LEGISLATIVE ASSEMBLY OF MANITOBA Monday, 27 April, 1987. Time - 8:00 p.m. CONCURRENT COMMITTEES OF SUPPLY SUPPLY - HEALTH MR. CHAIRMAN, C. Baker: Committee, come to order, please. Who's first? Are we going to have some figures for the Support, or how are we dealing with that? The Honourable Minister. HON. L. DESJARDINS: Don't worry about it. We'll finish Health and then we'll have first, Minister's Salary and, during that time, we'll finish before we pass Minister's Salary.- (I nterjection)- What are you laughing for? � MR. CHAIRMAN: Okay, are we finished? We've got , Ambu lance Program now,

Section 7. I don't see any hands up. I assume the Member for Pembina wants to ... MR. D. ORCHARD: Mr. Chairman, wasn't the Minister going to give me some information over the supper hour? HON. L. DESJARDINS: We brought that document. The other thing, we said we'll give it to you as soon as possible. Is there anything we were supposed to get tonight? MR. D. ORCHARD: Mr. Chairman, just on Ambulance before we leave, the Commission, according to the annual report, "ambulance vehicles and equipment are inspected annually to ensure compliance with minimum standards.

" There's been the odd community and one of them - gee whiz, I've got to get the road map - Billy Uruski's area on No. 6 Highway. I talked to the chap up there, and basically they were in the process of � looking for a new ambulance even though their other one had low mileage and that sort of thing because it didn't quite fit standards, and they were being put to some additional cost. How often do we retire serviceable ambu lances because the y don't meet minimum standards? Is ii because the standards are changing on a regular basis?

They were in the process of buying one from the Forces Base that was being wound down in the north . end of Billy's constituency. A MEMBER: You mean the Gypsumville? MR. D. ORCHARD: Yes, the Forces Base, but it wasn't Gypsumville where the ambula nce was going into service. HON. L. DESJARDINS: Mr. Chairman, this is only a guideline, but it's usually approximately 14 0,000 miles - not kilometres, miles - or eight years, but that's a guideline of course. The one that you're talking about, I'm told did not meet the minimum standards on this. It would have been poor service. MR. D.

ORCHARD: I didn't see the ambulance, but the y were of the concern tha t it was reasonably serviceable yet , and I only bring it up because everybody's short of money. It wasn't life threatening, but then I guess maybe the one time it may have been life threatening, everybody would get blamed, wouldn't they? Isn't that what we try to cover ourselves for constantly in this little legislative game we play? Okay, that can pass, Mr. Chairman, unless there are other questions. MR. CHAIRMAN: Ambulance Program -pa ss. Air Ambulance Program - the Member for Pembina. MR. D. ORCHARD: Mr.

Chairman, now this is Air Ambulance. This is the one that applies throughout the province basically. HON. L. DESJARDINS: To what? MR. D. ORCHARD: This Air Ambulance Program is the one that applies throughout the province. This isn't strictly restricted to Northern Manitoba? HON. L. DESJARDINS: No, on emergency situations. MR. D. ORCHARD: Okay, can you provide at a later date the details of usage in the first full year? HON. L. DESJARDINS: From Janua ry to the end of December 1986, Lifeline has transported 458 patients. The majority have been from north of the 53rd Parallel.

However, 79 patients have been from Dauphin, Swan River and Brandon. The 19 87-88 budget includes $1. 751 million for operational costs and $1. 0 44 million for leasing costs. The experience that we've had during this first year, it's been found that approximately 25 percent of the cases being tr ansp orted requi red a physician in attendance, and the Mani toba Health Services Commission is at present exploring the idea of retaining an emergency critical-care physician on call to provide the service to the Air Ambulance.

If you remember last year, I also stated that we were going to look at the operation this year, and we wanted to see that we get our money's worth; in other words, if we have to pay for the pilots and pay for the nurses if they're on stand- by. Also, we would look at improving the situation. We've made some recommendations to Cabinet, and we haven't got that yet, but we're not asking for more money, just the money that's here. We feel that we could expand in some areas of the North probably with the same money that we have now. MR. D.

ORCHARD: Are you saying that you're in the process of moving the air ambulance and stationing it out of the North? Is that what you're saying? 1345

Monday, 27 April, 1987 HON. L. DESJARDINS: No, no. Stationing it in the North? MR. D. ORCHARD: Yes. HON. L. DESJARDINS: No. MR. D. ORCHARD: Okay, so that . HON. L. DESJARDINS: I'm looking at the possibility of increasing the service, because the cost, of course, is for the pilot and staff. If they're standing by doing nothing, for a few more dolla rs we might be able to increase the service, but that will be announced. We don't have to wait for a year. If there's anything at all, that will be announced. MR. D. ORC HARD: I thank the Mini ster for the add itional information which jus t did nothing but confuse me.

HON. L. DESJARDINS: Well, that's part of the game. MR. D. ORCHARD: I realize that. HON. L. DESJARDINS: Let me try to be fair and be a little more specific. There's a possibility of going out of province. I offered this bit of information because that was discussed last year, the possibility to see that. Then there are some places up North that we might be able to cover also with approximately the same cost. MR. D. ORCHARD: Okay. Now that means that one of the instances, I think, that I've discussed with the Minister, and I know that he's had correspondence on, is certain heart procedures.

I'm not a medical expert, so I don't know what they are, but they are unavailable in Winnipeg and people go to London, Ontario for them, and transportation there is to Toronto and then back out to London. It's very complicated. HON. L. DESJARDINS: That's exactly the kind of thing we're looking at. MR. D. ORCHARD: That would be at no cost to the patient? HON. L. DESJARDINS: I doubt if it would be at no cost, but there again, this has to be approved by Cabinet. We're looking at the actual costs though, not the staff. Just running the plane would be quite highly subsidized.

I'm not saying that it would be at no cost at all. MR. D. ORCHARD: Well, that's a very interesting development because that was causing problems. However, it was not only the logistics of getting into London, Ontario; it was also the cost as well. HON. L. DESJARDINS: A charter flight to Toronto now would be $6,500.00. Well, anyway, it would be cut down quite a bit, this is a prohibitive price, but I can't say much more until I get back from Cabinet with something concrete. MR. D. ORCH ARD: Mr . Chairman, this is Air Ambula nce, Ambula nce, even No rthern Patien t Transportat ion.

The issue, it depends on how the team is used, but I think it's the neonatal team that goes out from Winnipeg to pick up mothers who are in the process of dangerous delivery. Bills have been issued under that program from time to time and in some instances they've been reimbursed or cancelled; in other words, the individual has not been billed. Is there a policy now where there's no more billing and anybody who's billed should ignore the bill on that program? HON. L.

DESJARDINS: This, we would have the Provincial Government, the Winnipeg Ambulance and the Health Sciences Centre discuss the matter to see if we could arrive at a program. It's not the Provincial Government alone. It's not the air ambulance alone either. MR. D. ORCHARD: No, I realize that. It can be a ground ambula nce. HON. L. DESJARDINS: So this is something that would be our first priority, if we ever expanded. In fact, I'd sooner spend money there than the previous program that we talked about, about the special grant. Because these are people who have to be brought in and it's a little bit tougher. MR. D.

ORCHARD: Okay, then on a case by case, as they come to a person's attention then, is the process to simply write you a letter, draw it to your attention and attempt to get it resolved that way, in the absence of formal policy? HON. L. DESJARDINS: I'm not saying there's not a policy, but we're trying to expand the program, that's what I said. It hasn't been announced yet. There's a policy, it's from a certain . . . MR. CHAIRMAN: The Memb er for River East. MRS. B. MITCHELSON: Thank you, Mr. Chairman. I just want to ask a few questions for clarification.

The Air Ambulance Program, is there a charge for each trip, with the air ambulance, to every patient? HON. L. DESJARDINS: Not in the program that exists now as an emergency service. No, that's covered. MRS. B. MITCHELSON: So there's no cha rge whatsoever for the Air Ambulance Program for any patient that's transported? HON. L. DESJARDINS: Not now, but it might be expanded. It might increase or start a program where there could be a charge, where there could be a cost, but really help subsidize what we talked about earlier, maybe transporting out of the province. MRS. B. MITCHELSON: Mr.

Chairman, I guess I need a little more clarification because the Neonatal Program then, is that not under the Air Ambulance Program? Is that a different program? 1346

Monday, 27 April, 1987 HON. L. DESJARDINS: That could be under the Air Ambu lance and the City of Winnipeg ambulance, and the provincial - the other program. MRS. B. MITCHELSON: Okay. So if I'm understanding correctly then, if a ground ambulance goes out from Winnipeg to bring someone into Winnipeg because of a high-risk situation, they are . . . HON. L. DESJARDINS: At the present, the patient pays for that. MRS. B. MITCHELSON: At the present time the patient pays, but if it was an air ambulance that picked up that ... HON. L.

DESJARDINS: The patient would still pay for the ground ambulance to take the patient to the air ambulance and back from the air ambulance to, let's say, the Health Sciences Centre. � MRS. B. MITCHELSON: Okay, so if I'm getting this ' right ... HON. L. DESJARDINS: It will be sent only on an emergency. MRS. B. MITCHELSON: Ok ay. So where is the air ambulance stationed? HON. L. DESJARDINS: In Winnipeg. MRS. B. MITCHELSON: In Winnipeg. So it goes from Winnipeg to . . . HON. L. DESJARDINS: Wherever. MRS. B.

MITCHELSON: . . . the closest airport and that patient would come by ground ambulance to the airport and then would be brought into Winnipeg from there. So they pay the ground portion but not the air portion. Ok ay. You indicated a little earlier that I believe it was 25 percent of the patients had to be accompanied by a physician via air ambulance? HON. L. DESJARDINS: Yes, I did say that. MRS. B. MITCHELSON: How are those physicians paid for that service, or are they paid? HON. L. DESJARDINS: That doctor is a doctor who would be on the staff of the hospital, and he would be paid by the hospital.

He'd be on salary by the hospital or some part of his salary from the hospital. He's part of that team. MRS. B. MITCHELSON: Okay, so if there's an indication that the physician is needed to accompany that patient, he would go from that hospital, be paid - well, most physicians aren't paid by a hospital - or are they in the northern areas? HON. L. DESJARDINS: If he's already been salaried by the hospital, which most of them are, he's already 1347 paid. That's covered.

If not, there would be a special arrangement made, a special salary, and that's where we're looking at the possibility, if it's going to be needed in that many cases, to see if we should have somebody working on the air ambulance, a doctor or an attendant. MRS. B. MITCHELSON: So you're looking now at having a full-time physician paid for by the government, a contra cted position or whatever , who would accompany the air ambulance for every patient. HON. L. DESJARDINS: . . . especially when they are in need. MRS. B. MITCHELSON: Just when they are needed, okay. I believe that's all. MR.

CHAIRMAN: The Member for Pembina. MR. D. ORCHARD: Under the Neonatal Program, every patient using it or every family using it, are they all billed or are there some exceptions in the billing? HON. L. DESJARDINS: Officially, the patient has to pay. There have been some instances, if they haven't got the money - you know, you don't get blood out of a stone - there have been arrangements. Either the hospital has raised funds at times or there has been a fund for bad debt and so on. There are certain cases. I want to be very careful.

I don't want to encourage to say that you just don't pay the bill and that's it, I thought you had a special case. That's why, if there's any hesitation, I want to make sure that the regular policy is that they would have to pay for that, but there have been some cases, as I say, where they receive help either through private fund raising or whatever. MR. D. ORCHARD: The Salary line for the eight staff who are in the Air Ambulance Program is increased by 15 percent. Why a 15 percent salary increase? That's higher than normal. HON. L.

DESJARDINS: The big difference there is overtime and stand-by wasn't covered in previous years and that's 11 percent. The regular increase was 4.3. MR. D. ORCHARD: This Med ivac jet is leased, with an option to purchase. Is this your lease or is it Department of Highways' lease? What I'm anxious to see is a copy of the lease so we can have a little look at ... I've had some experience in these aircraft deals and .. . HON. L. DESJARDINS: It's the Commission that leases the ... MR. D. ORCHARD: Would it be possible to see a copy of the lease? HON. L. DESJARDINS: Sure. MR. D.

ORCHARD: Or it can be done at a later date. HON. L. DESJARDINS: Sure.

Monday, 27 April, 1987 MR. D. ORCHARD: Thank you. HON. L. DESJARDINS: You're talking about - not with the air ambulance that we're leasing with a ... MR. D. ORCHARD: Okay, on page 16, it says, ''This program provides funds for one Cessna Citation S-2 Jet, which was designed and equipped to be specifically used as an air ambulance. The lease was originally for five years and has an option to purchase at the end of each year." HON. L. DESJARDINS: Okay, that's the one. MR. D. ORCHARD: Mr.

Chairman, I presume that Highways has that full complement of staff at their disposal all the time - pilots, engineers, etc., etc. HON. L. DESJARDINS: Yes, they service them, but the nurses, the doctors and so on would be our responsibility. MR. D. ORCHARD: Now the plane's been operating satisfactorily, it hasn't been on the ground when it should be up in the air? HON. L. DESJARDINS: No, other th an reg ula r maintenance, it's been working well, except the first day it came here, it had to be towed in, when we were at a press conference to unveil it, and it was being towed in, but that's all.

That's a couple of years ago. MR. CHAIRMAN: Life has its embarrassing moments, eh? The Member for Pembina. MR. D. ORCHARD: The operation expenditures are increasing now. Is the charge for use the same? Like Highways, in other words, charges a certain cost. HON. L. DESJARDINS: It would cover the individual wages and so on, of course, and gas, yes. They're not doing us any favours. MR. D. ORCHARD: What do they do with you? They don't provide you an estimate every year. They simply charge you cost-plus? Straight cost, presumably. HON. L. DESJARDINS: They'll tell us every year what it is, what the cost will be. MR.

CHAIRMAN: Air Ambula nce Program- pass. Northern Patient Transportation Program - the Member for Pembina. MR. D. ORCHARD: Well, Mr. Chairman, can the Minister indicate to me whether - in the description it says: "For certain elective cases." For instance, I'm not sure if health care facilities in the North have abortion committees at their hospitals. Is that the kind of elective case that would qu alify for No rthern Patient Transporta tion? HON. L. DESJARDINS: Yes, if the service is not provided in that area. MR. D.

ORCHARD: Do you have Northern Patient Transportation by case type such as you could single out the num ber that have been brought to Winnipeg, presuma bly , for an abortion procedure? HON. L. DESJARDINS: No, we don't have it by case. In this case, it would be quite difficult because it's not always specified. It could be for some examination or some thing, and then they decide they'd have an abortion or whatever. MR. CHAIRMAN: The Mem ber for River East. MRS. B. MITCHELSON: Mr.

Chairman, could the Minister indicate then how many elective cases and how many emergency cases there were in Northern Patient Transportation? HON. L. DESJARDINS: I have the emergencies here for the first six months of '86, compared to the first six months of'85. January in'85 was 18 4; January in '86 was 257; February, 158 and 17 4; March,'85 was 21 9 and 14 8 in '86; April was 175 in'85 and 138 in '86 - Holy sam, what happened here! - 237 in'85 in Ma y, and 117 in '86. Yes, that is a bad comparison in a way. I thought it didn't make too much sense. It's because of this air ambulance being in place.

Also, it takes a lot of emergencies. But anyway, that's what they would have. That's the emergency to show that the air ambulance is using. It was 21 9 in June of'85 and then 182. So you see, although it was for the first few months, there was quite a difference in'85. Then it turned out that there were more cases in'85 than '86. The total for those six months in'85 was 1, 182; in '86, 1, 11 6. MRS. B. MITCHELSON: 1, 11 6? HON. L. DESJARDINS: But in comparison to the early months, there was a big difference with '86, there were more in '86. In the later months, it was the opposite when the plane come in. MRS. B.

MITCHELSON: Ok ay, so th ese were emergency cases? HON. L. DESJARDINS: Yes, those are just emergencies. MRS. B. MITCHELSON: Ok ay, and what about elective? Do you have the breakdown for elective? HON. L. DESJARDINS: No, we don't, not here anyway. I'll try to get that for you. MRS. B. MITCHELSON: Well, I don't need it month by month. If you had so many northern patient cases in the first six months and you had 1, 11 6 emergency, if there was a total, then we could figure out how many were elective. HON. L. DESJARDINS: We'll get it for you. MRS. B.

MITCHELSON: Okay, so then the Northern Patient Transportation Program, is that a ground 1348

Monday, 27 April, 1987 transportation then. If there's an air ambulance, is this - no? HON. L. DESJARDINS: It could be both. It could be by car, by bus, by ambulance or by road ambulance or by plane, whatever the most appropriate commercial is available. MRS. B. MITCHELSON: Wh atever mode of tr an sporta tion, and it's di rectly funded by the Commission, so this is a completely paid-for service by the Commission. There's no . . . HON.

L DESJARDINS: Yes, and there's still an advisory comm ittee up north of doctors and administrators in different places up north who work and make their recommendations, and they have a certain responsibility also. MRS. B. MITCHELSON: So then, under the Northern Patient Trans portation Progr am, if a patient was - tran sferred . . . HON. L. DESJARDINS: Excuse me, I want to make sure you understand. There is a budget we provide for the elective part of it, especially there's a budget that's given to these different centres. That comes from Churchill, Flin Flon, The Pas and Thompson. MRS. B.

MITCHELSON: They have a certain budget for the elective cases and, once that money is used up in the year, then that's all the money they get for it? HON. L. DESJARDINS: Well, they have a budget. MRS. B. MITCHELSON: So then part of the Northern Patient Transportation Program could be also part of the Air Ambulance Program. Could that be combined sort of? HON. L. DESJARDINS: Well, when we talk about air ambulance in this case, we mostly mean the commercial • planes. We're not talking about our ambulance which J is used mostly for emergencies.

But it could be that a patient is sent here by the carrier, a regular plane. MRS. B. MITCHELSON: Okay, my understanding then for the Northern Patient Transportation Program, if a patient is transferred into Winnipeg in an emergency situation, it's comple tely funded by the Commission? HON. L. DESJARDINS: Not the ground ambula nce, the air ambulance. MRS. B. MITCHELSON: Not the ground ambula nce part, just the air ambulance part, but the ground ambu lance portion then is still paid for by the user. MR. CHAIRMAN: Northern Patient Transportation Program- pass.

Now we've got three items we're going to discuss together. HON. L. DESJARDINS: Well, we'll try to go on lines, but we agree that we won't be too strict on that. In fact, the Capital Program could be - there might be a certain case, the Capital Program tonight too. MR. CHAIRMAN: The Member for Pembina. MR. D. ORCHARD: Mr.

Chairman, there were a couple things that I was going to quiz the Minister, and it's been explained on the reconciliation of the printed vote to the adjusted vote, because the Hospital Program had been increased by $10 million but that was a tr ansfer from the Medi cal line, according to the reconciliation offered earlier on today. HON. L. DESJARDINS: Those were the community health centres, yeah. MR. D. ORCHARD: Yeah, and a resulting decrease in the Medical Program by almost the same amount. I guess I'm back on track because I've got the figures both ways here. Mr.

Chairman, this is rather a massive area to all of a sudden start to delve into, so if I'm a little bit disjointed in terms of my questioning, bear with me. They all end up, I suppose, in betterment of the people of Manitoba. Mr. Chairman, is the Children's Hospital now fully serviceable and usable and working? HON. L DESJARDINS: Yes. MR. D. ORCHARD: What is the status of the . HON. L. DESJARDINS: Some operating rooms will be situated with the adults, but it was always meant to be. The Children's Hospital is fully operative. MR. D. ORCHARD: What is the status of the multiple lawsuits over Children's Hospital? HON.

L. DESJARDINS: It's still in litigation. MR. D. ORCH ARD: Ha ve you been to court for preliminary hearings or anything yet? HON. L. DESJARDINS: They're not suing us. It's between the architect and the contractor. MR. D. ORCHARD: But isn't the Province of Manitoba a co-defendant in a couple of -(Interjection)- those? HON. L. DESJARDINS: No. MR. D. ORCHARD: I should just ask the Member for Kildonan because he knows more than the Minister over here. He's given all the answers ahead of time. Mr.

Chairman, one thing that amazed me, well, sort of amazed me in retrospect after I thought about it a little more, was an announcement the Minister made in the House in conjunction with, I think, the Variety Club, where you're putting in intensive care unit beds in the old wing of the old Children's Hospital. It struck me afterwards that why would you be doing that when you had a brand new Children's Hospital. Were there not enough intensive care unit beds designed . . . HON. L. DESJARDINS: No, that is suppo sed to be meant in the last phase, and the intensive care beds 1349

Monday, 27 April, 1987 are all together for the children and the adults; and that would take too long. In the meantime they needed something. When the Variety Club came forward and offered to work with us on some priorities, that certainly made it a little easier because that money would be spent and eventually it'll have to be torn down again, but that could take five, six, ten years. In the meantime it was felt that the children needed those facilities. MR. D. ORCHARD: When will they be on stream? HON. L. DESJARDINS: The temporary? MR. D. ORCHARD: The ones announced. HON. L.

DESJARDINS: Approximately a year from now. MR. D. ORCHARD: Mr. Chairman, physiotherapy is available through a numb er of rural hospitals as well as most of the City of Winnipeg hospitals. Can the Minister indicate whether physiotherapy staffing levels are able to be maintained in Winnipeg and in rural Manitoba? HON. L. DESJARDINS: I know that we have a very acute shortage in certain areas, of physiotherapists; it is a problem. I think that there's an area that I'd like to see us beef up. I think it is important and in the past we haven't had all the funds or the staff. MR. D.

ORCHARD: I don't know whether it's unique to our corner of the world, but I'm told in the area of Morden, Winkler, Carman, generally Manitou, and I don't know whether it goes as far east as Altona, but they've got five physiotherapy positions budgeted, but they've only got, I believe, two of them filled right now. Is that a unique circumstance to the area or is that rather a common problem as you go throughout rural Manitoba and even the City of Winnipeg? HON. L. DESJARDINS: Yes, I'm not saying it's equal, but it's a problem all over, I believe. MR. D. ORCHARD: What's the problem?

Is it salaries in other jurisdictions that are drawing our physios away? HON. L. DESJARDINS: It's the training. MR. D. ORCHARD: It's the training aspect. Are we into a situation with physiotherapists - and I have to confess, I have not met with them to find out because they've written us all letters. I hav en't had the opportun ity to meet with them. Is it the same as Pharmacy, where you simply can't expand the faculty capacity and take more in for a few years? What is the problem with graduating physiotherapists? HON. L.

DESJARDINS: We did meet with them and it was a real concern, and we've asked the Health Review Committee to work on a committee with them because that hadn't been done and that was a concern that we had. I haven't got a date yet, but that is being looked at. No, we met with them and I don't remember exactly all the concerns. That's a while back and we asked the Health Review Committee to work with them, as I say. MR. D.

ORCHARD: Are we into that sort of split responsibili ty between your department and the Department of Education in terms of funding, wherein the expansion of the training program may be constricted because university or Red River - like, where is the training program? Is it at the Un iversity of Manitoba? HON. L. DESJARDINS: Yes. MR. D. ORCHARD: And .it's not at the community college level. It is at the university level. So that we're proba bly, I suppose, into the administrative argument that they simply don't have the dollars to expand the program.

Is that fair, to sum up, from the lack of physics being graduated? HON. L. DESJARDINS: Yes, definitely, there are the two departments involved, and the Department of Education is involved, and it reflects with the number that we're training, and that seems to be the concern now in other provinces also. So that could be another concern that we could lose some to other provinces. MR. D.

ORCHARD: I guess if I can state our case, and I say this without having met with the physiotherapists, but many people, particularly people involved in accidents or with broken limbs, back injuries, a whole gamut of injuries, probably the physiotherapist is one of their most important individuals for speedy recovery, not having particularly rural hospitals adequa tely staffed.

Like in the City of Winnipeg, there might be alternate services available; i.e., through Workers Compensation Board, there's a possibility, or even privately in the City of Winnipeg, but rural Manitoba simply doesn't have those range of options available. I have to say, Mr. Minister, that is a major concern, and I'm not going after you and blaming you or the department because an untrained staff shortage is a problem, but I think it would be one of the areas of medical personnel that would require some pretty immediate and defin itive action to try to resolve that.

It may well mean some ded icated funding to expand the training program at the University of Manitoba. HON. L. DESJARDINS: I agree with that. I think one of the concerns is probably - you know how this was started. It was covered only in certain areas. Right now, the private operators are not covered, and it could be at that time that we weren't covering enough, maybe there wasn't the demand. That's what I want to look at. But let me say that we want to look at that also in our review that we're doing with chiropractors also - is there an option, one or the other, and so on - we want to look at that.

Usual ly, if you go to a chiropractor, you can go as much to a physiotherapist - I'm not saying in all cases - but that's one of the concerns, that's one of the things that is mentioned to us. So there is no decision, but we're looking at the whole thing. 1350

Monday, 27 April, 1987 It is kind of a similar service to a point, and it might be tha t we will have to try to beef up the physiotherapists. We will have to beef it up. Oftentimes when there is a new service and so on, because of maybe the lack of funds or something, they forget the role of the physiotherapist in that, exactly like my friend was saying, not only in . . .- (inaudible)- but in surgery after surgery and so on. It's really helpful. MR. D.

ORCHARD: Could you explain to me then, like right now, for instance, you've mentioned chiropractors; they are not under the purview of the Canada Health Act which put the ban on extra billing. In other words, if chiropractors billed for their complete service, that way they would not be in violation of the Canada Health Act; they might be in terms of the provincial act. HON. L. DESJARDINS: No, because some areas they prefer it like that. In certain provinces, the last thing they want to do is be covered. MR. D. ORCHARD: No. Similarly, then, physiotherapists are not part of the Canada Health Act either, are they?

HON. L. DESJARDINS: Sure, in the hospitals, they would be. MR. D. ORCHARD: Oh yes, but I mean most of the insured service that we provide, if you happen to be in a hospital and fortunate enough to have a physiotherapist to help your post-recovery, but that isn't always the case. What I'm saying to you is ... . HON. L. DESJARDINS: I know what you mean. You're right. Because it's not insured in a doctor's office or in a private office. MR. D. ORCHARD: That's right.

So that what we have seemingly is the anomaly of if you go through the hospital system, it's paid tor com pletely; if you go through a clinic or a private physiotherapy service, you pay for it yourself. Now maybe this is an area where you need to have some fresh thinking, because it would seem to me that by having a 100 -percent insured service in effect by delivering it through the hospital where the physio is available, you are doing the opposite to what you're attempting to do; i.e., take programs out of the hospitals and put them in the commu nity.

In a way you're defeating that purpose by having the physios 100 percent ... HON. L. DESJARDINS: Yes and no. We're not taking all the programs out of the hospital. We're trying to get a lot of people who will not be adm itted tor day service and that is the case; but you're right . . . MR. D. ORCHARD: You want to de-emphasize the hospital scene. HON. L. DESJARDINS: Yes. But this will be looked at. We have more money, not that much, but another $200,000 for new jobs, and we can't even fill that in certain areas. MR. D.

ORCHARD: I realize that, because Morden, Carman, Winkler are having a difficult time keeping physios on staff, and I don't think they are unique. 1351 Is this maybe an area where you start taking a look at a Pharmacare type of program tor physiotherapy services where there is a shared responsibility? The way it's working right now is you don't have a sufficient level of service and it's not insured. It was never intended to be a 10 0-percent insured service.

Maybe this is an area that you can look at in order to expand the service and putting it into a Pharmacare type of program where a patient pays so much money? HON. L. DESJARDINS: I'd have no problem with that, or maybe under certain cases, maybe emergency or still some at the hospital would be covered, but that's something we certainly will have to look at because there is no doubt that we're suffering from a shortage of physiotherapists. MR. D. ORCHARD: You don't have the money to expand it as a complete insured service. HON. L.

DESJARDINS: No, not as a complete, but we could have part of it as a complete, the way it is now, and then expand it. MR. D. ORCHARD: And I think the same thing, while we're on this nice cooperative topic ... HON. L. DESJARDINS: It's a program that is already done in that way to a certain point because they can get insurance through Blue Cross and there are quite a few people who do that. The big trouble right now - there might be a number of reasons - is the recruiting or training of enough physiotherapists. That's the main thing right now. MR. D. ORCHARD: Okay. Mr.

Chairman, when we take a look at the Hospital line in the budget, the adjusted vote takes into consideration the transfer of community health centres and puts them over into the Hospital line of funding. In your opening remarks, you indicated that we have a total deficit of some $23 million in the hospitals tor last year, approximately 13.3 of which you are going to pick up. Now my question is that in no way reflects in the adjusted vote in this year's Estimates, does it? HON. L. DESJARDINS: Not in 19 86-87, but in 19 87- 88. MR. D.

ORCHARD: Okay, that's the next question then, because you see, you've added roughly $1 3.3 million, presumably, to the base funding of what - with the straight transfer, we'll use the adjusted vote figure of 654. Part of the hospital budget increase then will be an increase in the base-line funding to accommodate for your pickup of a portion of the deficit due to cost increases, contract settlements? HON. L. DESJAR DINS: The full 13 would be there and then a pickup of the other. As I say, that money is what we need to increase and improve a community clinic also and those programs. MR. D.

ORCHARD: All I'm interested in is getting some app les-to-apples comparison of figures.

Monday, 27 April, 1987 With the Community Health Centre Program funding in place in the Hospital Program line and the app roved budget that you are covering off, according to your opening remark, we should have funding in the neighbourhood of $668 million, roughly, which would leave, if I do some rough calculations, and don't hold me to the exact numb ers, a $39 million increase in the hospital budgets available to fund deficits from last year that haven't been covered, totalling $9.6 million, and any cost increases of operating those facilities in the coming year. That $39 million will cover both of those areas?

HON. L. DESJARDINS: That's correct. MR. D. ORCHARD: I'm ju st doing another quick calculation and knocking $9 million off the 39 because we've got already a little better than $9 million of deficits. We're down to $30 million of new funding to cover increase in costs, expanding programs, whatever the hospitals may desire to do over the next fiscal year of actually available new money. HON . L. DESJARDINS: No t ne cessarily for the hospitals. That covers the whole deficit in there. We are dealing with the hospitals. As I said, we need money to go for this transition period.

We are working with these people with the coverage that we asked them; we worked with them to budget without a deficit in the two years, and that fund would be used then to promote the community clinics or whatever else is needed to change the system up to a point. MR. D. ORCHARD: Okay. Then if I am following you correctly, I think my numbers are roughly correct. HON. L. DESJARDINS: I'll give you this; it might help. The budget facilities in '86-87 supplementary funding was 16 ,964.3 million. The price, economic increase, 21, 13 0.8 million; '87-88 new initia tives is 230.5 thousand.

The annual izat ion of '86-87 approved equipment borrowing, 416 .3 thousand. The new facilities opened in '86-87, 3,352. 1 million. MR. D. ORCHARD: Run that one by me again, the new facilities. HON. L. DESJARDINS: 3,352. 1 million. MR. D. ORCHARD: That's '87-88 figure? HON. L. DESJARDINS: Okay. The new renovative construction for '87-88, approved equipment borrowing 462.5 thousand; new facilities opening in '87-88; 4,304.2 million, and other increases 2,769.1 million, and then there's another reduction of 329.5 thousand. That's a reduction, the last one.

The total increase is $49,300.3 million for budget facilities. MR. D. ORCHARD: Okay. Now this is where we can waste too damn much time unfortunately. But what I want to establish is dealing with the facilities, like you've got new facilities that have come on stream and new equipment that's going to be taking $4. 7 millio n additional this year, okay. HON. L. DESJARDINS: 4.766.7. MR. D. ORCHARD: Yes. So we're always talking rough figures; it won't be exact figures.

What I want to do is find out on an identical basis, factor out new facilities, factor out new equipment, just how much more budget does an existing set of facilities funded last year have to operate with this year? What's their increase? It won't be the 49 million. HON. L. DESJARDINS: Well, we can't be that specific. We're still working with the hospitals. That's the two first figures that I gave you, the supplementary funding, the deficit of 16,9 64.3 and the price economic increase of 21, 130. 8 thousand. MR. D. ORCHARD: So that would be roughly 38 million. HON. L. DESJARDINS: Yes. MR. D.

ORCHARD: And a portion of that, correct me if I'm wrong, picks up a substantial portion of last year's • deficit? HON. L. DESJARDINS: Yes. MR. D. ORCHARD: Okay. In terms of brand new money, let's call it that, to operate those same facilities this year over last year, the real figure would be down to 21.1 million. HON. L. DESJARDINS: Right. MR. D. ORCHARD: Okay. Now, I'm going to make the same argument I made with you last time around.

Out of the roughly $700 million that we're budgeting this year, which are going to go to operate those hospital facilities, is a figure of 80 percent roughly correct , in terms of salary component of those budgets? What would you use if you're wanting a ballpark figure? HON. L. DESJARDINS: It'd be closer to 75, it'd be just under 75. (Mr. Deputy Chairman, M. Dolin, in the Chair. ) MR. D. ORCHARD: If I used 700 million, of the 707, would that roughly give me the amount of funding that's going to be provided to those hospitals throughout the province?

You've got community clinics in there; they're staffed roughly the same way, the community health centres. HON. L. DESJARDINS: That also - as I say, we're discussing this with the facilities. We're also looking at the teaching hospitals, also the staff of the teaching hospitals, the concern that we had. We want to make sure that we're making a fair comparison. There's enough discrepancy that we know there's something wrong, but not necessarily as much as we figure. MR. D. ORCHARD: I'm just doing a quick calculation here, Mr. Minister.

If you use a 75 percent figure on the - we're funding hospitals to the tune of $700 million. 1352

Monday, 27 April, 1987 If you use the 75 percent figure as a rough guesstimate of salary costs, all of which has been subject to an additional three-quarters of a percent on payroll tax - that in my calculation eats up $5.25 million roughly of the increased budget. HON. L. DESJARDINS: Don't count that health and education levy too fast. We're still negotiating with that. MR. D. ORCHARD: That's an interesting statement. In other words, are you saying that . . . You see, we've got $21. 1 million basically of new money for the facilities to operate on year over year, because they were over budget before.

We've got telephone rate increases, which would be a portion of the other 25 percent. We've got hydro rate increases, which would be a portion of the other 25 percent. But we know for a fact, that on the rough calculation of 75 percent salary component in those $700 million worth of fundings, that we've got in excess of $5 million in payroll tax. Now you're saying not to worry about it. � HON. L. DESJARDINS: No. I said that, as I said in the House, they were negotiating that with the hospitals at this time. MR. D. ORCHARD: Now with the intention - I want to fill out what this negotiation is.

Is the negotiation to provide them the costs of the increase in the payroll tax? In other words, supplement their funding by approxima tely 5 million? HON. L. DESJARDINS: Mr. Chairman, that's certainly an option providing that we could work with them to stay out of a deficit, apart from that. MR. D.

ORCHARD: Now, that means that if that happens here, in order to keep hospitals out of the deficit, that we basically provide 5 million more in funding to cover the payroll tax, then I think you'd have a pretty tough time if you make that exemption in health care and the hospital facilities and not doing it in the personal care homes where we've got what, $16 6 million � in funding and probably 75 percent again? HON. L. DESJARDINS: The discussion that we had is for all the institutions. MR. D.

ORCHARD: All of them, okay, so that we're into the neighbourhood - I just made a quick calculation - that's another $1. 25 million. We could be up to $6.5 million, roughly. Now one of two things is going to happen. If you're not successful in your negotiations with the hospitals . . . HON. L. DESJARDINS: We 're qu estioning your calculation. MR. D. ORCHARD: Well, I just added $1. 25 million on payroll tax and personal care homes, basis 75 percent of the $16 6 million being salaried cost. HON. L. DESJARDINS: The actual salaries in personal care homes is calculated as 4.5 percent of the levy - actual salaries, 4.5.

What were you using? MR. D. ORCHARD: No, no, you're talking a salary increase there, right? HON. L. DESJARDINS: No, no, for the levy, the 4.5 figure that we're using on actual salaries. MR. D. ORCHARD: Well, that's the increase that the payroll tax would be. HON. L. DESJARDINS: Yes. MR. D. ORCHARD: Well, okay, we won't quibble over 2 million. HON. L. DESJARDINS: What's 2 million? MR. D. ORCHARD: I'm glad you said that, not me. But then that means that something less than 75 percent of your facility costs are salary. HON. L. DESJARDINS: Yes. MR. D. ORCHARD: That the 75 percent estimate is too high.

Regardless of that . . . HON. L. DESJARDINS: It depends if you include capital or exclude capital. I think it's 70 percent if you include capital and about 75 if you exclude it, somewhere like that. MR. D. ORCHARD: Okay. One of two things is going to happen. Either the $4.5 million will have to be found from within the budgets, or you're going to make them additional funding to the facilities; in which case, then, the deficit has to naturally increase because you're not going to find tha t probably in the rest of your Department of Health, although you probably could if you looked. But, Mr.

Chairman, that is a problem that now the government is finding themselves facing within their own funded institutions. We went through it with AFM earlier on today; now you 're negotiating with the hospitals. I presume, when we get to the Minister of Education, he, no doubt, will be having same and similar negotia tions with school boards, univ ersities, community colleges, because they, likewise, are having to pick this up from a global budget increase and they're going to indicate they can't afford to do it. Mr.

Minister, I should be directing these remarks at the Minister of Finance, but that's exactly the position you've put private sector business in and it's hurting you right now. You have to go back now and negotiate with your hospitals, your personal care homes - you're negotiating with MHO on this very issue - but business do esn't have the opportunity to negotiate with government. HON. L. DESJARDINS: Well, Mr. Chairman, the private sector - because that's the tax from the government - could be an increase in something else; it could be an increase, for instance, in gas. We know how it works in the private sector.

The private sector will have to 1353

Monday, 27 April, 1987 increase to cover, you know, instead of taxes - that's how they get it - and then the consumer ends up paying for it, we know that. This is a service industry and the only place they can get it is through the government, that you can save whatever you can. You can take it from within as much as possible, but there has to be a limit somewhere. If you agree that it's part of that, you'd have to give them more money, definitely. There's no easy solution.

Either you cut services or you increase taxes or increase the deficit or you, as I say, reduce the services; unless you've got some fat somewhere that you can save and we've tried that for a number of years now. It's not that easy. MR. CHAIRMAN: The Member for Pembina. MR. D. ORCHARD: Mr. Chairman, before we leave the Hospital lines, we'll talk about other aspects and other options. But, Mr. Chairman, right now, in terms of the Cancer Treatment Foundation, we have primarily the two treatment methods, chemoth erapy and radiotherapy. Mr.

Chairman, I don't have the num bers in front of me, but of something like - I'll give ballpark figures because I just simply don't have them in front of me right now - but probably 80 percent of the physicians there are specialists in chemotherapy versus radiotherapy. HON. L. DESJARDINS: What percentage did you say? MR. D. ORCHARD: Roughly 80 percent, but I may be out by 5 or 10 percent, but it's significantly skewed towards a provision of chemotherapy as a cancer treatment. HON. L. DESJARDINS: At the present, yes. MR. CHAIRMAN: The Member for Pembina. MR. D. ORCHARD: Yes.

Now I don't know whether that is right or wrong, or needs to be examined or should be looked at, but there are patients who are scheduled for radiotherapy that are coming in from rural Manitoba. I talked to my colleague, the Member for Virden, just today, and he's got several people from his area that are coming in for radiotherapy treatmel)tS, and one individual, I understand it, if I recall correctly from what he said, has to be in for treatments five days a week. This individual is finding that the equipment is not always up.

The equipment appears to have not been renewed over the last number of years, and because it ages like the CAT scan at the Health Sciences Centre, it's sometimes up, sometimes down, sometimes reliable, sometimes not. Now, Mr. Minister, what I would like to know is whether there has been an effort to renew the radiotherapy equipment in the centre so that we have a reasonable radiotherapy program there, or has the emphasis been primarily on the chemotherapy program? HON. L.

DESJARDINS: Yes, the new high-energy radiotherapy treatment unit and the replacement of an older form of unit for the Manitoba Cancer Treatment and Research Foundation, this equipment was approved in the Estimates process based on epidemiological evidence of need . . . MR. D. ORCHARD: Last year? HON. L. DESJARDINS: . . . for an increase - no, this year - in the number of cancer patients who would benefit from radiotherapy. At this time, the location of the new high-energy unit has not been decided. A committee, appointed by myself, will be concerting the two sites. At one time it was supposed to be at St.

Boniface. We discussed that with a certain place; we're not too sure if that's the right place. So we're considering two sites; that is, the St. Boniface General Hospital or the M.R . McCharles unit at the Manitoba Cancer Treatment and Research Foundation, and recommending the most appropriate location respective of both efficiency and effectiveness. Now based on sound evidence, not only are the number of reported cancer cases increasing, but also the numb er of cases that could benefit from radiotherapy treatments.

The government has approved the purchase of the new high-energy treatment unit and the replacement of our lower energy unit at the Cancer Foundation. The total cost of this equipment and the associated construct ion requir ed is approximately $3. 7 million and operating costs for the new equipment will be $2 18 ,000 annua lly. This program expansion will assist the needs of cancer patients in Manitoba to ensure the most up-to­ date and efficient, effective care available to those who require it.

I think that there's been concern between the two - my friend is absolutely right - between chemotherapy and radiotherapy; it depends who you speak to and we've had some discussions. MR. D. ORCHARD: Well, you see, that's exactly what we have been hearing. It's sort of like trying to corner mercury on the top of a table - you know it will squirt out here and there - and you can't really get a handle on whether there is a legitimate problem, whether there is a perceived problem, etc., etc.

But the numb ers that were given to me, and I'm sorry I don't have them, but there was a significant skewing of the medical expertise to chemotherapy versus radiotherapy. I'm not an expert in the treatment of cancer, by any means, but I do know that radiotherapy has a very significant role to play in treatment. HON. L. DESJARDINS: The trend seems to be going the other way now. MR. D. ORCHARD: To chemotherapy. HON. L. DESJARDINS: They've probably exhausted the same people who had the concern. It was brought to our attention and . . . MR. D. ORCHARD: Yes. They will be; that's good. Now, Mr.

Chairman, on the issue of cancer treatment, the Minister might recall, last year at Estimates time, I took a neighbour who had cancer to Toronto for some treatments. There are a couple of things I want to first of all point out to just in the operation of the hospital. 1354

Monday, 27 April, 1987 He was at the Health Sciences Centre and I went down to visit him a couple of days where the only thing he was in for was CAT scan and he was rescheduled on several occasions for the CAT scan. It just seemed to me to be, well, it was a hell of a thing to put him through, because he sat there waiting, looking at four walls and out the window, No. 1; but he was occupying a bed for that time that that CAT scan was down and I think that if there is an area that hospitals in general have to really take a look at, it's in the diagnostic equipment.

I'll use the example of the Mayo Clinic which probably is the other end of the spectrum. Apparently you go down there, and if you're scheduled ahead of time so they know you're coming, it's bang, bang, bang, bang, and the tests are done. There is no waiting around. At the end of the day, you know exactly what maybe is going to be done, etc., etc. Now part of the problem was the fact that the CAT scan was old and not as mechanically reliable, if that's the way to put it, etc., etc., and that's a move that's being made to resolve that in terms of the installa tion of new CAT scans.

But I found tha t to be an unacceptable situation from the two standpoints: first of all, the patient is sitting there, waiting in anticipation; and, secondly , the cost had to be fairly substantial simply to have that person occupying a bed when they didn't have to be there. But that's not the issue that I really want to talk about; that's an aside. I took the fellow down to Toronto and he was using the services of a specialist down there, a doctor who was in the Toronto General Hospital, but he had set up a free-standing clinic in downtown Toronto.

I had quite a long afternoon's discussion with this physician because his appr oach to cancer treatment was extremely unique. In non-medical terms, I'll just give you the background of it. It involved his belief that cancer was - okay, maybe I should start from square one. This individual, this physician, did not like to have cancer patients come to him after having chemotherapy, post-chemotherapy or even full radiotherapy, and his argument on both of those treatments is that it is not as selective in terms of getting at the cancer treatments and therefore you do harm to neighbouring healthy tissue.

And I don't think that's wrong; I believe that happens with chemotherapy. People lose their hair. They go through some pretty stressf ul times when they'r e un der chemotherapy; the same thing with radiotherapy. His approach was that cancer is a rapidly growing cell structure in your body. Its primary food source is sugar. Now, I didn't know that; I still don't know whether that's right or wrong, but that was the indication that his research had done.

What this individual had done, and he was in contact with a number of specialists who are treating cancer in the United States and across Canada - one across Canada, I believe, and several in the United States, from Texas to the eastern seaboard. These physicians were all working on the same sort of concept of cancer treatment, that being that, first of all, if the cancer cell relies on sugar as its food source to grow and expand, you block the uptake of sugar.

So there were experimentally licensed drugs - I have to call them drugs because I don't know what else they would be - that his patients would take which would prevent the uptake of sugar, No. 1. And then they would apply to the malignant areas ultra heat through a directing heat pad. His idea was that, first of all, by blocking off the food source, namely, sugar, that you put the cancer cell in a weakened position but normal healthy cells in your body had the abililty to take in starch and convert it to sugar or any other number of food processes within healthy cells.

So this chemical which blocks sugar did not affect any healthy cells, only cancer cells. Then in a weakened position, the application of the ultra heat really knocked the cancer cells out and he used about, I believe, if my memory serves me correct, a 10 percent dose of chemotherapy as well, which also went under the low rates and attacked the cancer cells as well. To me, I was fascinated when I talked to this man, and my neighbour talked to a number of patients who were at this clinic, some of whom had liver cancer, were diagnosed terminal five years ago and were leading normal lives.

They were under the full impression that they were cured. Now, liver cancer simply isn't normally curable. The concept is fascinating, so I broached the question to him: why is it that you are doing this on your own? Why are you not in on the Cancer Research Foundation? This physician was originally from Winnipeg and he alm ost didn't like to answer the question, but the basic assumption came down to that there is an extremely powerful lobby in the health care field which is dedicated towards primarily chemotherapy in terms of treatment of cancer.

That's driven by the research firms developing the chemicals used in chemotherapy. He believes that there may not be room, because of that, for some original and somewhat different approach to treatment of cancer in terms of acquiring public monies for research, etc., etc. Now I haven't taken the time and I can't tell you whether that's right or wrong. I suppose your staff could investigate whether we're doing any unique approach to cancer treatment in some of our Cancer Research Foundation funding in Manitoba.

But this whole concept seemed to me to be something that we, as responsible legislators, should be asking for more information on, because as I say, unfortunately my neighbour was not one of the lucky ones, but he talked to a number of people there who were extremely fortunate in receiving, and in this fellow, by the very nature of being a sort of a treatment centre of last resort, received the very worst of patie nts. Ma ny of them had sur passed anybody's expectation, including their own as patients, of surviving. I think there was something there to it.

I simply use this opportunity to explain it because, No. 1, I don't have an opportunity. You can't do that in que stion perio d; you can't do it in any other opportun ity. When I got the figures just recently in terms of the emphasis of chemotherapy in our own treatment centre, it again rang the bells of some of the things he was saying. So I use that as an example for you to maybe take under some consideration and maybe you might want to make some inquiries. I tell you, Mr.

Minister, it would be almo st worth your while to talk to this individual, this physician, in Toronto because he was a very refreshing individual to talk to in terms of treatment of cancer. HON. L. DESJARDINS: Well, Mr. Chairman, I thank the honourable member for those comments. I'd read 1355

Monday, 27 April, 1987 something about this; I'd never heard of this doctor. I'd read something not that long ago, and of course there have been some concerns as some people hesitated and got in touch with me, some of them without giving names originally, to express their concern re the problem that we might have had in Winnipeg here re chemotherapy versus radio for treatment. This is something that I would like to talk to my honourable friend and get the name of that doctor, and certainly it could be worth following.

It seems unbelievable that the people will not do everything in such a thing as cancer but, nevertheless, we should look at it to make sure. We brought somebody in to talk to us about that other thing, ab out the rad iotherapy vis-a-vis chemotherapy and in health. It was somebody who used to be in Winnipeg before who has now left, who has kind of retired, and he had that concern. That's why we set up that committee and so on, but this is certainly worth following. I'd read something in general, not in as good detail as you gave it to us. MR. CHAIRMAN: The Member for River East. MRS. B. MITCHELSON: Thank you, Mr.

Chairman. Jus t while we're still on rad iother apy and chemotherapy, I wonder if the Minister could indicate, I know we're acquiring or purchasing this new machine for radiotherapy. Is there any provision made for funds being set aside? Like, what's the life of this machine first of all? HON. L. DESJARDINS: Which one, the new one that MRS. B. MITCHELSON: The new machine for radiotherapy. I can't remember the name. HON. L. DESJARDINS: Eight to ten years old, eight to ten years. MRS. B. MITCHELSON: Eight to ten years before it would need replacement, the normal life. HON. L.

DESJARDINS: Is that the new high-energy radiotherapy treatment unit? Replacement of that, I'm told, is eight to ten years, but then that doesn't mean you have to replace the whole machine. MRS. B. MITCHELSON: It might need some updating or some maintenance work of some kind. I understand there are a lot of other machines in the radiotherapy department. That isn't the only machine that's used exclusively for radiotherapy. There are other machines th at are bec oming very qu ickly outdated, need maintenance or need changing in fact. I'm wondering if there's any money that's set aside. HON. L.

DESJARDINS: Were you absent for a while? Were you here all . . . MRS. B. MITCHELSON: I was here all the time, yeah. But I didn't hear it, maybe I just wasn't listening. HON. L. DESJARDINS: Well, I made the announcement that the total costs that we had appr oved for these facilities for radiotherapy treatment were $3. 7 million. That's why I didn't know if you had heard that. MRS. B. MITCHELSON: For that one machine? HON. L. DESJARDINS: Well, it's a new high-energy radiotherapy treatment unit, and an older form of unit that has to be replaced at the Ma nitoba Cancer Treatment and Research Foundation. MRS. B.

MITCHELSON: Well, is in fact then that the only radiotherapy machine that is in existance and is being used in the department? No, there are others and there are some then that are outdated. That's the point that I'm trying to make, some that need repair on an ongoing basis, that break down as a result of being old, being outdated. HON. L. DESJARDINS: Well that's one that we're looking at replacing. ,, MRS. B. MITCHELSON: Yes, I understand that is one, but I'm sure there are more that could be replaced. What I'm wanting to know is: Is there any money set aside or put into a fund?

We know that, eight or ten years down the road, these machines are going to be outdated, are going to need replacement. Do you make any provisions in the department at this time to set aside some funds so that, when a new machine does have to be purchased . . . HON. L. DESJARDINS: There is a fund, I think it's about $9 million at this stage, per year. MRS. B. MITCHELSON: Per year, that's sort of set aside to - okay, that's what I was trying to . . . HON. L. DESJARDINS: Although that was reduced, I think, in a number of years, and then we're building it back up now. MRS. B.

MITCHELSON: That's what I was wanting to kn ow. I just want to go on for a few minutes again back to some questions that I asked in the House, I believe it was last week, the beginning of last week, about the St. Boniface Hospital and the cutbacks in the number of maternity cases that are going to be serviced at St. Boniface Hospital. I believe that, well from an

article in the Free Press, there were 4,338 deliveries last year at St. Boniface Hospital. I guess the Commission had agreed to fund 4,000 cases, and they were going to pick up the excess or the deficit from those excessive cases, but they're talking about cutting back to about 3,500 deliveries now at St. Boniface Hospital. HON. L. DESJARDINS: 4,000. MRS. B. MITCHELSON: They're cutting back to 4,000 from the 4,338? HON. L. DESJARDINS: From about 4,300, yes. MRS. B. MITCHELSON: I know there's a lot of concern out in the commun ity, and I believe a lot of the MLAs, 1356

,,, , Monday, 27 April, 1987 myself included, are receiving letters from their constituents who have so chosen to go to obstetricians who practis e at the St. Boniface Hospital and do indeed deliver babies at St. Boniface Hospital. There's some great concern and a lot of pregnant women are being put under a lot of stress and strain as a result of being told that there may, in fact , not be space at St. Boniface Hospital for them when their delivery time comes. They go through the preparation and, if they 're going to have natural childbirth, they visit the hospital.

They see the faci lities and they become familiar , so that it's the least stressful situation when their delivery time comes . There is a lot of concern out in the community that they are not going to be able to go to St . Boniface Hospital where provisions are made for high-risk situations. Those who are so-called low risk will be sent over to Victoria or Misericordia Hospital as a result. HON. L. DESJARDINS : Well that's the concern . If you remember, and the members of your party criticized me as we;1 when we closed Seven Oaks and Concordia on that. What I said at the time is exactly what happened .

The people wanted to make sure. They talked to their doctors, and more and more the mothers wanted to go where there was at-risk, just in case . They weren't busy enough in those other areas . Now, the Health Review Committee are telling us, well, don't close any more. There's no need that all of them should go there. That makes sense that the at-risk will go to St. Boniface and Health Sciences Centre, and I think Victoria told us that they could do another 300 or 400. That's what we're saying. On one hand, people are saying , why did you close Seven Oaks .

It might be that some people eventually would want all the deliveries . I know that was the other extreme. I think the Salvation Army Hospital in Halifax - is it? - and in Victoria or Vancouver are doing practically all of them . At one time, there were - what? - 6,000-7,000 . So now we're looking at the whole thing, but it's no use keeping some of those places to keep them busy if they can do it. They can do just as well th ose who are not at risk.

The thing is people want the best and they're concerned and what if something happens - exactly what we said when we were told: why aren't you keepi ng Corcordia and Seven Oaks Hospitals opened? So that's what we're discussing with them now and trying to arrive at something . Then again, we talked awhile ago about the medical profession not agreeing on everything , and they don't on th is. They've had for years and years while I was at the Commission yet, they had the Peddle Report. You must have heard of the Peddle Report, and that became highly political with the profession itse lf.

The special ists were saying, all right, let's get an at-risk area , and let's all do it at the same place, and other doctors would say, no, that's not needed . Then there was the division between the rural and city, the specialists and the family medicine and then the city and the rural area, so it's not that easy. The last report of the Review Committee is saying , no, leave some of those other hospitals open. It has to be feasible , and that's what we'r e doing now and we're working with St. Boniface Hospital.

I think that we're not always too happy with the way this was done, and there has to be some discussion and not scare the publ ic either. MRS . B. MITCHELSON: Mr. Chairman, I understand where the Minister is coming from, and I know there was some criticism when Concord ia and Seven Oaks were closed . The rationalization that the Minister gave at that time was that the hospitals were small and the services weren 't adequ ate and they weren't busy enough, whatever happened ... HON. L. DESJARDINS: No, no, let me correct you. I never said the service was inadeq uate.

The service was good, but the public was demanding like they're doing now. Like now , you're saying , why can't we go to the St. Boniface Hospital? I'm saying, go to these smaller hospitals if you 're not at risk . The people were doing that and, at a place like Seven Oaks Hospital , they had about - what? If I remember right - that's a few years ago - 35 staff for less than one delivery a day, point­ someth ing a day. That's what I'm saying , there are the two sides. But we're working with St. Boniface Hospital to relieve that concern that the public might have.

Also, the other point that was mentioned about admitting privileges to the - no, that was your colle ague who asked me the question. Now, we're not going to have all the doctors with admitt ing privileges in all hospitals, obviously not. But in a case like this , we'll have to make arrangements; there 'll have to be arrangements made. MRS. B. MITCHELSON: Well, Mr. Chairman, I still have some concerns with this. I believe, at the time tha t Concordia and Seven Oaks were closed, a deal that was struck with St.

Boniface Hospital was that the labour floor would be expanded to take care of the over flow from the hospitals, from the beds that were closed. In fac t, indications are that the numbers of deliveries at St. Boniface Hospital are going up, so there is genuinely a need for some spaces. HON. L. DESJARDINS: Mr. Chairman, even before we closed that, we were working on a program with St. Boniface Hospital and the Health Sciences Centre to expand because of exactly what_ you're talking about today, because of the demand, and that's what I said at the time.

Now they said, with that change, it will be very easy to allow for - with the change we are doing at this time , we will be able to take over from what Seven Oaks are doing, and they did, and Concordia, between the two. In Victoria, they tell you that they could go three, so what do we do? We have a choice. If we just specialize in that like some are advocating, then we would have to close those other hospitals also .

There's no point in keeping the hospitals that aren't busy, especially if there's more and more demand and if there's a tendency for the prospective mothers to want to go, just in case it' s a difficult case. Then in other areas, some people are telling us to bring in the midwifery and have more of the births in the homes and so on, so still it's not cut and dry. There's a lot of expert advice here that does not agree , so we are looking at the whole thing. MRS. B. MITCHELSON: I have some diffi culty with deciding who 's a low-risk and who's a high-risk 1357

Monday, 27 April, 1987 candidate when nobody really knows for sure until that mother is delivering whether that baby is going to be at risk or there are going to be some complications as a result of that delivery, where the baby might need some intensive care as a result of a very difficult delivery with some compl ications. I'm wondering who's going to have to accept the responsibility, should someone come in to St.

Boniface Hospital in early labour and is considered low risk and sent over to another hospital, a hospital not of her choice, as a result of the policy at the hospital saying that they've had to decrease the num bers and there just is no room available and they've got to be sent over to another hospital. HON. L. DESJARDINS: They're not decreasing in the numb ers. The facilities that they have, they can handle 4,000 safely and, after that, it becomes dangerous. Now if that statement that you made is correct - and it might be - it is also correct, you don 't have to wait till somebody decides to go to St.

Boniface and they're low risk and then there's a change. Even those, if that could happen, and it does in certain cases, a certain percenta ge, but if th at's the case the n , if we're responsible for that, then we're also responsible for keeping those smaller hospitals without the high risk open, and then we should close them. We should have only the Health Sciences Centre or St. Boniface or whatever do all the cases. So that is something that is considered. Now on the other hand, what will the people in the rural areas tell us?

Do you think the doctors will buy that, and what will the area in Victoria and those hospitals? Our Health Research Review Committee tells us that no, we shouldn't close any more at this time. As I said, some people are advocating there should be more births in the home with a midwife and so on, so these are all different things that we have to look at. We have to take into consideration the concern that you're saying, and I doubt if people who are transferred would not find a place either at the Health Sciences Centre.

And that's why they want certain people to go to other hospitals who are not in danger so they can take the at-risk because that was the first intent. So we're looking at that. We'll look at it again, but it's not an easy solution. They're all would-be experts who give us this different advice. MRS. B. MITCHELSON: Well, Mr. Chairman, the Minister says we have to look at all different situations and we have to look at people who choose to have their babies at home with a midwife, they choose to go to their local rural hospital, they choose to go to their local community hospital, the smaller hospitals.

That's all fine and well, if they should so choose. But if we have the right to choose and a pregnant mother should so choose to go to St. Boniface Hospital, for whatever reason, because it is her choice to choose her doctor and her hospital, and she is sent to another hospital that doesn't have provision for high-risk cases and something happens to her as a result or something happens to her baby as a result - and maybe we haven't come across a death as a result. I'm sure we've had some complications and I'm sure some of them could be substantiated.

But I'm telling the Minister that somebody is going to have to be held responsible for the loss or the da mage of a mother or a child as a result of them being told that they have to go to a hospital not of their own choosing, or they are told to go somewhere where they did not choose to have th eir ba by. Somebody is going to have to accept that responsibility, and there are going to be some legal implications at some point in time down the road as a result of these decisions. I think the Minister is really going to have to think seriously and work very closely with St.

Boniface Hospital, because there are people out there who have this as a genuine concern, and I can understand their concerns. HON. L. DESJARDINS: First of all, the honourable member is wrong when she says there's only the responsibility if the people don't get to go where they choose. If we're giving them a choice of something that's dangerous, we're just as responsible. If it's not good in a certain case, even because those people chose that, but that's what we have to find out. I don't know why you're shaking your head. You're saying that if they go to the St. Boniface hospital and the St.

Boniface Hospital says to you, you're not an at-risk case and we need the beds for at-risk cases at this time, so therefore go to this hospital, you'll be well taken care of and if something develops, then we're responsible. But if a person goes directly to the Victoria Hospital and then something develops there, well it's okay because they chose to go there. I say it's not okay. Either we've got to give the proper service and I'm saying, are you advocating at this time that we close those other beds and build more beds at St. Boniface Hospital and the Health Sciences Centre? That's what I want to know.

Are you suggesting that we should have every single bed for del ivery ready for high risk? What are you going to do in the rural area? MRS. B. MITCHELS ON: Mr . Chairman, I'm not advocating anything. The Minister is trying to put words in my mouth really. HON. L. DESJARDINS: You've been trying a hell of a long time to make me responsible for something that I'm not. MRS. B.

MITCHELSON: But if I should so choose or just let me say that I lived out near Concordia Hospital, I so chose to go to an obstetrician who practised at the Health Sciences Centre and I so chose to have my baby at Health Sciences Centre for my own reasons, okay, I didn't want to go to an obstetrician or a general practitioner from Concordia Hospital because I wanted to be in a hospital where there was some provision for high risk. I chose that and that was my personal choice.

There are people who do choose to go and they know full well what's available at the rural hospital or at their local community hospital and they choose to do that. We are not held responsible as a result of that. If you choose to go somewhere where there is more service available and you are told by government, because of government polic y or because of government cutbacks, that you cannot go to that 1358

Monday, 27 April, 1987 hospital and something should happen, then I say that you are solely responsible. One of the letters, and I'll just quote from a letter, someone with a concern about the po licy that's supposedly going to be implemented at St. Boniface Hospital. It says, "We are taxed into the poor house, which the government tells us is necessary to cover the rising costs of health care and then we are denied the very service we have paid for so dearly." How can I sum it up any better than that? HON. L. DESJARDINS: You can sum it up by being responsible.

First of all, when you're talking about cuts, you're all wet because there is no such a thing as a cut. I'm telling you now, that if we would do that on every area, if we're doing that in every area, then what would you do when those beds are full? You would have to make darn sure that there are enough beds that that they would never be full and that would be very good planning, and that would really reduce the cost and that would help us give good service. The thing is that there are so many beds.

At times this is not required as far as the doctors are concerned and, first of all, it is not a policy of the government. It is a hospital who are saying they've done that for years. Certain beds are full, they'll tell you and you can't get in. It's the same thing here. Now the point is, I've told you as openly as I could abo ut the different advice that we're ge tting, the different concerns tha t we'r e having and we've increased that and the same people, your mates, were criticizing me a few years ago because I closed some of these hospitals. Now you want to go all the other way.

I'm saying that we're looking at that. We're looking at the possibility. You can shake your head all you want, but if you've got a hospital that has the facilities, we're not going to build more beds at St. Boniface for that and keep 300 or 400 beds at the hospital not filled, not used at all, just so people have the choice. There is a limit in what you give. MRS. B. MITCHELSON: Mr. Chairman, I'm sure the Minister and I can argue this all evening, but I just will make my point.

When Concordia Hospital and Seven Oaks Hospital were closed, there was a need for more maternity beds obviously somewhere else within the city and the commitment wasn't fulfilled to increase the labour floor at the St. Boniface Hospital to deal with that overload. Now we're running into the problems and the Minister can tell me that there are no cuts, but when he says they're only going to do 4,000 deliveries next year or they're only going to fund 4,000, and there were 4,300- and-s ome done, to me that's a cutback.

It is a cutback in services and I'm sure that we haven't heard the end of it and I'm sure there'll be a lot more people out in Winnipeg that are going to write to their ML As and to continue to put pressure on this government to look very seriously at providing the funding for St. Boniface Hospital so that those people who should so choose to go there or so choose to have an obstetrician who practises at St. Boniface Hospital will have that choice available to them. HON. L. DESJARDINS: Well, there's no use arguing forever. MR. CHAIRMAN: The Member for Kildonan. MR. M.

DOLIN: I'd like to follow up a little bit on the questions from the Member for River East. At the moment, what hospitals are obstetrical patients being sent to where they are not high risk in coming out of St. Boniface? HON. L. DESJARDINS: Sorry. MR. M. DOLIN: What hospitals are non-hig h-risk patients, overload from St. Boniface . . . HON. L. DESJARDINS: Miscericordia was cut down, in their case they could do more, Victoria and Grace. MR. M. DOLIN: Not Misericordia? HON. L. DESJARDINS: Yes, Miscericordia. They've all cut down because they are not as busy. The point I was saying, it's not that we had to cut down.

We never expected to do more. We couldn't handle more than 4,000 safely and the point is that more and more people now, either through their doctors or whatever, even those that are not at the high risk are saying I want to go to the hospital. If we're going to have to increase, you can only do so many, no matter what hospital, unless you change the whole system and then we would have to close those other hospitals. Some people are telling us the opposite. So, St.

Boniface Hospital, if there is somebody who is not at risk because they have a responsibility, they're high risk are saying, here, you'll be well-treated in this hospital. They've got the facilities. You go there. Of course, if they are at risk, then they would be moved the same as has happened in the past. MR. M. DOLIN: I'm geograp hically looking at the hospitals that are available to non-high-risk delivering mothers. It seems Miscericordia is in the centre between Victoria, Grace, St. Boniface and Health Sciences and they are all centred and that Concordia is doing some referrals.

The Minister, correct me if I'm wrong, but is Concordia doing non-high-risk deliv eries now? HON. L. DESJARDINS: No, Concordia is not. Concordia and Seven Oaks were closed. MR. M. DOLIN: Then my question is, in the City of Winnipeg the northern-most hospital doing any kind of delivery is Health Sciences, in the city? North of Health Sciences, dealing with the population, comprising at least half the population of Winnipeg on both sides of the river, there are no hospitals for non-high-risk deliveries, now that Concordia and Seven Oaks are closed? Is that not correct? HON. L.

DESJARDINS: That is correct, but that is not as big a factor as . . . MR. M. DOLIN: Okay. Could I suggest to the Minister, perhaps consideration be given, at least in the short term. I see you're well aware of what I'm about to say. Perhaps the Miscericordia, which is about 10 blocks away from both Health Sciences and St. Boniface is not the appropriate place to allow people access for 1359

Monday, 27 April, 1987 non-high-risk deliveries; perhaps, even on a limited basis, to reopen some obstetrical beds in Concordia and Seven Oaks could be a reasonable consideration to allow lower risk for the people in those areas. HON. L. DESJARDINS: Now I got it both ways. MR. M. DOLIN: You can't have it both ways. All I'm suggesting is . . . HON. L. DESJARDINS: I know what you're suggesting. MR. M. DOLIN: . . . will the Minister reconsider? I'm not asking for a decision at this point. I'm serious in my request is the fact that geographical location is of relevance ... HON. L.

DESJARDINS: But that's not going to . MR. M. DOLIN: . . . low risk into high risk. HON. L. DESJARDINS: That's not going to meet the concern. MR. M. DOLIN: . . . whether or not it is not possible to reconsider perhaps Misericordia no longer doing del iveries, but some of those deliveries being done at Concordia or Seven Oaks? HON. L.

DESJARDINS: The problem is that apparently you need more and more - what we had said at the time - of the prospective mothers want to go, just in case, they want to make sure, either they talked to their doctor or somebody, into a hospital where they can look after their needs if they become an at-risk. So, therefore, just changing them around won't mean anything, especially if you're talking about the cases that aren't at risk, it's not the location.

First of all, it depends on where the doctor practises, so there were a lot of people who went to Seven Oaks from the other end of town, and there were some people who went to Concordia from the other end of town. In fact, the recommendation was that if there is going to be a third one, for this it might be that the answer to that mostly, and I would hope the member is listening, because this might be . . . MR. M. DOLIN: This member's listening. HON. L. DESJARDINS: No, but the other one is not. We're looking at the concerns that you say and what could happen.

I'm certainly not announcing policy at this time is that there would be a third one, not that you can keep on forever at building more and more beds, unless that's all you're going to do in that hospital. But the point is that it could be a third one, in case of problems such as that, that would be equipped and do the at-risk, the high risk, and that was suggested. If that's the case, it should be around the centre of town, somewhere around Misericordia. As I say, I'm not announcing any government policy; I'm saying another option that might happen. That's what the specialists will tell you. MR. M.

DOLIN: Just as a final comment on this issue, could I suggest to the Minister that perhaps because Seven Oaks is a newer hospital, it was equipped for obstetrics - we now have ophthalmology in the middl e of an obstetrics room that could be full of babies with everything set up - that perhaps instead of considering an older hospital which needs revamping for the comfort and safety of the mothers, that if the Minister is considering a third hospital? Perhaps Seven Oaks would be more appropria te. HON. L. DESJARDINS: Can I say that we'll consider all the options? MR. M. DOLIN: Good, I'm glad to hear that. MR.

CHAIRMAN: The Member for Pembina. MR. D. ORCHARD: Just on this topic, Mr. Chairman, as I pointed out to the Minister earlier before supp er, he skilfully sometimes tries to avoid the issue. The issue on obstetrics at St. Boniface is the closing of obstetrics at the Concordia and Seven Oaks and the repercussion of that three-year-old decision. Part of the decision then was to, I believe, expand the obstetric facility at St. Boniface. Now you've got a circumstance where you've got instances where your admission policy may well deny access to a mother and her physician at St.

Boniface, because there's no room in the inn, if you will. It is not a problem that has just happened; it is part of the fallout of closing of those . . . HON. L. DESJARDINS: Not at all. MR. D. ORCHARD: Well, the Minister says not at all. But you're going to have an awful tough time convincing anybody from the Member for Kildonan's constituency; and the Memb er for River East; the Memb er for Rossmere's constituency, where Concordia and Seven Oaks Hospitals respectively are closer and don't have obstetric wards, that that isn't a fallout of that decision. By having a restrictive admission policy at St.

Boniface because the facility is crowded can indeed put some expectant mothers, whose physician doesn't have admitting privileges at Misericordia or Victoria or another hospital, in the position where the mother is going to a hospital without her physician that's been with her for some time. Well, Mr. Chairman, the Minister shakes his head, but that's the nuts and bolts of the problem. HON. L. DESJARDINS: All right, let's go back again and look at this situation. When we closed Concordia and Seven Oaks, the statement was made that it was so important to stay in the area.

Now, one of the main reasons why that was done was because more and more people were requesting to go where they had the facilities for the high-risk delivery. Before we even made a decision to close Concordia and Seven Oaks, we were in the process of dealing with the Health Sciences Centre in St. Boniface to increase the facilities. When we closed that, the last year was 250 and 173, it was about 400 between those two hospitals, and we went from 3,000 to 4,000 at St. Boniface, so that's an increase. We increased at the Health Sciences Centre also. Now, the Grace, Misericordia and the Victoria had 1360

Monday, 27 April, 1987 facilities and they went down, even if we closed those hospitals. So the point is it's not the beds, the beds for the at-risk, that's the idea. That's what the people want which we had said at the time, so my friend is absolutely wrong when he's saying that we're playing games and we try to blame - that's exactly what happened . Now the situation is we say we want more beds, we don't want these smaller hospitals, and that is being looked at and the review comm ittee tells us that, no, we shouldn't close any more at this time.

One of the recommendations by some, where it has also been, well, fine, you should have, in case something happens for the high risk, a third hospital as security, as a stand­ by or something. That's what we are talking about at this time. So it's not a question of beds. We've got a lot of beds, but everybody wants to go to the same place. They want to go where they have the at-risk program, and St. Boniface Hospital is saying, all right, we were supp osed to work with 4,000 and we're getting more than that, so we've got to start saying to people, who are not at risk, go to the smaller hospitals.

Then, of course, definitely there has to be - that's why I was shaking my head - arrangements made to make sure that the doctors in cases like that will have to devise some way with the hospital to make sure that they have admitting privileges in those other hospitals. So the point is the options that we have is we go all for specialty and when the member was out for a few minutes, we talked about the Peddle Report, which made that recommendation, and there was an uproar and a battle with the medical profession, because those rural doctors wanted no part of that at all, and the problem is still there.

It's not that cut and easy and it's not a question of beds or beds closed; it is that everybody wants to go to the same kind of beds now, it seems. MR. CHAIRMAN: The Member for Brandon West. MR. J. McCRAE: Mr. Chairman, on a different subject. I'd like to cast the memory of the Minister back to the fall of 19 85. At that time, the Manitoba Health Organizations was negotiating with the In ternational Union of Operating Engine ers, on behalf of eight facilities.

At that time, the province was considering a report calling for a restructuring of the Manitoba Health Organizations to give the government a more active role in labour negotiations. Can the Minister tell me what report that was, and if it's been made available to the Legislature, and what the governmen t's position is on what role it should be taking in labour negotiations? HON. L. DESJARDINS: There was a report called the Johnson Report. It was made by the former Deputy Minister of Health. That was made available and it has been made available - it's a numb er of years ago.

It talked about some changes with the MHO . We have dis cus sed with the MHO some of th ose recommendations that we go along with. There's been some discussion with the MHO and something should be announced fairly soon. I don't envision vary major change, we're not doing away with the MHO or anything like that. 1361 MR. J. McCRAE: Mr. Chairman, would the Minister agree that the mandate of the MHO is still then to negotiate on behalf of its participating facilities or on behalf of its policy advisory committee and not on behalf of the government? HON. L. DESJARDINS: That was never the mandate of the MHO as such.

The MHO receives that mandate from the hospitals only, the MHO is not a body that is set up to negotiate as such. That's part of the service that they offered to their member's hospital. But if the hospitals say no, we want to do our own negotiating or we want somebody else, that's the way it happens. This is not something that belongs to MHO . There has been some concern from the labour with MHO , that's been an ongoing battle. MR. J. McCRAE: Mr.

Chairman, in cases where the MHO isn't doing the negotiating, does the government step in and get involved with labour negotiations between those facilities not represented by MHO? HON. L. DESJARDINS: If they're not represented by MHO they're represented by the hospital. A hospital will, each institution in negotiating will set up their bargaining group and it could be the MHO or it could be people from their staff or whatever. The government will, dealing with the doctors or anything like that; we don't deal directly with them but then the government will say, that's the maximum that is available at this time.

Nobody can just disregard that, they have to get the funds somewhere to pay. The government has to be involved in that case because they, you know, somebody's got to put the money in. It all comes from the taxpayer through the government. MR. J. McCRAE: The Minister is talking about putting a ceiling on how much is available to a specific facility. The case I'm referring to, Mr. Chairman, refers to a Memorandum of Agreement between the Manitoba Health Organizations and the International Union of Operating Engineers, negotiating on behalf of eight facilities.

This has resulted in a collective agreement that runs from January 1 of'85 to December 31 of '87. At the time of those negotiations for that agreement, Mr. Sigurdson, who was then Chairman of the Manitoba Health Organizations said that he was instructed by two government officials to offer the union in that case, $200,000, not to be passed on to the employees but directly to the union to be used for an education fund. The Memorandum of Agreement, Mr.

Chairman, says that the employers agreed to contribute a one-time only total amount of $200,000 to the union on a pro rata basis and proportionate to union membership at each facility. This is not, Mr. Chairman, a case of the government putting a cap on what could be negotiated. This was in the summer of 1985 and the term used at that time is that we were on an election window or something of that nature. An election was coming along that fall; $200,000 is directed to be offered to a union, according to this newspaper

article to bring a strike to an end. I'm wondering what the Minister's position is on that now in view of my earlier question, is the government taking a more active role in labor negotiations?

Monday, 27 April, 1987 Mr. Sigurdson at that time had said that this was an interference in negotiations. We've certainly been hearing a lot from the Minister of Labour recently about interference in labour ma tters. Here we have the Government of the Day in 1985, instructing the MHO to offer a labour union $200,000.00. Two days after the government offered the $200,00 0 payment a collective agreement was reached. I wonder if the Minister has any comments. HON. L. DESJARDINS: Yes, I do.

I can tell you this, that the situation is, first of all that agreement that you're talking about came to less than what was offered by the MHO : The situation is this, that government has to deal, has to have a policy on wages in certain areas. They've tried at times to cut down on actual increase and gone down with other services, for instance, such as the service that might have been done. I can tell, without any hesitation, and you can check with Sigurdson and anybody else that you want, that I've never instructed MHO or anybody else to do anything at all.

What has been provided through the Commission, they've been saying this is what the government is ready to do. We are signing agreements with MGEA and different groups. We've tried to have a certain policy that you don't jump all over the place. That has been passed on. That was a concern; how do you let the MHO know if they are negotiating for management let's say, and what is available. That's what we've done in the past. At the request of MHO , because there was a concern and MHO said, well we'd like to have talks with you on that, listen to what we have to do and we have to have talks with you.

This is what has happened. I don't think that you can make the comparison about interfering on something that is in front of a labor board or something as during a collective bargaining. You say this is what the government is ready to do, because we have policies to look at a lot of emplo yees that work for the government. Of course, all the money comes to the government, every single penny - well, the taxpayers of course, but through the government.

Therefore the government has to app rove and as they say this is all you get they also say we're ready to do that and they try to bring as uniform a policy as much as possible. I don't apologize for that at all. MR. J. McCRAE: Is the Minister suggesting that Mr.

Sigurdson was being untruthful when he said as reported in the Winnipeg Free Press, that he was directed, their negotiating team, MHO 's negotiating team was directed by two government officials to offer the union $200,000 even though that education fund which was to be financed by the $200,000 was not even on the bargaining table in the labour negotiations. Was Mr. Sigurdson being untruthful in making that allegation? HON. L. DESJARDINS: If he said that I ga ve him the instruction, he certainly was, you can check with him.

The point is that from time to time the government has offered the MM A, for instance special allowance for shoring up different areas that they were lower. That was done through government. That was accepted and we have made the same offer to be consistent with some of the agreements that we've had to make with the many empl oyees of government. Either MGEA or in the department of Education and so on. We've tried to have policy on employment that would not jump from one to the other, without any guidance at all. MR. J. McCRAE: Mr. Chairman, Mr.

George Smith, the business manager for the Operating Engineers certainly at that time said that he bargained away his 2 percent increase on behalf of the employees in the first year of the cont ract for the education fund. The point is that the $200,000 didn't go to any workers, Mr. Chairman, it went to the union. This is sort of in line with some of the things that we've been saying recently that the government seems to be in lock step with the union in this situation in lining the union pockets to the tune of $200,000 worth. HON. L. DESJARDINS: It's the same thing when we go to the MM A. The MMA's a union. MR.

J. McCRAE: The workers don't get it is the point, Mr. Chairman. The union does, $200,000.00. No w, Mr . Chairman, another clause in this Memorandum of Agreement is that the Training and Education Fund shall be audited by the Provincial Government on an annual basis for the life of this collective agreement. Two years of that colle ctive agreement have gone by, Mr. Chairman, so there should be two audits. Have they been made available to the Legislature? HON. L. DESJARDINS: I wouldn't have that. I guess the Minister of Labour would have that. Do we have that?

Apparently we've requested an audit from their auditor that I didn't know about. MR. J. McCRAE: Would the Minister make those audits available to either myself or the Honourable Member for Pembina? HON. L. DESJARDINS: That, to me, should be public knowledge, as far as I'm concerned when I get it. MR. J. McCRAE: It is public money, Mr. Chairman, and I should think . . . HON. L. DESJARDINS: It's a one-time cost though. MR. J. McCRAE: A one-time $200,000 fund set up for a union, and I must insist, Mr. Chairman . . . HON. L.

DESJARDINS: Not for a un ion, for the members of the union to do exactly what is proposed for a specific purpose. MR. J. McCRAE: That's why I think the audits will be interesting for the Member for Pembina or myself to receive, and I trust the Honourable Minister will make those available to us shortly. HON. L. DESJARDINS: Fair enough, we can do that. MR. J. McCRAE: Thanks, Mr. Chairman. 1362

Monday, 27 April, 1987 MR. CHAIRMAN: Committee rise. HON. L. DESJARDINS: No, we agreed to go on. MR. CHAIRMAN: You want to go? I'm sorry, I didn't realize that you agreed. HON. L. DESJARDINS: Another hour or so. MR. CHAIRM AN: Sor ry, you should inform the chairman what you agreed to. HON. L. DESJARDINS: We did. MR. CHAIRMAN: The committee will sit down again. The Member for Pembina. MR. D. ORCHARD: Mr. Chairman, I want to bounce a concept off the Minister, and I will confess that I've got to put a little more meat on the skeleton or the concept. HON. L. DESJARDINS: Not on me, I've got enough. MRS. B.

MITCHELSON: Well, he didn't call you a skeleton. HON. L. DESJARDINS: It's about the only thing you didn't call me. MR. D. ORCHARD: Mr. Chairman, when we go through the latest Annual Report of the Health Services Commission, it gives 1985-86 net MHSC payments to various hospital facilities throughout the province. I've done some calculations on them, but there are a few questions that I'd like to ask first off. Can you tell me what the occupancy rate is in various hospitals? Do you have that readily available?

I can give you some specifics that I'd like to make the comparison with, because I'm familiar with two of these hospitals, Carman and Winkler Bethel; and then because, when I was in Ste. Rose, there was substantial discussion on the Dauphin Hospital, so Dauphin; and then let's perchance take, okay, HSC as one and Misericordia as another, just as two of the Winnipeg hospitals. Would it be possible to determ ine the occupancy rate in those facilities? (Mr . Deputy Chairman, M. Dolin, in the Chair. ) HON. L. DESJARDINS: We'll see if we've got something here. If not, we�ll get it. MR. D.

ORCHARD: It's not essential that I have the occupancy rate, although . . . HON. L. DESJARDINS: Have you got this,'85-86? MR. D. ORCHARD: No. Is it one of the packages that was there today, because I haven't had a chance to look at that? HON. L. DESJARDINS: I didn't even know. It must have been when we were here. Do you want any special one, or do you want . . . MR. D. ORCHARD: Yes, like I've got three hospitals - Carman. What would be the occupancy rate there? HON. L. DESJARDINS: Where is Carman? MR. D. ORCHARD: It's in the 16 -30 bed one. HON. L. DESJARDINS: 63. 1 percent for the 30 beds, eh? MR. D.

ORCHARD: Yes, 30 beds. Now let's go to Winkler Bethel. That's the last one on the 31- 60 bed group. It's a 57-bed facility. HON. L. DESJARDINS: It's 58. 7 percent. MR. D. ORCHARD: Okay, 59, call it then. How about Dauphin? HON. L. DESJARDINS: Dauphin - wait a minute. MR. D. ORCHARD: It's one of those ones like Morden where it's got acute .. HON. L. DESJARDINS: They're in construction. MR. D. ORCHARD: Maybe it's included under acute care. HON. L. DESJARDINS: 81 .9, 82 percent. MR. D. ORCHARD: Okay, let's call it 82 percent. And Dauphin might not be a good one, so we'll leave it at any rate.

And then how about Health Sciences Centre, Misericordia as two Winnipeg facilities, or two over 125 - bed facilities? HON. L. DESJARDINS: Misericordia, 84.6 percent; Health Sciences Centre, 79 percent. MR. D. ORCHARD: The reason I use Winkler and Carman as examples is that Carman's got a new hospital. You were there for the opening of it. HON. L. DESJARDINS: We were there for the opening. MR. D. ORCHARD: Yes, I had you invited. HON. L. DESJARDINS: Wasn't I nice to you? MR. D. ORCHARD: Well, you were publicly civil, but you weren't privately very nice to me. HON. L. DESJARDINS: Holy God! MR. D.

ORCHARD: That's not quite correct. The Min ister's always very civil to me, both private and public. But, Mr. Chairman, in terms of Carman, there's a good medical team there, and they're doing some pretty subs tantiv e opera tions there - I do n' t know the termino logy for it - but the bowel operation, where they end up with the - colostomy. They do those, and they've got the stapler instead of sutures and that sort of thing. Winkler's also got a good surgical team, got one very 1363

Monday, 27 April, 1987 excellent surgeon down there. Dauphin has turned into sort of a referral centre. A lot of people from Ste. Rose go up there, and I haven't toured the hospital, but I'm pretty sure that's a pretty fair facility. In broad general terms, we've got Carman operating - and I'm using'85-86 MHSC payments. You've got them operating on a cost per bed - and of course this is not a good figure because of your occupancy rate - but it's $68,000, on the basis of operating one of the 30 beds per year. You've got Winkler at $57,585, got Dauphin at $74,779.00.

Then you move into Health Sciences Centre as one of the teaching hospitals, you've got $16 2,000 per bed. Misericordia is the lowest actually of the Winnipeg hospitals at $87,000 per year per bed. Something like Brandon is $93,000; Concordia, $93,000; Victoria, $98,000; Seven Oaks, very high at $14 7,000.00. But you're looking for ways of containing costs in the hospital system. It has been proposed to me by rural physicians, I will admit primarily.

And you'll recall the other day, when we were debating, where there is that, once you get outside the Perimeter, everybody thinks that Winnipeg is trying to glom onto all the services, etc. The proposition has been made to me, Mr. Minister, that in a lot of our rural facilities - and Winkler and Carman could be the examples I'll use at home, because I'm most familiar with both of those - have surgeons, have facilities, have the ability to do quite a diversity of surgery. I talked to a fellow the other night who had the hip replacement done at Winkler, which is getting to be pretty complex surgery.

Now the argument has been that through the College of Surgeons and Physicians and possibly through the MM A, you end up with restrictive procedures or restrictive practices being put on a number of the hospitals. In other words, you can't do certain operations in the Carmans and in the Winklers and in the Dauphins as examples. Often they have a physician, a surgeon, who is qualified to do it, but there is some other reason. It may be good, or it may be justified. But you've got hospitals that are running at 63 percent capacity, so they could do more procedures.

You've certainly got the cost per day considerably lower than the Health Sciences Centre, or than any other of the hospitals in Winnipeg, significantly lower per day. I make to you a proposition of should you not be studying within your department the ability to offer a more diversity of.services in some of our rural hospitals that are equipped with the physician manpower to do it?

Because the proposition has been made to me that if you just allow some of the - if it's allowed, not you - I'm using the wrong terminology - because you don't have as much control over it possibly as what the College of Surgeons and Physicians may have, but if more procedures were done in the Dauphins, the Winklers, the Carmans, you can lower your costs, because the cost per day is lower in those facilities, and save yourself what appears to be a bundle of money.

Secondly, you provide a reason to expand your skilled physician or specialist base in rural Manitoba, because you offer them the ability to carry that out in other than a Winnipeg hospital scene.

Thirdly, you've got the advantage, certainly for rural Mani tobans who many rural Ma nitobans come to Winnipeg for elective surgery all the time, -or surgical procedures all the time, if you do more of them at a hospital closer to home, providing they want to do them there, that is, because they may choose to go to a specialist in Winnipeg, which you can't really control; but I say the opportunity should be there to diversify the deli very of medical services thr oughout rural Manitoba.

I'm not so sure that we're not running into a created institutional block to doing that, rather than a medically viable reason for not doing it in the Winklers, the Carmans, the Dauphins, etc. As I say, I've got to do more investigation on this, but on the surface, it would appear as if there could be some fairly substantial dollars saved, because those Dauphin Hospitals, Winkler Bethel Hospitals, Carman Hospitals appear to be able to operate at a lower cost when you're attempting to really tailor the budget. MR. CHAIRMAN: Mr. Minister. HON. L.

DESJARDINS: Well, in effect, when I read the five-year capital program, if you remember - and you spotted it immediately - we talked about some areas. We were looking at this, and that's exactly what we want to look at. We've talked before of regional facilities. It's been in name, but what have we done? You're talking about regional, those would be the ones up north, Flin Flon, Thompson. I have a list here. We talked Morden, Winkler, Selkirk, Dauphin, Steinbach, Portage, Swan River and those kinds of hospitals.

Certainly, that should be a different level and we should do as much as possible, not something else but something instead of doing it in the city. Why bring them all the way? Now, it used to work well. I'll tell you a good example in Flin Flon. It used to work well when all the doctors were together. Then there was a disagreement and they divided, the doctors, because you can send your patients where you want. We're sending them all the way, by-passing the doctors who had been partners of theirs before, who were well qualified to provide the service. They were sending them to the Health Sciences Centre.

I think we've got to get the right to stop that. We've discussed that, and that's been in front of the medical profession at one time. Now if we do that, I want to make sure that we don't just invent something to keep that place like some of the areas, more surgery and so on that might not be needed - but I'm sure that's not what you're talking about, I think - instead of having it here to lower the cost. But if you do that, you will also have to look at the - you see, we're talking about the regional bases. Then there would be the district, which would be a little larger. Well this is what I had.

Maybe you don't agree with this, this was done fast. Besides the northern hospitals for the regional, we were talking about Morden, Winkler, Selkirk, Dauphin, Steinbach, Portage and Swan River. Then the district hospitals, we had Arborg, Ashern and Baldur , Beausejour , Birtle, Carberr y, Carman, Crystal City, Deloraine, Eriksdale, Glads tone, Glenboro. Is that the kind of hospital you're talking about? Then the community hospitals - but you have to look at the community hospitals.

It could be that we could close the acute care beds and have a smaller community where it's viable of having some personal care homes for the area and maybe one or two or three multipurpose 1364

Monday, 27 April, 1987 beds that could be used in an emergency and so on, but count on those other hospitals. We can't duplicate these hospitals all over the place. We could keep probably the staff and that by using the personal care home as we' ll need them, and kind of a clinic, community clinic type. I think we could do that with the support of their area. We'd very much like to look into that, exactly what you stated. MR. D. ORCHARD: I am pleased to hear that, and I probably will be discussing this more with the Minister.

I don't know whether it's real or whether it's simply perceived, because sometimes you can get that way when you start talking to . . . HON. L. DESJARDINS: Well, the problem is to keep the doctors. They used to say in the area, well you know, the spouse of this doctor doesn't want to work in the rural area, and that is certainly one of the reasons. But we're told - and that makes it more complicated - that it's not that any more. First of all, they want to work for the group. They don't want to work together 24 hours a day, those days are gone.

But then, they are so used today and we're looking at - that's another thing we'll have to look at - with the university, look at what they're teaching in those medical colleges or medical schools. Now, it seems that if they are not near a CAT scan and everything possible, they can't operate. They haven't got all the specialists and, therefore, that's why it's so hard to find somebody who will go into the rural area. Now we might be able to have some kind of a comprom ise. That would be more of this equipment that will get in those hospitals if we can do that work.

That could be providing you don't just dupl icate here again and just put more and more of those things. That, we'd have to be very careful. MR. D. ORCHARD: Like, I'm not talking about the CAT scans in a rural hospital setting. HON. L. DESJARDINS: No, I'm saying that's the doctors. That's why they find it hard to go in the rural areas. MR. D. ORCHARD: Right.

Look, I think, given the experience that you see in terms of malpractice suits, etc., etc., I don't think I can necessarily blame the phy sicians for wanting to have th ose kinds of assurances against or as much assurance against a malpr actice suit as you can possibly get. It's a fact of our society nowadays, you know, sue the bastards. That's always the bottom line. I mean, sue everybody. Now, Mr.

Chairman, the concept that I basically want to get into and have gotten into, and the Minister appears to be, the department appears to be looking at, is not creating a new service out of an existing hospital but rather, as you say, transposing from the Winnipeg centres to the rural areas where it's safe and where the physician expertise is there. Because I simply tell you that I know from experience that the physician team in Carman, it's a very small hospital when you take a look at bed numb ers, etc., but they do very good work. I say that without any equivocation and the same thing applies to Winkler. HON. L.

DESJARDINS: But it's not even transferring at first. The first phase is keep some of the things there instead of bring the patient to Winnipeg and then after that it could be that you could transfer some people. MR. D. ORCHARD: That's right. So if that is a direction that's being looked at, it seems to me that you've got dollars that can be saved there. HON. L. DESJARDINS: We can talk to you about that. MR. D.

ORCHARD: Now, okay, let's get off that and let's talk for a few minutes about the proposal that's before the Minister in terms of meeting budget by some of the major hospitals, wherein there are the proposals for a number of bed cutbacks. In Health Sciences Centre, etc., etc., I don't know whether I've got them, it doesn't matter, we've gone through the numbers in the House in question period. The Minister knows what I'm talking about. Now, can I ask the Minister some general questions in terms of what government policy will be in the event of approving hospital bed cutbacks?

In Brandon there's an outright closure of, what? 20, 31 beds. Thirty-one beds right now, as an example, because they seem to be on the leading edge of the new cost containment process of closing beds, but there are 31 beds closed and then they're closing an additional 48 for a four­ month period over the summer. That was the proposal. Now; Mr. Chairman, the policy last year at this time was no staff layoffs as a method of budget cost containment. Now, is that policy still in place? Will there be no staff layoffs? HON. L.

DESJARDINS: As of this time, yes, until everything is approved but the situation is this, that we call the hospitals in, and we said, all right, you've got a deficit, and I remember we had the figure in front of us, that sheet in front of us, and we've agreed, $13 million, there was another 10, we said, all right. We picked up this $13 million over a deficit. Then we said the other one, all right, we want you to come in, we left it up to them, we didn't give any directive at all.

We said you've got to stay within your budget and you've got to cut down and we'll do it together in an orderly way, we'll do it two years. All right. And that is the funds that we will have to move in the community health care. So we're waiting, we haven't seen that. All the lists that you gave, that's them, that for a reason they've gone to the news media or somebody, I don't know and I don't really care. The point is that they aren't going to submit this to the Commission, and I think that most of them must be in by now. Now that will be reviewed and they'll be reviewed with us also.

We will have to see first of all what it will do, what it will do to the hospitals, the service of the the patients. For instance, the question that was asked today by your partner, on mental health -(Interjection)- aren't you a partner? - the possibility of making sure that these people have some service instead of just saying, well, you're out of the hospital. That's the first thing to do. And if we're not ready, it will be our fault. We'll have to work and it's not going to be done that easy. We've got to try many things. We've got to try some 1365

Monday, 27 April, 1987 of these community clinics that will, maybe with nurse practitioners and nur ses delivering the primary care, and th ose kinds of services, maybe with some physiotherapists in there and some of those kinds of services in those clinics. We're not interested in building clinics that will just duplicate or offer another service; we can't afford that. It is one or the other. It is not both so that is one of the things we are looking at.

We are also going to look at staff and we're going to, first of all, look within the hospital what kind of a change they can do, what kind of re-educating they can do. If need be, we will look at attrition, first of all, and then we will look at some of these people, work with the unions. In the past there have been different unions and they said, no, you can't, if you're going to hire somebody there, it's our union. In fact it might be the same union but a different local, and they might say, okay, you've got to hire somebody else. Well, we won't go for that.

We definitely, in other words, if somebody that's off the hospitals, they would have the first chance. We're not going to fire somebody and then start getting more people. The union will have to work with us on that. Now, we've set up a committee of these people who work, so when that comes in, let's say Brandon or any hospital, we look at the situation. We'll also look at them when they say, well, give us the money to buy - I still have trouble with that word - the lithotrite, whatever, anyway, the stone crusher, that kind of thing.

They used to come with us in the past, they used to come to us and say, hey, we can save money because we don't have to have this person in the hospital for more than maybe an afternoon or a day instead of a few days, waiting for all the tests, have the operation, and then it's harder on the patient and costs a fortune. So we won't need as many beds. We used to say, that's a great idea. We give them the equipment to get the people out of bed, but they'd hurry and put somebody else in the bed.

And it kept on, kept on, so now we're saying, all right, you had the beds to do that, if you're going to get this money to do it, then you won't need those beds. So we're not going to cut beds actually, but the only way that we're going change this by getting all this equipment and say, okay, you said you don't need this bed - because the beds will always be filled as fast as they can do so - so we're looking at that situation. That's what I said when I said we're going to do it in an orderly way and in a way that we don't take the service away from the public, so that's what we're going to do.

In the meantime, of course, that policy of people being moved around will have to be changed when it's approved. MR. D. ORCHARD: Okay. Mr. Chairman, the question is rather straightforward, and I don't want to get into the debate of the bed cuts or any of that sort of thing, but if you are reducing the size of your plant, in Brandon's instance, it's something like a 9 percent reduction in the available bed count, at the 31 that have been closed permanent ly, the simple question is, that given - and I believe we discussed that earlier before supper - that 70 percent of your costs in the hospital is staffing costs.

If you were hoping to achieve budget savings by closing of beds, it naturally will follow that you have to lift your moratorium on layoffs. HON. L. DESJARDINS: Absolutely. It's ridiculous to think that you can achieve it by keeping all the staff there and then closing beds. What the hell is it going to do? MR. D. ORCHARD: That's right.

Now, my question is will this staffing, the reduction in staffing, with bed cuts be equally applied, i.e., nursing staff, support staff, even administration, because let's bear in mind that the administration of hospitals are saying, well, we've got this idea of saving money and it involves closing down certain beds. If the beds are closed, there shouldn't be the need for as much administration, and I am asking the question: If there's a 10 percent bed cut, will the 10 percent staff reduction, if that is the applicable figure, apply universally throughout all categories of staff? HON. L.

DESJARDINS: Well, the principle, yes. Now to say that it's going to be . . . it might be very difficult and impossible to live with, say a percentage of everthing. You might have one cook; you're not going to say you want a one-armed cook or something like that. It might be that some admin istration that you still need more - that's the point they already make. But the principle, yes. That's one of the reasons why we want to see the programs with them before we accept, before they can announce. But you're right, we've got to eventually cut staff.

We want to move that staff as much as possible, first with attrition and so on, and then transferring out of there - on some it's going to be tough. Exactly the point you're making, it's going to be tough. What do we do with people, cleaning staff, but we still have to addr ess that. Those people could be in the commun ity, work in the community; that's where we'll take our staff if at all possible, to work in a commun ity. MR. D. ORCHARD: Mr. Chairman, you've got two prongs, basically, that I see that you're going to have