1991 Legislative Session: 5th Session, 34th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 17, 1991

Afternoon Sitting

[ Page

12749 ]

CONTENTS

Routine Proceedings

Oral Questions

Free trade with Mexico. Mrs. Boone –– 12749

Privatization. Mr. Lovick –– 12749

Omni-Script Services Ltd. Mr. Sihota –– 12750

Public Accounts Committee meeting. Ms. Marzari –– 12750

Enrolment cuts at Vancouver Community College. Mr. Jones –– 12751

Flight access for physically challenged. Hon. Mr. Rabbitt –– 12751

Presenting Petitions –– 12751

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Strachan)

On vote 38: minister's office –– 12752

Mr. Perry, Mr. Vander Zalm, Hon. Mr. Parker

MONDAY, JUNE 17, 1991

The House met at 2:05 p.m.

Prayers.

MR. REYNOLDS: As you know, Mr. Speaker, this Legislature has

a trophy called the "Speaker's Trophy" for tennis, for which once a

year members of this House, Clerks and other staff play against our

friends from the media. On behalf of our members, the Clerks, the

auditor-general and others, I'd like to report that we defended that

honour greatly again this year and beat the media. In deference to them

and to show encouragement for next year, we won't give out any scores.

MR. LONG: Mr. Speaker, in the House today I have a friend and

a constituent, Mrs. Shirreen Morgan, who is also the SuperHost

coordinator for the Powell River area. It's one of the greatest tourist

programs that has ever been brought into British Columbia and is

emulated around the world today. I would like the House to make her

feel very welcome.

HON. MR. FRASER: Mr. Speaker and Members of the Legislative

Assembly, it's my pleasure to introduce Ambassador Woo and

Consul-General Lee from Korea. Would the House please join with me in

making them welcome.

Oral Questions

FREE TRADE WITH MEXICO

MRS. BOONE: My question is to the Premier. The Premier has

spent much time changing hats recently and, quite frankly, we're not

quite sure where your head is at. Apart from being scared stiff, does

the government have an official position on the trade deal with Mexico?

HON. MRS. JOHNSTON: Mr. Speaker, in response to the question

from the member opposite, the minister responsible is not in the House

at this time. But I would suggest that our main concern is and will

continue to be to protect the jobs of British Columbians. As a general

principle, we do support free trade, but we want to ensure that the

jobs and interests of British Columbians are protected. It's obvious

that the member opposite is referring to a statement I made on the

weekend, and I'd like to clarify it by telling you that I feel that,

the negotiations, if they are going to take place in Ottawa through

federal politicians, will really give us cause for concern, because I

don't believe that the interests of the workers in British Columbia

will be properly represented unless we are able to play an active

part

in those negotiations. That's our position.

MRS. BOONE: Supplementary to the Premier. Your government was cheerleading

on the sidelines through Brian Mulroney's first deal. As a result of that

deal, our fruit industry has suffered and our fishing industry was damaged.

Now the Premier wants "Trust us" ...to get into the game. Have you

decided to direct your minister to develop a position on this deal and to table

that position in the House immediately?

HON. MRS. JOHNSTON: I will take that question on notice for the minister.

MRS. BOONE: A new question to the Premier. The free trade

deal with Mexico poses serious threats to working people. Has the

Premier decided to table in the House all the studies and submissions —

and we know that there have been many done in January and February of

this year — that this government has received on this very important

public issue? Will you table them in the House, Madam Premier?

HON. MRS. JOHNSTON: I will take that question on notice for the minister.

PRIVATIZATION

MR. LOVICK: I also have a question for the Premier. On Saturday the interim Premier said that if she were the real Premier....

HON. MR. STRACHAN: Point of order, Mr. Speaker. As the House

is well aware, a member is referred to by the constituency they

represent or the cabinet portfolio they hold, and there is no portfolio

of interim Premier. I think the House should be advised of that. I find

those references to be offensive to parliament.

Interjections.

MR. SPEAKER: Order, please. We've heard more offensive language in the House, but perhaps members could bear that in mind.

MR. LOVICK: I know the other side is often offended by the fact that language sometimes defies reality.

Last Saturday the Premier said that if she were the real Premier,

privatization would be "taken off the shelf." Can she advise this House

whether the plans to privatize health care, as suggested in the phase 2

documents of her predecessor, have also been "taken off the shelf?"

MR. BLENCOE: Are you looking around for help?

HON. MRS. JOHNSTON: To the member for Victoria, I am not

looking around for help, but I'm looking to the appropriate minister.

Members opposite appear to have a very serious problem addressing their

questions to the ministers responsible. I would suggest that the

question would be better put to the Minister of Health.

MR. LOVICK: I asked the Premier to clarify a point that she

made acting as Premier. I think we're dealing with an avoidance

mechanism here, Mr. Speaker.

Another question to the Premier. What about GAIN? Phase 2 of the privatization program also

[ Page 12750 ]

talked about GAIN, the guaranteed income supplement. Can the Premier advise us whether that may also be "taken off the shelf?"

MR. SPEAKER: The first member for Nanaimo.

MR. LOVICK: Can the Premier advise the House whether

education, which was also on the privatization shopping list in the

phase 2 documents, will now be "taken off the shelf?" Can she give us

that answer?

MR. SPEAKER: Once again, if members would reflect on the

rules and just phrase their questions in a grammatically correct way,

then the question would.... Might I assist the member with the prefix:

has the Premier decided...?

MR. LOVICK: Mr. Speaker, if I offended, needless to say, I am

most embarrassed and certainly would not intend I'm glad that the

Premier has now had these extra few moments to get her thoughts

together. Can she then advise the House whether she has decided if the

GAIN privatization plan, as suggested in phase 2 of the original —

we're back to education this time — education part of the privatization

program, is to be taken off the shelf? Can she advise us on that? Can

she clarify once and for all that there isn't a hidden agenda on the

part of this government?

HON. MRS. JOHNSTON: I almost feel as if I'm at some type of all-candidates' meeting. If you wanted to have a....

Interjections.

HON. MRS. JOHNSTON: It's a wonderful audience, because we

don't generally have these numbers at the meetings. So maybe I should

take advantage and make one of my famous campaign speeches.

[2:15]

There appears to be confusion in the minds of the members opposite

with regard to some of the statements that have been made during the

leadership campaign that is presently taking place in our party. I

would like to tell members opposite that our concern on this side of

the House has been and will continue to be for the people of the

province, whether we're dealing in the area of education, provision of

health care or provision of social services. It has been and will

continue to be that.

OMNI-SCRIPT SERVICES LTD.

MR. SIHOTA: A question to the Minister of Government

Services. Several weeks ago I asked her a question in this House about

Omni-Script and rollover pension benefits accruing to that firm. The

minister took the question on notice at that time. Could she please

advise the House as to when she intends to reply to that question, or

has she decided to reply?

HON. MRS. GRAN: The answer is very simple. The employer that

you speak of is deemed a privatized employer. Part of the negotiations

for privatization as that employees would continue on with their

pension benefits. And that's the entire answer.

MR. SIHOTA: Obviously a deal was cut with respect to rollover

pension benefits to this firm. Could she advise the House whether that

was standard policy during the time the government was proceeding with

its privatization policy? Has this been done in other cases?

HON. MRS. GRAN: Mr. Speaker, in all cases of privatization

that I'm aware of, where they were government employees, their pension

benefits were guaranteed in the same way.

MR. SIHOTA: One final question to the minister. I suspect

she's going to take this one on notice; I'll just put it on the record

in any event. Would the minister undertake to advise the House the cost

of that practice to taxpayers?

HON. MRS. GRAN: I wouldn't want to give you an inaccurate

answer. My understanding is that there was no cost to the taxpayer. But

I would like to take the question on notice and bring back the proper

answer.

PUBLIC ACCOUNTS COMMITTEE MEETING

MS. MARZARI: A question to the Premier. The Premier has

repeatedly stated that she has nothing to hide. The Public Accounts

Committee is one mechanism through which she can prove that. Has the

Premier decided to ask her members to assist in the convening of the

Public Accounts Committee at the earliest possible moment or to not

block the meeting of the Public Accounts Committee?

HON. MRS. JOHNSTON: Mr. Speaker, I had a bit of difficulty understanding

the last part of the question

Interjection.

HON. MRS. JOHNSTON: There was too much noise from the

opposition side of the House for me to understand. You started out by

saying, hon. member, that we've stated on a number of occasions that we

have nothing to hide, and we don't. I wish I could say the same about

the members opposite and their secret transition team who went off to

Ontario.

HON. MR. FRASER: Who was on that secret transition team?

HON. MRS. JOHNSTON: Yes. Who was on that secret transition team?

I would suggest, Mr. Speaker, that the member put the question to

the members serving on that committee. I'm not aware of a problem, but

I can tell you that our members are very busy, and maybe there has been

a problem with the scheduling.

[ Page

12751 ]

MS. MARZARI: There has indeed been a problem with the

scheduling, Madam Premier. The committee was authorized last week, and

I as the convener have attempted to have a meeting tomorrow morning,

Wednesday morning and Thursday morning — at any time of their

convenience. Your members are not available to meet at the earliest

possible opportunity, at any time this week, Madam Premier. Have you

decided to ask them to assist in the convening of the Public Accounts

Committee? That is the question.

HON. MRS. JOHNSTON: I will ask them to assist.

ENROLMENT CUTS AT

VANCOUVER COMMUNITY COLLEGE

MR. JONES: I have a question for the Minister of Advanced

Education, Training and Technology. Following some 20 meetings last

year between the ministry and Vancouver Community College officials,

and following several public meetings with the community and the board,

the ministry agreed to fund a program profile for some 9, 900

full-time-equivalent students. Now it appears that the funding level

will reduce that number to 8,200 full-time-equivalent students, almost

a 20 percent reduction in the number of students attending Vancouver

Community College. How does the minister reconcile that tremendous

cutback with the statement in the throne speech that education is the

most important investment in our province’s future?

HON. MR. DUECK: The figures that were mentioned are

erroneous. However, in general terms, British Columbia has funded

advanced education very generously. As a matter of fact, it's the best

in all of Canada. We spend 27 percent of our budget on education;

Ontario spends 18 percent. We spent $690 million on Access for All, and

it's been tremendously successful. Therefore I'm saying that as far as

education is concerned, in general terms it is good.

However, as far as the community college is concerned, our senior

officials are now meeting with the senior officials and chairman of

Vancouver Community College. I hope we will have some results which

will be in the best interests of the students of the college and the

taxpayers of this province.

MR. JONES: To the same minister. I see we're having more

meetings. What's needed is not more meetings. We have some $123 million

in this budget under the heading "Access and Enrolment." That $123

million would fund some 20,000 college students in addition to what's

already existing in the system. Does the minister not feel that this

part of the budget is appropriate to be used at Vancouver Community

College?

HON. MR. DUECK: The $690 million Access for All program would provide

15,000 extra spaces over a period of some years. The success of that program

is such that we will not be able to fund or to have spaces available for everyone

who would like to go to college or university. That will remain the situation

for some time; it is virtually impossible. However, we've increased spaces

by some 2,500 for this coming year. We're now looking at whether we can

increase that even more.

What I am saying is that the budget was generous. We're doing

everything possible as far as the community college is concerned. They

requested fewer spaces this year than last year. We gave them a lift on

the spaces that they requested; however, I think an error was made.

We're now meeting with senior officials of Vancouver Community College.

Very shortly I will be able to bring some news to the House on how we

can correct this.

MR. PETERSON: Mr. Speaker, I rise on a point of order

relative to question period. The first member for Vancouver–Point Grey

asked a question of the Premier on the convening and sitting of the

Public Accounts Committee. I'd like to point out to you that it is her

job to convene the committee, not the Premier's.

MR. SPEAKER: The Chair would like to point out to all members

that the Chair has no idea of, or concern with, the matters of any of

the committees, including Committee of the Whole. Really, such matters

properly should not be discussed when the House is meeting.

FLIGHT ACCESS FOR

PHYSICALLY CHALLENGED

HON. MR. RABBITT: I have a response to a question from the

second member for Boundary-Similkameen on Monday, June 3, 1991, which

was taken on notice. Contrary to the member's statement that Mr. Rick

Hansen cannot fly into Penticton, I can inform the Legislative Assembly

that I have ascertained that Mr. Hansen can travel by commercial air

transport to and from Penticton twice daily. Both Air B.C. and Time Air

provide Dash-8 transportation, which, I am advised, is fully accessible

by wheelchair-bound individuals.

Also, contrary to the member's statement, the Minister of Labour is

not responsible for this. The air transport industry is fully regulated

by the federal government in terms of safety, transportation

regulations and Human Rights. I do agree that human rights does very

valuable work in educating the public on these issues, and it is

available to the member to provide further consultation.

Presenting Petitions

MR. JONES: Mr. Speaker, I rise today to present a petition.

MR. SPEAKER: The proper time for presenting petitions was just a moment ago, but we will let it go ahead anyway.

MR. JONES: Thank you, Mr. Speaker. The petition is signed by some 300 students at Vancouver Community College, who say:

"We the undersigned are shocked and appalled by the consequences

of the budget cuts at Vancouver Community College, King Edward campus. Six months

[ Page 12752 ]

after the 'year of literacy,' budget shortfalls will cause

a reduction of over 45 percent in adult basic education. In the ESL division

over 800 students will not be able to complete their programs, while thousands

training. Over 95 teachers will lose their jobs at King Edward campus. We urge

you to rectify this situation."

I request leave to submit this to the table.

MR. SPEAKER: Leave is not required. Petition is presented.

Orders of the Day

The House in Committee of Supply; Mr. Pelton in the chair.

ESTIMATES: MINISTRY OF HEALTH

On vote 38: minister's office, $360,045 (continued).

HON. MR. STRACHAN: Mr. Chairman, I want to respond to some

questions raised last week by the second member for Vancouver Centre

with respect to the new Triage facility in east Vancouver.

The questions were four in nature: dealing with the community

reaction to the proposed new Triage facility in east Vancouver; whether

the increasing numbers of apparently mentally ill homeless people are a

product of deinstitutionalization; what monitoring systems are in place

for people discharged from Triage or from the institutions; and whether

services are being provided for teenagers.

First of all, in response to the Triage question in general and the

replacement facility, I want to advise the committee that the current

facilities are really not adequate and do not meet the Community Care

Facility Act regulations, and replacement is a high priority. It is a

critical component in the system of care to maintain mentally ill

individuals in the community

The current proposed site was chosen by the city of Vancouver. The

size and cost of the site has dictated that the new Triage be 58 beds

in order to meet the per-unit allocation criteria for capital costs set

by the B.C. Housing Management Commission.

Triage has not yet submitted an application for the necessary zoning

change to make it possible for the project to proceed. Whether or not

this project will proceed is a decision of the Vancouver city council

and the board of Triage. There have been public meetings, and there

will be further hearings if and when the zoning application is

considered.

The new facility will be licensed under the Community Care Facility

Act, which will impose new standards with respect to professional

supervision, staffing and care procedures. In view of the fact that the

new facility is larger and the location is more sensitive — closer to

schools and residential areas — should the project proceed, Triage will

be more restrictive with respect to receiving individuals on parole or

who have just been discharged from Riverview. While Triage has not had

professional staff running the facility, it maintains close links with

the Strathcona community mental health team. Together they provide

expert professional care for the residents who need it, and this

relationship will continue at a new site.

[2:30]

Some specific issues were raised in the debates last week, and three

of the questions dealt with pedophiles, violence, criminal records,

deinstitutionalization and monitoring systems.

With respect to the question of pedophiles at the new Triage

facility, let me say that pedophiles are no more likely to be at Triage

than anywhere else in the community, as pedophilia is not associated

with serious mental illness. Presently Triage notifies local schools if

there is a pedophile in the facility. This provides the community with

better protection, and the policy will be that Triage will not accept

any known pedophiles at the new site.

With respect to violence by residents at Triage, some residents have

a history of violence, but there have been no incidents of violence at

the present site involving the general public, and mentally ill people

are no more likely to be violent than anyone else.

As well, dealing with those who have criminal records: some

residents at Triage have been involved in the criminal justice system,

but generally for trivial offences such as dine-and-dash — which is

eating and then not paying for your meal in a restaurant. Should the

new site be approved, Triage has agreed not to take direct referrals

from the justice system.

The other question the member asked is: are the increasing number of

people on the street a product of deinstitutionalization? Let me say

that since Riverview has downsized since 1955 from 4,000 beds to the

current 1,000, a number of service developments have occurred:

treatment technologies have advanced, reducing the need for

hospitalization; 725 acute assessment and treatment beds have been

added to hospitals; over 2,800 community-based residential beds of

various types have been added to the system; and day treatment and

activity programs have been set up in most communities.

A joint study involving the Greater Vancouver Mental Health Service

Society and the Vancouver General Hospital will also help to determine

the home communities of many people with mental illnesses who

congregate in Vancouver and why they prefer to live in the city. The

implementation of the mental health initiative is being monitored by

the Provincial Mental Health Advisory Council, with membership drawn

from all the major stakeholders in the mental health community:

consumers, professionals, advocates and service providers.

Finally, the second member for Vancouver Centre asked what

monitoring systems are there for people discharged from Riverview? Let

me advise the committee that Riverview is an active treatment hospital

which routinely discharges patients once their illnesses have subsided

or stabilized. This is different from the deinstitutionalization

process which, over ten years, will provide alternative placement

facilities and services for longer-term residents of the hospital.

Once patients have recovered from their illness to the point where they can be maintained in a community

[ Page

12753 ]

setting, they are referred to the community mental

health system, where they are actively monitored as community service

clients. Some choose not to remain as clients, which is their right,

and this limits the ability of the care system to monitor their

situations. Riverview and community mental health staff are piloting

assertive case management projects which will provide aggressive

aftercare to minimize the loss of treatment-resistant clients. Outreach

workers have been added to the Vancouver mental health agencies, such

as Lookout, St. James Social Service Society and the MPA courtworker

program, to link individuals with mental illness to the service.

Finally, what services are being provided for teenagers? Let me

answer in this way: the highest priority for mental health services for

youth is to provide specialized services in local communities which are

coordinated with the community services for youth provided by other

ministries and organizations such as hospitals. Specialized

consultation is available for youth who are in the care of Social

Services and Housing or who are young offenders. Many of these youth

are in out-of-home placements such as foster homes and group homes.

Clinical assessment and treatment services are provided to individual

youths and their family; and referral for specialized services at the

Maples, B.C. Children's Hospital, VGH and Jack Ledger House are

coordinated through the local mental health office.

There are many more notes, and I guess I could read on, but I did

want to first of all brief myself on the issue of Triage. I'm pleased

that the member did ask those questions, as I was able to better

understand how the replacement is going to come into being and

understand some of the questions that the member from Vancouver Centre

so appropriately raised, as this is an issue that will no doubt deal

with his riding.

With that said, I'll take my place, Mr. Chairman, and anticipate further questions from members of the committee.

MR. PERRY: Mr. Chair, if I didn't know it was against the

rules of the House to read from statements, I might have been forgiven

for thinking the minister was reading that. It went so fast that I may

have to study some of the answers. I was attempting to follow it all. I

too had raised some questions and appreciate the response.

Maybe I could begin on a positive note again, since it's been a

while since we last continued this debate and it's going on three weeks

since we began it. I can begin on a positive note by just finishing off

the point I was attempting to make when we ran out of time last

Thursday. There's a young Chinese-Canadian boy named Gordon Wu from

Toronto whose parents were in Vancouver last weekend. I was going to

make the point that he's joined by another young lad from British

Columbia somewhere on Vancouver Island in the similar position of

requiring a bone marrow transplant as their only possible hope to

preserve their lives.

I think any member here putting oneself in Gordon Wu's parents' position

could identify with them. I had the privilege of meeting Mr. Wu on the weekend

at one of the clinics he had organized, with the help of the Chinese community

in Vancouver, to attempt to find a bone marrow donor for his son. Meeting the

father and seeing the mother on television, it's pretty hard not to identify

with them. Their son has a rare condition that will take his life, because there's

no effective long-term treatment for it. He does have the possibility of being

effectively cured by a transplant, yet the possibility is very slim because

the odds of any given individual matching him as a donor are so slim. In the

case of Gordon Wu, the odds are higher of a match for a donor from the same

genetic stock or ethnic origin, in this case Chinese. I think his parents have

not only done their own family a service but have done the public a tremendous

service, as did the parents of Elizabeth Lue last year, by raising this issue

and raising the profile of bone marrow transplantation.

I was able to help out a bit, putting my medical skills to a small

amount of use by helping to draw some blood on Saturday at the Richmond

hospital. It was quite impressive to see the response from the public,

particularly the Chinese-Canadian community — people who have, for

ethnic and cultural reasons, some hesitance about donating blood or

even the act of giving a blood sample, screwing up their courage and

coming in, I can see the minister and his staff smiling; they're

probably thinking it takes a lot of courage to come and have me draw

blood from them. I can reassure them that I didn't miss once.

But seriously, it was really a moving experience to see the clinic.

I wanted to mention it here so that the public has the opportunity to

get wider exposure. Bone marrow donation, if you match to somebody, is

one of the most fulfilling things you can do in life. For a politician,

it's probably the ultimate fulfilment. What do I mean by that? My

colleague the second member for Nanaimo two years ago was privileged to

match her bone marrow to her own brother, who otherwise would have

died. She now, unlike the rest of us, is literally able to be in two

places at one time, because she is not only here in the Legislature — I

don't see her in her seat right now, but she's somewhere in the

precinct — she's also at this very moment living in Port Coquitlam, in

her brother's marrow and blood; that part of his body is actually her.

It's kind of a strange thought — an exciting one for politicians — but

it's very important that the public understand more what a precious

gift it is, not just to the recipient but to the donor, to be able to

actually save another person's life. The average person has very few

opportunities in life to do that.

I wanted to mention that there is another opportunity for members of

the public — particularly, in this case, Chinese Canadians, because

they are more likely to match — to participate next weekend at Richmond

General Hospital and also at Mount St. Joseph Hospital.

I wanted to make a suggestion, too, because the Red Cross, for

historical and many good reasons, has been naturally rather wary of

individual campaigns of this kind. They have cooperated and have tried

to help, but have maintained their distance. That leaves the parents

[ Page 12754 ]

in this case having to foot the entire bill, at $75

per test; to attempt to tissue-type donors — in this case at UCLA in

the United States; and to foot the costs of the clinic.

Hopefully the real benefit of the clinic will come to Gordon Wu and

perhaps to this other young British Columbian, but it's much more

likely that somebody else will benefit. So in reality that family is

doing the public a tremendous service. Perhaps in Canada, perhaps

somewhere else in the world, some child or even an adult will benefit

from the work they're doing. We all have a stake in it, therefore.

I think it would be

an act of great generosity for the government to

contribute something towards the costs, because in reality not only is

the family bearing the costs, which is an investment for all of the

public of the world.... Anyone who is on this bone marrow registry as a

donor is potentially available to someone with a serious blood disorder

anywhere in the world. The Wu family and the volunteers who are

contributing are bearing that cost now. But they are also doing a

tremendous job of breaking through intercultural barriers, breaking the

ground in education and encouraging people in an ethnic community which

has been reluctant to donate blood in the past. This kind of effort is

breaking through that barrier and bringing us much closer together. So

I think it would be a great opportunity, if the minister has any

discretionary funds, to make some symbolic contribution to that,

recognizing that there's enormous benefit for all of us in these

campaigns.

I don't know if it's reasonable to expect him to reply now, but I'd

ask him to at least consider that possibility in the intervening week.

If we wants to reply, I'll sit down for a moment.

MR. BARNES: I'd like to ask the House to grant leave in order that I might make an introduction.

Leave granted.

MR. BARNES: Mr. Chairman, I'm very pleased to notice Jim

Kirk, the communications officer from my election planning committee,

in the public gallery. If the House would join me in making him

welcome, I'd very much appreciate it.

HON. MR. STRACHAN: I'd like to make a couple of comments. At

the outset, the member remarked on my reading an answer. He is correct

to the extent that speeches should not be read — and I never do read

speeches. However, when one is providing technical information — which

I was doing — it is quite appropriate to read answers of that nature.

We were chuckling a bit over here as the member was talking about

blood-letting. I guess I was thinking of the old barber-surgeons who

used to exist. I didn't want the record to show that we were at all

being glib or trivializing the issue he brought to us, because it is

very serious. I'm happy that he was able to explain that process to the

committee and the public from his point of view as a physician.

I can advise the committee, though, that on this issue of bone

marrow transplant there is a national unrelated bone marrow registry.

It is cost-shared by the province and the feds. It is located in

Vancouver and run by the Canadian Red Cross. I'm advised that the

British Columbia Ministry of Health was instrumental in the

establishment of this registry. Further, I'm advised that my assistant

deputy minister Chris Lovelace, who is sitting on my left, is on the

advisory committee representing the provinces in this

provincial-federal government relationship.

[2:45]

Finally, I can advise the member that I don't have any discretionary

money, but if we were to partake in the cost of the tests he's talking

about, we would ask for cost-sharing with the federal government, as we

do with the rest of this bone marrow registry. I can advise the member

that as those tests are done — although the parents of the patient are

paying for it — they are registered with this unrelated bone marrow

registry. So there is a benefit to the system as a whole and to those

who require bone marrow transplants.

MR. PERRY: I raised a number of times earlier in the debate,

both in interim supply and in the Health estimates proper, the question

of the cardiac surgery waiting-list. I expressed my reservations about

the figures offered by the former Minister of Health, suggesting that

the average waiting time for cardiac surgery had been reduced in the

last year from about 20 weeks to 10.5 weeks. There is a contradiction

between that statistic and one available from the Vancouver General

Hospital — which does about half the cardiac surgery in the province —

where the average waiting-list was 20 weeks. This would suggest that

the waiting-list must then have been zero at St. Paul's Hospital and at

the Victoria hospitals.

I want to make the issue a bit more concrete by giving an example.

Often people are reluctant to bring their personal suffering before the

people of B.C., but the second member for Cariboo had a telephone call

this morning from a woman who is prepared to share her problem with the

public so that the public can know what a typical reality is. I'd like

to describe this situation and then ask the minister whether he has

revisited the figures we debated a number of times.

The woman in Quesnel is named Juanita Wilson, and she's 66 years

old. I don't think her case is particularly dramatic. She's probably an

ordinary British Columbian and typical of people in this position.

She's been diabetic for a number of years. She's the mother of six

children and grandmother of four. She's says she's about to have

great-grandchildren soon. She has survived difficult orthopedic surgery

in the past. She has had fairly severe angina or heart disease for a

number of years. She's now one of those statistics on the waiting-list.

In her case the problem is not only pain in her chest that wakes her up

three times during the night but also the inability to make her bed,

vacuum or dust her house or do the laundry. She now has a homemaker

coming in three hours per week to help her with those daily activities,

because the exertion

[ Page

12755 ]

exceeds the capacity of her arteries to supply blood to her heart.

She went on the waiting-list sometime between May 10 and May 15, so

we don't yet know what her wait-time will be. But she's one of those

people who is living under tremendous pressure. She was told that she

could expect to be operated on perhaps within two months. I'm told by

her cardiologist that although St. Paul's Hospital, where she was

referred, is now operating quite smoothly, there's now a worry that in

the summertime the number of open-heart operations will be cut back

again because of a nursing shortage in summer. In that case, the

cardiologist tells me, this woman might wait until November or even

Christmastime for her operation.

She doesn't qualify to go to Seattle, because it's too complicated.

She has risk factors that are more severe, and therefore the American

hospitals do not want to take her on, presumably at the price that was

negotiated for these cases. So she sits on the waiting-list, with the

anxiety not only in her mind but also in her husband's, her six

children's and the grandchildren's. For her it is not a very great

consolation to know that.... The minister says the waiting-list has

been cut from 20 weeks to 10 weeks on average; I say that that's

statistically impossible. It doesn't make sense. It must be longer than

that. I'd like to just bring that to the minister's attention and

remind him that there are literally hundreds of such people — 700 or

800 at the last count — on that waiting-list.

I'd like to ask hon. members to try to put themselves in the

position of that woman, her children or her husband and imagine what it

actually feels like. When you speak to the cardiologist who recommended

the operation, she will tell you that it is designed to improve her

life expectancy, to reduce the chance that she will die prematurely; in

other words, to try to save her life. It's not merely for pain control,

although in this woman's case that in itself would be a perfectly valid

reason for this operation. It is an attempt to save her life. Therefore

she's living on tenterhooks.

I'd like to tell the minister also that when we broke off on

Thursday last, I quoted from a letter from a doctor I did not name in a

British Columbia town I did not name in order to protect the

confidentiality of those patients. When I spoke to the doctor to let

him know that I had referred to his letter, he told me that what was in

the letter was not half of the story. He described to me some further

incidents of patients requiring radiation treatments for cancer, some

of whom were shipped by ambulance long-distance to Vancouver and then

treated to a cab ride home to a neighbour's house after they'd ridden a

long distance by ambulance. One was transported by helicopter because

of severe pain and subsequently received a questionnaire from the

ambulance service that had made the decision to use the helicopter

which asked whether the helicopter had really been necessary The

patient was asked that by questionnaire. I'd like to re-emphasize that

the letter I read from — although it remains anonymous — is very real.

I'd like to ask another question which stems from that. When I spoke to

that doctor again, he told me that the patient I referred to had been offered

the possibility of being treated in Seattle — as I'd put it, being exported

for treatment to the United States. The patient didn't know what costs would

be covered, and the primary doctor, the family doctor, who wrote to me also

didn't know what costs would be covered and what arrangements would be made.

And the reason for that is obvious when you think about it.

Although the ministry agreed to export patients to Seattle, since we

don't have the capacity to deliver effective standard radiation

treatment for cancer in a timely way in B.C. anymore — we used to, but

we don't now — it had the simple option of notifying primary-care

doctors or all doctors that this option was available. There's a very

simple way to do that: through the Medical Services Plan newsletter.

Statements are sent to all doctors every two weeks, with payment, and

since nobody ever opens an envelope as fast as one that contains

payment, notices included in those envelopes are widely read and do not

languish in a mail pile. It would have been very simple to notify

doctors of the program in Seattle, of the financial conditions for

patients, whether transportation and accommodation costs in Seattle

would be covered, whether there would be any bill to the patient and

what to do about emergencies or family problems occurring during that

time. And it still would be simple to do that. I'd like to draw that to

the minister's attention, because clearly there's been a failure of the

most basic communication.

I can think of only one reason, and that is that it is acutely and

chronically embarrassing to the ministry and the government to have to

admit that we must now export patients for cancer treatment. I don't

blame them a bit for being embarrassed. I'd be darned well embarrassed

had I presided over the erosion of our health care system over the last

ten years — or five years — of this government. But embarrassment is no

excuse for making the patients into further scapegoats. We do need

effective information, and one of the first steps is for the doctors to

know how the system operates. I leave that as a suggestion as well.

HON. MR. STRACHAN: I said this last week, but I'll say it

again: with respect to the wait-lists, I can advise the committee that

the initiatives we have taken have resulted in the average waiting time

being reduced from 20 weeks to under 11 weeks for those patients now

being treated who have had the surgery. We've surveyed them, and we

arrive at those numbers that show that the waiting time has gone down

considerably. The member should also be aware — as a matter of fact,

the member is aware — that the referring doctor can state whether the

case is urgent or emergent and really bump the patient up on the

waiting-list.

With respect to the U.S. referrals, the member should know, since he

is a physician, that the Cancer Agency and not the Ministry of Health

dealt with those protocols and referrals. If the member wasn't aware of

that, he is now. He could phone Dr. Klaassen of the Cancer Agency and

receive details on that issue if he wishes. But it was not a Ministry

of Health initiative,

[ Page 12756 ]

nor was it the doctors' initiative. It was an initiative of the B.C. Cancer Agency

By the way, I met with these people this morning and was pleased to

find out that this cancer agency is probably the best such agency in

Canada. There is nothing else like it in any of the other Canadian

provinces. It does a remarkable job of developing protocols, drug

strategy and many strategies to do with handling people who do have

cancer. It's our monitoring agency and does an extremely good job. As I

said, there's nothing else like it in Canada. I was very pleased to

hear that information this morning as I met with them. I think that we

British Columbians can be proud of the B.C. Cancer Agency and the

remarkably good work they do on behalf of those people suffering from

this terrible disease.

MR. CHAIRMAN: The member for Kootenay seeks leave to make an introduction.

Leave granted.

MS. EDWARDS: I very warmly welcome today 25 grade 7 students

from St. Mary's School in Cranbrook, with their teacher Ms. Ireson and

two of their parents — and perhaps more by now. One of these students

expects to become a politician, so I would ask the House to help me

welcome them very warmly.

[3:00]

MR. PERRY: The B.C. Cancer Agency, while it has considerable

autonomy, is of course funded by the Ministry of Health. Like all

hospitals and health institutions, it's a creation of the government of

British Columbia and belongs to the people of B.C. Therefore the

ministry has responsibility for it. I still think it would be eminently

sensible for the ministry to advise physicians in B.C. of the existence

of the program. Perhaps the Cancer Agency ought to have done that

itself.

Clearly, from the instance I gave and others, the reality is that

the primary care doctor — who actually has to handle the patient coming

into the office or telephoning, or whose spouse is calling and saying

this is not acceptable — needs to know how the program works. There's a

simple expedient, which is in the next MSP statement to send out a one-

or two-page letter explaining how the program works and what the

funding conditions are — be it on Cancer Agency stationery or Ministry

of Health stationery. It really wouldn't matter as long as the

information is out there.

[Mr. Ree in the chair.]

Before we go further, I'd like to make a comment while we're on the

theme of information. I again refer to a point we visited before, which

is the change in policy within the ministry under the present minister.

The mellifluous tones represented in this Legislature disguise — need I

or dare I say it — the ferocity of a pit bull in terms of the jealous

guarding of information within the ministry. I complained about this

before, but I'd like to draw to the minister's attention again that on

this side of the House we continue to have difficulty obtaining basic

information from officials within the Ministry of Health, a problem

which we never experienced during the tenure of the former Premier's

government. There were many things I was critical of but I was never

critical — and I'm pleased to say it in the presence of the former

Premier — of difficulty of access to information from the staff, with

the rare exception of reports that were deliberately withheld by the

minister or the former Premier. The staff were courteous enough to give

the opposition briefings in advance of legislation under the condition

that we respected the confidentiality of the information, and that

agreement was always respected to the letter by our side and was freely

offered by the ministry. I never experienced any difficulty in having

my telephone calls returned promptly, be it from home or at home or

under virtually any circumstance. I could offer nothing but praise on

that account.

Suddenly, in the last month, something has changed. Maybe it's the

absence of the former Premier, for all I know. When we call for

information we are finding officials who insist that all inquiries must

be routed through the minister's office. The minister has been gracious

enough to send me a letter explaining this policy, but I am obliged

once again to protest it as unreasonable, because not only is it

putting us to a lot of extra work: I feel it's causing acute

embarrassment to ministry staff who are public servants and who, after

all, have a responsibility to provide information to anyone in British

Columbia who needs it — not just the government, not just the

opposition, but any British Columbian who pays their salary. So I'd

like to encourage the minister, if I could once again, to revisit that

policy, and I'll give him the opportunity by reminding him of a number

of my outstanding requests for information for these debates.

One would be for the Pharmacare review committee report. I still

think that we could serve the public of British Columbia by discussing

that report in these debates. There is still time. Some members have

rebelled at the proposition that we'll continue the Health debate for

three or four weeks, but I have a convoy of elephants outside with

additional files in case we need to.

The minister on June 10 undertook to provide me with copies of

correspondence relating to Health ministry initiatives on signs warning

against the consumption of liquor during pregnancy, and offered to

table that correspondence, providing it were not ultra secret, at the

earliest opportunity. I suppose it's conceivable that that information

might be ultra secret, but I think right now the public is more

interested in the Mashat affair than that, and probably the minister

could get away with releasing that correspondence.

I made a number of other requests which I thought were before me

right now, but I don't find them all. Among other things, I'm still

interested to know the information provided by the Greater Victoria

Hospital Society about laundry costs so that the House can assess

objectively for itself whether the province saved a little bit of money

on those Saanich contracting costs, or whether the province lost $1.25

million on that deal.

[ Page

12757 ]

I will attempt to identify the other outstanding requests a little bit later.

One of them that the member for Boundary Similkameen referred to

earlier in the debates was disagreement over the number of elderly

people living in the School District 16 area of Keremeos. I wonder if

the minister has come up with that information. I have in my hands a

very interesting proposal from a local pharmacist, Walter Despot of

Keremeos, the president of the local intermediate and extended-care

society, whose initiatives we've discussed in the Legislature. He makes

a very strong and rational case for the need for additional facilities

for people in that part of the province. I remember that the minister

and the second member for Boundary-Similkameen had some dispute over

the figures for elderly people. Mr. Chair, I wonder if the minister

could tell us if he has updated the statistics. Can he answer that

question for us?

MR. CHAIRMAN: At this moment the Chair would like to point

out to the member a reference under standing order 61(3): "The Chairman

shall preserve order and decorum in the Committee of the Whole...."

Likewise the Chairman would like to bring to your attention the

appointment of the Chairman by the House under standing order 15. It's

"the Chairman," not "Mr. Chair."

HON. MR. STRACHAN: First of all, to the students from the

Kootenays, welcome; and to the student who wants to become a

politician, I'll tell you how to do that. You begin by going to the

hardware store and getting a bag of marbles, and you put them in your

mouth; then you read from Sir Erskine May and from George MacMinn.

Occasionally a marble will drop out, and when you have finally lost all

your marbles, then you can become a politician.

Now back to the questions. In terms of the policy of providing

information to Members of the Legislative Assembly, I'm not aware of

making any changes, so I find the member's questions curious. Anything

that's available to the public is immediately made available to MLAs as

they write. Questions to me that are not on the public record or

questions about the Ministry of Health I will attempt to answer as

quickly as I can. That's the policy of the Ministry of Health, and it

has always been my policy in the many portfolios I have held. I really

think members opposite and members in the government benches will agree

that my administration of all the portfolios I have held has always

been open, and I have always readily and freely agreed to provide as

much information as quickly as I can to any member who requests it. So

I find it difficult to understand where the member is coming from in

terms of releasing information, because it certainly isn't policy to

change anything.

In terms of advising the member about upcoming legislation, the reason I haven't

offered any advice on upcoming legislation is that we don't have any upcoming

legislation this year. If I had some, you would have a briefing. If you spoke

to other critics — the Environment critic or the Advanced Ed critic — you would

know that in fact it was always my policy to give the critic information and

briefing on legislation as it was coming into the House. I think that's

better for the process of debate. If I did have any legislation coming forward

this year, I certainly would share it with you for the benefit of your input

and also for the easier and more understandable passage of the legislation I

was presenting.

The Pharmacare report: I haven't seen that yet, Mr. Member, but when

I do I will review it, and I see no reason why I wouldn't share it with

you. But that will be after I have had a chance to look at it.

In terms of the discussions we're having with Labour and Consumer

Services about advising pregnant women about alcohol use or abuse, we

have not received the final correspondence on that from the Ministry of

Labour and Consumer Services, so there's not much I can provide to you

in terms of completing the report. But when that is available, I will

let you know that as well.

Now back to the question on Keremeos. I have some information. The

second member for Boundary Similkameen said that the population of

seniors is 30 percent, and the Ministry of Health said that the

population is a little over 22 percent. We agreed last week in our

estimates to review our source of data, and this is it. The total

population of Keremeos in 1989 was 3,655, and the number of persons

over 65 was 912, or 25 percent of the population. These figures, by the

way, are provided by the planning and statistics division of the

Ministry of Finance and Corporate Relations. All actual figures are for

1989. In 1990 we projected that it would be 25 percent of the

population. The projection for 1991 is 26 percent of the population.

For 1992 the projection is that 26.8 percent, approaching 27 percent,

of the population will be over 65 in the village of Keremeos.

I don't know if this information is earth-shattering, but these are

the best projections we have. Our Ministry of Finance and Corporate

Relations provides statistics to us categorizing populations by age and

sex.

MR. VANDER ZALM: Regarding the advice given to the student

about the loss of marbles, I should also say that most politicians

often speak for themselves, and not all politicians have lost their

marbles.

Before I commence with my comments, I also want to say that I would

hope the minister will give me a very brief response, I'm concerned

about the length of these estimates. We might still be here in

September if the minister continues to filibuster. Frankly, I'm

concerned about the cost to the taxpayers for all of this, so I don't

mind if it's only a brief response to the point that I want to raise.

But before I raise the point, I want to make reference to something

said by the second member for Vancouver–Point Grey. I find it very

difficult to criticize him after his complimentary remarks. As a matter

of fact, I've had a good rapport with the member for a good while, and

I would like to see it continue. But I do have a criticism, although

not with respect to what he said about getting advice from the

ministry. I too find it much more difficult to get anything from a

ministry now than I did only a few months ago. Now

[ Page 12758 ]

I'm not sure that the reasoning is identical, but

certainly I too find it much more difficult. Frankly, it's a lesson

sitting here as opposed to sitting over there. You find that the

bureaucracy oftentimes responds very quickly to one in position, but

when you hold a position which is not quite like the one you held

previously — more like the average person out there in all the

communities we represent — it's much more difficult getting the

information. I can't make that criticism about the Ministry of Health,

because I've not had the occasion to ask for any information. So

present company excluded.

I want to make one comment about something the second member for

Vancouver–Point Grey said. I saw it in the Blues, and I don't think it

should go totally unmentioned. He made some criticism last week in

debate about this member for Richmond, and he intimated in so many

words that because I was a Catholic, I was somehow discriminatory with

respect to any application or any grant requests from Planned

Parenthood. I suppose he could have said Catholic, Presbyterian,

Anglican, Evangelical or anything like that, and we as Christians are

supposed to simply say that he's talking about discrimination.

[3:15]

When he uses our faith, our religion, in the context of a particular

matter where we're dealing with.... That's not discrimination in the

eyes of the member. But he should consider that he would not have said

Sikh, Moslem, Hindu or any non-Christian denomination, because his

comments might have been seen as discriminatory. So I think he should

really refrain from using that, in all honesty and fairness to the

member. If you can't use an adjective when making reference to a

non-Christian member, you shouldn't use it with respect to a member who

might be a Christian.

It's ironic that he was talking about discrimination when he raised

a person's religion as the reason for that person perhaps having been

opposed to funding for Planned Parenthood. That's unfortunate. We see

too much of this in our society today, where Christian people often

simply sit back and take this. If we were to use the same approach to

non-Christian people, it would be seen as something terribly

discriminatory. I only raise that to correct the record and to caution

the member in his use of a person's religion as to how they might have

dealt with a particular request from a group in our province.

The matter I wanted to raise with the minister and the ministry

people was something I received from a good friend who has recently

gone through some considerable effort to seek a hip replacement. I'll

simply give the history of this particular person's attempt to obtain a

hip replacement to indicate where much of the problem is in the

delivery of health services in the province. Particularly in health it

has become horrendously bureaucratic. It's become too much of a big

business with little thought of the limited resources available to

provide the best service to the people in our province.

On February 20, 1990, my friend went to see his GP, Dr. A, about a

hip problem. On February 26, 1990, he went again to see Dr. A and asked

him to refer him to an orthopedic surgeon. On April 12, 1990, he went

to see Dr. B, an orthopedic surgeon. On April 23, 1990, he went again

to see Dr. A to get the results from Dr. B. However, he could not get

any positive answers one way or the other. On July 20, 1990 — and this

friend of mine was now in some considerable agony — he went to see GP

Dr. C and asked to be referred to Dr. D. A friend had told him that Dr.

D was a good orthopedic surgeon. Dr. C set up an appointment for him

with Dr. D, and he had to wait only one month to see him. On August 20,

1990, my friend went to see Dr. D, who told him that he needed a hip

replacement. He said: "I will place you on the waiting-list, and it

will be about one year before I can help you." On November 23, 1990, my

friend again went to see Dr. D, who said: "If your condition gets

really bad, I may get you into the hospital a little sooner." At the

beginning of February, 1991, my friend talked to a friend who asked why

it was taking so long to get into the hospital. His friend, a lady

public servant, said: "I know somebody in the Ministry of Health, and I

will find out why it's taking so long." Two days later my friend

received a phone call from Dr. E in the Ministry of Health, who struck

my friend as being very helpful and who promised to find someone who

could attend to this and let him know why the long delay.

On February 11, 1991, my friend went again to see surgeon Dr. D, and

Dr. D asked, "Did I take you off the waiting-list?" to which he

answered no. At least, if he had taken him off the waiting-list, he had

not been told so. A couple of days later Dr. E of the Ministry of

Health phoned him, and on about February 13, 1991, said that he had

inquired why he was not taken into hospital yet, said that normally it

should take three months and unfortunately Dr. E had said a year, but

that Dr. F in the Royal Jubilee told this person that he could get in

earlier.

Now I could go on. It continues, and there is a long list — a

further three pages of referrals — to where eventually my friend does

get into the hospital, has a hip replacement, feels a whole lot better

and is able to get around. He's very satisfied with the services

provided him in the hospital. Incidentally, my friend lives on

Vancouver Island and ended up getting his operation in the Fraser

Valley.

The point is that he went through a lot of referrals before he came

to the hip replacement. I think people in communities throughout this

province unfortunately oftentimes go through this again and again. They

come to see their doctor, are asked to come back and are referred to a

specialist. They then have to go back to their doctor to get a report

from the specialist, and it's on and on — referral after referral. The

bureaucracy, the system and those involved in the system undoubtedly do

well by it. But what about the people that we're supposed to serve?

That patient — the person who needed the hip replacement — didn't do so

well. Eventually he did, but too often the system caters to those who

deliver the service, not those in need of the service.

I must confess that I've been a party to it. I was there. You could

easily say, and so you should: "Why didn't you do something about it?"

I guess I'm guilty as

[ Page

12759 ]

well. But it's tough. For anyone who has served in

that Ministry of Health — which is a massive ministry with a huge

bureaucracy, not only of itself, but which it serves throughout the

province — it's tough. But it must be addressed. We can't continue with

this referral process and with the process beyond the referral that

tends to cater to those who deliver the service, as opposed to those in

need of the service.

So I would ask the minister that this be given priority

consideration by the ministry and this government. Let's start

concentrating on the people we serve, as opposed to those who make up

the system.

HON. MR. STRACHAN: The first member for Richmond wanted a

brief answer, so the brief answer is this: yes. A couple of months ago

we put in place a health issue hotline for people to phone if they have

any issues they want to bring to our attention.

With respect to the procedure and wait-list, we have also put in

place a provincial surgical registry. This registry will assist

providers, hospitals, and ultimately patients in making informed

choices regarding options for surgery and will assist hospitals in the

allocations of their resources to meet the surgical needs of the

patients they serve. In other words, the situation that the member for

Richmond identifies is a concern of ours as well, and we are attempting

to address it as best we can through this provincial surgical registry.

MR. PERRY: If I can, let me very briefly clear up any

misunderstanding about the remarks of the former Premier. If I left any

impression of criticism of Catholic faith, that was not my intention,

and I hope that was not the perception.

Just reviewing the final record of Hansard ,

I see that what I actually spoke of was — referring to Planned

Parenthood, a very effective organization at the dissemination of birth

control information — why they had not been able to receive provincial

funding. I stated:

"In part, perhaps it relates again to the former

Premier's personal biases. Catholic agencies withdrew from the United

Way in the past because the United Way accepted Planned Parenthood into

its fold. Perhaps it was the Premier's own religious beliefs, because

of the withdrawal of the Catholic social agencies from the United Way

over that issue, that had prevented Planned Parenthood from getting

funding, "

It is a historical fact that the Catholic social agencies withdrew

because they were uncomfortable with Planned Parenthood and with the

idea of birth control or abortion. Of course, they are entitled to and

can be respected for upholding their moral views. The real question was

whether that was in the interest of the public for government to decide

not to fund Planned Parenthood.

Since the former Premier has brought it up again, I note that when I asked

the minister whether he was prepared to consider funding Planned Parenthood,

he answered: "To answer the last question first, I won't comment on

that organization. I do not know how fairly or unfairly we are treating them."

Perhaps he's reviewed that in the interval and would now like to comment

about Planned Parenthood?

HON. MR. STRACHAN: I do have some information I'll offer to

the committee which has been provided to me. The organization of

Planned Parenthood used to be reimbursed through the salary and

concessional component of the Medical Services Plan for clinical

services provided to Planned Parenthood by physicians. However, this

mode of funding ceased at the end of the 1983-84 fiscal year and has

not been reintroduced. I know from looking at those dates, having been

here as you were, that that was a restraint measure if it took place in

those years.

However, the current ministry policy is to provide information

through health units, physicians' offices and other outlets on a full

range of choices with respect to reproductive health. The ministry has

supported the British Columbia Public Health Association in developing

a broad range of information on pregnancy prevention and the choices

available to women facing an unexpected pregnancy. These pamphlets, as

well as videos — which are rented free of charge — are available

through the office. The ministry also allows community organizations to

make use of available space in the health units, and Planned Parenthood

is one of the many organizations which can benefit from this offer.

[3:30]

Physicians can claim for their services for confidential counselling

on reproductive health matters, and public health nurses throughout the

province are also experts in this area of health. So I would submit

that we are endeavouring, in every way we can, to provide as much

information, counselling and assistance as we can to those seeking

information on reproductive health and on planned parenthood issues not

the organization itself. I can assure this committee that the decision

not to fund them was obviously a matter of restraint, because many

budgets and provisions were cut during the 1983-84 fiscal year. They

were done for reasons other than any issue having to do with the

politics of reproductive health, but rather with the politics of trying

to control our budget during those years of very tough revenues.

However, let me say, from what I can see from this briefing note,

that we are offering very good advice and many ways of providing the

public with information on reproductive health and on planned

parenthood.

MR. PERRY: The point isn't as trivial as it might seem.

Planned Parenthood has a reputation in many quarters as being the best

agency for the delivery of reproductive counselling and birth control

information, particularly to teenagers. I pointed out to the former

Minister of Health on July 25 last year, on page 11418 of Hansard ,

that the ministry had issued a birth control pamphlet largely based on

information from Planned Parenthood in which the name of Planned

Parenthood was selectively omitted. Other organizations were published

as sources of information in the community, and Planned Parenthood was

apparently deliberately left off. Now that we are reassured — and I can

see the reassurance sinking into other members on this side,

particularly the female members of the

[ Page 12760 ]

Legislature; I can see that reassurance reflected

in the peacefulness of their faces — that politics has never intervened

in the delivery of health services, particularly reproductive health

services in B.C., maybe the minister could simply say that Planned

Parenthood won't be discriminated against in the future, will be

eligible on the same basis as everyone else to compete for grants and

will be reinstated to its rightful place of pride in ministry leaflets

as a source of good information for the public.

HON. MR. STRACHAN: I can assure the member that if they were

left out of any of our information, it wasn't done for any trivial

reason. I'm not saying that planned parenthood is trivial, and I hope

the member isn't taking my answers to conclude that I am being trivial

on this issue. But we feel that in the general area of reproductive

health, we are providing for professional services and for the

dissemination of a broad, impartial range of information and referrals

throughout the province. We feel we're doing this in a most forthright

manner. I find it very difficult to accept any criticism of the

information that we make available to British Columbians with respect

to their reproductive health.

MR. PERRY: Could I return to one of the other interesting

points the former Premier made? I thought his example of the experience

of a friend requiring hip surgery was an interesting one, so I jumped

the queue with one of the papers in my own file to bring it up now in

juxtaposition with what the former Premier said.

I have frequently encountered complaints.... I think members will

recall that at one time there was an advertisement campaign showing a

man requiring hip surgery outside on the steps of the Legislature,

attempting to climb the steps and pointing out that he couldn't get up

the steps. That may have been a slight exaggeration at the time.

I hope I can pride myself on taking the same approach that the

former Premier outlined, of arguing in this Legislature primarily for

the people who use the system, and although some hon. members opposite

have sometimes intimated otherwise, I've tried to confine my arguments

in this chamber to advocacy for patients and people who use the system

in general. I think it's a very good approach.

But one of the areas where I've had a lot of trouble in getting

through, seemingly, to the Ministry of Health is exactly that situation

of joint replacement — principally hip surgery, because it's by far the

biggest bulk of the problem. I think it's an intriguing one, because

often elderly people, many of whom by definition develop their hip

disease when they're elderly through osteoarthritis or other

conditions.... Many of that age group went through the war, and a lot

of them went through the Depression. Many were immigrants from

countries where health systems were less good than here. They tend to

be pretty conservative and very patient. They don't complain easily;

they don't jump on the phone to their MLA or write to their MLA at the

very first complaint. So I've always taken particularly seriously

complaints from that sector.

The hip surgery problem has troubled me for several years, because

I've never been able to understand the logic, from the government's

point of view, that when you need hip surgery for the relief of pain or

to improve your mobility, there is an advantage to waiting. That seems

ultimately to be the logic of the Ministry of Health argument: that it

would be good for you to wait for a little while and think it over and

perhaps get used to the pain. Maybe it's so that they will feel more

grateful when their pain is relieved. I don't know; I've never really

understood that logic.

If the ministry were saying, "We don't want doctors to operate on

people who don't need hip surgery, " I'd be behind them 100 percent,

and so would most anybody, including most doctors. Virtually all

doctors don't believe in surgery when it's not necessary, and certainly

the public doesn't want to pay for it. That would be a very sound

logic. If the ministry said, "We think too much hip surgery is being

done compared to other jurisdictions; not only are we spending too much

money on this, we're putting too many people under the knife who don't

need it; we want to audit hospitals, find out the indications for the

surgery, check to see whether the patients really feel better

afterwards, find out what the success rate is, whether some of them are

dying during the surgery," all those would be good questions.

I'm happy to say that it's mooted that the ministry is thinking

about doing that. Maybe if the minister has a little discretion and

gives them a little bit — maybe a thousand dollars or two — they could

do that study. Good hospitals should be doing it on their own already.

Good hospitals are doing it on their own already, and good doctors are

doing it on their own, and good general practitioners — the kind that

the Premier described — should be doing it with their patients. They

shouldn't refer to doctors who do too much surgery. So we do have some

built-in controls. But if the ministry were worried about that, that

seems a perfectly legitimate and reasonable argument to make. I, and I

think virtually all British Columbians, would back them 100 percent —

as long as they respect the usual norms of patient confidentiality,

which they would.

But, Mr. Chairman, that is not what I have seen happen. I hear

stories of people for whom the rationale for the surgery is impeccable.

The pain is severe; it's disabling. The individuals, typically elderly,

are waking up at night unable to walk and function as they used to. The

only effective remedy is surgery. Drugs sometimes help, but sometimes

they cause ulcers, bleeds and all kinds of other problems.

I see people exactly like those described by the former Premier wait

for a year. What is the benefit of that wait? Does the cost go down a

year later, when it has to be done? Of course not; we all know better

than that. If anything, the cost goes up. Is it an edifying experience

to suffer pain? Maybe the Old Testament said that, but most people who

have suffered pain would say that a day or two would be enough to get

the message across — one night perhaps.

[ Page

12761 ]

I've been at a loss, and I've heard doctors complain. I usually try

to pin them down: "Have you actually got any people on your list? Let's

see it." One of them actually sent me a list. I'm not going to table it

because of the names on the list. This is Dr. Stanley Leete up in

Campbell River. The ministry could speak with him if they wanted to. He

points out, as you will see, that some of them extend back nine months:

"I would like to stress that the hospital here has

been extremely cooperative and has bent over backwards to facilitate as

much surgery as possible. As you know, the major problem is lack of

funding. It seems to me it is an extremely short-sighted policy that

the government follows inasmuch as a lot of these patients are in the

workforce, and while they are off work, they are just adding to the

financial load that our taxes must support. I hope you will be able to

help get us a little more financing."

He's not asking for a lot there; what he's asking for is the funding

to buy the artificial hip joint, the piece of metal that would go into

those people. Let me just follow up in the former Premier's vein,

because it's important. I know that Health ministers wriggle under

these letters. They don't like to hear them, do they? I see the former

minister sitting there; an expression of pain is still on his face two

years after hearing some of these stories. They're not nice to hear,

but they're salutary. Sometimes the pain should not just be with the

people suffering in their hips; there should be a little pain for us

sometimes to know what it's like,

Here's someone who preferred not to be identified describing the

situation very effectively. It's dated April 12, 1991. The former

minister received a copy; he could trace it down if he wanted to. There

are the following numbers in the postal code: a 6, an 8 and a 9. This

individual writes:

"My doctor, Dr. A, referred me to orthopedic surgeon B

for a possible hip replacement. On June 8, 1990, Dr. B confirmed that I

would require a hip replacement and that the waiting-period would be

approximately nine months. I was shocked that I would have to wait so

long for the operation, but I accepted it. I contacted the hospital

numerous times up to January 3, 1991, when I was advised I was No. 6 on

the waiting-list. This translated into 12 weeks, making the date the

first part of April. Dr. B is allowed to perform only two

hip-replacement operations per month. I called the hospital on February

21 and was advised I was still No. 6 because the budget for purchasing

prostheses, the actual metal joints, was exhausted in mid-February, and

there would be no further operations until money was available in the

new budget effective April 1, 1991. I was then advised that I could not

expect to have my operation until at least July or August. My

waiting-period had gone from nine months to 13 or 14 months. I

discussed this atrocious situation with both Dr. A and Dr. B on March 2

and March 14 respectively. They both accepted my assessment of my

deteriorating condition because it was all too obvious. Please refer to

attachment for details."

The attachment, also dated April 10, 1991, is brief, succinct and to the point. It says:

"The following outlines my present condition.

"1. Constant pain.

"2. Sleepless nights.

"3. Walk with the aid of a cane.

"4. Unable to walk more than a few yards at a time.

"5. Left ankle now aches continually from strain of walking unnaturally to favour the hip joint.

"6. Medication has very little effect. It's apparently as strong as it can be without creating stomach problems.

"7. Lack of exercise and waiting for hip operation is creating

unwarranted stress.

"8. Due to item 7, I feel that my cardiovascular

system is degenerating and will continue to do so until I obtain my hip

operation and I'm able to obtain necessary exercise."

That reminds me that I sometimes think there must be people in the

Ministry of Health who read that Oliver Wendell Holmes poem, the

"Wonderful One-Hoss Shay, " in high school. You, Mr. Chairman, probably

read it, as I did. And they believed it. They think that maybe if we

wait long enough, people will actually just disintegrate in one go and

then they won't cost us anything — instead of having to spend that

miserable money on the last few years of life, which health bureaucrats

like to complain about so much.

Let me go back to the letter.

"I realize that both the federal and provincial

governments have reduced their funds towards the health system.

Granted, they have increased their funds, perhaps at least to keep pace

with inflation, but it is your priorities in spending such funds that I

cannot accept. I have been advised that there is no shortage of nurses,

beds or operating facilities in that hospital, just your unrealistic,

inadequate amount of money available for the purchasing of prostheses.

That is what is creating the unwarranted delays for hip replacement and

similar operations. I believe it is time for you and your board to

review your priorities, enabling the doctors to do justice to your

patients.

"Please advise what steps you will make to rectify

this undesirable situation for the benefit of the people served by the

hospital."

That one was addressed to the administrator. I imagine that even the

administrator — he or she — lost some sleep after getting that letter.

But I'd like to know: what did the Ministry of Health do about it?

[3:45]

HON. MR. STRACHAN: The member, Mr. Chairman, has actually

answered his own question. You see, he knows, and now the committee's

going to know, that we fund hospitals on a global basis. We don't fund

hip or cataract or cardiac. We don't set a preference for what

procedures a hospital does. I'll say that for the member's benefit

again, because he knows what it is; he's a physician. He has attempted

to create the impression in this Legislative Assembly that the Ministry

of Health decides on procedures. It is the hospital, Mr. Member, that

decides on the procedure. I think you have left an incorrect impression

with the committee about the establishment of procedures, and I want to

set that straight.

I'll say it again, Mr. Member: neither the Ministry of Health, nor

the minister, nor the staff — none of those people, none of us — decide

which procedures a hospital is going to do. That hospital decides which

procedures it is going to do, and you know that.

[ Page 12762 ]

MR. PERRY: I'm really smarting after that one.

HON. MR. STRACHAN: Then why were you lying?

MR. PERRY: Why was I lying? We know, of course, that

hospitals have global budgets. The problem is, what are they going to

do when the global budget is clearly not sufficient for those needs?

The ministry surely has a responsibility to decide — as the ministry

has done during external reviews when it has appointed tough external

reviewers to walk into a hospital, spend a few days looking around and

make recommendations: "This is good; this is not so good; this could be

eliminated completely or done better."

The ministry accepts that responsibility. Presumably it accepted

some responsibility, or indicated its concern, when it launched the

Pharmacare review. We have spoken back and forth over the last few

days, regrettably with very little light shed from the government side

in response to questions for fact on what I suggested might be the

potential for a $50 million saving in the Pharmacare budget for costs

of drugs, I suggest that that's feasible. The ministry has undertaken a

study which has never been published. It spent money on it, paid

consultants $250 each to go to a meeting, and yet the report's not

available. Maybe the report could be useful even to hospitals, so that

they could adjust their budgets more rationally to allow enough for the

prostheses which are clearly needed.

If the ministry really is concerned that too much orthopedic surgery

is being done, maybe it could help hospitals — rather than each one of

them reinventing the wheel — assess whether all the surgery they're

doing is necessary. I don't think it washes just to wash one's hands of

that. The ministry is a big bureaucracy. There are 4,000 employees or

more in that ministry. There are a lot of talented people who ought to

be able to bring some skills to bear on what I think the former Premier

was arguing and what I'm certainly arguing: that there are a lot of

people in British Columbia who actually are getting less good-quality

service now than they were five to ten years ago, and that these delays

are often getting worse.

Let me turn to a few other issues, Mr. Chairman. Many members will

have received correspondence in the last year or two about a strange

condition called chronic fatigue syndrome or myalgic encephalomyelitis.

In the United States it's usually referred to as chronic fatigue

syndrome; in England, perhaps as ME; and the support groups in B.C.

have been referred to as ME groups.

It's a very bizarre and baffling condition. Hundreds of thousands of

dollars — maybe more — must have been spent by doctors, and multiple

referrals of the kind the former Premier described must have been made,

attempting to figure out what is going on in some people experiencing

this condition — for want of a better name. The typical individual is a

healthy young person — let's say a 14-year-old child, a friend of the

member for New Westminster whom she told me about last year, or a

seven-year-old child, such as the daughter of good friends of mine.

Most members probably have constituents in this situation. There's a

young teacher who used to be on the football team at Simon Fraser

University, and a teacher in Langley who has become incapacitated.

Someone who was in perfectly good health experienced what seemed like a

typical childhood or adult viral illness — a temperature, a bit of

fever, a few aches and pains — and then never got over it, was left

drained of energy, often depressed, with strange muscle pains and a

variety of strange symptoms. They never quite got back on their feet.

That's what this condition is, and it's one which no specific

diagnostic test has been able to pin an exact label on.

I'm sure members must have encountered people in this situation — I

see some of them nodding. It's very baffling, because it goes on for so

long sometimes. Fortunately most people eventually recover from it,

apparently spontaneously.

These people have been organizing a rather effective lobby, I would

think; they certainly have been effective in contacting and even

pressuring me. I was always interested in this condition, because I

once experienced something like it myself when I was in university, and

I knew physicians during my training who had looked after people with

some kind of similar condition. So I've been listening to them. I've

been skeptical, but I continue to listen to them, and I've seen enough

in my correspondence to know that something is going on out there. The

medical profession as a whole — and the university faculty of medicine

and the Ministry of Health, I think — have been quite slow to catch on

that there is something happening out there, like other jurisdictions

around North America and the rest of the world.

I want to ask a specific question. I know the minister has had

correspondence with these groups, as have I. I think some of the advice

he's received — perhaps not from the ministry; maybe from medical

sources — has perhaps been incautious, and led the former minister to

dismiss this issue in the past. But I'd like to ask a specific

question: what is the ministry policy — and the rationale for that

policy — on the need for a specific evaluation clinic?

The patient groups have requested over and over again a specific

chronic fatigue syndrome, or ME, evaluation clinic, perhaps at

Shaughnessy Hospital in Vancouver, which could provide a definitive

evaluation of patients. I want to make clear to the minister that many

patients — or some — seem to see this as a facility which will cure

them. I don't personally believe that is possible at the present state

of knowledge.

I do believe that an evaluation centre could provide people with a

more thorough understanding of their condition, a better expectation of

what will happen to them and some sense of security that they have been

fully evaluated. I also think that it could save money, because it

could save on the redundant, repetitive referrals — that tennis-volley

syndrome that those people often experience through being sent to one

specialist after another, none of whom has any idea what is wrong of

them, but all of whom extract a fee.

I think there is potentially a constructive role for such an evaluation centre. I know the ministry has

[ Page

12763 ]

been quite reluctant to endorse that, and I'm curious to know why.

HON. MR. STRACHAN: Just let me comment on a couple of items the member brought up.

First of all, with respect to Pharmacare — those were his first

comments after he ducked the issue of global budgets in hospitals — the

member was advised earlier that we would be providing the Pharmacare

report as soon as it is available.

With respect to chronic fatigue syndrome, I'll advise the committee

that the first member for Nanaimo discussed this issue at some length

the other day. I know the member wasn't here, but he obviously hasn't

read the Blues either, or Hansard ,

to understand what our discussion was about. This has been canvassed

before, but I'll repeat it for the benefit of the member, and he can

perhaps look up the answers in the Blues of last week.

We do have a serious concern with chronic fatigue syndrome. I am

advised that there are a few hundred patients suffering from this

syndrome. The member talks about people being shuffled from one doctor

to another. The reason for that is that the diagnosis of chronic

fatigue syndrome is not clearly established by the medical profession,

and usually rests on the exclusion of other causes, which is why you

would be sent to other physicians — to exclude the other causes and do

the testing. There is no specific therapy, and we feel that care by

family physicians is appropriate, along with support groups.

What we have done, though, in terms of a strategy, is to ask the

dean of medicine at UBC, Dr. Martin Hollenberg, to encourage

researchers in the faculty of medicine to apply for grants to study the

causes, effects and treatment of this condition, which we feel is

appropriate. As a former Minister of Advanced Education, I can say that

it is a strategy which has resulted in research being done on other

medical concerns and which in many cases has proven to be effective.

That's where we are on the issue at this point. If the member, who

is a physician, has any medical advice for the committee or the medical

community, I'm sure we'd be delighted to hear it.

MR. PERRY: I'm very flattered that the minister would ask for

my opinion, and perhaps he'd even be willing to let me draw blood from

him sometime. I'm trying my best, but he hasn't come within range yet.

The two sword's-lengths still separate us, and I haven't found a

syringe and needle quite that long yet.

Mr. Chair, I actually had read that part of the debates. I know that

one of the other members on this side raised it. It hadn't really

answered my specific question. I don't think the minister has yet.

I wonder if he's looked at the costs — which I suppose technically the ministry

might be able to do — of testing and referrals related to that diagnosis, either

chronic fatigue or myalgic encephalomyelitis. Could he tell us what the Medical

Services Plan knows about the primary-care referral charges to the plan and

laboratory diagnostic tests? I don't suppose he has, but he could. That's

what we have computers for, after all. If he did, he might well find that the

costs of testing alone right now in this field would warrant the establishment

of an evaluation centre.

I agree completely with the ministry's position that the

primary-care physician is the best person, in general, to deal with

these problems. However, as in other complex diseases such as Lyme

disease, multiple sclerosis, ALS — whatever — there often is a value to

some interdisciplinary clinic which performs very careful

state-of-the-art analysis. Such clinics have been established in this

field at the University of Washington in Seattle, for example. They

probably will spring up elsewhere in the country.

I've had a number of discussions on this subject with the UBC

people, and they seem potentially interested. But, as always, there's a

question of how these would be funded. For example, under

fee-for-service it's very difficult to do a proper evaluation. Under a

once-a-week or even twice-a-month sessional clinic, it might be

practical to evaluate people comprehensively and save a lot of money in

the long run.

[4:00]

HON. MR. STRACHAN: The member talks about identifying the

number of patients and identifying a strategy. It's a bit difficult in

terms of our coding system because normally nothing is found. And how

do you code something that's not there, except this syndrome that

patients feel they have and obviously exhibit some concern about? It's

not like ALS or MS or other such diseases. In fact, it's very difficult

to categorize.

However, we can look at that in our own administration in terms of

identifying and tracking the syndrome and how doctors are managing who

deal with patients with the syndrome. I don't know what else I can

offer in the debate at this time, Mr. Chairman, except to indicate that

the member has indicated a procedure he would like to have put in place

in terms of our administration, and perhaps we can do that. But it's

not like dealing with a known disease where we have clearly-established

tests and diagnoses and can say yes, this is MS or ALS or something

else. It's a rather mysterious item at this point and for that reason

is difficult to code.

MR. PERRY: Let me turn to another rather different issue. The

minister will be aware that within British Columbia hospitals in the

last two years, there has been an initiative, funded by another

ministry, which was rather unique in North America. These were the

chemical dependency resource teams designed to identify patients in

hospital who were suffering from alcohol addiction — alcoholism — or

dependency on various other drugs and to help them to get into some

kind of effective treatment program at the point of maximum opportunity

while they were in hospital. Good doctors and nurses have always done

that, but it has been one of the great failings of the health

professions that probably in alcoholism, as nowhere else, they have

failed to have much of an impact on patients. Therefore a lot of people

were very excited when that chemical dependency team program was

started in British Columbia. It recently ended suddenly

[ Page 12764 ]

and dramatically at the end of a two-year period, when what was assumed to

be long term but turned out to be temporary funding was ended. The hospitals

were told: if it's so good, carry it on out of your own budgets.

Mr. Chairman, you probably know, coming from your part of the world,

that some of the teams were quite popular. In Vernon, for example,

there was a strong public reaction against the elimination of the team.

In St. Paul's Hospital in Vancouver, where a phenomenal percentage of

the patients are affected by alcoholism, there was a lot of concern at

that team's elimination.

One of the disturbing things I find is that the teams apparently had

no built-in evaluation program. I've been told, in the case of one

major hospital, that even the records were being destroyed, presumably

through the best of motives: to guarantee patient confidentiality. But

that made it almost impossible even in retrospect to look back and see

how many people had been seen and what kind of intervention was

achieved. I find this very disturbing, because it had drawn a lot of

attention. It's the kind of things ministers talked about on public

occasions. Presumably many ribbons were cut, and now it appears to have

dissolved. The hospitals that are the most progressive and aware of the

impact of alcoholism are very upset about it.

In Victoria at Royal Jubilee, Dr. Thornton produced a report — the

first of its kind perhaps in North America — suggesting that up to 25

percent of the people in the hospital at any one time were there in

direct consequence of their abuse of alcohol. It is a shocking figure.

It is absolutely shocking, even for people who work in that field.

I would like to know what the Ministry of Health has done to help

hospitals maintain these programs where they seem to be working well or

to offer some bridge funding, assistance or any kind of guidance. I am

hearing a lot about it not only from the people who worked in those

teams and who naturally have a stake, but from people who are

independent of them.

The letter from Dr. R.J. Ross in Vernon described the situation in

Vernon this way: "Vernon is unique in that it has developed an

efficient, effective and inexpensive system of care: the Vernon

treatment centre, the hospital chemical dependency team, the Howard

House male residential recovery program, alcohol and drug clinic and

Round Lake treatment centre. These all work in close cooperation with

the 12-step self-help groups." He goes on to pay tribute even to the

local MLA.

He describes the Vernon treatment centre where he works, and he describes the chemical dependency teams this way:

"The chemical dependency team interviews patients in hospital

when they are most vulnerable. It sees patients daily and influences the care

of many more. It has improved the awareness of hospital and medical staff of

the disease of chemical dependency. The chemically dependent person is now treated,

not ignored. These measures stop repeated hospital admissions. Clear parameters

for admission treatment have been developed."

That means treatment of alcoholics, for example, when they come into hospital.

"More work needs to be done, especially in research

and education. There is a need to develop techniques for even earlier

intervention, especially in emergency...."

"I believe that the provincial government has its priorities

wrong. In the name of fiscal restraint, it seems determined to destroy this

practical and cost-effective system without consultation and apparent thought.

These three programs have had their funding cut."

He's talking about the whole system in Vernon in that case.

What I'd like to ask the minister is: doesn't it trouble him...?

Even though this was funded initially out of another ministry, clearly

it is in the health realm; the teams were working in hospitals. Nobody

else, to the best of my knowledge, funds anything in hospitals aside

from the Ministry of Health or voluntary groups. Doesn't it trouble him

that we seem to be on the verge of becoming world leaders in addressing

alcoholism and suddenly it's just gone without any evaluation, kaput?

It's gone without any evaluation, without any remorse. Is the minister

thinking of doing anything to get this program back on track?

HON. MR. STRACHAN: As the member has indicated, this is a

program within another ministry; it was within the Ministry of Labour

and Consumer Services. The chemical dependency resource teams were

funded by Labour, and the hospitals were offered the opportunity to

take

part in this. They had one year and then the 50 percent funding

for year two, and they were aware of that, as I understand it, when

they first went into the program.

I understand as well that Labour and Consumer Services may be

considering a continuation of the program, but I'm afraid the member

would have to pose the question to that minister, or write to him.

In terms of the general concern, yes, I do have a general concern

for any people who suffer from a disease such as alcoholism or

dependency on any type of drugs, and as Minister of Health I would

certainly agree with the member's concern. But this specific program is

funded through the Ministry of Labour and Consumer Services. The

question would be best posed to that minister, but my understanding is

that they are reconsidering the program that they put in place two

years ago.

MR. PERRY: If we're to believe that the minister's answer

indicates some possibility that the Ministry of Labour and Consumer

Services will revise its decision, maybe the Minister of Health could

consider an urgent directive to hospitals to stop destroying records of

patients who have been treated. Clearly it would not be in the interest

of a program to continue shredding or burning files — even if for the

best of reasons of confidentiality — if we're going to go back to those

programs.

I want to pin down the minister a little bit on whether within these

estimates that we're debating there are any funds for initiatives

within the Ministry of Health in alcoholism, particularly within the

hospital system. I'd just like to revisit a column that Denny

[ Page

12765 ]

Boyd wrote in the Vancouver Sun on Friday,

May 3. He's one of the few journalists who, perhaps because of his

personal knowledge of the problem, seems to write seriously about this

issue. Thank heavens he's there occasionally bringing it back to public

attention. He points out that Dr. Thorton's study at Royal Jubilee

Hospital suggested that the costs of alcoholism just in the British

Columbia hospital system are in the order of $72 million per year.

Denny Boyd points out that the chemical dependency resource teams were

costing approximately $1.5 million per year. Regardless of which

ministry it comes out of, it's all related to health and it's all the

same taxpayers' money.

I want to point out one accolade that was received. It must be a

rare event. Somebody in Toronto actually wrote to compliment us in

British Columbia on what we are doing in this field, and to express his

concern about those hospital-based teams. This is the president of the

Canadian Medical Society on Alcohol and Other Drugs, Dr. James Rankin

of Toronto. He wrote:

"It has been known for many years that patients with

alcohol- and drug-related problems are heavily over represented in

hospital admissions, and that as a group they tend to present us with

more serious and complex medical problems than the average patient. As

such, they contribute a disproportionate amount to the costs of the

hospital system as well as to health care costs generally."

The point I'm trying to make, Mr. Chairman — I see you understand it

— is that it's such an important area that we can't afford to have

capricious planning and funding — one year on, one year off, two years

on, two years off. I believe we clearly need initiatives within the

Ministry of Health to deal at the hospital level, at least, with

alcoholism and drug abuse problems. If the Ministry of Labour is going

to keep alcohol problems for out-patient services — it never made sense

to me — at least the Ministry of Health ought to be providing the

continuity of making sure that we improve our hospital treatment.

I want to pin that Minister of Health down. Is there anything out of

the $5.4 billion budget — is there even a million dollars in there — to

deal with alcoholism, which we think is costing at least $72 million a

year in hospitals?

HON. MR. STRACHAN: I'll respond to the member again. As he

knows — and he may disagree with this — it is an area that has been

funded typically over some years now by the Ministry of Labour and

Consumer Services, and he should pose the question to that minister.

In terms of hospital records, I don't quite follow what the member

is trying to get at. We ask all hospitals to keep all records for seven

years. That's a requirement of the Evidence Act. If there are any

records being destroyed, we will question who is doing that, and we

will begin that questioning now with respect to the hospitals that are

allegedly destroying records. My information is that they are to keep

records for seven years.

In terms of the general concern the member raises about alcohol, chemical and

drug abuse, I can tell him that I share his concern. As the member may or may

not know, I and other members of cabinet are on the Kaiser Substance Abuse Foundation.

This is a very serious concern in our province, and it's a very serious

concern of mine. I don't want the committee to think that we in any way

see this as a trivial issue, because it certainly isn't. We are at all times

aware of the tremendous cost to society of drug and alcohol abuse. We endeavour

in many ways to ensure that we are acting responsible in every way in alleviating

that problem.

[4:15]

The member, quite facetiously I hope, points out that we've had one

compliment from Toronto. We've had many compliments from many

jurisdictions with respect to health care in this province. I can tell

you that on the issue of drug and alcohol abuse, one program that the

Social Credit government put in place some years ago is probably the

most effective program in North America, and that's the CounterAttack

program. It's been extremely successful with respect to getting

drinking drivers off the road.

In many other areas we have really led North America, including our

CounterAttack program, our legislation dealing with driving while

impaired and jail sentences — we were the first jurisdiction in North

America to impose a jail sentence for a second offence. We take this

whole issue very seriously. We've had many more compliments on this and

other programs from other jurisdictions, more so than the member

alludes to. In no way will I accept the criticism that we are not

concerned about alcohol and drug abuse. It is a very serious concern of

ours, and in many areas — in many ministries — we are doing all that is

possible within our budget and policy to ensure that we are alleviating

the cost to society from this type of abuse.

MR. PERRY: Just to remind ourselves that there's a ways to go

yet, the quarterly analysis of fatal motor-vehicle accidents — the last

quarter I have is October to December 1990 — shows that while the total

number of motor-vehicle accident fatalities in B.C. rose only 11

percent, so to speak.... I point out that it's improper to refer to

those as "accidents." They are usually more accurately referred to as

"collisions" because most of them are preventable. The number in which

alcohol was judged to be a contributing factor rose 53 percent in the

last calendar year from 106 deaths to 162 deaths. So while

CounterAttack is a very good and important program, let's not reassure

ourselves too much that we've got that problem in hand.

Just to pursue the treatment of alcohol for a while, I'd like to ask

one other specific question, which is what is the fate right now of the

special clinic at Sunny Hill Hospital for fetal alcohol syndrome? I've

had a number of letters from parents — some of them adoptive parents —

of children affected by fetal alcohol syndrome who are some of the most

difficult children to raise, some of them with unimaginable personality

problems, as well as physical and mental disabilities.

[Mr. Pelton in the chair.]

[ Page 12766 ]

I've been getting letters from parents who are very worried about

funding — for example, one dated March 28 from people in Abbotsford

saying: "Yesterday we heard some most disturbing news: the fetal

alcohol syndrome clinic at Sunny Hill Hospital for Children has been

informed that their funding has been withdrawn as of April." It goes on

to make a very poignant argument. I won't read the whole letter, but

it's quite disturbing to see the situation those parents are in. Can

the minister inform us what the status of that clinic is?

HON. MR. STRACHAN: I'm advised that The Sunny Hill Hospital

program has been largely informal. The fetal alcohol syndrome resource

group, which is a voluntary group of health professionals interested in

fetal alcohol syndrome and effects, has been connected on an informal

basis with Sunny Hill Hospital. This group has used the hospital to

administer research projects and grants, but this is not supported as a

hospital-funded program.

Mr. Chairman, I'll also advise the committee that I'm going to be

absent for a few moments from the assembly, and my colleague the

Minister of Lands and Parks is going to enter into the debate. I will

return shortly.

MR. PERRY: I've been waiting for this moment for two years. I

remember when the Minister of Lands and Parks held his travelling road

show in Vancouver. He wanted to expand the tree-farm licences to cover

more than the area of British Columbia, if I remember, and to include

Alberta as well. Whatever it was he wanted to do, I remember the

pleasure I had of appearing before him at that time. He seemed so

uncomfortable that I used up a little more than my allotted time. So

it's a pleasure to be standing here looking at him again now.

Last week during the debate we raised the issue of the College of

Physicians and Surgeons inquiry into the sexual abuse of patients. We

suggested that the minister might want to communicate with the college

about the desirability of expanding its committee — not to dictate to

the College of Physicians and Surgeons but to communicate the

importance of ensuring in the public eye that the committee was seen to

function fairly. I wonder if the minister could tell us whether the

ministry staff has made any progress in that direction.

HON. MR. PARKER: Mr. Chairman, I will take that question as notice for my colleague the Minister of Health.

I'd like to raise a couple of points in this debate about health

care in the northwest. I live in Terrace, and I can tell you that the

health care services we get in the community are excellent. The Mills

Memorial Hospital has become a de facto regional hospital with a large

number of resident specialists. We're grateful to the Ministry of

Health for their support for our hospital.

I'd like to point out to the minister that the Terrace Health Care

Society is one of the first societies in the province to take on the

responsibilities of acute care, intermediate care and extended care.

They have an initiative before him and his colleague the Minister of

Social Services and Housing for supportive housing, which is the step

between independent living and intermediate and extended care. That

initiative has come from this community group, the Terrace Health Care

Society, and it's one that conserves and uses funds more efficiently. I

am pleased that he and our colleague the Minister of Social Services

and Housing are reconsidering the submission that was received last

fall for the establishment of some 40 units of supportive housing in

Terrace. The Ministry of Lands was able to provide the land adjacent to

the extended care facility, and therefore the supportive housing

facility will be in close proximity to medical care and medical

attendants.

I'll defer further comments to the Minister of Health in response to the critic's earlier inquiry.

MR. PERRY: I'll just repeat my question now that the

minister's back. Last week we had some brief discussion concerning the

College of Physicians and Surgeons' review committee on sexual abuse

issues. I think we suggested politely to the minister that it might be

worth raising with the college the importance of the public perception

of that committee — that it be seen to function unequivocally in the

public interest, especially in view of the comments reported in the

media of two prominent psychiatrists who work in the field and who

encourage the college to widen the membership of that committee to

include lay people.

The minister indicated at the time that he was prepared to discuss

that with the college. I think he agreed with us that it was reasonable

to raise the issue in discussion. I wonder if he could tell us where

he's gotten with that.

HON. MR. STRACHAN: With respect to sexual abuse by

physicians, the member is correct; we did discuss this last week. A

letter is now being prepared for my signature to be sent to the College

of Physicians and Surgeons. It will deal with the concept of more

public hearings and lay membership on that committee.

With respect to the recent comments made by the member for Skeena,

the Minister of Lands and Parks, I have a tendency to agree with him.

As a ministry we are now looking at the whole issue of supportive

housing, along with the Ministry of Social Services and Housing. There

are many excellent suggestions coming not only from Terrace but from

other parts of the province and other societies, so we are reviewing

that, whole issue now. I can tell the committee, though, that in terms

of supportive housing there are now many good agencies in the private

sector providing that type of supportive housing. It's nothing new to

us, but we are looking at it with some interest, and I will be

responding to the member as quickly as we can finalize a response to

his inquiry.

MR. PERRY: Let me go back to one other issue that I raised

earlier in the debates: the financial situation at Mount St. Joseph

Hospital in Vancouver. I exchanged

[ Page

12767 ]

correspondence with the former minister last

December, I believe, pointing out that the proposed cuts or layoffs at

the hospital, and the closure of wards due to a budget overrun,

appeared to me to directly compromise the care of patients who would

not have anywhere else to go. I pointed out in my letter to the former

minister that I had inspected the surgical ward proposed for closure,

and I described in these debates a week or two ago what I saw then:

patients with classical, serious medical and surgical problems who

required treatment. If they weren't treated there, they would have to

be treated somewhere else, perhaps at a higher cost.

Aside from that observation, I recommended to the minister at that

time — if memory serves me, it was about December 7 of last year — that

the ministry accede to the hospital's request for an external review of

its funding so that the truth might out and the chips fall where they

may, depending on the result of that report.

I have been asking to see that report now for several months, as

have people who work at the hospital, to know whether it in fact

confirms the ministry's position that the hospital should be expected

to pay back its overrun during the current fiscal year or whether the

hospital has a valid case. Perhaps its load has increased so much that

its base funding ought to be increased.

[4:30]

I know that the ministry has previously taken the position

informally in conversations with hospital administrators and staff, to

paraphrase: "You're doing too good a job; why don't you just stop doing

such a good job and fewer people will come to you?"

That has always struck me as a strange position. If the ministry

said, "You're wasting money," that's one thing. Let's root it out. If

the ministry said, "You're doing unnecessary procedures or treating

people unnecessarily or keeping them there too long," that's fine.

Let's fix that as well. If it said, "You are providing cultural

services like enhanced translation or cultural sensitivity for people

who only speak Chinese, Polish, Tagalog, Korean or Vietnamese" — the

people that the hospital attracts — "but you know we can't afford for

people to understand what's being done to them; let's go back to the

bad old days when the doctors would just cut 'em open and take it out,

and they'll never even know what happened to them...." I remember that

from my old days in medical school in Montreal. That often happened. It

wasn't the language issue then; it was just a bad way to practise.

Surely we've got beyond that.

Those are the questions that occur at Mount St. Joseph. They were

widely regarded in their community as a pioneering hospital, the first

one in British Columbia to take seriously the issue of equal access to

health care for cultural minorities and of surmounting some of those

barriers of communication.

Therefore I felt the review was very important. I keep asking for it; I have

here in my file a letter from the minister dated May 31, 1991. It is a very

polite letter reminding me why I had to write to him and why a telephone call

from my staff wouldn't have sufficed. It told me: "With respect to

Mount St. Joseph's Hospital, I am advised that the hospital review"

— and it was not an external review, whatever it was — "will be complete

towards the end of May, and the results will be communicated to the hospital

board of trustees shortly thereafter."

So it says that the report would be completed towards the end of

May. This has been in the works since late December. It is now June 17,

and when I checked today, I'm told by the hospital that it has not yet

received this report. So again I have a few simple questions. Is there

a review underway? If so, is it an external review, or is it the

hospital itself doing the review? Who are the reviewers? How long have

they been working? How much have they been paid to do this job, or how

much time have they taken off from their other jobs? When will the

report be prepared? And will the minister commit that, given the public

interest in the issue, those parts of the report that are not

inherently confidential or inherently damaging — for example, to an

individual employee or patient — will be released in a timely way?

HON. MR. STRACHAN: I'll answer the member quickly and

briefly. First of all, a brief description of Mount St. Joseph

Hospital. Last year they attempted — for whatever reason — to provide

nearly a 20 percent increase in workload. This was far above the

population growth or any other model that they would use for the funds

provided, so they did end up in a deficit position, which we attempted

to respond to.

The review is part of the normal three-year review; it's being done

by team one. It's part of their duties, so we don't identify a specific

cost to it. It's part of the workload of the regional teams to do these

regular reviews, so there's nothing specific we can take out of it.

In terms of patient care, there will be beds closed at Mount St.

Joseph. But St. Vincent's Langara Hospital will be opening 225 beds

this summer, and they will take the people who are affected by the bed

closures at Mount St. Joseph Hospital. These are typically longterm

care patients.

MR. PERRY: Mr. Chairman, there is another fundamental

illogicality in the approach the minister has just outlined. The

minister said that for some reason the hospital increased its workload

by 20 percent in the last year, and therefore it ran out of money. If

we were to say about any other endeavour that they had increased their

workload by 20 percent in a year, we would be applauding. In this case,

they are to be penalized because they did more work.

Again, let me be perfectly clear. If the minister said they did work

that was unnecessary or of poor quality or that could have been done

more cheaply elsewhere or which could have been done to the greater

satisfaction of the patients someplace else, those would all be

rational arguments to hold against the hospital — or at least to ask it

to revisit. I know that most of those arguments don't apply. I think

the reason the workload went up by 20 percent — or at least this is

what the hospital has told me — is that people in the relevant

[ Page 12768 ]

ethnic communities: the Chinese Canadians, the

Vietnamese Canadians, Korean Canadians, many eastern European groups

such as Polish and German and the Filipinos specifically feel they get

a better quality of service. They feel more comfortable in that

hospital, and therefore some of them actually come in from the Fraser

Valley to there.

A 20 percent increase in workload means that the capital facilities

and the heating costs of that hospital are being amortized that much

more rapidly. We're getting 20 percent more productivity out of that

capital investment. If we had a huge capital investment sitting empty

somewhere else, maybe we would worry about that; at least it would be

embarrassing. It doesn't necessarily mean it would be more cost

efficient to transfer the people elsewhere.

I really have difficulty following the logic of the ministry

position. I emphasize that if their review or study of the hospital

suggested that procedures not warranted are being undertaken, that

patients who don't need to be treated are being seen there, that people

are coming to the emergency department who don't belong there or that

lab tests are being done that are wasteful or redundant, it's entirely

appropriate for the ministry to be aggressive and to root out that

waste as vigorously as it can. It's just a question of wanting to know

the truth of what is going on there.

When I visited the hospital, the surgeons told me that their

operating rooms are the most efficient in the city of Vancouver, and

their turnaround time to wheel a patient in and out and get the next

one in and out of the operating room is so much better that some of the

surgeons prefer to operate there rather than at other hospitals. They

can operate more efficiently and make better use of the capital

facility and the human investment — the taxpayers' investment in the

nurses who work there.

I'd like to know if that's true. If it is true, then they ought to

be a model and a paragon — not a scapegoat. If it's not true, then

let's see the facts.

The minister still hasn't answered my question. He indicated to me

in writing, just 18 days ago, in a letter dated May 31, that he was

advised "that the hospital review will be complete towards the end of

May...." He wrote this letter and signed it, presumably knowing that

the report had been submitted at that time. Now the hospital tells me

they haven't got it. Has it been submitted? If not, does the minister

know when it will be submitted? Does he know why he was apparently

misinformed about that? How long are people to be left hanging out on

the clothesline, waiting to know what their fate will be at that

hospital? How long do we have to wait before a rational discussion can

begin on what's to be done to deal with that budget deficit?

HON. MR. STRACHAN: First of all, Mr. Chairman on the issue of

hospital budgets, hospitals are funded on a global basis, as I've said

many times during these discussions. The funding is adjusted by the

demographic characteristics of the population that a hospital serves,

primarily age and sex, and is based also on population growth and

referral patterns. Hospitals are expected to operate to serve their

communities' needs with the funds available, and Mount St. Joseph has

been doing that for some time but, for whatever reason, exceeded its

1990-91 budge