Social Services Committee — Department of Health, and the Department of Social Services call for private ad hoc services — 15 May 1991

1991-05-15

Newfoundland and Labrador — Committees

May 15, 1991

SOCIAL SERVICES ESTIMATES

DEPT. OF HEALTH (UNEDITED)

The Committee met at 7:00 p.m., May 15, 1991.

MR. CHAIRMAN: Order, please!

Good evening and welcome back, Mr. Minister and

your staff, to what may be a very historic estimates committee meeting,

considering some of the deliberations this afternoon that find us all here.

Let me very quickly introduce the Committee to you.

To my immediate left the Member for Humber East, Ms. Lynn Verge; and Mr. Arthur

Reid, the Member for Carbonear; Mr. Jack Harris, the Member for St. John's East;

Mr. Aubrey Gover, the Member for Bonavista South; and Mr. Doug Oldford, the

Member for Trinity North. And I want to welcome the young gentleman from the St.

John's Evening Telegram. Of course our secretary for this evening is certainly

no stranger to any of us, the Clerk of the House of Assembly, Miss Betty Duff.

So Mr. Minister perhaps it is now appropriate for

me to ask you if you would be kind enough to introduce your staff again for our

friends at Hansard.

MR. DECKER: Thank you, Mr. Chairman. Dr.

Williams is the Deputy Minister; Gerald White, Assistant Deputy Minister; Brian

Lemon, Assistant Deputy Minister; Debbie Sue Martin; and John Downton.

MR. CHAIRMAN: Thank you very much. Inasmuch as

the Minister was here before with his staff for some three hours and odd minutes

I do not think there is any need for an opening statement. I am sure the

Minister would agree. And I would turn it over to the Deputy Chair, Ms. Verge,

for the initial question.

MS. VERGE: Thank you. I would like to begin by

asking about mental health services, particularly mental health services for

young people, for adolescents and children. Examining the estimates of the

Departments of Social Services and Education we heard the Ministers responsible

acknowledge that there is a continuing rise in the reports to the Child Welfare

authorities of child abuse, sexual abuse and physical abuse. While the Minister

expected that the number of reports of child abuse would have levelled off by

now, he told us that in fact has not happened, that there continue to be more

and more reports of child abuse.

The Minister of Education acknowledged that an

appallingly large number of children are going to school hungry. The social

assistance caseload in the Province is perhaps at an all-time high. The Minister

told us last night that there are 50,000 individuals in the Province on welfare

now. All these statistics mean that there is a great number of young people in

the Province in need of mental health services.

Now I know the Department of Health has been

operating in St. John's two services, the mental health service for children at

the Janeway Hospital and the Anderson Centre. I know that when the previous

administration established the Anderson Centre it was with the intention of

progressing to adding similar mental health services for young people in other

regions of the Province. I recall in the winter of 1989 the Department of Health

came to Treasury Board saying that its priority for expansion for the 1989-1990

budget year was establishing a young people's mental health service modelled on

the Anderson Centre, which had proven to be successful in St. John's, in central

Newfoundland where there were virtually no mental health services for young

people and where to this day there are virtually no services. It was the

Department's plan or vision to proceed in later years to set up a mental health

service for young people in western Newfoundland and a similar service in

Labrador.

Over the past two years nothing has improved. In

fact the services in St. John's have lost staff and I understand the Anderson

Centre now has a waiting list of over 150. The Department of Social Services,

trying to meet the need for counselling, psychological and psychiatric services,

or mental health services for young people, instead of going to the Department

of Health and cooperatively ensuring that the Department of Health staff are

boosted to meet the need, have instead followed a different course. The

Department of Social Services has now called for proposals from psychologists

and psychiatrists, evidently intending to contract out on an ad hoc, piecemeal

basis.

I would like the Minister to address this general

subject of the unmet needs across the Province for mental health services on the

part of young people; to address the staff shortage at the Anderson Centre and

at the Janeway in St. John's; to talk about the appallingly long waiting list;

to talk about the absence of services in other regions of the Province; and to

comment on the discrepancy between the delivery of service by the Department of

Health, and the Department of Social Services call for private ad hoc services.

MR. REID: Mr. Chairman, a point of order.

MR. CHAIRMAN: Mr. Reid.

MR. REID: Will you tell me where this question,

related to information in the estimates, is in the estimates?

MS. VERGE: 2.3.01, Mental Health services.

MR. CHAIRMAN: I wonder if the Vice-Chair would

be kind enough, when a point of order is raised, to give the Chair an

opportunity to respond.

MS. VERGE: I am sorry.

MR. CHAIRMAN: I appreciate the assistance of

course, and I suppose God only knows sometimes I need it. But I would want to

hear the point of order raised by the hon. Member for Carbonear. And I think I

know what the Member is talking about. May I just take a moment to say in all

fairness that the Chair would ask the Committee members tonight to probably be -

not probably, but to be, so the Chair does not have to make rulings that it does

not want to make - a little more direct, a little more precise, and a little

less....

MS. VERGE: (Inaudible).

MR. HARRIS: You mean no speeches?

MR. CHAIRMAN: Yes. I would want to thank the

Member for St. John's East. I was trying to be a little kind. Yes, exactly that.

I do not need speeches, the Minister does not need any speeches, the Committee

does not need speeches. What we need are direct questions and hopefully direct

answers. And I would suggest that -

MR. HARRIS: I would hope we will not be hearing

speeches from the Minister either, will we?

MR. CHAIRMAN: Well, I would hope not. I would

ask the Minister to give the same consideration. But I have listened to the

Member for Humber East now for approximately five minutes -

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: Well. The Chair has been talking

AN HON. MEMBER: And what's the question?

MR. CHAIRMAN: - for maybe - and I am trying to

come back to your point of order, Mr. Reid. It is a very good point of order,

and I would ask hon. Members to consider exactly what we - we know what we were

prolonged with this afternoon, and the amount of dialogue in debate that kept us

here until 6:30 p.m. this evening and it is not again the Chair's intention to

cut anybody off, but we would do ourselves a lot better, all Committee Members,

if we would ask direct, concise, unpolitical questions and I am sure the

Minister would respond in the same light.

Having said that, Mr. Minister.

MR. DECKER: Thank you, Mr. Chairman.

I am not qualified to comment on what Social

Services is supposed to have done - I can only take the hon. Member's word for

it. I cannot say whether it is accurate or not so I do not want to comment on

what Social Services are doing. I am going to ask Debbie Sue Martin to give an

outline of just what we are doing with the mental health programme in the

Province. There seems to be a little bit of a misunderstanding as if the whole

thing is at a standstill, which is not quite accurate.

The Anderson Centre has not yet been up to full par

since it has been put there and we have been aware of that and are trying to

deal with it. We are in the process now of putting the Anderson Centre under the

Janeway Board and we are hoping that rather than having a free standing

structure we might be able to have more success with recruiting.

But Debbie Sue if you would be kind enough to

explain to the hon. Members just what our mental programme is throughout the

Province.

MS. MARTIN: I could probably start off with the

Anderson Centre that is here in St. John's. The Centre has been open now since

1988 and we have yet to have the full complement of staff working at the Centre.

The major reason for that has not been the lack of effort at trying to recruit

but it has been very difficult to recruit the people who have the specialty

training and the specialty experience that is needed to deal with the mental

health problems of children and adolescence. We have done a number of

recruitment efforts; we have advertised publicly; we have done advertising

outside the Province as well and it has just been quite difficult to recruit

into the positions. We currently are accepting referrals, we do have a waiting

list at the Anderson Centre, but we have seen approximately 1,000 people since

the Centre opened. There are three programmes there: the preschool, school age

and adolescence age children and each one of those are specialized programmes.

We thought there was a lot of benefit to having this programme closely aligned

with the programmes that are offered through the Janeway while still maintaining

its autonomy and its community base service. In recent years it has been quite

evident that children do not do well by spending three weeks in hospital. What

they need is an ongoing support and involvement from families and things like

that. So, we are moving along with that and as soon as that transfer is

completed we are hoping to fill those positions with another major recruitment

effort.

The other efforts that we have been making, because

we do recognize the limited number of people who are available with specialized

training, we have had discussions with Memorial University to look at providing

a programme here in the Province that would equip people to work in specialty

programmes and particularly with children's mental health. There are not many

programmes even across Canada that are directed specifically towards children's

mental health. As you mentioned, we have had a change in the staffing. I think

we are probably one less that we would have had last year but we still have six

people working there. There has also been an increase in one of the other

services that we have operating in St. John's, the St. John's Adolescence Health

Counselling Service, which is on LeMarchant Road, and there has been an increase

of one additional staff member to that service over the last year.

I do not know what other specific kinds of things

we - I guess in terms of the other thing, that is the St. John's area, we have

over the past year, I guess we have eight other hospitals that are providing

some mental health services.

Some of these are ones that were already in

existence but there are some new programmes; there is not specialized children's

services associated with this, but each one of the programmes has identified, as

you mentioned, I think anyone who is aware of anything happening lately knows

there is a lot of increase with the demands for victims of sexual abuse and

things like that.

Carbonear has been given funding to have a

full-time mental health worker and that person I think, if he has not started

already is fairly close to starting. Stephenville, in this last year has two

people, a psychologist and a social worker and the Stephenville area has

identified children's mental health as one of its main priorities and they will

be directing some portion of that programme to children's services.

Port aux Basques has one full-time psychologist,

and again, it is not a dedicated children's service. If you look at the

statistics on the referrals that are there, you will find that about 60 per cent

of the people seen are children or young adult and we define adolescence up to

the twenty-first birthday, we do not cut off at sixteen, that sort of thing.

Labrador City has four workers in their mental

health service and there is one, who is a new person and over the last year was

the fourth but prior to that, there was one person who was basically working

full time with children and they have a lot of demands there.

The other place that has instituted some mental

health service over the last, I guess eighteen months, has been Clarenville, and

they have a full multi-disciplinary team there comprising a psychiatrist, a

social worker, a psychologist and a psychiatric nurse. A lot of the work they

are doing, not alone doing some tertiary kinds of treatment, they are trying to

work in the schools, working at the promotion of good mental health, that kind

of thing as well, but a lot of their work there is with children and families.

You do have the usual problems of distances and things but, that is a first for

Clarenville to have that full team in place out there.

Out in the Burin Peninsula, the Burin Peninsula

Hospital has two people working in mental health; they have a psychiatrist and a

social worker and the other two places are in St. Anthony at Curtis Memorial.

Now they have two psychiatric nurses, they do not have other disciplines

represented on their service right now and the last place that offers some -

none of these places, I should have said at the beginning offer in-patient

treatment, this is all an out-patient outreach community based service as much

as you can, when it is based in a hospital kind of thing.

The last place would be Melville Hospital; Melville

Hospital has one social worker and one nurse who work in the mental health

service.

MS. VERGE: What about Corner Brook? We always

had a child psychologist, Dan Ashborne there a few months ago and I do not think

he is going to be replaced.

MS. MARTIN: Yes. I said the ones whom I have

just listed there are the ones who do not have in-patient services for mental

health, but, I could run through, like Corner Brook does have an in-patient unit

for mental health and they also use their Paediatric unit for some admissions

for children who do require admission and as you mentioned the CAG service there

just recently lost its director and-

MS. VERGE: And last year it lost its teacher

when the Department of Education eliminated that position, so it is down to two

positions now.

MR. CHAIRMAN: Order, please!

I have great difficulty with the Member asking

questions to which she knows the answer.

If Ms. Martin would continue, I am sure the Chair

and the other Members of the Committee would be very pleased.

MS. MARTIN: I would mention as well that there

is a children's service at Corner Brook, there also is a mental health service

at Gander and Grand Falls, which again, is not dedicated to children's services

but does not exclude children from services.

There is a recognition of the need for working

between paediatricians and psychiatrists, the kind of problems that children

have in mental health are not only the purview of paediatricians, they would

also be the purview of psychiatrist. There needs to be a concerted effort or a

co-ordinated effort involving paediatricians, schools, social services sometimes

and over the last year there has been trying to be a recognition of that and

people trying to work at the problem, not as an individual, in something that

can be solved in two or three weeks or two weeks, but that it is an ongoing

problem that will require a lot of support from a number of areas, not only the

hospital sector. That is probably about it in terms of children's, because

outside St. John's there is nothing more specific (inaudible).

MS. VERGE: Would you comment on the (inaudible)

waiting list?

MR. CHAIRMAN: Thank you, Ms. Martin. No, no,

there is no need of a point of order. I just want to remind the hon. Member for

Humber East that there are five committee representatives. I would suggest to

the hon. Members there has certainly been a fair amount of time and I want to

thank Ms. Martin for her very detailed and comprehensive report.

Mr. Harris.

MR. HARRIS: Thank you, Mr. Chairman.

The Thomas Anderson Centre has been questioned by

the Member for Humber East, could the Minister say how many positions are

currently involved with the Thomas Centre, how many positions have been approved

and, there is some talk of recruitment problems, but how many positions have in

fact been approved and if the Minister could find the people to fill them how

many would it be able to have under current budgetary allotments?

MR. DECKER: The current budgetary allocations

have nothing to do with it; we do not have a full complement, I do not know if

it is twelve or fourteen we are supposed to have, but we if we can recruit we

can fund, so do not confuse budgetaries with the bodies, we just cannot get the

qualified people. But what is the number (inaudible).

MR. HARRIS: But what is the right terminology,

are we talking about approved positions or - just tell me because I do not know,

I am going to be naive now, I will not ask for budgetarial allotments; how many

positions would you fill if you had the people to fill them?

DR. WILLIAMS: There are ten approved positions

and there are four vacant.

MR. HARRIS: So approved positions is the

correct terminology?

DR. WILLIAMS: Yes.

MR. HARRIS: And you have four vacancies and the

last time there was a recruitment plan?

MS. MARTIN: Okay. We have not done a formal

recruitment since last spring; I guess it would have been around May and June of

last year, and since October of last year we have been negotiating the transfer

with the Janeway and we have not done any recruitment during that time.

MR. HARRIS: So the transfer at the Janeway, the

unit is going to move into the Janeway, is that it or, what do you mean by

transfer?

MS. MARTIN: No. The unit will maintain its

autonomy, but it will come under the administrative structure of the Board of

the Janeway in a similar way that there are other health programmes, a perinatal

programme that operate under the direction of the Board of the Janeway.

MR. HARRIS: Is it the intention, and I am just

looking at the brochure that is produced by the Department of Health, is it

intended that that be a provincial referral centre or is it still just to serve

the St. John's or Avalon area?

MS. MARTIN: It is not intended that it be a

provincial centre. The intention was that other similar types of centres would

be set up throughout the Province in the Central, Western, and Labrador region.

MR. HARRIS: Is the planning time-lined for

those other centres?

MS. MARTIN: We have -

MR. DECKER: We would like to get one centre up

and working and fully staffed so that we can have a true model but after that is

done we will then decide, depending of course on the budget of the Province when

we will go to other parts of the Province. But we really do not have an accurate

picture yet until we get it up and working. After it is up and working we plan

to move out.

MR. HARRIS: So, this idea of having them across

the Province is part of the overall long-term ultimate policy, but we will see.

It is part of the dream, is it? There is no definite decision to do that is

there?

MR. DECKER: No, Mr. Chairman, dreams are things

the NDP have and they are really good dreamers. It is part of our plan in due

course once we get one up and going we will make it a reality. It is not just a

dream.

MR. HARRIS: The Minister must be really

delighted to have these paid monkeys to laugh on cue. I am really pleased.

MR. GOVER: A point of order, Mr. Chairman, I

believe that the Speaker has already ruled that a Member cannot refer to another

Member as an animal. I would ask the hon. Member for St. John's East to withdraw

that unparliamentary remark.

MR. HARRIS: I do not think that was

unparliamentary. I think the thing that was unparliamentary was trained monkey,

I said paid monkey and that is a very different thing.

MR. CHAIRMAN: Trained, paid or whatever I think

the reference in this House was that under no circumstances were any hon.

Members to refer to other hon. Members in a derogatory sense using an animal

connotation I guess. I would ask that the hon. Member for St. John's East

withdraw that statement.

MR. HARRIS: The reflection on the animals which

I made I will take back. I would not want -

MR. CHAIRMAN: I ask the hon. Member without

reservation to withdraw the statement.

MR. HARRIS: I do withdraw that statement

without reservation.

MR. CHAIRMAN: Thank you.

MR. HARRIS: However, I do find that the people

on this side are rather easily amused.

AN HON. MEMBER: Yes, we are especially when you

are (inaudible).

MR. CHAIRMAN: I thank the hon. Member for

having the courage to withdraw.

AN HON. MEMBER: (Inaudible).

MR. HARRIS: No, paid not trained. You may not

be trained.

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: Order, please!

There is no need of any further debate, I would

want the hon. Member to continue with his questioning. Up until now I would have

liked to compliment the hon. Member on his line of questioning but I am not so

sure now; anyway, continue.

MR. HARRIS: If members did not invite those

comments they would not be made.

MR. GOVER: (Inaudible) asked to be called a

paid monkey, Mr. Chairman.

MR. CHAIRMAN: The point of order has been

addressed and the hon. Member -

MR. GOVER: There would be no need of a point of

order if the hon. Member would stop the unparliamentary language.

MR. HARRIS: I would prefer, Mr. Chairman to

question the Minister and the officials on the important matters that we are

here for.

MR. GOVER: Well, get on with it.

MR. HARRIS: You will have to remember this was

all started by the partisan comments of the Minister, Mr. Chairman, and I think

that has to be noted.

AN HON. MEMBER: That is true.

MR. DECKER: I apologize, Mr. Chairman,

(inaudible).

MR. HARRIS: So, we have for the immediate

future, for the next fiscal year and beyond perhaps a single centre in St.

John's.

The Minister is talking about a model that needs to

be tested and up and running before it works. Is there some special methodology

being used here that is different, some new counselling procedure that needs to

be tested, or are we really just talking about different modes of delivery of

service, whether you do it with a team or whether you do it with individuals? Is

this something that really needs to be tested?

MS. MARTIN: The model is an alternative service

delivery model. Traditionally mental health services for children were offered

through a hospital setting through an in-patient program that is usually headed

by a physician or a psychiatrist. As I mentioned earlier, that in the past has

been seen to be not as effective, with children in particular, but probably not

as effective with adults either. This is a different model in that it has no

in-patient program associated with it. There are plans, and there is approval

for a day treatment program which would be a partial hospitalization in which

children would attend during the day but would remain with parents and families,

you do not have the disruption that you would have by taking a kid away from

their family. There is also some benefit in having a number of disciplines,

mainly psychiatrists, social workers, psychiatric or mental health nurses, and

sociologists, as well as educators all available and being able to deal with the

children's problems. It is a different model in that, particularly in

Newfoundland, we have never had anything that has not been, I guess, on a

medical model. This is an alternative model.

MR. HARRIS: Is it not the case that as much as

two years ago the Department had satisfied itself that the model being adopted

was a good model?

MS. MARTIN: I think the model was accepted as

being the best model that was available. We have not been able to confirm that

because we have not had the opportunity to have a full complement of staff there

to make sure that the model is going to work the way we want it to.

MR. HARRIS: Was there not priority

recommendations for those other centres made a couple of years ago, or are we

now taking back that recommendation and waiting and seeing? That is what I am

concerned about. What the Minister seems to be saying is that we are now waiting

another little while to see whether or not we like it, but I understand this was

already accepted as a good model and that it was recommended to have centres in

Gander and other places.

MR. DECKER: Mr. Chairman, the hon. Member some

day might serve in some Government and he will learn that no Minister has the

authority to pre-commit next year's Budget, or the Budget after, that sort of

thing. We do have long-term plans but there is a process we have to go through,

and I would certainly hope that in that process there will be a place for

duplication of the Anderson Centre. Some day you might learn that I cannot

pre-spend on next year's Budget. That is a process I have to go through.

MR. CHAIRMAN: I would like to acknowledge the

Member for Carbonear.

AN HON. MEMBER: Could the Chair indicate what

(Inaudible) there have been so far?

MR. CHAIRMAN: I would like to think that we

should not exceed ten minute increments. I did not want to interrupt Ms Martin

when she was answering the questions put forward by the Member for St. John's

East, but I think your line of questioning, Mr. Harris, is excellent, it is back

and forth, and it is direct. The Member for Humber East asked in five minutes,

probably about nine questions that I could remember, so if that is the way she

wants to do it, to extend the answer up to sixteen minutes, and you were just

over ten minutes, I would like to move to do it in ten minute increments.

MR. HARRIS: May I deal with that point of

order? We have been through this before and if I have been asking questions back

and forth and it is ten minutes from the beginning of the time that I speak to

the end of the last question, that is a ten minute increment.

Now if the Member for Humber East wants to spend

six or seven minutes or eight or ten minutes speaking and then there are another

ten or twenty minutes coming back, that is a total allocation of about twenty

minutes, and I just do not think it is a reasonable allocation of time if the

time allocations spent are measured in that way. To be fair, if that were the

procedure, if I could ask fifteen questions in ten minutes and have them

interspersed by answers then that would be fair to me, and I just wonder whether

the Chair would be a little more flexible in dealing with that because you do

not manage to get very much done, if you allow in your ten minutes the Minister

and the officials to answer the questions.

I mean we can stay I suppose all night until the

other fellows decides to shut her down, but I would like to get some questions

in at least before that happens.

MS. VERGE: To that point of order, I have to

support the Member for St. John's East. I think each of us should have roughly

the same amount of time. I have a different style of speaking and questioning

than does the Member for St. John's East, but I think he should have just as

much time as I had and I think he is asking a good set of questions and I think

we should allow him to finish his exploration of this subject before cutting him

off.

MR. CHAIRMAN: Yes, well to that point of order,

I would want to remind both the Member for Humber East and St. John's East, that

the Chair has been totally honest and candid. I think I have been more than

lenient, I have given both the Member for Humber East and St. John's East more

time collectively, night after night than I have given the other hon. Members on

this Committee.

There is no point of order. The Chair will decide

as to who asks questions and when. I am now recognizing Mr. Reid, the Member for

Carbonear.

MR. HARRIS: On a point of order, Mr. Chairman.

I do not sit here and ask questions at the favour of the Chair. I sit here as a

Member of the Committee, as a Member of this House, elected, with the right to

ask questions and question the Minister on the Estimates, regardless of the

Chair's view of how fair he has been, and I am not suggesting that he has been

unfair. We have spent an awful lot of time arguing about how fair you are or are

not, which has wasted an awful lot of time. There are a lot of important

questions to ask and I do not think we need to wrangle about all of that as long

as we are prepared to stay here and ask the questions.

You know if you want to do it in ten minute

increments that suits me fine, as long as I get an opportunity to ask these

questions and keep on going. We spent three hours down at the Colonial Building

and I think I might have had fifteen minutes out of it, that is not sufficient

as far as I am concerned.

This is a Department that spends $800 million or

$900 million on a very important aspect of our political and social system -

MR. CHAIRMAN: The Chair has no intention of

debating with the hon. Member for St. John's East. There is no point of order as

far as the Chair is concerned.

The hon. the Member for Carbonear.

MR. REID: I have no problem, Mr. Chairman, in

yielding to this socialist parasite, paid or unpaid, if you wish to do that, Mr.

Chairman.

SOME HON. MEMBERS: Oh, oh!

MS. VERGE: On a point of order, Chairperson.

MR. CHAIRMAN: I will ask the Member for

Carbonear to withdraw that statement.

MR. REID: Oh, I withdraw, Mr. Chairman. I

forgot you ruled on that; I did not realize a parasite was an animal. The

question is to the Minister: Mr. Minister, you must be really disappointed

tonight, that after what we went through this afternoon in this House, that one

Member of the Official Opposition, and, not being even the Health critic, you

must be disappointed that the Health critic from the Opposition side tonight has

not showed up and I know you must feel disappointed because there would have

been lots of good questions.

The question I have for you, Mr. Minister is a more

serious one. In the Province in recent years under Workers' Compensation, it is

becoming a serious problem in my area in particular, and it must be true

everywhere in the Province where hospitals are paying out tremendous amounts of

money to cover workers' compensation. Can you give me any idea of what we have

to pay out in workers' compensation every year. That is automatically taken out

of the budgets of these hospitals and nursing homes is it not?

MR. DECKER: Yes, Mr. Chairman, before getting

to the question, your preface about the disappointment that the Health critic is

not here, I am indeed disappointed and I would like for the record to show that

we have already spent three hours, which means that I had to bring back

officials from the department. Last night we sat three hours and waited to be

called to this Committee, and tonight we went through an hour and a half of

wrangling in the House and I was expecting to see the Opposition Health critic

as well as a half dozen members from the Official Opposition here tonight to ask

questions.

MS. VERGE: On a point of order, Mr. Chairman.

It is unparliamentary to refer to the absence of any Member of the House. And it

is ironic that just a few minutes ago the Minister of Health and the Chairperson

complained about my asking so many questions. Now they are expressing

disappointment that they are not getting enough questions. So the next time I

have a turn I assure the Minister that I will pack in even more questions.

MR. CHAIRMAN: Yes, I want to remind the

Minister -

MR. DECKER: To that point of order, Mr.

Chairman. As I was saying, Mr. Chairman, I am surprised that the hon. Member

would have the face to even address such a point of order. The fact of the

matter is that her party today had this House in a total uproar, and she is

forcing the Department to bring back officials who had -

MS. VERGE: On a point of order, Mr.

Chairperson.

MR. DECKER: I am on a point of order, so ask

that hon. Member to shut up, Mr. Chairman.

MR. CHAIRMAN: Order, order!

MR. DECKER: I am on a point of order. So if she

won't shut up (inaudible).

MR. CHAIRMAN: Order, please! Order, Mr.

Minister.

MR. DECKER: I am extremely disappointed -

MS. VERGE: On a point of order.

MR. DECKER: - that this hon. Member did not

have the courtesy -

MR. CHAIRMAN: Order, please! Order!

MS. VERGE: The Speaker ruled in favour of the

Opposition this afternoon after the Government House Leader tried to pull a fast

one on us.

MR. CHAIRMAN: Order, please! First of all, I

would remind the hon. Minister that it is unparliamentary to talk about the

absence of any Member in the House. I am not sure and would want to take some

advice from the Table as to whether or not that also applies to a Committee of

the House, I would suggest that it does. So I would ask the hon. Minister if he

would be kind enough to withdraw his statement about the absence of the hon. the

House critic.

MR. DECKER: I will withdraw that, Mr. Chairman.

MR. CHAIRMAN: Thank you, Mr. Minister.

MR. DECKER: And I withdraw stating that the

Health critic was not here.

Mr. Chairman, the price of the workers'

compensation, I think, is somewhere in the vicinity of $18 million for the whole

Province. The recent increases in workers' compensation cost somewhere between

$9 million and $10 million, just for the increase. So you are absolutely right.

It is a tremendous amount of money which is being paid out.

MR. CHAIRMAN: Just as a point, the question

from the Member for Carbonear and the response from the Minister took three

minutes and thirty seconds.

Mr. Gover.

MS. VERGE: Mr. Chairperson, why would he not?

He is a Liberal Member who is trying to make the Minister look good.

MR. CHAIRMAN: I want to remind the hon. Member

for Humber East that each Member of this Committee is entitled to their fair

share of time. I am sure that the Committee would agree to that.

MR. HARRIS: Did you count all the political

bantering and bull in all of that three minutes and thirty seconds?

MR. REID: You took up a lot of the time -

MR. HARRIS: Was that all counted in the

Minister's spurious remarks about other Members, and things like that, was that

all counted in the three minutes and thirty seconds?

MR. CHAIRMAN: Yes, it was.

MR. HARRIS: Okay.

MR. CHAIRMAN: Mr. Gover.

MR. GOVER: Thank you, Mr. Chairman.

Mr. Chairman, just before we proceed, I must say -

MR. HARRIS: Do not say it please.

MS. VERGE: Resist the temptation.

MR. GOVER: - it is unparliamentary to impute

motives to any particular Member of the House. And the Member for Humber East

imputed a motive that the Government Members on this Committee are only here to

make the Minister look good. Now I can state quite categorically that I am not

here to make the Minister look good, nor am I here to make the Minister look

bad. I am here to get some answers to some questions, none of which have been

given to me by the Minister or his staff or the Premier or any Member of the

Cabinet. I am here to ask questions that I consider relevant to my particular

district and the health care in the Province. So, you know, I resent the fact

that motives are being imputed to me here tonight. I am just a private Member of

the House of Assembly. I am not bound by Cabinet solidarity. I do not even

necessarily have to endorse the course of action taken by the Government so I

resent the implication made by the Member for Humber East with respect to making

the Minister look good, look bad, look indifferent. We do not care how he looks.

That is up to the Minister, not up to me.

SOME HON. MEMBERS: Oh, oh!

MR. GOVER: And -

MR. CHAIRMAN: I want to make a quick comment. I

totally agree with the hon. Member. I would ask the Vice-Chairperson for the

sake of expediency to get the deed done. These kind of comments from all hon.

Committee Members are unnecessary and should be contained so that we can get on

about our business.

MR. GOVER: Thank you, Mr. Chairman.

I would like to go back and ask the Minister a

question that I believe I asked him, maybe not at last year's Estimates, but

maybe the Estimates before that. As the Minister is aware there is a tremendous

problem in rural Newfoundland with recruitment and retention of physicians. And

when I last asked the question, the Minister had some plans as to how the

department could improve the recruitment and the retention of physicians in

rural Newfoundland. And I just wonder since that, I cannot remember if it was

last year or the year before, what plans has his Department put in place to

encourage physicians to practice in rural Newfoundland and have the plans that

he has put in place met with any degree of success?

MR. CHAIRMAN: Mr. Minister.

MR. DECKER: Now that is what I call a sensible,

well thought out question.

MR. HARRIS: Obviously, he is a Liberal.

MR. DECKER: It is obvious that the Member has

the concern of the health care of this Province well in hand, and I compliment

him on that. Mr. Chairman -

MR. GOVER: Just before the Minister comments, I

would like to say to the Member for St. John's East that I do have a hospital in

my district and we have tremendous problems recruiting physicians for that

particular hospital. Now if he would like to say to the residents of the

Bonavista Peninsula that they should not be concerned about the answer to this

question, I would like him to say it on the record.

MR. HARRIS: I will say something on the record.

I will say that if the Minister of Health wants to answer your very important

question about the people from Bonavista well he should answer it and not make

partisan, bull comments.

MR. CHAIRMAN: Order, please! Order, please!

Mr. Minister.

MR. DECKER: Mr. Chairman. In Bonavista, as the

hon. Member just pointed out, not only is there a problem with recruiting

doctors but there is a problem of retaining doctors. Retention in the Province

is also a major problem which we have. The problem is going to get worse because

now the residency rate for the intern has been changed and now they have to

intern for two years where it used to be one. Traditionally we could always at

least depend on foreign doctors coming in. It is getting more and more difficult

to get foreign doctors through immigration now, and as I say the two year

internship is going to be a problem.

Over the past year I have been working very closely

with the medical school at Memorial University, and the phrase we use is

`growing our own.' We are trying to put in place a system whereby we grow our

own physicians. The University is graduating about fifty doctors a year, forty

of which are usually Newfoundlanders. Many of them are setting up practice on

the Avalon Peninsula where we have too many general practitioners. That makes

the problem even worse, especially when we are in a capping situation which we

are now. We only have x number of dollars which must be shared out among

everybody.

But I am not in a position to say precisely what

our plan is because it has not been totally approved by Government and it has

not been totally approved by the University. But I could tell the hon. Member

that we are getting very close to coming with a programme which will hopefully

address the problem in getting doctors for rural Newfoundland. It is a very

serious problem and for anyone who represents a rural district of this Province

it is one of the major problems we have in the health care system and we are

working to address it.

MR. CHAIRMAN: Yes. Thank you, Mr. Minister.

Mr. Gover.

MR. GOVER: Yes. Just to follow up along that

line of questioning. Bonavista Hospital like many rural hospitals is concerned

with a primary level of care which only requires a GP. I should not say "only"

but requires a GP as opposed to a specialist. And there is certainly a high

level of turnover at least in my area with respect to these particular

physicians. But the Bonavista peninsula is also served by a regional hospital.

My friend here represents the district of Trinity North, the G B Cross Memorial

Hospital in Clarenville.

And according to the Minister's three-tiered

structure for health care, specialist services are supposed to be available at

the regional hospital, such as the regional hospital in Clarenville. And I just

wonder - I am not so familiar with the hospital in Clarenville as I am with my

own hospital - is retention and recruitment of specialists for the regional

hospitals a significant problem, or a problem to the extent that retention and

recruitment for GPs in the smaller rural hospitals is?

MR. DECKER: Yes, it is a similar problem. We

have a similar problem. But now I am going to ask Dr. Williams to explain just

what we are doing with our specialists because we have not been doing too bad in

the last year and a half. Some of the hospitals are giving bursaries to people

to go outside and train for certain specialties so we have been bringing them

back. So I am going to ask Dr. Williams if he would be kind enough to explain

what we are doing about the specialists. But a similar problem exists

(Inaudible).

DR. WILLIAMS: Thanks very much, I am Bob

Williams.

Back in 1980, the Department of Health with the

corporation of the Newfoundland Medical Association and the Medical School, set

up a programme of bursaries in essence for physicians who were undergoing

specialty training.

This bursary was set up in the form of an interest

free loan, which the resident who was in training in a specialty area would get

in his or her final two years of residency training, in return for a return

service commitment to the Province.

This programme has been up and running for

approximately those eight to nine years and it is under the direction of a

tripartite committee representatives from the Department and the medical school

and the Medical Association; I can get you the detailed breakdown of the number

of physicians who have been approved for those bursaries, where the physicians

have practised in the Province and the current retention rate, but the results

of that programme are fairly significant and in fact, over the past ten years

there has been a significant increase in the medical and human resources

available in the Province.

I think in Clarenville for instance, if you are

talking about Clarenville, there is one of the specialist there who is from the

Province who was a recipient of one of those bursaries, and Clarenville is one

district which comes to my mind there maybe more, but I am just trying to think

that these physicians who are specialists are scattered throughout the Province,

some at the Regional Hospitals, so there has been I guess, a greater success

rate over the years in recruiting specialists for our district and rural

hospital networks, but it is an ongoing problem.

It is a problem basically that is similar all

across Canada. If you look at provinces like Manitoba and Saskatchewan which are

very rural, they have similar problems with distribution of physicians in the

Province, both GPs and specialists, and there has been a variety of attacks on

the problem, but the programme that was put in place ten years ago has worked

and I can get you the specifics and the number of physicians who have gone

through and where they are practising and in what they have specialized.

But I have some figures, if people want to hear

them, they are just figures that our medical manpower division has prepared for

the Department as we are monitoring it on a regular basis; we have our own

medical manpower data bank, but perhaps the best data bank for medical

physicians in the Province is operated by the Medical Association, because they

have a compulsory membership and so all physicians who practice in the Province

must be members of the Medical Association.

Back in 1983, there were 695 physicians in the

Province according to the information we had, and currently, the last data we

have, we have not updated it for this year; January 31, 1990, I need to get the

1991 figures but there were 867 physicians in the Province from 1983 to 1990.

We are trying to look at about a 50/50 balance

between specialists and general practitioners, that would be a reasonable rate.

Although one can say that it is a difficult problem with getting physicians for

rural parts of the Province and rural parts of North America in general, a study

done some years ago in the Canadian Medical Journal, published by the Canadian

Medical Association indicated that we, in this Province, had done fairly well

compared to other provinces.

It is a constant struggle. We have depended on

physicians who are what we call foreign trained physicians, physicians from

Ireland, England, India, South Africa, Australia and New Zealand have been the

prime stock, and many of the physicians who are now in practice in the Province,

have come over from other countries and have given valuable service in the

Province. Some of them still remain in rural Newfoundland, others have gone away

and done specialty work and have come back and are (Inaudible) staff in the

Province.

With changing, I guess, licensure status because of

a two year internship that apparently we are heading for in Canada for medical

school graduates, that may have some implications for foreign medical graduates

who wish to come to Canada and wish to come to Newfoundland with respect to

their long term licensure. Right now they have to meet the requirements of the

Newfoundland Medical Board. And because requirements from country to country are

different, especially with respect to internship - and for instance in Canada

you have to do a rotating internship with a number of months psychiatry, a

number of months paediatrics and obstetrics and some of the other disciplines -

in some of these other countries they might do just six months in medicine or

six months surgery, and different mixtures. So we have to do some upgrading.

With the two year programme it may have some

implications for our ability to recruit physicians from other countries. So we

are having to in Canada take a close look. And as the Minister said we have had

a lot of ongoing dialogue over the past year with the medical school. There was

a rural health (Inaudible), I think, Minister, about a year ago which you spoke

at and there was some good information flowing from that. Just yesterday we had

a meeting with the representative of the medical students' society at the

medical school, and we are now looking at how we might address, on the long term

basis, the problems of physician recruitment and retention in cooperation with

the medical school, with graduates from Memorial University.

MR. CHAIRMAN: Thank you, Dr. Williams.

MR. GOVER: Just for clarification. The 695 and

the 867, is that GPs and specialists, total physicians?

DR. WILLIAMS: Yes.

MR. GOVER: Okay.

MR. CHAIRMAN: Thank you.

Ms. Verge.

MS. VERGE: Thank you. I notice that the

Department of Health has a Policy and Planning division or branch. It is

provided for in the estimates on page 198 under head 1.3.01. I would like the

Minister to tell the Committee what issues or ideas the Policy and Planning

branch of the Department are now examining. What are the priority areas for

reform or significant change of health care that this part of the Department is

examining? And related to that, what does the Minister see as the major health

problems in our province, the major causes of disease and preventable death?

And related to that again, the Department of Health

has a relatively small and insignificant effort which I think unfortunately in

the estimates on page 203 is labelled Health Prevention and Promotion. It seems

to me Government uses the word "health" to mean "illness." At any rate, under

Health Prevention and Promotion there are listed education, promotion and

nutrition, on which the Minister is proposing to spend $600,000 out of over $800

million estimated to be spent by his entire Department. I am wondering if there

is a hope for preventing illness? Hopefully not preventing health, all hinges on

a paltry allotment of $600,000 out of an $800 million budget?

MR. DECKER: Yes, I am not going to say that one

disease is worse than another disease. I would not want to get into that. The

question about -

MS. VERGE: But perhaps the Minister could

comment on -

MR. DECKER: Mr. Chairman, can I have

protection, I am being abused?

MR. CHAIRMAN: Yes, I would ask the hon. Member

to at least give the Minister a sentence and a half or two sentences.

MR. DECKER: At least a sentence and a half.

MS. VERGE: Mr. Chairperson, I was trying to be

helpful -

MR. DECKER: (Inaudible), she is being a pest.

MR. CHAIRMAN: Excuse me now. There is great

difficulty in expecting when you pose a question in a certain form for the

Minister not to respond in the same form. So I would ask you to give the

Minister a chance without interference, please. Thank you.

Mr. Minister.

MR. DECKER: Mr. Chairman, I am not going to

dare to suggest which diseases are major or worse or better than other diseases.

When a person has a particular disease, whatever that is, it is a serious

business, so I do not think that is in the realm of my expertise to discuss on -

MS. VERGE: On a point of order, Mr.

Chairperson. I asked the Minister a very important, but straightforward

question: What does the Minister see as the major health problems in this

Province?

MR. CHAIRMAN: Well the Chair heard the word

`disease', I was as startled as probably the Minister was. So if there is a

misinterpretation of the question I will give the Member a chance to clarify the

question.

MS. VERGE: Well that is what I was trying to

do. I asked the Minister to tell the Committee what he considers to be the major

health problems in this Province today? Now I assume the answer to that question

would involve some discussion of diseases, prevalence of diseases, the causes of

diseases. But quite simply what does the Minister see as the major health

problems in the Province?

MR. CHAIRMAN: Thank you.

MR. DECKER: Mr. Chairman, this is a difficult

question to answer, because she is asking for my opinion. Now the facts are

there are certain cardiac diseases which are the major numbers in the Province

and all this sort of thing. You know, we can get these statistics. But whether

or not I consider a heart attack as being a worse disease than someone who has

cancer or this sort of thing, I do not think my opinion is the issue here. But

we can provide statistics to show where the demand on the system is increasing

and all this sort of thing, we can certainly do that.

The Health Policy and Planning, Mr. White is

responsible for that Division. I am going to have him explain to hon. Members

just what it is that Division does. And the Health Prevention and Promotion. Now

Dr. Hogan was here last night, but he is not here tonight, maybe Dr. Williams

would be the best person to ask. Jerry White will take first the Health Policy

and Planning, and Dr. Williams will talk about the Health Prevention and

Promotion.

MR. CHAIRMAN: Thank you, Mr. Minister. Dr.

Williams.

DR. WILLIAMS: Probably I will attempt to deal

with both those issues. The area as referred to in the Estimates under Health

Policy and Planning, I will read out some of the key functions in that area.

This is sort of a support area to the Department of Health in the Province. It

is a resource, I guess, to most branches of the Department of Health. One key

area is the Research and Statistics Division. And that Division is set up to

provide and maintain reliable and current health statistical data, morbidity

data, mortality data, hospital utilization data, demographic and other related

socioeconomic data that any division of the Department of Health needs in order

to operate.

So it is utilized by the Department of Health in

doing planning, it is utilized by our institutions branch in looking at some of

the data in utilization in the area of hospitals and nursing homes, this type of

thing. It is utilized by health care professionals in delivering and

administering planning activities and evaluation of their programmes in the

Province and gives an overview of the health status in the Province in general.

One of the key efforts in that division now is

directed towards a national thrust in Canada, along with Health and Welfare

Canada, Statistics Canada and other provinces of Canada plus a number of

non-government organizations throughout the country, in trying to devise a

reliable, I guess, system of health data for Canada.

There is a lack of co-ordination on the national

level with health information in order to plan programmes at the national level

and ultimately for provinces to compare their information, how they are doing in

the health care area with other provinces and utilizing those data to plan, as

well as the ongoing function of that division which is administered by Cathy

Ryan, there is also this national thrust on which Cathy is spending a lot of

time. Now it is an important issue for Canada. We really do not have a good

system of national health data for the country, so that is one of the key areas

that we are talking about in that whole area, as a resource.

The other area is the Health and Human Resource

planning area and we talked about that before in the issue of Physician Human

Resources Planning. That division establishes policies and programmes with

regard to supply, demand, production distribution, utilization, productivity and

Government legislation of all health manpower groups in Newfoundland in order to

improve health care effectiveness and efficiency.

Some of the key areas that group is dealing with

now is the Nursing Human Resources Committee, in looking at nurses human

resources, planning for other health care professionals; that division is

involved in the medical manpower planning, involved as well in the

administration of what we call Training of Health Services personnel.

The Department of Health provides bursary

assistance to a wide variety of health care professionals who are in training,

so that division administers health bursaries as well and the final area, and

this will speed things up a little bit, is a systems designed and development

area and that is the basic health information system support to computers and

that within the Department, so that is it. That is the Resource and Planning

area for the total department.

MR. CHAIRMAN: A quick question.

MS. VERGE: Under the heading Policy, what

issues or ideas for significant improvement or reform are the officials of the

Department and the Minister examining now; is any one in the Department standing

back and trying to look at the woods as opposed to fixing sight on the trees, is

anyone examining in a comprehensive way what we are doing here in the western

world, Newfoundland, similar to other parts of North America and western Europe

and considering significant changes or looking at other options?

You know, given the kind of financial pressure that

is on the system now and given the life style related illnesses, given the

incidence of poverty, especially among children, given the poor diets, given the

bad habits of our people, is anyone thinking about a radical reorientation or

even a slight change in focus?

MR. CHAIRMAN: Thank you.

Mr. Minister.

MR. DECKER: I think the Member is confusing

overall Government policy with a particular division within the Department. I

will address part of the question but first I would like for Dr. Williams to

just continue on with - do you have something further to say on that?

DR. WILLIAMS: That is a good question because

we often ask that ourselves in the Department of Health. When you are operating

in the sense of a large department with so many people in the system, 12,000

people, and responsibility for such a large budget, it is difficult sometimes to

step back and take a look at the broader picture. But this is not necessarily

the only area where we are looking at policy. We do have meetings of our senior

executive, we do discuss policy. This is the area where we formulate I guess

major policy papers that we discuss with the Minister and issues. We have a

number of issues from time to time that are ongoing that we look at with other

provinces.

For instance one of the things that has been

mentioned before is the issue of new drugs coming on the scene in Canada and new

health technologies. Some of these drugs are very expensive. They are for

specific illnesses. We have been looking at policies with respect to these type

of issues and looking at health legislation issues. Looking at how roles of

various health professionals are changing and the need to introduce legislation

and this type of thing. So these are the kinds of things that go on there.

One of the areas that we talked about earlier, the

whole issue of health in this Province. One of the key areas that arose out of

the Newfoundland Health Review that was published in 1986 - and I think we had

some discussions here about that before - was the area of the incidence of heart

disease in this Province. It seems to be as you move from west to east in the

country, and that is similar to the situation in the US as well, as you move

from west to east for some reason the incidence of heart disease increases

fairly dramatically and we are no exception to that rule. But there have been

some major changes in heart disease and incidence rates and deaths from heart

disease over the past ten or fifteen years. In fact a 25 per cent decrease.

And one of the major things that arose out of this

area in the public health thrust is a thrust with Health and Welfare Canada. We

have completed the first phase which is a detailed analysis of our population

for risk factors for cardiac disease. And now, based upon the identification -

it was a pilot project done with the provinces of PEI, New Brunswick,

Newfoundland and Health and Welfare Canada - and we took blood samples,

interviewed people throughout the Province, a statistical sample, and now we are

moving forward. We have a major committee in place from all facets to do some

detailed planning and health promotion efforts aimed at decreasing the high

incidence of cardiac disease in the province by attacking the risk factors. And

based upon the survey that we have come upon there are issues of diet, high

blood pressure, and smoking is another issue that we need to tackle.

So that is one area in the area of diseases that we

are looking at that is preventable. There are other preventable diseases. We

could talk about them all night if one wanted to talk about them, but that is

just one example of some of the issues that are ongoing in public health. This

part of the public health budget you are looking at is only a component of our

public health. It is not the total expenditure on public health. Much of the

nutrition counselling, much of the other preventive programmes, do not take

place in the consulting services budget you are looking at but it takes place in

the health unit, so you have to look at the health units budget as well. Because

this is just a planning focus. The actual implementation and the health

promotion takes place at the regional health unit level.

MR. CHAIRMAN: Mr. Minister.

MR. DECKER: Mr. Chairman, I shall move on now.

I think the hon. Member was also referring to the overall Government policy and

Government long-term planning for the health care system.

I am pleased to advise that over the past year we

have indeed done a major review of the health care system in the Province. In my

introductory remarks the first night that we met I spent twenty minutes or so

explaining just where we are going. We did have a major review which lasted

about six to eight weeks, mind you as I said it was accelerated because of the

budgetary situation that we found ourselves in. We have been making a major

restructuring of the health care system and a lot of the things which we have

done in this year of fiscal restraint was simply what we intended to do over the

next five years anyway. I should tell the hon. Member and she will be pleased to

know that much of the programmes and much of the advice we are following came

from the Royal Commission of 1985-86, which we are following as close as we can

because that was indeed professional work, which was not fully implemented for

whatever reason.

The hon. Member will realize, of course, that the

Social Policy Committee, along with other long-range planning, is responsible

for the health policy of Government but I would not confuse that with the Health

Policy and Planning Committee which is a division within the Department and

which is a more technical committee as Dr. Williams has already explained. But

the overall policy is done within the Social Policy Committee and most of their

recommendations are made to the Minister.

MR. CHAIRMAN: Thank you, Mr. Minister.

Mr. Harris.

MR. HARRIS: Thank you, Mr. Chairman.

I am interested in this area of - well it is not

exactly planning, well, I guess it is in some sense - research into health care

delivery. Health care is a very, very expensive system; most of the money goes

to pay salaries of medical professionals. I was very concerned when I learned

the last time we met that the Government had taken the $2.5 million it got from

the C-22 Federal Funds and put it into general revenues when this money was, at

least politically, earmarked for research. Would it not make a great deal of

sense, Mr. Minister, to spend money on research in the area of health care

delivery? I know the Minister will tell us about - and he is rightfully proud of

the ongoing demonstration project in Ferryland with respect to the nurses in

primary health care delivery, but I am not talking about these expensive

demonstration projects. I am talking about a grant of maybe $10,000 or $20,000

to someone in the health care field at the university in the school of nursing

or the school of medicine who might need support to do a research project to

prepare a paper for publication, to do a little travel and look at some other

facilities and provide the kind of background evidence that might be required to

help us develop and promote some alternatives that would be less expensive

perhaps, coordinating efforts. I suppose the ideal would be to have health care

delivered by the persons who are able to do it for, not necessarily the lease

amount of money, but perhaps at lesser cost at that level. Indeed, in modern and

progressive thinking about health care, closer to the community where it may in

fact be more effective in terms of both delivery of the service, and in areas

that would include prevention of the interventionist kind of cost when things go

wrong.

Does the Minister have any regrets about taking

that money and putting it into the pot and not using it for research and

delivery of health care; is the Minister prepared to reconsider that or can he

identify in his budget areas where that is being done?

MR. DECKER: Mr. Chairman, I have to agree

totally with the hon. Member, he made some excellent points.

When we took that research money and put it into

general revenue, it was not an easy decision; it was not something that we did

with any amount of glee, as a matter of fact we had planned to use it for

research dollars exactly along the lines the hon. Member was talking about, but

this year, because of the recession and because of the problems we find

ourselves with, that $2 million dollars went into general revenue - it was a

judgement call.

We had to decide whether we would go with all these

good things that the hon. Member talks about, and no person can doubt the

benefit of these things, or laying off another 100 nurses. So this is what it

boils down to and we chose the lesser of the two evils, neither of which was

desirable, so the lesser we thought was not to lay off the nurses, so it is not

something we did or have any regrets, that is not the issue, I mean my personal

feelings are not the issue here, but in a normal year, without being faced with

these fiscal restraints, we probably would have gone with the research committee

and would have done all the fine things the hon. Member mentioned and they

certainly are valuable.

MR. HARRIS: I do not want to enter into debate

with the Minister, but you know, the Minister always talks about laying off 100

nurses, what is wrong with the poor nurses that they have to be laid off every

time the Minister is making decisions. Surely, that is not the key expense point

in the health care system. But if we are talking about the long term here, what

I was suggesting and I think that the Minister will have to agree is that a

research effort in this area could lead to reductions in expenditure in the long

term and if the Minister is doing planning and is doing all these other things

and studying statistics, then surely he can see his way clear to finding some

money for nursing research or health care delivery research.

I am told by people at the School of Nursing, for

example, that although they have people in graduate level programmes, they have

almost no money to engage in research, that they do not have much access to it

from the National Health Research Council, because it is controlled by another

medical profession, the doctors. They do not have any money for that or they

have very little for it; they do not get their share, they feel, of this type of

money and you know, they may have alternatives or be able to come up with

alternatives that will be helpful. So I just feel that the Minister perhaps is,

by saying that we lay off 100 nurses every time we talk about $1 million or $2

million, that is being a little unfair and if the Minister is serious about

looking at health care alternatives and delivery, perhaps the Minister could

find in his budget somewhere, a fund that could be made available for this type

of research to academics at Memorial University, whether they are in the field

of mental health or nursing or in the medical school itself, but particularly in

the area of the delivery of health care systems.

Is the Minister prepared to consider something like

that?

MR. DECKER: Mr. Chairman, I can only repeat the

first answer as I said earlier, I could say 200 maintenance care workers, I

could say take some ambulances out of service. The thing is, I am in the

position to have to make that judgement call and in my judgement, as good and

valuable as this programme was, we could not have everything, we had to make

some judgment calls, and that is the one I made. The economic program whereby,

perhaps you might find the money somewhere, we cannot very well apply that

particular philosophy to the way we run government, Mr. Chairman, because a

dollar spent is a dollar either taxed or borrowed, it has to come from

somewhere. So perhaps we will find somewhere, is not quite the economic

philosophy that we operate under. We like to have the million dollars before we

allocate it.

MR. CHAIRMAN: Thank you, Mr. Minister.

Mr. Harris.

MR. HARRIS: Along the same lines, Mr. Minister,

we spent a fair degree of money on the Memorial University Faculty of Medicine.

I see an allocation of -

MR. CHAIRMAN: Perhaps you would quote the

subhead number, Mr. Harris.

MR. HARRIS: Yes, I am looking at subhead number

3.1.01 - Memorial University Faculty of Medicine, $17.6 million, overall vote. I

recall when the medical school was being set up and Lord Taylor was here,

brought over by the then Premier to set it up, there was a great deal of

emphasis placed on this notion, I think it was called community medicine. And

this medical school was going to be the forefront of - it was called community

medicine in those days - and I wonder if the Minister can tell us what has been

the results of all this money over the last twenty years in the medical school

in the area of what is called community medicine. I know that they have

developed a speciality in family practice at Memorial which is certainly of

assistance in that area, but my own sense is that the bloom is off the rose on

that and we have not really seen any development of an ocean of community

medicine that we can see in our Province where the Minister is still trying to

find a solution to having medical professionals come to rural areas, we are

still experimenting with models, as Debbie Sue Martin has pointed out. We are

still trying to figure out a certain basic thing. We certainly have not spent

$18 million a year for the last - but we have spent a lot of money for the last

twenty years on this medical school. And I would be interested in the Minister's

comments on this whole notion of community medicine at Memorial and what

happened to it.

MR. DECKER: Mr. Chairman, I am going to ask Dr.

Williams to go over the Community Medicine Program. I do not share the same

opinion. Before doing that I would like to comment on the University Medical

School which is costing #18 million a year now. When the medical school was set

up there was a shortage of doctors per se in this Province, and the shortage was

as much on LeMarchant Road as it was in Nain. Now the University has done

tremendous work over the past number of years to the extent that we now have an

oversupply of GPs, especially in St. John's. We have sufficient GPs in Gander,

Clarenville, in all the major parts of the Province. So the University addressed

the need over the past number of years which met our needs right there, as a

matter of fact they have gone too far in that we have too many GPs in the

immediate St. John's area.

I have been working very closely with the

University over the past year and a half and we are trying to address the

problem which exists in rural Newfoundland. The idea of community medicine: that

particular program is a part of the university which the university is

rightfully very proud of and I do not think the hon. Member is fully cognizant

of what that branch of the university is doing. So I will ask Dr. Williams if

you could enlighten the hon. Member, Mr. Chairman.

MR. CHAIRMAN: Thank you, Mr. Minister. Dr.

Williams.

DR. WILLIAMS: Perhaps just as a bit of

background, of course, any university, especially a medical school has, I guess,

three main goals, or I see three main functions of it, one is obviously the

education of medical students. That is one of the key goals of any medical

school. I also see a research function, any centre of learning has a research

component. And I think the third part and a very important part of the medical

school, and particularly in the medical school in Newfoundland, is the service

component. I think in the service area the Minister has alluded to, we are

seeing more and more specialists coming out of Memorial who have gone away or

stayed here and under special training have located to many of our regional

hospitals throughout the Province as well as St. John's and provided some of the

much needed speciality services in the Province

Without a medical school I think some of the

programmes we are now carrying on in St. John's that are what we call tertiary

level programmes may not be able to be conducted here but people will have to go

outside the Province for that particular service. So the physicians who are on

staff at the medical school do provide a significant service role along with

their teaching and research role. As well, data collected by the medical school

comparing Memorial with other medical schools in Canada has shown that the

retention rate for Newfoundland residents going to Memorial has been on a par or

better as far as retaining those graduates within the Province. Compared to

Dalhousie or other medical schools in other provinces they have had a very good

record. They produced a document some two to three years old now which showed

how well they have done in that area.

In regards to community medicine - and I am going

to just separate family practice from community medicine, although they are

closely allied and I think they should be more closely allied - when it comes to

community medicine they have a number of people in the community medicine area,

the pure community medicine area. And some excellent work has been done at

Memorial. Doctor George Fodor, I think, is one of the leading people on the

issue of high blood pressure, heart disease and research in North America, and

he has had some interesting findings, some of which are being used in the

cardiovascular disease prevention strategy that has now been implemented with

the Federal Government.

As well, Dr. Max House - he has a foot in I think

every department over there - has pioneered I guess the issue of communications,

in terms of providing health services and in health education. And he is

recognized the world over. He was runner-up for a major World Health

Organization prize just recently for his work which is internationally known in

the area of telecommunications and how this can help provide education in the

health care field. Also how it can provide transmittal of cardiograms.

Electroencephalograms are now done in places like Labrador and the test is

transferred by phone and transmitted to the General Hospital where it can be

read the same day by a specialist. So these are things that are all possible. He

is now experimenting, and has actually almost perfected, the mechanism whereby X

rays can be sent by telephone lines. So an X ray can be taken in Melville, be

transmitted to the General Hospital, and could be read by a radiologist on staff

there, just as well as if it is done at the hospital.

So there has been a lot of good work I think come

out of there. What one does not see in the medical school budget, and which is

not reflected in the budget because it is a grant that is given by the

Department of Health, is the money that comes in to the Province. Some of the

staff who are working at Memorial are not supported by this budget per se, but

are supported by grants that come in from the NHRDP in Ottawa, the Medical

Research Council, the Canadian Rheumatism Society, the Canadian Heart Foundation

or this or that type. So there is a significant amount of money out - I thought

at one stage it might have been up to $6 million maximum in a year comes in to

the medical school in research dollars to the Province.

With respect to the family medicine programme,

again they have one of the best family medicine programmes in Canada. I think it

is well recognized. We have very high competitive rates for entering that

programme. A newer thrust now that the medical school is taking is to ensure

that the family practice programme is more directed towards meeting the needs of

rural Newfoundland. They have a new chief of the department now, Dr. Robbins,

for the last few years, and they are redirecting or rearranging themselves more

towards rural Newfoundland than ever before. And they have a significant number

of their graduates in rural Newfoundland. Not necessarily by the way people from

Newfoundland but people from other provinces have come, taken the family

practice programme, and are practising in places such as Twillingate, Melville,

places throughout the Province.

With the two year training programme that is going

to come in I think that will place more emphasis on the family practice

programme and I think more physicians will opt to go that route because one will

need two years to get a licence anyway. Presently a family practice programme is

two years so that will be for many physicians an initial point into a practice.

Already there are plans under way to have the university more involved with

their rural practice sites hoping in that way to encourage physicians who are in

training to go back to those sites when they are finished their training

programme.

As you are probably aware, Memorial Medical School,

Family Practice Department, actually staffs and operates the Dr. Newhook Clinic

in Whitbourne. So, they are providing actually the primary care services in

Whitbourne. I guess one could argue and debate the roles but that is the way I

see it.

MR. CHAIRMAN: Yes, I just might add the clinic

on Shea Heights.

DR. WILLIAMS: Oh, yes.

MR. CHAIRMAN: Thank you, Dr. Williams.

MR. HARRIS: I was mouthing it for him. I

thought he was going to say that too.

MR. CHAIRMAN: Thank you.

The Member for St. John's East questions and

answers have taken up sixteen very quick minutes and the Chair suggests this

might be an appropriate time for a coffee and perhaps tea, juice or whatever you

wish. Coffee is in the Government Common Room.

We will have a ten minute break and I am sure when

we return the Minister and his staff will be here to provide the answers.

Thank you.

Recess

MR. CHAIRMAN: I hope everybody feels a little

better now.

Moving right along, the hon. the Member for Carbonear,

Mr. Reid.

MR. REID: Mr. Chairman, we have been sitting here

now for almost two hours. I am not sure of these times but in my estimation both

the Member for St. John's East and the Member for Humber East have accumulated

something in excess of sixty minutes tonight, and the three Government Members

have approximately sixteen and a half minutes accumulated. We have already had

three full hours previous to tonight. We made the Minister and his staff wait

last night three hours for us, it was two hours tonight and I am finding a lot

of the questions to be very repetitious. A lot of the questions I do not even

understand to be quite honest about it.

I would like to move inclusive 1.1.01 and 4.5.02 of

the Estimates be as presented.

MR. CHAIRMAN: It has been duly moved by the hon.

Member for Carbonear that subheadings 1.1.01 inclusive to 4.5.02 and seconded by

the hon. Member for Trinity North, Mr. Oldford -

The hon. the Member for Humber East.

MS. VERGE: Mr. Chairperson, to the motion. I have

a couple of questions on heads along the way, particularly on head 4.2.01,

Grants to Hospitals. The total estimated is $483 million and I would like the

Minister to give us a breakdown of the grants.

MR. CHAIRMAN: A point of order, the hon. the

Member for Carbonear.

MR. REID: Mr. Chairman, please advise me if I am

wrong here, there has been a motion made and duly seconded and the only debate

can be directly to the motion.

MR. CHAIRMAN: That point of order is correct and I

would ask the hon. Member for Humber East to speak to the motion.

MS. VERGE: To the motion. One of the heads which

the Member for Carbonear moved that the Committee pass is head 4.2.01, Grants to

Hospitals, total estimate $483 million, which is a very significant part of the

proposed spending of the Provincial Government. Now, the Minister has

acknowledged -

MR. CHAIRMAN: Yes, the Chair would agree with

that. But I want to remind the hon. Member she has the right to speak to the

motion and only speak to the motion once. And the motion is that: inclusive,

1.1.01 to 4.5.02 be passed. So if the hon. Member wants to speak to the motion

and speak to the motion once, it does not permit the hon. Member as far as the

Chair is concerned to address a question to the Minister.

MS. VERGE: Of course. Chairperson, there are lots

of precedents for discussion about heads when it is moved that they be passed.

The usual procedure of committees is that we go through the heads one by one and

along the way Members of the Committee ask questions, so we know what we are

voting on. And before we vote on $483 million for hospitals I think the

Committee is entitled to be given a breakdown of that amount, entitled to be

given the proposed allocation among the different hospitals, with a comparison

of the amounts provided to each of the hospitals last year. What is the

percentage change in Department of Health grants to each of the hospitals from

last year?

MR. REID: Point of order, Mr. Chairman.

MR. CHAIRMAN: The hon. Member for Carbonear on a

point of order.

MR. REID: On the motion, Mr. Chairman, the

Minister or none of his officials may debate or vote on the motion, therefore

the motion is as stands and nobody on the other side can debate or discuss or

even speak. And I will not allow it, Mr. Chairman. The motion is inclusive, and

I would like for the Chair to rule on the motion as soon as possible.

MR. CHAIRMAN: Now the Chair certainly appreciates

the advice from the hon. Member for Carbonear and would concur with the hon.

Member that the motion is read, and duly seconded. I would let the hon. Members

for St. John's East and Humber East speak to the motion once and that does not

include asking the Minister and/or his staff a question.

MS. VERGE: Point of order, Chairperson.

MR. CHAIRMAN: The hon. the Member for Humber East

on a point of order.

MS. VERGE: There is nothing in the rules that says

that committee Members may speak only once to a motion. Consistent with the

long-standing practices of estimates committees of this House, as we are dealing

with the heads one by one before voting on them, it is perfectly normal to ask

questions to make sure that we all understand what it is we are voting on. All

you have to do is read Hansard for the last several years to see all kinds of

examples of estimates' committees scrutinizing heads one by one as they are

moved.

MR. CHAIRMAN: Yes, but the Chair would want to say

to the hon. Member that participating in the last three years in estimates that

there were times with different Departments that I observed each subheading

being moved one at a time. Now, it was moved that: shall - the Table would ask -

1.1.01 pass, and of course it is voted. But in this case there has been a motion

duly moved and seconded that all subheadings inclusive be passed. And I think we

are looking at a different precedent entirely.

MS. VERGE: No, Chairperson -

MR. CHAIRMAN: No, the other evening -

MS. VERGE: - there are lots of precedents for

(Inaudible) -

MR. CHAIRMAN: If the hon. Member would let the

Chair finish. I know the hon. Member has great difficulty letting anybody finish

but the Chair would like to finish.

The other evening - I am not sure, I think it was

Environment and Lands - that we passed all subheads inclusive. There was no

breakdown. It was duly moved and seconded. The opportunity was given to all hon.

Members to speak to the motion. And it is my understanding, and I stand to be

corrected by the Table, that each hon. Member is permitted to speak to a motion

once, and the mover should close, and then the question should be called. What I

am going to do is to just recess for as long as it takes me to clarify the

position with the Table.

MR. GOVER: Point of order, Mr. Chairman.

MR. CHAIRMAN: The hon. the Member for Bonavista

South on a point of order.

MR. GOVER: Thank you, Mr. Chairman. I would just

like to bring to your attention the fact that the position the Member for Humber

East is taking now is inconsistent with the position she took last night when a

similar motion was on the floor. Her argument then was: well, we cannot have

this motion because this would effectively close debate on the estimates. Now

she has shifted her argument. She is saying: well, this is not a motion to close

debate, now we can have questions on the subheads. But that certainly was not

her argument last night. Her argument last night was: the motion would

effectively shut down the Committee. And that was also, I believe, supported by

the Member for St. John's East. That the motion was a motion to close down

debate.

MR. HARRIS: We must have been wrong (Inaudible).

MR. GOVER: So that was their position last night.

They are certainly taking a contrary position tonight. So the long-standing

precedent - the Member must be confused or failed to recollect that last night,

because her position is certainly inconsistent. And I would say that the motion

is duly on the floor. And the only question that can now be entertained is

whether the motion is in order or not. And that does not involve questions

relating to the subheads.

Thank you, Mr. Chairman.

MR. CHAIRMAN: Well I do not think the Chair has

any other alternative but to rule that the motion is in order. And to pick up

again after last night, if last night was to be precedent setting, and I want to

thank the Member for Bonavista South, that we were prepared to ask the question

last evening. We did have some points of order associated with the motion. And

subsequently what evolved was that the Member for Bonavista South withdrew the

motion. And the Member for Eagle River - who was here replacing the Member for

Carbonear - seconded the motion, the Chair requested that he also would remove

his second, because the Chair could not of course call the motion out of order

until that happened, and he did. Of course at that point in time we continued on

into further estimates.

So I would again want to remind all hon. Members that

the Chair wants to be sure that the Chair is doing exactly what should be done

in this particular case, and I would want to recess and discuss the motion and

points of order associated with it with the Table and then we will reconvene.

So, for a minute? Thank you.

Recess

MR. CHAIRMAN: Order, please!

Good evening. The Chairman would welcome the Members

for Grand Falls and Humber Valley. Thank you.

The Chair is certainly not surprised to find out that

the Chair was exactly right in its decision, that the motion was duly moved,

duly seconded, and it incorporated and included all subheadings. There is no

room for discussion. So again I would say to both the hon. Member for St. John's

East and the hon. Member for Humber East

that they have -

MS. VERGE: You should welcome (Inaudible).

MR. CHAIRMAN: I just welcomed him.

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: I beg your pardon?

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: No, not now. I am sorry. The Chair

would love to give the Member for Grand Falls an opportunity to speak. However,

we have a motion here and the entitlement is only for the Member for Humber East

and the Member for St. John's East to speak once to that motion and the Chair

would now ask the Member for Humber East to speak to the motion and, of course,

it has to be to the motion.

MS. VERGE: Yes, Chairperson, as the Member for

Bonavista South so helpfully pointed out this motion was made before Committee

Members had finished their examination of the Estimates, to cut us off. To have

a vote on all the heads of the Department Estimates is the same kind of a motion

made prematurely by one of the Liberal Members on the Committee last night.

Now last night the Committee had the good sense to

back off and allow Committee Members to finish our examination of the Estimates.

MR. GOVER: On a point of order, Mr. Chairman.

MR. CHAIRMAN: Order, please! A point of order, the

hon. the Member for Bonavista South.

MR. GOVER: Am I mistaken, did the Chairman just

not rule that the motion was in order? So where the Member draws the conclusion

that the motion was prematurely made last night, when it was made before three

hours expired last night, it was made before three hours tonight expires, is

ludicrous. I mean what is in affect happening is a questioning of the Chairman's

ruling that the motion is in order.

MR. CHAIRMAN: Yes, I would ask the Member for

Humber East to carry on. As she well knows the motion last night was just as in

order as the motion is this evening, it was because the Member for Bonavista

South and the Member for Eagle River of course withdrew that we continued. So it

is not fair for the Member to say that the motion last night was out of order

because it was not out of order.

MS. VERGE: Mr. Chairperson, I just talked about

the motion last night the same as the one here tonight having been made before

Committee Members had finished our questioning of the Estimates of the

Department we were considering. Now last night the Member for Bonavista South,

being a gentleman learned in the law, and very fair and reasonable, withdrew his

motion and allowed the Committee time to finish our questioning. It did not take

much longer. Then when the motion was finally put to pass the heads of the

Department we were examining, even though we differed on whether the Estimates

should be passed, we all had a better feeling about it.

Now here tonight we are looking at the Estimates of

the Department of Health, which is the largest spending Department of the

Government, proposing to spend over $800 million. I had just a couple of more

questions, one in particular on the $483 million proposed expenditure for

hospitals. A simple question. And I would ask the Member for Carbonear, who I

know also is a learned, reasonable fair gentleman who does a good job on

chairing the Social Services Legislation Review Committee -

AN HON. MEMBER: (Inaudible).

MS. VERGE: - to back off and just allow the

Committee a little bit more time to finish our questioning on the Department of

Health before we finally vote on these Estimates.

MR. REID: May I speak to the point of order, Mr.

Chairman?

MR. CHAIRMAN: You certainly may. The hon. the

Member for Carbonear.

MR. REID: Can I assume, Mr. Chairman, -

MR. HARRIS: (Inaudible).

MR. REID: There is a point of order along here

somewhere.

MR. HARRIS: (Inaudible.

MR. CHAIRMAN: Order! Order!

MR. HARRIS: On a point of order, Mr. Chairman.

This gentleman moved a motion, he is now speaking presumably to the motion.

MR. CHAIRMAN: No, to the point of order.

MR. HARRIS: No, I did not realize there was a

point of order. Is there a point of order?

MR. CHAIRMAN: The hon. Member is entirely correct

and I want to remind the Member for Humber East that the Chair will not tolerate

of course, any repetition just to absorb time; as long as the hon. Member is

speaking to the motion, directly to the motion, then the Chair would be prepared

to give the Member the time to do so.

Before the Chair recognizes the Member for Carbonear,

let it be understood that if it is not a point of order and the Member for

Carbonear is recognized, then that would end debate on the motion and then

rightfully so, the Chair would call the question, so the only Member for St.

John's East is right. I would ask the Member for Humber East, if she will be

kind enough to finish speaking to the motion.

MS. VERGE: Chairperson, I think I had finished,

for the time being any way, speaking to the motion, but I was intending to raise

a point of order, making a suggestion to the Member for Carbonear that he follow

the very humane and thoughtful example of his colleague from Bonavista South in

withdrawing his motion and allowing the Committee just a few more minutes to

finish our questioning on the Health Estimates, especially on such significant

heads as Grants to Hospitals, $483 million, we have not probed that yet-

MR. CHAIRMAN: No, no. I am sorry, the Chair cannot

let the hon. Member move off into figures; I mean we have already discussed the

motion and the Chair is not going to permit any Member to discuss anything in

the Estimates; we are now speaking to the motion and I think the Chair has given

the hon. Member for Humber East sufficient time to speak to the motion and I

would now recognize the Member for St. John's East, before I call the question.

MR. HARRIS: Thank you, Mr. Chairman. I want to

speak to the motion and I also want to address some of the points that the mover

of the motion raised in moving and speaking to the motion.

I want to say that this being the end of our Estimates

Committee, I find this process intolerable, unconscionable, insulting to the

intelligence of the public; if this were televised I think the public of

Newfoundland would be shocked to see how elected politicians get on.

MR. REID: Get all of this, catch all of this

because this is his last chance tonight (inaudible).

MR. HARRIS: I would like the hon. Member for

Carbonear who said -

MR. CHAIRMAN: Order, please!

MR. HARRIS: - we debated this for three hours, we

talked about it for three hours before and we have been here for two hours

tonight, well, we are spending, the Minister is proposing to spend $837 million

and I have worked that out at $166 million an hour that we are dealing with here

and I think that the public of this Province is entitled to have the Members

that they have elected, question the Minister and officials on areas of policy,

on areas of expenditure, on areas of alternatives and to do that in the most

expeditious way and as lengthily as it needs.

Now the Member for Carbonear suggested that it was

becoming highly repetitious, I did not hear any single question being asked

twice, in fact, I have to commend this Minister as compared to some of the other

Ministers, who questions were forced to be asked five, six, seven and eight

times because the other Ministers were purposely misunderstanding and

misinterpreting the questions.

At least this Minister was dealing with the questions

one at a time and not trying to make, except the occasional political comment,

make things more confusing than they need be. But I think that the process that

we are talking about here and the behaviour of Members, and I have to say that I

have not always been totally toeing the line myself because the nature of the

process does not allow you to do that, but I must say that I find this process

and the whole approach to it, insulting to my intelligence and the intelligence

of the public and to the Ministers and everybody involved. It seems to me that

the approach seems to be to get these things over with the least amount of

questions being asked, with the least amount of controversy, with the least

amount of questions, and to come in and suggest let us get this over with and

get out of here because there is a hockey game on or because it was two hours

late when we started or whatever, these are not very good reasons at all for us

to shut down these estimates committees.

There are lots of questions that I would like to ask

about the health care systems that are there. One question that the Member for

Carbonear brought up was the $18 million spent on workers' compensation. I think

that is a very large amount of money but the important there is not how much

money we are spending, and it is a very serious thing, but the problem that that

indicates for the working conditions that the people who are working in the

hospitals endure so that they end up making claims against Workers'

Compensation.

AN HON. MEMBER: To the motion.

MR. HARRIS: This is all to the motion.

MR. CHAIRMAN: Order, please!

I think the hon. Member for St. John's East has had

ample opportunity to speak to the motion. Actually, the hon. Member is drifting

from the motion and is digressing. He has already made his point about the

unfairness and so forth and so on and I think done so very well. However, he

must understand that the Chair has no alternative but to respond to the motion

and I think I have given the hon. Member -

MS. VERGE: A point of order, Chairperson.

MR. HARRIS: Is there a time limit on this? Is

there two minutes, three minutes or four minutes?

MS. VERGE: The Member for St. John's East was

making a very good commentary on the whole process of examining the estimates.

MR. CHAIRMAN: Order, please!

The Chair heard the hon. Member repeat twice and in

one instance the third time the irresponsibility of this process to the public.

I want to remind the hon. Member for St. John's East that if he has something

new to add to the motion then the Chair will entertain that. The minute that the

Member starts to become repetitious then the Chair must recognize the fact that

we have to question the motion.

The Member for St. John's East.

MR. HARRIS: The Chair interrupted my new comments

on the issue of working conditions in our hospitals and nursing homes and seems

to want to exercise some editorial control over my intervention on this most

important motion which causes the expenditure of $837 million being recommended

through our House.

Among the questions I wanted to ask was this question

about working conditions in our hospitals and nursing homes and what is being

done to ensure that we do not have these high expenditures for employees in the

Workers' Compensation system as a result of suffering work related injuries

because of, either the nature of the work or the type of supervision or the

expectations that are being placed on people. There are lots of questions but I

do not think it is appropriate to use this speech to try and raise all the

questions that I would want to, but I wanted to give that as one of the things I

wanted to get into and there are lots of other areas.

I think it is inappropriate that we be shutting down

this debate right now. I think the process seems to be designed to prevent

rather than elucidate issues or prevent them from being explored. I am not very

happy with that but it seems quite clear that the Chair is quite intent on

having this meeting shut down. It is only 11:15 p.m. there is lots of time.

MR. CHAIRMAN: I want to tell the hon. Member that

the Chair is not intent on having this meeting shut down. The Chair has a

responsibility to control the meeting and the Chair has discussed with the

Table, whether or not the motion, as moved by the Member for Carbonear and duly

seconded by the Member for Trinity North, has been in order.

The Chair was advised that it certainly was in order.

I am sure the hon. Member for St. John's East understands the Chair's

responsibility, and the Chair has no other option but only to give hon. Members

an opportunity to speak to the motion and then to ask the question. The

suggestion from the hon. Member for St. John's East, that the Chair is trying to

rush this, the Chair has absolutely nothing to do with the time frame allocated

to this evening's meeting.

MR. HARRIS: I am concerned; to the motion itself

and the fact that the motion is in order of course, has no bearing and I am not

suggesting that the motion is not in order; but the fact that the motion is in

order has no bearing on whether or not it is appropriate to be brought at a

particular time and I certainly can speak to that and I have been speaking to

that. I apologise to the Chair. I did not intend to say that the Chair was

trying to shut down the meeting and so I take that back, because I think the

Chair is dealing with the motion that is before it.

But I do think that we have not been given adequate

time to consider these Estimates. Like the Member for Humber East, I do not

think that we would necessarily have gone beyond the midnight hour, which I am

sure the Chair would be concerned about, but we have spent fifteen minutes

debating the fact that we have been shut down a little early-

MR. CHAIRMAN: The Member for Bonavista South on a

point of order.

MR. HARRIS: -and I am not very happy with that and

those are my remarks and I tend to vote against this motion, Mr. Chairman.

MR. CHAIRMAN: Thank you. The Member for Bonavista

South speaking to the motion.

MR. REID: What are we going to do here? Why do I

not withdraw my motion?.... Mr. Chairman, this is terrible.

AN HON. MEMBER: Why don't you go home.

MR. REID: At ten minutes to eleven I made that

motion, it is going for twenty minutes after now-

MR. CHAIRMAN: I want to remind the hon. Member for

Carbonear-

MR. REID: Mr. Chairman, are we going to be here

until twelve o'clock?

AN HON. MEMBER: (Inaudible).

MR. CHAIRMAN: Order, please!

I want to remind the Member for Carbonear, that each

Member on the Committee is entitled to speak to the motion.

MR. REID: For how long, Mr. Chairman?

MR. CHAIRMAN: As long as the question is not

called, then the Chair would give the hon. Member for Bonavista South

(inaudible).

MR. REID: Go ahead; then I will want to say

something on the motion too, then.

MR. CHAIRMAN: Well you will close it.

The hon. the Member for Bonavista South.

MR. GOVER: Thank you, Mr. Chairman.

Mr. Chairman, with respect to the motion, you have

already ruled that the motion is in order and I just want to, certainly with

respect to the motion and the allegations which are made and the concerns which

have been raised about the insufficient time to examine the Estimates of this

particular Department, that pursuant to Standing Order 120: All questions

relating to this particular Department at twelve o'clock tonight, which is in

forty-two minutes time, will have to be moved in any event, so the maximum

amount of debate left and questioning time left for these Estimates, whether the

motion is moved or not, under whatever circumstances one can imagine, is

forty-two minutes.

Now, the Member for St. John's East says that he finds

the process ludicrous and he would not want to see it televised; well he is

certainly entitled to his opinion, but I-

AN HON. MEMBER: Want to see it televised?

MR. GOVER: I do not want to see it televised.

MR. CHAIRMAN: Order, please!

MR. GOVER: I would advise the hon. Member that I

was on a committee that recommended televising the proceedings of this

particular House, so my position is fairly clear on the matter, and I would

remind the hon. Member that although he may find the proceedings useless, I am

certain the Member for Humber East cannot say the same thing, because she has

asked a great many questions and received answers, maybe not satisfactory, but

answers all the same on a great variety of subjects from acute care beds, to

nursing homes, to prevention, to AIDs, what have you. I myself have asked

questions on EPF, the spectrum of care in the Province, the recruitment and

retention of rural doctors, and I for one do not find the process to be useless

or ludicrous or in any way demeaning to the Minister or to the public. As the

hon. Member says if television was here perhaps the proceedings would be

conducted differently. But to say they are ludicrous, I mean if the Member wants

to maintain the position that the proceedings are ludicrous what is he even

doing here? His presence here is a negation of that particular argument.

But the point I want to make is that in any event

there is only forty minutes left. We have had three hours of debate. These

gentlemen were on call for three hours last night. The Department of Education,

which has a similar expenditure to the Department of Health, was moved in less

time than this particular Department, so the quantity of money involved has

nothing to do with the issues and certainly the Department of Education is as

controversial as the Department of Health. I find it surprising that Members

would now chose at this late hour to start asking questions about the $483

million in expenditures. You know - what were they doing for the five hours the

Committee was sitting before this?

So my point is that the debate is going to expire in

forty minutes anyway, I certainly feel that I have exhausted the questions I

wanted to ask and I am certain that the Government Members have also. We have

restrained ourselves to allow the Opposition Members to utilize the time of the

Committee. And as my colleague for Carbonear has pointed out, tonight the

Opposition Members on the Committee have had sixty-four minutes to sixteen and a

half minutes for the Government Members, which is a ratio of six to one, and

while we may be on the Government side we are entitled to equal time on the

Committee, and it is going to expire in forty minutes anyway, the motion is in

order and I would certainly endorse the motion.

MR. CHAIRMAN: Thank you.

MS. VERGE: Mr. Chairperson, I would just like to

say that in the time that we have wasted on procedural wrangling about when to

vote -

MR. CHAIRMAN: Order, please! Order, please!

MS. VERGE: - I could have finished the questioning

about the Health Estimates -

MR. CHAIRMAN: Order, please! Order! The hon.

Member for Humber East had her opportunity to speak to the motion. I would now

ask the hon. Member for Carbonear to close debate on the motion.

MR. REID: No question, Mr. Chairman.

MS. VERGE: (Inaudible).

MR. CHAIRMAN: The motion is that Subhead 1.1.01

inclusive to 4.5.02, as moved by the Member for Carbonear, seconded by the

Member for Trinity North, be passed.

On motion, subheads 1.1.01 through to 4.5.02, carried.

On motion, Department of Health, total heads, carried.

The Chair will now entertain a motion to adjourn.

On motion, the meeting now stands adjourned.

Document details

Collection	Newfoundland and Labrador — Committees
Citation	1991-05-15
Type	committee
Volume / chapter	committees_standingcommittees_socialservices_ga41session3_1991-05-15_ssc-hea_.htm
Language	en
Format	html
Source	PROVINCIAL
Identifier	0b229c3551bfc3e21eb7af995d4f6a8cacb62e32

Source file is stored in the law ingest library (html).