Manitoba Hansard — Sitting 74 (35th Legislature, 2nd Session)

35-2-74

Manitoba — Debates (Hansard)

MG-8048 Rf e- ;;..BH9J Second Session - Thirty-Fifth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 40 Elizabeth II Published under the authority of The Honourable Denis C. Rocan Speaker VOL . XL No. 74· 1 :30 p.m., THUR SDAY, JUNE 27, 19 91 Printed by the Office of the Queens Printer, Province of Manitoba ISSN 0542-5492

MANITOBA LEGI SLATIVE ASSEMBL Y Thirty-Fifth Legislature LIB - Liberal; ND - New Democrat; PC - Progressive Conservative NAME ALCOCK, Reg ASHTON, Steve BARRETT, Becky CARR, James CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOMIAK, Dave CONNERY, Edward CUMMINGS, Glen, Hon. DACQUAY, Louise DERKACH, Leonard, Hon. DEWAR, Gregory DOER, Gary DOWNEY, James, Hon. DRIEDGER, Albert, Hon. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim, Hon. EVANS, Clif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY, Neil GILLESHAMMER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKES, George LAMOUREUX, Kevin LATHLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS, Clayton, Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MclNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold, Hon. ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROGAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STORIE, Jerry SVEINSON, Ben VODREY, Rosemary WASYL YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITUENCY Osborne Thompson Welli ngton Crescentwood River Heights Radisson The Maples Kildonan Portage la Prairie Ste.

Rose Seine River Roblin-Russell Selkirk Concordia Arthur-Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas lnk ster The Pas St. Norbert Elm wood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Flon La Verendrye Fort Garry St. Johns Swan River PARTY.

LIB ND ND LIB LIB ND LIB ND PC PC PC PC ND ND PC PC PC LIB PC PC ND ND PC PC ND LIB PC ND PC ND LIB ND PC ND PC ND PC PC PC PC PC PC PC ND PC ND PC PC PC PC ND PC ND PC PC ND ND

3952 LEG ISLATIVE ASSEMBLY OF MANITOBA Thursday, June 27, 1991 The House met at 1 :30 p.m. PRAYERS ROUTINE PROCEEDINGS PRESENTING REPORTS BY STANDING AND SPECIAL COMMITTEES Mr. Jack Reimer (Chairman of the Committee on Law Amendments): Mr. Speaker, I beg to present the First Report on the Committee on Law Amendments. Mr. Clerk (Wllllam Remnant): Your Standing Committee on Law Amendme nts presents the following as its First Report: Your committee met on Tuesday, June 25, at 8 p.m. in Room 254 of the legisla tive Assembly to consider bills referred. Your committee heard representation on bills as follows: Bill 5-The Mental Health Amendment Act; Loi modifiant la

Loi sur la sante mentale Mr. Anthony Dalmyn - Canadian Mental Health Association Mr. Bill Ashdown -The Society for Depression & Manic Depression of Manitoba Mr. Gordon Mackintosh - Manitoba Association for Rights and Liberties Ms. Chrys Rak - Private Citizen Mr. Sid Frankel - Manitoba Association of Social Workers Dr. John Walker - The Psychological Association of Manitoba Ms. Catherine Medernach - Sun Network Dr. Caroline Sehon - Citizens for Quality Mental Health Care Ms. Annette Osted - Registered Psychiatric Nurses Association of Manitoba Mr.

Vern Mccomas - Manitoba Schizophrenic Society Your committee has considered: Bill 3-The Coat of Arms, Emblems and the Manitoba Tartan Act; Loi modifiant la

Loi sur les armoiries, les emblemes et la tartan du Manitoba; Bill 43-The Workers Compensation Amendment Act (2); Loi no 2 modifiant la

Loi sur les accidents du travail; and has agreed to report the same without amendment. Your committee has also considered: Bill 5-The Mental Health Amendment Act; Loi modifiant la

Loi sur la sante mentale; and has agreed to report the same with the following amendments: MOTION: THAT

section 1 0 of the Bill be struck out and the following substituted: Subsection 17(2) repealed and substituted 10 Subsection 17(2) is repealed and the following is substituted: Psychiatric assessment 17(2) A psychiatrist shall make an assessment within 72 hours after the filing of an application under subsection (1 ), and ifthe prerequisites for admission as an involuntary patient as set out in subsection 16(1 .1) are met, the psychiatrist shall complete a certificate of involuntary admission.

Exception 17(3) Despite subsection (2), if a patient has been a patient of the psychiatric facility for more than 72 hours when the application is filed, the assessment under subsection (2) shall be made within 24 hours after the filing of the application. MOTION: THAT the proposed subsection 24(1 ), as set out in

section 17 of the Bill, be amended by adding "consent to or" after "has the right to". MOTION: THAT the proposed subsection 26.4(6), as set out in

section 24 of the Bill, be amended by striking out clauses (

c) and (

d) and substituting the following:

3953 LEGISLATIVE ASSEMBLY OF MAN ITOBA June 27, 19 91 (

c) is a psychiatrist or physician who is treating or has treated that person; (

d) is an officer, employee or staff member of the psychiatric facility in which that person is being treated; or (

e) is a lawyer who is acting for or has acted for that person. MOTION: THAT

section 28 of the Bill be struck out and the following substituted: Subsection 26.6(1.1) added 28 The following is added after subsection 26.6(1 ): When hearing must begin 26.6(1.1) A hearing in respect of an application made by or on behalf of a patient shall begin as soon as reasonably possible after the applic ation is received by the review board under subsection 26.5(1 ), and in any case within the period of time prescribed by regulation. MOTION: THAT

section 31 of the Bill be amended by striking out the proposed clause 26.9(3)0) and substituting the following: 0) the standards committee of the psychiatric facility, including a medical staff committee established for the purpose of studying or evaluating medical practice in a psychiatric facility; or MOTION: THAT the proposed clause 26.9(3.1 )(a), as set out in

section 32 of the Bill, be amended by adding, ", including its legal advisors and assistants," after "who receives it". MOTION: THAT the proposed subclause 26.9(3.1 )(b)(iii), as set out in

section 32 of the Bill, be amended by striking out "sealed in a separate file and stored in a safe place" and substituting "returned forthwith to the medical officer in charge". MOTION: THAT subsection 26.12(2), as set out in

section 41 of the Bill, be amended by striking out "s ubsection 80(1 .1 )" and substituting "subsection 80(1 .2)". MOTION: THAT the proposed subsections 80(1 .2), (1 .3) and (1 .4), as set out in

section 45 of the Bill, be struck out and the following substituted: Other powers of Public Trustee 80(1.2) When the Public Trustee is the committee of a person described in clause (1 )(b), (

c) or (d), the Public Trustee may (

a) determine where and with whom the person shall li ve ei ther tem porarily or permanently; (

b) commence, compromise or settle any legal proceeding that does not relate to the estate of the person; and (

c) consent to medical or psychiatric treatment or health care on the person's behalf if (

i) a physician informs the Public Trustee that the person is not mentally competent to make treatment decisions given the criteria set out in subsection 24(3); and (ii) the person is not a patient in a psychiatric facility. When Public Trustee Is nearest relative 80(1.3) For greater certainty, nothing in clause (1 .2)(

c) affects the right of the Public Trustee to make treatment decisions on behalf of a patient under

Part I in circumstances where the Public Trustee is the patient's nearest relative. Limitation on Public Trustee's powers 80(1.4) The Public Trustee shall, (

a) when exercising any power conferred by subsection (1 .2), consult with the person's nearest relative when reasonably possible; and (

b) when exercising any power conferred by clause (1 .2)(c), do so in accordance with the best interests of the person having regard to the principles and the crit eria des cribed in subsections 24.1 (3) and (4). Consent 80(1.5) The Public Trustee may only place a person pursuant to clause (1 .2)(

a) with a person who consents to the placement and the person may on reasonable notice to the Public Trustee withdraw his or her consent and the Public Trustee shall then make a new determination under clause (1 .2)(a). MOTION: THAT the proposed

section 106, as set out in

section 48 of the Bill, be amended by renumbering

June 27, 19 91 LEGISLATIVE ASSEMBLY OF MANITOBA 3954 clauses (h), (

i) and 0) as clauses (i) , (

j) and (

k) and by adding the following as clause (h) : (

h) for the purpose of subsection 26.6(1 .1 ), prescribing the period to time within which a hearing of the review board shall begin; All of which is respectfully submitted. Mr. Reimer: Mr. Speaker, I move, seconded by the honourable member for Fort Garry (Mrs. Vodrey), that the report on the committee be received. Motion agreed to. TABLING OF REPORTS Hon. Leonard Derkach (Minister of Education and Training): I would like to table the report of the Manitoba Task Force on Francophone Schools Governance. Hon.

Harold Neufeld (Minister of Energy and Mines): One of the requirements of the recently tabled Mines Act is to have the Energy and Mines Annual Report filed no later than 90 days after the end of the fiscal year. I am proud to say that the department has lived up to that obligation, and we are now filing our 1990-91 report for Energy and Mines. Hon. Clayton Manness (Minister of Finance: Mr. Speaker, I would like to table a report of amounts paid to members of the Assembly as required by

Section 65(1) and (2) of The Legislative Assembly Act. * (1 335) Introduction of Guests Mr. Speaker: Prior to Oral Questions, may I direct the attention of honourable members to the gallery, where we have with us this afternoon from the Anishinabe Oway-ishi Program 18 students. They are under the direction of Marie Mason and Joan Davis. This program is located in the constituency of the honourable member for Point Douglas (Mr. Hickes). On behalf of all honourable members, I welcome you here this afternoon. ORAL QUESTION PERIOD Chlld and Famlly Services Restructuring Consu ltations Ms.

Becky Barrett (Welllngton): Mr. Speaker, since Monday, in this House, the opposition has been asking the government and particularly the Minister of Family Services to table, if they are able, documentation that shows consultation that has taken place by the government and the Department of Family Services leading up to their virtually overnight announcement about the restructuring of Child and Family Services agencies.

In 1987, the former government received the Reid-Sigur dson Report, which was a six-m onth public process that looked at all aspects of the Child and Family Services agencies and made some excellent recommendations. I would like to state that the Reid-Sigur dson Report said that the increased accessibility of the new system has been responsible for a greatly improved ability to detect abused children.

It also recommends a decentralized system, quote: As it is only through this means that we can ever hope to make an impact on the large number of problems and act to provide services that are of assistance to families. My question to the Minister of Family Services, yet again, is: Can he table or tell this House of any review that has been done by this department that would give the lie to this recommendation on the part of the Reid-Sigurdson Report that decentralization is the way to go to help children in Winnipeg? Hon. Harold Gllleshammer (Minister of Famlly Services): Mr.

Speaker, I have said consistently, what worked in the former system was the decentralization of service. What has worked is left in place. What has not worked was the decentralized administration, and I do not know whether the honourable member wants to acknowledge a difference between the two or not. We have looked at the Reid-Sigurdson Report of 1987 where they referenced the fact that there were problems in the system, that there was tension and unproductive disputes. We have reorganized the system admi nistratively but left the ser vice component in place.

I would quote from a May 15 report in the Winnipeg Sun where the then president of the Manitoba Association of Child and Family Services agencies is quoted as saying: I think some services certainly could be centralized, but we have to keep in mind service delivery should continue to be decentralized. That is exactly what we have done. We have left the de centralized service deliver y in the

3955 LEGISLA TIVE ASSEMBLY OF MANITOBA June 27, 19 91 communities, because that is the part of the system that has worked. She goes on to say in this report that she could see services lik e accounting, the province's adoption, foster parent programs being amalgamated, and these are initiatives that have come forward from the president of the Child and Family Services associations. We intend to look at those recommen dations and to have a more centralized administration and at the same time to leave that decentralized service in the community. Ms. Barrett: Mr.

Spea ker, the qu estion of central ization of things such as adoption and accounting is not the same thing as taking 90 board members, who were elected by the community, and making them into nine board members who are appointed by the government. It is not the same thing at all. To quote from Reid-Sigurdson on page 276, where they say: A dupl ication of administration has not been observed to be a problem within the Child and Family Services agencies.

It also states in Reid-Sigur dson that there was not a single person, who they interviewed in their six months, who was in favour of any return to a recentralized system. I ask the Minister of Family Services if he can table information from individuals or groups that they have talked to that state that recentralization will provide better services to the children of Winnipeg and Manitoba. * (1 340) Mr. Gllleshammer: The member asks about community involvement.

We have left in place the creation of a system of community committees whereby the members of the community who are interes ted and involved with the child welfare system will have a voice to come forward to the new agency to make their feelings known. We have also put in place a situation where the community can elect board members to sit on this new executive. The member goes on to ask about reports. We have talked about the Reid-Sigurdson Report. We talked the other day about an inquest report that was made public and was referenced by a spokesperson for the city police and the Winnipeg Sun yesterday.

I have mentioned two external reviews done by the department, and the critic for the Liberals has asked about those reports, that there are factors in there to do with individual families and children that we cannot make public. I have also mentioned a number of child death reports going back to '87-88. All of these are crying out for a co-ordination of services to assist children and families, and this in itiative whereby we are cent ralizing the administration is going to go a long way to resolving some of those problems. Meeting Request Ms.BeckyBarrett(Welllngton): Mr.

Speaker, this government has also made a great to-do about its consultation process and the openness of its ministers and its members to views of the public. Tonight there is a public meeting dealing with the recentrali zation of Child and Family Services agencies to which the minister and his staff were invited. I would like to ask the Minister of Family Services if he or any member of his staff is coming tonight to share views and opinions, and if not, why not? Hon.

Harold Gllleshammer (Minister of Family Services): I was informed this morning of a rally in a hotel here in Winnipeg where there are going to be concerns expressed about Child and Family Ser vic es. I will be in my constituenc y at a graduation this evening. I will tell you that I did meet with the past presidents of all of the Winnipeg associations and a couple of other provincial associations on Monday. I did meet with the executive directors of the Winnipeg associations on Monday.

I applaud parents for their continuing interest, and I am aware that they have formed an association called the Concerned Citizens of Families and Children. I have agreed to meet with members of that organization some time in the next few weeks. Child and Family Services Regional Boundaries Ms. Jean Friesen (Wolseley): My question is also for the Minister of Family Services. This minister, in what the Winnipeg Free Press has called an arrogant manner, has destroyed overnight our community- based child and family welfare system.

One of the agencies elim inated was the Child and Family Services of Eastern Manitoba, an agency which dealt with a wide range of urban and rural commun ities from the Brokenhead to Steinbach. Two days ago, the

June 27, 19 91 LEGISLATIVE ASSEMBLY OF MANITOBA 3956 minister was unable to table the new boundaries of his super-agency. I would like to ask the minister today if his master plan has matured enough to table those boundaries. Can he tell us the fate of those communities outside the city of Winnipeg? Is he, for example, planning - Mr. Speaker: Order, please. The question has been put. Hon. Harold Gllleshammer (Minister of Family Services): Yes, I was asked the other day if I had a copy of the boundaries with me. I indicated at that time that I did not have a copy in the House. I have one today.

It is part of the regulations, and I will be pleased to table it for members opposite. I would further say that there is no interest at this time and no disposition at this time to centralize organizations outside of the city of Winnipeg, as the member asked. I would indicate that we have a very complex system in the province, where we do have agencies such as the one in Winnipeg, one in central Manitoba and one in Westman. We have areas of the province where the department delivers that service, and of course, we have the five Native Child and Family Services agencies. It is a complex system that we have.

I ind icated in comments the other day that certainly I see a lot of work that needs to be done with the Native agencies. We have met on a number of occasions to talk about jurisdiction and talk about other issues, about codes and standards. I made the commitment at that time that we would be mee ting with the lea ders of the Native community, from their child welfare committees, to further explore those problems. * (1 345) French Language Services Ms. Jean Friesen (Wolseley): Mr. Speaker, my second question is to the same minister.

This government claims to have a commitment to French Language Services, yet the ·minister has elimi nated a decentralized agency with regional committees rooted in the commun ities of St. Boniface, St. Pierre-Jolys, Ste. Anne and others. Mr. Speaker, my question for the minister is: In his new world order, what specific guarantees are there for direction from the French community, and is he comm itted to the appointment of Franco-Manitobans to this board? Hon. Harold Gllleshammer (Minister of Family Services): We have left in place the offices.

The staff who were providing services last week are the same people and the same offices that are there this week. I am aware of the desire to have culturally appropriate services delivered. We did make an approach to a person to represent that community, and that person has declined. I am aware of the need to have representation from that community, and we will be moving forward to resolve that as we make further appointments. Ms. Friesen: Mr. Speaker, I think there is more than one person in the French community, and I do hope that you do pursue those invitations. Community Committees Ms.

Jean Friesen (Wolseley): My fi nal supplem entary is for the Minis ter of Cul ture, Heritage and Citizenship (Mrs. Mitchelson). Between January and March of this year, the Fran co-Manitoban communi ty held over 45 community development meetings across the province in anticipation of a five-year agreement, Entente Canada Communaute. Would this minister indicate how the abolition of community-based boards of Child and Family Services of Eastern Manitoba fits with her government's support of the Canada Communaute initiative? Hon. Harold Gllleshammer (Minister of Family Services): I indicated, Mr.

Speaker, in my previous comments, that we will be working with communities to develop community committees so they will have a voice that they can bring forward to the new agency. Those will not be in place for some months yet, but we will be working actively to have those put in place and to have people from the various communities have a voice on those committees. They will have an opportunity not only to elect a person to the new board but they will also have the opportunity to make their feelings known to the new board.

Just in response to the comment the member made, yes, I am aware that there is more than one per son capable of represent ing the Franco-Manitoban community. I think the member would realize that, in matters like this, when you approach somebody, you have to give them the time to consider it, and once the decision has been made, then you have to go back and look at other alternatives.

3957 LE GISLATIVE ASSEMBLY OF MAN ITOBA June 27, 19 91 Anti-Racism Programs Government Initi atives Mr. Kevin Lamoureux (lnkster): Mr. Speaker, my question is for the Minister of Justice and Attorney General. On several different occasions, we have brought up the concern of racism inside this Chamber. We had brought up the issue of the racist pins, and the Minister of Justice and Attorney General took no action. We brought up the whole issue of the racist calendars, and this government took no action. We brought up the Ku Klux Klan line, Mr. Speaker, and we have seen no action from this government.

My question, put quite simply, to the Minister of Justice and Attorney General is: Why is this government failing to take action to combat racism? Hon. James Mccrae (Minister of Justice and Attorney General): The honourable me mber certainly raises a serious matter, albeit in a manner of which leaves open the question of how serious he views the matter. This government has made its position on these matters very clear with respect to the aggressive investigation of complaints of racist or hateful behaviour in our jurisdiction, and that is precisely what we have been doing.

The honourable member is probably referring to the latest issue that has been raised by the critic for the New Democratic Party and others with respect to the Ku Klux Klan and possible activities of that movement in our province. I can tell the honourable member that our department is reviewing the applicable legislation in our province to see what opportunities there are for us to combat racism as it is being put forward in this province. I do not like to speak for other ministers who are not able to speak for themselves in this Chamber on any given day. The honourable Min iste r of Agriculture (Mr.

Findlay) , who is the Minister responsible for the Manitoba Telephone System, shares my concern, and no doubt, when he is able to, he would be able to discuss matters related to the operations of the Manitoba Telephone System. That being said, my department is reviewing applicable legisla tion in this province to see what further action may be taken. The honourable member implies that no action has been taken. The honourable member would lik e to see people prosecuted where there is no likelihood of a success for prosecution. That is not the policy of this- Mr. Speaker: Order, please.

Racism Investigations Telephone Messages Mr. Kevin Lamoureux (lnkster): Mr. Speaker, time after time, we bring forward a serious issue of this nature, and time after time, the Minister of Justice and Attorney General tries to explain in his long-winded answers as to why it is that they are not able to combat racism. Action speaks a lot louder than words, and the action from this government has been very lacking. In Alberta, in regard to the telephone line, there was a line of similar nature in which the Alberta government was able to cut off the services.

This government, on the other hand, has failed to take any action to bring it to the attention of the Canadian Human Rights board. My question to the minister is: Why does he continue to refuse to take action that would prevent people from using lines or telephones in this nature that promote racism and hatred in the province of Manitoba? * (1 350) Hon. James Mccrae (Minister of Justice and Attorney General): The question has been asked and answered in the past, and it was asked and answered in the first go-around with the honourable member today in Question Period.

The honourable member refers to the situation in the province of Alberta where the Canadian Human Rights Act,

Section 13 , was brought into play. That opportunity is not there for us in Manitoba, because our Manitoba Telephone System is a provincial Crown corporation which does not fall under the jurisdiction of the Canadian Human Rights Commission. Mr. Lamoureux: Mr. Speaker, the minister can ask them. If this activity is allowed to continue, the problem is going to get a lot worse before it starts to get better.

Will the minister agree today to examine the Alberta case to see if it is in any way comparable to the situation in our province, and if so, will he take immediate action to cut off the KKK phone line and send a strong message that racism in this province will not be tolerated? Mr. McCrae: Well, we have already done precisely what the honourable member asks that we do. If he had been listening to the last answer I gave, I told

June 27, 19 91 LEGISLATIVE ASSEMBLY OF MANITOBA 3958 him that the Canadian Human Rights Commission in Manitoba's situation has no -( interjection)- Mr. Speaker: Order, please. Mr. Mccrae: The Canadian Human Rights Commission, Mr. Speaker, has no jurisdiction over the Manitoba Telephone System, so the honourable member raises a question that we have already done that work to satisfy ourselves about that. The honourable member seems to have a little bit of a problem in that he cannot control himself today and wants to keep talking after he has finished asking his question. I am trying to give him an answer.

He does not seem to want to listen to the answer. The Liberal position is not always as consistent as I would like to see or as Manitobans would like to see. If only the Liberals had taken the same kind of position they seem to be taking today with respect to impaired drivers on our highways, we would have had far better success, I suggest, in getting our drinking and driving initiatives off the road. The Liberals did everything they could, everything in their power at that time, when we, with the support of the New Democratic Party, were trying to take some leadership here in the province of Manitoba.

We would like to take leadership in areas related to racism, too, and we would prefer to have help from members of the Liberal Party, as opposed to this kind of a tactic that they are using in the House today. Business Practices Act Proclamation Mr. Edward Connery (Portage la Prairie): Mr. Speaker, last session, this government and this Legislature passed The Business Practices Act. The Business Practices Act was a bill that was crying out for introduction into Manitoba for many, many years. The NDP sat on it.

While they talk about concern for the public, concern for the people, they did absolutely nothing for the consumers of this province. Mr. Speaker, we went through a long and protracted consultation. We, for the first time in the province of Manitoba, had the Manitoba Society of Seniors in, we had the Consumers' Association, along with all of the other business communities, to discuss a good bill. Mr. Speaker, it is important that that bill- Mr. Speaker: Order, please. The honourable member, kindly put his question now please. Mr. Connery: -be put into place very quickly, Mr.

Speaker, and I ask the Minister of Co-operative, Consumer and Corporate Affairs-b ecause before I left office, I had instructed the department to have regulations in place that they would be ready for the first of July. I would ask the Minis ter of Co-operative, Consumer and Corporate Affairs what the status of those regulations are pertaining to The Business Practices Act- Mr. Speaker: Order, please. The question has been put. * (1 355) Hon. Linda Mcintosh (Minister of Co-operative, Consumer and Corporate Aff airs): Mr.

Speaker, I would like to thank my honourable friend the member for Portage la Prairie for that question and thank him, at the same time, for the preliminary work that he did in introducing this bill and for getting it underway after a long period of neglect in this area. Having said that, Mr. Speaker, I am pleased to report that the bill is in the final stages of preparation for proclamation. The information packages are currently being prepared. I expect to have it ready for proclamation within the next week or two. Immigration Government-Sponsored Refugees Ms. Marianne Cerllll (Radlsson): Mr.

Speaker, the number of government- sponsored refugees coming to Manitoba has dropped this year by 40 percent. This means that $2 million of federal money that accompanies these people will be lost to Manitoba's economy. What is the minister responsible doing to ensure that this trend, with respect to refugees and immigrants, does not continue? Hon. Bonnie Mltchelson (Minister of Culture, Heritage and Citizenshi p): Mr.

Speaker, I am pleased to report that, as of last week, the newly formed branch within my Department of Citizenship will be headed by an ADM, one Doris Oulton, who will be working very actively to co-ordinate all issues regarding new immigrants and citizenship of the province of Manitoba. One of the priorities will be to negotiate an agreement with the federal government on levels of

3959 LE GISL ATIVE AS SEMBL Y OF MAN ITOBA June 27, 1991 immigration to the province of Manitoba. Manitoba is not uni que in the ins tance where less government-sponsored refugees are coming just to Manitoba. It is across the country. In fact, we will be negotiating very aggressively for an agreement whereby we in Manitoba will receive our fair share of immigrants in accordance with our population of the country. Prairie Regional Documentation Centre Ms.

Marianne Cerllll (Radlsson): Today we find that the trend is continuing with respect to Manitoba's treatment by the federal government in this area and that Winnipeg is going to lose the Prairie Regional Documentation Centre which assists immigrants and refugees to prepare their cases for claims. Is the minister aware of this, and how will the government address the issue of backlog which has been exacerbated by the federal government's new refugee assessment process and its centralization of immigrant and refugee services? Hon. Bonnie Mltchelson (Minister of Culture, Heritage and Citizenship): Mr.

Speaker, I will do everyth ing, and we as a government will do everything within our power to ens ure that immigrants who come to our province and need access to services will find that service available in the most expeditious way. Ms. Cerllll: This is another example of services that are leaving the province. Government Initiatives Ms.

Marianne Cerllll (Radlsson): Can the minister table correspondence to show what she has done and wh at she can do, if she can table correspondence now-she thinks she can do anything now to bring the centre back-to show that she is in fact standing up for immigr ants and refugees in Manitoba? *

(1400) Hon. Bonnie Mltchelson (Minister of Culture, Heritage and Citizenship): I think our commitment to new immigrants and immigrants in the province of Manitoba-the record stands and shows that we as a government have been very proactive. Mr.

Speaker, when in fact we saw thatthe federal government was reducing their commitment to ESL training in the province of Manitoba, we came forward with a strong commitment as a province, and as a matter of us making that concerted effort, there will be 20 percent more money going into ESL training in the province of Manitoba for new immigrants than there was last year, so we have shown our commitment. We have shown our commitment to immigration and to the multicultural community through our mul ticultural policy that we initiated.

We have shown our commitment to anti-racism initiatives by working co-operatively with the Manitoba Federation of Labour on training modules, not only for the Civil Service, but right throughoutthe working sector in Manitoba. Mental Health Care Nursing Shortage Mr. Gregory Dewar (Selkirk): My question is for the Minister of Health.

Over and over, this mini ster has stated his government's commitment to quality mental health services in Manitoba, but yesterday the Registered Psychiatric Nurses Association of Manitoba asked this government to address the problems that will result from the decline of more than 50 percent in the number of psychiatric nurses in Manitoba as a direct result of the closure of the Selkirk school. What answer does this minister have for this association?

Will he table in this House evidence which indicates that there will be a sufficient number of trained nurses graduating to fill the future needs of mental health services in this province? Hon. Donald Orchard (Minister of Health): In the consolidation of the two schools of nursing, it is anticipated that we will have 45 student placement slots. I might indicate to my honourable friend that-a nd I am going from memory-I believe in 1988 there were a total of 38 graduates in the province of Manitoba from two schools of nursing.

In 1989, I believe the numberwas47 graduates from the two schools of nursing, and in 1990, I believe the number was 43. Based on the anticipation of having 45 training slots available in the consolidated school of Brandon, which is an increase over the number that is there now, as one might expect, we are hopeful that will meetthe graduate needs of Manitoba, which have been in the range of, as I say, about 38 to 47 over the last three years that I have information on memory.

June 27, 1991 LE GISL ATIVE ASSEM BLY OF MAN ITOBA 3960 Of course, my honourable friend must respect that this consolidation of the school is the beginning point of enhancing the educational opportunities for registered psychiatric nursing at the Brandon site in Brandon, Manitoba. School of Psychiatric Nursing Selkirk Closure - Review Mr.

Gregory Dewar (Selklrk): Given the dramatic shortage of trained psychiatric nurses that will result from the closure of the school, will this minister now reconsider his decision to close the school, a move that was even condemn ed by the Manitoba Chamber of Commerce in its most re cent convention? Hon. Donald Orchard (Minister of Health): I hate to break with the normal opinion that New Democrats have that the Chamber of Commerce is nothing but an arm of the provincial government when it is Conservative and political striped. My honourable friend did not choose to listen to my answer.

The graduates over the lastthree years from two schools have ranged from 38 to 47. We are anticipating 45 slots of training available in the consolidated school. There is some consistency in that number. Secondly, when my honourable friend indicates a shortage of psychiatric nurses in the province of Manitoba, my honourable friend ought to know that, of those graduates, ranging from 38 to 47 over the last three years, anywhere from 14 in one year down to about eight or nine sought employment outside of the province of Manitoba.

The balance were employed in Manitoba, but the ones who sought employment outside of Manitoba did so because employment opportunities were not available. They wanted to remain in Manitoba, but sufficient positions were not available to be filled by those graduates. Mental Health Care Nursing Consul tations Mr.

Gregory Dewar (Selklrk): Will the minister agree to real partnership in the mental health system and grant the request by the Registered Psychiatric Nurses Association to place a psychiatric nursing consultant in the Mental Health Division so that the minister does not make any more mistakes like the closure of the Selkirk school? Hon. Donald Orchard (Minister of Health): Mr. Speaker, I always take my honourable friend's offer of co-operation very seriously.

I just hope that, when the New Democratic Party comes around the issue of the consolidation, the improvement of regi ste red psych iatri c nu rsing in Br andon, Manitoba, they consult with the member for Brandon East (Mr. Leonard Evans) and assure that he is in disagr eement with that as portrayed by my honourable friend the member for Selkirk. Where does the New Democratic Party stand? Do they want improved psychiatric nursing training in Brandon, as the member for Brandon East (Mr.

Leonard Evans) does as a front bencher of the New Democratic Party, or do they want to participate in the sillin ess of my honourable friend from Selkirk? Manitoba Interest Rate Assistance Cash Payments Mrs. Sharon Carstalrs (Leader of the Second Opposition): My question is to the Minister of Finance. Mr. Speaker, in the 1990-91 budget, one of the highlights of his announcements was a program called the Manitoba Interest Rate Assistance Program, an interest rate assistance program which would be given to farmers and which was targeted as some $23.6 million. Mr. Speaker, I asked the Minister of Agriculture (Mr.

Findlay) last December for the amounts. He would not give them to me. I asked him again in March for the amounts expended on this program. He would not give them to me. Finally, in Estimates on Monday night, he did give them to me, and it was not $23.6 million. It was $1 4.4 million. Will the Finance minister tell the House today if it is now the intention of this government to take the remaining $9.2 million and give it out in direct cash payments to the farmers of the province of Manitoba? Hon. Clayton Manness (Minister of Finance): Mr.

Speaker, in accordance with the open fashion of this government, the Minis ter of Agriculture provided that number to the Leader of the Liberal Party (Mrs. Carstairs) the other night. The member knows full well the accounting policies of the Province of Manitoba. When we put forward the budg et ary am ount of twenty-t hree -point-some mil li on dollars, Mr. Speaker, it was our full expectation that all of that

3961 LE GISL ATIVE ASSEMBL Y OF MAN ITOBA June 27, 1991 money would be called upon and it would indeed flow. Inasmuch as the farm community chose in part not to exercise their right to call upon that, that money therefore lapsed, as is the general nature of all expenditures of government when indeed it is not called upon. It was set aside for use; it was not called upon by the farmers of Manitoba in totality, and therefore it lapsed. It will represent a saving, a contribution to deficit reduction for the '91 fiscal year. Mrs.

Carstalrs: That is a fascinating statement, since there is an agreement signed between the provincial and federal governments saying that the Province of Manitoba will provide $62.5 million directly to the farmers of the province of Manitoba. Included in that $62.5 mil lion is the $23.6 million. The agreement further goes on to say that any signi ficant shortfall in these Manitoba initiatives below $62.5 mil lion will be made by Manitoba in the form of cash payments directly to producers. Is the Minister of Finance now saying that he is not going to fulfil!

Manitoba's part of the agreement between the Province of Manitoba and the federal Government? Mr. Manness: Mr. Speaker, it is my understanding that the covenants of the contract read by the Leader of the Liberal Party are still at issue, are still being discussed, but let me remind the honourable member, indeed all members of the House, that this government has contributed in excess of $40 million in terms of our commitment to the Gross Revenue Insurance Program. I would argue in part that a sig nificant part of that is in keeping with the covenants under the contract from which the member has just read. Mrs.

Carstalrs: Mr. Speaker, the Order-in-Council No. 642, signed by this government, very clearly states the province's obligation to not only the federal government but, much more importantly, to the farmers of the province of Manitoba. Is this minister saying that they are not just prepared to break faith with the federal government, but they are also prepared to break faith with the farmers of the province of Manitoba? What effect will that have on future federal payments to agriculture in our province? * (1 41 0) Mr. Manness: Well, absolutely not, Mr. Speaker.

Let me make the categorical statement, no government in the space of the last 10 or 15 years in the province of Manitoba has directed more cash to the farm communi ty than this provincial government has in this fiscal year.

Whereas budgeting formulations in the past have had us set aside a large allowance for losses in the MACC account, that number is much lower. The total amount of $100 million-plus this year for the most part, virtually all of it, will represent an infusion into the agriculture community. That was not the case previously. Before, we had a larger portion within the drug and in the Semen Centre and in the lab testing areas that represented a service area. That has been removed and replaced by our premiums in GRIP and also in NISA, which will represent direct infusion of millions of dollars by this government.

We are proud to do it, and we have honoured our commitment to the farmers of this province. Gasoline Products Price Increase Mr. Jim Maloway (Elmwood): Mr. Speaker, my ques tion is to the Min ister of Co-operative, Consumer and Corporate Affairs. We have been informed that a gasoline station, the Shell station in St. Boniface has increased its gas prices today by 9 cents a litre, from 45.9 cents to 53.9 cents. We have also been informed that another station, an Esso on Notre Dame, expects to increase its price per litre from 47.9 cents to 53.9 cents by the end of today.

It has been reported that other gas outlets across the city are following suit. The fact of the matter is that the price per barrel of gasoline increased only 16 cents in the last day from $20.08 yesterday to $20.24 this morning. I would like to ask the minister whether she is aware of any wars or turbulence in Alberta over the last few days that would necessitate such an increase in the price of gas to consumers? Hon. Linda Mcintosh (Minister of Co-operative, Consumer and Corporate Aff airs): Mr.

Speaker, I note incidentally that, over the last few weeks, indeed over the last more than a month, when the prices have been depressed, I did not get any questions. I did note that the question came today when the prices have gone back up in an attempt to end the depressed price war scenario we have had over the last few weeks. Mr. Speaker, you know, the prices fluctuate. The member is aware of that. He has seen that we are

June 27, 1991 LEGISLATIVE ASSEMBLY OF MANITOBA 3962 consistently in the lowest prices across the country. We currently have the fourth lowest price in Canada, of the major cities surveyed by Energy, Mines and Resources Canada. We have prices that have been consistently lower than they have been in NOP Toronto, where they still are incidentally higher there in southern Ontario than they are here in Manitoba, and that is fairly consistent. Mr. Gary Doer (Leader of the Opposition): What are you going to do? Mrs.

Mcintosh: If the Leader of the Opposition wants to add his ques tion to the member for Elm wood and ask what I am going to do, and if they are implying that what they think I should do is to regulate or interfere, as has been done in some other provinces, may I point out with respect that which I think they may already know, that prices in the regulated provinces are higher than us and have been higher than us since before I became minister, long before I became minister. They remain higher than us at this time, 60.3 cents, as a matter of fact. Pricing Regulations Mr. Jim Maloway (Elmwood): Mr.

Speaker, it is very clear to me that this minister is indicating an intention to do absolutely nothing. She is more concerned about the oil companies' profits. It is very clear that the oil companies are giving orders and direction to this government. One only has to look at the financial statements that the party filed in the last week showing the contributions- Some Honourable Members: Oh, oh. Mr. Speaker: Order, please. Mr. Maloway: ... those oil companies.

My ques tion to the mi nister is: Will she endeavour to regulate the price of gasoline under the Public Utilities Board, since that is what is done with hydro rates, gas rates and Autopac rates? If it is good enough for those commodities, why is it not good enough for gasoline? Hon. Linda Mcintosh (Minister of Co-operative, Consumer and Corporate Aff airs): Mr. Speaker, the prices we are experiencing now are the same prices that we had last summer. If you look on the year to year, our prices are the same now as they were last summer.

Despite the shock that the market has had because of the Gulf War, we are not seeing an increase over last summer, and there are not a lot of consumer products that have not increased in that same span of time. I do not know if the members opposite want us to get into all kinds of arenas that we have not traditionally been in. Maybe they want us to go back to building airplanes, I do not know.

May I point out that, among the many experts and people who I have talked to since I have become minister, one whom is respected, I know, by the opposition, Professor Nicolaou, has spoken quite clearly against the concept of regulation saying that it is not advisable. Mr. Speaker: lime for Oral Questions has expired. Committee Changes Mr. George Hlckes (Point Douglas): Moved by the member for Point Douglas, seconded by the member for Welli ngton (Ms. Barrett), that the composition of the Standing Committee on Public Utilities and Natural Resources be amended as follows: Burrows (Mr. Martindale) for Flin Ron (Mr.

Storie). Moved by the member for Point Douglas, seconded by the member for Welli ngton, that the composition of the Standing Committee on Indus trial Relations be amended as follows: Elmwood (Mr. Maloway) for Thompson (Mr. Ashton); Transcona (Mr. Reid) for Swan River (Ms. Wowchuk). Mr. Speaker: Agreed? Agreed. Mr. Edward Helwer (Glmll): Mr. Speaker, I would like to make some committee changes. I move, seconded by the member for St. Vital (Mrs. Render), that the composition of the Standing Committee on Industrial Relations be amended as follows: the member for Sturgeon Creek (Mr.

McAlpine) for the member for Roblin-Russell (Mr. Derk ach) ; the member for Ass iniboia (Mrs. Mci ntosh) for the member for Ste. Rose (Mr. Cum ming s); the member for Fort Garry (Mrs. Vodrey) for the member for Arthur-Virden (Mr. Downey); the member for Emerson (Mr. Penner) for the member for Lac du Bonnet (Mr. Praznik); and the member for Riel (Mr. Ducharme) for the member for La Verendrye (Mr. Sveinson). I move, seconded by the member for Fort Garry (Mrs. Vodrey), that the composition of the Standing Committee on Public Uti li ties and Natural Resources be amended as follows: the member for

3963 LEGISLATIVE ASSEMBLY OF MANITOBA June 27, 1991 Seine River (Mrs. Dacquay) for the member for Ste. Rose (Mr. Cummings). Mr. Speaker: Agteed? Agreed and so ordered. House Business Hon. Clayton Manness (Government House Leader): Mr. Speaker, I would like to make an announcement of a committee time, but first of all, I would move, seconded by the Minister of Justice (Mr. McCrae), that Bill 44 , The Public Utilities Board Amendment Act, be withdrawn from the Standing Committee on Public Utilities and Natural Resources and transferred to the Standing Committee on Industrial Relations, by leave. Mr.

Speaker: Does the honourable government House leader have leave to switch committees? No. There is no leave? Leave is denied. Order, please. Mr. Mann$ss: Mr. Speaker, Bill 44 has been referred to Public Utilities and Natural Resources, and I will ask then that standing committee to sit tonight at eight o'clock to consider Bill 44 , and if required to sit tomorrow afternoon at 1 p.m. to also consider Bill 44 . Mr. Speaker: I would like to thank the honourable government House leader for the information. •

(1420) ORDE RS OF THE DAY Hon. Clayton Manness (Government House Leader): Mr. Speaker, I ask whether there is a willingness to waive private members' hour this afternoon? Mr. Speaker: Is it the will of the House to waive private members' hour? No. Leave is denied. Mr. Manness: Mr. Speaker, I move, seconded by the Minister of Justice (Mr. Mccrae ), that Mr. Speaker do now leave the Chair and the House resolve itself into a committee to consider of the Supply to be granted to Her Majesty.

Motion agreed to, and the House resolved itself into a committee to consider of the Supply to be granted to Her Majesty with the honourable member for St. Norbert (Mr. Laurendeau) in the Chair for the Department of Health; and the honourable member for Seine River (Mrs. Dacquay) in the Chair for the Department of Industry, Trade and Tourism. CONCURREN T COMMITTEES OF SUPPLY SUPP LY-HEALTH Mr. Deputy Chairman (Marcel Laurendeau): Will the Committee of Supply please come to order. This afternoon, this

section of the Committee of Supply meeting in Room 255 will resume the consideration of the Estimates of the Department of Health. When the committee last sat, it had been considering item 2.(

c) Women's Health : (1 ) Salaries $415,200, on page 84 of the Estimates book and on pages 42 and 43 of the Supplemen tary Information book. Shall the item pass? Mr. Guizar Cheema (The Maples): Mr. Deputy Chairperson, can the minister tell us, has the position for the director of the department been filled? Hon. Donald Orchard (Minister of Health): Yes. Mr. Cheema: Can the minis ter tell us the qualifications of the individual who is the director of this department? Mr.

Orchard: Sue Hicks-and I guess she has been with the ministry for a number of years-w as in the directorate prior and had come from the regions to the department. Mr. Cheema: Mr. Deputy Chairperson, what is the experience in terms of the women's issues affecting health care, specifically? Mr. Orchard: Well, she has been active in a number of general public health issues and, most recently, issues more focused on women's health issues, and that is through a variety of involvements and experience, including involvement with the Canadian Public Health Association. Mr.

Cheema: I am asking the basic qualification of this individual that relates to health care. Mr. Orchard: Nurse-Master of Public Health in Nursing. Mr. Cheema: I ju st wanted to know the qualifications. There are two more positions out of 1 O positions. How many positions are not filled yet? Mr. Orchard: Two vacant positions and two term positions. Mr. Cheema: Wha t are those two vacant positions?

June 27, 19 91 LEGISLATIVE ASSEMBLY OF MANITOBA 3964 Mr. Orchard: A program specialist and a clerical support. Mr. Ch eema: How long has this program specialist position been vacant? Mr. Orchard: Several months, about December, I think. *

(1440) Mr. Ch eema: Mr. Deputy Chairperson, what is the function of this program specialist, and who has been filling in for several months for this very sensitive position? Mr. Orchard: The balance of the staff have been carr ying an additional load, if you wil l, of responsibility. Everyone works on the projects of the directorate. Mr. Ch eema: Mr. Deputy Chairperson, can the minister then tell us what is the reason why this position has been vacant? Are they not able to find a suitable candidate, or are there different other reasons? Mr. Orchard: There is always a process of delay in filling vacancies.

We are very, very careful as to how quickly we fill vacancies; it is part of the process. Mr. Ch eema: Mr. Deputy Chairperson, it is, again, a pretty good answer or part of it. I am just asking, though, who has been doing the job. This person is supposed to do it, and what are the reasons why this position is still vacant? Is it going to be filled within that depar tm en t? Has this position been advertised? Mr. Orchard: No, it has not been advertised. The workload, as with all vacancies, when you have a vacancy, the workload is shared across the remaining staff as a normal share of workload. Mr. Ch eema: Mr.

Deputy Chairperson, I do not want to be too critical about this position, but I think when so much has been said about this directorate and so many announcements were made and it has been a part of the, twice I guess, of the throne speech that so many things are going to be done for this directorate, particularly the Breast Screening Program and the midwifery issue, I am just very curious to know why such a sensitive position of a program specialist has been vacant for several months and why this has not been advertised so far? Mr. Orchard: Well, Mr.

Deputy Chairman, there are vacancies that are distributed throughout the department. They happen upon occasion. When staff decide that they wish to move on, we sometimes have ample notice to fill, we sometimes do not. Vacancies are a part of government. We do go through a very deliberate process of filling vacancies, and this one, the workload is being shared across the other program specialists who are part of the directorate. If my honourable friend wants to conclude that not filling it is an example of not wanting to proceed with women's health issues, that is fine. That would be a wrong conclusion.

It is part of government in terms of the way we have been operating in terms of filling vacancies. The vacancy will be filled, but it has not been filled to date. Mr. Ch eema: Mr. Deputy Chairperson, how many of the program specia lis ts are within the department? Mr. Orchard: There are two others. Mr. Cheem a: Mr. Deputy Chairperson, could we have the terms of reference for this particular position, if we do not have it today, or the duties of this particular position? Mr. Orchard: Yes, we can provide the job description. Mr. Ch eema: Mr.

Deputy Chairperson, can the minister tell us, other than initiating the Breast Cance r Screening Program and some issues concerning midwifery, what specific initiatives have been started un der this Women's Hea lth Directorate? Mr.

Orchard: Outside of breast cancer screening, aboriginal women's health, child health, early postpartum discharge, parenting in terms of the "Nobody Is Pe rfect" program, work with Planned Parenthood Manitoba, reduced postpartum stay ini tiativ es, re productive health counselling, reproductive technologies-I guess about a fairly recent participation in that in terms of the federal initiative- and, of course, my honourable friend mentioned breast cancer screening, and in the midwifery study programs. Mr. Ch eema: Mr. Deputy Chairperson, the minister has mentioned the program of reproductive health.

I will just again ask him to reconsider his decision for dei nsuring the reversal of sterilization on compassionate grounds, and I think it will not be a saying that the opposition told you so, we are just asking on compassionate grounds. It is not a large

3965 LEGISLATIVE ASSEMBLY OF MANITOBA June 27, 1991 number, and I think it should be left up to the Health Services Commission to decide on those bases. Would that be a reasonable request? Mr. Orchard: Mr. Deputy Chairman, I have had discussions around that issue. A legitimate case came forward about an individual whose spouse died unexpectedly and suddenly, and we are giving very, very serious consideration and I believe will accommodate that request.

At the same time, my colleagues suggested when the issue was di scussed that the same circumstance of personal tragedy can exist, for instance, if ones children are tragically lost, and we are considering that as well in terms of attempting to narrow the focus of the reversal of sterilization. So my honourable friend's suggestion on the loss of a spouse has been taken very, very seriously by government, and in a discussion the second issue came up of tragic loss of children. I think my honourable friend will be pleased with the resulting discussions. Mr. Cheema: Mr.

Deputy Chairperson, I really appreciate that approach. I think it is very positive. If there are a few things not being done, and if the government is not going to change its mind on certain issues, but specifically if they are going to make some provision that will really be very helpful and at least allay some fears in terms of somebody who cannot pay for the reversal of sterilization. I do not have the exact amount with me, but I think it is quite expensive in certain cases. I will go with a further issue, as one of the initiatives the minister has mentioned is aboriginal women's health.

Can the minister tell us who is in charge of this program, and what is their mandate? Mr. Orchard: Mr. Deputy Chairman, I think it is fair to say that we are trying to, through consultation and discussion at the Women's Health Directorate, identify maybe specific directions, if that is the appropriate phraseology to use, to deal with some of the issues surrounding aboriginal women's health and that, of course, will lead us into discussions about aboriginal women's health and their newborns, because some of the areas where we know there are more unfavourable statistics, the health status statistics.

We are attempting to formulate problem identification, prioritization and discussions toward policy and assistance in some of those areas. Let me deal with some specifics. I mentioned the "Nobody Is Perfect" program. What I will do is, I think, if my honourable friend has not a copy of the kit and the information educational brochure, I will make it available. Basically, it is a parenting skills program with mul ticultural content and has been utilized in some northern communities.

A small number of aboriginal women have been trained as facil itators, and it is to upgrade the potential parenting skills of aboriginal mothers. *

(1450) Twenty-five trained community health workers are employed by Manitoba's Community Health Services division, and nearly all are aboriginal women. They are living and working within their own communi ties where they provide health services in conjunction with public health nursing staff of the area. The program has been, I think, quite successful, and that is part of ongoing, and I have to say, hopefully, enhanced opportunity for aboriginal women in terms of expanding their opportunity to be part of the care delivery regime.

Manitoba Health, Manitoba employment and economic security were jointly funding a 30-week health care orientation training program at The Pas. The purpose of the program is to expose aboriginal women to careers in health care and provide basic knowledge for solving personal health problems. Eleven women from Cormorant, Moose Lake, Easterville and Grand Rapids are enrolled in the first session, so there are some of the initiatives that are ongoing right now. Mr. Cheema: Mr. Deputy Chairperson, the minister has ind icated that some of the statistics are indicating the severity of the problem.

Even though the minister knows that some of the aboriginal issues are in the age group of the very young, and they have children who are having a lot of problems, but some of them are registered, some of them are not registered, so they are really lost within the system. I do not want to go through all the statistics where I think there is a problem. It is quite a serious one. Also, it should be combined with the sexually transmitted diseases, have an AIDS education program and street outreach worker programs, some of the things which have been initiated, but I think more needs to be done on the reserves.

That still brings a question of who is responsible to do all of those things.

June 27, 19 91 LEGISLATIVE ASSEMBLY OF MANITOBA 3966 As long as the Department of Health is aware of and continues to take some leading role, as they have done in this departm ent, in this area specifically, I think it is a good model. I have been able to do some research personally, and I was very pleased. I just wanted the minister to know that it is a positive step. My next question will be in terms of-the minister knows that our party has put forward a very important resolution in front of the House.

It is on the fetal alcohol syndrome, which has very serious manifestations due to the alcohol used during the pregnancy. The statistics are there. The issue is not new, but it may be new for the politicians. I am asking the minister to give due consideration for that particular resolution by the member for River Heights (Mrs. Carstairs) to make sure that it gets proper attention and not get lost in the usual stuff of one-hour time and trying to put more speakers and some proposals, and then self-congratulating governments as the minister has done many times.

I am asking his particular attention to this particular issue. I think that

part could be included under the aboriginal part of the program so that the education can be done. I hope that the minister will support our resolution. Mr. Orchard: Mr. Deputy Chairman, the ministry and the Women's Health Directorate already undertake a pretty proactive awareness and education program on fetal alcohol syndrome. It is an integral part, as I understand, to the prenatal classes and the public health education classes. It is very much a part of the counselling that we provide.

When I mentioned earlier about our communi ty health workers that are nearly all aboriginal women, they very much carry the message to the Native women who are expecting. I think it is fair to say that in fetal alcohol syndrome the problem-and one always risks when one uses a generali zation-but I think it is fair to say that the problem follows socioeconomic lines. The middle and higher income women, I think, are less affected than are lower income socioeconomic groups.

So that we have discussed and have been trying and indeed have been focusing-not just before this government but the department has been focusing-on greater efforts in education and awareness along the socioeconomic lines as well, because we recognize that as a higher-risk group. Mr. Cheema: Mr.

Deputy Chairman, also the minister knows full well that the infant mortality rate is qui te high in the aboriginal population as compared to the others and does have a direct bearing with the socioeconomic status and also the poverty and some other factors and also the problem with the federal government how they have handled the whole issue of Native health for the last so many years. I think particular attention can be given to that aspect. My next question is regarding a postpartum discharge program.

As we have discussed every time in Estimates, I think last time the minister said that we only had programs in two hospitals, St. Boniface and I guess at women's hospital, and they were thinking of expanding to other hospitals. Can he give me an update on that particular program? Mr. Orchard: I have to apologize to my honourable friend, I was just discussing with my assistant deputy minister and missed the last part of his question. Mr. Cheema: I am asking if this program, based on the success of this program, is going to be expanded to other hospitals. Mr. Orchard: Mr.

Deputy Chairman, I think that I can answer yes to that. The reason I say I think I can answer yes to that is that is one of the issues that is being studied at the Urban Hospital Council level. Let me indicate the reason why. The program, I think, it is fair to say has been successful in the two hospitals in which it has been tried. We know it works, we know it works well. It was-how do I put this genteelly?

The program was forced to work all during the month of January, because a number of newborns and their mothers were discharged very, very early, probably in some cases earlier than the formal program would normally dictate. That was right across the system. The young fellow who works with me in the farming operation at home had his first born-he and his wife had their first born-during January.

She is a Bachelor of Nursing graduate, worked at the hospital and found that she was home within 24 hours and found it to be a very interesting process to be on the patient end of advice she had been giving for a number of years as a practising nurse. Okay, the point being, though-and I think my honourable friend would understand-is that we were able within the month of January to undertake quite significantly lowered stays for all mothers, with

3967 LEGISLATIVE ASSEMBLY OF MANITOBA June 27, 1991 few exceptions, because of the strike. It also showed us that we can support that activity in the community in times of crisis. Which means that with reasonable program development we can support it very, very clearly-we can support it in a planned fashion. So that the Urban Hospital Council is dealing with it as an issue, and it certainly has been an issue that is part of the range of issues studied by the Winnipeg hospital role study.

That study, as an interim report, is at the Urban Hospital Council for any advice it might be to them in terms of decision making. Mr. Che ema: Mr. Deputy Chairpe rson, I think positionally for the last two years it has been shown in Estimates that this program is very successful. Certainly, due to the strike-I think I have to be careful what I say about strike, which hospital I am going to name. I have learned my lesson in a very hard way, which was a very innocent way of doing things, but those things happen.

I think it was one of the lessons learned that the early discharge program was very effective and could be put into place in other community hospitals. I will go to my next question. I * (1 500) Mr. Orchard: I think my honourable friend also knows that only with community support can it work, but the point I made is that it was able to work with safety for mother and new-born in times of crisis caused by the strike in which there was not the formal opportunity to plan, et cetera, et cetera, its implemen tation.

So I think that is why I can almost prejudge maybe one of the recommendations that may come out of the Urban Hospital Council, this being one of the recommendations for change. Mr. Ch eema: Mr. Deputy Chairperson, I think that my next question may be part of the Health Services Commission about the re-organization of some of the obstetrical units in the hospital. I will wait till that

section comes. The next question is in regard to midwifery. We got the copy of the report from the minister's office and I want to thank him for that. Can the minister give us some guidelines on how and when we are going to achieve the final draft for any regulations in regards to midwifery in Manitoba, and when the minister will bring the required legis lation to proceed in that direction? Mr. Orchard: Mr. Deputy Chairman, the report that I sent to my honourable friend was the report from the College of Physicians and Surgeons and MARN. That report now is subject to wide community distribution.

I think we probably sent 200 reports to different or�anizations who had an interest in the issue. We want to hear their reaction and their feedback and their su gges tions to the College-MARN report. We have got a committee tha t will then collate or study -I hate "studies"- consult with the community. I hate to use that word because you know who is here. At any rate, we want to try and put together reasonable and workable rec ommendations on the implem entation of midwifery within the Manitoba system. Chairing that committee is Dr. Patricia Kaufert.

The committee is just in the process of gearing up, and I think the first meeting is tomorrow on it. Let me indicate to my honourable friend, one of the major guiding principles for implemen tation of midwifery that I wish to see is that midwifery does not become an add-on and cost to the system and another layer in terms of service delivery. If midwifery is going to be a legitimate alternative that women choose-it has to be, in my estimation and I would hesitate to approve it otherwise-if it is going to involve layered professional input and hence drive the cost, it must be within current costs.

I think everybody who has talked about midwifery has made the case that it can be as safe, it can be more satisfying for the mother and the family. They have often combined that in a win-win presentation to government, that it can also be done in a less costly fashion to the health care system. I want to assure myself that that is possible and achievable and, should it be, I think you would see this government very much proceeding posthaste with implem entation of a pr ogram.

If the recommendations come back that it is a service available but adding to the cost of the system then it will not, in today's circumstance, receive the open and favourable welcome that a program proposal that meets agendas, as I had mentioned a few seconds ago, would. Mr. Ch eem a: Mr. Deputy Chairperson, I just wanted to put a few comments on the record as we have gone through this report also. I think one of the issues here is whether this is going to be an add-on position. Are you going to have extra

June 27, 1991 LEGISLATIVE ASSEMBLY OF MANITOBA 3968 resources to put in place and still provide the same services? I am sure, as the opposition, probably we should not be commenting on that, but I think as a responsible individual I think we will have to make sure that there is no possibility of extra cost. Otherwise, we are just dupli cating services. I am sure there is going to be a lot of competition then: who is going to do what and who is going to be responsible? Ultimately there should be some mechanism to make sure these are, as much as possible, not add-on services to the taxpayers.

I think there are a number of other issues in terms of the education standards and setting a special area for the nursing, for this particular position, and then who is going to be responsible for liability. I think those issues have to be very carefully looked at in terms of the final responsibility because it is a very sensitive area where there could be some difficulties even with a normal, so-called normal, pregnancy. There could be problems and there is always a 5-1 0 percent chance that things could go wrong.

I think that issue has to be discussed because as far as I know I think there are two or three provinces that may have the same kind of smaller projects, not really a larger area, especially I think Quebec has one. Ontario did have a part of- they had one project, but really no province has taken a major stand on the whole issue. I would ask the minister to look into those aspects very carefully so that the proper standards and proper care can be provided and at the same time as much as possible we should try to avoid the add-on cost.

I think in that regard the consultation process with the College of Physicians and Surgeons, the nur ses' organization and the community group one is a very positive one, so that everyone knows what they are getting into, and so that the ultimate result should be a compromise, but not on the basis of paying more money out of taxpayers. I just want the minister to be-as I was going through the report and I found some of the remarks, I think they should be taken into consideration and finally we will see something very positive.

I think other provinces probably can learn from our experience in bringing in, maybe initially, a small project in one hospital in one area, and then develop a Manitoba model which is going to be really unique because of our demographic variation and our population, and our aboriginal communities and isolated communities in certain areas. So rules and regulations may not-not rules and regulations, but the European model may not apply in Manitoba. I think we have to be very careful. We do have to model in one area, one hospital-probably not hospital-but one area and then eventually develop on that. Mr.

Orchard: Mr. Deputy Chairman, I appreciate my honourable friend's contribution because he has echoed some of the concerns that one would have in in troducing the program . In terms of the committee that would be moving the report through to recommendations and a plan for implemen tation, they are looking at what Quebec and Ontario are proposing to do, so that is part of their study, to see whether we can learn in advance, rather than reinventing the wheel.

I should have mentioned this, but my honourable friend mentioned a first in Canada, and indeed we have the opportunity, I think, with this report and with the kind of co-operation around the issue, because to be first in Canada-I am quite sure that this may even be the first in Canada, but certainly in Manitoba: this is the first time that two professional associations, nursing and physicians, have come around an issue to jointly work on a report.

I guess that kind of demonstrates the co-operative atmosphere that we have been able to foster, and that will benefit all of us, taxpayers through to health care consumers. *

(1510) Mr. Cheema: Mr. Deputy Chairperson, just one comment and then the member for St. Johns (Ms. Wasylycia-Leis) will maybe ask questions on this particular section. I think it is one example of a very true part of the consultation, how this thing as a whole evolved over a period of so many years. Ultimately at least all the interested parties know what they want to achieve . They have all formulated the policy and they have come to at least basic consensus on some of the focal points. Definitely, it is the first one that is going to be in Canada.

If it is going to be wider as we hope it to be, I think it will be very positive. Ms. Judy Wasylycla-Lels (St. John s): Just to follow up questions where I left off the other day on breast cancer, and I know we have been over this issue a few times, but I would like to get it a little

3969 LEGISLATIVE ASSEMBLY OF MANI TOBA June 27, 1991 clearer in my own mind in terms of the government's plans. The minis ter gave us some fairly shocking statistics the other day: 157 deaths from breast cancer; 655, I believe he said, diagnosed cases of breast cancer for the year 1989. Other information shows us that one in every 11 Canadian women is struck with breast cancer. Also, statistics show us that mammography plays an important role in reducing deaths by about 20 percent and therefore is an important interventionist technology.

I know the minis ter has said that he has concerns-I believe he has said he has concerns about the technology in terms of breast screening, and that he is awaiting studies. I am just wondering if he could give us a clarification in terms of what the evidence has been to date in terms of problems and which study is he waiting for and what exactly is it focusing on? Mr. Orchard: Not that I want to get into a debate with my honourable friend, but did my honourable friend say that mammography has reduced deaths from breast cancer by 28 percent?

I would be interested in knowing where that comes from because-a nd I do not want to get into an argument over the issue with my honourable friend, but that is the whole problem that is emerging as more expert knowledge is focused on mammography and it is a value to the system. We have some concerns over recent studies which are showing that in fact that there is an increased incidence with screening rather than without, and that is a result of studies which can only take pl ace after sever al years of scree ning programs in other areas and jurisdictions.

It might be interesting to note that while we are wrestling with not government but a committee of experts in Manitoba in terms of coming to grips with providing a recommendation to the Province of Manitoba, I want to tell my honourable friend that Norway as a nation, for instance, has recently, I guess within the last year, rejected the suggestion or the program of mammography as an early detection program because it has not been demonstrated to their satisfaction that it works. My honourable friend the member forThe Maples (Mr.

Cheema) says he has to be cautious from time to time about what he says, but let me be as open as I can with my honourable friend. A great number of people believe the answer to early detection lies with breast cancer screening. That has been pushed by two groups in North America: No. 1, manufacturers of the equip ment; and No. 2, physicians who believe that use of the equipment will do that.

You might recall last week, we got into the issue of the technology drive in medicine and in health care, and this is a classic example, because we have women believing that if they do not have a mammography, they are pmbably not receiving adequate health care, but yet growing opinion of exp er ts upon st udying mam mography are beginning to question its value as an early detection tool. It is an expensive program. That is not the reason why we are wishing to seek a greater knowledge around its potential implemen tation.

That is not the reason at all, but because it is a sig nificant commitment of resource, we want to make sure it works, and there are people who are of the opinion that it may be not as effective as has been sold to us by the manufacturers and the proponents, radiologists mainly, out of the American health care system wanting and advertising openly and raising the awareness without medical outcome proof or statistics or data to reinforce that it is an adequate program. That is the stage we are at right now.

Our committee is very diligently trying to work through information to provide us with a good recommendation. They have not done that yet. I am hoping that they complete their investigation and give us guidance by the end of this year. You know, when a nation like Norway, as a nation, comes to the conclusion that they are not going to provide mammography as a screening detection device, they are faced with the same question of whether it works or not that we are wrestling with right now. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I appreciate what the minister is saying.

I certainly also want to err on the side of caution, although on a case like this we are dealing with some pretty shocking statistics in terms of half of our population and particularly high statistics among women over the age of 65. It seems to me that we do not have a minute to lose in terms of finding some technology to ensure early detection so that measures can be taken, treatments can be undergone so women do not have to die.

June 27, 1991 LEGISLATIVE ASSEMBLY OF MANITOBA 3970 I am wondering if the minister shares my concern. Here we are in the year 1991. Breast cancer has been around for a long time and we still do not have proper technology, and we are not prepared at this point to implement a program that will cut down on the number of deaths of women in our population. Why are we still at the point of studying something that has been around for so long? Mr. Orchard: You know, I have been trying to explain that to my honourable friend, not only today but for the las t two weeks .

Ther e are the proponents of mass screening by mammography. The major push in the world I have to say comes from the manufacturers of the equipment. Their goal may or may not be as broad as our goal. Their goal is to sell equipment and make money selling the equipment. Our goal in the health care system is to assure that when we make that investment that it is going to achieve the objective we believe it should, early detection and saving of lives in women.

The difficulty is that after introduction of that technology, studies are emerging that show in fact it may increase the incidence of cancer; in other words, to put it as bluntly as I understand it to be, may cause cancer. I cannot, in conscience, personally without full knowledge recommend a program which may cause cancer. • (1 520) Point of Order Ms. Wasylycla-Lels: Point of order, I think the minister misread my question. I was not repeating my earlier question about the program.

I was expressing my concern as well in terms of if there are health hazards associated with a particular technology then that should be dealt with. I was asking the min ister-a nd this was not a critical question in terms of his goal as a minister or his government-but I am asking him if he has any understanding or knowledge to help me and others understand why in the year 1991, . when breast cancer has been around for so long, we are only at the stage of trying to figure out what might work as a detection method. Where have we gone wrong as a society?

Is it because we are dealing with a particular group in society? Has it to do with research in terms of this area? I am just asking if he has some understanding based on his department advice or groups he consults with in terms of helping us understand that. Mr. Deputy Chairma n: The honourable member for St. Johns did not have a point of order. She was only clarifying her question. *** Mr. Orchard: Mr. Deputy Chairman, I cannot answer that, but I think I can answer it in this way.

I believe that when the technology of the screening devices was advanced to production and sale, I believe that the proponents or the manufacturer believed that they were providing what my honourable friend wants. Unfortuna te ly, as sometimes happens with new technology, it did not deliver the expected goal, and we are finding that out in terms of studies done on initiatives where the screening program has been brought in. That is what is causing the experts who are reviewing the issue to advise some caution, and I think they are cautious in terms of what advice they might want to give.

Now, if my honourable friend wants to say, and I detect it in her question, because it affects a group of people, because it is a woman's issue it has not taken priority, I cannot say that that is the case, and I do not think anybody can say that that is the case. I certainly have not been advised by anyone anywhere that because it is a woman's health issue, it is not an issue. So I cannot answer my honourable friend's question . Ms. Wasylycla-Lels: I appreciate that, but I think ther e is probably some correlation.

Some people-a nd I do not want to get the minister's back up on this-have made a parallel between breast cancer and AIDS as two very serious health issues, but because they have been particularly prevalent in a particular group, in the case of breast cancer, women, and the case of AIDS, our homosexual community, there has been less attention paid to research and development of treatments. I simply suggest that to the minister. I have no basis for saying that, except I think one area where we can look at understanding our lateness in responding to an issue like breast cancer is in terms of the research dollar.

I am wondering if the Minister of Health could tell us what percentage of the health research dollar in Manitoba goes towards women's health issues. Mr. Orchard: I will have to try and provide that information to my honourable friend, but if my honourable friend is saying that there is a link age between breast cancer, because it affects women,

3971 LEGISLATIVE ASSEMBLY OF MANIT OBA June 27, 1991 and AIDS, because at one time was alm ost exclusively in the homosexual community, and that AIDS does not receive research money because of that, my honourable friend ought to talk to researchers from North America involved with the Un ited States research. The exact opposite accusation is made, that we have put too much resource on AIDS and it has taken money away from cancer and heart and lung and other disease entity researchers in the United States.

Exactly the opposite case is made by researchers in the field, and I do not know where my honourable friend gets her information from, but I happen to have that kind of information coming from the research community, so I reject my honourable friend's link age of AIDS and the homosexual communi ty and no research because it is inaccurate, No. 1, with breast cancer in women as a link ed issue somehow. It is not lin ked in anybody's mind that I know of. Ms. Wasylycla-Lels: The minister says he will get information about the percent of research dollar in Manitoba for women's health.

I am doubtful that the percentage, although I hope it is better than the Canadian average, is much higher than the national average, which is 3 percent. Three percent of the total health research dollar goes to women's health issues. I am wondering if the minister perhaps could see the correlation between that kind of lack of research in women's health issues and our lateness as a society in terms of addressing something as serious as breast cancer. Mr.

Orchard: I guess my honourable friend can conclude as she wishes, but is my honourable friend trying to say, because only 3 percent of health research nationally is attributed to women's health issues that the other 97 percent into cancer, into heart disease, into stroke, into every other disease entity there is does not have an applicability to 51 percent of the population who are women? Women get cancer, women have heart attacks, women have strokes, women have lung disease, on and on and on.

Now in terms of specific focus on issues such as breast cancer, I cannot give my honourable friend the percentage of it, but you know, not that I want to belittle my honourable friend's issue, but men get breast cancer too. A good friend of mine went through extensive surgery for breast cancer-a male.

I know my honourable friend maybe wants to make a case, but to make the case that she is making would have women absolutely outraged that the initiation of research into AIDS at the National Institute of Health and the Centre for Disease Control and other very sizable established research communities in the United States could be criticized by every woman in the province because originally it was a male-h omosexual disease.

I do not think any women criticized trying to come to grips with AIDS, to find out whether there is a cure, how we can develop vaccines and other areas of research, because AIDS-I think my honourable friend would admit now, because I have heard her use the argument that AIDS is no longer a narrow disease entity; it affects all people. So in making the argument she has made now of research would defeat the argument she wants to make on AIDS as being potentially a disease of all Canadians or all humankind. Ms. Wasylycla-Lels: Mr.

Deputy Chairperson, I do not think anyone will dispute the fact that as a society we had been and continue to probably be slow in terms of addressing an issue like AIDS. It has taken a long time to get government's attention focused on that issue. It has been a long time coming to get the public aware of it. I think there is certainly a correlation between that and the issue of breast cancer and other health issues of particular concern to women.

No one doubts that and no one criticizes the research dollar that addresses issues that cut across both sexes, but we know, and the statistics show us every day, that there are particular health needs of women tha t continue to be underresearched, underaddressed and shuffled off to the side and, whether we are looking at the inadequate testing of birth control measures before put on the market, whether we are looking at the still yet available adequacy of screening equipment, we have a problem. I hope the minister just recognizes at least that much that I am saying.

I just wanted to raise a question in light of statistics around the women's health situation. It has been brought to my attention that illness among working women is 20 percent higher than among men, that illness among women who work full time in the home is 50 percent higher than among men. So we have a clear difference in terms of the health status of men and women, something that needs new research, new approaches and new understandings.

June 27, 1991 LEGISLATIVE ASSEMBLY OF MANITOBA 3972 So I am wondering if the minister has any plans to address those kinds of statistics and ensure that rese arch dollars, program planning and departmental work and so on try to come to grips with this differential health status picture? Mr. Orchard: Mr. Deputy Chairman, what is the source of the statistics my honourable friend has just used? Ms. Wasylycla-Lels: The source-h e could contact Dr. Donna Chow, whom he no doubt knows in terms of her work in the area of cancer and women's health issues. Would you like any more information about the source? Mr.

Or chard: Is this a pu blished resear ch document she has done or- * (1 530) Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I am sure that if you contact her-she is the author of papers and has made presentations and has done work through the Women's Health Research Foundation of Canada. Mr. Orchard: Mr. Deputy Chairman, I want to deal with the issue that my honourable friend mentioned, about inadequate research, for instance, into birth control methodology, and how that has possibly caused, well, it has caused some health problems.

I want to guarantee you that should a government have made the decision not to provide that birth control device to women, there would have been those who would have criticized the government for making that decision because they were denying women their right to health care services.

So when government says, I do not know whether that is a good thing to do, and they are attempting to put in pla ce the kind of research before technology is introduced to the system, it is done to prevent those kinds of things, but the easy thing for-a nd it is fed by the supplier and often groups who promote that, to have that device, that technology available, and if you do not make it available people are going to die, and that is what drives the system.

There are critics, and I am saying critics generically, who are willing to come out and beat governments about the head for delaying anything for a moment, when, in fact, implem entation of it may well cause greater health problems than it is attempting to resolve. Let me deaf with the issue in terms of research into that. We have made the case at the ministerial level that what Canada needs is an opportunity, because this really comes home when reading second opinion. We do not have, anywhere in Canada or indeed North America, evaluation for new medical technologies.

We put stuff into bodies-well, this is maybe an overstatement but we will use medical devices with fess evaluation than we require automakers to go through in putting devices on cars. The case is made that we had better get our act together, and we agree. We have participated, in part, on some initiatives because, you have to appreciate, this is a very, very complex issue, to evaluate medical devices. First of all, you have to decide who does it. My opinion is, that for a population of one million and with the health budget we have, we cannot afford to evaluate every medical technology.

That position is shared with other health ministers. It is only Quebec and Ontario who have significant-sized provinces, wherein they can un de rtake , possibly independently, evaluation. We are making the case that this is an area for federal-provincial co-operation, so that we can establish the standards. I hope we are able to achieve some co-operation there. The biggest issue is going to be, okay, who pays? Well, we are all going to have to pay.

We do that within the Canadian blood system where we have a national agency so all provinces did not have to re-invent the wheel, and we all contribute according to our population. So I think we can do that. The second issue is how then, if we have the formal approval vehicle in place, are we going to be able to have the opportunity of evaluation, because the public pressure is going to be there. I will give you two examples in the province of Manitoba. We have CAT scans at Brandon General Hospital and the two teaching hospitals, St. Boniface and HSC.

We have one community hospital that is into its second year of operation of a CAT scan. All other community hospitals are ready to go with a CAT scan. They want to have CAT scans because the drive in the system is there. They make, in their estimation, an excellent case for those CAT scans. Do you know what we do not have in Manitoba? We do not have an evaluation as to the protocol for use of a CAT scan. In my opening remarks, you might recall that I indicated one of the areas the Centre for Health Policy and Evaluation is pointing out to us is that in a five-year period of time, I believe

3973 LEGISL ATIVE ASSEMBLY OF MAN ITOBA June 27, 1991 it was, the investment, the cost of medical imaging went up 450 percent, driven by CAT scans, MRls and other sophisticated imaging technologies and modalities. That is only the beginning. I mean I had the opportunity to see what is on the horizon. There is a medical imaging technology, which is not MRI, where you line up, through magnetic intervention, the ions on your body and get an image. It is not X-ray, as is CAT scan, but it is sensors so sensitive that they pick up every single electrical impulse of your nervous system.

These detectors are so sensitive and they have to be so well shielded that were they sitting out in the open, they would have detected the kick-in of the moon rover on the U.S. manned space visit to the moon. Where they kicked the el ectric moon rover on, it would have picked it up. That modality of imaging is next on the horizon. Let me tell you what it can do. It shows you areas of dead tissue. If you have suffered a heart attack and part of your heart muscle tissue is dead, this will show it, because there are no nerve endings sending out the impulse.

I see a li nkage where that can fit into our health care system. I will give you the linkage. We do open heart surgery. Some open heart procedures are probably done on individuals with dead heart tissue. I do not think I am saying something that is untoward. The medical efficacy of that has to be questioned, but yet you cannot-how does a medical practitioner make that decision? I mean, you have a person who honestly believes as a patient and a family that open heart surgery is going to help the individual. How do you end up saying, well, I do not think it will work?

That kind of imaging modality can better prioritize those who receive the treatment and take it independently away from the judgment call of the physician, who will be blamed if they do not give-and I understand what drives them to make decisions in part. But then the question is: Are we going to use it with an effective protocol and not have it become a commonly used technology across the system? The Centre for Health Policy and Evaluation, having identified the problem we have of growth, is now working very, very dili gen tly to develop protocols for use for both CAT scan and MRI, because St.

Boniface has the MRI in operation adjacent to their research building doing research but also clinical imaging. No question about it, Health Sciences Centre wants an MRI. I have to ask myself, is the $7 milli on-$8 million investment that would require one of the highest priority investments for a million people? Secondly, once invested in and the capital is in place, the imaging costs are, I am going by memory, $700-$800 per image, and I think it takes pretty close to an hour to do the image.

Is that an appropriate use of scarce resource in terms of improving the health status of Manitobans? * (1 540) I am hoping to be guided in those kinds of decisions by the Centre for Health Policy and Evaluation so that I am not accused by critics-a nd I am not saying my critics in opposition, but by critics and observers of the system who say, well, you know the Minister of Health is just deliberately holding back, he is denying us care and we are going to die, because those are the very easy correlations that will be made anytime government would not accede to the latest technology request.

We are taking on evaluation outcome research. Let me bring my answer full circle for my honourable friend so that she understands where we are coming from. The Centre for Health Policy and Evaluation, through the li nkage that we are attempting to develop with Statistics Canada population, will allow us to understand differential health issues.

In other words, where a group, be it through socioeconomic circumstance, location in the province, gender, age, appear to have a health problem which can be remedied, that kind of research allows us to focus our health care dollars in new program and possibly prevention, possibly treatment. It also opens the window to confirm in fact the statistic my honourable friend makes may well be correct, of 20 percent greater incidence of disease amongst working women.

That is an opportunity that we have to statistically identify and, having that information, should that be the case, allows us then to find out what drives that and whether there are prevention remedies that may be introduced into the workplace to intervene early. So-long answer, short conclusion. The mechanisms that we now have in place and maturing allow us probably a greater opportunity to focus on gender specific women's health issues than ever we have had before. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, the minister may have not heard me when I also gave the statistic about illness being 50 percent higher

June 27, 1991 LEGISLATIVE ASSEMBLY OF MAN ITOBA 3974 among women who work in the home than among men. I think both those statistics in terms of working women and women who work in the home are important in terms of where we go with respect to health care policy for women and make it incumbent upon us to address very seriously the underlying social conditions. I think those statistics probably, without doing a lot of research, point to economic, social factors and barriers facing women today. I apprecia ted what the mini ster said about evaluation and testing.

I would suggest that, while there is a correlation between products being put on the market and public demand before perhaps adequate testing and research has been done, there is probably an even stronger correlation between such products getting on the market and doctors encouraging and wanting those tests and those products because of the whole fee structure. There could also be a very high correlation in terms of, and I think the minister already said this, between just the drive of the health products companies to get things moving.

I would guess, based on the kinds of incidents that we have had in our society over the last little while, that it is likely that when it comes to women's health and partic ul arly repr oductive health issues, products do not go through the same kind of stringent evaluation and research and get put through the same standards that would be the case in terms of products and services and drugs for the population as a whole. I think that the recent controversy around the Meme breast transplant is a good one.

We are not sure about all the facts on this one and it is still an ongoing controversy, but I think. that points to a serious issue. I wanted to ask the minister on this whole topic about the correlation between-or to ask him if research has been done in terms of the correlations between breast cancer and diet nutrition and correlations between breast cancer and treatment for PMS, because I think there are some serious issues there as well. Mr.

Orchard: I am informed that both of those issues have been studied, not in Manitoba, but have been studied and apparently are part of the study material that the impleme ntation committee on mammography is looking at. Ms. Wasylycla-Lels: I appreciate that. I was quite shocked to learn that when it comes to PMS, the standard approach in our society these days is to basically say we are dealing with an ovarian failure, therefore we are dealing with a hormone deficiency and therefore we need estrogen therapy.

Studies recently tend to show that among those who end up having estrogen therapy, there is a dramatic increase in terms of breast cancer. In fact, it was told to me recently that among women who have been on estrogen therapy for nine years or more, there is a 70 percent increase in breast cancer, and among those women who have been on both estrogen and progesterone therapy for over four years, there has been a 200 percent increase in breast cancer.

I think that tells me that we have not done the kind of research that is necessary and sometimes it seems to me, and I do not want to get the minister all excited, women tend to be used as guinea pigs, much more so than in the case of men. I think if men could get pregnant, we probably would have seen safe products for birth control on the market a lot earlier than we did or than is the case today. Mr. Orchard : Mr. De put y Chairman, it is interesting. My honourable friend and I are even going to agree a little bit on this, and this may just absolutely blow my honourable friend from St.

Johns away, but I do not disagree with what she is saying.

I have had some discussions with the Women's Health Clinic, and it impressed me that their program-now I cannot say because I simply do not have knowledge of what other groups are doing in terms of their assistance with PMS-but if my memory serves me correctly, they have a woman physician on staff and they approach PMS from not the chem ical in tervention me thod, with the emphasis solely on chemical intervention, but rather on an acceptance to a degree that this is a natural phenomenon of aging that women will go through and give them noninterventive advice on how they can come to grips with the issue.

I cannot tell you what they are, but all I can say is there are groups that very much are taking the issue seriously. I support their initiatives. I was very intrigued with the discussions I had. That is going back about a year and a half or two years ago. These issues will come out and be resolved as a natural evolution, and I saythatfrom this standpoint. The students in medicine used to be almost exclusively men. If you want to go back 35 or 40 years ago, I bet you did not find more than a couple of women in the faculty of medicine. Now I think it

3975 LEGISL ATIVE ASSEM BLY OF MAN ITOBA June 27, 1991 is close to 50 percent, and as more women are trained as doctors, then there will be more emphasis on the practice of medicine in a nonpharmaceutical, or however we want to put it, method for women because there will be more understanding by the practitioner as a women on women's health issues, rather than the practitioner as a man on women's health issues. I am not saying that men have not taken women's health issues seriously.

They have, but I think it is also fair to say that they do not have the same perspective and understanding of the issues that women trained in medicine do. These things -(i nterjection)- All I am saying to my honourable friend is, you know, I am not hung up on what my honourable friend says. I think she is right. Discussions I have had, particularly on PMS, have very much confirmed what she has said. There are opportunities to deal with that in a more progressive way, I guess is the word to say, rather than the traditional- well, my honourable friend said, the feminist way.

I do not know whether I would say the feminist way, because that might cause my honourable friend to call me a pinko. I know she would not do that to me. Well, you would never call me a chauvinist. The issues are being addressed and are being addressed in a more noninvasive way, which I think is appropriate and proper. -( interjection)-Well, I will not get into what I do personally. * (1 550) Ms. Wasylycla-Lels: Mr. Deputy Chairman, just to back up briefly, I have one more moment on the mammogram and breast cancer.

Right now, in the absence of a breast screening mammogram, I assume that all patients, all individuals who need a mammogram require or must-how can I put this ?-are then referred for a diag nostic mammogram. Is that correct? Mr. Orchard: I want to correct just one word: "need." Women who have been told they should have a mammogram right now have to access formal fee-for-service system and have a diagnostic mammogram. The process is the same, but the costs are higher than what you would normally encounter in a screening program. Ms.

Wasylycla-Lels: Could the minister indicate what the waiting list would be for women who have been told that they should have a mammogram? Mr. Orchard: Mr. Deputy Chairman, I do not think there is a waiting list and very small if there is one. Ms. Wasylycla-Lels: Roughly how many billings are done in terms of the diagnostic mammogram? Mr. Orchard: It has been growing. I think I have it here now. Manitoba Health Services Commission in 1989-- there were over 24,000 mammogram billings; cost, $1.9 million. It is estimated, because that is the best we can do, that 60 percent of these were done for screening purposes.

Ms. Wasylycla-Lels: Could the minister clarify what-is he saying of these billings, some were screening mammograms? Mr. Orchard: The estimate of the just over 24,000 mammograms, costing $1 .9 million, is that 60 percent of them were done for screening purposes, in other words, meeting a criteria of a screening program. Ms.

Wasylycla-Lels: It would seem then that there is not only from a human health point if you have some urgency to get the results of the study on breast screening, but there is also a cost issue involved because, in fact, if the breast screening procedure is roughly half the cost of the diagnostic mammogram, then the minister could be looking at saving up to a million dollars. So I just wanted to make that point, and ask, is it by this end of the summer or this fall that the minister expects to receive the final report and then make a decision? Mr.

Orchard: The working group-I am expecting a report in the fall of this year with recommendations from them . I am trying to find in some of my information here-yes, my honourable friend is right. If we can do a shrewd enough negotiation with the radiologists, probably we can cut the cost per mammogram, currently diagnostic at $75, in half and probably can contain costs. You have to remember, on the other hand, if we are going into a screening program we are going to-the target that has been suggested is 50- to 69-year aged women so that you would probably have greater numbers.

Your cost to the taxpayers would go up, probably not go down, because you would do more numbers. Secondly, bear in mind that there is no mature access criteria as to who ought to have a mammogram outside of the screening age group. Scree ning age groups have even been recommended for 40 and up, and the drive currently

June 27, 1991 LEGISLATIVE ASSEM BLY OF MAN ITOBA 3976 in the United States has intrigued-I knew this was some place, but the latest media advertising in the U.S.A. and from numerous American professional gr oups, promotes mammography sc reening commencing at age 35. There is not really the statistical justification for 50 to 69.

I say that because Norway made the decision that they were not going to do it because there was not the evidence there, but appreciate my earlier point about the drive, that now young women may well think that they are being denied qual ity medical services if they cannot get a mammography at age 35. I am concerned about that because scientific evidence does not prove positively that it is good, and there is some evidence that it may, in fact, increase the incidence. Ms. Wasylycla-Lels: Just one more question on mammography.

In terms of the minister studying this whole issue, in addition to studying the health consequences of the actual screening process itself and the cost effectiveness of it, is he also looking into the different models, should a breast screening program be deemed to be the right way to go? Is he looking at the different options of putting in place such a program? I am thinking specifically, given the nature of our province and its simila rity to Saskatchewan, is he studying their travelling mammography unit? Mr.

Orchard: Well, that is one of the options of a fixed location unit for the major population centre of Winnipeg and then mobile units should the program come in. That prejudges that we are going to go with the program, but that certainly is one of the options. Additionally, we continue a one-to-one teaching and edu cational and exam ina tion program. I do not have, because appreciate I do not know what is the right thing to do, a preconceived idea as to what we ought to do. *

(1600) That is why-and then maybe it might help if I indicate to my honourable friend the members of the working group, because we have probably put together the pre-eminent experts in Manitoba on this committee. There is Dr. David Bowman from the Manitoba Cancer Treatment Foundation; Dr. Barry Anderson-now I do not know where he has come from; Chuck Sawyer; Pat Kaufert; Dr. Noralou Roos from the centre; Charlene Black; Dr. Heather Domke from the MMA; Dr. McKeown, who is a radiologist; Dr. Janice Sasneck, a pathologist; Dr.

Patricia Mirwaldt; Tracey Kelly from the Cancer Society; Leah Weinberg; Sandra Gessler, and then Sue Hi cks as dire ctor from the Women's Health Directorate. As a matter of fact, Sue Hicks chairs the group. Ms. Wasylycla-Lels: Just quickly, very briefly, on the issue raised by the member for The Maples (Mr. Cheem

a) on the early hospital disc harge postpartum follow-up program, a program which I certainly support and have personally benefited from. My question is-- and I am concerned that it appears that there has been a significant increase in terms of early hospital discharges, but not a commensurate increase in terms of public health staff to do the kind of follow-up work that is required, so you end up with overworked public health staff resources being stretched to the utmost and probably less than adequate services provided. I am wondering is that the case, and if so what is being done about it? Mr.

Orchard: Well, I think, pretty clearly, that was the case in January and possibly for the week leading up to and maybe for a week or two afterwards, not as a regular occurring event. Clearly, we understand that the program cannot be brought in without the ability to provide adequate community services. Let me tell my honourable friend what we are trying to achieve.

If we are going to, for instance, bring in as a program the early postpartum discharge across the system, and that is going to cost us some additional resource in the community and save resource in the hospital, we want to make the transfer from institution to the community. If you do not do that without being unfair to the institution, that budget line will continue and then you have built and you have added to the community line.

There has to be the replacement and that is not always easy to achieve, because every hospital will make the case that they have other places within that they can utilize that budget, but that does not get you to ins titutional reform and enhan cement of community-based programs unless you make the linkage. Ms. Wasylycla-Lels: Related to that issue, of course, is the whole midwifery issue and as the member for The Maples (Mr. Cheema) noted, the minister is circulating a report from the College of Physicians and Surgeons and MARN, a report

3977 LEG ISL ATIVE ASSEMBLY OF MAN ITOBA June 27, 1991 which has a particular point of view. It is very much focused on the nurse-m idwife issue and does not at all recommend the other options. I am wondering, in this consultation process, if the minister is encouraging a response equally to the kinds of proposals and suggestions being made by the Advisory Council on the Status of Women. Mr. Orchard: Well, actually, Mr. Deputy Chairman, the Advisory Council on the Status of Women can feel gratified because that is why we ended up with the joint report between the college and MARN.

Without belittling the work done by the Council on the Status of Women, one of the critical analyses of that report was that it did not have the input of the professional side, be it nursing or physicians. Their report led us to the joint efforts of MARN and the college to deliver the report which is out for comment, including from the Status of Women, so tha t they can adv ise or critique the recommendations. In general, I think there are several issues that have been identified which have to be resolved for implemen tation of program. The first one is in terms of the add-on to the system.

I do not think anybody wants to have midwifery as a pure add-on to the system. In saying that, you have to come around with one other major is sue: Who practises midwifery and what are their training requirements? After you answer that question: Can you access trai ning programs elsewhere? Can you, for instance, certify already trained midwives who are here from other countries that have midwifery as part of their health care system? All of those questions are answerable, if you will.

Then you have to establish the liability issue, and of course one of the things that sort of maybe confused the issue was not the issue of midwifery as a professional care delivery system, but midwifery got very much associated with the issue of where a birth takes place, i.e., the home-birthing issue. The attachment of midwifery to home birthing is probably linked in many minds, but they are not necessarily the same issue. They are entirely separate. Mid wives can deli ver home births. In some countries they indeed do that under certain circumstances. That is not the link age that we made as government.

We wanted to look at midwifery as the pr ofession and how it can be potentially incorporated into the Manitoba health care system. You get around that issue; then you have to deal with the where issue. After you establish whether it can be introduced, what is the professional training? What is the liability? What are the circumstances under which the program would operate? Then you can move into the where issue. The where issue, I will tell you right now, I do not want to touch until we get the other questions, the fundamental questions, on whether the program can be fit into the Manitoba health care system. Ms.

Wasylycla-Lels: I would just make one final comment on this issue, and that is: I hope we do not in this whole process shut the door to options other than nurse midwifery. I hope we look at the results in Ontario and I hope we study other countries' examples, because the way I read the report that the minister is circulating, it is a pretty definitive statement on a general policy basis. It does tend to rule out looking at other options. I just hope that the minister and his government does not close the door on that whole issue. Mr. Orchard: I do not think we are closing the door.

I think we are trying to open the door on what is an appropriate educational standard for midwifery in Manitoba. Anytime government would bring in a new program as part of the health care system we become responsible for the qual ity of service delivery that comes out of there. That is why I indicated to my honourable friend, I did not want to get into the issue of where birthing takes place, but rather the qualifications of who might be a birthing attendant, and so I used the generic language of birthing attendant that may well be what is commonly known as a midwife. Ms.

Wasylycla-Lels: I am raising mostly concerns around "who" not "where" because I am concerned about the focus on going the nursing route and the baccalaureate route in order to qualify as a midwife. We have not resolved a position on that. I understand Ontario is not going that route and I would like to keep that option open.

Now, on to an issue that has tended to be fairly controversial in the past and will probably be so again and that is the question of reproductive health and whether or not the minister has changed his mind at all about the ques tion of deinsuring therapeutic abortions in community clinics in order to avoid a costly court case? Mr. Orchard: We are going to argue over the language again. We are providing access and

June 27, 1991 LEGISLATIVE ASSEMBL Y OF MAN ITOBA 3978 coverage under the health care system as required by the Canada He alth Act . That issue was resolved, I believe, in July of 1988 and, in our opinion, remains resolved. We have, as my honourable friend well knows, an outstanding issue which may well be before the courts. We believe our provision of therapeutic abortions in Manitoba will sustain any challenge initiated by anyone on any of the provisions of the Canada Health Act. We have not deins ured therapeutic abortions as my honourable friend has so alleged. *

(1610) Ms. Wasylycla-Lels: The minister would not want to quarrel with the phrase "deinsuring therapeutic abortions in community clin ics" because that is precisely what he has done.

In the past when we have raised this and questioned the wisdom of it and referenced it in terms of provisions that tlave been made with respect to paying physicians' fees in other private clinics, the minister has suggested that the Morgentaler Clinic has been treated differently because the minister has said, and I am going back to Question Period of October 1 990 in our Estimates for last year, that he has referred to "anyone performing a therapeutic abortion ought to have access and admitting privileges to hospitals. n Is the minister still basing his-or at least part of his decision on that thinking and that argument?

Mr. Orchard: Mr. De put y Cha irman , if my honourable friend mi ght recall, the college extensively dealt with the issue and indicated that any therapeutic abortion must be performed by a physician with admitting privileges to a hospital. That led us to a crafting of the regulation that my honourable friend refers to and the issue around which we passed the regulation was an assurance of access then to needed health care in a procedure which has risk, as all medical procedures do.

In making that regulation, we have ensured a greater degree of health protection for women in Manitoba and not, in any way, restricted or interfered with the Canada Health Act. Ms. Wasylycla-Lels: I would think the minister should know that the college licens ed the Morgentaler Clinic to perform therapeutic abortions because it was satisfied that the clinic could do the service safely in a free-standing clinic. Mr. Or chard: Well, now hold it. Mr.

Deputy Chairman, before my honourable friend gets too far out on the limb as to what the college did or did not do, what the college did was inspect the facility and indicate that the equipment and the facility was up to the standards that they insist on in terms of infectious control, et cetera. In licensing the Morgentaler Clinic, they sa

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-2-74
Type	hansard
Volume / chapter	35th 2nd hansardpdf 74.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	0d37d438c424eca27e10732b4daa09225549342d

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