1993 Legislative Session: 2nd Session, 35th Parliament HANSARD

The following electronic version is for informational purposes only. The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, MAY 13, 1993

Afternoon Sitting

Volume 10, Number 1

[ Page 6235 ]

The House met at 2:03 p.m.

[E. Barnes in the chair.]

G. Farrell-Collins: I would ask the House to help me welcome 45 students from Walnut Grove Secondary School in Langley township. They are here today on a tour along with their teacher, Ms. J. Lauber. Would the House please make them welcome.

Hon. L. Boone: In the gallery today are two friends, Faith Hulbert from England and Kay Hayes of Victoria. Would the House please make them welcome to our wonderful city and province.

M. Lord: I'd like the House to join me in welcoming today members of the Catholic Women's League of Canada. Joining us today in the gallery are Ruth Hazlett, Madeline Durjata, Margaret Beardon and Jacqueline Lenarduzzi. Would the House please join me in welcoming them.

L. Reid: I'd like the House to welcome 27 students from Garden City Elementary School in the riding of Richmond, as well as their teacher, Ms. Gilbert.

A. Warnke: In the gallery today is a former student of mine, whom I taught ten years ago at the University of British Columbia, Rob Guzyk; and Carolyn Jones, who works as a television journalist in Adelaide, Australia. Would the House please make them welcome.

W. Hartley: Visiting here today is a group of students from Davie Jones Elementary in Pitt Meadows. Please make them welcome.

H. De Jong: From the beautiful constituency of Abbotsford we have with us today Diana Pope, who is spouse to another Fraser Valley Credit Union director. We also have with us Lil and Ross Jersey, who at one time were neighbours to us in Abbotsford. They are accompanied by Rosemary Juby, who is from Sault Ste. Marie, Ontario. I ask the House to give them a cordial welcome.

F. Gingell: In the precincts today is Patti Bruce from Delta. I hate to outdo the Minister of Government Services, but she has with her two visitors from England: her aunts, Maizie Watson and Elsie Standen. I ask you please to make them welcome.

Hon. M. Sihota: Hon. Speaker, Mr. Garth Gislason, our chief of Hansard and television services here in the Legislature, will be retiring from his duties at the conclusion of the legislative proceedings today. Garth began his legislative career as a sessional reporter in 1973, so I guess he's seen a lot of d�ja vu all over again.

Interjections.

Hon. M. Sihota: No, but that's not why he's retiring. By 1976 he was appointed chief of Hansard, where -- I'm sure all members who've had an opportunity to interact with him will agree -- he has done an outstanding job over that time period. Garth should be especially congratulated for successfully overseeing the installation of our television system in 1990, which the previous administration, in conjunction with the other parties in the House, brought forward. I would add, hon. Speaker, that our televised proceedings here in B.C. stand second to none in Canada, for the obvious reasons.

I know that Garth is held.... Maybe some of you didn't get that. I know that Garth is held in high regard by his staff and is respected by his colleagues, both here and right across this country, for his wealth of knowledge with regard to these matters.

I also understand, hon. Speaker, that Garth will be retiring to the sunny climes of Mesachie Lake, an area I grew up in. It's a small community just outside Lake Cowichan, where I was born, and in the old days it was where one of the first Sikh temples in British Columbia was situated. It's an area that is now, of course, full of golf courses, beautiful lakes and access to remarkable fishing. I'm sure that Garth will enjoy the climes of Mesachie Lake, and it's something that is well deserved. On behalf of all hon. members, I am certain that I can convey to Garth all the best in his future endeavours and thank him for a job well done.

Hon. Speaker, Mr. Peter Robbins, our deputy chief of Hansard, will begin as acting chief of Hansard. I'm sure that Mr. Robbins will continue to ensure the high quality of Hansard service which hon. members presently enjoy.

J. Dalton: I wish to endorse, on behalf of the official opposition, the remarks of the Government House Leader. Garth will certainly be missed. I know you're watching, Garth, and I presume you're going to take a tape of this session with you in your retirement. I think perhaps also that Garth may not be watching too much television from now on, if he wants to enjoy his retirement. He may not wish to sit down -- as many people were told to do; and well they should -- to watch these sessions. But, Garth, we do wish you well. I know that all members and all the people of this province do so. We owe a lot to that gentleman.

C. Serwa: I, too, welcome the opportunity, along with the Government House Leader and the Opposition House Leader, to recognize Garth and to congratulate him on his 20 years of service not only to ourselves as legislators but also to the people of the province.

I hold Garth and the entire Hansard staff in the highest regard for their accuracy, the amount of activity and the rather trying conditions they often have to work in, whether in the field or here in the Legislature in the rather congested quarters that the expanded group has. There has been a great commitment to accuracy on the part of

Hansard , and we're all the beneficiaries of that commitment. The attitude of Garth has been transmitted to the staff, and again, we have benefited well from that. I would encourage the communicators

[ Page 6236 ]

of the Legislature, the scribes who sit in the balcony, to strive to match the accuracy and objectivity that has been exhibited by Hansard. I think it's an example for them to strive toward.

On behalf of the Social Credit caucus, I congratulate Garth on his contribution of 20 years' service not only to this Legislature but also to the people of British Columbia.

D. Mitchell: Just very briefly, I'd like to add my words of thanks to Garth Gislason, someone I've known for many years. I know that his staff in the Hansard service regard him as a sea of calm in the hurricane of words that emanate from this chamber every day during the session. His staff works for 16 hours a day, every day, when the House is sitting.

Their commitment to maintaining what is the best Hansard verbatim reporting service in Canada, as well the finest television production of legislative proceedings in the country, I think is testimony to the leadership that Garth has shown as a pioneer in Hansard in British Columbia. I'd just like to add my words of congratulations to him and hope that his retirement in the Lake Cowichan area, to his dream home that he's building there, goes very well.

Ministerial Statement

COMMISSION OF INQUIRY INTO VANCOUVER STOCK EXCHANGE

Hon. G. Clark: I rise to make a ministerial statement. The government announced this morning that Mr. James Matkin has been appointed under

part 2 of the Inquiry Act to review the regulation of the VSE and its market participants. Mr. Matkin, who recently left the Business Council of British Columbia, has been given six months to recommend how to improve the regulation of the Vancouver Stock Exchange. I would like to tell this assembly why the government has commissioned this review. It is generally accepted that the VSE should strive to be a fair and efficient venture capital market and could make a significant contribution to the development of a strong and internationally competitive financial services sector in the province.

Since its establishment in 1987, the British Columbia Securities Commission has made great strides in improving the regulation of the VSE. With its highly dedicated and professional staff and new legislation, the commission has built a strong and well-deserved reputation for tough but fair enforcement. This government has every confidence in its work. I have no doubt that its regulatory reforms have greatly improved the reputation of the VSE. I don't think anyone would disagree with this assessment, but the VSE can't seem to shake its reputation as a haven for fraudulent and abusive practices.

The VSE's troubled reputation is one of the obvious reasons for commissioning the review, but it is only a symptom of the VSE's problems. The VSE is caught in a kind of catch-22. It won't be able to overcome its reputation until it can attract and retain more good listings, but its reputation makes it difficult to attract those listings. This is one aspect of the problem.

It is clear from Mr. Matkin's terms of reference that the purpose of his review is to give us a fresh, independent look at the underlying cause of the VSE's problems and show us where we are on the right track and where we could think about refocusing regulatory resources with respect to the VSE.

I would like to read the terms of reference. Mr. Matkin will inquire into and make recommendations on the responsibilities of the VSE to regulate the various participants in its market and the adequacy of its powers and activities in meeting those responsibilities.

The responsibilities of the British Columbia Securities Commission are to regulate the VSE, various participants in the VSE's market, the adequacy of its powers and activities in meeting those responsibilities and the civil remedies provided under the Securities Act to parties to securities transactions in B.C., the effectiveness of the offence provisions of the Securities Act in providing a deterrent to illegal activities in the securities market in British Columbia, and the allocation of resources to criminal prosecution of securities-related offences in B.C.

[2:15]

Mr. Matkin's review will help us assess what new directions might be taken to regulate the Vancouver Stock Exchange. That should also help the Securities Commission to fulfil its mandate effectively and efficiently. I cannot overemphasize that the review is intended as a positive step towards helping improve the regulation of the VSE and investor confidence in that regulation. That kind of turnaround could enable more British Columbia companies to seek public financing through the VSE, making the VSE a key factor in the development of British Columbia's financial sector and overall economy.

F. Gingell: Hon. Speaker, capital markets are a critical and important component of a successful business infrastructure. It is important that our exchange be well regulated, well policed, and so, well respected in the business community. But respect can only be earned. I hope that this inquiry and the recommendations flowing therefrom will be a foundation stone in creating a market that has investor confidence. I'm very pleased that the minister has seen fit to call this inquiry, and the opposition looks forward with interest to the results therefrom.

C. Serwa: It's a pleasure to rise.... I would like to thank the minister for advance notice of this, but I shan't, because we didn't get any advance notice.

The Vancouver Stock Exchange has been a very important focal point for the raising of venture capital in the province of British Columbia. In fact, a great deal of the strong economic activity we have in this province is dependent on the ability to fund and finance all sorts of projects throughout B.C. I know that we as well as the government are as concerned with jobs and opportunities for people as anyone else in the province.

There is no question that this is a welcome initiative. Certainly, when the Minister of Finance and the

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Minister of Labour and Consumer Services were in opposition, they spoke long and loud of their specific concerns, and it's nice to see that after almost two years they're starting to take some action on this. The credibility of the Vancouver Stock Exchange is really required to maintain the faith, trust and confidence of investors. So we agree to that. We're also well aware that the Minister of Finance has an incumbent responsibility to make these recommendations and the review available to the public, and we look forward to the release of that information.

Deputy Speaker: Hon. members, in response to a point of order raised yesterday relating to the conduct of question period, I have examined the Hansard Blues for Monday, Tuesday and Wednesday of this week. This examination of Hansard discloses that several of the questions and many of the answers do not comply with the limitation expressed in standing order 47A(b), which I will repeat for the guidance of all members at this time: "...questions and answers shall be brief and precise, and stated without argument or opinion...."

Question period belongs to all members of the House and is not the exclusive property of the opposition, nor is it the exclusive property of the government. If

preambles to questions are inordinately long or contain provocative material embodying argument or opinion, it might be expected that answers to such questions would tend to be disorderly. If answers to questions are excessively long and likewise contain argument and opinion, dissatisfaction and calls for order will undoubtedly follow.

While a robust exchange is the hallmark of a good question period, if members on all sides of the House are uncomfortable with the present status of question period, I would ask members themselves to take the time to examine the Hansard Blues and measure the propriety of their questions and answers against standing order 47A(b), which I have quoted. Members will understand that while the Chair does not wish to continually intervene in question period, thereby interrupting the natural flow of questions and answers, it may be necessary to do so if dissatisfaction continues to be expressed.

Finally, all hon. members will recognize that there are extensive rules in the parliamentary authorities limiting the scope of questions and answers during question period. If these limitations were strictly enforced by the Chair, it seems that question period would be unduly restrictive. The Chair will restate the most useful guideline which can be found in the parliamentary authorities: questions and answers shall be brief and precise, and stated without argument or opinion. The Chair seeks the cooperation of all members in this matter.

Thank you, hon. members, for your attention.

Oral Questions

WELFARE PAYMENTS MANAGEMENT

V. Anderson: My question is to the Minister of Social Services. Will the minister, in the name of open and honest government, briefly tell us when in fact she first read the "non-existent," "speculative," "inaccurate" draft of the project to monitor administrative error and fraud that was prepared by her staff in November 1992?

Hon. J. Smallwood: I'd be pleased to answer that question. I read it the day before I tabled it in the House.

V. Anderson: A question back to the Minister of Social Services. The minister initially denied that the report existed. Then she dismissed it as speculative and inaccurate. Next she acknowledged that the staff had implemented changes from that report, apparently also without her knowledge. How can the citizens of this province now believe the minister in what she says? Will the minister please tell us who is in charge in her ministry?

Hon. J. Smallwood: To the member and his extensive question, let me start by telling you that I am very proud to be a part of this government and in charge of this ministry. Now let me answer the multiple questions that you put to me.

First of all, I have publicly said that it is regrettable that this report was not brought to my attention prior to releasing it in the House. I regret that very much and have registered that with our ministry staff. This is a priority area for me. It is an area that I have been working on actively for the last 18 months, since we came into government. The beginning of this work commenced on receiving the auditor general's report, the audit that was done in 1991. The recommendations from that report are recommendations that we are acting on.

The report that you are talking about, hon. member, is a report that was commissioned by ministry staff as an administrative tool to carry out the task that I set out for them.

Deputy Speaker: The hon. minister will be concluding soon?

Hon. J. Smallwood: The opposition critic asked me three or four questions. I am treating those questions seriously and intend to answer them.

The administrative tool, the report that I tabled with this House, helps guide the work of the enhancement of the auditing

section within our ministry. It was recommended and directed by the auditor general's report of 1991. I have said that this report is speculative.

V. Anderson: The auditor general, the clients of the ministry, representatives of the RCMP, 200 of the minister's own staff and the public at large have all stated there are problems with the social assistance system in this province. Will the minister commit today to an official independent inquiry, a total review of this welfare ministry?

Hon. J. Smallwood: Let me say that we agree with the auditor general. We are acting on the auditor general's recommendations. It is the second time that

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the auditor general has brought this to the attention of government; in 1980, with the previous government, the auditor general said the same thing. We are acting on his recommendations, and we are bringing this system under control.

A. Warnke: My question is to the Premier. The Minister of Social Services -- who, incidentally, has increased her budget by over $900 million in the last two years, and not only that, had the audacity to come in here just weeks ago with the biggest budget overrun -- first denied a report addressing extensive fraud and error, and even denied it to the Premier's own staff, then doubted the report's findings and then tabled the report, adopting 16 of the 58 recommendations. How can the Premier accept a member into the cabinet who withholds information from him and from the public, and who has exhibited no credibility in handling her portfolio?

Hon. M. Harcourt: It is unfortunate that there are a number of British Columbians who want to work -- who are in industries in towns throughout this province that are suffering through some changes in forestry, mining and other areas -- and have to apply for social assistance. But that safety net is there for people in need. According to the Canada Assistance Plan, if people qualify, they receive social assistance.

I think people are aware that at least 20 percent of the caseload in this province is a result of people moving to British Columbia from other parts of Canada. Those people find that the generosity of the people of British Columbia has been tested by a federal government which has off-loaded over $500 million of extra social assistance taxes onto our taxpayers. I think most people realize that that's the situation we face.

It wasn't the minister who increased her budget. That is an entitlement received by people in need. The minister has made it very clear over the last few days, and the members unfortunately don't want to listen. They just want to ask the questions they have prepared. They haven't listened to what the minister has said about this government establishing a fraud squad to search for people who are trying to defraud the system.

Where there is administrative error, there are administrative problems that have been identified by the auditor general. This government and this minister is prepared to move on that, too.

A. Warnke: My question is again to the Premier, because evidently he missed the point completely the first time around. We are beginning to see, in this administration.... Just a week ago the Minister of Agriculture, and now the Minister of Social Services, clearly demonstrated: "Oh, I was just uninformed, and now I'm going to blame my staff." By publicly expressing that, the Minister of Social Services has clearly demonstrated that she does not trust her staff, does not understand her staff, does not respect her staff and has lost confidence in her staff. Therefore, hon.

Speaker, will the Premier, in the name of good government and ministerial responsibility, replace this minister in order to restore the credibility and confidence of this disastrously run ministry?

[2:30]

Hon. M. Harcourt: I think I heard most of what the member had to say between sputters, and even the last of what he had to say. I will repeat what the minister has said: fraud and administrative errors in the welfare system did not start on October 17, 1991. The auditor general's report, which this staff report was asked by the minister to look into, was based on findings from 1991. The minister has moved from the beginning to take the fraud artists out of the system and into the courts and jail system.

She has said that where there is administrative error and we can improve the system, we will improve the system. I have confidence that this government, with this minister, will be able to deal with fraud and administrative errors and problems effectively.

R. Neufeld: My question is to the Minister of Social Services. It's obvious that this minister is living proof that the Peter principle is the only principle that's working well within this government. She's in charge of a budget of $2.8 billion and doesn't even know where the money is being spent. She talks about the auditor general's report and trying to act on that for 18 months. She's been told many times about fraud within her ministry. She commissioned a report and it's been there for five months. Why did she not know that some of those recommendations had been acted on and that the report was finished?

Interjections.

Hon. J. Smallwood: If the member who asked the question would like to listen, I would really appreciate the opportunity of once again putting on the record that from the moment we took government, from the moment the auditor general tabled his report, we began the process of dealing with the accountability of the system. We did not wait for a report that was tabled in November. We have been working on enhancing and protecting this system since day one.

A week ago in this House I stood up and brought to the attention of the House the initiatives that we have progressively put in place over the last year, before we had additional resources in this budget to dedicate to our enhanced fraud squad. That's one, Mr. Member.

Two, in recognition of the enhancements needed to our auditing system, we sought and received support from Treasury Board and from members of this government, during a very difficult fiscal time, to enhance the ability of this ministry and to give them the additional tools needed to be able to account for that system.

Let me tell you that the people in our ministry are doing an admirable job, and it's about time that a government backed them up for that.

Deputy Speaker: On a supplementary, the hon. member....

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R. Neufeld: I would say to that minister that increasing her budget....

Deputy Speaker: Order, hon. member. Please wait until you're recognized.

The hon. member on the supplementary.

R. Neufeld: Well, it's about time that minister.... She increased her budget by $900 million. She ought to be able to take care of those issues and know what's going on within her budget. She doesn't know what's going on within her budget.

Last fall in this House I asked for an investigation with regard to the fraud that was going on within the ministry. The minister scoffed at that idea and said it was groundless and that there was no fraud. Why do we now find in this report $100 million in fraud and another $36 million in administrative errors?

Hon. J. Smallwood: Mr. Member, batting numbers around in such an irresponsible fashion doesn't deserve a response.

The member asked about the increase in this budget. Let me share with the member the legal requirements of this ministry. The provincial legal requirements....

Interjections.

Deputy Speaker: It would be very helpful if the hon. minister would try and answer the question.

In light of the appeal to all members, this is....

Interjections.

Deputy Speaker: Order, hon. members! I think it's a matter that we should all reflect upon, because clearly members are not pleased with the questions or the answers because of the length of time they have taken. Members should realize that if questions are provocative, as I've pointed out under

section 47A(b), they're likely to induce a similar response. The rules, if strictly followed, would not involve members bringing information to the House but simply asking questions, with ministers responding to those questions. The idea is that this exercise be as efficient and exacting as possible. Clearly, we do have a problem, as all members will recognize, I'm sure.

Hon. J. Smallwood: I'll be as short and concise as possible.

The increase in our budget is driven by a legal requirement to meet need in this province. It is legally required of us both provincially and federally. In addition to that, enhanced resources and support to the hard-working staff in this ministry have been made available to be able to control and account for those tax dollars. That task is one I take seriously and am dedicated to, and from day one I have said that any fraud is too much.

Deputy Speaker: Hon. members, because of the time that was taken by the Chair's appeal to members, an extension will be allowed. The Chair is prepared to allow one more question.

FAMILY MAINTENANCE ENFORCEMENT PROGRAM

K. Jones: I can assure you that this is not a provocative question.

To the Minister of Social Services. The taxpayers of this province are carrying millions of dollars of financial burden for fathers who refuse to pay child support. In order to reduce the burden to taxpayers, will the minister commit to revisiting this program to ensure that mothers get the much-needed money and protection from these delinquent fathers?

Hon. J. Smallwood: For the member's information, our ministry is actively working with the Ministry of Attorney General to look at the enforcement program, which is in the purview of the Ministry of Attorney General. We are very supportive of this province's children and single parents.

Deputy Speaker: That concludes question period, hon. members. I must say that substituting for the Speaker does have its shortcomings. Thank you all.

Orders of the Day

Hon. M. Sihota: I call Committee of Supply, and wish to advise all hon. members that the Ministry of Attorney General estimates shall convene in the Douglas Fir Room as

Section A.

Section B, the Ministry of Health estimates, will convene here in the chamber.

The House in Committee of Supply B; M. Farnworth in the chair.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 47: minister's office, $419,400 (continued).

R. Chisholm: A decision has been made within the Ministry of Health that any health care facility that will be opening a new program or service during the 1993-94 fiscal year cannot receive any funding for changing demographics. Can the minister explain to this House the equity of such a decision when in my riding, for example, the acute care hospital continues to need to respond in the emergency room and in other services to a population base that has increased by approximately 6 percent? The acute care hospital is already at the government's desired size of approximately 2.75 acute beds per 1,000 population.

The new services coming onstream during '93-94 -- 100 multilevel care beds on a geographically distant site from the hospital -- are intended to meet a totally different need than existing acute care services. This policy decision unfairly penalizes the budget base of the hospital. Can you tell this House what steps the government will take to review this seemingly arbitrary policy decision?

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Hon. E. Cull: Far from being arbitrary, the funding allocation formula this year was worked out cooperatively with the B.C. Health Association, which represents hospitals, and with the representatives of the employees from hospitals. The formula was not arbitrarily determined by the Ministry of Health; it was determined in consultation with workers in the industry.

R. Chisholm: A few months ago this minister stated that 100 acute care beds were going out to Chilliwack, and these 100 acute care beds were extended care beds. I'm just wondering how the minister assumed that these were acute care beds, and when these were authorized as extended care beds.

Hon. E. Cull: The beds that are being reallocated to Chilliwack are, I believe, extended care beds. I don't have the information here, because we dealt with this the other day, and I had already set aside the Shaughnessy briefing material. In any event, the message from the royal commission wasn't so much in terms of acute care beds, extended care beds or others, but it was pointing out that we have too many people in acute care beds that really do need to be in multilevel care beds. The need in this province is not for more acute care hospital beds.

With some exceptions in the fast-growing parts of Surrey, Delta, White Rock and central Fraser Valley, the need is to provide an alternative for people who are stuck in acute care hospital beds because there isn't any place for them to move into multilevel care beds. Chilliwack General Hospital will be benefiting from 100 new multilevel care beds.

R. Chisholm: When will the hospital be getting these 100 multicare beds? They are not installed already, or in the new building that is being built in Sardis.

Hon. E. Cull: Earlier this year I made the announcement about the entire capital budget for '93-94 and the 436 multilevel care beds that will be built throughout the province. Individual announcements will be forthcoming in the months ahead.

R. Chisholm: It's a different sort of situation there, hon. minister. The Chilliwack General Hospital received a budget increase of $3,000, which is 0.001 of a percent. This is to a hospital that had a growth of 6 percent this year. You have made agreements with different organizations which this hospital cannot meet. It is already facing a million dollar deficit without even considering the new labour accord. With this new labour accord it's going to have another $800,000 added to that deficit.

How do you expect this hospital to be able to operate economically without any deficits if you do not give them the increase they need to fulfil all their duties?

[2:45]

Hon. E. Cull: Chilliwack General Hospital isn't any different from any other hospital in this province, in that they're all facing very challenging budgets. I'll remind the hon. member that he has been calling for spending cuts, not for more money in general -- except when it comes to his riding, and then he wants a spending increase. The amount of money provided to hospitals this year was done in consultation with the hospitals. I will also point out to the member that the hospitals, through the HLRA, negotiated their contracts with the unions.

If there is no labour accord they will have to pay wage increases of 4 percent retroactive to April 1, 1993. With the labour accord, they are only obliged this year to pay 1 percent in wage increases. They are then obliged to deal with the reduction in the work hours starting July 1, and the hospitals themselves have told us that they do not believe they will need to backfill any more than 50 percent of those hours. Hospitals are learning all over the province, as they work out their budgets with or without it, that they are better off with this accord.

R. Chisholm: Maybe the minister misunderstood what I said. The hospital received a $3,000 increase. As I said, that's an increase of 0.001 of a percent. I will quote from the chairperson in charge of the hospital, and they were calling for financial responsibility: "The local board soundly rejected the tri-union labour agreement last Thursday, saying it was too rich for the Chilliwack General Hospital to swallow. The primary reason for the board voting the way it did is money. Board chair Casey Langbroek said: "We simply don't have the money for this agreement."

How do you expect this hospital to have a balanced budget or not be in a hole, where you have to bail them out a couple of years down the road, if you're going to keep on making these agreements that hospital boards cannot take into their budget and pay?

Hon. E. Cull: It doesn't take a great deal of thought to realize that if you have a very small percentage increase in your budget, which Chilliwack and many other hospitals have to face this year, you're better off if you're facing a 1 percent increase in your wage bill rather than a 4 percent increase. I assume those hospitals knew what they were doing when they negotiated and ratified their collective agreements with their unions in the last year and that they understood what 4 percent meant.

R. Chisholm: I guess the minister isn't about to address the problem. Like I have said to you before, there has been a 6 percent increase of population. If you add that to what I've been trying to tell you, it adds up: we are going into the hole -- it is a deficit. When you go from a 371/2-hour week down to a 36-hour week, you're giving them a raise, too, I might add.

We may as well go on to another subject. Maybe we'll gain some ground here. This one is a reference to an individual who is a long term care patient. He is married. You've raised it to $34 dollars a day from $23.10. This individual is now going to have to pay $13,000. His wife has Huntington's disease, and his only option right now for keeping himself in extended day care facilities is getting a divorce. That is the only option you have left him. This is unreal; it's

unrea-

[ Page 6241 ]

sonable. The man is working; he's only making so many dollars. You've increased it so that he cannot pay his bills and survive with his wife and family. When are you going to take these individual situations into account with your budget and your board?

Hon. E. Cull: It's unfortunate that the hon. member wasn't in the House yesterday when we talked about this. I explained that in cases where there is a spouse, either inside or outside of an extended care or multilevel care unit, the continuing care staff are calculating their increase in fees, if any, both ways -- with their own individual income as if they did not have a spouse, and in a joint income as if they did have a spouse -- and giving them the best rate of the two.

If someone has a spouse who is living outside of a multilevel care facility and making an income, the individual within the multilevel care facility can declare themselves to be involuntarily separated and have only their income treated in this case. In other cases it might be more advantageous to consider the spouse jointly, because it could be that the person who's in the multilevel care home has the income and is maintaining a spouse at home on that. It's very important that we make sure we give the people who are in couple relationships the very best and lowest rate possible.

We took that into consideration right from the first day that the policy was announced.

R. Chisholm: Hon. minister, maybe you should be telling that to staff at the hospital level, because they don't seem to understand it the same way you do.

I'd like to go on to another area. This is a question on representation on local health councils for seniors. Are you going to have seniors represented on these councils?

Hon. E. Cull: Again, this matter was canvassed earlier in the estimates. The answer I gave was to point out that when the councils are fully in place in 1996, they will be more like municipal councils. There will be people who will be elected or appointed to these boards; they will not be there representing particular segments, caregiver groups or any part of the population. They will be there representing their community, as municipal councils and school boards do.

R. Chisholm: The monitoring of medication for seniors seems to be a problem. Do you foresee in the near future a provincewide central organization or computerized system to monitor medications, especially for seniors?

Hon. E. Cull: Again, hon. Chair, we discussed that yesterday. Yes.

L. Reid: There are a number of issues I wish to visit this afternoon. The first is whether or not there's been any action taken from the minutes of the extraordinary Vancouver City Council meeting on April 27. Let's add some history to the record: "At its meeting on March 23, 1993, council approved a request to address it concerning the proposed closure of Shaughnessy Hospital, subject to the representative from the Ministry of Health agreeing to attend," etc. Those individuals were present.

During the course of the meeting the mayor indicated there were 31 delegations on the speakers list -- again, a very decent reflection of the level of concern from the city of Vancouver as to the future of medical services within their area. There were a number of individuals who spoke to the question. At the conclusion of the meeting: "The delegations requested council to urge the minister to take a further look at the proposed closure of Shaughnessy Hospital and the redistribution of services."

Some of the points raised by the delegations: 50 percent of the patients go to Shaughnessy because of specialized services; the closure will not save money, as money will have to go to the receiving hospitals to enhance services and to assist specialized services; the Shaughnessy site and its related services are unique in Canada; Shaughnessy is one of the best teaching hospitals in North America; the sexual assault program and the women's health centre will not be able to operate as efficiently as on the Shaughnessy site, as no other location will offer the necessary related services; and in order to be effective, the sexual assault program has a series of protocols for collecting evidence, which can only be maintained by ensuring the availability of staff trained in the collection of evidence.

At the end of the meeting the mayor asked the council for some response. It was moved by Councillor Wilson that Vancouver City Council urge the Minister of Health and the provincial government to establish a Shaughnessy Hospital task force to review the present services provided and the impact of their proposed relocation, that the task force make recommendations to the minister on what services should remain at the Shaughnessy Hospital site, and that the transition team planning for closure be deferred pending the report of this task force.

It seems to me that the extraordinary meeting of the Vancouver City Council has asked the minister for a specific action: that the decision be deferred pending the receipt of this report. Certainly, in that we are in the process of Health estimates and I know it is the minister's wish at some point that these estimates conclude, it seems to me that we cannot continue to have individuals in the community still wishing for information, still wishing for a decent decision to be delivered at the time that these dollars for Shaughnessy Hospital are being allocated elsewhere.

It's not prudent decision-making, in my view, hon. minister; it's not even showing any healthy respect for process. It simply says that we're going to plow ahead regardless of what communities believe and feel, regardless of what practitioners in the field believe. It's not a decision that can be supported by this caucus, and it's not a decision, frankly, that was supported by the community members for the city of Vancouver on that particular evening, April 27. It's not a decision, as I'm well aware, that's supported by members of the larger community, the province of British Columbia.

Certainly I know the minister will rise up and say that the task force is operational and is making its report, etc., etc. The issue that I want this minister to

[ Page 6242 ]

address is deferment of the decision -- and certainly discussions today to look at something as important as the spinal cord unit not being moved till after this summer, because May to October is the most frequent and trying time for spinal cord injury. I think what all the groups are asking, hon. minister, is that some time be allowed for consideration of all of these issues.

Rather than have something that goes forward in September or October, at the very least this should be allowed to percolate and be examined in some detail by all the reasonable caregivers in this province, so that the stresses of what people perceive to be an urgent move are not allowed to continue. This is not helping the delivery of health care.

The decision that you have been asked to reach is to defer. I would hope that there would be detailed consideration of a reasonable deferment of six or eight months to allow the spinal cord unit to be operational through the autumn, which is indeed their busiest time, and for other programs to truly be evaluated as to their best relocation or their future at that site. I'm asking you specifically to respond to the Vancouver City Council's motion to defer a decision on the closure of Shaughnessy Hospital.

Hon. E. Cull: I am aware of the motion that was passed by Vancouver City Council. If the clerk of the council has sent that to me, I'm not aware of it yet; I have not yet received it in my mail. But I do have a meeting on May 20 with the Mayor of Vancouver. I'm sure that he will bring it up with me then.

The member talks about all the people who have been opposed to the decision. I would like to remind her that the mayor of Vancouver, one of the candidates for the leadership of her party, is in favour of the closure of this hospital. The chief medical officer, Dr. John Blatherwick, is in support, as is the dean of the medical school, a number of hospital chief executive officers -- too many to enumerate -- and many health care practitioners who happen to take a different point of view in this.

There is a task force in place; in fact there are many task forces in place right now. People who want to participate in decisions about the relocation of Shaughnessy Hospital are more than welcome to get involved in the task forces that are looking at this. Indeed, many of the people who provide those services in Shaughnessy Hospital now are actively working with our transition coordinator to sort them out.

Finally, I would just like to point out that if the member wishes to continue to lobby for deferral of this decision, perhaps she will talk to her colleague from Chilliwack. Ask him what part of the hospital budget, that he already feels is inadequate, Chilliwack is willing to give up. As I have told this member before, the savings that we expect to realize from Shaughnessy Hospital have, to some extent, already been reallocated in the budgets that have been given to hospitals. So I guess she will have to sort out with her colleagues how we would work that out. If we're talking about a deferment, we're talking about having to take back money from other hospitals to keep that one going.

L. Reid: The question was: is the minister listening to the report of Vancouver City Council with reference to deferment? I'm well aware of all the other items you've raised in debate.

Hon. E. Cull: I've heard the point of view of the people who presented their issues to Vancouver City Council. I'm aware of the resolution, although I have not yet seen or had it sent officially to me. I'm meeting with the mayor; I've certainly been listening to him. I've been listening to all of the people who have something to say about this issue.

R. Chisholm: The funding letter sent by your assistant deputy minister to hospitals states in part that there is need to downsize the acute care hospital in relation to other health services. The budget for most hospitals will be insufficient to permit the maintenance of existing staffing levels. This funding letter goes on to state that in all cases hospital management staff and union representatives, representatives of other ministry programs and common community stakeholders will be active participants in both the process of the review and the implementation of agreed-upon recommendations.

The consultation contemplated in the budget letter to the hospitals and the tentative framework settlement require time. Hospitals should be involved in careful planning and infrastructure in our health care system before radical surgery is carried out on their existing programs and services. But a carefully planned infra-structure cannot be achieved in a few weeks or a few months. It is unrealistic to expect hospitals to balance their budgets within a short planning horizon before the government takes steps to downsize hospitals.

There should be a clear, agreed-upon plan in place among all of the stakeholders in each community on what will be offered in place of hospital services. Then and only then should an orderly transference of hospital workers to these new programs and services occur.

[3:00]

What steps can you assure this House will be taken by the government that will address these concerns that I've addressed right now?

Hon. E. Cull: For the information of the member, the hospitals and my staff and the B.C. Health Association and myself started discussions about the '93-94 budget many months before it was brought down. They had a very clear indication of how much money would be available. Indeed the information they were working from at that time was less generous than the final budget allocation. We were very conservative in the information that we gave to hospitals. So they have had many months to prepare for this. Indeed many hospitals did start their preparations earlier this year -- as early as January in some cases -- for making decisions about the future of their hospital.

The cost of maintaining the acute care sector this year, without changing any of the services and also recognizing the growth in population, is a 10 percent increase. I would like to ask the hon. member if he is supporting a 10 percent increase in hospital funding.

[ Page 6243 ]

Because if he's not, there is going to be some change in hospital funding and in hospital services this year.

L. Reid: I want to respond directly to a news release of today's date: "Pharmacare Panel to Review B.C. Drug Plan." It talks about being given three and a half months to come back with some recommendations. It talks about moving in a new direction to emphasize the promotion of good health, spending smarter and local decision-making.

My question refers directly to the estimates debate of last year, when a Pharmacare program review was announced with a number of recommendations, which apparently were to focus on ways of managing costs without compromising the purpose of the program. That was June of last year. I would be interested in knowing what transpired from the report which you announced during the estimates process last year. Was it put in place? Why is a second one necessary within less than a year?

Hon. E. Cull: The report the member refers to, which I did release last year, is the report of the Pharmacare Advisory Committee, which is a standing committee, if you like. A panel of experts provides advice on the Pharmacare area on an ongoing basis to the ministry. They issue reports from time to time.

We've implemented a number of the recommendations in their report, including the delisting of some drugs that were recommended in that report, which occurred earlier this year. Also, we have put in place some of the programs they recommended, such as a trial prescription program, and some of the management techniques they suggested.

Some of their other recommendations have a tremendous public impact, such as recommendations they made with respect to seniors and the seniors plan. Prior to launching any changes in the overall benefit structure of the six plans that make up Pharmacare, we believe that it is important to have a public consultation and involve not only a small group of experts but also the wider public and the professional associations, which have a lot to say.

For that reason, I was absolutely delighted today to announce the Pharmacare review panel, which will be chaired by Howard Petch, former president of the University of Victoria and current chair of the B.C. Seniors' Advisory Council. He will be assisted by Dr. Janet Martini, a geriatric specialist at St. Paul's Hospital, and Derek Dawes, a pharmacist and a director of the drug and poison control centre.

L. Reid: The minister made mention of the report that was done last June. I understand that 12 recommendations flowed from that. In that we are in the estimates process and discussing the expenditure of dollars, I would be very interested in learning if there has been any progress made on those 12 recommendations in cost management. Has any economic benefit been derived from any one of those 12 recommendations?

Hon. E. Cull: The average annual increase in Pharmacare over the last five years, from 1987 to 1991-92, has been 16 percent. This last year we brought it down to about a 12 percent increase. That's still too high. But obviously some of the initiatives that were put in place by Pharmacare are starting to have some impact.

Some of these changes, though, have just recently been put into place. The trial prescription program, which I think is going to be very effective, has only been in place for a very short period of time. We have not been able to gauge the cost saving for that yet. Certainly the B.C. Pharmacists' Society has supported that very strongly, because there are probably millions of dollars worth of drugs thrown into the garbage every year or flushed down the drain by people who get large prescriptions and discover they are not able to take them and then can't do anything with them.

The trial prescription program allows for a smaller amount of the drug to be given to the person initially, to determine whether they have any side effects or whether it's effective. Those things are going to take a bit of time, but I think they will prove to be effective over time.

L. Reid: Again, hon. minister, I'm interested in cost-efficiencies. I trust that all 12 of the recommendations will be effective over time, including the trial prescription program. But this is the estimate process for this budget year. As these new plans have been in place for 11 months, have any cost-efficiencies been recognized? Are there any comments -- other than in the fullness of time -- that you can make about other issues that can be examined in terms of fiscal restraint, good fiscal management?

Hon. E. Cull: I think I already indicated that we'd gone from an average of 16 percent growth to 12 percent growth in this program. While that percentage increase in costs is still too high, that's a 4 percent drop. That is progress; that is cost-effectiveness.

L. Reid: In your press release, you note the impact of an aging population in terms of the costs of this program. My comment would be that we do have an aging population, and we're certainly going to have a more extensive aging population over the next number of years. The research points out that both males and females in our society will indeed have a higher age range, a larger number of years. I don't believe your moves can address that. I think that's a reality that needs to be recognized, as is the drug patent legislation, which you also refer to in your press release. Those are realities we have to deal with.

Now that you've taken care of what is doable, is there any other way -- indeed, recognizing the aging population and drug legislation -- that we can anticipate any cost savings? I don't dispute where we are today, but I certainly want to know what the target is. What is our targeted goal for a decrease in the pharmacy budget in the Pharmacare program?

Hon. E. Cull: In the last five years the average annual rate of increase in population growth in B.C. has

[ Page 6244 ]

been 2 1/2 percent, the rise in the population over 65 has been 3 1/2 percent, inflation has been 4 1/2 percent, the Health ministry budget has been 10 percent and Pharmacare has been 16 percent. Clearly the costs in Pharmacare are running well beyond aging population, growth in population and inflation. In fact, even if you add all of those up, it's still not explained in terms of the pressures from demographics on the Pharmacare budget. The number one cost is the price of new drugs, so there are a number of initiatives that we want the panel to address.

There are initiatives around the effective prescription of drugs -- making sure that physicians are following effective policies and procedures in prescribing medications. Janet Martini, a doctor on the panel, talked quite eloquently about that earlier today. There is the need for us to ensure that patients have better education about the need, usefulness and effectiveness of drugs. As a result of changes in the United States, direct advertising to patients for prescription drugs is now coming into Canada. Patients often go in with a pretty clear idea of what they want, whether their physician approves it or not.

There is the question about the use of drugs. The trial prescription program is starting to help that, but if you talk to physicians there are many cases of patients who are having prescriptions filled, taking those prescriptions home and stockpiling them. They have no intention of taking them for all kinds of reasons. We are wasting money there.

We also have to look at the question of the price of drugs. Certainly the federal government, with the increase in patent protection, has done the provinces no favour. By extending the patent protection legislation under Bill C-91, the cost estimate here in British Columbia for two drugs alone amounts to an additional $146 million over the patent life of those two drugs. In one case it's six years, and in the other case it is 15 years. It's not an insignificant amount of money for just two drugs.

In addition to that we have to look at the whole question of generics. If we have a generic competitor, prices for drugs drop by 20 percent. If you have three or four generic competitors, they drop by up to 60 percent. We have to have a look at the effective alternatives to some of the high-priced drugs.

There are many things we can do in terms of looking at effective use of drugs: making sure that they are making people healthier, effective prescribing and responsible behaviour on the part of patients. Howard Petch, who is very interested in overmedicalization of the elderly, this morning indicated that the latest statistics he had seen -- if he recalled the number correctly -- showed that every senior citizen in this province could take a sleeping pill every night for 275 days of the year. That's an awful lot of sleeping pills. You have to ask yourself if that is appropriate medication for those people.

In fact, he questioned whether perhaps a lot of the falls and broken hips have more to do with that than they have to do with anything else that's going on in seniors' lives."

L. Reid: There seems to be a lot of discussion among seniors' groups about the dispensing fee for prescriptions. Is there any discussion within your ministry of perhaps standardizing it so that seniors are not rushing all over town looking for the best dispensing fee? Is that an issue in the ministry?

Hon. E. Cull: Seniors pay 75 percent of the dispensing fee and receive the drugs free. Just in case anyone isn't aware of this, there is no markup on drugs in British Columbia. The pharmacist doesn't get a markup on the cost of the drugs; they're provided at cost. The only money that the pharmacist gets is the dispensing fee. We allow the market to set the dispensing fee. We think it is healthy to have some price competition between pharmacists in setting a fee. The dispensing fee that will be recognized by Pharmacare is 15 percent above the average in the province. The average right now is $6.07.

While it may be inconvenient for people to do some comparison shopping, in a program like this it is much better value overall for the taxpayers of this province to have a little bit of healthy free market competition between pharmacists than it is to establish the fee at the government level or control it in some other way, or to pay whatever anyone chooses to charge without any control on it. Since the senior pays such a small portion of the overall drug cost, there's not much incentive to keep those fees competitive.

L. Reid: In the province of Quebec there is apparently a process that allows pharmacists to receive compensation for providing a medical opinion on the dispensing of a drug; i.e., a patient may come in with a prescription or make a request over the counter that is not in the person's best interest. They may perhaps dissuade the individual from purchasing that product, but they are still able to receive some remuneration. It seems to be working extremely well in Quebec. It's not driven by the product alone; there is actually some dialogue going on between the caregiver and the receiver. Has that reached the discussion stage in your ministry?

D. Streifel: Hon. Chair, I apologize for breaking into the exciting proceedings this afternoon, but I request leave to make an introduction.

Leave granted.

D. Streifel: It's my pleasure this afternoon to introduce to the House a group of students, teachers and parents from Edwin S. Richards Elementary on Cherry Avenue in Mission. They're touring the precincts today, and I think some of them are lining up jobs and positions for the future. I wish the students, teachers and parents a good trip to Victoria. Keep your ears and eyes open, and thank you for the questions. I bid the House make them welcome.

[3:15]

Hon. E. Cull: I think it's very important that the skills of pharmacists become better used in our health

[ Page 6245 ]

care system. One of the things that the pharmanet computer program will do is allow pharmacists to play a more proactive role in working with patients and physicians. In some cases physicians and pharmacists have very good relationships. Physicians are quite happy to get advice and further comments from pharmacists. In other cases, it doesn't work quite as smoothly.

The pharmanet program will allow pharmacists to play a more proactive role because they will have the full drug history of the patient there in front of them on the computer screen. They will also be able to identify anything that might be a contraindication, or where somebody has an awful lot of drugs prescribed, you begin to wonder why or whether there's been any recent review of the prescriptions. We have been talking to the pharmacists' association about ways of paying for the professional services beyond the dispensing fee. We will continue to explore the concept of a pilot project with them. No decisions have been made.

L. Reid: The minister made reference earlier to the trial prescription program. The average size of a prescription is typically 78 days. In terms of safe practice, a 30-day prescription is the way to go. The difficulty, once you start enforcing it, is that people bring in their unused excess drugs. What is your ministry looking at in terms of biomedical waste for used prescriptions? Apparently, it's now possible to return your prescriptions to your pharmacist, but what is your pharmacist to do with all this unused medication that is available in communities?

Hon. E. Cull: Not all of the prescriptions would fall into the category of hazardous waste. But in the cases where they do, and with other medical products which can be characterized as hazardous waste, we are working with the hazardous waste commissioner, Dorothy Caddell, to look at not only municipal and domestic hazardous waste but also biomedical waste.

L. Reid: What is the ministry policy on disposing of the medication that does not fall into the hazardous waste category? I can assure you that the pharmacists who visited my office had countless thousands of vials of drugs. Frankly, they need some response in terms of how best to dispose of those products.

Hon. E. Cull: Sorry, I don't have the answer for that. I don't know whether the ministry does have a policy. I'm sure the jurisdictions of waste management come into this, as well as Ministry of Health policies, so that's a question we'll have to take on notice and get back to you on.

L. Reid: For my clarification, hon. minister, what is the current status of remuneration for pharmacists who attend individuals in extended care situations? Are there any anticipated changes?

Hon. E. Cull: The pharmacists are paid a rate per patient, depending on the number of patients or beds that they're responsible for. The pharmacists' association had been asking for an increase in those rates for some time. It's called plan B. We recently made an increase, and I know they're very happy with it.

L. Reid: Earlier in her remarks, the minister touched on co-pay -- seniors paying 75 percent of the dispensing fee. Is there any change anticipated to that under the ministry?

Hon. E. Cull: We've just appointed a review panel to look at all aspects of Pharmacare in terms of affordability, effectiveness and fairness. They will be looking at all of the programs and the structure of the benefits, and until they've completed their work there are not any further changes anticipated in Pharmacare.

L. Reid: For the record, does the ministry at this time have any plans in terms of encouraging research and development? I know the minister takes tremendous issue with drug patent legislation and the like. From the official opposition view, we wish to see some research and development going on in the pharmaceutical industry, because provinces east of us are able to turn some of that research and development money into funding for ongoing drug programs that benefit their citizens. Is the minister prepared to look at research and development in the pharmaceutical industry under the new review that's going forward, or is that a separate issue under the ministry?

Hon. E. Cull: It is a separate issue, and because of the remarks that the member just made, I should make it clear that when I went to Ottawa in November on behalf of nine of the ten provincial Health ministers to speak to the Commons committee on Bill C-91, we were not asking for the bill to not proceed. In fact, in my first remarks to the panel I made it clear that we respect the protection of intellectual property and welcome research and development.

But we were asking for a number of amendments to the legislation that would strengthen consumer protection so that the patented medicine prices review board would have some real teeth to prevent price gouging. As I said, with B.C. being able to estimate the costs on just two drugs at $146 million over the next number of years, you can see that it is very important that the patented medicine prices review board has some teeth. They don't right now, unfortunately.

Unfortunately, the federal government chose to ignore all of the recommendations from the Health ministers but one very minor one: they moved the review board from the jurisdiction of one ministry to another ministry -- still without teeth.

Some of the research that has been done in Canada under the previous extension of patent protection hasn't been really much in the way of research; it's been more in the area of clinical trials. While it's nice to have the employment, it doesn't do an awful lot in terms of developing scientific knowledge and the expertise that we would like to see flow from this increased cost to taxpayers.

British Columbia's share of research actually went down after the last extension, prior to Bill C-91, despite the promises from the drug companies that we would

[ Page 6246 ]

see more R and D here in British Columbia. I'm more hopeful that as a result of the discussions the Minister of Advanced Education and the Minister of Economic Development have been having with Merck Frosst, we will see a significant research lab for genetic medicine developed at the University of British Columbia. I would really like to see that lab go ahead, because I think it would be beneficial not only from the health care point of view but also from the point of view of really developing opportunities here in this province for our young scientists and researchers.

While the discussions are still happening, there has not yet been a commitment from the drug company to that particular project.

L. Reid: With reference to the minister's previous comment, clinical trials can and do form part of the research projects that are underway. They are often the basis for deciding whether or not a particular research project can go forward. In terms of research and development, the minister made the comment that a clinical trial would not have a positive benefit for British Columbians. I would make the comment that indeed it can, and it should be supported in terms of British Columbia hopefully doing more than welcoming research and development projects. It's important that we actually commit pen to paper, so that we work together.

I appreciate the minister's comments about the Ministry of Advanced Education, but I hope that it will be an interdisciplinary project that will look at the Ministry of Health and the Ministry of Advanced Education for the very reasons the minister cited. It would be fabulous to have individuals employed in our province who actually graduate as scientists and technologists from our colleges and universities. I would welcome that.

One of the other concerns in the field, hon. minister, looks at product selection, and that came to pass over the last number of months when a number of products were de-listed from a number of different areas. The individuals who prescribe those drugs did not feel that their insight had been sought. Is it your opinion that product selection should remain in the hands of pharmacists and physicians, who hopefully know the best product line to explore and how that product will best benefit the patient in their care. I certainly would speak strongly for the linkage between the pharmacist, the physician and the caregiver, at any level, in arriving at the best possible product.

I know that in the case of my particular riding, a number of seniors had very innocuous products delisted, such as vitamin E cream, which caused tremendous concern. Vitamin E cream costs $8.00 a tube, and for individuals who are bedridden, two or three tubes of that in a day is an expense that is well beyond their means to pay. Yet if we don't look at those kinds of decisions.... The practitioners in the field found the replacement product to be a whole lot less effective, and it ended up costing a whole lot more because they needed to use more of the product.

My comment goes specifically to whom we are seeking advice from when a product is de-listed. I would strongly make the case that product selection should remain in the hands of the individuals who can attest to whether or not the product is valuable in the first place. I'd appreciate your comments.

Hon. E. Cull: The member was asking a few minutes ago about whether we had implemented any of the recommendations of the Pharmacare advisory committee. Indeed, those were the recommendations of the Pharmacare advisory committee that she was urging us to implement if we were going to get on with dealing with Pharmacare.

The products that were de-listed included things like diet pills, cough syrups and prescription antihistamines. In the area of prescription antihistamines, we've recently had a look at the prescription ones versus the nonprescription ones. They're equally effective in being able to meet the needs of the patient, and the difference in price is 14 cents a day versus over $2.00 a day.

So you really have to ask some questions about some of those products which have been covered because they were prescription but were no more effective and were certainly very many times more expensive than products that were available at the counter in any event. A doctor can advise someone to buy an over-the-counter drug.

I'm very sympathetic to the needs of people who are bedridden, but we should not confuse being bedridden with the inability to pay. Some people who are bedridden have quite an ability to pay. Some people who are bedridden happen to be in long term care facilities where all of their costs are covered for those kinds of drugs. So we are having a look at those particular non-prescription products that can be self-prescribed but are then paid for by the taxpayers of this province.

There have to be some controls put in somewhere; otherwise we're going to be going down the road of Saskatchewan, Ontario and New Brunswick, where we're going to have to make serious cuts to the overall program to be able to keep it affordable. I don't think anybody agrees that a 16 percent increase in Pharmacare expenditures is affordable in this economic climate, so we have to find the most acceptable ways of doing it. In any event, where there are people who have particular situations, we will sometimes make arrangements with their pharmacist that those products be covered under Pharmacare.

So while I won't comment specifically on vitamin E cream for the bedridden person, that is not beyond the realm of possibility.

The other products that were de-listed, again on the advice of the Pharmacare advisory committee, were the nonsustained-release drugs of a particular kind. There was a lot of confusion as to whether the nonsustained-release and sustained-release drugs had different impacts in terms of people's ability to tolerate them. It's a misunderstanding that the sustained-release drugs are easier on the stomach. In fact, in all cases, you're supposed to take these pills with meals, with food, so that they are easier to take. In some cases the information that people had about them turned out to be misunderstandings.

I think one of the most common causes of prescription medicine abuse is lack of a clear understanding on the part of the patient as to what they

[ Page 6247 ]

are to do with the drugs: how they're to take them, how frequently, when, for how long. We have to find a way of making sure that patients have a better idea how to use drugs effectively.

L. Reid: I very much appreciate the minister's comments. If indeed there are going to be exceptions, I welcome that, because the original discussion did not include creams and lotions, which certainly seems to be a significant issue for seniors and also for individuals who are restricted to using a wheelchair. It seems to be a significant issue that we perhaps can address with some success very soon.

[3:30]

I'll move to the issue of prevention. Certainly the New Directions health care policy looks at prevention of illness and health promotion. From my reading, we're at approximately the same level of funding as last year: $242 million. I also understand from my reading that contained within that are the drug and alcohol programs, the Centre for Disease Control and the office of health promotion. If indeed the majority of recommendations under the New Directions looks at health promotion, and if we're spending the same number of dollars, is that a new commitment?

Are there new programs, or are we simply expending the same number of dollars? How does that fit into the overall direction you wish to proceed?

Hon. E. Cull: Doctors do preventive health care and health promotion as part of their regular activities, but it's impossible to determine which part of the approximately $1.5 billion is spent in the Medical Services Plan for prevention and which part for treating illness. So if you exclude the MSP portion of the budget and just look at the rest, we are now spending three times more on preventive health care programs than we were when this government took office in November 1991.

The budget for health promotion this year has increased by $2 million -- which is a small amount, but we're dealing with a small program. They are a very effective program with a total budget of $5 million. So there has been a significant increase in health promotion. Many of the preventive health care programs are in alcohol and drug -- although not all of alcohol and drug is prevention; some, of course, is treatment -- in mental health, in community and family health and in public health.

The overall package of programs in which preventive health care resides has increased by 8 percent this year, which is twice the rate of increase that the Ministry of Health received as a total. That very clearly indicates the priority that we are putting on preventive health care, health promotion and community-based health care. While we have only had a 4 percent budget increase to deal with overall, we have managed to divvy that up across the ministry to ensure that those areas which are our priority under New Directions are getting the largest increase possible.

L. Fox: I have a couple of specific questions to the minister on specific issues. In discussing the reductions in the waiting lists over the course of the last couple of days, the minister has talked about the success they have had in radiology and radiation, and that what made the issue more complex and difficult was that there was difficulty in achieving highly trained specialty staff in order to meet the demand.

Is the minister satisfied that the conflict with the doctors that presently exists -- in which we have seen some neurosurgeons leave British Columbia for greener pastures, so to speak -- is not hindering the opportunity to recruit the necessary staff and technicians needed in order to increase these types of therapies in British Columbia, even though there is a shortage worldwide?

Hon. E. Cull: The vacancy rate for neurosurgeons in the United States is equal to the total number of neurosurgeons practising in Canada right now. So if they were to fill all of their vacancies, we would lose all of our neurosurgeons. Unfortunately, with the kind of health care system that they have down there -- which fails to cover 40 million people in their country -- they are also able to pay two, three and sometimes four times the annual incomes that neurosurgeons earn in Canada. That situation will be very difficult to remedy, even if we should wish to raise their incomes to that level.

We always see wage differentials between Canada and the United States for highly skilled, high-demand professionals.

If you look at the statistics over the last decade for the number of physicians that leave all of the provinces to go abroad -- I would assume that many of them go to the United States also -- the numbers have remained fairly static for each province over time. They have not wildly fluctuated. During the time when Ontario had their doctors' strike, they certainly did not jump up and down over that period. There seems to be a relatively steady pattern.

We do know that more doctors move to B.C. every year than leave the province. British Columbia has one of the highest ratios of physicians to population of any province in Canada. That doesn't mean that we don't have shortages for specialists. That doesn't mean that other provinces don't have shortages for specialists, and we have to address that.

One of our strategies in the New Directions document is to develop a human resources plan to manage the physician human resources, not just sit back and hope that these people are going to arrive here and decide to practise in B.C. or be trained in the appropriate specialty. We actually have to start discouraging people from going into some areas and encouraging them to go into other areas where we have shortages. We have to provide training programs so that we can get them to practise in the geographic areas of the province where we have shortages.

We may have to do things about our incentives for physicians to make sure that they go into those areas where we need more people in a certain kind of practice; for example, psychiatrists who practise in emergency rooms, as opposed to practising in their private offices. We have a lot of psychiatrists, but we don't have them where we need them. Even in the cities we don't have them where

[ Page 6248 ]

we need them, in many cases. There are a whole variety of things that have to be looked at with respect to specialists and the shortage of specialists.

Has the dispute with the B.C. doctors affected this? Possibly it has. What is really interesting, I think, is the most recent high-profile case of a physician who announced that he was going to be leaving the province because of bureaucracy. When I investigated and met with this gentleman here in Victoria, the problems he had were with the B.C. Medical Association around the fee

schedule and with the hospital with respect to operating-room time. They were internal problems to the profession. They were not problems with the Ministry of Health. Although the announcement was made that he was moving to the United States, to the best of my knowledge, he's still here in B.C.

L. Fox: I ask the question because of a phone call I had this morning from Alert Bay. I also have a faxed letter that was sent to you only today, minister, that expresses some real concern about a family member who has a brain tumour and needs radiation treatments. She has been told by local doctors that there is a waiting list of 200 to 300 in Vancouver, a waiting list at the Vancouver cancer clinic and a waiting list of at least 100 in Victoria at that treatment centre.

This young lady is presently on medication. Her family, for the minister's information, is on their way to arrive at the Legislature tomorrow morning at 10 o'clock because they are so appalled that their daughter is unable to receive treatment. She's presently on Decadron and the side effects of that drug are extremely horrible. She is being told by the medical profession that she must stand in line. Obviously that's a very emotional issue for one particular family.

Having lost a member of my family to that particular disease, I can respect the difficulties and the stress that's on the family. They wait not knowing from day to day whether their daughter will receive treatment, not knowing who creates the priorities on a waiting list and not knowing who to contact. They are also probably not feeling good in taking the political route. While they have their daughter successfully treated, then there is somebody else that doesn't get the treatment. Those are the kinds of difficult decisions that I'm sure this family is going through.

The letter that they wrote to you is dated today. I'm quite sure, hon. minister, they will seek to meet with you tomorrow. This is the kind of concern that is really dramatic and very emotional. Waiting lists in those particular areas are extremely important. I recognize that they have gone down.

These people are concerned that the minister talks about the lack of hospital operation rooms or time. I've gotten into those arguments with doctors over the fact that they haven't been able to meet the demand for hip replacements, for instance, because of the lack of operating room time and the lack of beds available to them. They've gotten into situations where they have to prioritize their patients on the basis of need and pain. It's a rather awkward situation for a doctor to be in.

Given the need of families such as this, is there any way that we can look at sending patients outside of the province for treatment? It's my understanding that we're now sending some prostate cancer patients to other jurisdictions to receive treatment because we can't facilitate them. Could we not possibly do here the same kind of program as we're presently doing with the prostate cancer patients?

Hon. E. Cull: When waiting lists get up to a level where they really start to impact on people's lives, not in a life-threatening situation because as we've already canvassed earlier in these estimates that emergency situations always go to the top of the list, when the waiting lists for non-emergency situations start to grow and get to that level, whether it's for hip replacement, cardiac surgery, general surgery or radiation therapy, I too am really concerned.

I indicated very early on to my staff that we had to find some means to address these waiting lists. If we were doing nothing about the waiting lists, if we were not taking any action to try to bring those waiting lists down, then I would say, hon. member, that you have every right to stand up and demand from me that we do something, that we take some action, that we recognize the seriousness of cases like the one you have just talked about. But we have recognized that this is a problem, and we have been devoting resources to it.

We have made some tremendous increases in our capacity to deal with radiation therapy particularly. This government has made decisions to enhance those resources. Unfortunately, making the decision doesn't get it there the next day; you then have to build, construct, modify, buy equipment, get staff, do whatever has to be done to implement it. That takes a little bit of time.

Recognizing that it takes some time, we've funded extra shifts at the B.C. Cancer Agency to get the equipment and the facilities that we have now used on two shifts a day instead of only one shift a day. Because of the lack of staffing to do that, we have not been successful in all cases. We've tried to address the staffing issues, both through aggressive recruitment and through long-term training, but again that has only started to have some partial impact. The waiting lists have gone down. They've gone down moderately; they have not gone down enough yet to satisfy me.

We still need to put more effort into the overall issue of waiting lists, certainly in the area of cancer radiotherapy waiting lists. There are more things that we can do. There are more things that we are doing.

With respect to your question on whether we can arrange for out-of-province treatment, the answer is yes. We have contracted with Washington State facilities for radiotherapy treatment. Since I don't know the specifics of the case that you're talking about, I think it would be worthwhile to have my staff look for the letter that you say I have received today and see what we can do to address those particular concerns. We have to look at this in both the short term and the long term. It is a difficult issue, but believe you me, we are trying to devote resources to it.

We share your concern and the concerns of the family that you mentioned that in some cases any wait is too long. While a certain wait-list sometimes is good for hospital management and

[ Page 6249 ]

surgery, beyond a certain amount you really do start to get into health concerns.

[3:45]

L. Fox: I'm sure the minister recognizes that in my attempt to ask the question in the best way I could, I wasn't faulting the minister for lack of action with respect to the waiting list. I was just trying to point out, I guess, the concern of waiting lists, particularly in this area. When the only treatment for an inoperable brain tumour is radiation, obviously the earliest possible treatment is in the best interests of the patient. I'll leave that, knowing that these people are on their way down to see the minister to see whether or not some action can't be taken.

I take it from the minister that she's prepared to review the particulars of that case in an open and honest way, and that's fine with me.

One thing I did want to talk briefly on -- perhaps not so briefly -- is that as I mentioned the other day, I have some problems splitting out at what point this ministry is responsible for the ambulance air service and at what point it falls into Government Services. But I think -- I hope I'm right -- as long as it's being used as an ambulance, it falls under the category of the Health ministry, but when it's being used as a government service or a transportation plane for representatives or employees of the government, then it falls under government services.

Hon. E. Cull: The government air service is administered by the Ministry of Government Services. The Ministry of Health contracts with them as an airline for ambulance services, as we contract with some private air carriers, helicopter services and others, as you know full well. They are the provider of the services and we purchase them via contract and have some priority call on them.

L. Fox: I want to canvass at some length the services in the Prince George region. The minister is well aware there is a contract with Carson Air to provide some alternate services to the Airvac system on an on-call basis. Presently in Prince George, we're running into some extreme difficulties in terms of the actual ambulance service itself. There were 19 incidents by halfway through this month where the ambulance took 20 minutes or longer to get to its destination within the community. Part of the problem is that there are two stations, but there are only 16 full-time people handling 6,000 calls a year.

In Kamloops, for instance, there are 21 full-time equivalents handling 6,500 calls a year; in Kelowna, there are 20 full-time equivalents handling 7,000 calls. Manning two stations with 16 full-time employees becomes extremely difficult.

I don't want the minister to assume that I'm just asking for more people or money. There's an opportunity to look at some efficiencies in the system that give you the best of both worlds. We have Carson Air, with a plane on the ground, getting very little work out of the Prince George region. I understand that only last week they were considering giving up the contract because they're not getting sufficient work -- call-time, wait-time, and so on -- to pay for the assets. At the same time, we have all the air ambulances centralized in Victoria. There are many good reasons for that; I'm not here to debate those.

But in talking to the ambulance attendants, there have been many occasions where there have been excessive delays because we've waited for an aircraft to come from other parts of the province to pick up a patient from Prince George. If we had two or three extra employees in the Prince George region who, when not needed through Carson Air, would be able to increase the service within the area, we could get the patient to Vancouver at half the cost through the contract of what it costs to bring the jet up from Victoria.

My request is that some consideration be given by the ministry to reviewing whether or not some efficiencies could be achieved and still improve the service to the residents of the Prince George region.

Hon. E. Cull: I don't think that's an unreasonable request at all. As you know, I announced a review of Pharmacare this morning, and one of the questions a reporter asked me was: "Why didn't you do this sooner? You were actually asked about it last year." I indicated to him that there have been a few things going on in the Ministry of Health over the last 18 months. We've done the royal commission, brought in a new Medical and Health Care Services Act, made major changes in establishing tripartite commissions for the supplementary practitioners and a lot of things.

I'm telling you these other things by way of saying that the Ambulance Service is something that I agree does need some review. We did not get to it earlier because of all of the other items that have been on the agenda in the ministry.

I agree with you. I think there are some puzzling discrepancies between the staffing levels in different communities, even though we are supposed to be staffing based on call volume. I can't tell from the information that I have whether the communities are incorrect in terms of what they tell me are the call volumes and the number of staff they have there, whether the Ambulance Service is not providing the full figures on this, or whether it has some different way of calculating it. There seems to be some real missed communication between communities and the Ambulance Service in a number of cases.

Regarding your comment about the location of aircraft or the use of contract services, I think that's something that would be worthwhile having a look at. As I said earlier in these estimates, the B.C. Ambulance Service has a world-class record and an international award, so I'm not in any way suggesting that they don't do a fabulous job for the people in this province. Since I have been talking about cost-effectiveness and efficient management, eventually we will have to look at all parts of the ministry to ensure that we are getting the best value for our dollar there.

The Ambulance Service is clearly one of those areas which should be looked at in the near future, as opposed to something that's off in -- we are in year two now -- maybe year three or four.

Some things are more urgent than others; some things have more impact on the health budget than others. As I think you can see, we have been trying to progressively work our way through hospital

[ Page 6250 ]

efficiencies, Medical Services Plan efficiencies, now Pharmacare, and there are others on the list. I think people in the Ambulance Service would welcome some administrative efficiency reviews. Many of the paramedics have talked to me about things that they think could be done to improve the system, so if we can find a way to have another look at it and get some more efficiencies in place, I'm totally behind it. Your suggestion of having a review is a worthy one, and it is one that I am considering. It's a question of timing and resources and making sure that we have everything we need to start it.

L. Fox: I thank the minister for her most encouraging comments. I talked very briefly about this last year in estimates, and the minister might recall -- I doubt it, though; it's a year away -- that I am concerned that we don't go a year down the road and do a review. There might be a real opportunity here to have a very small review of the delivery of service in the Prince George region -- the efficiencies and so on. These attendants tell me they are under extreme pressure. They are facing very angry patients because of delays in getting there, and I am concerned.

Last week I got a call from a lady whose husband collapsed in the driveway, and literally lay for 20 minutes because there was no ambulance available. I think that's too much to expect. The minister and I both know that we have a better service than that. Going along with those kinds of concerns -- and the history is there -- it would be very easy to pick up. I spoke to one of the duty officers last week who was investigating that lady's concern and they confirmed that up until that point there were 19 calls which were over those kinds of time frames.

I think it's a very emergent problem in Prince George for those reasons, as well as the fact that if we don't look very seriously at whether or not we can utilize the private airlines that are on contract, we're going to lose that airline. And we may have a very difficult time achieving another one -- at least at the cost that this one is prepared to do the job for. I would urge the minister to consider doing something on a regional basis. I look forward to her comments with respect to that.

Hon. E. Cull: The other thing that occurs to me, in terms of pursuing the Prince George issue, is the task force that we will be establishing to look at northern health issues. Some of the concern in Prince George isn't just simply a local problem; it could also happen in Burnaby or Sooke. It is related to the fact that the populations are sparser and more spread out; the distances are longer; and the winter conditions that ambulances have to travel through are different from the conditions they travel through in the lower mainland and Victoria.

I would expect that some of that would be addressed as part of looking at how we could provide better health care services to people in the north and in isolated communities. But I hear you.

I think the commitment we have is, in a consistent way, to sequentially start to look at those areas of the ministry or the health care system where we feel there are some changes needed and some efficiencies that can be realized. We have to approach it as thoughtfully as we can without trying to do everything all at once, because we wouldn't be able to accomplish that. I think the ambulance service is one of those areas that we will see some work done on before we get back into this system a year from now, when you will ask me these questions again, with another twist.

L. Fox: While I appreciate the minister's intent, I am concerned that the emphasis could be lost in that huge task force's mandate and that it wouldn't deal with the concerns to the extent that it should, given all the other issues out there. I would ask her to give consideration to something a little more specific. I think the findings would probably be something which could be utilized around the province.

I just want to comment very briefly on the review of Pharmacare which was announced by the minister today. It's a review which I certainly support. Although I don't know any of the individuals on the task force or on the review panel, when you look at their backgrounds, they certainly have the expertise to deal with the issues. I only hope that they are going to be able to go the regions of the province. In the very quick time that I had to go through it, I was unable to actually find the terms of reference or in fact a list of locations that this review panel would go to. If the minister could enlighten me a bit on that, I would appreciate it.

[4:00]

Hon. E. Cull: They are going to be travelling the province and holding public meetings. We are hopeful that public members will come out to these meetings, not just pharmacists, physicians and stakeholders. We want to see some general people from the communities who are interested in where health care is going in B.C. They will be travelling to ten different communities. I don't have the list in front of me, but Prince George will be one. We can get the list for you, if you'd like. I know they are going to be out and about the province quite a bit.

I guess if there's a real demand for them to go to a community that isn't on the list, because there are people there who are interested in discussing it with the committee, I'm sure they will consider that request.

We have also established a 1-800 number so that no matter where you live in British Columbia you can call and get information about the review panel, have information sent to you or submit your opinions or advice. We will be taking written submissions as well.

L. Fox: I want to get on to one other issue from the Vanderhoof region, which I've spoken to the minister about, and that's the Kingsley case. I gave a copy of a letter from Kabi Pharmacia -- I guess that's how it's pronounced -- in which they're requesting a meeting to deal with cases such as Mr. Kingsley's. This letter was sent to the minister March 24. The Kingsleys are still waiting for an answer.

I think the minister is aware of the situation where in order to stay out of the hospital, which would cost something like $500 to $600 a day in that particular hospital, he is presently renting a pump and buying the medicine at a cost of $647 on a bi-weekly basis. He is in extreme hardship trying to meet that

[ Page 6251 ]

expense. Perhaps the minister can tell me if there's been any movement with respect to this particular case.

Hon. E. Cull: I know the member brought this to my attention a couple of weeks ago. I immediately asked the people in my correspondence unit to locate this particular response and light a fire under the staff that were investigating it. I'm afraid I don't have an answer for you right now. I'm certainly not making excuses about this; I will go and have a look at it. However, we get 400 letters a day in my office. While March 24 seems like a long time ago -- and it's starting to get to be a long time ago -- sometimes staff do get totally swamped, particularly if they have a lot of correspondence on one area.

I will commit to getting an answer for you for Mr. Kingsley by the end of this week. I hope the staff who are watching this on TV right now are paying attention to this and scurrying about to see if we haven't got an answer on its way to me.

L. Fox: Thank you. I hope it's an affirmative answer because here's a situation where this man and his family could put a huge demand on the medicare system. A cost similar to what he's paying every two weeks personally would be a daily cost should he be hospitalized and have to get the IVs on a daily basis in order to achieve his treatment. This individual is one of those individuals who fall through the cracks of our network. He can't qualify for social assistance because of his assets and can't go to work because of his illness. His family's been placed in a condition of extreme hardship just trying to meet the demands of his medication.

Has the minister decided whether or not the issue, in the copy of the letter that I gave her from this company, is something in which she would see some benefit by she or her staff meeting with the representatives of the company?

Hon. E. Cull: Yes. As I indicated to the member when we spoke about it the other day, it sounds like a very interesting proposal. Certainly I'm always interested in anything that allows people to maintain more independence and be out of hospital. We, or certainly I, would be interested in learning more about this. I'm saying this about my staff assuming that they don't know anything about it; perhaps they do. That's part of the problem in trying to answer your question right now.

I haven't had the information back from staff to find out whether they have met with that company, are aware of it, have any other considerations along this line, or whether the Kingsley family is one for which we could make arrangements. I don't have any of the answers, but as I just said, I'll make a commitment to getting this one resolved promptly.

L. Fox: I'll leave that then. I recognize the end of the week is only tomorrow. Perhaps the first of the week would be more than ample, and I will expect it at that time.

I want to get back, very briefly, to the issue of extended care. I have a concern -- and I started to get into it the other day when we ran out of time -- over the level of care that is in fact given and the consistency of that from one complex to another, recognizing, of course, that societies have boards and that some of the determination is done at the local level. I have a letter from an individual who is extremely concerned that (

a) the rising cost in the housing portion of the long term care facility is going to provide extra costs; and (

b) the level of service now applied within this particular facility -- I hesitate to mention the name of it, but I'll make the letter available to the minister later -- is less than desirable. A further issue is that because of policy within that particular facility, she cannot provide extra service for her mother by hiring an assistant to help with daily things such as brushing her teeth more often or giving her baths more often, or whatever. She's limited by the policy and by what's acceptable within the union contract and all those other good things.

She has a further concern, and I believe I do too. I think I mentioned to the minister before that my wife is an HEU worker in an intermediate care facility. Given the fact that this new accord, albeit not in place at the present time, would limit the work hours to 36 from 37.5, there's a great concern that the effect will be a reduction in service, given the limited amount of staff that a lot of these facilities have. Could I ask for some reassurance from the minister that this in fact isn't going to happen?

Hon. E. Cull: The accord, as it stands right now -- and as it hopefully will be ratified -- applies to the acute care sector. But you're right that because the unions and the employers are involved, there are implications, obviously, for the continuing care part of the ministry.

On the question of reduced work hours, when we've looked at it in the acute care sector, the hospitals have estimated that they would have to backfill approximately 50 percent of those reduced hours. I would guess that in the continuing care sector it's going to be a larger percent because there isn't as much flexibility there. If this report is ratified, and if it is extended to continuing care, then we will have to start to work with those particular institutions to resolve what the flow-through would be -- how it would affect them and their budgets.

Like all the facilities right now, the continuing care facilities are, I guess, very pressed with their budgets. We do try to work with them to realize whatever operational efficiencies we can. I don't believe there are any institutions out there that don't have some operational efficiencies that can be realized. Some of them will probably be very small, but some might be considerably larger. Our responsibility has to be to work with those organizations to see what we can do to assist them to manage their operations as efficiently as possible.

Having said that, I'm fully aware that the staffing guidelines provided by the ministry are not fully funded in all cases. There is a shortfall in terms of the continuing care guidelines in the funding. That's something we inherited; it isn't something that was created as of November 1991. We have been trying to address that within the abilities of our budget over the

[ Page 6252 ]

last two budgets. We paid particular attention to the IC 3 level.

As I'm sure you are aware, people are coming into intermediate care with a higher level of acuity all the time, which means that they need more services. We have made small increases to the funding formulas to recognize the higher acuity level of those IC 3 patients. As we start to reallocate funding in the health care system, we're going to have to make sure that we continue to reallocate into the continuing care area.

If we want to be successful, as I do, to get that 25 percent of patients out of the acute care beds into the continuing care, intermediate care and extended care beds that they need to be in, we're going to have to not only build the beds but make sure there are sufficient resources to provide an adequate level of care there. That's the objective, but there are cases where we're not there yet. We have been moving towards it, but we're still not fully there yet.

[E. Barnes in the chair.]

L. Fox: I know that the minister canvassed the accord to some extent early in the estimates, but one has to be concerned, and I'm pleased that the minister has shown some concern with respect to the level of service in the long term care facilities.

Given the fact that in most homes there is resistance against the hiring of an outside nurse or help in order to give a particular family member a little better quality of life -- perhaps someone that can spend a little more time in a very compassionate way with some of these people -- there is a great concern by families of the seniors who are in these facilities about the level of service. I ask the minister to consider that in her deliveries and in her thoughts over the negotiations of this accord.

Perhaps I have some misinformation or a lack of understanding as to how this regional seniority process works within this accord and I wanted to talk a little bit about it. It says that you can seek other employment and look at other jobs of a similar nature within the region. Could an HEU worker or an HLR or BCNU worker within Vanderhoof bump somebody in Prince George should they not be a full-time equivalent or a full-time employee but a permanent part-time employee? Is that kind of thing possible?

Hon. E. Cull: We did spend a bit of time exploring this earlier in the estimates debate. It seems like we talk about this one at least once every day in some form or another. The region under the accord is left for an arbitrator to determine what the region is and what the comparable job is. That's what the parties agreed to at the time. In this case, the definition of region and comparable job was to be determined by a third-party arbitrator.

[4:15]

The answer to your question is that once the region is defined -- I can't tell you what the region is -- someone can only move into a job and port their seniority into that job if a job is vacant. A job is declared vacant by the institution. Someone in Vanderhoof can't bump someone who's in a job in Prince George. Prince George would have to say, "There is a vacancy here," and then that would be part of the pool available to employees in that region, and they would be offered those positions.

If they were offered a comparable position in their region, they would have to accept that position or no longer be employed. Your job security doesn't extend beyond being offered a comparable job in the region that has been defined for you. Positions in hospitals or institutions are only declared vacant and part of the accessible pool once the hospital itself says, "Yes, we have a vacancy here," which means that if there is a vacancy, there can be some shuffling around within the hospital, and the vacancy might end up being over here rather than where it started off.

The hospital does have management ability to determine how they may first of all redeploy their own staff to fill those vacancies.

L. Fox: I appreciate that clarification. I had heard parts of it, but with everything I've been trying to consume through these estimates, I lost it. Now that you've reminded me, I recall the discussion.

I was concerned, though, about the issue.... For instance, Prince George Regional Hospital announced that they would have to lay off 31 extra employees in this budget year. Given that there are no openings in the region for those 31 extra employees, and given the fact that last year they had to lay off 61 employees and opportunities from attrition are extremely limited, under the accord who pays the cost associated with keeping those employees on the payroll until they find a comparable job in the region?

Hon. E. Cull: First of all, Prince George Regional Hospital is undergoing a review to look at its financial situation. It was a commitment made to the hospital last year. If it hasn't started yet, it will be starting very soon, because the promise was to do it very early in this fiscal year. So with respect to the 31 employees, that may change depending on the outcomes of their operational review.

The attrition rate continues even with those direct layoffs; there will be some attrition taking place. So whatever number of employees are laid off by the hospital, there will be other opportunities for them within the community. Obviously they don't have to be in hospitals; they may be in the community health sector. With the 8 percent increase in funding, we will be doing more hiring in parts of the community health sector. There may be jobs in that sector, in long term care facilities and in other parts of the health care system in that region.

But if a hospital goes through everything it possibly can in terms of trying to manage and they still can't place those people, they still can't rejig their existing budget to keep those people, part of the accord was to provide a fund to be managed by the hospitals and targeted to assist hospitals through a short-term period of less flexibility, so they could continue to operate and have the extra time they needed to allow attrition, early retirement or other job opportunities in the community to become available. So that kind of flexibility was

[ Page 6253 ]

contemplated in the accord. It was calculated as part of the $57 million funding over three years and continues to be part of the arrangements. As you know, right now Vince Ready is working with the two parties to see what can be resolved in terms of renewing or reviving the accord, and I'm sure the hospitals will be making those concerns known to Mr. Ready.

L. Fox: If I were an employee of a hospital, irrespective of what union or what area I was in, if I could be guaranteed that I wouldn't lose my job or a job equivalent to what I had, the last thing I would do is volunteer to be part of the attrition numbers by accepting early retirement or anything else. As long as I have a fully paid job guaranteed to me, there really seems to be very little incentive to get into an early retirement program. That's one observation, and I wouldn't mind your comments on that.

There is some other information I wouldn't mind having. The minister talked about $57 million as being part of a package to address those kinds of interim concerns. Does that include the $10 million for the early retirement, the $22 million for the educational training program and the $9 million for the labour adjustment program? Are those part of that $57 million dollars?

Hon. E. Cull: The $57 million is the total wage, benefit and other costs, over the three years of the labour accord, that are in excess of the costs that would have been under the currently applicable collective agreements that are in place. The agreements that are in place recognize the 4 percent increase this year, the 9 to 11 percent that will be required to deal with the HEU comparability as a result of the arbitration in 1994, and assumptions about the collective agreements required to continue those agreements for another two years.

So yes, the $57 million includes the early retirement fund and the labour adjustment fund. The $22 million that you are referring to with respect to education, I think you are confusing with the doctors' education program and with the liability and disability insurance program. There isn't any $22 million for education.

The Chair: Before recognizing the hon. member for Prince George-Omineca, I would ask the committee if they would permit me, with their indulgence, to make a brief introduction.

Leave granted.

The Chair: Hon. members, I had the privilege this morning of meeting with some very special guests who are from the Czech Republic and the Republic of Slovakia. They are here in British Columbia on a 14-day study exercise. They will be finding out as much as they can about training and counselling programs that we have in this government. They are members of the ministries of labour from their countries. One of the things that they are very interested in is entrepreneurial programs for women.

The delegation is being guided by Paddy Randall and Catherine Thompson of Klohn Leonoff, a British Columbia firm in Richmond. I would like the House to make this very special delegation welcome. I was deeply honoured and felt very privileged to meet with these people who are, as you know, in a transition in their country. They are moving toward a free-market society, and it was very enlightening and very helpful to have them share their comments with us.

A rather long introduction, hon. members, but I think you will agree that it is a rare opportunity to have people with us from that part of the world. I'd like you to join me in making them welcome.

K. Jones: I would also like to ask leave to extend this type of greeting.

Leave granted.

K. Jones: On behalf of the official opposition, and I'd say on behalf of all members of the opposition and all members of this House, we would also like to extend our greetings to the delegations from both the Czech Republic and the Republic of Slovakia.

It's good to see the continuing harmony with the people who have come out here sharing their desire to learn about the entrepreneurial process and to find out more about how women can be involved in establishing new jobs in communities. It was also a real pleasure to talk to these people. We had a pleasant luncheon and I had the opportunity to meet several members who have come from the country which is part of my ancestral heritage. I found it a great opportunity to learn more about my roots.

Thank you very much for coming, and I hope you have a very successful visit and learn as much as you possibly can while you're here.

Hon. T. Perry: I'm privileged, as Minister of Advanced Education, Training and Technology and Minister Responsible for Science, and on behalf of the government, the Minister of Labour and the Minister for Economic Development, Small Business and Trade, to officially welcome the delegation and acknowledge my delight in seeing Klohn Leonoff here escorting them, as well.

The Chair: The hon. member for Prince George-Omineca. Thank you for your patience, hon. member.

L. Fox: By all means, hon. Chair. I think a delegation such as this is certainly worthy of recognition.

But if I can get my train of thought back, we were talking about the $22 million for retraining. Earlier in the estimates, when I asked the question with respect to what we were going to do to retrain nurses to fill the vacancies and about the home care and layoffs, I was under the impression that there was a $22 million retraining.... But perhaps I misunderstood that or there was some misunderstanding between the question and the answer. Is there no money within this accord to look after the retraining of employees to fill vacancies in other areas?

[ Page 6254 ]

Hon. E. Cull: That's exactly what the $9 million labour adjustment fund is for. It includes retraining and relocation.

L. Fox: At this time, I will allow the member for Abbotsford to ask a few questions.

H. De Jong: I was just wondering whether the minister can enlighten us a bit on whether there has been a stepped-up program of inspections by the health department in senior citizens' homes, particularly in the area of dietary needs.

Hon. E. Cull: No, I can't confirm that.

H. De Jong: If there is any inspection done in that particular area, is it fostered by the local health office or is it because of complaints it receives? Has the minister got any idea about that?

Hon. E. Cull: I would guess that there are a number of areas of jurisdiction. The first would be that the community care facilities licensing board, which licenses facilities and therefore can unlicense them or pull their licence, would have the ability to investigate that. I would think that with respect to kitchen facilities, there probably is some jurisdiction of the medical health officer. I'm sorry, it's a technical area; I'm not familiar with the different breakdown in jurisdictions, but that would seem reasonable to me in terms of licensing.

There's also the continuing care manager for those institutions that we provide funding to, which doesn't involve all of the continuing care facilities. But for those that we do fund, we have a quality assurance group which does inspections and looks at the services and service levels.

[4:30]

H. De Jong: The reason I'm asking these questions, Mr. Chairman, is basically following a concern -- I wouldn't say necessarily a complaint -- expressed by the chairman of the Ebenezer Senior Home Society. The Ebenezer Home has been in the Abbotsford area for the last 25 years. I suppose you could call it a home. It was initiated by people from the Netherlands back in the fifties and sixties and has been accommodating not only people of Dutch background but also of Canadian background. Whenever there was room and it couldn't be filled, then of course they would accept other people.

It has had, and is still receiving, a fair amount of financial support from churches throughout the lower mainland, from the Dutch community basically; but it also receives other funding, of course, and people are paying a per diem rate. It does have some sort of a cultural background, and that cultural background is reflected in some of the dishes that are cooked for these old folks. A number of my uncles and aunts stayed in this home for many, many years.

In fact, there's one in there now who has been there for the last ten years and is 96 years of age, so certainly people are having a good long life in that home. I think that can be said for many of the people who have stayed there. They've enjoyed it, and they have done well there.

It would appear that they have been advised by someone in the Ministry of Health that they need to have a full-time dietitian on staff. That is a concern to the board, because they are always on the border of making ends meet at the end of the month in terms of providing the care. The care goes far beyond the normal care that's given in a senior citizens' home. There are people there who perhaps should be in a home of greater service to them because of their health needs, but they like to stay in that particular home because they've been there for some time.

To have this additional cost pushed onto them, because apparently the push is pretty strong from whoever made that inspection and that particular suggestion.... It was not only a suggestion; it would appear, if I sense the concerns of the chairman of the board correctly, that it was basically a demand by the Ministry of Health that they have to have a full-time dietary person in that facility.

I wonder whether the minister has any knowledge of this and of the cultural background that may, in terms of dishes served, vary from the Canadian types or standard of foods being served in those facilities. Certainly I have had no complaints from any of the citizens of that home, and I know a lot of them in there. They're happy there, and they seem to be thriving. Everybody seems to be as healthy as can be expected at their age, and this particular demand from whatever person in the Health ministry seems a bit unreasonable to me at this point in time.

Hon. E. Cull: The particular care facility that you're referring to is not one that's funded by the ministry, so our jurisdiction extends to licensing under the community care facilities licensing regulations. I don't profess to be an expert in the regulations. Certainly I'm not an inspector, so I don't know all the details. I can assume that if they're being asked to have the services of a dietitian, it is to meet regulations and standards established through guidelines that are enforced in all facilities.

I don't see any reason why a dietitian would have any difficulty dealing with what different cultures eat. We're not talking about imposing a particular cultural diet on people, we're talking about making sure that there is an adequate diet. I've been sitting here trying to think about what a Dutch diet would include, and I can't. I'm sure that within the various foods that are part of that culture they would be able to find a balanced and appropriate set of menus to meet the needs of the people who live there.

I can't give you any more details than that at this time. I have to assume, though, that the care facilities licensing board is following the regulations and making sure that they meet the standards. The whole purpose of having such a board is to ensure that care facilities are licensed and, once licensed, are inspected and maintain a certain level of standards.

H. De Jong: My final comment on this is that during