requirements for an additional full-time person. One of the things that the British Columbia Ambulance Service is doing, in trying to support that, is making sure that everybody who's providing service up there is trained up to a Canadian paramedic level 1, which means that they will have a higher level of skill and expertise for the paramedics that are there. But at this stage of our discussions, there isn't enough to justify a whole additional FTE.

[1845]

Hon. P. Priddy: It is based on the two, but quite honestly, it is primarily call volume.

G. Abbott: I won't launch into a debate on that, but will just note that particularly the north Shuswap area could involve ambulance trips of probably up to 60 or 70 miles in the summer months when, regularly, there's probably in the neighbourhood of about 20,000 people -- vacationers mainly -- in that part of the world. I know there are call-outs during the summer in a volume that certainly there wouldn't be in the winter. That's a distinctive feature of that area and perhaps could be taken into account when considering the need for those positions and the need for that service, particularly.

The final area, as I mentioned to the minister privately just before dinner, and I'll just put this on the record. . . . I know that the issue would come back in the mental health section of these estimates. So I'll just mention the issue so that the minister could have staff perhaps explain the ministry's response.

This is further to a letter of March 10, 1999, from the B.C. Schizophrenia Society provincial office. It's in respect of an issue that's raised by one of my constituents, Mrs. Adrienne Rideout. She has written to the minister and others with respect to another constituent who suffers from schizophrenia. There are concerns by Mrs. Rideout -- and certainly by Mr. Holmes, who suffers from the schizophrenia -- that there have been problems with respect to his signing away of lump sum payments or CPP benefits. Also, apparently, after the CPP payments were, in the words of the Schizophrenia Society, "unfairly confiscated. . . ." Mentally ill people are now receiving T4As and must declare the money they never received, as taxable income.

At any rate, this is a letter of March 10, and it's signed by Fred Dawe of the Schizophrenia Society. I'll just ask the minister if she could take this particular issue on notice and bring back a report, perhaps during the mental health portions of the estimates to come.

Hon. P. Priddy: We will do that. I know that one of your colleagues canvassed that fairly thoroughly around the Human Resources estimates as well. But I will take the information, as you've requested.

To the hon. critic, if I might, that there is a question from Okanagan-Boundary that was raised just before dinner. We have some of the information and not all. I would prefer to be able to answer the question when we have all of the information. We got as much as we could, but it's not complete. Given that it was the dinner hour, there were some folks we couldn't reach that quickly.

C. Hansen: I appreciate the minister trying to accommodate that request that came up just immediately prior to the break. I know that my colleague from Okanagan-Boundary is anxious to at least put the issue on the table, if that's okay with the minister. We don't have to deal with it tonight, because I appreciate that we don't have the necessary staff here to deal with it. But if it's okay with the minister, we'll at least get the issue on the table and then try to deal with it later in the estimates process.

[1850]

I think that the concern from the administrator and the mayor of Midway. . . . They were almost in shock that all of a sudden, out of the clear blue, this would happen. So if the

[ Page 14092 ]

C. Hansen: I thank the minister for seeing if we can deal with that, with the short notice that we had. Certainly we can pursue that when the estimates process resumes after today.

Turning to Pharmacare, which is the issue that we want to deal with for the balance of the day today, I want to start specifically with the pharmacy participation agreement, which has raised the concern of a lot of pharmacists from around the province over the last few months. It was raised yesterday by my colleague from Surrey-White Rock. I was interested in the minister's response in terms of where the consultations may go from here. When we had the opportunity to raise it during question period a couple of weeks ago, the minister obliged quickly in terms of suspending the implementation of the new agreement, until it could be revisited at least. In that context, I know that the suspension of the original agreement that had been in place over the last 20-some-odd years was revoked and that the implementation -- the date for the new agreement -- was postponed indefinitely at this stage until some of these details could be sorted out.

I'm wondering if the minister could elaborate on the status of the original agreements. My understanding is that pharmacists have now been notified that the original agreements continue in force until such time as a new agreement can replace them. That new agreement will come into effect sometime in the next few months, and I'm wondering if she can give us a better understanding as to what process is going to take place from here towards finalizing an agreement.

Hon. P. Priddy: I think there are two parts to the question. The first part is about the status, if you will, of the agreement. Pharmacare has sent letters and consent forms to all pharmacies, serving notice of the termination of the revised agreement and extending the current pharmacy participation agreement. The process as it will proceed from here -- although we had certainly done some of this before -- is meetings between ministry staff and the Pharmacy Association, the chain stores and individual pharmacists.

C. Hansen: One issue that I know the minister is familiar with because of the comments she made yesterday is the dilemma that the pharmacists in British Columbia face with regard to any kind of a coordinated effort to negotiate with the government on these issues. It's an area that is covered off in other professions, in terms of doctors having the ability under legislation to negotiate through the B.C. Medical Association. You've got other professions in this province that all have that ability to negotiate collectively as professions. I'm wondering if any consideration has been given to allow the pharmacists in this province to negotiate collectively so that they can deal with these issues in a way that doesn't have some of the ramifications to it that the current situation does.

[1855]

There are three pieces to this one, I think. One of them is that up until perhaps recently, around this agreement there has not been any kind of unanimous support for the pharmacist association to be that particular body. I gather there is more support now for that, but there hadn't been previously.

Secondly, we will certainly be able to have those discussions with them during the discussions that will occur. But the other uniqueness about the pharmacists is that it's not quite the employer-employee relationship that some other health care professionals might have, because they derive significant sources of their income from products other than pharmacy products. There's some uniqueness to that that has to be discussed. Will it be on the table for discussion? Yes. Can I predict the outcome? Not yet.

C. Hansen: I think that when the minister talks about not-unanimous support for the association, she may be referring to the fact that not 100 percent of all pharmacists in British Columbia belong to the association. But I think that's probably true of other professions. Certainly, if you look at the BCMA, they don't have the unanimous membership of all the doctors in British Columbia, either.

I think it was a really difficult time for the B.C. Pharmacy Association when they went through this particular dilemma in terms of the imposition of the new pharmacy agreement, in terms of what they could or could not do on behalf of their membership. I think the issue that really came back to the individual pharmacists, who were being faced with the dilemma as to whether to sign or not sign this new document, was that everybody was saying: "Well, why don't they get together and lobby as a group to make sure that their interests are served?" And then they wind up being faced with this dilemma that any collective action may in fact work against them in the long run.

I'm wondering, when the minister says that now that there is more unanimity or that they have come together more, if she is saying that they are prepared to actively consider recognizing the profession in a way that allows them some form of collective action in terms of dealing with government. In saying that, on one hand -- either from the point of view of the minister, as part of a current government, or us as opposition, who hope to be government -- certainly it's in government's interest to have organizations that speak on behalf of the professions. It certainly gives government much more focus, rather than having to go out and deal with each individual pharmacist in British Columbia on an individual basis in order to make sure that everybody's point of view is being properly represented. My particular point of view is that I think the interests of government are better served by having some kind of provision for them to deal with government in a collective way. I'm just wondering if the minister is able to make some commitment that we can make some positive strides toward allowing them to take some collective action.

Hon. P. Priddy: What I can promise is that we'll have active discussion at the table with the other issues.

C. Hansen: When we raised the issue of the pharmacy agreement in question period a few weeks back, the minister had talked about some of the discussions that had gone on beforehand. I guess some of the pharmacists were surprised to learn that these were considered to be negotiations -- or that they in fact had an input into the final result. There certainly are aspects of the agreement that have been put forward that

[ Page 14093 ]

[1900]

In terms of the future question about whether there will be a broad enough representation, yes, there will be. They have very, very different needs, if you look at a Canada Safeway versus my locally owned community pharmacy. Those are very different, and we have to have all of those people at the table -- and would wish to. What I would not want to end up with in the end, I would hope, would be three different groups saying, "No, this won't work for me; I have to have a separate organization" and somebody else has to have a separate one and somebody else has to have a separate one, so that government is asked to work with four different organizations around one particular part of the health care system. But yes, there will be broad representation.

C. Hansen: I think the comments the minister just made probably speak to why it's in the best interests of government to ensure that that's an industry that's able to speak with one voice to the extent that it's possible.

One of the issues that has come up is the issue of what constitutes the cost of drugs that the pharmacists has to pass on to the customer outside of the dispensing fee. I guess there is a concern on the part of some of the individual pharmacists that I've talked to that the ministry may be looking at a very narrow definition as to what that constitutes. It's not to say that anybody says that that definition can't change, but rather, if it changes, you then start upsetting the whole economic base of some of these small pharmacies, particularly in smaller communities. If that basis is going to change, it's going to throw a whole bunch of other things out of kilter. I'm wondering if the ministry is putting forward a very rigid definition as to what constitutes the cost of medications that are sold to customers through pharmacies.

Hon. P. Priddy: There may be people -- and we will have those discussions -- that feel we are being too rigid about those kinds of costs. We actually seem to be working with what has been the working definition out there. What we are concerned about is simply the actual acquisition cost of the drug for the pharmacy. It seems that that varies significantly, depending on the kind of pharmacy that you're in. We're just trying not to have a really unbalanced playing field for people.

C. Hansen: I appreciate the response from the minister.

As I have had it described to me by several pharmacists, they will go out and negotiate very aggressively on cost, to try to get the cost down as low as they can. There are ways that they can do that, through bulk buying. There are ways that individual pharmacists or groups of pharmacists can actually work with manufacturers to try to reduce those costs, and then that gets factored into the overall profitability of a small business. So when you wind up with a dispensing fee as a revenue source to the pharmacist, that becomes a factor in a whole bunch of things. Part of it is other areas they can negotiate costs in, in a way that can keep their dispensing fees as low as possible.

[1905]

To say that dispensing fees are going to be held at a certain level but that we're going to do away with any incentive for these pharmacists to try to find other ways of driving their costs down. . . . The net result of that in the long term is going to be that the customers are going to pay more, and dispensing fees will have to go up in order to maintain the financial viability of some of these pharmacists, particularly in smaller communities. In the end, it's the consumer that's going to wind up paying the price for this.

I certainly understand the rationale that may be behind the ministry's move towards saying that everything that has to do with the cost of medications has to be reflected in the cost that's charged to the customer. But if you do that, what you're going to do is, firstly, take away from the individual pharmacist all of that incentive to drive down costs, and secondly, put upward pressure on dispensing fees. I don't think that's in anybody's interest in the long run. I'm wondering, in terms of these consultations that are going to take place, whether or not those are the kinds of factors that would be taken into consideration.

Hon. P. Priddy: I have two points. I think the member probably knows that we currently pay the actual acquisition costs plus the 7 percent for a dispensing fee. I think the member makes a point that needs to be acknowledged. You don't want to take away an incentive for pharmacists to get, if you will, the best buy or the best acquisition, whether they do that in group buying, or as chain stores do, in very large group buying. Pharmacare pays about 50 percent of the cost of

[ Page 14094 ]

It is one of the issues that was raised. It is one of the reasons we've agreed to suspend it and do consultations. I would expect it to be a fairly major piece at the table.

C. Hansen: Before I leave the issue, the minister had indicated that this negotiation would take several months. She made that comment yesterday in a response to the member for Surrey-White Rock. Is there a particular time frame in which she anticipates these consultations will be resolved? Is it open-ended, or is there in fact a target date in mind?

Hon. P. Priddy: I'm reluctant to actually put a time frame on it at this stage, until we actually get to the table and find out how difficult or easy this is going to be. Obviously we want it resolved as quickly as possible, but I think some of these are going to take some time. There are some fairly strongly held feelings. I'd be reluctant to put an end date it on before we actually get to the table and have a couple of meetings.

C. Hansen: I'd like to turn now to the auditor general's report that came out last August. The auditor general made ten very specific recommendations. I would like to ask the minister to deal with them in terms of what action has been taken since last August to implement them. I'll just deal with them in order, if that's appropriate.

[1910]

Hon. P. Priddy: You're right. That's the first recommendation of the auditor general. As a result of that, the Pharmacare drug benefit committee has been asked to undertake a review of the current drug benefit list by therapeutic class -- the purpose for which it is used. Respectively, their mandate has been modified to include this responsibility. The drug benefit committee meets every six to eight weeks, actually, and is comprised of Pharmacare pharmaceutical staff, the director of Pharmacare and representation from the therapeutics and the pharmaeconomic initiatives. So they are reviewing all of those drugs by therapeutic class as a result of the first recommendation.

C. Hansen: My next question is: is there going to be a periodic report coming out of that process? Is this an ongoing process, or will it actually culminate in a yearly report that will capsulize everything that they have dealt with over the previous months? Or is this just an ongoing process with ongoing reports?

Hon. P. Priddy: Probably on an annual basis. I don't think there was a recommendation for a public report, but nevertheless, on an annual basis there will be different drugs that are either delisted or added to the pharmaceutical benefit coverage. And while there wasn't any plan to regularly report out publicly, there's no reason why that could not happen. I mean, it's not secret information.

C. Hansen: Does the minister anticipate. . . . Is this going to be a stand-alone report, will it become part of the annual report, or is it. . . . I'm wondering, in terms of following the implementation of this recommendation: what is it that we look for when it comes to this annual reporting?

Hon. P. Priddy: No, it would be a stand-alone.

C. Hansen: I do want to deal with each of these in order. I'm actually going to go through one to ten, but I do have questions about each one as we go.

The second recommendation that came out of the auditor general is: ". . .obtain appropriate and timely information from organizations receiving ministry funding. . . " to provide programs that foster appropriate drug use. Again, I'm wondering if the minister could advise the committee on how that recommendation is being implemented.

Hon. P. Priddy: As a result of the recommendations, Pharmacare is actually currently revising a number of the contracts that we have with other organizations to better delineate reporting requirements of organizations. The College of Physicians and Surgeons would be one example. Pharmacare has increased their efforts to manage and administrate current contracts in a way that makes sure they do deal with that issue. Pharmacare must receive those reports prior to the allocations of funding.

C. Hansen: Does the minister anticipate that these will be public reports? I can understand there may be circumstances -- or at least portions of it -- that may not be appropriate because they're dealing with the internal workings of different organizations, but there should certainly, I would expect, be some public component of that reporting.

[1915]

C. Hansen: The third item dealt with the extent of patient non-compliance with drug therapies. It was interesting. There was a national survey that was done, or at least published, recently that showed that British Columbia has the lowest rate of compliance on drug therapies of any province in Canada. So this one in particular. . . . I was wondering what measures would be taken to "encourage and support," as the recommendation reads, the medical profession and others "to determine the extent of, and the reasons for, patients' non-compliance" when it comes to specific drug therapies.

Hon. P. Priddy: Just a question of clarification: can you quote the report? The Pharmacare staff that are here -- senior staff -- are not necessarily aware of it, so could you just quote it so that we can reference it at another time?

[ Page 14095 ]

Hon. P. Priddy: Where it came from wasn't going to change my answer any. It's just that because we weren't aware of it, I wanted to make sure that we had an ability to follow up on it as well.

I don't know whether it's accurate that we have the highest non-compliance. I won't doubt the fine work of polling companies. Nevertheless, non-compliance is an issue. Whether it's the highest or the lowest or in the middle, non-compliance is still an issue, and we need to be doing things about it. So let me just talk about a couple of the things that we are doing that I think are beginning to make some difference.

We are offering community programs to the public which focus on the management of specific conditions, such as arthritis and hypertension. Very often those of us who hang around the edges of the health care profession enough or those of you who are health care professionals always feel really comfortable with the information a physician has given, but sometimes people are just afraid to ask or don't understand how the proper use of their medication actually benefits their treatment. So there are community programs that actually help people understand how their drug therapy makes a difference to their condition. We believe that by doing that, we are enhancing the opportunities that drug compliance will increase.

Also, one of the objectives of the federal-provincial-territorial utilization committee -- we really have to have long titles in the area of health care, I guess, just to keep people wondering what they all are. . . . Anyway, it's a federal-provincial-territorial utilization committee, and Pharmacare participates in that. One of the large goals of that, as well, is consumer education. We're actually currently testing the feasibility of a patient decision guide. The impact of the guide will be measured with respect to patient behaviour, their health care and their interactions with their physician around prescribing. Pharmacare in British Columbia is, actually, leading that project.

I'd use two other examples. One is the community asthma education project. We know that with asthma, non-compliance -- not in terms of not using, but perhaps in not using correctly -- is a fairly significant issue. We have a project worth about $1 million to do education that will increase people's knowledge and compliance with the kind of medication or inhalers that they're using. There's also one -- which isn't in front of me, but I'm pretty sure we have it anyway -- in South Surrey-White Rock, which is helping elders to better understand and utilize their medication, and which has had extremely good results.

[1920]

But this is quite different. This is talking about the use of PharmaNet in terms of evaluating health outcomes. As I understand it, people who are trying to research in this area do not have access to this data. Certainly I appreciate the fact that there are confidential issues here. I think our freedom-of-information commissioner, David Flaherty, is to be commended for some of the really innovative work that he has done, leading the way in North America in terms of protocols for dealing with health information and patient information. But certainly, if we're going to start evaluating health outcomes in this province in a serious way, access to PharmaNet is going to be a very important tool. I'm just wondering if the minister could report on where we're at in the implementation of that.

Hon. P. Priddy: I just want to echo the comments about Mr. Flaherty, the freedom-of-information commissioner. When we started to do the extension of the PharmaNet into emergency rooms and so on, he actually went to White Rock, to the Peace Arch hospital. People walked him through the entire program so that he could understand, you know, how people were dealing with those issues of confidentiality. He was actually very helpful to us in that regard.

As it relates to this particular recommendation, we're currently working with Health Canada on a pilot project, which is looking exactly at that: the use of PharmaNet both to identify and to solicit participants for public education programs. But the issues that people are really struggling with -- I mean, this pilot project will continue -- are confidentiality and privacy issues, and those must be sorted out before people will have any confidence in how we use this to actually produce health outcomes or to know whether drugs have produced health outcomes.

I'm confident that this pilot project will be successful. We will sort out these issues, and that will allow Pharmacare to use PharmaNet in the way that this recommendation looks at, which is about: are there really health outcomes? Are there really effective health care policies as a result of those drugs?

C. Hansen: Certainly I think we all share the concern about confidentiality of information, but my hope is that we will proceed in a very deliberate way to address those issues and deal with them. It's certainly not in anything that we're discussing today, but I'm aware of other issues where concerns about confidentiality become the excuse as opposed to the reason. In this case, I hope that we can continue the pressure to move forward so that these issues can be dealt with quickly, and we can get on with the process of using some of this information for better health outcomes.

The next area that I want to ask where we're at is again dealing with PharmaNet, and that's the recommendation that we identify all sources of prescription drugs other than community pharmacies, which are now part of PharmaNet, and determine whether or not that information should be included in PharmaNet. If the minister could give us an update on that.

Hon. P. Priddy: As regards that recommendation, Pharmacare is currently working with both the B.C. Renal Agency and the B.C. Cancer Agency to transfer their formularies and to initiate claims submission via PharmaNet, which will provide for a more complete medication profile for patients.

C. Hansen: Maybe now is a good time for me just to take a break and map out where we see discussions going this

[ Page 14096 ]

[1925]

The sixth issue in the auditor general's report is to encourage independent reviews of the reference drug program and to report those results. I'm wondering again if the minister could give us the context of how we could expect that report to come forward and how often we will see it. Is it going to be an annual report, and in what format?

Hon. P. Priddy: Currently, in part as a result of the recommendation but in part as a result of the work of people in the ministry, there are independent reviews of the Pharmacare reference drug program that are currently underway by, I think, the University of Washington, McMaster University and Harvard University. These are, however, fairly sophisticated and long-term studies, and I can tell you what they are if you have some interest in that. The staff tells me that we would not expect to see results within 24 months, and they would certainly be public then. They would be the kinds of reports that you would see, for instance, in the New England Journal of Medicine. Then we would need to do that on a regular basis after that.

C. Hansen: In fact, I know that we reviewed some of the stuff during the first supply debate back in April, and I gather from the minister's response that the three she outlined then are the extent of this program. There are no additional ones other than the three we discussed at that time.

The seventh is to consider expanding the trial prescription program to help minimize drug waste. Again, if the minister could just give us an update.

Hon. P. Priddy: We are continuing, as a result of this recommendation, to work with the College of Pharmacists and the Pharmacy Association to look at the expansion of the trial prescription program. Pharmacare is also currently undertaking review of the cost-effectiveness of this policy.

C. Hansen: The eighth point here is one that I know becomes an issue around the whole pharmacy participation agreement, and that's to conduct field audits of pharmacies. I know it's an issue that a lot of the pharmacies were very concerned about -- how that manifests itself in the agreement. Certainly there are ways of doing field audits that are not as intrusive on the affairs of a small business as what was proposed in the pharmacy agreement. So unless the minister specifically wants to respond to that, I don't need any more elaboration on that, because I think I know where we're at in that. That's part of the negotiations that are going to be taking place with the pharmacies.

The ninth point is the framework for performance indicators that measure the results of programs for managing the cost of drug therapies and fostering appropriate drug use. And again, I think this harks back to the one we dealt with earlier, unless the minister has anything more to elaborate on that.

The final point is that of measuring, evaluating and reporting to key stakeholders on the performance of programs, for managing the cost of drug therapies and fostering appropriate drug use. So I'm not sure if the minister has any more to add from the discussion we had under the previous recommendation, but I would certainly welcome any additional comments she has on those three recommendations.

Hon. P. Priddy: On the first of the last three of the field audits, we actually conducted audits of seven pharmacies in 1998. Reports of those audits have recently been issued back to the pharmacies reviewed -- which, of course, is their right to have. It's perfectly reasonable if there's change to be expected, if it's needed. Pharmacare is also developing a procedures and policy manual which enables pharmacists to better understand -- because it's hard for all of us sometimes to understand -- Pharmacare policy. So it just tries to be much clearer about what the Pharmacare policies are.

[1930]

The last one is around the measurement and evaluation which you referenced. "Pharmacare Trends," which is a report of Pharmacare's costs, operation and product utilization, is published on an every-other-year basis. The document reports on a wide variety of historical information, trends data, which illustrates the performance and status of Pharmacare programs. We're working on the '98-99 one now, and we would expect that to be included eventually in the annual report.

J. Weisgerber: I have a few questions around the new Pharmacare agreement, or the proposed agreement, and I certainly don't want to cover the same ground the critic covered with respect to this agreement. But there are a few issues that I did want to get on the record. When this agreement was first presented, I was very much afraid that we were going to lose the dispensary in the only pharmacy in Tumbler Ridge.

The community is in some turmoil in any event, as are many of the business people. It seemed to me that the pharmacist there was simply going to throw up his hands and walk away, at least from the dispensary part of his business, and that troubled me deeply. I wanted to make sure, before I responded too quickly to him, that he wasn't a lone voice. The fact that the People's Drug Mart chain, which represents a large number of independent pharmacies around the province, expressed some similar concerns gave me a sense of the validity of the issues raised in Tumbler Ridge.

For example, when the agreement was presented, one of the clauses in the proposed agreement -- 4.08 -- dealt with the Financial Administration Act. Not surprisingly, the pharmacist didn't understand the implications of the Financial Administration Act. One wouldn't expect him to. But the concern was that he had a great deal of difficulty -- and I've been privy to the correspondence between him and the ministry -- getting an explanation from the ministry on what that

[ Page 14097 ]

The other thing that caused great frustration for him was that under section 6.03, he was required to pay interest on any amount due by him as a result of an overpayment or some error in billing. But the payment time for the ministry was increased from 30 to 60 days. Those things, not surprisingly, seemed to him like the ministry wanted to have its cake and eat it too. It wanted to be sure that it had all the time it wanted -- not only with the statutory 30 days but through the application of the Financial Administration Act -- to essentially pay when it was ready and able to do so, but the agreement sought to impose interest from the day of demand on money due in the opposite direction. Perhaps before I highlight a couple of other concerns, the minister might want to respond to those issues.

[1935]

J. Weisgerber: In keeping with my promise not to rake over all of these issues again. . . . On the proposed agreement under schedule C, there's a reference to a rural incentive program which apparently kicks in only when there's one pharmacy within a 25-mile radius. Could the minister, for my own benefit, tell me what the rural incentive plan entails? I'm assuming that it's some premium or benefit, given that it's referred to as an incentive plan. But I simply have no knowledge of it and would like to be more familiar with it.

Hon. P. Priddy: This is actually a program that has been in place for a number of years. During 1994 there were 19 pharmacies in British Columbia that were registered with the rural incentive program -- in some rural areas of the province where there's insufficient population to fully support a retail pharmacy, in order to help maintain pharmacy services in communities in which there's a sole pharmacy, or with the nearest pharmacy being in excess of 30 kilometres' distance.

Pharmacare is billed at a rate of less than 500 plan A seniors, plan C -- well, anyway, 500 plan A, plan C and plan F wrapped all together. . . . So if it's under 500 prescriptions per month for those categories, then the pharmacy receives a monthly subsidy payment under this rural incentive program. The program reimburses on a scale that pays more as the number of prescriptions increase, to a maximum of $437.50 for 250 prescriptions. Once this level's been reached, the amount declines to zero as the 500-prescription level is reached. I can send you the details of this if you would like to have them.

A. Sanders: I'll start my questioning with a few questions to the minister just to clarify the situation. Is the minister familiar with the Aaron Millar inquest?

Hon. P. Priddy: In general detail, I am.

A. Sanders: Just to fill in a bit of the blanks, Aaron Millar was a young man in Victoria who in 1997, in a state of paranoid schizophrenia, with absent medication, mortally stabbed his mother. There was an inquest after Aaron Millar was apprehended, and we learned a lot during that inquest. In that inquest a number of recommendations were made by the panel doing the inquiry. A number of individuals took a lot of time and a lot of thought to process and to come up with a number of recommendations. Recommendation 31 reads as follows: "The Ministry of Health should ensure that anti-psychotic drugs are included in their drug plan primarily because they are clinically effective and not because they are cost-effective." The rationale for that decision was that the emphasis should be placed on funding drugs that are clinically effective in order to ensure the safety of the community and the best possible treatment of the patient.

Is the minister familiar with the Brenda Barrass inquiry?

[1940]

A. Sanders: Well, I'll fill in a bit of the details. Brenda Barrass was a young woman who, again, was schizophrenic and had tremendous problems with compliance of medication. She was treated a number of times in emergency departments and admissions to Riverview, and in 1996 she slit her throat with a bread knife at home. In the inquiry into Brenda's demise, the inquiry made a number of recommendations. Recommendation 28 was that restrictions on new, clinically proven medications for treating schizophrenia must be removed to allow physicians to prescribe the most appropriate medication available at that time.

Is the minister familiar with the Brian Smith inquest?

Hon. P. Priddy: No, I'm not.

A. Sanders: Allow me again to paint the picture. In 1995 Jeffrey Arenburg, a schizophrenic who had had tremendous problems with medication and was off his medication, fatally shot CJOH TV sportscaster Brian Smith in the forehead, outside of the television station. He believed that it was the only way to stop the voices in his head from spinning conspiracies and the media from broadcasting his thoughts over the airwaves. He judged, based on his best ability, that Mr. Brian Smith was the individual who needed to be removed; thus he would probably be cured of the voices that he had been unable to stop.

Is the minister familiar with the Andrew Goldstein case?

Hon. P. Priddy: No.

A. Sanders: Andrew Goldstein was a very intelligent young man who had significant cognitive ability in the areas of mathematics and physics. Unfortunately, in his teen years he developed schizophrenia. In 1997, Andrew Goldstein was standing in the subway in New York and was overcome by

[ Page 14098 ]

In an article written by Michael Winerip in the New York Times, the article starts. . . . This gentleman evaluates the Andrew Goldstein case as follows: "Maybe they should have just stencilled in large letters on Andrew Goldstein's forehead: 'Ticking time bomb. Suffers schizophrenia. Is off medication. Run for cover.' "

Kendra Webdale, the unfortunate victim of Mr. Goldstein at a time when he was not in control of his own emotions, is no longer here.

Is the minister familiar with the Canadian Psychiatric Association's recommendations on antipsychotic medications?

[1945]

A. Sanders: I'm talking about the atypicals.

Hon. P. Priddy: One of my staff has read it. I'm not sure that they would be able to answer all the questions about its content, but one of my Pharmacare staff has.

A. Sanders: I'll make it easy, because this is not a quiz.

The Canadian Psychiatric Association, in 1997, 1998 and 1999, has recommended transparency and harmonization of Pharmacare policies in order to not restrict any new-generation antipsychotic medications from the seriously mentally ill.

Is the minister familiar with the belief of the CMHA with respect to the new atypical antipsychotics?

Hon. P. Priddy: My staff say that they have some familiarity with it.

A. Sanders: The CMHA -- the Canadian Mental Health Association -- the B.C. Schizophrenia Society and the Mood Disorders Association all, without exception, believe that all of the new medications for schizophrenia should be available to our most seriously mentally ill people.

You know, hon. Chair, when we talk about schizophrenia, we're talking about a disease that has tremendous impact. It has tremendous impact on the life of the individual who suffers from schizophrenia, but as illustrated in the cases that we've discussed, it has a lot of impact on you and me. People who are schizophrenic will have a number of symptoms. They will have a decrease in functioning. They will be unable to hold down jobs, very often. It will usually occur in men when they're in their adolescent years -- 12, 13, 14. In women, it will tend to be in the twenties and thirties. At that time they will experience a rapid decrease in their ability to look after themselves. It will decrease their ability to communicate. It will decrease their ability to function in any way, shape or form in a useful way in society. They will have a perceived impairment in cognition; they will not be able to rationalize normal thought patterns.

They will have hallucinations. They will hear voices; the voices will be brought to them over the wires or out of the telephone book or, in the Brian Smith case, from the television. Many times these hallucinations will be command hallucinations, meaning that they will command the individual with schizophrenia to do something which is beyond his or her control. Many of our untreated schizophrenics appear in jail. In fact, we have more schizophrenics in the United States, for example, in jail than we do in mental institutions. People with schizophrenia are often in trouble with the judicial system.

Now, there are a number of medications for schizophrenia. There are the old medications, which cost cents a day. Unfortunately, those medications have a very significant list of side effects. In the side-effect profile, there are the temporary side effects that occur when you're on the dose of medication, such as dry mouth, blurred vision, constipation, urinary. . .where you can't urinate at all. You may have rash or blood pressure problems, where you feel dizzy when you stand up. You may have movement disorders. Either you're moving all over the place and can't stop, or you have spasms. You can have just about everything on the antipsychotics that we cover under Pharmacare.

[1950]

Pharmacare has decided, in its wisdom, that these medications are too expensive to cover. Last year there was an agreement to cover risperidone, after significant debate. Risperidone is now covered. Olanzapine is only available on special warrant, meaning that you have to try other medications and fail before you get olanzapine. Seroquel is not covered at all. British Columbia will not offer Seroquel to the schizophrenic patient who presents in jail, in the emergency department, in the doctor's office or down in east Vancouver living on the street, where we find many of these people these days.

There is a united and almost universal belief that these medications should all be available. That's whether you're talking about the Canadian Psychiatric Association or independent lay communities that have looked at these through the inquiry process and the judicial system.

So what's wrong in British Columbia? Why is it that olanzapine is not available for those who are newly diagnosed with schizophrenia? Why is it that we do not cover Seroquel at all? Is the minister aware of how many provinces besides British Columbia cover Seroquel for the schizophrenic patient?

Hon. P. Priddy: I believe it's all but one.

A. Sanders: And the one is us. Every province covers this medication except for British Columbia. Is the minister aware of how many provinces cover olanzapine?

Hon. P. Priddy: I could not tell the member the exact number. I know that there are some provinces that cover it as a second line, and there may be ones that cover it as a first line. I don't know the numbers.

[ Page 14099 ]

What basis on earth does this ministry have to not cover olanzapine and Seroquel for the sickest people in our society, who not only harm themselves but often commit harm to those they love and sometimes to strangers?

[1955]

I want to go back for a moment to a couple of points. One of them is that I wouldn't be familiar with all of the cases which the member raised about the personal stories that were told. But I do know that in the case of Aaron Millar, olanzapine was prescribed for him and was available to him. His psychiatrist at the time stated in his testimony that access to medication was not a problem. While I'm sure that in some of those of other circumstances, that may have been the case, it was not in the first one and, I suppose, one of the better-known ones here in Victoria.

I think the comment that people must try. . . . The comment is true about olanzapine being a second-line drug and people being asked to try another drug first. I don't think, though, that people are asked to try old drugs first. I mean, people have access to risperidone, and they have access to clozapine. Those are not old drugs; those are new drugs. Those are considered, if you will, atypicals.

There were 32,000 prescriptions written for olanzapine last year paid for by Pharmacare, so it's not as if people have not had access to it. But in terms of being paid for by us, 32,000 prescriptions were paid for last year.

The therapeutics initiative committee, which is the committee we rely on -- it is a committee of professionals -- still makes the recommendation that Seroquel has not enough research to say that it is effective. I think that the member would then say: "Well, every other province" -- or every other province minus two, or whatever it is -- "says it does." I am not an expert, nor would I pretend to be; nor should I choose to tell the therapeutics initiative committee what they should find in their research based on the drug. But I would say that of the antipsychotic drugs that are available. . . . There are about 30, I think, and Pharmacare restricts only one antipsychotic drug. There's only one antipsychotic medication that we do not cover as a first or second line.

A. Sanders: There are a few things the minister said. First, there's the Aaron Millar situation. When the inquiry was done and all the information was looked at. . . . This is not a recommendation from me, hon. Chair; this is the recommendation from the Aaron Millar inquiry. These people spent a very significant amount of time coming to the recommendations that they made. The recommendation which I have mentioned said: "Cover all the antipsychotic medications." That's the first point.

The second point is about the professional panel on therapeutics initiatives. The minister's right; I would concur that all of the therapeutic initiatives. . .are made up of professional people who have professional qualifications. Isn't it interesting that B.C.'s the only professional panel that comes up with: "These drugs shouldn't be covered"? I would probably take the weight of a whole bunch of provinces and say: why did they come up with the decision that these should be covered, and British Columbia did not?

My third comment is that this is the most vulnerable group in society. You will not find someone acutely psychotic in this chamber or lobbying outside the building to have their issues heard. It is absolutely unconscionable to say that we cover a whole bunch of other drugs -- more than other provinces -- so that justifies that this one's not covered. That is completely out of line.

[2000]

Now, let's take a quote from the previous Minister of Health, from the estimates last year. We were speaking about the appropriateness of using the new medications for schizophrenia. The previous Minister of Health, the now Minister of Finance, said: "It's almost the one illness where you have one chance to get it right, and then you have to work really hard to get a second chance." The minister was acknowledging in debate that very often with people who are acutely psychotic, you only have one chance to treat them. If they come into your emergency department or your family practice office or the mental health clinic and you don't treat them with a medication that they can tolerate, you may not have the opportunity to see them again. We have hundreds of cases like that. We have the Aaron Millars, the Brenda Barrasses, the Andrew Goldsteins and the Jeffrey Arenburgs of the world who end up at the other end, the receiving end -- psychotic people who have not been lobbied for and who've not been advocated for and who are uncontrolled and off medication. So I don't buy any of the minister's arguments, I'm sorry. They don't hold, they don't wash, and in fact one of them I don't believe is even true.

[ Page 14100 ]

"Dear Minister:

"I'm a mental health services consumer who needs your help. Last January my psychiatrist, Dr. Sidhu, put me on a new antipsychotic called Seroquel. She said that there was no alternative for me. You see, I have tried all of the other antipsychotics. What happened was that they affected my ability to swallow food. Some were so bad I couldn't swallow solids at all and had to drink a can of Ensure and it took me about half an hour.

"We found one drug, Stelazine, that wasn't bad, but I still had problems swallowing. In December of last year things were getting worse, and about three times a day I would have food lodged in the back of my throat, and my swallow just wouldn't quit. I would stop breathing for fear of choking. I'd wait in a panic to start swallowing again. This was terrifying. Sometimes it ended up in choking. Nine-one-one had instructions that if I called up and wasn't talking, they were to send the firemen and ambulance to see me. Since I only had one minute of consciousness after I stopped breathing, I was to run out into the hall in my apartment building.

"While I was on Stelazine, I needed three other drugs. I needed clonazepam to try and relax my throat. I needed methotrimeprazine, another heavy-duty psychotic, to help me sleep, and all the other sleeping pills did not work.

"Now on Seroquel there's been a dramatic change. I am no longer having swallowing problems at all. I haven't choked in three months. We took my mother out on Mother's Day to the Keg, and for the first time in seven years, I was able to swallow a thick steak. As well, the doctor took me off the other medications. I don't even need the side-effect pill procyclidine. Now she is taking me off the clonazepam, as it is a Valium-type drug, and it must be taken off slowly. All of these other drugs affect memory and before trying Seroquel, she thought she would have to raise the clonazepam. Now I am down to two pills. Eventually I will be on one, Seroquel. I don't need a sleeping pill with it.

[2005]

"I also have to say that there has been a big change in my quality of life. It feels like I've got my personality back. I read now; I haven't for years. All symptoms of schizophrenia are gone, such as delusions. I am a peer-support worker and, to the surprise of my supervisor, I asked for a client in Mission. I didn't like to use to drive and now I don't have any problem. My supervisor says that I laugh a lot now.

"My problem is that Seroquel costs me $3.35 a day. That works out to about $120 a month. Right now, my doctor is giving me Seroquel for free, but I hear that the company has been turned down once by Pharmacare and they are writing to hear in July what will happen. I'm on B.C. disability and with my rent being $485 a month, I just can't swing it. I'm asking for help for myself first, but you know, I know quite a few others in Abbotsford who are doing overall much better on Seroquel.

"Please do something for me and them. You know, it's so hard to advocate for ourselves, because we have schizophrenia. It is stressful to speak up and there is a horrible stigma. Thank you for your attention to this matter. I hope to hear from you soon.

"Susan Rothney,

Borkman Crescent,

Abbotsford."

Hon. P. Priddy: I don't know if that letter was addressed or copied to the ministry as well. If that is the case, and if we have not responded, then if the member would provide us with a copy of the letter, we will do that. I think that responding to individual circumstances in the House -- by people who don't know the individual and who don't know all of the medical circumstances -- is not particularly appropriate.

A. Sanders: There's nothing more appropriate; there's absolutely nothing more appropriate. Now, if the minister chooses not to respond, that's a different story.

There is good therapeutic evidence. There is good clinical evidence. There is the evidence from all of the organizations who are supposedly in the know. We are talking about the most disadvantaged people in society; 90 percent of them are probably on some kind of supportive care from the province. We're talking about new medications that keep people out of hospital. Medication costing $120 a month does not compare to $500 a day in hospital. As the minister knows -- I believe she has some psychiatric background -- many of the people in acute psychosis with schizophrenia, especially if it's not treated, can end up in hospital for months on end.

[2010]

I want the minister to reconsider these two medications. We do cover risperidone. Seroquel is the same cost per day; it's not more. Olanzapine is; Seroquel isn't. Each one of them has different side effects. Olanzapine, for example, is better for women. It's better for people who have lost their menstrual periods from being on risperidone; it's better for those who have leaking from breast tissue on risperidone; it's better in terms of not causing permanent side effects, like tardive dyskinesia. There are a number of reasons that it is better. Seroquel has studies, as well, and has been around for quite some time -- perhaps not here, but elsewhere -- and is covered by all other provinces. The inquiry suggests that these medications should all be covered, and I believe that on the new list of drugs that will come forward for coverage under Pharmacare, the antipsychotic drugs are not among those drugs. We know that the plans are not to include them in the next year as well.

I think the minister has received bad advice, and I think she needs to reconsider that. I think she needs to weigh all the evidence and to recognize the target group that is primarily affected by this particular oversight. I welcome the opportunity for the minister to change her mind on this issue, because truly I know that in her heart she knows I'm right.

Hon. P. Priddy: A couple of things, I guess. One of them is that I will ask the therapeutics initiative committee to review Seroquel. I have done that with other drugs that have not been covered. I cannot guarantee the outcome, but I will ask for it to be reviewed.

Secondly, with olanzapine, I'm not sure it's fair to say, if there are 32,000 prescriptions written a year that we pay for, that it's not covered at all. But I don't know if we know automatically when a patient comes to the office what will work. Of people who are on olanzapine, 30 percent of those people who are on olanzapine discontinue their use of olanzapine and move to other drugs and other medications that they find more effective and that are all, according to our research, currently covered under Pharmacare. That's not to

[ Page 14101 ]

The second-last comment I would make is, as I say, that I will ask to have the information reviewed. But you know, we're talking about people on the therapeutics initiative committee who are general practitioners, pharmacists, professors of pharmacology, people who are on medical staffs in universities, people who work in the community, people from the BCMA. I mean, this is a fairly broad group of people, and it's a group of people who are not "all academics." Many of them work with patients on a daily basis -- including, by the way, the College of Pharmacists, and so on. So it is very hard sometimes for me to say, and it would be hard to say: "I'm sorry, I reject your therapeutic advice about a particular drug."

The last comment I would make is that I do understand that the earlier you can intervene with someone who has schizophrenia and has had their first break -- which as the member indicated, comes at different times for women and men and comes younger for men. . . . If you can intervene with someone for their first break, then you do have a far higher chance of success. But if we really believe that we only have one chance to treat someone who has acute schizophrenia, then I would be very distressed and discouraged by that. There are many people who have repeated treatment and tried repeated drugs -- even if those are Seroquel or olanzapine -- and have to try again or have to try a different therapy. So I think I would be fairly distressed to think that people with schizophrenia only have "one chance."

A. Sanders: I'm pleased to address all of those concerns. First of all, I would want the minister to make sure that the decisions that the therapeutics initiative committee makes are the decisions that get to her. I gave the example of olanzapine being recommended by the committee and then letters coming out from the ministry that say there's no advantage to it. So I would check the links in the system. Many of the people on the committee are people that have taught me in school, and many of them are very well respected, as are the therapeutics initiative committees in every single province across the country -- all of whom have come to a different decision than British Columbia. So those would be the points that I would make there.

[2015]

Thirdly, the minister said she was very alarmed to think that we could only treat people the first time. She will know, I think, again, that the first time a person is treated -- the first intervention -- is very important; however, it's not the only time you can treat someone.

Many people who are schizophrenic aren't diagnosed for three, four, five years sometimes, because they don't manifest all of the symptoms. But the first time you put them on a medication -- especially if they are paranoid. . . . If the physician gives them medication that makes them have horrible side effects, and they are already feeling -- based on their paranoia -- that the doctor is giving them something poisonous, you can bet they won't be back. If they don't have side effects, you're going to have a patient who might think: "Gee, maybe it is okay. Maybe I haven't been done in by this person who claims to be helping me" -- and maybe they will come back. So "first time" means a whole lot of different things. But you know what? In every single episode of that, they are all important, and it is the variety that is necessary to make the best treatment.

The fourth thing I'd like to respond to that the minister may or may not get as advice from her staff when she leaves here tonight is that no one is asking for the ministry to write in stone every drug they cover. If, for example, these drugs were covered during the period of time that any queries are worked out. . . . And that doesn't mean every drug in the world needs to be covered, but for this group of people, to provide the variety that's necessary. . . . If evidence comes in the future that these drugs aren't good, then the minister can certainly reverse the decision and take them off. But in the interim, when we have the medications available, when patients are responding to Seroquel but not to olanzapine, when they're responding to olanzapine but not to risperidone, when they're responding to clozapine but not to any of them -- then, for gosh sake, give the people who are trying to look after these people the opportunity to make the decision that is the best. For a group of people in our society who end up in jail, who end up on social support -- 90 percent of them -- who are unable to work, who are unable to function, whose lives basically fall apart, how can we compare that we cover a whole bunch of other drugs, and therefore that's a justification for not covering drugs for this particular part of society?

C. Hansen: I just want to follow up on the comments by my colleague from Okanagan-Vernon, because I think the minister has missed the point, at least in the last comments that she made in response to my colleague. It's not whether or not every individual in British Columbia who has a first episode with schizophrenia has to be prescribed one of these two medications. I think the issue is: who makes that decision?

It's the doctor that has to make that decision. It's the doctor that knows what is best suited for that particular patient. And for that doctor to be effective, the doctor has to have access to medications that can work in a variety of circumstances. The minister mentions that 32 percent of those that go on olanzapine don't stay on it. But it's not for a Ministry of Health to make a decision as to what an individual patient takes. That's what doctors are trained for; that's what psychiatrists are trained for in this province.

[2020]

[ Page 14102 ]

And certainly when you start looking at the tools that are available to doctors, this obviously is a very important one. So I think we have to be careful that we, as politicians or officials who are working and serving the public in the Ministry of Health, don't set ourselves up as the arbiters in terms of what a doctor can or cannot prescribe in treating an individual who's suffering from mental illness. Otherwise, we're not going to be able to start to address this -- if we don't make sure that all the tools are available to deal with the problem when it first starts to develop.

I want to address the issue of the therapeutics initiative committee. The minister has mentioned that on several occasions. One of the things that surprised me was that there is not a good understanding as to who the committee are, and even tonight the minister has fallen back on this group as the advisers, as the ones that are somehow the arbiters on some of these issues. There's not a good understanding as to where the therapeutics initiative committee fits into this scheme, and I'm wondering if we can start by having the minister explain the relationship between the therapeutics initiative and the Ministry of Health, and in particular the Pharmacare branch. I gather it's an arm's-length committee, but could the minister explain to us how that relationship exists, how individuals are appointed, what kinds of terms they will serve for and what terms of reference and their mandate will be.

Hon. P. Priddy: The therapeutics initiative committee is a committee funded through a five-year grant to the University of British Columbia from the Ministry of Health. It's arm's length from government, and it's arm's length from what you might describe as vested interest groups. The mandate of the therapeutics initiative committee is to review and then disseminate to health professions Pharmacare information on the therapeutic benefit of prescription medications. That is a large part of what their mandate is. They evaluate new and existing drug therapies by the standards of the best evidence in the scientific literature. They provide to the Ministry of Health and practising physicians evaluations of new drug products and therapeutic guidelines for existing drug therapies. I gave you some indication earlier of some of the people -- and I can certainly provide the list to you -- who are on the therapeutics initiative committee.

It is a scientific information and education committee. It is funded by us but through UBC, so it has an arm's-length relationship with us. They put out about ten newsletters a year. They hold an annual conference for physicians on prescribing, and they publish in their newsletters reviews of the drugs that they've recently reviewed. The one that I've seen is the one that. . . . Well, I've seen others, but the one I have with me is the one they put out on Seroquel, saying that they did not feel there was enough evidence to recommend it at this stage.

C. Hansen: Could the minister tell us whether or not the ministry has an obligation. . . ? I gather from her comments that they are an advisory body and that the minister can take or reject their advice. I'm wondering if the ministry would always accept the advice of the therapeutics initiative committee.

[2025]

C. Hansen: I guess that I'm thinking more of an example of the reverse. My colleague referred to a decision regarding olanzapine that was taken by the therapeutics initiative committee. It was one that raised a lot of concerns about the relationship between the committee and the ministry. I know that my colleague didn't ask the minister to address the specifics of it, so I just want to reiterate.

This is information that was obtained through a freedom-of-information request. These are the minutes of the scientific information and education committee meeting of Monday, February 10, 1997, on the therapeutics initiative. . . . Very specifically, it's a motion. It reads: "Moved and seconded that the evidence at this time shows that olanzapine has some therapeutic advantage over other drugs in the same category." It was passed: nine in favour, none against and four abstentions. And yet we wind up with a letter -- which, again, my colleague referred to -- that was put out by the director of Pharmacare earlier this year. It states: "The therapeutics initiative review of new studies published in the peer-reviewed psychiatric literature found no evidence of olanzapine superiority." So I'm wondering: how can we go from a recommendation of the therapeutics initiative committee -- a motion passed without dissent -- to, basically, the very contradictory position being taken by the ministry a year or so later?

Hon. P. Priddy: I'm not familiar with the letter that's been written. Since that individual is no longer with us, it's difficult to interpret. I do accept the comment of the therapeutics initiative committee that it was found to have some advantages. That's why it is covered, albeit as a second line, which is the 32,000 prescriptions that we cover, for $6 million, every year. So I don't doubt that. The letter that went out that you've read into the record. . . . I don't know if the word that was used -- or the word I think I heard -- was that there was no finding about superiority of the drug. The person isn't here, and I have no way of checking, so I'm afraid that I'm not able to answer that. But certainly physicians and pharmacists know that it's covered as a second-line drug, and they can get it on special authority.

C. Hansen: I guess my intent in raising this specific example was not to continue the debate on olanzapine and Seroquel that my colleague was putting forward earlier but really to get an understanding as to the role that the therapeutics initiative committee has to play. What I see time and time again is that when it comes to justifications of decisions that are made to restrict access to particular medications, they fall back on the therapeutics initiative committee. This body obviously has a very important role to play in terms of access

[ Page 14103 ]

I don't mean to discredit any of the individuals that serve on that committee. I've heard nothing but excellent comments about those who serve. But certainly in terms of the relationship with the ministry, their accountability. . . . If the therapeutics initiative committee has this kind of power and control in terms of decision-making -- where you can have a product that's being denied in one province only, compared to the other nine provinces, and the decision to do that. . . . The minister will fall back on the therapeutics initiative committee as the reason why that is done.

[2030]

Hon. P. Priddy: I don't think that people are falling back on the therapeutics initiative committee, nor do I think there's a denial. I don't think that 32,000 prescriptions a year is a denial of olanzapine. In terms of falling back on the therapeutics initiative committee, the only drug that is not covered is Seroquel, and I have said that I would ask the therapeutics initiative committee if they could review that. I'm not sure it's falling back on the therapeutics initiative committee to use their research and the newsletter they put out, which says that, in the opinion of all these people, they do not see the research that supports the benefit of it. As far as olanzapine is concerned, we have agreed that there are advantages. We have used it as a special authority drug. When they say there isn't enough research to support recommending a drug, I don't think it's falling back on them to say that's been their advice to us. We've followed it.

C. Hansen: When the minister talks about the special authorities for olanzapine, my understanding is that those special authorities are normally approved -- there is a time that it takes for that approval. I'm wondering if the minister could give us some indication as to what percentage of those special authorities would be rejected, how many would be approved and what kind of turnaround time is normal.

Hon. P. Priddy: I didn't take from the member's question that he was necessarily interested in all drugs, given the discussion we've been having. If I context the question this way and use olanzapine just simply as an example of special authority, 98 percent of those requests are approved, and the turnaround time is 48 hours.

C. Hansen: Certainly I did want to use that particular drug as an example, because one of the issues that was put to us is that you wind up with the special authorities going in. . . . Some doctors have 100 percent approval of their special authorities that go in. So it begs the question: why are we going through the 48-hour delay? Why are we going through the process of the forms being submitted, when basically those requests are being approved for the majority of physicians in British Columbia that make those requests?

[2035]

I wouldn't make any kind of commitment here about whether that is something we should look at or not. Currently it is a second-line or special authority drug. There are other brand-new drugs, or reasonably new drugs. Your colleague has referenced at least one of them which was just funded as of last year -- risperidone, as well as clozapine. I think that those drugs are effective as well, and we don't want people not to. . . . We want people to have that array to choose from, and we would like people to be considering those drugs as well, not only olanzapine. In part it has, I guess, had a high profile recently, but if we found that we were approving all of them, then I don't know. . . . We might have to look at it. At this stage it's still second-line, but I appreciate the point you raise.

C. Hansen: I guess the concern is that now that we've had a couple of years of experience with the reference drug program, there are some questions being asked about whether or not it is in fact cost-effective. If you look at the growth curve in the costs of the Pharmacare program in British Columbia, you certainly see 1995, where there was a little downturn in terms of the cost of the Pharmacare program, coinciding with the introduction of the reference drug program. Now that a couple more years have gone by, it appears that that was a pretty temporary blip and that the costs of administering the reference drug program may well exceed the whatever the savings may be as a result of having it in place.

My understanding is that there has been a review going on at some level -- I don't know how formal it is; and this is the intent of my question -- that there have been some talks with industry about the future of the reference drug program. I would like to get some detail from the minister in terms of how formal this process might be and where it might lead.

Hon. P. Priddy: I was just looking at the total cost savings, actually, by the reference drug class. The total to date, when you look at the ones that have been placed in the reference drug class, is almost $136 million. While there is a cost to administering it -- and I don't know what it is, but it certainly isn't $136 million -- there are significant savings as a result of the reference drug class initiative.

Secondly, in terms of discussions with drug companies about the future of reference-based pricing, in terms of the drugs that are currently reference-based, there are certainly no discussions with me. I know that there have been discussions going on with the drug companies about a variety of issues -- partly with this ministry and partly, actually, under the file of a couple of ministers who are colleagues of mine. But there have been no real formal discussions about reference-based pricing in terms of the drugs we currently have.

C. Hansen: I'm wondering if the minister is in a position to consider a more formal review of the program, in terms of whether or not the program is delivering the intended savings. When the minister talks about the $136 million saving, I'd certainly be interested in getting more detail in terms of where that number comes from, how it's arrived at.

[2040]

[ Page 14104 ]

So I'm wondering if it is time for a more formal reflection on the reference drug program, now that we have these years of experience behind us.

Hon. P. Priddy: Currently there is not a plan to review the reference drug program. I will certainly consider the comments made by the member, but there is currently no plan to do that. My staff tells me that the cost of administering this program is about $100,000 a year, and if we're saving $40 million a year, then it seems to me there are significant savings. We've saved $136 million since it began.

C. Hansen: I want to change to a totally different subject area, and that's the flexibility that is shown by Pharmacare in terms of how pharmacists can dispense medications.

There was an innovation that was brought to my attention: blister packs. It struck me as something that could be very useful to a range of patients. There is a pharmacist who has really approached this in a big way and had some fabulous feedback from patients, particularly those seniors who perhaps aren't as capable of organizing their daily medications. The blister packs seem like a wonderful innovation that would serve many people in British Columbia in a very useful way. Yet I gather that there isn't the kind of flexibility in Pharmacare that allows them to use some of these innovations in terms of packaging for patients. I'm just wondering if the minister could comment on this particular innovation and whether or not there is room for expanding it in British Columbia.

Hon. P. Priddy: I know that there is currently some use of blister packs, and that's been referenced. I know that continuing-care facilities use them, but that's more about what works for people who work there, as opposed to the fact that residents who live in those facilities are not using their own. I do know -- or at least I think I know -- that blister packs are used in group homes with people with disabilities, either for people dispensing medication or for people with mental handicaps who are dispensing their own medication when it's set up like that. Actually, we would be interested -- perhaps not for everybody -- in talking with pharmacists on an individual basis about the use of blister packs for elder patients.

C. Hansen: I thank the minister for that, because it is certainly one of those innovations that I think could be helpful. Again, as the minister says, it's not for everybody, but certainly I know of individuals that could benefit enormously from. . .individual patients that could have those. I know that we're not supposed to use props, but this is one that has been made up using candies instead of real medication. It's a wonderful invention. Certainly none of them have been popped open; I haven't started to sample the candies inside them yet. I appreciate the minister looking at that.

With that, rather than embarking on a new subject area at this time, given the hour, I move that we rise, report progress and ask leave to sit again.

[2045]

The House resumed; the Speaker in the chair.

Committee of Supply B, having reported progress, was granted leave to sit again.

Hon. D. Lovick: Hon. Speaker, I wish all members a pleasant break from our labours here and a happy Canada Day. And with that, I move that the House do now adjourn.

The Speaker: Adding to the motion. . . .

Hon. D. Lovick: I have subsequently been advised that I should move that this House stand adjourned until 2 o'clock on Monday.

The Speaker: Members, we now have the correct motion.

Motion approved.

The House adjourned at 8:46 p.m.

PROCEEDINGS IN THE DOUGLAS FIR ROOM

The committee met at 2:49 p.m.

HEALTH STATUTES AMENDMENT ACT, 1999

C. Hansen: This amendment to the Community Care Facility Act. . . . I know that some people in the province will be disappointed to see a minor tinkering with this particular piece of legislation, as opposed to a wholesale rewrite of the legislation. Certainly the fact that this amendment is coming forward in this context sends out a signal to some people that an overhaul of that act is not forthcoming. I'm just wondering whether the minister might be able to comment on that.

[1450]

Section 1 approved.

On section 2.

C. Hansen: My comments don't pertain specifically to this section but to the package of clauses that are in the act that repeal the. . . . The Naturopaths Act and the Psychologists Act have all kinds of other ramifications to them. Certainly we support the initiative that has been put forward to bring these professions under the Health Professions Act. But given that this is the first section that deals with that particular subject

[ Page 14105 ]

Hon. P. Priddy: There are no changes in the scope of practice either for naturopaths or psychologists as a result of the repeal of this. When the Health Professions Council reports out next year -- and I haven't seen what that reporting will look like -- there may or may not be changes contemplated. But this particular piece makes no difference to the scope of practice or how people practice at all.

Sections 2 to 9 inclusive approved.

On section 10.

C. Hansen: The changes that are being put forward are going to allow the amendments that were brought forward in Bill 22 last year to be proclaimed. I gather that the amendments that are being put forward in this legislation are the only thing that's holding up the proclamation of Bill 22. I'm wondering if the minister could give us an indication as to when we might expect proclamation and whether or not Bill 22 will be proclaimed in its entirety or whether it's going to happen section by section.

Hon. P. Priddy: Our intention and hope would be to do it as soon as possible, and while there has not been a final decision made, our current thinking is that we would bring forward the entire package. We're hoping to have cabinet have a look at those regulations before we adjourn, if it's possible -- depending, of course, on when we adjourn -- so that we can move as quickly as we can in the fall.

C. Hansen: Do I take it from that that we're looking at proclamation in a matter of weeks, perhaps? Or are we talking two months? What's the relative time frame?

Hon. P. Priddy: I would expect to see an announcement as soon as possible and probably a proclamation in October or November.

Sections 10 to 21 inclusive approved.

On section 22.

C. Hansen: Section 22 is providing some retroactive powers, I gather, to deem actions by the South Okanagan-Similkameen health district to have been done in a bona fide manner. I gather that some oversight had taken place. I know that in the minister's introductory comments on second reading, she didn't address this particular section, and I'm wondering if she could just explain the ramifications of it and what this is meant to correct.

[1455]

Sections 22 to 24 inclusive approved.

Title approved.

Hon. P. Priddy: I move that upon rising, the committee report Bill 76 complete without amendment.

Motion approved.

The committee recessed from 2:57 p.m. to 3:32 p.m.

Hon. J. MacPhail: I call committee on Bill 71.

FINANCE AND CORPORATE RELATIONS
STATUTES AMENDMENT ACT, 1999

On section 1.

G. Farrell-Collins: I just want to make clear that having perused this bill at some length, there is nothing that I think requires questions or explanations. I think it's all self-explanatory. Unless the minister has some amendments or something, I have no problem moving the bill forward.

Sections 1 to 14 inclusive approved.

Hon. J. MacPhail: I do have a floor amendment, if I could just pass it over to the opposition. It's to amend the act by adding a new section -- section 14.1. Do you want me to explain it?

I move the amendment.

[SECTION 14.1, by adding the following section:

14.1 Section 253, is amended

(a) in subsection (1) by adding "or under a regulation made under section 289(3)(s)" after "or (f)"; and

(b) in subsection (2) by adding "or under a regulation made under section 289(3)(t)" after "or (g)."]

[1535]

Hon. J. MacPhail: This corrects a drafting error in the bill that was introduced. It's required to preserve the ability of the

[ Page 14106 ]

Section 14.1 approved.

Sections 15 to 62 inclusive approved.

Title approved.

Hon. J. MacPhail: I move that upon rising, the committee report Bill 71 complete with amendment.

Motion approved.

Hon. J. MacPhail: I call Committee of the Whole to debate Bill 81.

REGULATORY IMPACT STATEMENT ACT

On section 1.

R. Thorpe: Following along on the previous bill, does the minister have any amendments to table with respect to this bill?

Hon. J. MacPhail: No.

Section 1 approved.

On section 2.

R. Thorpe: Is this bill mandatory or optional within the government?

Hon. J. MacPhail: It's mandatory.

R. Thorpe: Does it include every ministry, agency and commission and all Crowns of the government of British Columbia?

Hon. J. MacPhail: Yes.

R. Thorpe: I believe this is the place we'd do it, because this is called policies and procedures. When I review the application of policies, I'm just wondering: how does 4.0 of policies and procedures mesh with 6.0 and 8.0, taking into account the minister's previous answer?

[1540]

If I could just say, all of this was discussed in the task force on small business -- about how it makes the most sense to efficiently use the advisory board's time and the bureaucracy's time in order to make sure that this works efficiently. So Schedule A ministries are the ones that have to issue plans, but any other ministry or agency or whatever that is contemplating regulatory change at any time has to comply with the act.

R. Thorpe: So the act supersedes everything that appears on Schedule A and puts into effect that anyone -- any government agency, Crown corporation, ministry, etc. -- in that big government world has to comply with doing regulatory impact studies on regulation reform. Is that correct?

Hon. J. MacPhail: Yes, the act requires the policy, and that's why we're discussing it here, as the member notes. The policy and procedures outline regulatory plans, so those are the bodies that have to come forward with plans each year. But the act, as the member notes, applies to anyone who is contemplating a regulation.

R. Thorpe: I appreciate the minister's response to that. I want to make sure, so let me ask the question very bluntly. Are there any loopholes here so that people can get out of having to do the regulatory plans and the regulatory impact studies, as far as you're concerned? Or is it your intent that there be absolutely no loopholes -- they must comply, as the minister said on March 26, within the "spirit and intent"?

Hon. J. MacPhail: Here's what we discussed on this. Actually, I don't believe there are any loopholes in the intent of the act, but let me give you one example where I believe that we will simply not be doing a regulatory impact statement. Sometimes we bring in regulations around vaccinations of children, and it's only for public health. We won't be doing a regulatory impact statement for that.

R. Thorpe: In the act and in here it talks about the BTF, the task force that's going to do this. How are these individuals going to be selected? When is it going to take place? And what kind of a transparent process are we going to have to ensure that we have the very best people at the access of government to be part of this?

Hon. J. MacPhail: The Business Task Force recommended what the composition of the advisory board should be. They recommended that various classifications -- for lack of a better word -- of people be represented.

A Voice: Associations.

Hon. J. MacPhail: Yes, associations. They made the recommendation to me. They also recommended that we remove the two deputy ministers as members of the task force, and they would just be advisers to the committee. Based on their recommendations, I've sent out a broad call for nominations to these various associations and categories of groups.

The Chair: Excuse me, member, but I think that was on section 4. Shall section 2 pass?

[ Page 14107 ]

[1545]

The Chair: Excuse me. I thought the Business Task Force was. . . .

R. Thorpe: Section 2, hon. Chair, pertains to regulatory impact policies and procedures. This document happens to be policies and procedures, which I believe dovetails into this.

The Chair: My apologies. I just saw Business Task Force there. Okay, keep going.

R. Thorpe: Thank you very much. I do appreciate your guidance.

When could we expect an announcement on that? When do we expect that process to be completed and those individuals announced?

Hon. J. MacPhail: The recommendations are coming in as we speak. I would expect that within the coming couple of weeks, I'll be making an announcement.

R. Thorpe: Section 6.0 of the policies and procedures talks about ministries having to do regulatory plans, etc., each year. When will those plans have to be completed each year? Will they be part of an annual business plan, and will they be available for the estimates process?

Hon. J. MacPhail: The first plan has been requested for August, and they will be updated quarterly. I would assume that they will be available for estimates.

R. Thorpe: So as we move more and more towards -- although we're moving quite slowly -- the accountability matrix and the performance measurements matrix, do we see this process also becoming a very integral part of the annual business plans for each ministry, commission and Crown corporation?

Hon. J. MacPhail: The ministries that I have the honour to represent have strategic plans, and certainly these will be part of that.

R. Thorpe: One of the concerns I have is with respect to 9.0: "Regulatory plans must be in a form required by the Minister of Finance and Corporate Relations." Let me ask this question for clarification. Who in government is the champion to ensure that everybody is doing the regulatory reform -- the impact studies and the plans? Where is the clearinghouse or the management centre? If we could get answers to those.

Hon. J. MacPhail: I'm the lead minister on this issue. I will be the one requiring the procedures to be completed and following up and monitoring it towards completion. The individual ministries themselves do the work. Also, the small business task force advisory committee works with me. As one of the members said on the day we introduced this, they'll be bird-dogging this, as well, with me.

R. Thorpe: It will be, as I interpret the minister's words, the Minister of Finance in charge of the money. "I pay; I say. If they don't get the reports in, no money." That's how it's going to work; at least, that's my interpretation. They may initially start out as bird dogs, but if it starts to come apart at the tracks, I'm sure that they'll have other animal terms that can be assigned to the Business Task Force.

Section 12.0 says: "Regulatory plans must be signed-off by the minister responsible, in the case of ministries, and otherwise by the head of regulatory authority." Is this a change?

Hon. J. MacPhail: No, it isn't. It's just put in writing.

R. Thorpe: The sunset provisions of the procedures here. . . . And of course, we support the sunset provisions, as long as the time frame isn't too far out into the future. What is planned to happen with the existing regulation within government now?

Hon. J. MacPhail: The advisory committee will be asked to do a backward-looking review as well -- a retrospective review of regulations -- and make recommendations on the future of regulations that are currently in existence.

R. Thorpe: My take on that is that we can expect, sometime in the deliberations of the BTF, an inventory of all existing regulations and their assessment on what's going to be reviewed and when it's going to be reviewed -- if in fact it's going to be reviewed. Is that a correct assessment on my part?

[1550]

R. Thorpe: With respect to this piece of legislation, if you read it carefully, at least the way I've read it -- carefully and sometimes trying to read between the lines, and sometimes words jumping right out at you -- "major regulatory decisions" as stated in 22.0. . . . Who is going to decide, and how is it going to be decided which is a major regulatory piece? Who's going to make those decisions? How are those decisions going to be made?

Hon. J. MacPhail: The Business Task Force will make recommendations to the Minister of Finance on what is major. The task force will be guided by the determinations listed on page 4 of the policies and procedures. We'll have to give consideration to those issues -- whether the issue is likely to have a significant impact or be perceived as potentially having a significant impact on any affected parties or interests, not limited to business interests -- or the issue or any proposed alternatives to address it are likely to be controversial.

R. Thorpe: The decision is still going to rest with the government. In this case, because this is the champion, the Minister of Finance is going to make that final decision. Was that the original intent on March 26 when you made the announcement? Or have we backed off a little bit and given ourselves a couple of ways of getting out of regulatory impact studies?

Hon. J. MacPhail: This reflects the original intent. The review was always to be on the basis of major initiatives. All parties said there was no intent. . . . Even though the media may have interpreted this as more red tape, it was exactly the opposite. There was no intent to paralyze government. It was always that the task force would advise government, with government making the final decision.

R. Thorpe: Is any kind of dispute resolution mechanism envisaged or planned for if the Business Task Force deems

[ Page 14108 ]

Hon. J. MacPhail: I think it probably will be the reverse -- that perhaps the Minister of Finance will be adding requirements for review, rather than taking away. This is a volunteer committee, although they have proven to be an extremely dedicated group. If there is a dispute -- which I can't anticipate, frankly, because it's been a very good working committee, and I have virtually accepted their advice to date -- I would imagine that the task force members, who are independent, will make that dispute known publicly. The court of public opinion will prevail.

R. Thorpe: As it does from time to time, sometimes not on a very timely basis.

Section 25.0, which talks about the quarterly review, etc., says: "The minister may then change the direction given to ministries and regulatory authorities as required." What does that contemplate?

Hon. J. MacPhail: That's to allow both the minister -- and then receiving advice from the task force. . . . If the regulatory plan moves an issue from major to minor or from minor to major, then different direction can be given.

R. Thorpe: With respect to 27.0, an impact statement is not required. But is it expected that the spirit and intent of RISA will be applied? I see the possibility of people arguing that their regulatory plans and changes are not major. So how will that be monitored?

[1555]

Section 2 approved.

On section 3.

R. Thorpe: Was section 3 originally envisaged in the March 26 announcement, or is that something that you had to put in?

Hon. J. MacPhail: Yes. As a matter of fact, the task force said that this is not about giving courts more work to tie up the business of either business or government. All task force members, particularly the subcommittees, said that while this was mandatory. . . . They had two requests: (1) that the legislation be mandatory and apply as widely and broadly as possible, and (2) that the advisory committee be mandated through legislation as well. As long as those two checks and balances were there, they did not. . . . No one wanted this to be able to go into the courts and to have an aggrieved person tie up the whole process of moving forward in the courts.

Sections 3 and 4 approved.

On section 5.

R. Thorpe: So section 5 really gives the government the right to do whatever it wants to do whenever it wants to do it, regardless of the spirit of RISA. Is that correct?

Hon. J. MacPhail: Let me start with the history of what the Business Task Force wanted. They wanted to ensure that there was no specific power given to government through the legislation to exempt regulatory policy decisions from the act. You'll note that there is no exemption for certain areas of policy or even areas of regulation to be exempted. But what this section does. . . . This section is part of general regulation-making power that exists throughout the legislative process. It really provides specific power to exempt a regulatory authority from application of the act. It's a general application power. It doesn't go beyond the general application power to the specific.

This exists in other areas of regulation-making as well. For instance, it includes the power to enact regulations that are considered necessary, advisable, ancillary or consistent with the act. It provides for administrative and procedural matters for which no express or only partial provision has been made. It can limit the application of a regulation in time or place or both, and it can provide for contravention of a regulation to be an offence. That's what general regulation power includes throughout government.

R. Thorpe: So basically what you talked to me about there was section 41 of the Interpretation Act. Let me, again, cut right through to it. There is absolutely no intent on the government's part -- and, most importantly, on the minister's part -- to provide government with a loophole to get out of the spirit and intent of this worthwhile exercise.

[1600]

R. Thorpe: That may be the case, and I hope that that is the case. But we haven't seen a whole bunch of spirit-and-intent regulatory impact statements come through with respect to the legislation that has been brought before the House, with the exception of this.

Hon. J. MacPhail: I did one today.

R. Thorpe: But we haven't seen that, have we? So it may not be deemed to be major.

I thank the minister for her comments. I want to take the minister at her intent and spirit. I know that the people I've talked to on the advisory council -- committee, council or board, whatever the correct terminology is -- look forward to working with the government. I also want to thank the minister's staff who have briefed us on this legislation and kept us well informed. We do appreciate that.

Sections 5 to 7 inclusive approved.

Title approved.

Hon. J. MacPhail: I move that the committee rise and report Bill 71 complete with amendment and Bills 76 and 81 complete without amendment.

Motion approved.

The committee rose at 4:02 p.m.

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