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.
(Hansard)
WEDNESDAY, JULY 7, 1999
Afternoon
Volume 16, Number 19
[ Page 14167 ]
The House met at 2:07 p.m.
Prayers.
G. Janssen: Joining us today is June Payne, a nurse and health administrator from London, Ontario. With her is her daughter Judy Payne, a legal adviser in the Ministry of Finance in Victoria.
W. Hartley: I'm pleased to introduce two people that I met with this morning from Delta Cedar Products, which is the largest value-added remanufacturer on the coast of B.C. As part of their growth in the last seven years, they have doubled their workforce and created a new mill, Halo Sawmill, in Pitt Meadows. They are Glen Franke, the comptroller, and Rowland Price. Would members make them welcome.
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Hon. C. McGregor: I would ask the House to indulge some introductions in acknowledging some special guests we had in the House with us yesterday. I understand they visited MLAs on both sides of the House, and they brought with them a special token to acknowledge the importance of the Vancouver Island marmot and the marmot recovery efforts that we're engaged in in the province of British Columbia. I hope that everyone is enjoying their marmot friends and that they will use them as an opportunity to promote the very worthwhile project that the Marmot Recovery Foundation has been promoting in building a captive breeding facility.
Hon. Speaker, if I could acknowledge the young people who were here yesterday
The Speaker: Yes, proceed.
Hon. C. McGregor: I'd like to acknowledge Alison Ludgate, Becky Haegart, Jasmine Chiang, Vanessa Nation, Roslyn Howell, Kate Partridge, Gillian Dixon, Matthew Nation, Michael Lee Gresham, Morgana Gresham, David Ludgate, Robin Tilby, Miranda Calderwood, Lauralyn Calderwood and Alexandra Skey -- students from Glenlyon-Norfolk School -- and Carol Ludgate, Laurie Nation, Chris Nation, Mary Tilby, Colleen Calderwood, Debbie Howell and Charles Peacock -- the parents that accompanied them.
Hon. J. MacPhail: I'd like to actually pay tribute to what are becoming the thinning ranks of the press gallery -- and I'm not referring to their hairlines in this case. Today is a special day for a member of the press gallery. It's the forty-fourth birthday of Scott Sutherland. I would say that even though he is attempting to grow a beard, we should probably wait until his forty-fifth birthday to judge it. Happy birthday.
J. Weisgerber: In the gallery today are three gentlemen: Merrick Andlinger, president, and Irshad Ahmed, vice-president, of Pure Energy Corp. in New York, joined by Bill Vanderland from Nanaimo. They're here promoting clean-burning ethanol and meeting with government officials. Please welcome them.
J. Sawicki: I would like to introduce three special guests. The first two are Coro Strandberg and Blaise Salmon. Coro is currently the chair of VanCity and was nominated Woman of the Year. More importantly, she is one of my constituents and one of my dearest friends. Blaise Salmon is a financial planner, and he's a volunteer president of Results, which is an international organization working to end world hunger. But it's the third guest, their new daughter Mireta, that's the focus of this introduction. She's three weeks old, and she's already had a picture taken with her MLA and with the Premier. Would the House please make them all welcome.
P. Calendino: I've just been informed that there are two constituents of mine in the gallery. They are students who reside in Burnaby but probably go to school here in Victoria. They are James Blasina and Steven Gibson, and I would ask everybody to make them welcome.
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VANCOUVER TRADE AND
CONVENTION CENTRE PROJECT
G. Campbell: On June 21 the Minister of Employment and Investment informed us during his estimates that the total cost of the convention centre project was going to be $810 million. He was then contradicted by the Premier, who now says that it's going to be $900 million. On Monday the Minister of Employment and Investment told us all that there was a $300 million cap on the provincial contribution to the convention centre project. Within 24 hours the minister was contradicted by the Premier, who said that there was going to be a $530 million cap.
My question to the Minister of Employment and Investment is: when the government can't get its own story straight, is it any wonder that nobody trusts them and that no one wants to do business with British Columbia's government?
Hon. M. Farnworth: There are a number of issues. One, we have been in negotiations to ensure that we can get the best deal on the trade and convention centre project for the taxpayers of British Columbia. This is a project that is composed of a public part, around a convention centre, and a private part, around a hotel. Now, the costs have changed somewhat on the hotel, and the question is whether or not the province should be picking up some of the costs associated with the hotel.
An Hon. Member: What do you think?
Hon. M. Farnworth: I'll tell you what I think, hon. member, and it's the same thing this government does: there is no blank cheque. We are not going to be paying for costs that are legitimately the costs of the hotel or of Greystone. That's what we're saying.
The Speaker: Minister, conclude your remarks, please.
Hon. M. Farnworth: Our negotiating team is negotiating hard on behalf of the interests of the taxpayers of British Columbia.
The Speaker: First supplementary, the Leader of the Official Opposition.
G. Campbell: The staggering incompetence of this minister is shown by that answer. On Monday the minister said that
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there'd be a $300 million cap; the Premier came in and said: "No, it's $530 million." This Premier undercut our negotiating stance from the word go when he said that the province would go it alone. He undercut it with the federal government, and he undercuts that every time he undermines this minister. Every time he contradicts this minister, the province's position is weakened. How can this minister stay in a cabinet with this Premier when he is undercut day after day after day?
Hon. M. Farnworth: Well, this is the same leader that's undercutting his colleagues day after day after day on their side of the House.
The issue around the province's contribution to the
Interjection.
Hon. M. Farnworth: Well, you've never had a good line, hon. member.
The Speaker: Members, members.
Hon. M. Farnworth: The province's contribution to the convention centre project is based on a number of issues. One is the agreement that's negotiated at the table. Second -- and my comments on Monday relate directly to it -- is whether or not the federal government participates in the project. We have been negotiating with the federal government. We would like to see them contribute $170 million to the project. The question, at the end of the day, becomes: if they are not there, then do we cancel the project because they're not participating, or do we recognize the significant benefits to the province of British Columbia and make some decisions about whether or not we should proceed?
The Speaker: Minister, thank you.
Hon. M. Farnworth: The fact of the matter is that we are negotiating an agreement that is in the best interests of the people of the province of British Columbia.
The Speaker: Second supplementary, the Leader of the Official Opposition.
G. Campbell: This minister clearly doesn't get it: this Premier is destroying the province. Does this minister have the gumption to stand up to the Premier? Is there anyone on that side of the House who will tell the Premier that it's time for him to go, so we can get on with building the province again?
Hon. M. Farnworth: This government is negotiating an agreement on the trade and convention centre that's in the best interests of the taxpayers of British Columbia. This government is saying that there is no blank cheque. The question that the Leader of the Opposition should answer is the one that he failed to answer yesterday, when he was asked how much he would contribute to the project. How much does he believe the taxpayers of British Columbia should be contributing to the trade and convention centre project? He had no answer, just like on most other things.
G. Farrell-Collins: If the government has the guts to call an election, we'll start a business plan in 28 days, and we'll build the thing.
The fact of the matter is that the government isn't negotiating
Interjections.
The Speaker: Members, order, please. Order in the chamber.
G. Farrell-Collins:
Interjections.
The Speaker: Order in the chamber.
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G. Farrell-Collins: On Monday the minister responsible said there is a July 31 construction deadline. The next day, less than 24 hours later, the Premier said there is no such deadline. Can the Premier or the minister responsible tell us which it is? Is there or is there not a deadline? How much money is the cap? Is there a cap? Do either of them know what the other is thinking at any time? Would they like to put their seats together so that they can discuss it before they get up and answer the question? Is there or is there not a July 31 deadline for construction?
Hon. M. Farnworth: We have been working towards a July 31 start date, at which point we would receive the environmental permits which would allow us to start to do the work required in the water. This would involve environmental mitigation, habitat replacement and starting to do the work around the pilings. Plus, it would start us in proceeding further down the road to when the physical construction of the plant actually takes place. As a result of the actions that took place in the negotiations this morning between our negotiating team and those of Greystone and Marriott -- when additional demands were placed on the table which impact on the project -- we have said that we will not proceed with the project while there is not an agreement in place that's in the best interests of the taxpayers of British Columbia.
The Speaker: First supplementary, the member for Vancouver-Little Mountain.
G. Farrell-Collins: There has been no agreement all along. There has been no business plan; there has been no arrangement. There has been a nice theory and idea inside the Premier's head that occasionally he shares with the minister responsible. Can the minister responsible tell us: why is it that the people they're dealing with -- the people of Marriott and the people of Greystone -- came out of a meeting today and said that they don't know from minute to minute what the story is? They hear one thing from the minister's staff and his negotiating team and something else from the Premier's Office. Can the minister tell us how anybody in the world is going to invest and develop projects in British Columbia when the minister and the Premier can't get their act together?
Hon. M. Farnworth: We've made it clear that this government is committed to the trade and convention centre project. It has our full support. We have a negotiating team in place that is negotiating hard for the province of British
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Columbia. The complaints that I heard this morning from the other parties were: "Oh, the province is trying to unload costs on us." In other words, we're not there with a blank cheque giving away the farm. We're negotiating hard, as we should be. We are not going to apologize for negotiating hard in the interests of the people of British Columbia.
G. Plant: In the last 48 hours, the Premier and the Minister of Employment and Investment have outdone themselves in their race to disagree with each other and to raise the stakes of failure on the convention centre development. First it's $810 million; then it's $900 million. First it's $300 million; then it's $530 million. It's been nine minutes since the start of question period. Perhaps the Minister of Employment and Investment has yet another set of figures for this NDP-made disaster. Let's get a progress report. What's the total cost now? What's the total cap on provincial expenditure now? Is the province still saying that it will build the thing all by itself?
Hon. M. Farnworth: The province is committed to this project, and we want to see it go ahead. The business community wants to see this project go ahead; the people of British Columbia want to see this project go ahead. But it will not go ahead unless there is an agreement in place that represents the best interests of the taxpayers of British Columbia. Our negotiating team has said that the demands placed on the table today have an impact on the project. We're going to take time to consider what those demands and impacts are, and then we will respond. But we will not enter into an agreement that is not in the best interests of the taxpayers of British Columbia.
We want to see the project go ahead. As I said earlier, hon. Speaker, where is the opposition? How much money do they think the province should be committing to the project? You know what? When they were asked the question yesterday, they couldn't answer it.
The Speaker: First supplementary, the member for Richmond-Steveston.
G. Plant: Project after project, year after year, this government has sold the taxpayers of British Columbia down the river, and it hasn't protected them once. No government has less credibility when it talks about blank cheques than this government. Only an NDP government would spend $54 million -- and counting -- on a project that doesn't even have a business plan. Will the Minister of Employment and Investment stand up and admit that his project is a complete and utter disgrace -- that's all it is, and that's all it will continue to be?
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Hon. M. Farnworth: I suggest the member should in fact talk to Greystone and Marriott, because they are saying that they want to make the project work. The government is saying that we want to make the project work. But we are going to negotiate hard for the taxpayers of British Columbia, and we are going to ensure that we get the best deal possible and that the project will not go ahead until there's an agreement in place that represents that. The member likes to talk about the business plan. Well, there is a business plan in place, and we've been negotiating hard.
Some Hon. Members: Where is it?
Hon. M. Farnworth: What we've said is that when the agreement is complete, we will release the documents. We are in negotiations right now. We have been in negotiations to achieve a deal. But as I keep repeating, there were demands placed on the table today that have a significant impact on the project. We are not going to proceed with the project if those demands impact on the taxpayers of British Columbia in a negative way. We have a competent, tough negotiating team, and they're doing their best on behalf of the taxpayers of British Columbia.
SEX OFFENDER REGISTRY AND GUN REGISTRY
J. Weisgerber: My question is for the Attorney General. On Monday a judge released a known sexual predator who had breached every condition of his bail. Yesterday a judge released a Washington man who smuggled a gun into Canada, put it to his wife's chest and pulled the trigger. They let him off with a slap on the wrist. What plans does the Attorney General have to introduce some common sense into our judicial system?
Hon. U. Dosanjh: With respect to the first case that the hon. member is speaking about, I haven't the particulars. I'll try and get those and respond to the hon. member.
With respect to the second case that the hon. member raises, the Crown will be reviewing the particulars of that case and seeing if there is a possible appeal with respect to sentence.
The Speaker: First supplementary, the member for Peace River South.
J. Weisgerber: You know, it's ironic. This government is the only government west of Quebec that still supports Ottawa's idiotic gun registry, which wouldn't have done a damn thing to prevent this guy from smuggling a gun into Canada and threatening his wife with it.
The Speaker: Member, I'm sure
J. Weisgerber: I'm sorry, Madam Speaker. "Darn" would, I guess, be more appropriate.
But while this government supports a gun registry, it's still dragging its feet on a sexual predators registry that would at least ensure that people threatened by these kinds of sexual predators are notified about their whereabouts in the community. Will the Attorney General commit today to at least review his position on both these issues? I think he's dead wrong on both of them.
Hon. U. Dosanjh: I will be signing a letter today, which has been prepared for me, to ask the federal Minister of Justice to make some changes to the process in the gun registry. On the issue of the registry for sexual offenders, B.C. is the first province to introduce the most comprehensive notification policy in place in this country. We did that a couple of weeks ago, with the B.C. Association of Chiefs of Police supporting us. I have said that we would monitor that process and that once that process has been monitored, perhaps by the next sitting of this Legislature, we may have some legislation to be
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brought forward to actually establish a wide and comprehensive sexual offender registry, which is something that I support. I actually want the federal government to do it, because it's a national problem; criminals know no boundaries. They should be doing it. If they don't do it, we are prepared to go alone.
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Hon. D. Miller: I have the pleasure to table the first annual report -- from October 23 last year, when it was formed, to the end of the last fiscal year -- of the British Columbia Oil and Gas Commission.
R. Thorpe: I have the honour to present the fourth report of the Select Standing Committee on Public Accounts for the third session of the thirty-sixth parliament, entitled "Earthquake Preparedness in British Columbia." Hon. Speaker, I move that the report be taken as read and received.
Motion approved.
R. Thorpe: I ask leave of the House to suspend the rules to permit the moving of the motion to adopt the report.
Leave granted.
R. Thorpe: I move that the report be adopted. In so moving, I would like to commend all of the members of the committee, who have worked so diligently over the past 14 months in preparing this report. I would like to thank all of the British Columbians -- the parents, the individuals, the experts -- that provided insight into this report.
I would also like to thank very much our former Chair of the committee, my friend Fred from Delta South. This report is tabled in his memory. All of the committee and all British Columbians share and appreciate his guidance, his thoughtfulness and his appreciation and caring in trying to protect British Columbians into the future.
The Speaker: Thank you, member. You've moved a question of the adoption of the report. Oh, I'm sorry -- I recognize the member for Comox Valley, as Deputy Chair.
E. Gillespie: I would like to speak to this motion and also to commend the work of our Chair, Mr. Fred Gingell, the member for Delta South, who led us through the preparation of the "Earthquake Preparedness in British Columbia" Public Accounts report and who ensured that the voices of British Columbians were heard and represented in this report.
Motion approved.
Hon. J. MacPhail: I have the honour to present a few reports, if I may. First is the report of the business done in pursuance of the Pension (College) Act during the fiscal year ended August 31, 1998. I also have the honour to present the '98-99 annual report of the office of the auditor general of British Columbia. And I respectfully present the unclaimed money deposits report for the fiscal year ended March 31, 1999.
Hon. J. Kwan: I have the honour to present the 1998-1999 annual report of the homeowner protection office.
I. Chong: I rise to present a petition on behalf of 500 residents in the Gordon Head neighbourhood concerned about the potential closure of Torquay Elementary School.
E. Walsh: I rise today to table copies of a petition signed by more than 4,000 residents of the Kootenays. These citizens oppose the hunting of Rocky Mountain elk in the mating season and want the provincial government to end this practice and to help restore elk and other herds for the benefit of Kootenay hunters.
I am also tabling examples of more than 4,000 additional letters that I received which make the same request of the provincial government.
Hon. J. MacPhail: I call Committee of Supply. For the information of the members, we will be debating the estimates of the Ministry of Health.
The House in Committee of Supply B; W. Hartley in the chair.
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ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS
(continued)
On vote 36: ministry operations, $7,569,524,000 (continued).
C. Hansen: I want to start out by turning it over to my colleague from
Kamloops-North Thompson, but just before I do that
We're going to start out dealing with capital projects. Many of these were dealt with by my colleagues in terms of their constituency-by-constituency issues, but there are some loose ends that we'll clean up there. We'll be talking about the allocation of federal dollars. We'll talk a bit about public health issues, health research, communications and issues management, and legislation and professional regulations. We'll then go on to information management, the Medical Services Plan and mental health. With that bit of an overview as to where we're going with these discussions, I'll turn the floor over to my colleague.
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K. Krueger: Last week, at the beginning of Health estimates, the minister and I covered some questions with regard to the new psychiatric unit to be constructed at Royal Inland Hospital in Kamloops. That's the first of the capital projects that we'd like to talk about.
The reason that I bring it back to the minister's attention is that statements have been made by local health authorities since our discussion -- our discussion was well publicized -- wherein the minister said, with regard to the commencement of construction of the psychiatric facility in Kamloops: "My intention would be -- this is sort of one of those 'God willing and the creek don't rise' things -- that sod would be turned this summer." And a little while later in the debate that day, she said: "Yes, I intend that it go ahead."
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I know that she meant it, and it's certainly long overdue. The government has announced and reannounced this project over the last four years. There was a press release on March 8, 1996, entitled "Petter Reaffirms Psychiatric Facility to be Built in Kamloops." That was two Health ministers ago, all with this government. The second paragraph of that press release -- March 8, '96, mind you; almost three and a half years ago -- says this: " 'The decision is final,' Petter said. 'There will be no revisiting this issue now or in the future. We now have to get on with the job of building the facility, and that's exactly what I am going to ensure happens." Well, he was unable to ensure that that happened.
On April 26, 1996, shortly before the last general election in British Columbia, Kamloops-North Thompson MLA Fred Jackson and Kamloops MLA Art Charbonneau made another announcement, which it says is on behalf of Health minister Andrew Petter. It goes on to talk about how the city is donating land for the facility to be built. Again, that was over three years ago.
There hasn't been a spade in the ground. I think the minister is perhaps as chagrined as I am about that. As I say, she is the third Health minister since that discussion, counting the one we were talking about at that time.
Well, this week, in question period and in the news, everyone's thrashing around this question of the Vancouver Trade and Convention Centre, which apparently is about to see construction begin and in fact has had some $54 million spent on it without a business plan, without a budget as far as we can tell and without funding being in place. Then we have this situation up in Kamloops, where there's been long and careful planning, announcement after announcement, the budget carefully prepared, I believe, and the business plan in place. It's been studied to death.
In the meantime, of course, we have an appointed health board in that area. That health board has made some grievous mistakes in the past, including what I think may have been the inadvertent firing of the administrator of Royal Inland Hospital, who by all accounts was a tremendously competent administrator and probably should have been the CEO of the Thompson regional health board. But another individual, Mr. Garry Olsen -- whose comments I quoted in the chamber last week -- was appointed by this health board instead, thereby accomplishing the constructive dismissal of Mr. Chapin, which ended up in a half-million-dollar severance judgment against the Thompson regional health board.
Now this Mr. Olsen appears to be riding roughshod over the opinion of the people of Kamloops, who are almost universally opposed to some of his plans. He's had a good offer from St. Ann's Academy, which belongs to the diocese of the Catholic Church next door to Royal Inland Hospital, which wanted to provide land if that was necessary for a parkade or to even build the parkade and lease it to the health board. Mr. Olsen rejected that publicly out of hand and made insulting remarks about the church attempting to make money off the staff and patients of Royal Inland Hospital. This whole situation has degenerated into quite a nasty fight in Kamloops. Subsequent to the minister's commitment last week, Mr. Olsen's been in the media saying: "No, that's wrong. The construction won't proceed until spring of the year 2000." This just seems totally objectionable to me and to the people of Kamloops. We are opposed to him ramrodding his parkade through in the location that he's demanding it should be. There have been strong intimations to the community that if we resist that decision on the parkade, we'll lose the project.
The minister made it clear last week that as far as she is concerned and, I believe, as far as the MLA for Kamloops is concerned -- and certainly myself -- the parkade question can be resolved subsequently. The psychiatric unit should go ahead. There are grievous needs with regard to psychiatric care throughout this province, certainly in our region and certainly in Kamloops. The superintendent of police told me a couple of years ago that he had nowhere to take people with psychiatric treatment needs and sometimes found himself having to keep them in jail because there was nowhere for the police to take them, even though their activities were clearly caused by mental illness rather than necessarily any criminal intent.
Interjection.
K. Krueger: I ask you, hon. Chair, if you might silence the Minister of Energy, Mines and Northern Development, who's not in his place and is heckling me.
Whether or not you'd care to intervene and do that, as I think you should, I'd like the minister to speak to this issue of the Thompson regional health board and its appointed CEO making statements that are contradictory to what she has assured me and the people of Kamloops and this House, and assure us that direction will be given, that construction will begin this summer as she indicated it would and that the parkade question should be resolved as and when it can be, without impeding progress on that facility.
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Hon. P. Priddy: My position is unchanged. The facility will go ahead. I have not seen the recent comments. Although I understand they were in the paper, I haven't had the opportunity to see those. My only concern is that people deal with this parkade. They have approval to go ahead with it, and they'll have to deal with the parking. The facility must go forward. Now, it's still in design. The faster that design is done, the closer it brings us to a construction date. But the design by the people managing the project up there isn't finished yet.
C. Hansen: I want to take us back to last year's budget, particularly the
capital plan that was put in place last year. Specifically, if we look at the amount of
dollars that were allocated for capital projects in health last year -- actually, the
revised numbers for last year's budget
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that over again. The 1998-99 budget estimate for capital spending on health in the province was $222 million. When the revised numbers came in, when the budget was tabled at the end of March of this year, we found that the amount of money actually allocated for health-related capital expenditures in the last fiscal year was only $150 million. So we actually saw a decrease.
We often talk about whether there's enough money in the province to build the kind of facilities that we need. What we had last year was $222 million was set aside in the budget initially, money that the Ministry of Finance said was available for health construction in this province. So it's not a case of a wish list or of saying: "If only there was enough money." These are actual dollars that were put aside in the budget last year -- $222 million. What we find at the end of the year is that they actually underspent that capital budget by $72 million.
On one hand, you might say: "Well, in a time when our books are not in very good shape in this province, perhaps underspending a budget is a good thing." But let's come down two lines in the report that came with the budget this year, and let's look at the B.C. Ferry Corporation last year. The B.C. Ferry Corporation was given a budget of $85 million at the start of the fiscal year last year. When the numbers came in at the end of March of this year, we found that the revised forecast for the last fiscal year was $160 million. So B.C. Ferries overspent their capital budget by $75 million. At the same time, this government allowed spending for health facilities in this province to be underspent by $72 million.
That begs the question of where the priorities are in this province. I would like to ask the minister: in starting out on this section, where was she at the cabinet table when $70-plus million got diverted from health facilities in this province to B.C. Ferries?
Hon. P. Priddy: There are two points to this. My position was to advocate for capital funding for the Ministry of Health, which I did. There are two reasons, generally, that the Ministry of Health does not -- although I think we've cleaned up part of it -- always expend what is forecast. One of them is -- as the member knows, I'm sure -- that in most projects, it's a 60 percent-40 percent split with municipalities and regional health districts. We have had some difficulty over the last couple of years with regional health districts not having their 40 percent ready when the 60 percent from the province is ready -- which, of course, ends up with those dollars not being able to be expended because the region doesn't have them there.
The other thing I would note
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C. Hansen: I don't think the minister has really given us an explanation as to why
capital moneys got diverted in other directions. If they weren't ready to be allocated
last year -- and I want to go through a series of those, where promises were certainly
made and nothing happened
I'll put this in the form of a very specific question to the minister. There is an organization within the Ministry of Finance -- or at least it reports to the Minister of Finance -- the Provincial Advisory Committee on the Procurement of Design and Construction Services. I assume that this is what the minister is referring to. I gather that this is a board that hasn't even met for some time, that its main interest is in setting the capital budget in the first place and that the actual decisions to move ahead with specific capital projects within the Ministry of Health are driven by the Ministry of Health.
I can see the minister shaking her head, so perhaps she can enlighten us as to what happens to this capital budget and why she doesn't have a say on how it's allocated to some of these needed projects around the province.
Hon. P. Priddy: The answer to your question is that within the Ministry of Health, we do do the planning, based on the capital needs submitted by the regions. We take it, and we do the evaluation, with the prioritizing. We take it through the approval process at Treasury Board. Then that responsibility is picked up by the Ministry of Finance, in terms of getting that money out the door, managing the projects and doing the viability studies. The Ministry of Finance does any additional work that needs to be done. I'd like to spend every cent that we have, and I object if we're not able to do that. But once it's approved by Treasury Board, those dollars are expended by the Ministry of Finance.
C. Hansen: Yet I believe it is the public in British Columbia who expect that the Minster of Health is going to be advocating for the kind of health facilities that we need in this province.
Let's go back and talk about some of the hospitals and health facilities in this province that have not been built as a result of the underfunding -- underspending -- of that capital budget last year. Where have we heard that before, when we start talking about which hospital will not be built? Well, these are hospitals that have not been built; these are hospitals that have not been built in spite of commitments that were made many years ago. What I'm going to do off the top is run through a list of these, in the interests of time. Perhaps the minister can respond to them. We can certainly deal with them one at a time, if she wishes to.
I want to go back to January 4, 1996, when there was a commitment made to Creston Valley Hospital to receive money to renovate the treatment and emergency room. The project has still not started. Let's fast-forward to April 20, 1996, which is an interesting date, being in the middle of the last election campaign. Keremeos was to receive a new health facility. There has been no construction started on that facility yet. In the same week -- it was a busy week in the last two weeks of the campaign -- Clearwater, on April 25, was to receive funds for the construction of a new health centre. On the same day, April 25 -- this, I'd just like to remind you, was three days before provincial election day -- the Burquitlam Lions were promised an intermediate care facility that would have a major renovation and expansion. Nothing has happened to date. April 27: St. Bartholomew's Hospital was to be replaced by the new health and healing centre in Lytton. No construction has yet begun. April 29: G.R. Baker Memorial
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Hospital was to receive $850,000 in funding to plan for the expansion and renovation of that facility, and nothing has happened yet.
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Those were all in the days immediately leading up to the call of that election
campaign. So when we start talking about health facilities in this province that have not
been built and yet they were promised and moneys were allocated last year
Just to run through some of the other ones that happened subsequent to the election. We can come through to July 28. Fraser Canyon Hospital was to proceed with emergency department renovations, to be completed in early 1998. Well, here we are in the middle of 1999, and nothing has happened. On October 20, 1997, a new health centre was to be constructed in Alert Bay by the end of 1999. We're getting close. No construction has yet begun. On November 7, 1997, Port Hardy Hospital was to receive two new multilevel beds by the fall of 1997, and no construction has yet begun.
I would like to know, in terms of these commitments that have been made
Hon. P. Priddy: I'm not going to respond -- the member indicated that -- to all the things on the list. I think there are actually a couple of those that are open, but nevertheless, we'll look at the list at another time and get back to the member.
This year in the budget we had a $378 million increase in our capital budget. That increase is there because I lobbied for the capital needs of people in British Columbia. Now, I want every dollar of that expended. If a regional hospital district says to us, "I'm sorry, we don't have our 40 percent now," then it's very hard for that project to go ahead. And never have I had the Finance minister come to me and say: "We want to take health capital money and spend it somewhere else." But if it is underspent -- and it is; you're correct -- I cannot ensure that regional health districts have the dollars to put towards ours. As the member well knows, construction is no longer handled by the Ministry of Health; it is handled by the Ministry of Finance. But a $378 million increase says to me that I have lobbied and advocated on the part of British Columbians -- or you wouldn't see the largest increase in the province's history during my tenure as the Minister of Health.
C. Hansen: Actually, for the information of the minister, the total capital budget for this current fiscal year is $358.9 million. That's not an increase; that's the total amount that's been allocated. Then from that you've got to take away $100 million that this minister has allocated for Y2K projects, which are a one-time thing. They're obviously essential. So when you start talking about health facilities in this province that were promised years ago, that doesn't start the process of addressing that need.
But the issue is not whether or not there are basketfuls of taxpayers' dollars to be poured into health facilities. The question is the priority in the allocation of whatever capital dollars are available and who, in terms of government, is making sure that they're spent on health facilities where they are desperately needed. Certainly if you look at the actual increase in the capital budget from last year, it's actually -- let me see if I can do my math in my head here -- about $130,000-some-odd. If you take the $72 million that was underspent last year, and you take out the $100 million that was allocated to Y2K, what we see in terms of capital dollars available for health facilities is in fact going down in terms of the ability for any new initiatives in this province.
If the minister wants to respond to that before I move on to another subject, I'll give her that opportunity; otherwise, I'll move on.
[1500]
Hon. P. Priddy: I will just do so briefly. The amounts, even in the Y2K funding, by
the way
Your colleague talked about a project today which he's talked about previously. One of the things that sometimes happens is exactly what he described. Somehow, something happens locally -- in this case, a parkade -- where the local people who need the facility can't get agreement on how to move forward. I can't make that happen faster when it's the decision of a city council.
Can we work harder at getting money out the door? I'm absolutely sure that we can. But my job is to get as much money allocated as I can. That's what I have done. We do everything we can, including working very hard with Treasury Board, to get that money through as fast as we can. Quite frankly, we've been able to do that fairly successfully with some of the projects that you just named.
C. Hansen: I want to move to the allocation of federal dollars. In the budget brought down by the federal Finance minister earlier this year -- it was called a health budget -- moneys were allocated to the provinces for increased health spending. But if you look at the budget documents tabled by the Minister of Finance at the end of March of this year, what they show is that the total amount of dollars being transferred from the federal government for health-related matters totals $488 million -- the increase in the CHST funding that came through for health.
I know that the minister and the Premier made comments prior to the start of this legislative session that this year's Health budget would be increased to reflect the increase in transfers from the federal government -- and much more. But in fact, what we see in the budget that's been brought down this year is that Health spending in this province has gone up
[ Page 14174 ]
$478 million over what was budgeted for last year. It was actually only an increase of
about $350 million over what was actually spent last year. But the actual increase in the
Health budget from
I'm wondering what happened to the commitment made by the minister and the Premier that the provincial health budget would increase by considerably more than the transfers from Ottawa.
Hon. P. Priddy: I believe that the figure the member is referring to is indeed the CHST, but that includes health, advanced education and income security. It's not only for health. The commitment was that that amount of money -- and more -- would be spent on health, and that is correct.
C. Hansen: By far, the overwhelming part of that CHST increase is dedicated to health. Certainly I am going to go into the CHST supplement and where that has gone.
One of the provisions that was set out in the federal budget was an allocation of $3.5 billion to the provinces for the CHST supplement. That was funding to be allocated to the provinces over a period of three years. It was allocated on a strictly per-capita basis. British Columbia got its share of that $3.5 billion based on our percentage of the Canadian population. So in British Columbia our share of that $3.5 billion was $471 million, to be spread over a three-year period.
One of the things that the federal government did was leave it to the discretion of the provinces as to how they drew down their particular allocation over that three-year period. In British Columbia this government has chosen to draw down $350 million of that in this first year alone. So all that's left in that three-year allocation of funding, under the CHST supplement, is $121 million to spread over the remaining two years. I would like to ask the minister why it was seen to be fiscally prudent in this province to draw down that fund to the tune of $350 million in year 1, thereby leaving only $121 million for the following two years. Does that not jeopardize the future of health care in this province, once we get through this particular fiscal year?
[1505]
Hon. P. Priddy: I'm sure the member also canvasses the Minister of Finance. But
let's be clear that the money that's drawn down is one-time money. This year, while there
was one-time money and provinces could draw it down any way they wanted over the next
three years -- you're quite correct -- there was absolutely no base increase to the
incremental funding at all. What will happen next year is that
C. Hansen: In fact, I can enlighten the minister even further in terms of how
this ramping up is going to work. What happened in the federal budget is that they
announced that the CHST funding was going to be increased over a five-year period by a
total of $11.5 billion, and $3.5 billion of that was on the CHST supplement. The balance
was $8 billion, which as the minister says, starts to ramp up -- which is a strange word
to use -- as of next year. The $3.5 billion was meant to be a bridge to allow consistency
in funding over a period of five years. If the provincial government was to draw down only
the share that would have allowed for consistency over this five-year period, they would
not have drawn down more than $268 million in this fiscal year. As it ramps up
What this government has done this year, by drawing down $358 million, is that they have in fact shortchanged the following two years, even considering the ramping up that will take place. I would like to ask the minister whether we're going to see a decrease in funding for health care next year in this province or whether we're going to have to find brand-new sources for funding, internal to the British Columbia budget, that allow us to maintain the level of funding for health care that we have this year.
Hon. P. Priddy: No, we are not going to see a decrease in health care funding next year for the Health ministry in British Columbia. Actually, it's the first time I've heard about the five years. And I've checked with my staff, and they haven't heard about a five-year commitment, either.
Interjection.
Hon. P. Priddy: There is a four-year commitment, not five.
But aside from that, the choice to draw down was based on what we saw as the current needs in the province. There's no criteria around this that says it's intended to make sure it's consistent. I suppose we could have drawn down less. We could have less cardiac surgery, less orthopedic surgery, fewer long-term beds, etc. We've been able to keep up but not get ahead, and that need is so great in British Columbia, after four or five years of significant federal clawbacks in transfer payments, that that's what we felt we needed to do this year. No, there will certainly not be a decrease next year in funding for this ministry.
[1510]
C. Hansen: Actually, I find it very surprising that the minister wasn't aware of the basis upon which the CHST dollars will be allocated in the years to come, because those are dollars that are specifically allocated for health care in British Columbia. One of the things that I take great exception to is the way in which this government approaches the funding of health care over the long term. You're not going to protect health care in British Columbia unless you anticipate how we are going to fund health care five years or ten years or 15 years from now. Certainly I think it's a disservice to British Columbians when we only look at it from the point of view of one year and don't give regard to where those dollars are going to come from in the years to come.
What I'd like to ask the minister is: given that there is now going to be
[ Page 14175 ]
Hon. P. Priddy: I think it is important to note that in the four years preceding this budget year, the federal government cut back payments to this province -- from 15.4 percent to 10.8 percent of our health expenditures. We, in turn, did not cut back the health care system. We did not say: "Okay, we can't pick this up; we'll just have to cut back the health care system entirely by 5 percent." We chose not to do that; we chose to pick up the costs. But clearly that did mean that there were pressing needs and other things that have not happened in the province or the system as a result of that.
When the one-time money came in, I don't think we raided the cookie jar at all. We
said: "There has been a 5 percent cut from the federal government over four years. We
clearly have some pressing needs, and we will need to use more this year." But I do
not think that anybody was "raiding the cookie jar," given that
We do look at where money will come from, not only for this year but for next year. We know how much the federal contribution will be in terms of increases, and there will not be a cut to the health care budget.
S. Hawkins: I would like to discuss public health issues with the minister. What I've been hearing -- and certainly what members on this side of the House have been hearing -- is that public health services have suffered in the last few years. Certainly when I meet with public health nurses, I understand that because of the way the services are now funded -- through the Ministry for Children and Families and partly through Health -- the reporting system and the services, as well, are not as ideal as they could be if they were all under the Ministry of Health.
Public health doesn't get the profile that acute care does; it's not a high-profile
issue. But we all know that the services provided under public health are essential to our
constituents, to our patients, to our communities. I understand that population growth has
had quite a dramatic effect on public health services. Certainly immunization, speech,
nutrition, audiology and dental programs
First of all, I want to know from the minister exactly what her ministry funds, as far as public health, to the regional health boards and how she liaises with the Ministry for Children and Families to make sure that public health services are delivered for the need that's out there.
[1515]
Hon. P. Priddy: Can I clarify part of the question? I certainly have the amounts, and I can answer the question about liaison. Did you ask what we fund under public health?
Interjection.
Hon. P. Priddy: I thought you did. I'll just be a second.
If somebody wants to provide me with more as I move along, I will
I would say that over the last two years there has been a total of about an 8.52 percent increase in funding for the regions under public health, if you include Children and Families.
S. Hawkins: Can the minister tell me if the letters of funding for public health have gone out? I understand from some of the regions that they haven't received them yet. If she can give us a commitment to tell us how much each region received for public health, we would appreciate that.
Hon. P. Priddy: To the best of my knowledge, the letters have gone. And I'll get staff back in who can actually tell you the amounts.
S. Hawkins: I understand that about five years ago, perhaps six years ago -- in 1993 or 1994 or somewhere in there -- there was a considerable amount of work done around provincial standards for public health. I know there's a concern in this area, as well, about equitable funding. I know that, but I'm wondering if the minister can tell me if there are provincial standards established for public health services and what the minister is looking at for equitable funding.
I know the funding differs from region to region, just like it does for acute care and for other places. You know, it ranges quite widely per capita between regions. It can go from $30 in one area to $35 or $36 in another. I wonder if the minister can give us an idea if the ministry is looking at this, if there are provincial standards for public health and how the ministry is looking to establish equitable funding for this area.
[1520]
Hon. P. Priddy: Yes, there are standards. Some of those go back to '97, and some of them are recent. But there are provincial standards on environmental health, on community care licensing. We have both standards and targets on immunization -- which is, as I say, partly Children and Families. But it's a particular interest of mine, as people know. We're currently working with Children and Families on outcomes around public health nurses and, again, the SAND -- speech, audiology, nutrition and dental -- program and with MHOs -- medical health officers. The B.C. Centre for Disease Control has its own standards as well.
You asked about dollars. We are currently working with the new assistant deputy
minister -- as of today, to my left here
[ Page 14176 ]
our ministry to actually see about taking these dollars and rolling them into the regional budgets. So at that time we'll be looking at whether there's a way to do more equity.
S. Hawkins: I would be interested if the minister could give a copy of the standards that they've developed and commitments for any further ones that could go to the critic, so that we can have a look at them.
I'm also interested if the minister knows about morale in this sector, because since the reorganization of public health out of the Ministry of Health and into the Ministry for Children and Families, I have been meeting with more and more public health nurses who are concerned about standards and funding and reporting -- who they report to and whether the people that they report to actually understand what they do. I'm wondering if the minister has heard these concerns and if she's heard these concerns from the regional health board or from public health nurses. I'd like her to comment on the morale in that sector right now, because I think it is very low.
I am concerned. I know they're overworked. Again, it's that old home care stuff, because they do provide services in the home, as far as baby wellness visits and stuff like that. There's this really overwhelming feeling of doing more and more with less and less. Again, with the people that they're reporting to not necessarily being public health superiors, they feel that sometimes their message of what they need to get their job done is being lost. So I wonder if the minister has heard that.
Hon. P. Priddy: Yes, I have, both in this portfolio and in my previous one. So that's not an unheard statement to me.
I think that a couple of things have happened. Currently, of course -- with the changes -- public health nurses are working for the regions, which is a change -- aside from the change about who is responsible to Children and Families and who reports to the Ministry of Health, if you will. So both of those changes have been very difficult for a lot of people.
I talk about public health and preventive health a lot, and I talk about how hard it is to get people to focus on that as opposed to acute care. I think that people don't recognize the important work that public health nurses do. I guess that once you get into a multidisciplinary group there's a benefit: it means that more people learn to understand what your work is. But it takes some time for that to happen. Yes, I have heard it. Every time I'm out talking to people, I work to be sure that they understand how much the minister appreciates their work.
[1525]
S. Hawkins: Can the minister tell me how she's asked the regional health boards to
address this morale issue? I know that the nurses I met with have raised this, and I don't
know if they feel that their issues are being heard. This seems to be across the board in
just about all the health care personnel right now. Is the minister so concerned that
she's
Hon. P. Priddy: There are two things. One of them is that one of the strategic objectives in the strategic document is about improving workplace environments. That would certainly fall under that. We do meet regularly, though, with the Public Health Nursing Administrators Council -- the provincial one. Through that council, we do provide feedback to health authorities about information provided to us. But having had you raise it, I will put it on my next agenda with the health authority chairs and CEOs, because I meet regularly with them now. They're fairly informal, so we have some good back-and-forth conversations. I will commit to do that.
S. Hawkins: I thank the minister for taking that initiative on. I raised it last year, but I don't see it getting any better this year. So perhaps if she raises it at her level, it might get some attention at the local level.
I have a question, as well, in the public health area -- and this is another issue I raise every year -- with respect to the AIDS strategy. Every year we have asked for an AIDS strategy. We see the downtown east side as a model of what goes wrong when we don't have a strategy to deal with HIV and AIDS. I know that interministerial initiatives need to take place to deal with something like the downtown east side. I want to know where we are with that and if we do indeed have a provincial AIDS strategy. There was a panel -- which was appointed last year, I believe -- working on that.
If the minister can just give me an overview of where we are there. Then, can she commit to tell us -- or today if she has the numbers -- what the different organizations and regions received for AIDS funding? In my own area, I understand the funding has been cut by 44 percent. So if she could just answer those two questions.
Hon. P. Priddy: One point is that the AIDS strategy is actually out there. That's the document that the AIDS advisory committee is working with -- to advise us on how to make sure that that strategy does move forward. The HIV/AIDS advisory committee, which was struck -- I can't remember now -- about three months ago, has met on at least two or three occasions to move that strategy forward. There is reasonably diverse representation on that committee. The AIDS dollars are currently not regionalized, although the regions have got planning money to plan for AIDS support in their communities.
[1530]
What we've asked each region to do is say: "Here are some planning dollars. Tell
us how you would use dollars and what you need in your community before they're
regionalized." That was a fairly major concern on the part of the AIDS community:
that if the AIDS dollars went out, they would not be diverted somewhere else. That's why
we gave planning dollars: to actually develop a strategy for that. Although this is really
only about
The other point that I would make is that I think the urban development agreement that the Minister of Municipal Affairs has been working on has a good opportunity in the downtown east side to be able to at least bring together -- I mean with federal partners and municipal partners and so on -- all of the organizations providing those kinds of services. There are a myriad of them. I know the member knows that there are a variety of views out there as well. I think that's one of the best opportunities we've had so far to do some of the cross-ministry coordination of that.
The actual health authority dollars for consultation and planning was $120,000 to health authorities -- not to each one,
[ Page 14177 ]
obviously. Each health board had $5,000, and each community health services society
received $7,000. An additional $16,000 was allocated to five lower mainland regional
health boards to facilitate a lower mainland interregional HIV/AIDS plan -- because you
can't, in the lower mainland, only look at the downtown east side. While it certainly is
focused on the downtown east side, if you go to Surrey or anywhere else
I could provide for you -- I'm not sure there's a point to my reading it into the record -- the list of agencies, where they are and how much money they've received in the '99-2000 budget. I can read it into the record, but I'm not sure it's useful.
S. Hawkins: I would appreciate having the list. That's fine; the minister doesn't have to read it into the record.
I wonder how much contact the ministry has with the AIDS centre of excellence -- with
Dr. O'Shaughnessy's group at St. Paul's. I understand that he did a lot of work with the
medical health officer's report that came out about a year ago; I believe it was titled
"Somewhere to Sleep, Something to Eat and Someone Who Gives a Damn." In that
report it was very clear that the Minister of Health can't deal with the AIDS problem in
the province in isolation. It has to be the Attorney General; it has to be Housing; it has
to be Children and Families -- there's a whole myriad of people that should be involved.
It has to be the city of Vancouver; it has to be the health authorities across the
province. We know, certainly from touring in the area and from walking the streets with
the street nurses and aboriginal health nurses and with the police and fire and ambulance
What is the minister doing as far as liaising with these groups that are helping to treat patients down there? I wonder how much of a budget the AIDS advisory committee really has. I believe -- and I could be wrong -- that there was a budget for the AIDS strategy last year. I want to say that it's around $50 million, but I think two-thirds or more of it was for drugs. So I want to know, as far as funding the AIDS strategy, whether the minister could break down how much we're paying and where the money is being spent.
Hon. P. Priddy: As it relates to the Centre for Excellence in HIV/AIDS, not only does the ministry staff work regularly with them but also they are represented on the HIV/AIDS advisory committee. So we know that there's no thought whatsoever that the Ministry of Health could, would or should do it alone; there are far too many people who need to be involved with us. I have spent a fair bit of time working with the mayor of Vancouver, as well, around some of these issues.
[1535]
If you take out the thing that you've mentioned -- the actual cost of drugs -- then there's close to $8,600,000 spent on other parts of the strategy, such as funding organizations that have a piece of the strategy, and $2,400,000 on needle exchange programs.
S. Hawkins: Can the minister tell me what the public policy is behind the needle exchange programs? Is this an increase over what was funded last year? What basis is the ministry using to fund the needle exchange? It seems to me that there have been a lot of concerns, certainly, from community groups down in the lower mainland questioning whether the needle exchange is the way to go, or if there are other models we should be using. So what is the ministry's philosophy? Is it still harm reduction? Where are they going with the needle exchange and the IV drug users?
Hon. P. Priddy: Currently there's $2.5 million in funding for 14 needle exchange programs in communities throughout the province. As you know, there were additional dollars for the downtown east side to do some expansion. We will see from the regions, when the AIDS plans come in, what they have identified -- whether there's a further identified need for needle exchange programs. As you know, you have to locate one somewhere where you've got some connection to primary care and so on. You can't just sort of set it down where people don't have those other kinds of supports around them. But I heard the debate last year at the AIDS conference about whether needle exchanges work or not, and that would not be for me to say. Certainly the people I've talked with here who are the experts in the field believe they do. Is the ministry's position still harm reduction? Yes, it is.
S. Hawkins: I've heard the debate, and it concerns me. I do understand that our HIV rates have stabilized, more or less. It's not because, I understand, we've done anything better; it's basically because we've burnt out that level of people who could get HIV. Everybody who possibly could -- I'm talking about the downtown east side now -- basically has got there. That concerns me because I understand that we still have an epidemic raging in the downtown east side and in the province.
Places like Montreal and Seattle have done a better job at controlling this public health concern. Do we get advice from these places? Montreal had a huge problem about, I would say, six, seven or maybe even ten years ago. They seem to have got theirs under control. I understand that ours is perhaps a little bit different because we do have more access to cocaine and heroin out on the Pacific Rim here than perhaps they do. But Seattle's on the Pacific Rim too. Why don't they have the same raging problem that we do? I think part of it is that they have zero tolerance. I think they have stronger drug enforcement. They put more attention to that.
I've heard the debate on zero tolerance and harm reduction. Harm reduction, to me, says that we will always tolerate a certain level of addiction in our society and that we understand it's going to be there, so let's just decrease the harm. I have a problem sometimes getting over that. I'm wondering if that is the right way to go. There was a debate last year, which is still raging, whether we will allow areas where addicts can come in and shoot up -- like safe places. Certainly there's a debate raging with health care personnel, public health, the IV drug users groups, the police and municipal politicians. I think there are more against than for, if we're keeping score.
[1540]
What are the minister's ideas on this? Are we getting advice from other jurisdictions
that have been through this, who have reduced their rates? For some reason, I don't know
why
[ Page 14178 ]
now to deal with this. But certainly, I think, the AG has to be involved, because a lot of this is drug-related. I just want to know what the minister's thoughts are on this -- with harm reduction versus zero tolerance.
Hon. P. Priddy: I think there were three or four questions in there. So let me
start at
But if zero tolerance for people means that we won't treat anybody unless they're
already clean and sober, then we're not going to treat very many people. So for some
people, what harm reduction means is that you try and find a way to reduce the harm and
have the person move
The only two harm reduction programs we really have are methadone and the needle exchange program. But even if you look at the needle exchange program, that is a harm reduction; surely nobody would suggest that it shouldn't be there. So yes, absolutely zero tolerance as it relates to illegal activities -- to selling, to all of those things which as a country we can be much tougher on, and should be. I think that harm reduction as it relates to my perspective as the minister, in needle exchange programs and methadone programs, is necessary. We do know that with needle exchange and with methadone, it has made a difference in the rate of deaths of people who are certainly at least using heroin.
You asked about linking across the country. Our centre for excellence is actually considered to be the national centre for excellence. But certainly we work with centres across the country; there's no question about that. They very often actually will come to us. Maybe the difference has been the difference between in what cities heroin is used and in what cities cocaine is used. You know, when you get into talking about cocaine, you're talking about people who are injecting 20 times a day. So there are some different dynamics between cities and the kinds of drugs being used.
I mean, there are needle exchanges in the downtown east side. We could talk about the
downtown east side, as well, as we both have. But this is also a problem in Prince George
and in Kamloops and in Surrey and probably in Langley and
S. Hawkins: I appreciate those comments. It's a difficult one to wrap one's mind
around. But part of the problem that we had with the HIV epidemic -- a huge problem, I
think
[1545]
The policing and the immigrant issues that we're dealing with in the lower mainland -- I think those have a lot to contribute to that as well. I really hope that we're coming together with a strategy, a plan, that crosses different ministries, and that it's being given the priority that I think people out there -- people working in those areas and across the province -- want it to be given. Even though we've seen the HIV level stabilize, that doesn't mean that it's actually gone down. It means that we've gotten to a rate where people have basically burnt out. Every addict that could -- and anyone that could -- now has it. That is going to have a huge impact, as the minister knows, on our health care services, on drugs and on treatment -- certainly on the needle exchange program, for which I think the budget has been going up every year.
I just leave the minister with those comments. I know that next year we're going to stand up and ask the same questions again. Hopefully, we'll have some positive outcomes, and the minister can announce next year that things have actually gotten a little better and that there is an AIDS strategic plan -- it's in place, and it's working.
C. Hansen: This is under the heading of public health. I appreciate that we've broadened the latitude of that discussion a bit. The issue I want to raise is one that I appreciate doesn't fall under public health per se, but it certainly flows from the discussion that we've just had. That's the issue of alcohol and drug programs in the province. One of the things that I hear time and time again, both in large cities and in small communities around British Columbia, is that nobody really sees the rationale as to why the alcohol and drug programs are administered by the Ministry for Children and Families and not the Ministry of Health.
My understanding is that there have been some discussions with regard to who is in the best position to administer alcohol and drug programs. I'm wondering if the minister could report on any progress that's been made in that regard.
Hon. P. Priddy: The only specific discussions I'm aware of are the discussions going on with the Vancouver-Richmond health board. I know that the member would not expect me to enter into a debate about whether programs in another minister's portfolio should be in a different place.
C. Hansen: One of the things that I know my colleague touched on a few minutes ago was the liaison between the Ministry of Health and the Ministry for Children and Families. Certainly there are a variety of areas in terms of the funding from the Ministry for Children and Families for public health programs, which are in fact administered by the Ministry of Health or by the regional health authorities. We have examples such as the possibility of the Vancouver-Richmond health board taking over responsibility for alcohol and drug programs in that region on a contract basis with the Ministry for Children and Families.
I'm wondering if the minister could reassure us with regard to the liaison that takes place between the Ministry of Health and the Ministry for Children and Families and how active that liaison is. Too often we see complementary services by different ministries where there isn't really an active liaison taking place. I'm just wondering if the minister could explain to us how that liaison happens in the current environment.
[ Page 14179 ]
Hon. P. Priddy: There are two points. One of them is that there is an ADM policy
committee with the Ministry for Children and Families and the Ministry of Health. I'm not
sure if there are other ministries
C. Hansen: I want to move on to the issue of health research in British Columbia. In the federal budget that came down earlier this year, there was a very significant increase in the allocation of dollars to health research. Perhaps the best way to embark on this is to ask the minister if she feels that we are well positioned to maximize the advantage of this new federal funding to researchers in British Columbia.
[1550]
Hon. P. Priddy: I think we are in a position to use those research dollars. We can all always be in a better position around researchers. People in the province talk to me frequently about the need for more researchers in a particular area and how we can recruit more nephrologists or how we can recruit more researchers who therefore bring with them, obviously, the research dollars or the research projects.
But in terms of the federal money that was announced, I think we are. You have to be in shape not only with cost-matching dollars but sometimes with a facility and the people to do it. I guess one of the examples is the prostate research at Vancouver General Hospital. The best people in the country work there. They will have a first-class physical facility in which to work when the tower is completed. Those are the kinds of things, I think, that help make you prepared to utilize research dollars.
C. Hansen: One of the things that I think we often hear is the government of British Columbia jumping up and down and complaining that we don't get our fair share of the allocation of federal dollars. In the case of health research, my understanding is that federal dollars are allocated through a very empirical -- if that's the right word -- peer review that is motivated by where in Canada they have the best ability to deliver on the health research that is sought. It's certainly not something that's allocated on a political basis or a per-capita basis. If we want to get our share of federal dollars, jumping up and down and complaining about it isn't going to do us any good. I certainly would never accuse this minister of jumping up and down and complaining, but I would accuse some of her colleagues of doing that.
Hon. P. Priddy: We'll pass it on.
C. Hansen: I appreciate the minister's offer to pass that comment along.
But in this case, what we've seen in British Columbia is funding for health research decrease significantly in the last couple of years. As a direct result of that decrease in funding, I believe we have also seen a significant decrease in the amount of health research that is attracted to British Columbia.
If you look at the funding for the B.C. Health Research Foundation, we were at $10 million a year, and decreased to about $4 million last year. My understanding as of a few weeks ago was that they still didn't know what their 1999 fiscal year allocation would be for the Health Research Foundation. I'm wondering if the minister could tell us if that commitment has now been made.
Hon. P. Priddy: The answer to his last question is no, it has not yet been set.
C. Hansen: I want to put into context why this particular issue is so important to British Columbia. The Medical Research Council of Canada allocated about 8.5 percent of its operating grants to British Columbia in the '96-97 fiscal year and 8.2 percent in the '97-98 fiscal year. Again, as I mentioned, these allocations are not based on any political decisions, as I understand it, but are based on the peer review of grant applications that are submitted.
[1555]
One of the real concerns that I've had expressed to me is that British Columbia is diminishing the infrastructure that we have in this province in order to enable us to secure those national grants or those national research programs. If B.C. were to receive 13 percent of the MRC funding, which would be our per-capita share, there would have been an additional $12 million coming into British Columbia from MRC alone. Several people have looked at how that money would be levered in terms of British Columbia. There are all kinds of different formulas that are used, but if you apply the average of these -- which would be about a 5-to-1 leverage of the $12 million -- you would see a benefit to the B.C. economy of about $60 million coming into this province.
The other piece of information that's been given to me -- and this comes from MRC data -- is that they estimate that for every $1 million invested in research, we see 62 direct and indirect jobs created. So if B.C. were to receive its per-capita share of the research dollars nationally, there would be an additional 720 new jobs created in this province as a direct result.
The concern I have is that what we are doing in this province, by eroding the funding base for the Health Research Foundation, is eroding the infrastructure that we have with which to apply for these national grants. I'm wondering if the minister can tell us when the Health Research Foundation can expect to be allocated their budget for the fiscal year, which started over three months ago, and whether or not they can anticipate that there'll be an increase in funding for this coming fiscal year.
Hon. P. Priddy: As to when the BCHRF will have their figure, it will be fairly shortly, but I don't have a date for you. I would say, though, that there are a couple of other factors. I agree with the member that every X amount of dollars does create jobs -- and we could talk about how many jobs. I think we've had a couple of challenges here in British Columbia; they're not easy ones. But given a $1.2 billion cutback from the federal government over four years, people have to make hard choices about whether you put it into patients or into increasing research dollars. People can say: "Oh well, that's not an issue at all." Well, it is an issue if you're faced with needing to increase cardiac surgeries or orthopedic surgeries. I'm sorry, but I think that is indeed the case.
The other thing is that we do support other kinds of research projects here in British Columbia. You talked about the $12 million from the Medical Research Council, but we did
[ Page 14180 ]
just get -- or VGH just got it, not us -- an additional $10 million for VGH alone, in terms of research dollars. I think the infrastructure is not as sound as it was a couple of years ago. I would not disagree with the member on that. I think there's also some discussion going on with medical faculties about the size and capacity of medical faculties to attract world-class researchers. That, I understand, is also one of the challenges here.
C. Hansen: Certainly all provinces faced cuts in terms of federal government transfers for health care over the course of the last five years. Yet other provinces are doing significantly better than we are in terms of health research. If you compare B.C. to Alberta, just as an example, the share of MRC dollars to B.C. went from 12 percent in 1991 down to its current level of 8.2 percent, as I mentioned earlier -- at least as of a year ago.
By contrast, Alberta's share went from just under 10 percent to just under 13 percent, which is obviously significantly higher than their per-capita share. I think that if you start digging and looking at the reasons why, you suddenly realize that in Alberta they're putting funding into health research in the neighbourhood of about $13 per capita, compared to British Columbia, which is less than $2 per capita. So I think in there is some indication of why it is. It's not simply the cutback in federal dollars, but rather that there is that kind of encouragement and support from the provincial government.
[1600]
I'd like to ask the minister specifically why it is that the Health Research Foundation, three months into the fiscal year, does not know what its budget allocation is.
Hon. P. Priddy: There are two things. One of them is that we fund a number of research organizations, not just BCHRF, and we are still trying to decide the allocations amongst those organizations. In terms of the member's comment about Alberta versus British Columbia, I think that's true. Alberta did what British Columbia should have done 20 years ago, which is identify health research not only as an important thing to do from a public policy perspective but also as a growth-driver. They are significantly further ahead than we are in this area, and we need to make strides to catch up. I would not disagree with the member on that.
C. Hansen: I want to move on to communications. One of the issues I raised right at the very start of the Health estimates, a week ago last Monday, was the issue of annual reports. On a couple of occasions since, I've underscored that particular issue because of the fact that the annual report is to be used as an accountability tool in the future if things like the strategic vision document are in fact finalized, incorporated and proceeded with. Right now the most recent annual report that has been made public is for the fiscal year starting April 1, 1996. That was basically the fiscal year that started prior to the last election date, yet no other annual report has been forthcoming from the ministry since then. I would ask the minister: why is it that the ministry is running three years behind in terms of the development or the presentation of its annual reports?
Hon. P. Priddy: I think the outstanding report -- there is only one, which is '97-98 -- will be tabled in the next few days.
C. Hansen: So '97-98 -- '98-99 is also finished. But what I would like to ask for is a commitment from the minister as to when we might expect the '98-99 annual report, not the '97-98 annual report. One of the purposes of an estimates debate in this chamber is to hold the government accountable for how it is spending public moneys. The annual reports are one of the very important tools that the public has to rely on in order to hold the government accountable. I find it unfortunate that that annual report was not made available to us well in advance of the estimates process.
One of the things that I would like to get a commitment from the minister on is not only that we will have the '97-98 annual report tabled in a few weeks, as she says, but also that we will have the following annual report tabled in a very timely manner. I'm wondering when we might be able to expect that. I know the minister has been very careful not to make commitments on specific dates, but this is one issue that I want a specific commitment on.
Hon. P. Priddy: Just in terms of timing for next year's report
[1605]
In terms of timing for the next one, the information from CIHI comes to us at the end
of September, so we won't have any data to work with until September. The hope would be
that the report is
C. Hansen: I will intervene and answer the question for the minister. Certainly we see annual reports made public throughout the year, and it is the obligation of the minister to then table that annual report on the first sitting day following its release publicly.
The other thing that I would like to point out to the minister -- and I have certainly raised this issue in other ministries for which I have had the pleasure of being the opposition critic -- is that we often get too hung up on how pretty our annual reports look. What is important is what's in the annual reports, not what they look like -- or even, in fact, whether they're printed. I think it is a far more useful vehicle for annual reports to be put onto the web site for the ministry, which, I must say, is generally very useful. I would bet that most individuals who make use of the annual report in 1999 would much sooner access it on the web site than they would in their filing cabinet. So rather than even waiting for the printing of an annual report, I would encourage the minister to make sure that it's made publicly available through the web site at the earliest opportunity.
Certainly among the various accountability documents that we've talked about during the course of these estimates -- and I know the minister has talked about many, many different documents that all form accountability -- I see the annual report as being the one that has to knit a lot of this stuff
[ Page 14181 ]
together and at least reference where some of these other accountability documents are lodged. I think it's only with that kind of accountability that the public can be assured that $8 billion worth of taxpayers' money is in fact being spent wisely and with a view to achieving better health care in the province, rather than simply being spent for spending's sake.
When we were dealing with their strategic vision document -- I think it was -- on an earlier occasion, I asked the minister about polling that was done by the ministry. There was reference to regular polling that has been done in the past and, I gather from the strategic vision document, will continue to be done to evaluate the satisfaction of British Columbians with health care delivery in this province. I'm wondering if the minister could outline for us how frequently this kind of polling has been done and what kind of feedback we're getting from the public with regard to their changing satisfaction with regard to the delivery of health care.
Hon. P. Priddy: There have been two polls done in the last year, as it relates to public satisfaction -- which I think is what you asked. Yes or no?
C. Hansen: Generally.
Hon. P. Priddy: Okay. Generally, the last poll we did showed 52 percent of people believing or feeling that we were doing an excellent or good job on health care. Of course, as you know, Angus Reid certainly does its own, and sometimes there are health care questions in that. Sorry; I don't know if there's more to that question.
Interjection.
C. Hansen: It's nice to have an audience in the gallery that appreciates what we're doing here.
The minister mentioned that there were two polls specifically done on public
satisfaction. Could the minister tell us how many
Interjection.
C. Hansen: Sorry; I may have misinterpreted that. Could the minister tell us how
many polls have been commissioned by the ministry over the course of the last
[1610]
There was a poll that I was familiar with, which I believe was done in May of 1998, so I gather that these two polls have been done subsequent to that. Would the minister undertake to make those polls public -- the two polls that have been done by the ministry?
Hon. P. Priddy: Absolutely. Actually, they're in the archives -- B.C. Archives.
C. Hansen: When you say the archives, is it the archives of the ministry, the archives of the provincial government or the provincial library? Perhaps you could clarify that, because it's certainly something that I would be interested in taking a look at.
Hon. P. Priddy: They are publicly available. I don't know if it's actually B.C. Archives -- which it says here -- or the library, but I'll check. But they're public, yes.
C. Hansen: If the minister could advise me with regard to where I could take a look at them, I'd appreciate it.
I want to ask the minister about the number of press conferences that the ministry has held since the start of the calendar year. If you start looking at the number of press releases that have been issued over the course of the last three years, there has been a very significant increase in the number of press releases that have been issued this year. Certainly, when you start looking at what's in them, it's not like there's been any significant increase in the number of announcements that need to be made. Rather, it points to a deliberate strategy on the part of the minister to increase profile and basically to generate more press conferences and press releases. I'm wondering if the minister could explain why we see this dramatic increase in the number of press conferences that are paid for by the ministry.
Hon. P. Priddy: The notes I have don't actually show a dramatic increase in press conferences. There were 20 last year, for a full year. We've had about ten this year; we're in the seventh month of the year.
There is an increase in the number of press releases. I would suggest that the Health ministry certainly gets enough profile, so nobody needs to gain more. But there's a significant increase in a number of activities in the ministry this year, including tobacco, including the increase in the Health budget and including a number of the announcements that I know the member has either seen or been at. So there have been press releases about those -- occasionally in response to something, but generally about something that's going on in the ministry. But in terms of press conferences, there's not a significant difference.
C. Hansen: Certainly it's something we've been tracking, and I would gladly share some of the graphs and stats that I have, which do show a fairly significant increase. Maybe it's a question of definition as to what constitutes "significant."
The other thing that has been pointed out to me is that the nature of the ministry's press conferences has been changed. Rather than using the press theatre here in Victoria, which is a permanent facility, what we typically see is press conferences being staged at a particular facility where elaborate staging, draping and audio equipment are brought in. I'm wondering, at a time when Health dollars can certainly never go far enough, why the ministry sees it as a priority to stage elaborate press conferences rather than use those Health dollars where they could benefit patients in the province.
Hon. P. Priddy: Well, I must admit that I will now start paying attention -- and I think somebody else has -- to whether there are drapes or not at a press conference. But let me talk about location as opposed to whether there's a stage or there are drapes behind it already owned by the government. It's not that somebody does additional purchases for that. But you're quite right; there would be staff resources through the organization that we contract with.
[1615]
The reason for doing it in a facility -- as opposed to the press theatre here -- is
that when you do a press conference around something that's related to people, you want to
actually put some faces on those people. So when we've been at places like the Children's
Hospital, there have been people there
[ Page 14182 ]
experiences were, parents who talked about their experiences, physicians who talked about the difference it made or didn't make or whatever that was -- to the particular announcement. So I actually think that that's just a better way than a couple of politicians standing in a press theatre making an announcement -- if the press can actually talk to the people for whom the announcement will make a difference.
But I'm not sure that lots and lots of talking-heads press conferences are always the best way to go. The most recent one we did was actually very limited. There were only two media there. We did it so the media would have the greatest opportunity to talk to the patients and the physicians, which is what they did -- which is what an announcement should be about.
C. Hansen: Could the minister give us an idea of the number of outside
contractors that are used, typically, for these types of announcements and what a press
conference
Hon. P. Priddy: We don't use independent contractors for those, except for the setup of the facility. We don't use independent contractors to put them on, to organize them, etc. The cost of doing one is about $1,000.
C. Hansen: I want to move on to professional regulation issues. In terms of communications, that's all we have to deal with at this point, although I'm sure it's an issue that's going to get revisited in the weeks and months to come.
Interjection.
C. Hansen: But I gather that the minister wants to add something to that.
Hon. P. Priddy: No, actually.
C. Hansen: The first thing I want to ask the minister is with regard to the initiatives from the RNABC to change the structure, I guess, of the nurses' profession and specifically to bring the nurses under the Health Professions Act. I'm wondering if she could update me as to where we're at with that process.
Hon. P. Priddy: I just wanted to check if there was a different status for RNABC. As I'm sure the member knows, this is being done under the Health Professions Council, looking at whether to bring all professional organizations, if you will, under one umbrella. The indication I've had from the RNABC is that they would be prepared to move forward to do that, as long as all other health professions were.
C. Hansen: I gather from the minister's comments she just made that the Health Professions Council has not actually proceeded yet on this process.
I can see that the minister wants to respond to that. My understanding is that it was underway. But I also want to get an understanding from the minister in terms of the parameters of what they were considering, in particular in the area of scope of practice, when we might see that process move ahead and when it might become perhaps a more public debate than we've seen up till now.
[1620]
Hon. P. Priddy: I'm sorry; I should have given you a bit more detail in the beginning. This review has been going on for some considerable period of time, actually. The legislative review part of it is due to report out at the end of the summer. The scope of practice part of it is probably not due out until well into next year. There have been preliminary reports, though, on scope of practice in a variety of other professions. I don't think there is a preliminary report on scope of practice for nurses yet.
C. Hansen: I actually did want to go to those other professions. I wonder if the minister could tell us where we're at in terms of the changing scope of practice for other professions designated under the Health Professions Act or those other professions that still have their own stand-alone legislation.
Hon. P. Priddy: I can give you a copy, if you like, but I can briefly tell you
For chiropractic, there is a report. The hearing actually should have taken place by now, according to this date. For podiatry, the draft preliminary report was circulated some time ago, and the hearing is set. For physical therapy, there is a draft report, and their hearing was -- according to this -- last month. Massage therapy has a draft preliminary report, and they've had their hearing. Pharmacy has a draft preliminary report that's being prepared. I think it has not been released yet, so their hearing is a ways off. For dental technology, there was a preliminary report, and their hearing is set. That's it.
C. Hansen: Could the minister outline for us any initiatives that may be underway with regard to the changing scope of practice for opticians or optometrists in British Columbia?
[1625]
Hon. P. Priddy: With regard to opticians, I don't know -- because their scope of practice was actually set quite recently -- whether there would be any change to that, because it's quite new.
In terms of optometrists, I actually can't do it for any of those, because they're only
preliminary reports. There hasn't been a hearing with the council, so it's difficult to
[ Page 14183 ]
C. Hansen: With regard to the preliminary reports that are being circulated at this time, could the minister give us a general time line? I'm not looking for a specific time line for each and every profession that she outlined. But generally speaking, what kind of time line is anticipated before these particular reports are finalized?
Hon. P. Priddy: I don't think there will be anything in terms of a consolidated report much before next summer. They're not being done as one-offs; they're being done all together. So what I'll get is a final report from all of those. It won't be: "Here's the recommendation for optometrists, and next month we'll do nurses, etc." I won't expect to see much before summer.
C. Hansen: Could the minister tell us what opportunities exist for public input into the discussion? Certainly the drafts are being circulated, I understand, to the various professional groups -- colleges, etc. I just wonder if there is a formalized process or a deliberate process whereby the public could have an opportunity for input.
Hon. P. Priddy: There are at least two opportunities, if not three. A much smaller one is, of course, that there are public representatives on each of their college boards, if you will. Secondly, those hearing dates that I mentioned to you are all public hearings, and anybody might be there. As well, it's on their web sites.
C. Hansen: As the last area that I want to canvass under this particular section before we subsequently go on to information management, I want to raise the issue of baccalaureate degrees for nurses, which we raised briefly the other day under the context of training spaces in colleges. At that time, the minister indicated that that wasn't the best time to raise the issue of whether the requirement for baccalaureate degrees, as a requirement, was desirable. The Nursing Education Council of British Columbia has agreed unanimously that all new nursing graduates should have baccalaureate degrees. I'm wondering if the minister has taken a position with regard to that issue.
Hon. P. Priddy: No, I have not taken a position.
C. Hansen: I gather, then, from the minister's response that it is something that is being considered by the ministry, that it's not something that has been rejected. I'm just wondering if the minister could tell us when we might expect the minister to be making her views known as to whether or not this is desirable or otherwise.
Hon. P. Priddy: I think part of that will depend on the report about our future needs from the recruitment and retention committee, from the BCNU. Currently what we have is a mix. I think what we're going to need for some period of time is a mix of diploma programs, bridging programs for LPNs, BNSC programs, etc. So part of that will depend on the work of the recruitment and retention committee, but at this stage I don't envision taking a position. I think that at this stage and for some time to come, we are going to need both diploma and degree programs.
[1630]
C. Hansen: I want to quote from a Georgia Straight article that I referenced before, when we had an earlier discussion on a related topic. It's from the June 3 issue of Georgia Straight. There's actually a reference in here to the RNABC. Actually, I'm not sure that this is an accurate portrayal of the RNABC's position, but I'll read the quote anyway, because I'd like the minister to respond to it. The Registered Nurses Association of B.C., which is the profession's regulatory body, has stated that the most important issue is "competencies as opposed to credentials." I'm just wondering if the minister could comment on that in terms of how we might evaluate competencies. I guess the issue that particularly comes up is the new licensure examination in Canada, which is to be offered as of June in the year 2000. I'm wondering where the ministry is in terms of incorporating that particular licence next year.
Hon. P. Priddy: I'll comment very briefly, but this is really an issue for the RNABC and not for the Health ministry. I think that across government or across the public we see all kinds of examples -- which, by the way, I do support -- of what people call PBL, or prior-based learning. There's a whole variety of terms that are used to do that. In point of fact, when people move from a diploma program and have served hospital duty and move into a degree program, there is competency-based training. People are given credit for that kind of work and experience. So I think that part already happens.
We certainly have no difficulty with the RNABC doing competency assessments. I think everybody would want to make sure that the bar is at a reasonable level for people. I do know -- it would not be for us to administer -- that the RNABC is participating across the country with people in developing a national exam as opposed to provincial exams, I guess. I think that many other professions have moved to Canadian board exams as opposed to provincial exams. I know that the RNABC is working with other provinces on developing that.
C. Hansen: I want to move on to information technologies, or information
management. Specifically, there are several issues that I want to canvass in this area. I
want to start by going back to last July 16 in Health estimates, when my colleague from
Okanagan West was asking about computerization. Specifically, my colleague asked:
"What is the plan, then, for computerization throughout the regions and then
connecting them to the ministry, so the ministry has the information it needs?" The
minister's response at that time was: "The computerization will be done through
HealthNet. Through HealthNet, the regions will be able to link up
It's now a year later, and I'm wondering if the minister can give us an update on where we're at with HealthNet.
[1635]
Hon. P. Priddy: All of the health authorities are on HealthNet and therefore have regular communication with the ministry. If you like, I could just give you a couple of points on those key functions that would fall within the larger information management, which are either complete or in progress -- most of which are completed.
Telecommunications infrastructure is installed in all pharmacies, hospitals and regions. Secure electronic mail service is available to all health providers that require it. Improved monthly reporting capabilities for acute-care facilities to report to the ministry are partially installed. Actually, I think that work is almost done. There's a completed pilot project to
[ Page 14184 ]
allow hospital emergency departments access to PharmaNet's patients medication profile
information
We have working groups set up to allow input from health authorities, medical practitioners and health industry software support organizations on how we're proceeding. There's a pilot project underway to integrate the B.C. Cancer Agency's systems with PharmaNet, which would provide improved patient services and improved cost control for oncology medications. Then there are a number of others that are in the planning stages.
C. Hansen: I gather from the minister's comments that she sees PharmaNet as an integral part of HealthNet in the province. I guess I had, perhaps mistakenly, seen them as two independent initiatives which obviously have to be linked together. Certainly I share the minister's comments with regard to PharmaNet, and I've heard good things about it. I do have some specific questions about PharmaNet, but I want to deal with the broader HealthNet question first of all. Where does the minister see the HealthNet system going from here? How far along are we in terms of getting it up and running to the extent that was originally envisioned? What kinds of changes and dynamics do we see to that in the years to come?
Hon. P. Priddy: In terms of sort of future directions, if you will, PharmaNet is a stand-alone piece in one way, but we do see it as part of that HealthNet -- that information management. We don't see those as two totally distinct entities, but certainly they provide a very different function.
But in terms of where we would see it going, eventually we would see this being available to health practitioners, not just to hospitals. In point of fact, we do have a pilot project around PharmaNet, where we're going to pilot PharmaNet in individual physicians' offices. As it relates to PharmaNet or to HealthNet, we see this as being available, where it's appropriate, to providers in the system.
C. Hansen: I want to share with the minister some comments that have been made to me and ask her to respond to them. Generally, the point has been made that in terms of information technologies, as opposed to our technologies surrounding equipment in the province, health care in Canada -- not just in British Columbia, but Canada -- is really far behind other industries when it comes to using information sciences as tools for effective and efficient communication, feedback, data collection, and the whole subject that's so important to us these days in health care: health outcomes.
We are significantly behind other industries when it comes to incorporating those technologies. At the same time, there is a concern that in terms of the initiatives that are coming from the Ministry of Health, we may not be moving fast enough in terms of the changing technologies that are available today. We may in fact be going down a path in terms of information technologies which we have already eclipsed in terms of what's available to us through Internet technologies as opposed to others that may have been available several years ago. I'm just wondering if the minister could comment on that and give us some sense of how flexible and how state-of-the-art the work is that is being done by the ministry today.
[1640]
Hon. P. Priddy: My staff tell me that in terms of what we're doing in HealthNet, it is state of the art as it relates to health care in Canada. But the member would also be correct in suggesting that the health care profession -- some people use industry; I'm always looking for a better word than that -- is significantly behind other industries. I don't know, if you looked at that across the spectrum, whether that would apply to all human services or not, which have been getting into technology much later than perhaps others.
Yes, that is correct across the country. But I'm told that our HealthNet, as it relates to health systems in the country, is state of the art.
C. Hansen: I indicated a moment ago that I had a specific question regarding PharmaNet. I accept the minister's comments that there is some excellent work being done around PharmaNet. Also, I think that a lot of credit is due to our outgoing freedom-of-information commissioner, David Flaherty, in terms of the work he's done in establishing privacy protocols to ensure that patient records are properly protected when we start building these kinds of databases.
Given that those kinds of protocols are in place, that patient records are protected and that confidentiality issues have been addressed, could the minister advise us as to whether or not there may be greater use of PharmaNet made in the future with regard to those that are doing research in terms of health outcomes in British Columbia? My understanding is that PharmaNet is seen as an incredible tool that could greatly assist us in designing cost-effective and meaningful change in terms of health care in the future, ensuring that we do have the positive outcomes that we're seeking. Yet as it currently stands, even though the protocols are in place for privacy, there still is very limited access to that data by those who are doing research in this field.
Hon. P. Priddy: I know that there are actually discussions going on with the research people and with the ADM who is in charge of Pharmacare, but who is not currently here. So there are discussions going on with both researchers and others from other research backgrounds, to look at that. Those discussions are current. We would do, I think, what you would expect. We would not go beyond, obviously, the boundaries of the comfort level of the current FOI commissioner.
[T. Stevenson in the chair.]
C. Hansen: Generally speaking, with regard to the computer work that's done by the Ministry of Health, could the minister give us some overview as to how much of the work gets done in-house and how much of the work gets contracted out to individuals who are not actually in the employ of the ministry?
[1645]
Hon. P. Priddy: If you take out capital projects -- which I think the member would want me to sort of subtract, if you will, from that -- out of $60 million, $2.2 million is spent on contractors.
[ Page 14185 ]
C. Hansen: So the $60 million is the budget, basically, for computer work that is done by the ministry, not including capital expenditures. Have I got that right? I just want to get some clarification.
Hon. P. Priddy: I think the answer is yes, you understood it correctly. The total operating budget for information management is $67.4 million, but if you take off the capital projects, it's just under $60 million. So out of that, the rest is all operating dollars for information management. The staff salaries are at about $10.5 million, and, as I say, $2.2 million on top of that is for contractors.
C. Hansen: Y2K is something I want to touch on in a minute. But does this include work that's being done under Y2K?
Hon. P. Priddy: Yes, some of this is. Some of the total is Y2K. It's $7.4 million, and some of those dollars would be contracted out as well. The $2.2 million on contractors I referred to is a fairly ongoing kind of amount. The Y2K, which is obviously a specific initiative, is $7.4 million.
C. Hansen: Is any of the contract work being done outside of Canada?
Hon. P. Priddy: I understand there was a small amount that was spent offshore, but our contract was with a Canadian company. They subcontracted offshore. I think it was about $200,000.
C. Hansen: I want to move to the HSCIS system -- the health sector compensation information system -- which I understand was set up several years ago to track compensation rates with various health providers around British Columbia that receive funding from the provincial government. My understanding is that while it started out as a great idea, it has really not become a very reliable tool today, because the reporting that is done by health facilities around the province has fallen off in the last couple of years. I'm wondering if that's an issue that the ministry is addressing and what actions are being taken to ensure that this is a reliable and useful tool for providing information on compensation rates around the province.
[1650]
Hon. P. Priddy: I think others have acknowledged the same points that the member
has raised. There is a steering committee with HEABC and the ministry. They've
commissioned an external review. I think it's an external review of the system to try and
look at where
C. Hansen: Is there a commitment on the part of the minister to make sure that this system is functioning as it was intended to function? When can we expect that review to be completed and, in fact, the HSCIS system to be up and operating and providing the useful data that it was intended to provide?
Hon. P. Priddy: You do have my assurance that at least the functions that this
system is supposed to produce or provide
C. Hansen: I want to move on to Y2K issues. Certainly several months ago I was publicly very complimentary about the work that the ministry had done about Y2K, and I haven't had reason to change my mind on that, because I recognize that the work that's been done by the ministry is certainly well ahead of the work that has been done by other provinces. What I do have concern about is the pace at which we are dealing with the funding for the projects that must be undertaken in order to capitalize on the very good work that was done by the ministry up until now. Now that we've identified pieces of equipment and software that are potentially threatened, we are very slow on providing the dollars to ensure that the health authorities and health facilities around the province are able to deal with those realities.
As an example, there's the $100 million that was allocated in this year's budget for capital projects relating to Y2K. The press release only went out on June 11, advising that the $100 million was in fact ready to be allocated. The funding letters that went out agreeing to commitments for Y2K were certainly very slow in coming. Now, as I understand it, a lot of these health facilities are really going to be under the gun in order to make the changes that they feel are necessary, because of the delay in the allocation of funding. I'm wondering if the minister could explain to the House why it took until only a month ago to give funding commitments to the facilities that now have less than six months to put in place the changes that they need to do.
[1655]
Hon. P. Priddy: Although I think the first 50 percent of the money will be in
people's hands by, I think, July 16, this is not
We did have to do an assessment about what kind of money people needed and in which kinds of areas. We had them identify that. But they've known the money was coming. A lot of the work was done last year. They certainly haven't not worked because, between the fiscal year and now, they didn't have a cheque in their hands.
So can we always be faster? Sure we can, but we've not had an indication from any health authority that this is going to prevent them from meeting their deadlines.
C. Hansen: The other issue that is being faced, I think, with those that are struggling to meet Y2K compliance is the rapidly escalating cost of the work that has to be done. The closer we get to that deadline in December, the higher the consulting fees and everything else that comes along with it.
[ Page 14186 ]
I had mentioned the other day, when we were dealing with some of the concerns raised in the press release by the Health Association of B.C., that I would deal with the Y2K concern at this time. I'll read you specifically the area of concern as it was outlined by the Health Association.
"Funding for Y2K was not outlined in the budget letters but was subsequently sent to health authorities under separate cover. Funding is provided only for capital costs -- operating costs, as defined by the ministry, will not be funded. This means costs related to data conversion, software and hardware installation and testing must be covered by the health authorities. Exclusion of operating costs is a serious concern, as health authorities must now divert funds from other services to meet Y2K costs."
I'm wondering if the minister could explain why those kinds of operating costs, those transition costs, would not have been included in the Y2K funding that would be designated from the ministry.
Hon. P. Priddy: The member is correct. The dollars are for capital purchases, and the health authorities have always known that. They've known that from the beginning. They did have fairly good operating cost increases in general this year. I mean, with any other piece of equipment that may be funded -- capital funding that might be funded by the ministry for another piece of equipment -- the health regions assume the responsibility of installing the software or doing the testing, etc. I believe that they will be able to do it in this case.
C. Hansen: But I think the issue is that the dollars -- they're required to do that as part of Y2K compliance -- have to come out of their existing budgets. They have to find that money somewhere. It's not like they're going to have a budget allocation from years gone by for Y2K compliance. This is a one-time deal. Clearly the understanding was that the ministry, in allocating funds specifically for Y2K compliance, was going to deal with all of these issues and not expect the various health authorities to have to dip into their existing budgets to find ways to implement the changes that have to be made. If the minister wants to respond to that, I'll give her an opportunity.
Otherwise I'll go on to the Medical Services Plan. Specifically, under the area of the Medical Services Plan, I want to start with the work plan that was put forward for 1997-99. The version that was provided to me from the ministry was the revised version as of May of 1998, which I assume is the most recent one. Certainly it was the one that was sent to me only recently.
[1700]
I want to deal with a couple of specific issues in this area. Under the area "Priorities," they talk about the need to support the Medical Services Commission in the management of physician supply and distribution. We now have many bodies involved with the issue of physician supply. I'm wondering if the minister could explain to us where the Medical Services Commission and this particular branch of her ministry fit into that overall picture.
Hon. P. Priddy: The Medical Services Commission actually has significant powers and has responsibility for managing, if you will, MSP. I have a little bit of information here. I'll just refer to it if that's satisfactory to you, only because I think it describes quite well the answer to the question you've asked.
The Medical Services Commission is charged with managing a program on behalf of the government, but the ministry is responsible for operating that program. So they manage the program, and the ministry operates the program. The Medical Services Commission -- the MSC -- makes policy with respect to MSP, but that policy is implemented by the employees of the plan, which functions as a program of the Ministry of Health. The Medical Services Commission's powers and responsibilities are actually laid out in section 5 of the Medicare Protection Act, so they are in legislation. They include responsibilities such as determining which services or benefits, whether a person is a medical practitioner or not, and licensing diagnostic facilities. That may be enough.
C. Hansen: My intention was to deal with some of the issues around the work plan and the workings of the Medical Services Commission and then go into some specific issues, one of which my colleague from North Vancouver-Seymour wishes to raise. I just learned that he has a meeting he has to slip out to, so if we don't mind interrupting this particular discussion, I'll defer to my colleague, and he can deal with that particular issue.
D. Jarvis: I'd like to ask a question to the minister with regards to prostate
cancer -- which we have discussed before, over the last year or so -- and the present
awareness about where prostate cancer is, knowing that most men don't want to talk about
it. There are very few advocates out there, except for lately, when it hit the papers with
Mr. Pattison's donation. My first question is: could you tell me
Hon. P. Priddy: That was never a commitment or an understanding. The part that we had to play in that was the completion of the tower, which we needed to complete anyway. But in order that there be a facility, there was never a commitment to cost-match dollars.
[1705]
D. Jarvis: With regards to prostate cancer, the Canadian Medical Association is
stating that there should be a yearly examination for all men 40 and above, but digital
only. It's only when there's the possibility of an abnormality occurring that they should
go into further testing, such as the PSA. The PSA test, as you are aware, is still costing
As you know, we talked
Perhaps we could even go into the fact that it may be an inequity, as far as women go, because women have their
[ Page 14187 ]
mammograms paid for. Why shouldn't men be -- especially from 40 to 70, which the CMA
says are those dangerous years
Hon. P. Priddy: I guess we're doing this for the record, because I know that the member and I have had this discussion on a number of occasions. I can't remember how many prostate cancer tests we did last year. Prostate cancer testing is available if your physician refers you and recommends it. In that case, if you're referred, it's covered. If your physician says, "This is somebody who I think may have a risk or should be tested," then you are tested.
The difference between women having mammograms that are covered and PSA not being a
universal screening tool is based partly on the evidence and partly on the recommendation
of the people who are the authorities in the field. The B.C. Cancer Agency and physicians
who deal with breast cancer have recommended it universally as a screening tool. That is
not the case with PSA testing; the B.C. Cancer Agency has not recommended it as a general
screening tool. It certainly supports its use with physician referrals but has not
recommended it as a general screening tool. In point of fact, they actually have suggested
that perhaps that ought not to happen; that is their belief around it. Nor have the
urologists, including some of the people that I know the member knows, like Larry
Goldenberg
So based on the fact that the experts in the field recommend mammography as a general screening tool for women, it is covered. If more evidence becomes available, and the urologists and cancer specialists out there recommend it, then we would look at doing it.
D. Jarvis: Well, I think the minister's got to concur that any way we could detect cancer early should be primary. The evidence out there is such that PSA testing versus digital is a much better way of processing it.
The last time I talked to Goldenberg and Gleave -- unless I misinterpreted them -- they were in favour of PSA testing for those people that are in the more dangerous years of their life. I think they were talking about somewhere around 50 -- anyone above 50. So for the life of me, I can't understand why the minister -- even if there was a better way of testing cancer -- wouldn't take that opportunity to use it. It's just as simple as that.
[1710]
Hon. P. Priddy: I'm not sure I have much to add to that. I will check back, in
terms of my conversations with the urologists involved, and see if that position has
changed since I talked with them. But any of the recommendations we've had to the ministry
are not to not use it. I would think many family physicians of men who are 50 or over
standardly recommend them as somehow at risk or whatever, and a PSA is done. But as a
generalized screening for anyone, there has not been
D. Jarvis: Just one more question -- and/or statement, at the same time. I
wonder how the minister would interpret it if I hadn't insisted myself on doing the PSA.
The general awareness for that test is not out there; we know that. Men are reluctant to
talk about it, so they don't talk about it. There aren't those advocates out there
suggesting that every man should go out and have it. It's slowly coming to the forefront.
But what if I had not gone and had the PSA test? The odds are that it would have spread
into my bones and all the rest of it. The game would be over in a few years. So, you know,
just on that point alone, do you not think it would be wise for men 50 years of age or
over to have automatic testing when they go for their annual checkup, like the
So okay. Well, the minister doesn't agree with me, so there we have it.
Hon. P. Priddy: I'm not disagreeing. I'm saying that we can't.
C. Hansen: I want to come back to the Medical Services Plan work plan. One of the references here under "Priorities" is to work with UBC and the Council of University Transfer Hospitals to develop an academic medical centre. I wonder if the minister could enlighten us on where that particular project is at and what that may lead to.
Hon. P. Priddy: As identified as a priority in the work plan, we have been
[1715]
The university wanted to know what we could do -- what we could all do, actually -- to develop a stronger academic component for a medical centre that would be more attractive. At this stage we are simply in discussion with them. But that is its purpose: to strengthen the academic part of that in order to better recruit experts, if you will, to come to the west coast.
C. Hansen: There is a line in this work plan that sort of jumped out at me. The
reason I was surprised to read it there is that one of the concerns I've had over the last
year is watching the division that has seemingly grown between the government and the B.C.
Medical Association. I know that in January the minister was quoted in the press as making
a comment that she wanted to work towards a better working relationship with doctors in
the province, although I don't think we've necessarily seen the results of that
initiative. But I was quite surprised, in reading the Medical Services Plan work plan, to
read this sentence; it's under "Challenges." It says: "Developing and
implementing policies and programs in an environment of conflict between the BCMA and
government
[ Page 14188 ]
[W. Hartley in the chair.]
Hon. P. Priddy: If you have something that says it's in it, I don't disagree with you. I haven't seen it, that's all. I'm absolutely sure that you have it; I just haven't seen it. I mean, I would suggest that although it has been much better lately -- and I would say that to the member -- it has not been, and I don't think it has ever been, a particularly easy relationship. It certainly has not been over the last couple of years, where I think we on both sides have not made enough efforts to work together.
One of the things that I said earlier -- it may have been in January; or I don't remember when -- is that we had some need to drop the rhetoric that we were using on both sides. I think that we have both done that, primarily since then. I don't think you'll find very many quotes from me -- you might, but I don't think many -- critical of physicians. I'm trying to be much more moderate, I guess, in any comments that I make. But we've still got lots of challenges; there's no question.
I have made contact with the new president of the BCMA, and we'll be meeting as soon as estimates are over and before the House adjourns. I've asked for him and me to look at ways that we can work together to get some kinds of successes, because there are areas in which I assume we will not find agreement -- I shouldn't assume, but I think it is unlikely. But there have to be areas of commonality as well. I think we've been unable, because of the issues on which we disagree, to find the areas in which we do agree, to take those areas forward in working together.
People are still at the table. I mean, people haven't broken off negotiations; I consider that to be at least a positive sign. We're making every effort in our consultation on particular issues to make sure -- and we always have, actually -- that there are BCMA representatives at the table. I've got a list here of about 20 committees -- some are new -- on which we've made sure that there's BCMA representation. So, you know, there are areas that are still really big challenges, but they're areas in which I, at least, as the minister am saying and asking my staff to say that these are areas in which we can work together, so let's not exclude those because of the others.
C. Hansen: I guess that leads me into the next question I have, and that's with regard to the status of comanagement in British Columbia. Certainly when the agreement was signed with the BCMA -- I guess it's now three years ago, if my memory is right -- there was great optimism that this was going to be a new model that was going to allow for that kind of renewed spirit of cooperation in terms of the comanagement of the Medical Services Plan and the Medical Services Commission in British Columbia. Certainly I think it hasn't unfolded to meet the expectations of those that were so optimistic at that time. I'm wondering if the minister could tell us what she sees as the status of comanagement as of today.
[1720]
Hon. P. Priddy: The first agreement around comanagement was actually signed in '93, and it was important enough that it was written into legislation. The Medical Services Commission is comanagement. There are three BCMA representatives on the Medical Services Commission. In terms of the committees I referenced earlier, which I have a list of, many of those are about comanaging or at least partnering in managing the system.
C. Hansen: One of the groups that does not feel that they're represented at the table in terms of the Medical Services Commission is probably the group that has the most at stake, and that's the public. When the meetings of the Medical Services Commission took place earlier this year, there was a strong lobby for those meetings to be held in public, so that there is some transparency in the deliberations of the Medical Services Commission.
I'm wondering if the minister could tell us why meetings and deliberations of the Medical Services Commission are done in secret, without any opportunity for the public to at least watch and understand the reasoning behind some of the decisions that come out.
Hon. P. Priddy: Two things. One of them is, just to put it on the record, that there are two public representatives -- three, actually -- on the Medical Services Commission. I know that you know that. The advice that we have from the Attorney General -- and we sought this advice quite early on -- is that there is no reason to, and we don't actually have a right to, hold those meetings "in secret" or "in private." The BCMA has often requested that those meetings be in private because of particularly sensitive issues being dealt with. I don't know if people were turned away the last time or not. If that's the case, I will follow up. If there's room and 20 people show up from the public, they're welcome to sit and watch.
C. Hansen: In other words, the meetings are at least open to the public, for the public to observe. My understanding earlier in the year was that the group was given the opportunity to make a statement and then was basically kicked out of the room while the rest of the deliberations took place. Certainly this is an area that is of grave concern, I think, to the public in terms of how their health dollars are allocated. I think perhaps there is an opportunity for much greater transparency than we see today. I'm wondering if the minister is in fact saying that the public is, from here on, welcome to at least sit and observe and listen to the deliberations.
Hon. P. Priddy: I think my answer would be a qualified yes. I think that was a negotiation submission that was being presented or discussed that day. So there may be circumstances, as there are with public school boards and municipal councils and so on -- although they should be as few as possible -- where indeed things do need to be discussed in a non-public way. Maybe the negotiations were one of them; I don't know that. Then maybe that needs to happen, but in general, yes.
[1725]
C. Hansen: I want to move on to the announcement that was made just a couple of weeks ago with regard to alternative treatments in British Columbia and the full range of Chinese medicine therapies that were introduced, or at least brought within the parameters of, I guess, the Health Authorities Act -- maybe I'm mistaken on the specifics of that. At the time, the Premier made a comment that traditional Chinese medicine therapies are important health options that could eventually be covered by medicare. I know that the minister expressed a very different point of view at the time. I'm just wondering, for the record, if the minister could clarify what in fact is the government's policy in that regard.
Hon. P. Priddy: The government's policy at this time is that they're not covered.
[ Page 14189 ]
C. Hansen: I want to move on to administrative issues regarding the Medical Services Plan. There was a great concern earlier with regard to the backlog in processing new registrants in the Medical Services Plan. I'm just wondering if that backlog has now been dealt with. I still hear stories of people who are extremely frustrated in terms of trying to contact the ministry to ensure that they are registered. I understand that we're no longer closing off telephone lines for correspondence days, but I'm wondering if, in fact, backlog has been effectively dealt with.
Hon. P. Priddy: You're quite correct. It is no longer closed for correspondence days. The backlog at the time this issue came up was about 100,000. We put additional staff on and have tried to move through this as quickly as possible. The current turnaround time is now about three weeks. There are about 30,000 -- just because we get so much. But we're down from 100,000 to 30,000, and a three-week turnaround.
C. Hansen: One of the questions that was asked of me was why the Medical Services Plan does not allow for premiums to be paid through automatic account deductions. Either it's a deduction off a cheque, or for those who pay their own premiums, they have to physically cut a cheque and mail it in. I'm wondering why we haven't looked at any of those payment vehicles that have become increasingly popular in the province.
Hon. P. Priddy: There is one bank where you can now do that. We're in negotiations with the other banks to provide that service.
C. Hansen: A couple of weeks ago there was a program -- part of BCTV's 6 o'clock news -- talking about the cheques that were made out to physiotherapists with regard to their MSP-covered portion. We've wound up with this absolutely ludicrous situation where boxes of cheques, in the amounts of $5 or $6, arrive on the doorsteps of physiotherapists around the province. I certainly understand the history as to how we got to that, but now that we've got to that point, is some common sense going to prevail to ensure that (1) we're not adding to the cost in terms of the amount of cheques that we're running out of the ministry offices and (2) we provide those physiotherapists with a more convenient way of receiving their payments?
Hon. P. Priddy: On the surface, I recognize that it looks like something that could be done better. I'm not sure what the better way is, but we do have people in the ministry looking at a different system. There are some legislative implications to it as well, so it's not as easy as just a different system. But there are people in the ministry who currently have that as their task to look at.
[1730]
C. Hansen: I have one issue to raise with regard to rural doctors, and then I want to turn it over to my colleague from Okanagan-Vernon.
When the Dobbin report was released last June, the minister made a commitment that all of the recommendations of Lucy Dobbin were going to be implemented. Yet here we are a little over a year later, and there are two key recommendations that in my view have not been effectively dealt with. One is a recommendation that pertains to support for doctors working in centres with diagnostic and treatment clinics, and the other is a very specific recommendation with regard to on-call services for specialists working in rural communities.
In there, she didn't have any particular answers. But her recommendation was that the ministry should be working with the health authorities to ensure that those issues were addressed. Lucy Dobbin, I think, rightly recognized that these were issues that were still powder kegs. My concern, generally, is that I think Lucy Dobbin is to be praised for the work that she did in a very short time to address a very critical issue that we had in remote communities in British Columbia. Her recommendations dealt with the short-term problems. I don't believe that anybody thought that this was going to be a long-term fix and that there would be continued discussions to deal with the issues that doctors in remote rural communities were going to be faced with. I'm wondering if the minister could explain to us why those two recommendations have not been fully implemented one year later.
Hon. P. Priddy: Two things. One of them is that I think the resolutions have been far more difficult than people anticipated. The fact that we've done all but two certainly indicates our commitment to do that. There are discussions ongoing. We have a rural and remote health committee on which there's a variety of people represented -- municipalities, physicians, etc. It is trying to deal with diagnostics and treatment. But I must admit that we are not a lot further along in that particular area.
As it relates to specialists, I think that the way it's been interpreted in the field and what Lucy Dobbin intended -- in my understanding -- are not quite the same thing. The issue is: when is a general practitioner a specialist? And are they a general practitioner and a specialist at the same time? If they are on call, and they are a general practitioner and a specialist, do they get double on-call dollars for being on call, because they are a GP who happens to have a specialty? So when they're on call, do you double their on-call pay? One of the issues that's been brought forward with me is that that should be doubled -- or whatever it was -- for specialists.
Those discussions are still ongoing. I'd like to have a solution to them. As it turns out, we do not. We will keep working.
I'm not sure that people would say that it was not a long-term fix, in general. I've
had letters from mayors saying how pleased they are to be able to have Dobbin in place. It
has met their short-term needs; they expect it to meet their long-term needs. I have one
here, which I haven't seen before, from
The two recommendations you've raised are not resolved. We will continue to work at them, but I don't currently have solutions.
[1735]
A. Sanders: Just for the information of the minister, this member will be finishing the discussion of the Health estimates over the next few hours. What I'd like to spend a period of time talking about now is the home birth demonstration project. Then we will move on to mental health. When we
[ Page 14190 ]
move on to mental health, I will provide the minister with the subjects that we will talk about, in order. So if there is a necessity for staff to be here for different subjects, they will have that courtesy.
I'd like to bring up a general circumstance with respect to the home birth demonstration project. For the record, the home birth demonstration project is delivery of our babies at home. The project was initiated, I believe, in December 1997 -- Ministry of Health "Home Birth Demonstration Project Handbook for Clients, December 1997." In the home birth demonstration project is the outline for the standard of practice for midwives certified in British Columbia.
In the project, there is a quote that I'd like to put on the record, and that is as follows: "In accordance with risk screening guidelines, we are required as midwives to consult with physicians if complications arise during or after birth or in the postpartum period. It is the midwives' responsibility to consult with physicians and to initiate all consultations with physicians from the midwife."
For the record, as well, I'd like to delineate two issues. The first issue is the global issue of midwifery; the second is the home birth demonstration project. I've worked with midwives my entire career. Whether recognized or not, many of our highly trained obstetrical nurses -- especially in northern locations, which these days seem to be north of Hope -- are Irish- or Scottish- or British-trained midwives who are working in the hospital setting doing a job that they do very well. What I'm not talking about is the midwife profession. I am talking about the home birth demonstration project.
What I'd like to do to outline and frame those concerns is to discuss, as I'm sure the minister knows, a patient who had a home birth in the constituency of Okanagan-Vernon. I'd like to provide the history on which to frame the questions. In 1998 a 35-year-old woman in Cherryville, which is located about 45 miles from Vernon, decided to have a home birth under the home birth demonstration project. As we are aware, this is a government-sanctioned project. She was presented with a handbook and made her choices that home birth would be the option she would take.
Two days before birth, in an uneventful pregnancy, this woman recognized a decrease in fetal movement. The midwife recognized that there was less amniotic fluid present, and there had been a drop from that of a considerable amount in the height of the woman's pregnancy -- three or four centimetres, which at term is a very considerable amount. Although certified midwives can authorize ultrasound and other tests, no tests were done, despite the fact that this was a 35-year-old woman, it was her first baby, and she was 12 days overdue.
[1740]
The woman went into labour in her home, which is what a home delivery is all about. And 40 minutes after the midwife arrived was the first time the baby's heart rate was checked. At that time, it was found that the fetal heart rate was very much diminished and declining. There were missed beats. Although the patient was not informed, the midwife felt that this was an emergency.
At that time it was found out that, despite the fact that this was a government-sanctioned program run from the province and not from the region per se, there was no emergency backup system in place. Some of the things that would constitute a backup would have been that the midwife had gone to the hospital and identified herself to the hospital nursing staff and physicians -- that she had required hospital privileges so that she was authorized to deliver a baby in hospital. No one, regardless of their skill and training, is able to deliver a baby in hospital unless they've gone through the authorization process of acquiring hospital privileges. There had been no contact from the midwife to the family practitioner at the onset of labour -- or at any other time, for that matter. There was no consultation with the physician to say that this woman was coming into hospital in a circumstance that was considered to be an emergency. Therefore there was no obstetrician present at the time of arrival at hospital.
The midwife did not know what equipment was in the ambulance and for that reason insisted that an ambulance be called, despite the fact that they had to drive all the way from Vernon out to Cherryville and all the way back, which is probably a round trip of an hour and a half, including stabilization. Upon arrival, the midwife found that the ambulance didn't have any equipment that she didn't have. Probably it would have been just as well for the patient to get in the car and be driven, once emergency conditions were identified.
The midwife asked for the ambulance to be stopped in transfer several times so that she could listen to the fetal heart rate. The midwife, in her clinical notes in transfer, said that there was a heart rate and that the heart rate was around 120 beats. It's difficult to say whether that was the fetus's heart rate, because the midwife did not take the maternal heart rate, which often in labour is around 120 beats as well.
There was no mention of fetal distress to the patient. There was no mention to the patient that this was an emergency. There was no mention to the labour room nurse or the ward clerk on maternity in obstetrics that there was a problem, just that this woman was going to be arriving.
Three hours after that first auscultation and finding of problems, this particular woman from Cherryville was informed that she had a dead baby. Subsequently, maternal complications developed. Despite the fact that we as a rule do not do caesarean sections for dead babies, the mother required a caesarean section to be performed because of her maternal condition.
In the sort of postmortem of this entire fiasco, one of the things that the patient mentioned to me and has asked me to bring to this House was that in the "Home Birth Demonstration Project Handbook," the home birth demonstration program argument purported that home birth was a "safe and viable option," and that is the exact phrase in the manual. This rests on the claim that midwives are competent to screen high-risk pregnancies and to ascertain when high-risk pregnancies are unsuitable for home birth.
My problem with that is severalfold. We're looking now at something that's a sanctioned government program. These are not people out in the bush doing home births because they choose to, in an unlicensed way. This is a program that is run by our government.
[1745]
We are in a circumstance where, in the home birth demonstration project, the safe delivery of any babe is dependent on four factors. It's dependent on the ability of the midwife to recognize either a mother or a babe in extremis and respond quickly to a dangerous situation. It is dependent on the availability of physician communication if there's going to be a transfer of function from one professional to another. It is
[ Page 14191 ]
dependent on the proximity to hospital and the availability of transport. And it is dependent on time. All of these factors were very crucial in this particular woman's first pregnancy and delivery.
A number of shortfalls in the system are very obvious in this particular case. The first is that the handbook talks about the dangers of a planned home birth versus a planned hospital delivery. It relies on a number of factors to ascertain what is a normal and safe delivery. Unfortunately for everyone who spends a lot of time with women in labour, the factors that we use to ascertain that it is a normal pregnancy are a different set of factors than the ones that constitute a high-risk delivery. Those factors occur only once the patient goes into labour. Therefore the factors that we use to decide that this can be a home birth are different than the factors that actually come into play when the baby is being delivered.
There was also, in this system, the shortfall that there was nothing in the book to tell the patient what adjunct services were not available. In other words, there wasn't an ambulance in Cherryville. The ambulance would have to come from Vernon and then return to Vernon, there would be a time frame for that to occur, and it would depend on ambulance availability -- all crucial factors in a home delivery.
It also pointed out the shortfall that there was no protocol worked out in the demonstration project to ensure that there would be safe transfer for this patient, who had decided on home birth and then found that that was no longer a viable option for her baby.
There is also, in the demonstration project, the shortfall that there is no midwife communication plan outlined in the book so that the patient knows exactly what is going to happen for her -- to ascertain and ensure that this circumstance would not happen again. Large studies show that 30 percent of home births do end up being delivered in hospital, because the labour and delivery risk factors of fetal and maternal distress correlate more with infant death than do the factors that ascertain whether home delivery can be done.
So what do we have, hon. Chair? We have a home birth project sanctioned by the Ministry of Health. We have a family, who are educated people, who read the manual and felt that this was a reasonable thing for them to do. Surely, because it is sanctioned by our province, it must have everything in place. And we have a family now whose child is dead. On autopsy, this baby was found to be completely normal except for the possibility of cord compression. This is not a baby that would have died for other reasons.
Based on that history, I'd like to ask the minister a number of questions. She, myself and her department have certainly had communication over this case. Based on that communication and where things are at, the first question I'd like to ask the minister is the following. The College of Midwives is not subject to the Freedom of Information Act. As far as I can tell, it is the only college that is not subject to the Freedom of Information Act. I am aware, for example, that the College of Physicians and Surgeons has a full-time person who handles only freedom of information. Could the minister let me know why that is the case?
[1750]
Hon. P. Priddy: It's difficult to imagine why that would be different, but my staff here is not aware of it. I will get a more definitive answer for the member and return it after the dinner hour.
A. Sanders: I think this is an absolutely critical question. I believe that in situations where our system fails people -- whether it is in the operating room, in the home or in the office of any professional -- we have the obligation for people to seek that information to put their own concerns to rest. I would encourage the minister to respond to this member with respect to that particular point and to make the information clear.
Since this time, the ministry has had time to look at the home birth demonstration project. Could the minister tell me if she feels the guidelines in the home birth demonstration project are comprehensive enough to give the professional doing the home delivery the necessary safety and skills to ensure that we will not have conditions like the one I described in Cherryville?
Hon. P. Priddy: I should have introduced Dr. Vicki Forester, who is a staff member who hasn't been here before.
I don't think it is necessarily for me to say that the guidelines are adequate; I'm neither a physician nor a midwife nor someone experienced in that area. I do know that the guidelines have recently been reviewed and that they are reviewed anytime there is occasion for concern, to see if there has to be any revision to those guidelines at all. They're reviewed by an independent evaluator and a panel of experts that includes three physicians and a midwife. So I don't think it's for me to say that they are satisfactory. It is for me to say that there is an external evaluator, with three physicians and a midwife, who reviews those guidelines and makes any recommendation for change.
I'm sure that the member has other questions, but seeing the hour, I move that the committee rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; the Speaker in the chair.
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Committee of Supply B, having reported progress, was granted leave to sit again.
Hon. P. Priddy: I move that the House at its rising stand recessed until 6:35 p.m. and thereafter sit until adjournment.
Motion approved.
The House recessed from 5:56 p.m. to 6:38 p.m.
[H. Giesbrecht in the chair.]
APPRECIATING OUR HISTORY
K. Whittred: Each spring for the last six years, hundreds of B.C.'s brightest grade 11 students gather to sit for a two-and-a-half-hour exam called the Begbie Canadian History Contest. These students are testing their knowledge, skills and understanding of history against other students for cash prizes. The contest is available in both English and French.
Today, hon. Speaker, the organizers of this particular event are looking at the incredible success of this endeavour
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and are asking: "Should we go national?" So the question we ask and address tonight is: do we need a national history contest? Indeed, is Canada ready for a national history contest?
In addressing that, perhaps we should look at: where did this contest get started, and exactly what is it about? Well, first of all, it is named after Matthew Baillie Begbie, who was, as I'm sure any British Columbian knows, the chief justice of British Columbia during the gold rush years. He was noted for his clear thinking and his racial tolerance. He was thought to be way ahead of his time for those years in terms of the kinds of reforms that he was willing to introduce.
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Now, the idea of holding a Begbie Contest actually originated in Victoria. It
originated in 1992, when a group of social studies and history teachers who happened to be
working on the provincial curriculum at that time -- and I think were a little bored in
the evening -- were enjoying a little drink at the pub. They got to talking about the need
for something that would bring a little bit of visibility and a little bit of profile to
those students in the system who were good in the social sciences as opposed to the maths.
Anyone who has taught in a high school in this province knows that each year at awards
time across the stage are paraded many, many students who have won prizes and certificates
in various national math contests -- things like the Euclid Mathematics Contest or the
University of Waterloo's
The teachers, who were largely members of an organization known as the British Columbia Social Studies Teachers Association, looked at what their priorities would be, what kinds of things this contest would endeavour to promote. One of their first goals was to come up with something that would increase the profile and popularity of Canadian history amongst students, parents and the general public. It was felt that there needed to be a vehicle by which to promote Canadian history. They went a step further, and they looked at the kind of skills that teaching history and learning history promote and realized that many of these skills are the kinds of skills that are very valuable in the workplace -- skills like researching, evaluating information, communicating information.
A second purpose that they thought about was the idea of simply examining a common core of knowledge, particularly around what it means for us to be Canadians and to make informed decisions about our future.
A third purpose that I think this group thought about was to challenge students to
think critically about historical and contemporary problems -- problems that have
challenged us historically would be things like the Komagata Maru incident and the
racial intolerance that has besmirched the history of this province -- and to be able to
relate those sorts of issues to contemporary situations. The group of people that came up
with this concept was not concerned about the recitation of a lot of historical facts,
names and places. Very often people look at history as
Perhaps another purpose was to encourage achievement in a time when the world is increasingly competitive -- hence the idea of a contest. There are many, many ways to increase the profile and the importance of something -- in this case, the subject being history. This was simply one vehicle amongst many that were considered.
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That, in a nutshell, summarizes the purpose of this Begbie Contest. Why, at this point in time, is this group of people -- who were successful in organizing a provincial contest -- hoping to move on to a national contest? Well, it's sort of interesting that one of the motivations came out of a meeting that occurred in 1996. A group of people were actually attending a convention, and at this convention somebody said: "Oh, we can't have a national contest. There's no such thing as a common Canadian history." Well, hon. Speaker, the organizers of that affair took note of that and said: "Hey, we think there is a common history, and we think this common history has to be promoted. So we're going to try to make this contest a national event."
Noting that my time has run out, I conclude.
F. Randall: I would like to thank the member for North Vancouver-Lonsdale for her comments about the national history contest and the work that the teachers have put into the program. I would certainly like to offer my congratulations to them. We know that teachers do an awful lot of work outside of their normal duties, and that it is very much appreciated. I guess we're all very familiar with Begbie; in fact, there is a building named after him in New Westminster. I've made a few notes on the history of British Columbia, which is what I understood this was mainly about. I would just like to run through those quickly, which may also contribute a little bit to history.
British Columbia is admired throughout Canada and the world for its high standard of living and the relative social and economic equality enjoyed by all of our citizens. Actually, there was a time when our current quality of life was not so wildly heralded. Provincial governments closely aligned themselves and their policies with the needs of resource industry owners, while the interests of common working folk, minorities and women were effectively deemed to be out of the scope of proper public debate. The interests of working-class British Columbians have not always been of concern to legislators in British Columbia. Early in the province's history, employment conditions in many industries were very dangerous, and when workers sought to organize and provide a voice for their collective concerns, they were frequently subject to the strong-arm tactics of company bosses.
Labour in B.C. has made considerable gains since those times. In 1973, for instance, the province introduced its first Labour Code to protect workers' rights. The B.C. government is making a concerted effort to ensure that the traditionally championed interests of capital are balanced with those of labour. That is the only way that our economy can remain stable and free from the strife and conflict that characterized labour-management relations in days gone by.
We have introduced labour legislation to affirm and protect the position of labour and to stabilize industry in the
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provincial economy. We have implemented or improved workplace safety measures so that work is both profitable and free from danger. We have implemented consecutive adjustments to the minimum wage to ensure that all British Columbians receive fair remuneration for their work. We have introduced the B.C. family bonus to assist our working families.
As most of us are aware, early in B.C.'s history women were cast into the moulds of nurturers, mothers and caregivers. Very few entered the work force independently, and the living conditions and status of most B.C. women were largely determined by their relations with the men in B.C. society.
Although women have made great strides towards equality since Emily Carr's days, the work is not done. This government is doing all it can to end the structural inequality of women in B.C. Among other initiatives, we have introduced over $86 million in pay equity adjustments. We are waging public information campaigns toward preventing violence against women. We have directed the funding to maintain existing and establish new safe houses for women leaving abusive relationships, and we are continually working to address women's health issues.
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B.C. racial minorities have long endured discrimination in both social and economic terms. This government has worked to reduce the marginalization that these groups experience. We have sought to improve the representation of minorities in the workplace by offering them targeted educational opportunities and employment initiatives that transcend historical biases.
Adding an issue that I feel strongly about, the terrible drug situation we have in British Columbia will certainly create a black mark on B.C.'s history. What we are doing is not working. New ways and new penalties must be used to deal with this deadly problem.
Again, I thank the member for raising the matter of the teachers and what they have contributed to education and history in British Columbia.
K. Whittred: I would like to thank the hon. member for Burnaby-Edmonds for his response to my statement. I'd like to use this last minute or two that I have to simply conclude my remarks and to draw attention to the people who have so successfully launched this project. When I concluded, I was talking about what motivated the organizers of this project to try to go national. I mentioned that one was this idea that we don't have any common history and a reaction to that and an expression that: "Hey, yes we do." And if we don't, we may in fact be in a rather sorry state.
A couple of other things that I might mention are the number of articles that we often see in the media, which address the subject that Canadian students perhaps do not recall the history that they've learned in school -- that it is not reinforced or that in fact having a sound knowledge of Canadian history is not something that we cherish and value very much. That, of course, is the reason for this particular contest; it's to give a little profile to those sorts of skills.
In conclusion, I would like to draw to the attention of the members the success that this organization has had. They have succeeded in making the Lieutenant-Governor, the Hon. Garde Gardom, the honorary patron of this particular venture.
I've already mentioned that the bulk of the work of this contest is done by groups of teachers from the B.C. Social Studies Teachers Association. Amongst that group, I would like to single out a couple of my former colleagues, particularly Charles Hou, Wayne Axford, Fred Lepkin, Deirdre Moore, Gordon Smith and Harold Wright. These are all former colleagues of mine who have been involved very actively with this project.
I would like to point out that the B.C. Ministry of Education's French programs unit has extended this into the French language. McGraw-Hill Ryerson has become involved -- Simon Fraser University, the University of B.C. We see that this project now is beginning to enjoy a rather wide sponsorship and is very quickly gaining acceptance through a number of very high-profile organizations.
I would like to take this opportunity to wish the organization well in its endeavours to take this contest to the national level. I for one, as a former social studies and history teacher, would be very proud to see the Begbie Contest, which had its origins in British Columbia, in fact become a high-profile, national history contest.
COMMUNITY FORESTRY: A KEY TO LOCAL
ECONOMIC DEVELOPMENT
E. Gillespie: Private members' statements are always an opportunity for us to talk about and celebrate some of the people and the activities in our own ridings. Tonight I'm delighted to stand up and speak about community forest pilot projects. Last summer in this Legislature we approved legislation establishing a new forest tenure: the community forest. In September 1998 a request for proposals for community forest pilot projects was released, and this summer the successful proposals are being announced. Over 80 proposals were received and over 20 reviewed, and seven pilot projects will proceed to the next stage of public consultation this summer.
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What are the key features of a community forest pilot agreement? The tenure is designed to support community-based forest management. It is area-based. It will provide more flexibility around the process for establishing and regulating timber harvesting levels and may provide rights to non-timber forest resources in addition to timber. It is to have a much longer term than other tenures.
Community forests are an important part of the forest action plan to promote diversification in British Columbia's changing forest sector. Community forest tenures will provide communities with long-term opportunities for achieving a range of community objectives. These include job creation, forest education, recreation and skills training and other social, environmental and economic benefits. It will provide communities with an opportunity for balanced and integrated use of forest land and allow communities an opportunity to participate more directly in the stewardship of the forest and its resources. It will provide communities an opportunity to get more value and local benefits from forests and will encourage cooperation among stakeholders.
Now, all of these objectives of community forest tenures are very important to the people of the Comox Valley. The reason I'm here tonight is to be able to talk about and celebrate the selection of the Comox Valley as one of the seven community forest pilot sites in British Columbia. On Monday, I felt
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that we in the Comox Valley had reached a place of fulfilment of the dreams and the hard work of a core of dedicated forest workers, planners, environmentalists, community activists and economic development planners who have been moving and have been educating me in this direction for years.
I am particularly grateful to Jack Talbot, a director of North Island Woodlot Corp., who spearheaded the development of the community forest and who has been preaching and practising sustainable forestry and sharing his expertise with others for years. I'm also grateful to Bob Woods, who on the day after my election introduced me to small-scale sustainable forestry at work in the Comox Valley and took me around to view this kind of work on the ground. The pilot that I announced in the Comox Valley on Monday will be used to foster partnerships between local groups like naturalists, streamkeepers, youth groups, local government and resident groups, and to provide public education opportunities.
I'd like to share with you just a little bit about the Comox Valley, about the Crown land that's available in the Comox Valley and about why this community forest tenure is very important to the people of the Comox Valley. Land-ownership circumstances in the Comox Valley are somewhat unique in the province, given the high proportion of privately owned land and relative scarcity of Crown land in the area. The Crown blocks that were part of the application for the community forest are with the suburban working forest interface and therefore have an extremely high social and environmental value. The small size of the blocks places a limit on the economic viability of the area under conventional resource management priorities -- that is, timber priorities. It does, however, lend itself to a small-scale community forest enterprise seeking to diversify the benefits.
To tell you a little bit about the Comox Valley, this is drawn from the community profile prepared by the Comox Valley Chamber of Commerce. In the Comox Valley, 73 percent of the labour force is employed in the service industry. The main industries include retail, public service and primary industries. Approximately 1,400 Comox Valley residents are employed in the forest industry but most commute to jobs outside the valley. This is quite a contradiction to the original settlement of the Comox Valley, where we have the community of Cumberland that was settled over 100 years ago because of the coal resources in that area. Future settlement relied on forestry and agriculture as well as fishing. Community employment has changed a lot over the years. It is now largely service-based. But we are at a point in our development in the Comox Valley where we are seeing a significant need to diversify.
[1900]
The proposed community forest makes sense in the diversification of the economy in that it provides local raw materials to local manufacturers, who will now be able to compete internationally for the first time, given the additional opportunity of initiating international freight. The community forest pilot has been very well integrated into other economic development opportunities and plans for the Comox Valley. One of those plans includes an international freight capability out of Canadian Forces Base Comox.
I'd like to speak to you a little bit about the kinds of partnerships that will be a part of the community forest pilot. Here are a few of the partnership opportunities. The Comox Valley Economic Development Society has developed, with funding available from Forest Renewal B.C., a forest enterprises strategy. One of the strategies is to develop a local industrial site for the purpose of establishing a valued-added forestry village and forest resource centre. The community forest initiative is naturally and complementarily linked into the Comox Valley forest enterprises strategy. The community forest will be able to focus on forest resource management, small-scale timber management, botanicals, recreation, tourism and harvesting while benefiting from the development of local log sorting and distribution, processing and manufacturing, marketing and promotion, product development and research and financing opportunities through the forest enterprises strategy.
I see that my time is up. I have much more that I'd like to say, and I'll reserve my comments for later.
G. Abbott: It's a pleasure to rise and participate in the discussion of community forests that the member has commenced here. As she rightly noted, this discussion around community forests is certainly an important part of the debate around tenure reform. Tenure reform has been thrust into the spotlight, as you know, in recent months and years because it forms an important part of the issues surrounding the possible renewal of the softwood lumber agreement with the United States. Certainly there is at this point in time, I think, a willingness on the part of British Columbians -- and, indeed, on the part of tenure holders -- to look at this whole issue of the diversification of tenure in British Columbia.
The member's right: community forests are an important part of that. They're only one part of that, though. Woodlots are certainly an important part in the diversification of tenure. Small business sales and some of the changes that have been made there are an important part of tenure diversification. First nations forests are another important element. I think, generally speaking, that community forests offer a good, promising and useful form of tenure reform in British Columbia.
In a couple of cases here in B.C., we're not entirely inventing something new. There are at least a couple of longstanding community forests in British Columbia. The one I know best is in Revelstoke, but I know that there are one or two elsewhere in the province as well. Of course, the government has more recently been involved in a very gradual expansion of the community forests in British Columbia. As the member noted, in the last couple of months there have been a few additional community forests that have been approved to proceed here in B.C.
I know, hon. Deputy Speaker, that you always welcome our dispassionate and non-partisan comments during these discussions. I'll offer one here, and that is that I think the process that has been undertaken has been generally a good one. I think that the province has taken a cautious approach to the creation of new community forest tenures, and I think that is indeed the right approach.
I also commend the advisory process that has been undertaken. The advisory committee has been a very good one. I know that they have received sound advice from all of the members of that committee, including Dr. David Haley of UBC and Dr. Geoff Battersby, the mayor of Revelstoke and chair of Community Forest Corp. in Revelstoke, who is a friend of mine.
Community forests, though, are not a panacea for the ills of the forest industry in British Columbia. They are subject to
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the same concerns and the same challenges that have dogged other forms of tenure in recent years. Of course, we've talked at some length in this House about the loss in excess of $1 billion that occurred in 1998 in the forest industry in British Columbia.
[1905]
What are those challenges and concerns that are facing community forests? Well, they're subject to the same regulations. They're subject to the same stumpage and so on as other forms of tenure in British Columbia are. Community forests generally harvest logs that they sell in the marketplace. They hope to achieve a certain price for that timber after paying off the harvesting costs, which are largely determined by the very process-oriented Forest Practices Code that we have in British Columbia. After they pay the stumpage, which is sometimes not reflective of the value of their timber, after they have taken care of any taxes that are payable, they hope to have a buck or two in their jeans. Without that buck or two in their jeans, there is nothing that a community forest can pass on to their community, just as the forest industry in British Columbia in the last year showed a $1.1 billion loss and had no dollar or two in their jeans to pass along to their shareholders and investors.
We have the same problems facing community forests that face MacMillan Bloedel, that face Weyerhaeuser, that face any large forest corporation in British Columbia. Unless we can address those problems, we are going to suffer the same problems in regard to community forests that we have in regard to other forms of tenure.
I thank you for this opportunity to comment on the member's statement.
E. Gillespie: There are some very unique features of these community forest pilots. Each one of the seven has a different kind of management plan. The Comox Valley community forest management plan is based on a woodlot management plan.
But I think the most exciting thing about the application is the whole element of cooperation that is a part of their application throughout and certainly was very evident among the people I met at the announcement on Monday. I was beginning to talk about that kind of cooperation that has already been in place in developing this application, with the Comox Valley Economic Development Society, Strathcona Wood Producers, who would provide log-marketing services, and small-scale private forest land owners. This is a very interesting part of the proposal, where North Island Woodlot Corp., which has submitted this application, has submitted it based on Crown land availability as well as the dedication of private small-scale forest land owners who have signed agreements-in-principle to participate in the community forest. This participation will increase the possible land base from 715 hectares to over 4,000 hectares. There's also cooperation with local small business logging contractors, who will be the people providing the capital, equipment and on-the-ground expertise to implement the community forest development plans, with the Vancouver Island Association of Wood Processors, who would be consumers of the wood supply, and with the Campbell River forest district woodlot licensees, who have already agreed to participate and support as members of the North Island Woodlot Association.
Once again, I want to emphasize this cooperative element of the application, because it's not only timber values that North Island Woodlot Corp. has included in their application. They've also included the values of community participation in what happens in their own neighbourhoods. They've included the values of other forestry resources. It could include salal and mushrooms. It will include recreational opportunities as well. This is a project that is bringing together all kinds of individuals and groups in the Comox Valley that haven't necessarily worked together in the past. But I can tell from the excitement I viewed and the words I heard at the announcement on Monday that that cooperation is going well into the future.
[1910]
The community forest pilot project announcements are a part of the forest action plan that has been developed by this government. The forest action plan has flowed from extensive consultations with a full range of forest sector stakeholders. It's a two-part strategy that aims to stabilize and modernize B.C.'s forest sector and to help the industry. In the short term, the forest action plan is taking immediate action to bring stability to the industry. Over the long term, we're working to build a new and modern forest economy, featuring more diversified and higher-value-added products.
THE STORY OF MORGAN LONG
S. Hawkins: I'm really pleased to have the opportunity to speak a little bit about community support and the gift of volunteerism. I think that many times in our communities we have people that do some very good things -- random acts of kindness -- and they're overlooked or not given the recognition that they deserve. I want to relate a very wonderful example of community support in Kelowna. My example involves many people and community leaders who stepped up to the plate sort of at the last minute and, on very short notice, helped to realize a dream of a very promising young Kelowna person. That little person is Morgan Long.
Morgan Long is a Kelowna-based artist. She's been drawing and painting since she was a year and a half old. I had the opportunity to actually go over to her house and look at her early works. She and her mom told me that at the age of ten, Morgan taught two art classes in her public school to grade 3 students. Then they went down to the SPCA in Kelowna and painted a mural on the wall. In addition to teaching at the young age of ten, her artwork has appeared on wildlife posters, where her work has been mistaken for Robert Bateman's, the wildlife artist.
She's generously donated her artwork for charity auctions to Canuck Place, B.C.'s Children's Hospital and the children's unit at Kelowna General Hospital. Her artwork of a prairie falcon was chosen to appear on greeting cards for a project that we did in Kelowna last year called "Return of the Peregrine Falcon." These greeting cards were used as a fundraiser for that project. Unfortunately, her work is so good that this original piece of art was stolen and still hasn't been returned, even though there was a reward posted for its return.
In March of this year, Morgan was watching TV, and she came across a TV show that featured a castle in Italy and an artist who was quite famous, I guess, and was showing his art there. Morgan's dream was to go to Italy, find this castle and show her art there. Morgan got on the Internet, found out where this castle was and wrote to the curator of the castle. Wouldn't you know it -- they invited her to show her art
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there. She sent pieces of her art, and they were quite impressed and wanted to showcase her work. Now, this is a castle just outside of Pisa called the castle of Vicopisano, and Morgan was invited to show her artwork from July 10 to July 20. They asked her to bring 20 to 25 pieces of art.
This is a rare opportunity, for sure, but I think it's rarer still for a child. Morgan is only 12 years old. She watches "Xena: Warrior Princess"; she can explain the theory of relativity; she's influenced by artists like van Gogh, Monet and Gauguin; she's very computer-literate; and she loves cats. She's just a kid. She graduated from grade 6 this year at Bankhead Elementary School as an honours student. But Morgan has a dream of being a famous artist. She's passionate about her art, and she has been described as a genius, a prodigy. These are the kinds of words used to describe this gentle, very confident little girl.
[1915]
Morgan needed help. Her family's circumstances and her father's failing health didn't permit a trip to Italy, so Morgan sent out over 50 letters to agencies all over the place -- I think all over Canada and certainly in the U.S. -- asking for sponsors. I'm really proud to say that many people in our community responded, and a group called the Friends of Morgan Long formed. Now, the Friends of Morgan Long felt that it was "very important to support and encourage our youth to pursue their dreams. We believe that our youth are the future of our community, of our province and of our country. In Morgan Long, we saw the potential for a very, very bright light that will reflect positively on our community and certainly on an international stage. Morgan Long, we felt, would be a great art ambassador." Well, this morning Morgan stepped on a plane with her mother and left for Pisa, Italy. She'd never been on a plane before; she'd never travelled before. And she did say that it was her dream come true.
Morgan has been a very ill child. About two years ago Morgan was very ill with scarlet
fever, and at that time, her drawings kind of took a turn. She paints in a very abstract
Community leaders have been very supportive. When Morgan comes back, she will have an art show at the Kelowna Art Gallery. The mayor has arranged that and is very proud of that. We had problems getting Arts Council grants for Morgan. She's only 12 years old, and to get those, you have to show in a Canadian art gallery. So there were all kinds of hurdles to pass, but because this child has so much potential and such a brilliant and promising career, you can't say no to her. She just won't take no for an answer.
I think it's wonderful that we have caring, community-minded people who came together, formed this group and believed that children should dream their dreams and that they should help them make their dreams come true whenever possible. For this child, her dream is to be a famous artist. I know that she will go places. People should keep Morgan Long's name in the forefront of their memory, because when she comes back, I believe she's going to have an art show in Victoria -- and possibly Whistler as well.
I do want to say thank you to all the people in the community that helped a little kid make her dream come true. It wouldn't have happened without people that cared enough to give their time and energy and certainly put up the funds to make this trip happen. So I want to take this opportunity to say good luck to Morgan and her mom and thank you to all the community leaders, the professionals and people in the media here, as well, that helped to send Morgan to Italy.
E. Gillespie: It's really a pleasure to rise on this subject to speak about Morgan Long and the wonderful opportunities that have been afforded to her through her own abilities and through the Friends of Morgan Long, who have supported her in her endeavour to leave for Pisa today.
Morgan Long is truly an exceptional young woman. Now, some would say that her work may remind them of Bateman's. I took a look at the photograph that I got from the newspaper, and I thought more van Gogh. Perhaps she's going through a number of stages. Certainly I would agree that her work is extremely unique and amazing, really, for a 12-year-old child -- not child but artist.
I understand she began painting in grade 2 and now spends up to three hours a day painting. It's wonderful. I appreciate the words from the member opposite about encouraging our young people to pursue their dreams. I think that it's so important for us as a society here in British Columbia to make sure that we always do.
I know that there are many remarkable young people in this province. Sometimes we hear of them through our schools. All too often they are unsung remarkable young people. Whether it's children who overcome poverty, hunger and violence to simply survive -- that's truly remarkable to me -- or young single parents who continue to pursue their education despite the difficulty of raising a child alone. That is remarkable to me. I had the opportunity to be at the North Island College graduation recently, where I met many of these students -- many of them single parents, many of them parents who are returning to school after a long absence in order to improve the opportunities for themselves and for their children.
[1920]
I'm proud of the young people of B.C. Every day I hear of some exceptional action. Today in this House we heard of the wonderful young students who achieved fourth in the world in the competition The Odyssey of the Mind competition, with their project on the Vancouver Island marmot. In June, British Columbia's secondary and post-secondary students proved that they have what it takes at a national level, returning home with 27 medals of achievement following the fifth Canadian Skills Competition in Kitchener, Ontario. British Columbia fielded a team of 61 competitors at this year's competition, with more than 600 students from across the country taking part. British Columbia competitors brought home ten gold, ten silver and seven bronze medals.
Sound Off: Save a Life is a program that offers promotional material, support and arts awards to student groups that promote the issue of organ donor awareness by putting on educational and musical events in their schools. The Sound Off: Save a Life program ran this year during National Organ Donor Awareness Week, April 19 to 25. Each year, five schools receive $1,000 awards toward their school music programs. British Columbia students showed they have what it takes. The five award winners for 1999 were: Burnaby South Secondary School, who put on a noon-hour concert, dance recital
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and performance by their school band; Thomas Haney Centre Secondary School, for coordinating a week of organ donor awareness activities that included vocal and jazz group performances, a jazz band concert and a draw for an electric organ; Bayside Middle School, for putting on a spring band concert featuring students, teachers and guests; Mount Prevost Middle School, for organizing their grades 8 and 9 band to play for elementary schools, running an air band concert and raising funds for the Kidney Foundation of Canada; and the Merritt secondary school, for putting on a live concert featuring school talent and broadcasting it throughout the school. The students who performed have also recorded a CD, which has been released in Merritt.
Hon. Speaker, these are just a few of the many amazing young people we have here in British Columbia. The accomplishments of students like these are truly inspiring. Recent surveys show that strong support for public education and the steps that government is taking to improve our school system have broad support across the public.
S. Hawkins: I certainly appreciate the comments from the member opposite. We all
have people in our communities who give their time, their energy and their money when the
need is there. Oftentimes, as I said, they don't get thanked or they don't get thanked
enough. It's been said that you make a living by what you earn, but you make a life by
what you give. Certainly the Friends of Morgan Long gave a 12-year-old child a wonderful
opportunity to realize a dream, and that was the dream of showing her work
internationally. This child says that she wishes to share her art not only with her
friends but with the world outside. She has a web page, and she certainly invites people
to connect to her web page and look at her work. She has received national recognition,
and I'm sure that she will be someone that our province and our country will be proud of.
When you have that kind of determination at that young age
Many of the people that make up this Friends of Morgan Long group are professionals, and they're community leaders. They're very, very busy people. They're involved in major community fundraising events, in community charity organizations and in service clubs. I really appreciate the time that they gave and the energy they put into this project. They had a very, very short window of time to come up with the kind of funds and the organization that was needed to crate her paintings, to come up with the insurance and the airline tickets, and to talk to the people in Italy. It was quite an amazing feat that it was accomplished in the last three weeks or a month.
[1925]
So to all of them, I want to say thank you. I'm proud of each and every one of them that volunteered to help Morgan, and I'm proud to say that we're privileged to have the kind of people we have in our community. I want to say how wonderful they are and thank them publicly for helping this child and for all the contributions they make to our community.
CODE 3
E. Walsh: I am honoured and delighted to rise in celebration of the British Columbia Ambulance Service's twenty-fifth anniversary. But before I begin, I would like to ask -- not that I'm sure I'm going to get too much response right now -- how many members in the House know about the Ambulance Service in British Columbia. What is the extent of their knowledge of its beginnings -- of where it began and why it began? I know from where the member across the way is speaking, because I know she has one member of her own family that is a paramedic with the Ambulance Service.
I won't ask the question right now of everybody here, but I will do it a little bit later. For the time being, I'd like to take everybody down memory lane with me. But for many people here, I promise that I will take them back. I specifically want to remind people here in the House and in the province of the vision and the legacy that the Hon. Dave Barrett, the Premier of the day of the NDP government, delivered to the people of British Columbia. It wasn't just to the people of British Columbia but to all the travellers and to all the people that visit the beautiful province of British Columbia.
It wasn't until the early 1950s -- and this is probably as far as anybody can verify -- that any kind of survey was done with respect to ambulance services and health care services in the province. This survey was done by Dr. Donald Starr. What he found was that ambulance services in the province were deplorable. In fact, he said that they were totally inadequate. That was in the early fifties. There was quite a mix of private and public services and systems. These were referred to as the scoop-and-run variety in the province, and that was typical of North American emergency medical services at the time.
What their survey found was that over 77 percent of ambulances lacked two-way radios -- no communication -- and more than half of the ambulances lacked equipment for the jobs of these people we entrust our lives with. They didn't have equipment for resuscitation. In fact, most of the drivers, as they were referred to at the time, didn't even have adequate first-aid tickets. As I said, it was found that the ambulance services were in fact quite deplorable.
Prehospital standards relegated patients to the care of untrained caregivers at the time. This meant funeral home operators, private ambulance companies or even, sometimes, no agencies at all. The dispatch and communications functions were also relegated to the taxi companies or truck firms, and this was by people who were not even qualified to give advice over the communications systems, let alone to a bystander.
There were concerned groups that came to the government in the early seventies and asked that one service be put in place in the province that would be both efficient and cost-effective and that would provide a better service for the people of British Columbia. On June 18, 1973, the Barrett government took the first positive step that would enable standards to be set, with the passage of the Ambulance Service Act. So in 1973, following through with their commitment to an ambulance service, Dennis Cocke, Health minister, commissioned the Foulkes report on health care in British Columbia. This included ambulance services in its review. The minister asked Dr. Peter Ransford, who was then a Victoria pediatrician, and Carson Smith, owner of the metro ambulance service in Vancouver, to write the report. As a point of interest, Carson Smith's increasing knowledge of ambulance services actually made him one of the foremost experts on ambulance services in North America.
[1930]
Minister Cocke was so convinced by the report that he asked Dr. George Elliot, his deputy minister: "How can we implement this service for British Columbians?" Well, Dr. Elliot, Dr. Ransford and Brent Parfitt -- who at that time
[ Page 14198 ]
worked for the Attorney General ministry -- concluded that an emergency health services commission was the best vehicle for implementation for the people of the province. By the spring of 1974 things were perking along pretty well. On July 1 the first office of the Emergency Health Services Commission opened on Nanaimo Street in Victoria with Carson Smith, who agreed to be director of operations.
It didn't open without many of its own challenges: the Purchasing Commission of the day insisting on three bids for every piece of equipment that the emergency services ambulances were going to be able to purchase; obtaining the necessary dispatch communications systems; Japanese blood pressure cuffs that fell apart within weeks; the direction to use blood-and-urine-stained mattresses which were discarded from Riverview. And you know what? There were part-timers in Duncan that took them and threw them out onto the street and said: "Look, everyone. This is what we are given to look after you as patients." Boy, have we ever come a long way today, and I'm really proud of that.
Ransford and Smith felt at the time that ambulances had to be considered an extension of the emergency department of the hospital. Paramedics, in becoming an extension of the emergency room department, would take the department into the community, so to speak. Training and equipment varied so much from municipality to municipality that ridiculous situations arose quite frequently. It was decided that in order to aid quick recognition of these emergency services, paramedics and ambulances would be given the recognition they so much deserved -- the recognition that there would be provincial uniforms for all paramedics and that the ambulances would all be one colour, easily recognizable in the province.
[W. Hartley in the chair.]
Individual services which stopped at municipal boundaries -- and which often caused
tragedies for many of the residents and for people that travelled through communities
I see that the light has gone red. I do have a lot more that I would like to share with you and with the people of the province, and I'll continue to do so after the member opposite.
S. Hawkins: I'm glad to have the opportunity to pay tribute to members of the B.C. Ambulance Service. It was very interesting to get the history. We know that this year is the twenty-fifth anniversary of the Ambulance Service, and we often don't give credit or thanks enough to our members on the front-line service.
I just want to recall a couple of things. I remember that when I was a very young nurse, about 15 years ago in Saskatchewan, I worked in a rural hospital as an RN. We didn't have a provincial ambulance service then. I don't even know if Saskatchewan has one now; I haven't worked there for a while. We had a private ambulance service, and oftentimes the nurses were called to ride in the ambulance to escort patients to hospital.
I got called out late one night. It was the first time I had actually taken a call. I had to accompany a high-risk maternity patient to Royal University Hospital in Saskatoon. She was a toxemic patient. We did a two-and-a-half-hour ride in about an hour and a half. I remember that it was a very dark and windy night. It was about midnight. I literally struggled in the back of the ambulance -- a very small place in the back -- manoeuvring IVs, drugs, vital signs and bedpans as the ambulance swerved and raced along to get the mother-to-be safely to hospital.
I am grateful that the services have evolved to the stage that they have, where we have trained personnel and a good level of prehospital care in this province. I certainly was pleased to have the opportunity on several occasions to do ride-alongs with our Ambulance Service. I've done that in Kelowna, I've done that in Vancouver, and I've certainly done that in the Kootenays, in Rossland. There were some very interesting calls, and I got a flavour of the level of service and expertise around the province. I was certainly very impressed with the competence, the caring and the professionalism demonstrated by the B.C. Ambulance Service front-line workers.
[1935]
But you know what? There are challenges as well, and I know the member is aware of them, because I know she's had many years of service in the B.C. Ambulance Service. I just want to outline a few of them, because this is what I have heard. I know that we have raised it in other parts of estimates in this House. There are serious concerns about training for part-time workers and for advanced life support personnel in communities around the province. There are concerns about ambulances being stuck at hospitals and stacked up because they can't get their patients discharged into the emergency units. Certainly they want to do that efficiently and effectively so that they can get back out into the community to monitor and attend to calls in the community. There is that concern around the erosion of response times. It's a huge issue, and I still hear about it.
There are concerns about rural communities being taken over by the B.C. Ambulance Service. Certainly we hear some of our members from rural and northern areas talking about the experience of a loss of perhaps a level of service or facilities that the community had before, once the Ambulance Service took it over. Those are concerns; they're very real concerns. They need to be addressed. Certainly the Ambulance Service has come a long way from where it was 25 years ago, but that's not to say it can't get better. These are things I'm hearing from the paramedics and the emergency medical people.
We know that effective prehospital emergency care is an integral part of our health care system, and I am very pleased today to recognize the very important work that our B.C. ambulance front-line workers do. I wish them well in their twenty-fifth anniversary year.
E. Walsh: I'd like to thank the member opposite for taking the time to actually talk to the paramedics that are out in the field and to become informed about the work that they do in the communities. As a paramedic for over 15 years, yes, I can actually attest firsthand to the dedication of many of the
[ Page 14199 ]
brothers and sisters that I do have in the Ambulance Service who always have maintained professionalism time after time and in situations that most people would find devastating to face even once in their lifetime.
Earlier I said that we have come a long way in the Ambulance Service. Last week we
celebrated Paramedic Appreciation Week. This year, on July 1, we are celebrating 25 years
of service of the paramedics to the province of British Columbia and its visitors. From
Vancouver's first ambulance that was built by Thomas Lobb, a blacksmith
I'll say it again: we have come a long way, and I am proud of the NDP government that had the vision and the foresight to identify a provincial ambulance service as an emergency priority and has proven to almost everybody in the country that, yes, we can do this here -- almost overnight. If I do sound proud of the provincial ambulance service, it's because I am proud of the provincial ambulance service that we have here in British Columbia. It remains the only provincial service in North America. There are 3,300 paramedics in the province, and they respond to well over 390,000 calls a year and also cover an area of close to a million square kilometres. This makes it one of the largest ambulance services in North America. In fact, Dennis Cocke once said: "It is something we have come to take for granted. Should we ever need an ambulance, it will be there promptly, with the best-trained staff and equipment available."
Let us not be so far removed from the early 1970s that we do not remember how far they have come, because to not remember may very well mean making the same mistakes again and ending up where we began.
[1940]
I would like to thank Dennis Cocke and everyone who has been so instrumental in creating and understanding this service that has been there for the people of British Columbia and who has understood the critical need for prehospital emergency care.
I would like to end by saying happy 25th anniversary to the B.C. Ambulance Service and to the paramedics, the dispatchers and the staff. I wish you all the very best in the coming year, the 26th year.
Deputy Speaker: Members, that concludes private members' statements.
Hon. P. Priddy: In this House, for the information of the House, I call 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)
On vote 36: ministry operations, $7,569,524,000 (continued).
A. Sanders: My goodness, we're talking about $7,569,524,000 -- as far as my hearing takes me. This is a very substantial amount of money and, for the record, the largest amount of money we spend on any ministry within the auspices of the provincial government.
I want to take the comments of the member for Kootenay very seriously -- she has offered a tribute to the improving ambulance services and a concern about any devolving of services from what we already have in the profession -- and to use that as a touchstone for the discussion that we are having, which revolves around the home birth demonstration project and the evolution to the situation of home birth in British Columbia. That brings a very large number of very serious concerns based on geography, based on training, based on expeditious employment of a service. I certainly want to make sure that we are not devolving the services and offering services that are less -- in any way, shape or form -- than what we had in this province prior to the implementation of the home birth demonstration project.
Before the break, we were talking about a specific patient who had had a very serious result from the home birth demonstration project -- where she had a home birth which resulted in the death of her son. This woman, who lives in my constituency, attributes the death of her son to a number of factors, a very significant one being the home birth demonstration project and the lack of articulated services within that project. Quite frankly, from having done 15 years of obstetrics, I don't disagree with this woman.
Now I have a number of questions to the minister, and what I would like to do in the time remaining is put them on the record and have the minister answer those later. I think that they're important enough to put on the record, but I don't think they're important enough, within the context of the constricted time we have, to spend time debating them in the House. I think that they need to be answered, and they need to be answered concisely. I would like to put them on the record and have the minister agree to answer them at a future date in writing. So I put to the minister: if I put those on the record, will the ministry answer those so that we can move on?
[1945]
Hon. P. Priddy: Yes, we will.
While I'm standing, you did have a question before dinner about FOI that I would just
answer now, if I might. Apparently the answer to that is that when the original
legislation was passed
A. Sanders: I look forward to having the College of Midwives under the FOI legislation so that the individual patient in this province can access the information that, to them, is the most important information on the planet.
I was going to do it later, but I think it's appropriate at this time to read into the record a portion of the letter that I have from Christina and Lea Sirr, the individuals in my con
[ Page 14200 ]
stituency who have asked me to bring forward this very unfortunate touch with the home birth demonstration project.
"With the popularity of midwife-assisted home births increasing and midwives acting as primary care providers, we feel this issue is vitally important to the public interest. The profession of midwifery has to be held accountable for providing competent, accountable professionals and balanced information on the safety of home birth. My husband and I believe that would-be home birth candidates are currently susceptible to mistakes of incompetent and/or negligent `professionals,' such as [the midwife we encountered], and it remains to be seen whether that midwife has a meaningful process of accountability in place by the College of Midwives. I have serious doubts.
"I find it extremely ironic that the material given clients [for the home birth demonstration project] emphasizes the alternative-to-patriarchal nature of the midwife-assisted home birth process: woman-centred, the woman defines who her family/support system is for the purposes of the birth and prenatal visits by the midwife, the woman is equipped to decide where she should give birth, and the importance of the woman's input and comfort with the home birth process is emphasized."
This is acknowledged as very different from what this particular patient saw as the "patriarchal" medical model of delivery.
"The values of openness, mutual respect and a healthy give-and-take of information are suggested [in the home birth demonstration project]. Theoretically, this is an appealing alternative [for] me and many others who have experienced an unresponsive, patriarchal medical system.
"In practice, however, when something goes wrong, and the College of Midwives of B.C. [and the midwife in particular] is on the defensive, it appears that the patriarchal approach [of what they consider to be the medical model] is quickly invoked. The College of Midwives will determine who is allowed to be present at the interview to gather information about the incident, not me [as the mother]. The College of Midwives will determine that my husband is [not] allowed to be present for the interview. Apparently I don't have jurisdiction in my own home to determine what support system I want present at this stressful time. The College of Midwives will take it upon themselves to advise me that I `probably won't need a lawyer' and that I `shouldn't bother recording the interview.' The College of Midwives will gather all the information from me that [is necessary] about this very personal and disturbing experience [i.e., the death of my son], and then slam the door shut on my access to knowledge about how that information is dealt with or incorporated into their policy -- considering me, for purposes of access to information on this issue, a member of the `general public.' As no one associated with the College of Midwives appears prepared to admit wrongdoing or responsibility, it appears that I am supposed to place my faith in some institutional process which is made deliberately obscure to me -- that something will be done and that something will be learned from this. Does this authoritarian, patriarchal flavour of all of this strike you at all? Is this a feminist way of doing business? Does the College of Midwives consider this conducive to healing? Does the college even care?
[1950]
"My husband and I would like to issue a personal request that the College of Midwives get back to me, in writing, with some official response to this information and some explicit indications of how, if at all, this information will be incorporated into future policy. I don't want a sympathetic phone call with verbal reassurances. I'd like to see some action. I have opened my life to you to share an extremely painful experience that your licensed midwife was largely responsible for, so please don't lock me out of the process. I entreat you to respond with some evidence that my son's death was not in vain, so that my husband and I can get on with our healing and so that other parents are spared the same tragedy.
"Sincerely,
Christina Sirr."
At this point, in case this point is lost in this House, I want to emphasize again that we are not talking about midwives. We're talking about home births. We're talking about research that says that home births are safe, which is primarily a European experience where European hospitals have helicopter pads on the surface of their maternity hospitals in order to deliver women who are in extremis to those hospitals. We're talking about high-density populations, where women are never far from a tertiary hospital or a secondary hospital where their obstetrical needs can be met.
We're not talking about British Columbia, which has no infrastructure provided by government to attend to those needs. We're talking about a British Columbia that has instituted a home birth demonstration project without the infrastructure to go forward so that people are protected. We're talking about a home birth demonstration project that does not have, in their booklet, the downside of delivering at home and having your baby die. We're talking about a situation where people are not informed, and it's government-sanctioned.
I don't care who you are in this province. There is not one woman who has come through the nineties who doesn't think, when they're going to deliver that baby, that that baby is going to be alive and well, unless they have a congenital defect that prevents them from being so. I want to know what this ministry has done, in terms of putting in a home birth demonstration project, to make my constituents aware that they're okay and that they are equally informed as to the pluses and the minuses of having a home birth.
[1955]
Hon. P. Priddy: Everybody wants -- well, I hope everybody would want -- this project to succeed, which means that it has to be scrutinized with vigilance. Every concern raised has to be examined not only by one body but probably by a number. In point of fact, that process is in place.
You have raised a number of points during your discussion that we have noted and will
follow up on. This is a project that was not done without looking at how it would work in
British Columbia. It was not done without a basis of research. But can they always be
better? Yes. And if there is any single or double or triple thing that we can do to make
sure that women and their partners, if they're there, have all the information to make an
absolutely informed consent -- or an informed decision, if you will -- about a home
delivery and that the guidelines around that reflect everything we can do to make that a
safe and, I hope, happy experience for people
A. Sanders: A couple of things in response before I read the questions into the
record. Number one, if you're going to look at a home birth demonstration project that
requires, for licensure in the college of midwifery, that a number of home births be done
prior to licensure
[ Page 14201 ]
ence in doing deliveries and they say that's not going to work, then you listen to them. You listen to them, because they're the people who live in that community. If they say that it's not safe to deliver at home when you live in Bear Lake and Mackenzie and on the outskirts of Prince George, then you listen to them, because they are right and you are wrong.
What we have incorporated into this home demonstration project is that the midwives have to do a certain number of home deliveries in order to be licensed. And you know what? That's wrong. You've started from the wrong place at the wrong time with the wrong principles. You are going to have babies die in this province as a result. There's no question about that. Whether they're in the Kootenays, whether they're in Cherryville in the Okanagan, whether they're at Bear Lake outside of Prince George, whether they're in Mackenzie or Mount Robson, they're going to die, because those babies are too far away to transport, and we don't have the infrastructure to do so. They cannot be helicoptered to a tertiary centre or a secondary centre in order to be delivered properly. The home birth demonstration project incorporates that belief system, and that belief system is wrong.
I speak for the women in this province who wait to have children until they're 35, 36, 37, 38, 39 and 40. We are in a province now that has an inverted pyramid. We do not have two parents with eight children. We now have two great-grandparents, four grandparents, two parents and one child. Those children are so valuable. We cannot move to a devolution of services. We have to have the women in this province know that when they go into labour, we as a province have sanctioned programs that will provide them with a safe delivery of their one or two children. There is nothing else that will work.
[2000]
If the minister feels that the home birth demonstration project provides that, then I want her to talk to her staff. I want her to think, when she goes to bed at night, and to make sure that those are the values that are garnered within what we're doing as a province. This is no longer outside of the system; this is in the system. This is for your children and for mine, when they make decisions.
The Chair: Shall the vote pass?
A. Sanders: Absolutely not.
Seeing that I don't have an answer, I'll read into the record the questions I want answered. Do certified midwives have the practical knowledge to screen out high-risk situations, under the home birth demonstration project? Does the minister realize that prenatal factors determine low-risk deliveries but that factors after labour are the ones that constitute high risk -- that these are a different set of factors, the set of factors that come into action when someone is delivering at home in Cherryville, an hour away from a hospital? What checks are in place to ensure the correct assessment of risk factors by those practising midwifery and to ensure emergency backup? Are there procedures in place in every region of the province right now to make sure that for people like Christina Sirr, whether they live in Mackenzie or Surrey or Vancouver or Cherryville, this will never happen again? What system for accountability, if any -- aside from lawsuits -- is in place for women to have retribution for the circumstances they've experienced under the home demonstration project?
What college licensing process requires that certification requires a number of home deliveries in order to remain licensed? I see that as a disincentive to acquire hospital privileges. For example, if I am a professional providing home delivery services -- whether I'm a midwife or a physician or anyone else -- why would I get hospital privileges? I could do all of my deliveries at home, thereby not having to worry about high-risk deliveries, transfer of patients and contacting an obstetrician. What things have been looked into to make sure that that doesn't happen again?
"The home birth demonstration project promotes safe and viable delivery of
babies." It has a stamp of approval from the Ministry of Health. Have we looked into
what regions do not provide backup services with respect to ambulance and hospital
services, hospital privileges, acknowledgment of obstetricians that they're now going to
be taking over care for those transferred cases. What unforeseeable circumstances have
been outlined to make sure that
I had a very large concern last summer when I was sent research from the Ministry of Health. I read it all, and I spent the last year looking over it in general. I found that the research sent to me was from European countries. It was sent from countries that had small, high-density areas and that had high infrastructure to make sure that home deliveries were going to be safe. A lot of them had flying squads that provided immediate infrastructure to make sure that the home experience was transferred into a secondary-care experience, where they were guaranteed a safe delivery.
[2005]
I want to know what literature the ministry is using now. I had extensive discussions with a number of experts in the area -- because this was a constituent of mine who was very unhappy about the death of her son -- and I talked to a number of world experts who have written extensively about the Canadian experience. And I want to know what the minister is doing, with respect to the Canadian-specific experience, to acknowledge and to justify home birth in Canada with respect to the literature that's been provided.
When I contacted the Ministry of Health last year, I was told that this was a
stillbirth and that I therefore didn't need to worry about the consequences. The baby was
a stillbirth, and under our legislation, a stillbirth isn't a problem. This parent took
her very unfortunate -- and, to them, very traumatic -- experience to the acting
children's commissioner, John Greschner, and he found that he couldn't investigate it,
because the child was a stillbirth. What happens in our province
I phoned the coroner, and what I found is that with the legislation we operate under -- the Coroners Act -- if a baby
[ Page 14202 ]
dies in transit to hospital
I want to know what the minister has done to look at that specific problem and to rectify it so that parents who decide to have births with a midwife or at home feel that somehow the province cares for them and that somehow the province will look after their needs.
It's a telling tale, hon. Chair, that the minister will not even answer those questions.
The Chair: Excuse me, member -- if you could take your seat for a minute. I believe we established earlier on that you would present some questions for the minister to answer later on, and you've done that.
A. Sanders: I presented ten questions for the minister to answer. The eleventh was a question for the minister to answer in person. So if there's any confusion over there with respect to those, I certainly apologize. But I think it's very clear to the minister. And it's very clear to those who listen to these debates that the answers have not been given to questions that are very straightforward for people who are looking at this circumstance. That in itself is very, very unfortunate.
[2010]
Interjection.
A. Sanders: Hon. Chair, there is a heckle from the nether lands of the gallery. Quite frankly, if you've lost your baby, this is not a temper tantrum that I'm going on. That is actually the most unfortunate thing I've heard in this chamber in the entire time I've been here.
Let's move on to mental health, seeing that there are no answers that have to do with the questions we've just looked at. In the next little while let's look into mental health. Mental health is a very important part of the health care area in the Ministry of Health.
[P. Calendino in the chair.]
Let's look firstly at the funding for the mental health area. On January 21, 1998, the government made a number of announcements about the new mental health plan. The minister at that time, the present Minister of Finance, couldn't keep herself out of the paper, looking at what we were going to do about mental health: "B.C. to Spend $125 Million to Get Mentally Ill Off the Streets"; "B.C. Acts On Plight of Mentally Ill"; "Mental Health Dollars Available in British Columbia." There was a plethora of announcements about mental health.
In that mental health announcement was a seven-year plan to replace Riverview with community mental health care. This was to provide housing and assistance for families of the mentally ill. The plan was to provide 2,600 housing units for the mentally ill and 1,000 subsidized units for personal housing. In the province right now we have 3,600 people on the waiting list for safe and decent housing for the mentally ill.
The present Minister of Finance, the minister at that time, said that there would be $125 million available for the mentally ill; that would not include construction of new facilities. If you look at that over an annualized kind of thing, it's sort of like $20 million a year plus pocket change. This was to look at the mentally ill in the province. In just one section, we have 60,000 people affected with severe schizophrenia and bipolar illness. If you look at it in terms of Victoria, that's like 10,000 people in a population of 330,000 who have severe mental illness.
When we look at this very grandiose plan
[2015]
Hon. P. Priddy: I am reluctant to go back to the subject before this, but I feel I must put on the record that I am not refusing to answer questions. My understanding was that the member was reading questions into the record. I have not refused -- ever -- to answer questions in this House, and I'm happy to answer any questions we can that the member has. It's important for me to put on the record that I am not in any way refusing to answer questions.
In the last two years, we've spent $26 million.
A. Sanders: If there are any questions from the previous discussion on the home birth demonstration project that the minister wishes to answer now, I'd be more than happy to hear them.
In that $125 million, some 2,600 housing units were promised. How many have been built, as we stand here in the House?
Hon. P. Priddy: It's 132.
A. Sanders: I suppose 132 is a start, with 2,600
Hon. P. Priddy: That really is under B.C. Housing, and I'm sure it was canvassed there. No one here actually has that answer quite close to them. Even though it's B.C. Housing, I'm quite prepared to get that answer back to the member.
A. Sanders: I think the reality here is that we are looking at a very small number of the housing units that have been promised. It's great for the minister to defer those to B.C. Housing; however, this is her mental health plan and that's where we're operating from.
[ Page 14203 ]
Last year, after the introduction of the new Mental Health Act, $10 million was promised for mental health. This is a very significant amount short of the potential $21 million per year that would be necessary to fulfil the $125 million in the mental health plan. However, with that $10 million, how much was spent in 1998-99?
Hon. P. Priddy: I want to go back to the previous question, because we do have the answer here. We've just signed a partnership with the Ministry of Municipal Affairs on housing, which we ratified to accommodate up to an additional 1,000 persons with mental illness.
A. Sanders: I don't believe my question was answered as to how much of the $10 million allocated for 1998-99 was spent.
Hon. P. Priddy: All of the $10 million was spent. Some $4.5 million was spent directly within the ministry, and $6 million was transferred out.
A. Sanders: That's not exactly true. Let's look at the facts. About $4.4 million was given by the ministry in the last quarter of 1998-99. Of that, $2.5 million went to the regions, $0.9 million for forensic, $0.1 million for the mental health advocate, $0.3 million for training professionals and, I think, $0.6 million for Riverview. So, actually, $4.4 million was spent in the very last quarter of 1998-99.
The other aliquot -- the $5.6 million -- was incubated in the HABC, an independent
organization that was used to incubate, hide -- whatever word you want to use for that
money
Let's be very clear with each other. We gave about $4.5 million, putting it in generous terms, to mental health last year, from a so-called budget of around $21 million, and $5.6 million was nestled in the nest egg of an independent organization and then reannounced as new money. None of that money was annualized. It was, in fact, a one-time allocation of money to be spent on projects, and I don't think it's even been spent yet, despite the fact that we're halfway through the year.
Could the minister give us a list of the projects that have come to her office for the one-time spending of that $5.6 million that was reannounced under the mental health plan?
[2020]
Hon. P. Priddy: While the $5.6 million was held by HABC for some one-time purposes, the $10 million is annualized into the base. The $5.6 million -- let me list some of them for you: augmentation of crisis-response, emergency mental health services in communities without psychiatric units, $1 million; support for educational activities associated with the provincial early intervention program; establishment of pilot telepsychiatry sessions in remote and rural areas; initiatives for regional system reform; support for a provincial best-practices conference; support for a conference to benefit rural and remote communities; and support for provincial information technology initiatives.
A. Sanders: You know, this government has $25 million a year to spend on advertising and communications, and if this is annualized money, then they'd better put some more into the mental health circumstance. A mental health announcement in the Province on May 4, 1999: "The B.C. government yesterday announced $5.6 million for mental health facilities. The money is part of a $125 million, seven-year boost to the mental health facilities announced in 1998." From my understanding -- and the minister can correct me if that's somehow misleading -- $1.5 million of that was annualized to relieve some of the pressure on emergency facilities and acute care for psychiatric organizations that had to deal with the transition from community forensic. All of the other money, as far as my understanding is from the organizations that received it, was not annualized. It was a one-time: "Here's your $5.6 million. Do with it what you will, and if you don't do anything you don't get it."
Maybe I'll leave it at that, and the minister can tell me whether that's in fact the case.
Hon. P. Priddy: It is correct that the $5.6 million was for one-time initiatives, if you will, or purposes. But the entire $10 million is annualized in the mental health plan base of the Ministry of Health.
A. Sanders: We won't wax eloquent here, when we're looking at a project that requires somewhere around $20 million a year and that we've given $5 million to -- and maybe actually annualized it. We'll see how much that is annualized as time goes by.
I think the minister has given me a partial breakdown of the $2.7 million that went to the regions. Will the minister provide me with a total breakdown of where that $2.7 million went?
[2025]
Hon. P. Priddy: I want to clarify that what I have here is the amount of dollars per region for adult mental health. I'm just not sure if that's what the member is asking about or if she's asking about the particular initiatives in each region that were funded. If she could clarify, that would be helpful.
A. Sanders: Either would be fine; both would be better.
Hon. P. Priddy: I can't break the projects down by region for you now, but I can
certainly
A. Sanders: I'd like that in writing from the minister.
What are the annualized projects?
Hon. P. Priddy: The ones I just read are all annualized.
A. Sanders: I'll look forward to receiving that in written form.
The 1999-2000 budget promised a $10 million top-up for mental health. That did not happen. Where is it?
Hon. P. Priddy: I understood the question to be that there was a $10 million top-up promised. As I'm looking around at
[ Page 14204 ]
my deputy and the ADM in charge of mental health, I'm not seeing them understand that question. Maybe you could help us a bit more.
A. Sanders: We will do that in a written form. My understanding from the organizations on the periphery is that there was a promised $10 million top-up in this year's Ministry of Health budget specifically targeted at mental health. It was not there, and individuals within those interest groups are wondering where it is. The minister can get that information to me in writing.
To make an overview and to acknowledge the people who are watching, we spend about $1 billion a year on mental health in this province on a population of four million people. Is this amount of money spent on target populations? In other words, to me as a citizen the target populations would be the severely mentally ill. How does the minister ascertain whether that money reaches a target population, yes or no?
Hon. P. Priddy: There are a couple of ways -- and then I want to comment on who
is most vulnerable, if you will; I think that was the phrase the member used, or something
like that. One of the ways is by the accountability that the health authorities have.
We've been very specific with health authorities about having to account in all areas, but
particularly in the area of mental health, in terms of their needing to be accountable to
us that any additional dollars are being spent on people who are the most vulnerable or
seriously challenged -- and we've identified who those are. But the other part -- and I
think the member herself is interested in the area of early intervention
But there is accountability on the part of the health authorities and, just in small part, the Medical Services Commission, which has an accountability and a reporting responsibility around how those dollars are spent in terms of physicians' services for those people.
[2030]
A. Sanders: Well, physicians' services are a very small part of the mental health budget. We need a strategic plan to ascertain that there is appropriate allocation of mental health dollars to the mentally ill. What statistics show us now is that approximately 20 percent of the dollars we spend actually go to the severely mentally ill. As we pointed out last week, that doesn't even cover a number of the acute-psychotic medications that are absolutely necessary for appropriate intervention for the very severely mentally ill.
When we look at health care costs, 20 percent of those costs, whether people like it or not, go to mental health in one way or another. About 80 percent of the costs of health care cover what we would call the top ten issues of health care. Believe it or not, those top ten issues are all psychiatric diagnoses. Why those diagnoses cost so much has to do with length of stay in our organizations, whether it be Riverview Hospital, the emergency ward, the psychiatric ward of the local hospital or the mental health clinics that our patients reside in for ongoing services, or the mental health teams that work in the communities. When we look at what mental illness costs our society, prevention is one of those things that can go a very long way in trying to accrue health dollars back into the system for all of those folks who now require services for broken hips, osteoarthritis, osteoporosis, cardiac disease, etc. In fact, for the mentally ill, the Clarke Institute's top three issues were housing, which was identified in the mental health plan but which we haven't actualized yet; drugs, which we went over last week with extensive canvassing -- those drugs have to do with assertive case management and making sure that those drugs are available for our patients who are psychotic either from schizophrenia or from bipolar disorders; and crisis management, which is something that the money from the mental health program was to activate.
I'd like to move on to Bill 22. Bill 22 is a piece of legislation that we passed in the very late hours of this Legislature, at a time not dissimilar to now -- the sort of nadir of the month of July -- in 1998. This bill has not been proclaimed. What does the government plan with respect to following through on the commitments of Bill 22?
Hon. P. Priddy: Let me just go back for a moment, and then I'll answer the current question.
In terms of physicians' fees for psychiatry, while they may not be the largest part, I don't think that they are a very small part of the overall budget. They are indeed $125 million, which is slightly over 10 percent of the mental health budget, so I don't consider that a very small part of the budget.
The other thing I would note is that we do have a best-practices initiative within the ministry. That target population has been defined within those best-practices working groups, and those working groups are working very specifically around those individuals or those areas that have been defined as either the most vulnerable or the most in need of support. So that's another way that we make sure that we serve the target population.
In terms of Bill 22 -- which I think passed unanimously last year, but I'm not sure -- the government will be, I would hope, proclaiming that reasonably soon. The reason it has not been proclaimed so far is as the result of an amendment that was accepted last year. It was put forward by the opposition and accepted by me, as the minister, and by this side of the House. As a result of that amendment, the bill was delayed until this session, until those things could be incorporated into legislation.
[2035]
The Chair: I just want to remind the members on both sides, quoting from Parliamentary
Practice in British Columbia, that "the necessity for legislation and matters
involving legislation cannot be discussed in Committee of Supply
A. Sanders: We are discussing last year's legislation, just to bring the Chair
up to date. We have had a plethora of bills brought forward
The Chair: Member, would you please take your seat. I'm advised that we cannot discuss legislation in Committee of Supply.
A. Sanders: Thank you, hon. Chair. Bill 22 is a very important bill to very many people, whether they be family members, people who are accessing the mental health system
[ Page 14205 ]
or people on mental health teams. I would have anticipated an omnibus bill through the
Legislature to change "mentally disordered persons" to "persons with a
mental disorder," which I understand is what is necessary. From a government that
said that we are probably going to be out of here on July 15
The mental health plan's objectives of service include a number of things. One is the development of appropriately flexible therapeutic plans to effectively treat and manage disorders. I refer, for the sake of brevity, to the discussion on Wednesday, June 30, 1999, where we looked in very significant detail at the access to new antipsychotics.
For a very short pr�cis, what we did during that time was look at first-line drugs, reserpine and clozapine; we looked at second-line drugs, olanzapine, available on special authority; and we looked at Seroquel, a medication that is about the same price as reserpine -- $150 a month or so -- that is not covered at all by British Columbia. British Columbia is the only province, incidentally, that has these restrictions.
This medication is for schizophrenia, which is a complex neurobiological dysfunction where people do not perceive or make sense of their experiences. If you look at the natural history of schizophrenia, one-third of people who experience schizophrenia will have psychosis at variable times; one-third will recover completely; and one-third will suffer continuously from the disorder. What happens from that inner experience of irrational belief systems and abnormal perceptions for people who, in general, average around 23 years of age for men and 27 years of age for women is that we have a group of individuals in our society who, on an average of 50 percent, attempt suicide. Ten percent of those individuals are successful. We had 551 deaths related to mental illness last year in British Columbia.
[2040]
So from that inner experience to the outer experience of desperate families who have had to deal with the disintegration of their family members, their friends, their associates, their relationships -- if not the death of their family members or if not the death of themselves, as Ruth Millar personally experienced in this particular community. We have individuals who have had their sick and disabled family members move on to unemployment and, eventually, poverty. For those people who have schizophrenia, the income through social services is around $500 per month in Victoria, with $450 being the average rent here; for those who have a disability benefit, it's $771.
The minister has told me she will look into this very serious problem of access to medication, and I believe her. She's worked in mental health. She understands mental illness, and she certainly understands the plight of the mentally ill within society. I have no question that she will look into access to new antipsychotics and access to the smorgasbord of new antipsychotics that need to be available under government sanction for those people in our society who are a danger not only to themselves but to many of us.
Having quickly over run the most important part of the mental health plan, which is access to antipsychotics -- because we've already described that and discussed it under another area -- I'd like to look at a couple of areas in the mental health plan that need clarification. One that I was very concerned about when I read the mental health plan, which I am in support of, is that the mental health plan is silent on what I consider to be provincial concerns of mental health.
These days, it seems, we're all for moving into regionalization -- the compartmentalization of health care. Quite frankly, that may be good when you're looking at certain services; but when you're looking at services that require leadership -- mental health being one of them -- it is inappropriate to regionalize those services. I look at the areas of forensic psychiatry, I look at the areas of women's needs, and I look at the areas of neuropsychiatry. When we have a mental health plan that has totally focused on regionalization and the regional plan, why is the mental health plan so silent on areas of provincial concern?
Hon. P. Priddy: Other than saying that forensic is already provincial, of course, two out of three priorities identified for this year are provincial in scope. One is the initiative around Riverview, which is indeed provincial and is relieving pressures. The second one is around mentally disordered offenders, which again is provincial.
A. Sanders: With respect, if the minister reads her own report on the mental health plan, she will find that these issues are not addressed very well in the provincial nucleus. I hope that the ministry, in its wisdom, will look at those. I understand the forensic one and the devolution of forensic into the regions, but there are a number of women's issues that are not regionalized to any extent in any plan that you would see. They need to have leadership; they need to have it from the minister. She needs to recognize those areas where she needs to be. Other provinces have addressed these issues very well, and they have included them in their health plans. I look forward to seeing the minister look at those, with respect to other jurisdictions, to make sure that British Columbia is doing the same.
[2045]
I'd like to turn to housing. I can't say that it's the second-most important because I'm not sure that it's not the most important. Access to acute antipsychotics and to housing are issues that are so integral and intertwined for the mentally ill that they cannot be separated. There have been many papers in the last decade that have looked at the devolution of Riverview -- "Between Madhouse and Flophouse." We know that many of our mentally ill do not end up in the suburbs. They do not end up in subsidized housing. They end up in areas of the province where most taxpayers have never, ever ventured. This has to do with affordable housing.
To the minister: with respect to the 2,600 housing developments that were promised and the 1,000 that were promised with a subsidy for the mentally ill, does the minister have a strategic implementation plan for housing for the mentally ill? Is this available for the opposition?
Hon. P. Priddy: I expect that housing, whether it's for someone with a mental health challenge or other people who are vulnerable, is probably the very first thing that helps make people safe and healthy. Of our seven best-practices working groups, one is working specifically on the area of housing to help us develop that vision as we move along. But as I've already indicated, we have signed a ratified agreement with
[ Page 14206 ]
the Ministry of Housing for 1,000 supported housing units. We have 132 that have already been built, and that's the status of that to date.
I want to go back just for a moment, though, to a previous question. When you look at the 81 commitments made in the mental health plan, 21 of those commitments are specifically related to provincial initiatives. While that is clearly not all from the province, 25 percent of the commitments are specifically related to initiatives by the province.
I wasn't quite sure what the member's reference was around women's health, but improved services for women with mental illness through the implementation of the mental health plan have been a significant focus, both of the mental health division of the ministry and of the Minister's Advisory Council on Women's Health. I don't know whether we canvassed this before, but we've had research and consultation regarding the response of service providers, which one of your other members canvassed with me under women's health. We're doing a training symposium for sexual assault and transition house staff to work more effectively with women with serious mental illnesses, because not feeling well accepted and having staff not understand when they seek those services is often identified by mental health consumers.
We've done a provincewide research project on women-centred mental health care, which we have funded along with support from Women's Equality and the B.C. Centre of Excellence for Women's Health. We have several other demonstration projects underway, and there's a pilot project going on in the capital region regarding screening and responding to domestic violence issues among women with mental illness. We certainly have considered the issues of women with mental health issues quite seriously, I think.
A. Sanders: We'll debate that a little bit further -- that the issues of women
are regional issues. They are not regional issues, and with one in four of our women in
British Columbia experiencing a major depression at some time during their working lives
With respect to new housing, it's important for the minister to acknowledge that a lot of these new housing circumstances are not new housing; they're renovations to housing that already existed. It is very important for the mentally ill in British Columbia to recognize that we don't have a lot more new housing this year than we did last year. We may have some renovations to old housing; but if we're looking to the construction industry to be providing us with brand-new buildings, that is something we will have to look forward to under a different administration.
We are in a situation presently where we have a waiting list of about 3,600 people
looking for subsidized
[2050]
Hon. P. Priddy: The waiting lists are kept by health authorities, and that information is shared with us.
A. Sanders: What is the strategic plan for managing that waiting list?
Hon. P. Priddy: The best-practices working group that's working on housing will be coming up and is currently working on some very specific strategies. I think that in many ways, those have to do with how the housing is actually delivered and supported. But in the meantime, as I say, we have started to build new units, and we have an agreement for 1,000 supported units with the Ministry for Housing.
A. Sanders: Just not to confuse the public, those are not new units. They are units that were in existence previously or perhaps remodeled or renovated.
With respect to the downsizing of Riverview, how much of the housing that is on the market is transition housing, and how much of it is for stable mentally ill?
Hon. P. Priddy: There are 22 transition beds on the grounds of Riverview. The rest is, if you will, stable housing stock.
A. Sanders: Well, seeing that we're talking about Riverview, let's just go there. How many beds are currently available at Riverview?
Hon. P. Priddy: There are 808.
A. Sanders: I think, again, that it's important for the communities to recognize that of the 808 beds -- Riverview being a 1,500-bed organization, certainly within my lifetime -- we actually have about 100 beds that are movable. The rest of those beds are occupied by people who could never be cared for at this time in the community. So we have 100 beds that are liquid and that allow for transition in and out of Riverview, which does account for the fact that wait-lists are still a problem in Riverview, regardless of the fact that 808 beds sounds like a whole lot of beds.
What is the plan in the '99-2000 budget with respect to beds at Riverview?
Hon. P. Priddy: We are committed to the provision of effective tertiary-level psychiatric care that is responsive to the needs of the regions. There are two pilot projects currently proceeding: Seven Oaks in Victoria and the 88-bed hospital in Kamloops. Once these two have been evaluated, we'll be in a better position to assess future developments.
[2055]
A. Sanders: We won't even go to the place where Kamloops is not the centre of the region for which it's going to provide, because that's a whole other story in a whole other book. However, it's important for the minister, who lives in the lower mainland, to recognize that Kamloops is not the centre of the universe and certainly not the centre of the psychiatric universe for the Kamloops-North Okanagan-South Okanagan region.
With tertiary beds, one would hope that the beds lost in Riverview would equal beds gained for care in the regions. What accountability structure is in place to ascertain that that will happen?
Hon. P. Priddy: Because there are more resources being directed towards the community in terms of housing and other kinds of supports in the community, we would expect to see a different kind and certainly more movement and a greater flow-through at Riverview. We'll be holding the regions accountable for their activities.
[ Page 14207 ]
A. Sanders: That doesn't answer my question. With the downsizing of Riverview, how many beds have been available in the community for tertiary care?
Hon. P. Priddy: As I'm sure the member knows, the actual downsizing of Riverview was halted in 1996. When people leave Riverview, the intention is that the dollars are attached to the patient and will move to the region with them.
A. Sanders: If that is the intent, then I concur that that is a very good idea. The dollars should follow the patient, with respect to mental illness. If they don't, then we're doing a tremendous disservice to British Columbia in general. Riverview needs an accountability model. Riverview is operated by a society. We're in a circumstance right now where we have a hospital where nurses are doing the same job in Riverview that they might do in an acute-care hospital for around $3 per hour less than a concomitant nurse in another area. What measures has the minister taken to bring Riverview into the accountability model, with respect to staff that other hospitals share?
Hon. P. Priddy: The Riverview facility reports as any other health authority does: on a monthly basis to the ministry, in the same way that the South Okanagan health authority or anyplace else -- North Okanagan -- would report.
[2100]
A. Sanders: Riverview operates as a society. We need to look at Riverview in a global perspective, I think, at least. We have a number of problems at Riverview that will come into account for whatever administration adopts this province as its child to nurture. We have a mean age of nurses at Riverview of 47 years -- which, incidentally, is the same age as the patients at Riverview. We have 50 percent of the psychiatric nurses at Riverview who will be retiring in the next five years. We have the 85 rule in place, which will probably mean that more people will be heading to retirement than we would have anticipated. There needs to be an action plan. We also have psychiatrists at Riverview, as well, who are about the concomitant age of those in the nursing profession who operate there. Riverview has stood as an island unto itself within the health care profession during the time that I have followed its course.
I would make a number of recommendations to the minister. The first is that we start doing some rotational services through Riverview for other nurses and other psychiatric places and do some kind of equalization of people, so that Riverview is a place to go for people who are interested in psychiatric nursing and not the poor cousin of the acute-care hospital. Whether that is the nursing profession or the psychiatric profession, I think that is appropriate and important. I think that the Riverview board needs to be incorporated into the overview of regionalization, if that's where we're going to go in the future. For the people at Riverview, we have the same provincial and academic interests that are shared by UBC, Vancouver General, St. Paul's -- whatever hospital you would like to look at. I think they need to be drawn into the umbrella of professionalism and the umbrella of accountability that is shared by other areas in the region. I would look forward to the minister looking at that and making sure that Riverview is part of the family and not an individual structure. With that, I would have the minister recognize that there is the need for an action plan, both for psychiatrists and the nursing profession who occupy the halls of Riverview and for those of us who have visited those halls either as patients or as practitioners.
I want to turn to access to services. Aaron Millar was a member of this community, and his mother was killed by him not very long ago with a ceremonial sword. Aaron Millar was acutely psychotic, schizophrenic and untreated. We won't at this time go into why he was untreated, but again, this community is very acutely aware of Aaron Millar's story. In that homicide, the inquiry recognized that 37 beds per 100,000 was a number that they felt was appropriate to garner access to services for the mentally ill. For a paradigm, the South Fraser region alone, which the minister is a member of, would require 120 additional beds at this time in order to satisfy that requirement from the inquiry. To the minister: is there any region in British Columbia that is adequately staffed according to the Millar homicide inquiry?
Hon. P. Priddy: If the standard the member is using is the coroner's report, I think you would have people who may use different kinds of numbers than the coroner's report. But if that's the standard that the member is asking about, the answer is no.
A. Sanders: That in itself is a telling circumstance. You know, mental health in this province -- in the world -- is a situation that, as a health care giver, is one of those things that people have been very reluctant even to acknowledge. It's okay to have prostate cancer; it's okay to have breast cancer. It's okay to have some disease that requires a physiologic or operative procedure. But mental health in the nineties, believe it or not, is still not an accepted and acknowledged and condoned circumstance for many. The Millar homicide has shown us, if nothing else, that we don't take this issue seriously -- despite the fact that in the top ten issues of what we look at with respect to health care dollars, mental health issues keep coming up.
The minister said that no region is staffed adequately, according to this inquiry. Along that line -- for informational sake -- it's appropriate and not unimportant to recognize that Delta has no psychiatric beds and that access to psychiatric beds at Richmond has been reduced. We all know that Richmond has regular corporate days, because they're not funded adequately to operate a full hospital. Again, access of the periphery to referral hospitals has been decreased. Delta is underfunded with respect to the per-capita average of the region -- again, part of the minister's area -- and, as far as I am aware, there is no action plan to look at that.
[2105]
In that one particular area -- and I mention it because it's the minister's area, and she would be familiar with it compared to Vernon, where I live -- children and adolescents are not even included in the mental health plan. There would be an additional 14 beds necessary by 2006 if we took in adolescent requirements from the mental health perspective.
We have a situation where not only has the mental health plan ignored children and adolescents but the ministry has taken adolescents and children and put them into the Ministry for Children and Families. We had a discussion on that earlier with respect to health care and how, quite frankly, that is a decision of concern, because it does not provide longitudinality of decision-making. Adolescents become adults, and their mental illnesses do not go away.
[ Page 14208 ]
One of the key strategies of the mental health plan was increased access to mental health centres in the regions. Could the minister tell me how many staff have been added to mental health services within the regions, so that we can activate the mental health plan?
Hon. P. Priddy: There have been 65 added this past year, on top of the staff that are already there. I would note that in the South Fraser region, with the construction of the tower at Surrey Memorial, there's an accommodation for 12 adolescent psychiatric beds.
A. Sanders: That pleases me. That's 12 more than they had previous to my discussions with that group.
As she's come from the Ministry for Children and Families, therefore now, as Minister of Health, the integration of those experiences will be very important to the minister. What we've done when we incorporated services is create a barrier to accessing services within mental health. Because of the incorporation into the Ministry for Children and Families of child and adolescent mental health, drug and alcohol addiction and other services, we now have a circumstance in government facilities where patients -- clients -- often have to go by the drug and alcohol counsellor that they're dealing with. They have to then go by the Ministry for Children and Families staff that have apprehended their children. They go by that into seeking the services of mental health counselling for whatever their individual condition is. This in itself creates a formidable barrier to access to services that, quite frankly, didn't exist three years ago.
This is prevalent across the province. This is not a fundamental of my community that is not extended to others. Has the minister been made aware of this? If she has, what solutions does she have to make sure that we are not creating barriers to access to services within the system?
[2110]
Hon. P. Priddy: I know that the member started her comments by speaking about children, but I assume that the question about the integration of services is about adults. Would I be correct?
Interjection.
Hon. P. Priddy: Yeah, thank you.
Certainly there's no question that I've heard about it; I've heard about it both with children and with adults. Our staff have travelled around the province. They've certainly heard about that; they've had that information fed back to them. The answer to this is the on-the-ground coordination and integration of services. I don't think that's something you can do at a provincial level. But you can do it on the ground and with some cross-training, which I know is currently going on in the field, in the area of both children and adults.
I also want to note, before we conclude the evening, that I have some answers to questions that some of your other members asked, and I will read them into the record. It will probably take about five minutes.
A. Sanders: I would be happy to receive those in writing -- because we are very short of time -- if that's okay with the minister.
The important point here is that we have the Ministry for Children and Families in charge of addictions, the Ministry of Health in charge of mental illness and the Ministry for Children and Families in charge of apprehension. They often have one secretary who coordinates all of those appointments. We have had individuals coming to access services in the last two and a half years who need all of those services, and we have created barriers to those individuals becoming healthy.
No matter how you slice it, that's not okay. We need to look at that. The minister needs to recognize that those are very serious issues. Her ministry needs to address those so that we can look at access to services and make sure that we are not doing things to add to the very serious circumstances in which services are not accessed by people in the population who would voluntarily do so.
I welcome the minister's responses to the other questions in writing.
In the last 15 minutes that we have, I'd like to talk about a number of areas. The first is the mental health advocate. The mental health advocate -- Nancy Hall, who is very respected around the province -- is required to submit an annual report. My colleague from Vancouver-Quilchena talked about the lack of annual reports within the Ministry of Health. Is there an annual report from the mental health advocate that we should anticipate in the near future?
Hon. P. Priddy: To the best of my understanding -- and the understanding of the ADM to whom the mental health advocate is responsible -- she's not required to submit an annual report. She reports directly to the ADM.
A. Sanders: That's a very concerning circumstance, because I can tell the minister, anecdotally, that many organizations anticipate an annual report from the mental health advocate. Whether that was public or internal has not been ascertained by those groups, but I think, to look at the collective wisdom, that they were certainly hoping that the mental health advocate would have a public report. We are aware, through our conversations in briefings with the ministry, that the mental health advocate reports directly to the Ministry of Health -- to the deputy minister, I believe. Does the minister feel that a mental health advocate, which by definition should be an independent body, can truly perform the functions of the role by reporting to the Ministry of Health, who employs them?
Hon. P. Priddy: Actually, yes, I do. The role of the mental health advocate is not as an independent officer of the Legislature. The role of the mental health officer is to be an advocate in the system and recommend changes to the ministry in the same way that has worked very effectively in what is now the Ministry for Children and Families but before that was Social Services or Human Resources. The quality advocate in that ministry makes internal recommendations to the ministry on issues that affect the lives of people who live with mental handicaps. So in point of fact, as the job description is stated, yes, I think she can be quite effective that way.
[2115]
A. Sanders: If the minister truly believes that, I have some swampland for sale for her.
The mental health advocate, according to the umbrella of organizations that truly care about the mentally ill, is an
[ Page 14209 ]
advocate for patients, an advocate for families -- for those people who, whether they like it or not, are involved in mental illness. That individual, in the same way that Joyce Preston reports to the public, should report to the public. The fact that they report to the ministry is a very good way to make sure that they don't report at all.
Let the record stand that there is concern about whether that advocate reports to the public, and let the record stand that the advocate does not report to the public at all but reports to the ministry. Thereby the issues that she feels are important will not necessarily be reported upon to the people who, on a day-to-day basis, have to deal with mental illness.
Let's move on to psychiatric services. One of the things in the mental health plan was a plan to request maintenance of core mental health services in each geographic area. Could the minister please define for this House what core mental health services are?
Hon. P. Priddy: Depending on where you are in the province -- and I know the member knows that -- there are primary, secondary or tertiary care services, so it's a little hard to say what is core. The best-practices working committee that is currently doing work will be making some additional recommendations to us about what must be present in a particular region or in a particular area, but it is currently defined simply by primary, secondary and tertiary services.
I would say, however, if I can go back to the mental health advocate for just a moment
A. Sanders: What are we trying to do in this province? Are we trying to actually improve things, or are we trying to cover our behinds? The reality is that if we're trying to do things, then we have a reporting structure that reports to people in the province so that we can make changes that are accrued from deficiencies within the service. Quite frankly, if someone looks at all the mentally ill people and their families in the province and reports to the minister, who can then cleanse the argument so that the report back is that everything is wonderful in British Columbia, we all need ruby slippers. That's not okay.
[2120]
The minister has said that core services depend on whether you have primary, tertiary or secondary services within your area. The minister has obviously never had a mental illness or dealt with mental illness, because core services are access to medication, housing and services within the community. And you know what? It doesn't matter where you live. You can be in North Overshoe or right next to St. Paul's. Those don't change. We need to have a definition of core services so that the mental health plan can work.
We can't say that we have core services and a strategic plan -- which nobody has been able to show me -- without defining what core services are. I now know that we don't have core services and that the regions don't have a list of what the core services are. I now know that regions can't compare themselves to ascertain whether they have more core services than another, because they haven't been delineated. I now know that we don't have a strategic plan to ascertain which regions have core services and which don't.
The good thing, as the minister said earlier on, is that the dollars will follow the severely mentally ill. If they need core services -- whether they are living in McBride, Zeballos or next door to St. Paul's -- those dollars will follow them in the future. The region may actually be funded for those who are acutely and chronically mentally ill so that they can be looked after and not be a danger to themselves and to society.
The minister mentioned early intervention. I have several questions on early intervention that I hope to get through before 9:30. Early intervention is a component of all mental health programs. They have conferences on early intervention. The importance is that early intervention doesn't just mean that when you're two or three or 13, you get services; it means that when you develop a problem, somebody in our society actually comes to look after you. If the government is truly committed to early intervention, they will have annualized services in the fiscal plan to establish early intervention for people who have a mental illness. What early intervention strategies, with annualized dollars, has this ministry got with respect to mental health?
Hon. P. Priddy: There is $1 million in this year's budget for early intervention programs.
I want to go back to the question around core services. I guess it depends, in different ways, on how you would define core services. But a different definition in the ministry would certainly be relevant to the seven best-practices working groups, which would also be a way of looking at core services. Regions do have these, and they do measure themselves by them: consumer initiatives, family support, assertive community treatment, crisis-response emergency services, in-patient and out-patient services, housing and psychosocial rehabilitation and recovery services. That's a different way to look at what would be core services in the regions and what we might measure that by.
I don't think it is just to say that there is no strategic way to look at this. When we look at the provincial plan for the province, we do have strategies for the decentralization of Riverview Hospital -- with things under each of these, of course: a best practices and evaluation centre; a supported housing and residential care strategy; an emergency acute mental health care strategy; a rehabilitation and employment project; consumer and family support; an early identification and intervention strategy; an outreach and clinical support initiative; and clinical human resources development, including education and training for clinicians and support workers. In terms of the work of the ministry, it's the work around policy and standards and the best-practices working groups, information technology, the mental health advocate and the other advisory structures that are available to us.
[2125]
A. Sanders: Again, just for clarification to the minister, if she's truly looking at early intervention, then she will remember that no matter how many pages you bring forward, early intervention is access for acute psychosis to all of the medications that are available; it is housing; it is support for families and annualized dollars for programs, none of which we've heard about tonight. If we go back to the antipsychotic medications, this province is the only province in the entire country, to this date, that is not willing to look at that. I look forward to
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the minister changing that so that when I come back to this House in whatever time, we will know that people who are so sick and cannot represent themselves will have access to all of the medications.
I have a very short period of time, so I'm going to put questions on the record to the
minister. I think they're so critical, they don't require answers
We have moved those dollars over, and according to Joyce Preston, those programs that had dollars for mentally ill juveniles have moved over. They have not materialized into programs that have been translated into the Ministry for Children and Families. Those dollars have been absorbed; they've gone somewhere into outer space. Now we have children and youth who do not have programs for their mental illnesses. As the minister knows from the discussions we've had, this is where schizophrenia develops; this is where acute psychosis develops. So not only do we not provide them the drugs, we don't even provide them with the programs anymore. I want to know: in the Ministry for Children and Families -- because the Ministry of Health used to be responsible, and I want the minister to look into this -- where did that money go? What programs were transferred, and where did they disappear? Is this where the children's mental health should be? Should it be back in the Ministry of Health? That, again, is because mental illness occurs in the adolescent.
The other things that occur for adolescents, which should be under the Ministry of Health and are no longer, are eating disorders, gay and lesbian issues, addictions and abuse. These are issues that are not under the Ministry of Health any longer. They come through every health care worker's office on a daily basis. And I'm sorry, but we don't say: "Go to the Ministry for Children and Families, because these are now under that ministry." They are health issues, and I want to know what the minister has done.
Women-centred mental health research. There was a project that was to end in April 1999. I want the results, the content and the continuity for that project and to understand what we spent that money on within the Ministry of Health, because women's projects are important.
Seniors. We have a real problem in seniors with dual diagnosis. Again, it comes back to addictions being under the Ministry for Children and Families, which is ridiculous. I want to know what the minister has done to make sure that that's the right place for it to be.
In conclusion, I thank the ministry staff for illumination of many problems and the opening of many other doors. I thank the minister for her time. I look forward to answers to all the questions, which have been offered in a non-partisan way. You know what? These are what are important to people in British Columbia, regardless of whether you're a Liberal, an NDPer, a former PDA member or an independent. We have to answer these questions. We have to answer them here, and we have to answer them now. There's no excuse for not doing so, and I look forward to the ministry and the minister taking on that responsibility.
Hon. P. Priddy: I thank the member for her comments. We will answer all of the questions, because we've answered all of the questions throughout the entire estimates, and that's what we will continue to do. So we don't consider it a reason for not answering them either, and we've made every effort to do so throughout the estimates. But I thank the member for her comments and her questions.
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Vote 36 approved.
Vote 37: vital statistics, $7,060,000 -- approved.
Hon. P. Priddy: I move we rise, report resolutions and ask leave to sit again.
Motion approved.
The House resumed; the Speaker in the chair.
Committee of Supply B, having reported resolutions, was granted leave to sit again.
Hon. J. MacPhail moved adjournment of the House.
Motion approved.
The House adjourned at 9:32 p.m.
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