MG ISSN 0542-5492 Fifth Session - Thirty-First Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS 30 Elizabeth 11 Published under the authority of The Honourable Harry E. Graham Speaker VOL. XXIX No. 398 - 8:00 p.m., TUESDAY, 17 MARCH, 1981 Office of the Queen's Printer for the Province of Manitoba

LEGI SLATIVE ASSEMBLY OF MANITOBA Tuesday, 17 March, 19 81 Time - 8:00 p.m. CONCURRENT COMMI TTE ES OF SUPPL V SUPPL V - HEALTH MR. DEPUTY CHAIRMAN, Lloyd G. Hyde (Portage Ia Prairie): Commit tee come to order. We're under Amb ulance Program, Northern Patient Transportation. The Member for Churchill. MR. JAY COWAN: Thank you, Mr. Chairperson.

I'm pleased that I have the oppor tunity, after having listened to the Minister at 4:30, to have calmed down a bit, because I don't think I have to tell you that the response of the Minister at that time was, in my opinion, not only aggravating but it was somewhat antagonistic.

When the Minister suggests that it is my responsibility that the program is not working, I can only offer my conclusion th at is a total abdication of the Minister's responsibility in respect to this program. (Interject ion)- The Minister of Agriculture says he agrees with the Minister, and it's not the first time that they were both wrong, nor is it the first time they were both wrong at the same time.

Ho wever, when it comes to this program, I can only suggest to the Minister that if he in fact is not receiving criticisms and concerns about the program, then there is somet hing wrong with the communications system between either the advisory councils and the Minister or the department and the Minister, because the criticisms are widespread and I'm not going to attempt to imagine where the breakdown in communic ation is, but I do know that if the Minister were, and I challenge him to do this, I ask him to do this if that will result in a more favourable response from him, although both be the case, I challenge him and ask him to set up some mechanism to go out into the field, to go into the commu nities of Lynn Lake, Leaf Rapids, Gillam, Church ill, Snow Lake, Thompson, Flin Flon, The Pas, and giv e the individuals in those communities first hand , the opportunity to come forward and to talk about this program with the Minister.

I don't believe that should be considered to be an unrealistic request on my part. And the reason I ask the Minister to do that, is because that is what we as a party did last summer. And we went out to the various communities in the north, a number of them, I think ten in total, and we sat down in meetings and invited anyone in that community to come forward and to discuss what they thought were the problems they were experien cing.

As well we asked them to bring forward what they thought might be some good suggestions and good ways in deal ing with those problems, and in almost every community, outside of the communities of Split Lake, Norway House and Cross Lake, we ran across concerns and complaints about the way the Nort hern Patient Transportation Program was working. In Gillam we ran across those complaints, they were mentioned to us that they were concerned because people under the NP TP program were being sent to Thompson by 1811 train instead of to Winnipeg, and they thought they should be going to Winnipeg.

Now, that's a judgment call on their part. But they had a very good rationale and what 1 considered to be justification for that particular requestaAnd the Minister is aware of it, because some persons in tha t community or representativ es of that community had written to the Minister, and ind icated that they were concerned about tha t particular prob lem. Excuse me, I am going to rephrase that, they had written to NPTP officials and carbon-copied both the Min ister and myself; that's the way the mail was routed.

So the Minister should be aware of that, and their rationale is that every individual in Winnipeg has a choice of their doctor. They can choose which doctor they are going to go to just becaus e of the circumstances. If you don't like a particular doctor you go to a different doctor. If you don't like a particular hospital you go into a different hospital. They in fact have that choice. In the north, as soon as you came under the Northern Patient Transporta tion Program you no longer had that choice, or that choice was not as freely available to you as it was to others.

You may want to go to a specific doctor in Winnipeg because you have built up a trust and confidence with that doctor, because you may have heard good things about that doctor. For any number of reasons you may want to go to a doctor in Winnipeg, and yet you are restricted from going to a doctor in Thompson because of the financial constraints of travel ling to Win nipeg on your own, and because the NP TP program won't pay for your trip to Winnipeg.

They also suggested that what happened in many instances was that people would get to shipped to Thompson, they would ov ernight in Thomp son hospital and then they would go down to Winnipeg anyway. So they were suggesting that was a problem as well, and they mentio ned other problems in respect to the program in that community, but I wanted to bring forward tha t perspective which origina ted out of the community of Gillam. In Lynn Lake an individual came forward and gave us an instance that his wife was in the hospital for a bad back and they referred her to the south and they suggested that she go by bus.

They gave her a bus travel warrant. Now, he said that he and she were not going to be satisfied with a 16 -hour bus trip for a person with a bad back and they fought for a plane ticket. I am happy to be able to report that they did get a plane ticket in that instance. but they had to fight for it. I can tell you that there are people who do not want to have to fight for the type of medical care which is coming to them automatically as citizens of this province.

To make them fight for that sort of medical care is to in fact disadvantage them because there are people who will not fight. there are people who will not take on the bureaucracy, and I think we should have a medical system that take s into account the fact that there are people who don't want to have to fight for the rights which are due to them normally. They also in Lynn Lake were concerned that an ind ividual who was coming to Winn ipeg on the

Tuesday, 17 March, 1981 Northern Patient Transportation Program who was required to stay over for further testing which would not necessitate hospitalization was responsible for their own accommodation; that there was no system to pay them back for their hotel bills or their per diems.

And if the program was put in place to sort of take away some of the disadvantages of living in the north, then in fact you would expect that it would pay for their accommodation, because an individual living in the City of Winnipeg, if they have to go on a second day for tests, don't have to go to a hotel; that individual goes back to their house. So that is an extra cost on an individual from the north, which I think the program should take into consideration. However, if there is an escort that goes down with the individual, the escort is given ove rnight re imbur sements.

They are pr ovided with accommodations or at least reimbu rsement for their acco mmodations. So there seems to be a double standard at play there. But that was a complaint that was brought forward in Lynn Lake as well. In Thompson we spoke to a nurse, whom would have first hand contact with this program and first hand contact with the medical needs of individuals in northern Manitoba. And you know what they said to us, and I'm not only talking about the nurse in this instance, but I'm talking about many other people who came forward . They said before the guidelin es were too loose.

We agree with that, and that the guidelines needed some reassessment and revision, and they agreed with that as well, and I've said many times when discussing this particular item, that the other program had its problems and in fact did need reasse ssment. lt was our government who und ertook that reassessment and it was our government who put in place primarily, this particular program. I've said that in the past too. And I think that if our government were still in power, that in fact this program would be undergoing the type of changes which are necessary.

So they acknowledge that there were problems before, as has ever yone, but they said this new system just doesn't work. The decision on whether somebody is going to fly or somebody is going to be based, is sometimes the most incompr ehensible arbitrary decision that an ind ividual can run up against. And they said, it depends on who you are, and these are their words, who you are and on what day it is when you walk in, determines in large part which sort of travel warrant you're going to get.

Now that's probably an over-exaggeration, but I'm certain that in fact it does provide some insight to some of the problems there. I'm not saying that's always the case, but I'm saying this is their concern and they said those who complain oftentimes get a better deal. So again we have the problem as you have to go up and fight for your rights, rights which should be due to you automatically, and they as well said, that an individual should be treated by the physician of their choice. In Snow Lake we heard much the same complaints. In Flin Flon we heard much the same complaints.

The fact is that every hearing that we held, was in an industrial commun ity where NP TP was an issue, was in fact a hearing where NP TP and criticisms of that prog ram were dis cussed and brought forward. So I think when the Min ister says that he has received no compla ints or very few complaints in respect to this program, he may in fact be correct from his prospective.

But I am providing the Mi nister with another prospective and I am telling him I received many complain ts ab out these programs, some of which are passed on to the Minis ter, some of which I tell the individuals to go back to their doctor or go back to their travel warrant representative in their community and try to get a different mode of travel made available to them. Sometime s the y'r e success fu l, sometimes they're not success ful. Sometimes they decide to carry on, sometimes they don't decide to carry on.

But what I'm pointing out to you is that in fact the system is not working as well as you would have it to believe, and I ask you to take that on trust. I have no reason to distort the situation, if in fact the situation is working well. I would be the happi est person here, if that situation was working well. Number one, it would reduce my workload as a constituency ML A, but numb er two, it would mean in fact that my constituents and other constituents in the north are getting the type of deal which was intended for them unde r the original pr ogram , and that is no t happening.

So I am providing you with that insight. I am relaying information to you, which you have not been appraised of through other means. And what I ask you to do is very simple. I ask you to confirm that inf ormation , and I don't ask you to go to the advisory comm ittees to confirm it. I ask you to go to the people to confirm it. And in fact if you set that mechanism up and people do not come forward with their complaints, then I will have to agree with you that perhaps I was getting a small select group of individuals who had a difficult time with the program but overall the program was working wel l.

That may in fact be the topic of discussion at next year's Estimates, if in fact the situations are the same, and if in fact you unde rtake that task. And I am perfectly willing to be put to that test, because I know that I have had enough representa tions in the back to at least have been able to form an opinion, my own personal opinion, that the program is inadeq uate in many ways. Now, the Minister said earlier in his speech that he really wasn't responsi ble for this particular program. At least that is the impression that I deriv ed from the Minister's remarks. Why did I derive that?

Well, the Min ister said first, it's the advisory committees at the local level who are developing their own guidelin es. So in fact if there is a problem, it's not the Min ister's problem, it's a problem that's being created at that level. He also said that he had been not appraised of any major complaints about the system over all. And then he said finally, that if I've been getting these complaints, I should be taking them to the advisory council and the advisory comm ittees at the local level and not interacting with the Min ister at this level. That was the implication.

Well, that is a total abdication of any Min isterial respon sibility in respect to this program. In fact, it is the Minis ter who must be responsible ultimately for the program. In fact, this is a proper and appropriate arena for these concerns to be brought to the Minister's attention. The Legislature serves that purpose as well as many other purposes. I don't mean to lecture the Min ister after having received a lecture from him, but I think he should know that, and I think he does know that. 1812

Tuesday, 17 March, 1981 And so I, in fact, am performing my function as an ML A to the best of my ability, and I think in the appropr iate manner, by bringing these remarks forward to the Minister in this forum. And I have done so in the question period, and I have done so by correspondence as well. I wrote to the Minis ter in August of 19 79, outlining a whole series of questions I had on the program. The Minister replied to me in December of 19 79, providing me with detail and data and providing me with information.

At that time, the Minister, in that letter did not suggest that I should go to the advisory council, he did not suggest that I should go to the local com mittees, he did not suggest that I should do anything other than I had already done. As a matter of fact, he says, I trust this is the information you were seek ing, however should you have any further questions about the program, plea se let me know. lt was an encouragement to go to the Min ister with questions about the program, and that's exactly what I have done in the past.

I think my actions are justified, I think there is no que stion as to the fact that the y are justified. However, it does leave in question the actions of the advisory council. Should they take the blame for this? Should the advisory councils in fact have to be the ones that are made ultimately responsible for the problems which I have suggested are happening with this program? I would say not; I would say not, because they are provided with a budget by the government and they have to operate within that budget, and the fact is that budget wasn't enough.

The fact is there wasn't enough money provided to run this program in the way in which it should be run. Last year in Es timates we talked about this particular program, and the Minister at that time said, the budg etary appropriation for the coming year, as the honourable member can see, is the same as last year; no increase whatsoever. Yet we know at the same time that costs had gone up. There were increases in other budg etary items within the Mi nister's Department. We kno w that if the program was being used to its utmost that in fact the cost of that program should be going up.

And the Minister said, in fact, that he belie ved the funding to be perfectly adequate, and he made the point, not just adequate but perfectly adequate. The fact is that the Minister told us there was an overrun on that budgetary item this last year, but that clouds the issue a bit.

The issue is why, if this program was being utilized properly and air rates were going up, and we know air rates were going up, and we know in fact that one of the criteria that should be used by the advisory committees at the local level in dete rmining what sort of budget they should ha ve, was based upon rate changes, percentiles, in the commercial air fares, and we know there were those sorts of rate changes. But I think those advis ory councils wanted to do what the Minister wanted them to do, and that was to keep costs down.

So I think that they may have in fact been overly stringent in their appl ication of the program. And there is a letter from the chairperson of the NP TP, and in that letter which is from November 19 80 to a resident of Gillam, it said it would be far too costly for our program to subsidize the people from any communities in our district to visit doctors of their choice in southern Manitoba or 1813 elsewhere. And this is the telling line within that letter, it says, "families and individuals that move to our communities must realize they have made the choice to move to the north.

They should also be aware that our commun ities cannot provide all the services that are available in the south but that we do attempt to do the best we can." I am certain that they do attempt to do the best they can, ho wever, I would disagree when it comes to the Northern Patient Transportation Program. We are not talking about movies, we're not talking about television service, we're not talking about shopping malls; we're talking about one of the most basic requi rements of any human being in this society and that is medical care, proper sufficient medical care.

And so the fact is, that what she is saying, is that people in the north should know by moving to the north that they have given up their rights to the same type of medical care which southerners have, and that should not be the case. That certainly is the case, but that should not be the case, and that's why this type of program was brought forward in the first place.

I see the Member for The Pas is here and the Memb er for The Pas was very instrument al in bringing this type of program forward and can probably provide you with more insight as to what the previous government thought was the need for this program than can I. But it is my unde rstanding that this program was brought forward to provide northerners with access to medical care which was available to southerners which was not available to them. lt was brought forward to take away the penalty, at least in respect to medical care, of living in northern Manitoba.

And if that is the case, I would suggest that it is not performing its function, and I would suggest that I am not the only one of that opinion, because that letter which came from the Chairperson of the NP TP program just a few months ago, said that they must realize that they are not going to get all the services that they got in southern Manitoba.

The person is even more blunt about it, the person says, "Some inconvenience is a fact of life when you live in our communities, not only in health care but for other service as well." Well, I would suggest that inconvenience is a fact of life but there should be not any inconvenience in health care, or there should be as little inconvenience as possible in health care, and the fact is that the way this program is being run now builds inconvenience into the health care system in the north and that is why I want the Minister to go out. I'm not asking for much from the Min ister.

All I'm asking for the Minister to do is to take my remarks seriously; to take them in the way in which they are intended, and tha t is sinc erely and with a considerable amount of hope that something will be done about a program which I believe, and many others believe, is inadeq uate and is failing its original purpo ses. So the question to the Minister, and I hope I have not been as antagonistic in my reply to the Minister as the Minis ter was in his statement to me, I have tried not to be. I would hope that the Minister will drop that veil of antagonism when he answers me in response to this.

But the question is, very simply, is he willing to set up a - and task force is too strong

Tuesday, 17 March, 1981 a word - but an investigative committee to go out into these communities, to make public the fact that they are coming into that community, to solicit the opinion and viewpoints of indi viduals in that community in respect to the Northern Patient Transportation Program. I will go one further on the Minister, I'd like to see him be able to do two things at once, to be able to deal with two concerns at once. At the same time I would hope they would talk about the problems that individuals in the north are experiencing with the high turnover of medical doctors.

Again, it's an area that the Minister and I have talked about, we will probably talk about it under another line in the Estimates debate, however I am suggesting at this time that that committee could deal with those two subjects.

The reason I think they should deal with the second subject as well is because on the task force, and the Member for The Pas was in many of the meetings in that task force and I'm certain he can confirm this impression, but during that task force trip through the north last summer people came forward with what I thought to be some very good ideas on how to deal with the medical manpower shortage in northern Manitoba.

They had given that problem considerable thought because it affected them directly; they knew first hand the problems of northern living, and they came forward with some very positive suggestions which I intend to forward to the Minister once I've compiled all the Minutes of the meetings, and that may be a month or so yet, but I wou ld hop e tha t the Minister would also, if he decides to put an investigative committee in place, dir ect them or mandat e them to perform that function as well. MR. CHA IRMAN: The Hon ourable Mini ster of Health. HON. L. R. (Bud) SHERM AN (F ort Garry): Mr.

Chairman, I don't know what I can add to what I've said on this subject already. The fact that it is locally admini stered and supervised and controlled; the fact that it is de emed desirable, both from the government's point of view and, I suggest, the point of view of both sides of the Hous e, and the communities themselves, that it be so administered; and that certainly there is a procedure for raising and addr essing gr ievances and introducin g suggestions for improvements and refinements that is a funda mental part of the system, through the local committees and the Advisory Committee.

I have not attempted to suggest for one moment to the Member for Churchill that the Minister of Health has no responsibility for this program. What I have attempted to suggest is that it's specifically designed to ensure that the Minister of Health and the Health Services Commission and the bureaucracy in Winnip eg do es not have authority over this program in the areas of decision making as to the services provided and the needs being met and the priori zat ion of transportation choic es.

The whole purpose of the structure, based as it is on advisory committees and local committees is to vest that decision making authority with the people who are on the scene and best know how to deal with the local problems as they arise. So I don't know what further I can add to what I've said on that subject.

Certainly I would be prepared to ha ve the adviso ry comm ittee revie w the complaints of the Honourable Member for Churchill and certainly we can ask the advisory committee to poll or sur vey, insofar as it's reasonably possible, the opinions of northern residents as to the effectiveness of the prog ram and the shortc omings of the program. I can say to the Member for Churchill however that neither I, nor the government, lives entirely in a vacuum on this subject.

The Member for The Pas has raised questions about the No rthern Transportation Program in a past session of the Legislature during an examination of the previous year's Estimates, largely relative to the method of administering the program and the local committee function and input. I have not had from the Member for The Pas, to my recollection, from the Member for Thompson, from the Member for Flin Flon or from the Member for Rupertsland, any complaints about the Northern Patient Transportation Program of a significant nature or of the nature sighted by the Member for Churchill.

The only source from which those complaints has come has been the Member for Chur chill. That does not in any way denigrate the quality of those complaints, but I suggest to him that there are other members of the Legislature from the north, including a member of the Go ver nment Caucus and Cabinet, and complaints of this nature have not been raised, nor am I entirely without some geographic contact in the north myself.

I have been in all constituencies mentioned most recently, and very recently in the Flin Flon constituency, and again I must say that in my conta ct with indi viduals, persons, memb ers of the community in th ose constituencies, such complaints have not been raised with me or add ressed to me. The only ones that I have received have been the four, five or six that I have mentioned earlier in the day, most of which, if not all of which, actually came through the Member for Churchill.

Again I say that does not reflect on the sincerity of those complaints, but obviously we have some problems with the Member for Churchill with respect to this program, and the Member for Churchill has some problems with us, and I will certainly make strenuous efforts to resolve them with him. I certainly will ask the advisory committee to attempt to get a reading from the public and from the communities, as broadly and as quickly as possible, on the subject matter of his comments. With respect to the turnover of doctors in the north, that is an item, Mr.

Chairman, that will be dealt with unde r Medical Servic es and Ne w Programs. I would appr eciate receiv ing any suggestions that the Member for Churchill says have come his way, in terms of possible solutions to this problem. We have a Standing Commit tee on Medical Manpower hard at work on the problem of doctor distri bution and supply. They have made a numb er of rec ommendations to us and one of our new programs is based on their recommendations.

That Standing Comm ittee on Medical Manpower contains significant and deli berate representation from the north, because obviously it's a part of our province that is more vuln erable to gaps in service and underservice than many others. That will be dealt with, as I say, Mr. Chairman, under another item of the Commis sion Estimates. 1814

Tuesday, 17 March, 1981 MR. COWAN: Is the Min ister ind icating that he has not received compla ints from any other polit ician outside myself, in respect to this program? MR. SHERMAN: To my recollection, Mr. Chairman, no. that is correct. I concede that the Member for The Pas, in la st year 's Estimates, certai nly had some questions about the Northern Patient Transportation Program, but my recolle ction is that they had to do with the decision making and adminis trative aspect of the program and the role and fu nction and responsibilities of the local com mittees. MR.

COWAN: I would just like to remind the Minister of a letter he received from a Member of Parliament for the area. Mr. Rod Murphy, who wrote to the Minis ter in October and suggested that his Thompson office had received calls, not one call but plural, calls from cons tituents asking for his intervention con cer ning the problems they were experiencing with the Ma ni toba Patient Transportation Program.

And he said, and these are his words, "again and again I hear the concerns of parents who must endure the 12-hour bus trip to Winnip eg with their childr en, in orde r to see specialists in Win nip eg, or to be admi tted to a Winnip eg hospital for surgery. In most cases parent and child are apprehensive and generally upset at not knowing what awaits them and his trip does nothing to ease their fears".

I will also suggest to the Min ister that there have been concerns brought forwa rd, although perhaps not as strongly as I have brought them forward, from other politicians from time to time in respect to this particular program. I do not stand alone in my criticism of the progr am. I would just wish the Min ister would accept that. We seem to be in a fight now over how many people are complaining. The fact is that I am telling the Mini ster that I am receiving a significant number of compla ints, otherwise I would not be bringing this forward to him.

I am telling the Minis ter that this received substantial discussion during our hearings in ten di ff erent nort hern Manitoba's communi ties. All I'm asking the Minis ter to do is to go out there and check those complaints to find out if there is any validity to them; to test the thesis that I'm putting on the table. But before he do es that, a letter to the Mini ster from the Admin istrator of Gillam. "The dis tric t is very concerned about the admin istration of this program, the lack of specialists in the north, and the definite lack of adequate transportation in the north".

The letter ends, and it's to the Min ister last fall, "we'd like to suggest a reassessment of this program to be made with a view of providing the best possible service to the patient, taking into account all restrictions of travelling in the north". There's another, here's an answer to the Regional Trans portation Office r of the No rthe rn Patient Transp ortati on Prog ram , da ted July 1980 to a constituent of mine.

And it says "The Thompson Region Patient Transpo rtation Commi ttee wish to advise that, due to increasing costs and the result in def icit position, the or iginal guideli nes of the Northern Patient Transportation Program will have to be adherred to more closely. This includes basing the means of transportation strictly on the medical condition of the ·patient. To ac complish this physicians will be required to comp lete warrants 1815 more accurately with a diagnosis given and the reason for referral filled in". Well, they were tightening the program up last year.

It was tight enough and they were tightening it up even when the Mi nister assured us that he felt the funding was perfectly adequate. Let's hear what the Minis ter had to say again last April. The Min ister said, and he was addressing his response to a question from the Member for The Pas, and the Minis ter said, "Mr.

Chairman, I think about the only answer and reassurance that I can gi ve the Honourable Member for The Pas on the point is that the commission advises me that there were all kinds of compla ints of the type the honourable member mentions when the program is being admin istered by the government, when it was being departmentally adminis tered, and that since it has been put in the hands of local commi ttees we have not received any such compla ints, or certainly not any signi ficant number".

The Mi nister then goes on to talk abo ut the funding on it, and what the Mi nister says is, "but on the basis of last year's reco rd", I'm quoting the Minis ter, "we believe this funding to be perfectly adequate", not just adequate but perfectly adequate this year. As an aside, off the quote from the Mini ster, he should be careful of those absolu te statments.

"The purpose of course," the Mi nister again, "of the program, as the honourable member well knows, is to subsidize the transportation of emergency cases and hospital transport cases and cert ain el ective and medical -surgical cases for residents who live north of the 53rd Parallel in Manitoba to hospital and medical services in the south, most noteably in Wi nni peg". And yet the regional transportation officer is saying that the funding wasn't perfectly adequate. As a matter of fact, they were having to cut back on the program because the funding was not enough, they were in a deficit position.

I am just trying to point out, and I am not trying to be in any way derogatory about it, that we make mistakes about these things from time to time. The Minis ter makes mistakes, I make mistakes, people in the field make mistakes, advisory councils make mistakes; we all in fact from time to time make mistakes. The Minis ter made a mistake last year in his assessment of the funding and in fact people suffered because of that mistake. -(l nterjection)­ Well, yes, they did suffer.

The Mi nister says they didn' t suffer, and yet the fact is that what has to happen is that because of increasing costs, and the resultant deficit position, the original guideli nes of the Northern Patient Transpo rtation Program will have to be adhered to more closely. That implies a tig htening up, a restrictio n, a contraction of the program. So it did hurt people. Let me read a case history into the reco rd. This person's wife became pregnant last year. The child was due to be born in November 1979.

It was a first child and it must be pointed out that many doctors in northern communities are hesitant to have a first child born in the community because there is more of a prevalance of complications in a first birth. The doctor strongly recommended that person deliv er her baby in the south, and they were informed that she would be covered by the Northern Pati ent Transportation Program for that delivery. The day

TUI!sday, 17 March, 1981 before her scheduled departure for the delivery they attended the hospital to obtain a warrant. Ttrey were told at that time that the doctor could not < uthorize the warrant due to their desire to have the child in their home town instead of in Winnip eg. The;1 further advised that his wife, if she wished to d·3liver in Thompson, would be paid train fare and not air fare. Has the Minister ridden that train lately? It's not a very pleasant ride when you are in the best cf health. The train arrives in Thompson - they just changed the

schedule recently - but it arrives in Tt rompson early in the morning and at leaves Gillam ear ly in the AM, 1 o'clock or 2 o'clock. We are talking about a pregnant woman getting on a train at 1 o'c i•)Ck or 2 o'clock and going down to Thompson to attend to hospitalization for the purpose of having a child, but they knew nobody in Thompson, and they had no place to stay in Thompson while waiting for t 1e baby, and they had no doctors to rely upon, thlly didn't know the doctors in Thompson.

All they w.mted to do was go to an area where they had a plac •3 to stay while wait ing for the baby, where they knew the doctors, where they had some faith. The individual in this case felt that it was not in the best intmests to the health of the family or the expected baby and decided to fly the person out at their own exl)ense. Then it turns around. Remember I told the Min ister a bit earlier about how this program is 2 rbitrarily admin istered, how it's hard to determine what the criteria are that are being used.

They thought they had a very legitimate case in respect to the birth of their baby - sounds logical to me. I think even the Mi nister will respond that it sounds logical. Perhaps it was not within the guidelines of the program, but their logic was indisputable. But later on 21 genetic specialist req!Jested that person's wife attend a follow-up coun selling session six months later in Winnip eg. He made the necessary arrangements for both of them, purch ased plane tickets for both of them, and ready to fly to Wi nnip eg at our own expense due to the fact that both he and his wife were in good health.

However, at that ti m3 they're inf ormed that the N PTP would p<ry their transportation costs by air for both of them to be in Winnipeg. And he says, in other words, I anr quoting the ind ividual, "when my wife needed tran:;p oration assistance due to her health condition she was only eligible for train fare to Thompson. When we didn't need the transporation assistance due to being in good health the pr ogram provided two air fare tickets to Winnip eg and return.

It is my opinion," I am quoting from the letter still, "It is my opinion that this entire program should be rev iewed and reaso nable guideli nes establishe d which would provide the best possible health care to all residents of the north. I have received many other comments on the Northern Patient Transportation Program from other residents and believe there is widespread dissatisfaction with its present set-up". Another case history.

A patient going from Gillam to Thompson, Manitoba, for psychological e·1aluat i on, forced to sit up on a train all night for approximately five hours transpor tation time, arrives in Thompson at 7:30 a.m. and then is forced to wander the streets and the shopping centre until an appoint rre nt time, which in this case was 2:00 p.m. Patients who are under medication for pain being forced to remain up all night on the train - carbon copy to the Minister, 1816 carbon copy to myself, a Reverend of a church in Gillam. The same indi vidual, March of 1979, his son was required to go to Thompson for a tonsillectomy.

The NPT Program paid coach fare to Thompson and return. The eight year old son would have been required to sit up all night from 2:30 in the morning to 7:30 in the morning on the train, undergo surgery and then return by coach for a further five hour ride upon completion of the operation. Pre and post­ operation tim e according to this person, in their opinion, should be spent in rest in order to speed recovery. As a result this person flew his son to Gillam and back. There are more case histories. There is something wrong with that program.

Is that so hard to accept that there is something wrong with the program. It's no reflection on the Minister; it's no reflection on the government; it's no reflection on the department or the advisory councils, it's just a matter of something being wrong with the program. I'll tell you what is a reflection though, the fact that no action, no positive action is being undertaken by the Min ister when appris ed of the problems in the program.

It's a reflection on the Mini ster and it's not a good reflection on the Mi nister; that is why I hope the Mini ster will take what appears to be a relatively simple and logical course of action and send some people up into the north, not the advisory councils, because they have a vested interest in the results of that survey. It is a reflection on their work if in fact the survey shows that ther e are widespr ead problems, and I'm not blaming them. They're trying to do the best they can under a limited budget, a budget by the way which is provided to them by the government.

I would ask the Mi nister, in response to the work of the advisory committees, if those committees take Min utes and hold Mi nutes of their meetings? MR. SHERMAN: Mr. Chairman , I can't answer that last question. I would expect that certainly the advisory comm ittee does, whether the four local comm ittees do, I can't answer definitiv ely but I would expect that they do. I'll just check with my officials. MR. COWAN: If they do, is the Mini ster prepared to provide us with copies of those Minu tes? MR. SHERMAN: Mr. Chairman, I'm advised yes, that the advisory committee does.

With respect to the local committees, they would operate according to their own rules and their own dictates and I can't confirm that the local committees take Min utes; but I would say, Mr. Chairman, that nothing the Honourable Member for Chur chill has said in the last few minutes is inconsistent with what I have said to him during this debate. I have conceded that I have had between four and six complaints and he has ident ified two or thr ee of them in his reference material. He may have a voluminous number of other complaints; he has not passed them on to me. Mr.

Chairman, on the subject of funding, I want to disabuse the Honourable Member for Churchill of the imp ression under which he is labouring with respect to funding. The Northern Patient Transportation Program in 1978-79 showed a surplus; the Northern Patient Transportation Program in 1979-80 showed a surplus; as a consequence of that and based on discussion with respect to the dic tates of spending

Tuesday, 17 March, 1981 priorities with the local committees, a budget was struck for 1980 -81 that admittedly in the printed vote, turned out to be insufficient. There was a shortfall of $1 15.000 projected in the requirements of the program for 1980-81, and that $1 15,000 was supplied through a supplementary vote earlier this fiscal year, so that the objectives, the needs and the requirements of the program could be met. The budget struck for 1980-81 was based on experiential years preceding that fiscal year, in which surpluses had resulted in the funding of the program.

That was the reason for the parameters that were applied to the 1980-81 vote appropriation.

But when it became obvious that other costs had developed , cost pr ice circumstanc es had begun to affect the budget and would have a disadvantageous effect on the program, we addr essed it through the administrators of the program and supplied as I say, the additional $11 5,000 through sup plementary Estimates, so that there waws no shortfall in funding, no shortage of funding, no squeezing of funds in the Northe rn Transportation Program in this cur rent fiscal year or in the preceding years in which this government has been in office.

Now, if the Member for Churchill is saying to me that $1 ,579 ,000 is not enough for the Nor thern Patient Transportation Program, and that we need $2 million or $3 million or $5 million, fine, I can say that about any health progr am. Anyb ody in this Com mittee, anybody in this Legislature, anybody in this province can say that about any health program. Surely, Mr.

Chairman, the Member for Churchill is realistic and pragmatic and responsible - and I underline the latter term - responsible enough to recognize that in a $700 million health care spending spectrum in Manitoba, we ar e dra wing on the resources, the reserves and the capab ilities of Ma nitoba taxpayers to a substantial limit, and I suggest to the Member for Churchill that the record is infinitely better than that demonstrated in many other jurisdictions in this country.

I would illus tr ate by just remin ding him of something he probably already knows, but it's an interesting and vivid example of what is provided here by the people of Manitoba to other people of Manitoba and themselves in health care spending and in social services spending, the budget for the State of California this year is $24.6 billion. That looks like a lot of money until the Memb er for Churchill and I stop and recognize that California has a population of 20 million people. It's the largest state in the union. We have a popula tion of one million people. Our budget is $2.3 billion.

On a per capita basis, the California budget should be $50 billion, not $24.6 billion and that, Mr. Chairman, through you to the Member for Churchill, is simply one ill ustrati on, I suggest a fairly comprehensible one and a reasonably vivid one, of the difference in the kinds of systems and services that we, the people of Manitoba and the people of Canada, make available to each other and to ourselves through health and social service programs. The Mem ber for Chur chill thinks the supply is infinite. It is not infinite.

There has to be priorization done. priorization is done; and it would have to be done by him if he had the responsibility. He doesn't have the responsibility, hence he can ask and plead for inequitable appr opr iation and distr ibut ion of 1817 available resources and imb alanc es that are not pr acti cal. We have provided the Northern Transportation Program with what its administrators have indicated to us it needs up to this point in time and we will continue to do so. As for the train trips, I go back to what I said before.

The responsibility for making those decisions as to modes of travel rests with the local physician, the patient's physician and the local committee and if the Member for Churchill doesn't like it, I suggest he go to the local committees, to the local physicians and to the advisory council about it. I will certainly refer his complaints to the advisory committee and ask them to review the kinds of criticisms raised by the Member for Churchill, but I reiterate that they represent, I think, a fairly limited and fairly unique position of criticism of this program.

It has not been general other than as has been con veyed by and through the Member for Churchill. He obviously has a lot of unhappy constituents, unhappy with the Northern Patient Trans portation Prog ram, and perhaps unhappy with many other things. If he wants to pass those individual compla ints on to me, we will certainly look into them. Those that he has passed on to me have been investigated. MR. COWAN: Mr . Cha irperson, there he goes again. We had tried not to be antagonistic and the Minister insists on being antagonistic.

We had tried to discuss this in a realistic, pragm atic and responsible way, to read the Minister's words back to him, and all we got was a diatribe about how I'm the only one that sees a problem with this program. I'm shouting in the wilderness. There's other colloquialisms which are more crude but I won't use them. The fact is that I read to the Minister, sections of Minutes from hearings that we held. I read to him sections from letter s from reveren ds, from admistrators of co mmunities, from indiv idua ls in commu nities, and they all say there are many problems.

I read to the Minister a letter from the Member of Parliament whose area -(lnt erjection)­ The Minister asked me if I read them to a local com mittee. My responsibility, Mr. Cha irperson, I would suggest is to read them to the Minister and the Minister's responsibility is to get in touch with the local comm itte e in order to deal with the problems that are brought forward to him. That is something he has suggested he is doing, that's some small sola ce. Ho wever, le t's discu ss what the Minister had to say.

The Minister gave the example of the Budget in California, and he said that example was a simple illus tration, one that was vivid and illustr ative, as to how much more we are spending on health care in this province per capita than they are in California. Does the Minister seriously expect us to believe that you can compare directly the health care budget of the State of California and the health care budget of the Province of Manitoba? He says you certainly can. Of course you can, because there is not an extensive medicare system; there are private hospitals in place; the doctors are paid by the patients.

No compar ison whatsoever. MR. SH ER MAN: But this is coming out of the Provincial Treasury, your taxes. That's exactly the point. If you want to finance a private Northern Transportation Program, go ahead and do it. Right

_ _ _ _ _ __ ____ _ _ _ T.:...:u=e·sd ay, 17 March, 1981 now there's one being financed out of the reserves of the taxpayers of Manitoba. MR. COWAN: Sort of like a private nursing home then? Is that what the Mi nister wants? D· )es the Mi nister want a private Northern Patient Transportation Program? MR. SHERMAN: The Member for Churchill obviously does. MR. COWAN: No, the Mem ber for Churchill obviously does not, Mr. Chairperson.

What I want is a good Northern Patient Transportation Prog1·am and I think the province has the best capability ol putting in place a good program and I think the prov nee has the responsi bili ty for putting in place a good program. I'd asked the Mi nister earlier if he would provide me with any Mi nutes which are available for 1earings of either the major Advi sory Council and/or 1 he local Advisory Council if they'r e available. Can the Mi nister commit hi mself to undertake to provid � those minutes to me? MR. SHER MAN: Mr .

Chairman, I will ce rtainly enquir e of the Adv isory Commit tee as to the availability of their Minutes but I can 't make that commitment without asking the Advi sory Committee. They're empowered and structured to act in their own realm of responsibility and authority anc 1 would have to make that request to them, but I will do so. MR. COWAN: I hope that they will respond in the positive in respect to that request and I h)pe that the Mi nister will make it to them shortly and provide us with that information. The Minis ter also suggested that these decisions rest with the local committee.

Will he not awee that the local commit tees are only given a certain budget and that they have to operate within that budget, which they may do successfully and which has been proven in the past that they have been able to do successfully? It does not in fact prove th� t it is a good budget.

All it proves is that they are able to accommodate themselves to the dir ectives of the government in respect to the provision of rnoney to them; that the government provides them with a budget and by imposing these sorts of diffic:ulties on individuals in the communities they're able to keep within that budget for the most part. Is that not the case? Let me phrase the question di ffer enl ly. tf the Min ister provided them with a budget 1 hat was larger, would they not be able to provide more air transportation in places where they thought it might be more necessary? MR. SHERMAN: Of course, Mr.

Chairman . but you could say that about any health program in the province. If we provided the Manitoba Health Services Commission with more money, they would te able to add additional insured services. MR. COWAN: Perhaps we should go bac:k to the beginning because I think the problem mal' be, that the Mini ster and I have differring perce ptions of what this program is intended to do. In the Min isters opinion, what is the rationale for the Northem Patient Transportation Program? MR. SHERMAN: Mr.

Chairman, the rationale for the Northern Patient Transportation Program is to provide medical service and medical evacuation to patients in No rthern Manitoba who need to be transported to or referred to medical centres and medical facilities to meet health needs. They are emergency transfers, hospital to hospital transf ers for persons in Northern Manitoba, North of the 53rd Parallel who need such medical attention and require to be accommodated in fully equipped health facilities in order to receive that attention. MR.

COWAN: The Minis ter did not say that it was intended to provide or at least to deal with the in equities of health care which is available to north erners when compared to that health care which is available to southerners. Does he belie ve that is an essential part of the program as well? MR. SHERMAN: Mr.

Chairman, I think what I said is what I meant and I thin k what the Member for Churchill has suggested is implicit in a Northern Patient Transportation Program designed to meet the health needs of people who live in what certainly can be described as a remote portion and under­ serviced portion of our province. MR. COWAN: Just so the record is straight, one small correction to what the Minis ter has said as well. The Program is available to persons north of 51 st parallel from Lake Win nipeg to the Ontario boundary, and in the rest of the province it's north of the 53rd parallel. MR. SHERMAN: That's correct, Mr.

Chairman. MR. COWAN: We do have a di fferent percept ion of what the program is intended to provide but that's really a moot point when it comes to this discussion tonight, because it's not my perception that matters and it's not really the Mi nister's perc eption that should be the sole arbitrating factor in respect to evaluation and maybe even some reformation of the program, it's the opinion of the people who have to use it.

The Mi nister said that he would ask the Advi sory Councils to check their procedures, he would relay this debate to them or relay the series of complaints which I've mentioned to them for their discussion, and he also suggested that he would have them survey the opinions of northern residents as far as is possible in respect to the operation of this program. Would the Minis ter be prepared to provide with each tr avel warr ant. a form which could be fill ed out anonymously which would be so written as to provide an unbiased form for an individual to write down specifically what they thought of the complaint?

That could be fed into a data bank either manually or thr ough the electronic computer and the results could be tabulated; and it would be able to give the Minis ter an even better overview of how this program is operating from the eyes of those individuals who use the program? MR. SHERMAN: Mr . Chairman. I'll take it under advisement. I won't confirm that I will do that at the present ti me. I would tr ust that the Ho nourabl e Member for Churchill would recognize that there are responsible members of the community. and many of 1818

Tuesday, 17 March, 1981 them from northern communities, who serve on that Advisor y Commit tee and I would think that certain appr oaches of that nature might be at worst , presumptious and at best at least reflections of lack of confidence in them. but I will certainly take the question under advisement. MR. COWAN: The plan is certainly not intended to be derogatory to the people who are giving of their ti me to sit on the Advis ory Councils.

It is only intended and put forward to the Minis ter to try to provide a mechanism for determining whether or not the criticisms and concerns which I brought forward on behalf of my constituents are as widespread as I belie ve them to be and are, in fact, as of a serious nature, as I belie ve them to be. And I would think the Mini ster would want to do that.

And I would even let the Mini ster have full control over the program, the analysis, the writing of the questionnaire, because I trust that his major concern would be to determine if the program is working as well as it should be and therefore he would put forward a proper program to test the NPTP as it stands now. He's taking that under consideration and that's the best I can ask of him right now. I certainly don't want to, nor could I if I intended to, pressure him into a statement that he would proceed in that way this evening.

But I do take some small solace in the fact that he is willing to consider it, and I would hope him to not consider it to be presumptuous, and I don't think the people in the advisory council would consider it to be presumptuous, because I think they too want to make this the best program possible, otherwise they wouldn't be sitting there. It takes of their tim e and their energy and the fact is they're doing it, because they want to see the best program possible.

So I think that they would welcome that sort of a test of the program as it stands now, and that sort of a mechanism to provide suggestions, in puts and critic isms from persons using the program, as to how to better provide the service which we all know is necessary. I would ask the Mi nister, and I don't expect him to be able to provide the information to us this evening, but it's my unders ta nding that each re gion is submitting an annual audite d fina ncia l statement refle cting the operation of the regional program to the Manitoba Health Service Commission.

Can the Min ister make those available to us for the years 1977-78, 1978-79, 1980-81? MR. SHERMAN: I'm advised, Mr. Chairman, that we don't have the 1980-81 audited financial statement yet, but the earlier ones can be made available. MR. COWAN: I'd ask the Minis ter then once the 1980-81 becomes available if he could forward that to me as well. I would expect that would become available after the end of the financial year. Is that correct, March 31s t? And the Minis ter of course is going to check into the minutes.

I would also ask the Mi nister to provide statistical detail and specific detail as to the number of trips, what mode of trans portation was used and the number of persons involved in those trips - that would take into consideration escorts, when escorts and paid for under the NPTP program - and the cost of those trips , broken down on a trip by trip basis for those same years. 1819 MR. SHERM AN: Mr . Chairman, I'd advised by officials of the commission that some of that information is available. It is possible that not all of it is available.

Some of it is avai lable, but it will require a considerable amount of work to put it together, so when the commission is able to do it, as soon as they can do it, we will undertake to have it done. MR. COWAN: I certainly don't want the commission to have to lay aside more important work in order to come forward with that information, however, I do believe that information will be of some value to both the Mi nister and myself, quite frankly. I note that the Mini ster ga ve a commit ment last year to the Hon ourable Member for The Pas that he would provide some of that type of information at that time.

So perhaps he can go back and see if he has that available in a completed form and just forward it to me and then all that would be necessary would be an updating as to last year's statistics. As well, this new program, the NPTP which was borne out of the patient air transport, the PAT, became effective on September 1st, 1977 before the government changed hands, and it was a program based on the report of the committee to review the Patient Air Transportation Program. I don't have that report in my files.

I would hope that the Minis ter would be able to provide me with a copy of that report, again not this evening, but in the near future. Will he undertake that commitment as well? MR. SHERMAN: Yes, Mr. Chairman. MR. COWAN: And finally, I would ask the Minis ter to, when compiling statistics add in that portion of the budget which is spent dir ectly by the commission for air ambul ance on an emergency patient basis.

In other words, the Mi nister indi cated there was a certain amount of money that was the commission's money to spend for emergency cases - that would be chartering flights, that would be, I assume the use of the MU -2, is that correct? Yes, he indi cates the use of the MU -2 as well I think. Also buying stretcher seats or stretcher space on commercial aircraft; if he could give me a breakdown for all the expenditures, case by case basis, on that for the last three years, or since September 1st, 1977 for the program. I would appreciate that information as well.

Finally, I think we have come to the conclusion that the Mi nister and I are going to have to agree to disagr ee for the time being. We're going to agree to di sagree on the number of complaints which have been brought forward in one form or another to one person or another in respect to this program. We are going to agree to di sagree I believe, on the adequacy of this program. Fair ball, the Minis ter says that he has to be more responsible then I do, because he is the one who is ultimately responsible for the purse strings.

I don't think that takes away from the responsible way in which I can approach this problem. Perhaps it gives me a di fferent prospective, but I think I am being responsible in bringing these concerns forward and suggesting to the Mini ster that perhaps there is indeed need for some change. And it may not be all that costly a change; I don't know. I hope when I get the information which is provided to me I can put it into some sort of useable form as to make an analysis as to how costly that change may be. But

Tuesday, 17 March, 1981 the fact is that we are going to choose to disagree as to the effectiveness of the program right now and the adequacy of the program right now. I want to make the point very strongly, so that the record is clear, that the discussion which I have participated in this evening is not meant to in any way discredit the work of the advis ory council. I don't know the quality of their work to be quite frank about it.

And not knowing I certainly don't want to be so presumptuous as to suggest that they are not doing the type of work which they should be doing and there was some implication that I may, in fact, not be recog nizing the full value of tho se committees, nor recog nizing the full value of the persons on those comm ittees. I don't want that implication to be left un answered , and as I said in the past, I think it is more a matter of the amount of money with which they are provided as it is to their abilities and their dedication to their job or to their task.

I would also like the Minis ter to discuss with those comm ittees a num ber of items. One is providing reasonable overnight room and board expenses for persons who come to the South and who must stay, or even go to Thompson and must stay overnight in order to undergo more testing, and they are not provided with those expenses as is. Ho wever, escorts are provided with those expenses.

I would suggest that the reason for that, or the only reason that I can conceive of, at the time, is it would be anticipated that the individual would be staying in a hospital and ther efore wouldn't need overnight room and board expenses. The escort of course would not be staying in the hospital and would need overnight room and board expenses, but the fact is that the individual oftentimes is not hospitalized but is asked to stay over to take a different series of tests.

The Min ister kno ws that tes ting proced ures in ho spitals is becoming more and more extensive; that's spelled with a 't' and not a 'p', although they may becoming more and more expensive as well.

But the fact is that with the new variety of tests which are available to the medical profession, in order to make a diagnosis, there are many cases and many instances where an individual would be asked to stay over to take further testing or to await test results; so that if the test results lfolhich came back showed a condition which had to be dealt with immediately, or showed a condition which necessitated mo re tests, that individual would be av ailable., That saves the government money, because what would happen otherwise is the individual would go back to the commun ity and then have to come out on an NP TP warrant again and take the new tests or have the condition dealt with.

So the fact is the government is saving money by the individual staying over but it's cost ing the individual money. Hotel rates aren't cheap anymore; I don't kn ow if they ever were cheap, but they certainly don't seem to be cheap any more and it is a considerable expense for someone from the north to have to stay in a hotel. Not all of them have relatives in the area. I would also like the Minister to take into consideration the exclusion of chiropractic services from the NPTP warrant.

That was another concern that was brought forward to us in Lynn Lake; individuals had to go to The Pas for a chiropractor and yet they paid for that out of their own pocket, it's a fairly expensive drive.

Dental services, again in the north, you do n't always have a qualified dentist in the community, although I might add, and I like to pay credit where credit is due, I don't know if the credit is due to the Min ister in this reg ard or if credit is just due generally to the dentists who have taken it upon themselv es to locate in the north, but we do have more good dentists in the north now than we did a number of years ago, and I think that situation is improving. But still for certain dental work to be done a person has to leave their community.

As well psychological assessments, I would hope, could be include d under the program. They are excluded presently, and I think there is a need, where referred by a doctor to take a psychological test, for some reimbur sement. Psychiatric services, except where a life threatening situation develops, should also be covered. Finally in Lynn Lake the y mention that those individuals in the community who were going out for detoxification to The Pas or to other centres, again, were not provided with NP TP warrants.

When a person is going out to the detox centre it's a difficult time for them physically and emotionally, as well it's a difficult time financially because they have to leave their jobs, although there are some very good programs now to assist them in that task. But it is to the benefit of all society that those individuals are helped to deal with the problem which they are unable to deal with on their own at that time, and so there might be some consideration that could be given to including costs for trips to detoxification centres. As well, the taxi costs between air flights is not covered.

If an individual flys into Thompson they have to take a taxi to the city, to the hospital. I think the last time I took a taxi which was to downtown Thompson it cost me somewhere in the neighbourhood of $4 or $5, I'm not certain, it may be more than that with a tip. But the fact is that those are costs that they have to incur which a person in Thompson wouldn't have to incur because they have the bus service, but there is no bus service from the airport to the medical centre.

As we ll, as I mentio ned earlier, a num ber of individuals coming in from remote communities into the city after a long bus ride, or even after an air trip, are unfamiliar with the transit system in the city, don't want to get on another bus. don't want to take the chance of getting lost, and many times opt to take a taxi at their own expense. Maybe that's their choice, maybe they shouldn't be reimbursed, but I certainly think that concern should be addressed and that issue should be addressed by the Minister and that he should come forward with some policy in respect to that.

I am not asking him in all these instances to chan ge existing policy, but I am asking him to seriously review existing policy to see if the program can 't be made bett er. -(Int erjec tion)- As the Mem ber for Transcona says, to have a heart. Well I think the Min ister does have a heart although he's done his best to hide it this evening. I will not give him the satisfaction of saying that he has done that entirely and I am certai nly not pleading but I am attempting to give the Minister's 1820

Tuesday, 17 March, 1981 heart a chance. All we are saying is give his heart a chance __:_ a little aside their, Mr. Cha irpers on, I apoligize. I just, in the few moments left, want to check to see if there are any other concerns of a general nature that I wish to bring forward to the Min ister. I can't see them right at the moment.

That does not mean that they don't exist, and that does not mean that I won't bring them forward to the Minis ter at a later date by corr esponde nce or perhaps even thr ough the Min ister's Sal ary portion of the _ Estim ates, but I do hope he takes what I have brought forward under consideration.

I do hope that he does, in fact, attempt to examine the many concerns which I have brought forward on behalf of my constituents and to attempt to get a handle on what appears to be a differing perception of the program. and there's many vehicles open to him, and I would suggest firstly a committe e that would go thr ough the north and invite repres entation from everyone, splen did ide a any way, and it always pr ovides good insight, always provides an opportunity for people to talk to their government MR. SHERMAN: Great country to see. MR. COWAN: ... Gr eat co untry to see.

The Minis ter could even get in a little fishing on the side. We can't promise that he will catch anything, but MR. SHE RMAN: I save my fishing for Treasury Board. MR. COWAN: Well, whil e the Minister is fishing dur ing the next Treasury Board meeting, I would suggest that he use a red devil lur e becaus e obviously the big ones have been getting away from him. I would hope that he does take the opportunity, if not himself, at least to send representatives of the department forward to check out these concerns and to deal with other medical matters which are of great concern to northerners.

I look fo rward , next Estimates procedure, to being able to examine a program that has been reinforced by positive action to make it more responsive to the concerns of the northerners, concerns of the patients who must use the program. MR. SHERMAN: Mr. Chairman, I would just like to comment that the Member for Churchill has certainly made an eloquent plea and stated an eloquent case for the north and the Northern Patient Transportation Program. and I want to assur e him that hi s comments and suggestions will indeed be taken to heart. MR. CHAIRMAN: The Member for Winnipeg Centre. MR. J. R. (Bud) BOYCE: Mr.

Chairman, I want to thank the Member for Churchill, but in listening to the dialogue which took place between him and the Minister. my mind went back to the former Member for Churchill , Go rdon Beard. in the '60s, and it sounded like some of the things I had heard before. Hi s case is not only well justified but it was well taken. And the Minis ter, in his responses to the 1821 questions. did more to dissuade me from my position vis-a-vis the Constitution than any debate I've been involved in because the responsibility rests right in this room, ultima tely, and right in that chair.

In listening to the Min ister's answers, I was almost tempted to interrupt the Member for Churchill and tell him to get every person that is aggrieved to apply for a writ of mandamus. The processes are there, they'r e expensive, but if the Crown will not perform that which they should be perfo rming, the person has the right to lay the case before the court. Whether they succeed or not is another question. But here again, Mr.

Chairman, through you to the Mi nister, this is anothe r manif estation of the governm ent's unwillingn ess to accept their responsibility, and as a southern member, if I was given the option to give a horse racing commission a grant for additional money to make sure that the provision of basic fundamental services in the north were provided, I certainly wouldn't opt for the horse racing grant. And many other things; two miles of road .

When the Mi nister brings in a fellacious argument comparing California expenditures, it was picked up immediately by the Member for Churchill, that if you add in all the moneys that are paid into the private plans. Kayser and all the rest of them, I think you will find that the provision of services in Manitoba is one of the most economical ones in the North American continent, including the enriched services that we provide. But here again it's a reflection of gover nment policy, and I remember the debates back in 1969-70.

We all pay for this particular program, as we pay for all of the programs that are being considered under this item. If a person takes a look back from whence we came, when it was the decision of the government of the day, which is being given lip service by the present gover nment, that they'r e continuing, that it was a transfer from a premium tax to general revenues, that some of us will pay less and some of us will pay more. Personally I am probably paying more and I am glad that I am able to pay more than I w0uld be under a premium tax.

But the Mi nister in his answers reveals himself and his attitude of the government towards the provision of services in the north. And it has been the case of the Conservative government since I can remember, as pointed out by the member that I referred to earlier, Gordon Beard , who is no longer with us, Mr. Chairman. but he sat as an Independent because of his disenchantment with the Conservative attitude relative to the nor th. They'll flood it or give it away, that was their attitude.

The fact that I can go down the street to a hospital and get everything that's available - and when I say down the street. through you, Mr. Chairman, to the Member for Churchill, the Health Sciences Centre does keep a roster, I don't know if people are aware of it, they keep a roster of rooms that are available in the neighbourhood in private homes. When I lived on Winnip eg Avenue my name was on the roster and they used to phone every once in a while to see if there was anybody staying with us. So people could stay overnig ht. I would ask. through you, Mr.

Chairman, to the Member for Churchill. if he would give me a copy of the letter that he quoted from refle cting the bureaucratic attitude of the people in the north vis-a-

Tuesday, 17 March, 1981 vis the del ivery of health services. Nobody questions the fact, Mr. Chairman, that we can't have dialysis machines in ever ybody's living room, or heart-lung machines, but the attitude of the government, as reflected by that bureaucrat, it sickens me, it really does. Not just from the people's standpoint, but in a developmental standpoint. How in heaven's name can we expect to keep people in the north if we're not even going to provide them the fundamental services? If that bureaucratic letter is a reflect ion of government attitude it's jus t horrendous; it is.

People have to accept when they go to the north that they can't get these things, in 19 81? And when the Minister says that the Memb er for Churchill is the only one who has raised concern ab out health services in the north, I remember questions from the Member for The Pas, I remember questions from the Mem ber for Rupertslan d, about the provision of services in the north, more related to the ambula nce services, that is true. But Mr. Chairman, the people are entitled to the services.

If we, as a provincial Legislature, pass Estimates, pass laws providing services for people, then those people are entitled to those services as best we can provide them. In passing some of the laws, Mr. Chairman, we get into arguments some time. A service "sh all" be provided. In another matter I was curious about how imperative "shall" is, relative to the law.

Nob ody expects miracles of government but they have to demo nstrate that they are making all reasonable efforts to provide those services and it is evident from the presentation of the Member for Churchill that this is not the case in the provision of health services in the north. MR. CH AIRMAN: Pass line 7; No rthern Patient Transportation Program, $1 ,579,000.00. We're going to revert at this time back to Personal Care Homes. The Member for Transcona. MR. WILSON PARASIUK: Mr. Chairman, I have a whole list of questions. MR. CHAIRMAN: Are you referring to . MR.

PARASIUK: Personal care homes, yes, 1 have a whole set here. I think this is, as I told the Minister before, a very critical issue. I have not gone into detail on a number of the other appropriations, but on this one I intend to because I think it's important for us to have a very clear idea of what the situation is and for the public, I hope, to have a clear idea. I'd like to begin by asking what is the present policy with respect to per diems. I know the Min ister put out a press release on it some time ago but I'd like him to repeat it now for the record, if he would. MR.

SHERMAN: Is the mem ber referring to the residential per diems? MR. PARASIUK: That's right. MR. SHERMAN: The policy is the same as it has always been, Mr. Chairman, there is a per diem residential charge that is paid by the residents and meets approximately 23 percent of the cost of the 1822 program. That figure has ranged from something substantially higher than that several years ago to an average in the 22 - 23 percent range in recent years and that policy remains unchanged. MR.

PARASIUK: Could I ask the Minister what the present per diem is as of today and what it is projected to be by the end of this fiscal year, the one that we're looking at the Estimates for ending March 31 st, 1982. MR. SHERMAN: Mr. Chairman, the residential per diem at the moment is $9.25.

On April 1s t, the start of the new fiscal year, it goes to $9.75 and during the course of the 19 81-82 fiscal year it rises to $11. 25 for a 19 81 -82 average; it rises at quarterly periods during the year, coinciding with quarterly indexing of pensions in order to protect the disp osable incomes of pensioner residents which continue to ris e after absorbing the per diem increase. The 1981 -82 per diem average will be $10 .50, averaged over the year. MR. PARASIUK: Has the Mi nis ter received an indication from Ottawa as to what the increases and the indexing is going to be? MR. SHERMAN: Yes, Mr.

Chairman, we have, on the basis of current escalators in the methodology applied to pensions, we have projected what the OAS and GIS rates will be at each quarter during the year. The new OAS, GIS levels for April 1st was just annou nced in the previous week by the Federal Minister, Minis ter of National Health and Welfare, the Honourable Monique Bgin, and as I recall it was fractionally higher than what we had projected. But with reasonable accuracy we calculate what those pension increases will be on the qua rterly indexing formula. MR. DEPUTY CHAIRMAN: The Member for Seven Oaks. MR. SAUL MILLER: Mr.

Chairman, on the same point, I believe the announc ed increase in the OAS works about to about $8.00 a month effective April 1. $8.00 a month is nothing like 50 cents a day. The concern I have is that, in advance, determ ining that it will be 50 cents a day, which is $1 5.00 a month cost to the resident of a personal care home, it will exceed the amount of the indexing that takes place. A $15 .00 a month increase in the OAS is a very substantial increase. I don't recall what is taking place, I do recall once an $11. 00 increase. but $1 5.00 a month increase is exceptionally high.

So it seems to me that you're exceeding the indexing which can be anticipated, and although they can projections, really it reflects the rate of inflation and they don't really know themselves what it's going to be six months from now. So it's doubtful whether it will be anything like $1 5.00 a month. it seems to me what's happening here, Mr.

Chairman, is that the recent increase in the GIS, which Parliament passed, a special $35.00 per month increase in the Guaranteed Income Supplement, for the poorest of the pensioners, it seems to me what's happening is that this government is intent on recovering as much of that as they can. The purpose of that inc rease was because people who are

Tuesday, 17 March, 1981 dependent only on OAS and very little else could qualify for an amount which improved their income somewhat. it seems to me what we are seeing here by, in advance, determining that it'll rise over four quarters, $2.00 a day; $2.00 a day in a year is over $700 .00 .

So it seems to me that what we'r e witnessing here is an attempt by the province to recapture what the Parliament of Canada voted to give to old age pensioners, certain classes of old age pensioners and that what we're seeing is not what we had before, which was every quarter and an announ cement which reflected the indexing that took place. What we're actually seeing is anticipation of some indexing plus the known $35 .00 which the Parliament of Canada voted and which this government seems to be rapidly interested in recaptu ring.

To me this is a pretty cynical way of operating because the money was voted in order to make more funds available to pensioners. it was not simply voted so it could be recovered through higher per diems in personal care homes or anywhere else. So, I'd like a comment from the Minister on that. MR. SHER MAN: Mr. Chairman, certainly appreciate the perception and the concern of the Honourable Member for Seven Oaks and I want to assure him that my offic ials and I and the government shares that concern.

The step that has been taken, however in fact, does not reflect any attempt to recapture what the Parliament of Canada has voted to the old age pensioner, because those pensions of course are available to all old age pensioners and it's only a minimal numb er of our pension ers who are in personal care homes. In fact, statistics demons trate that 90 percent of our elderly persons are independent and self-contained, to one degree or another in their own places of owned or rented premises.

So what we're lookin g at is the pensioner in personal care homes and although it may appear as an attempt to recapture what the Parliament of Canada has voted to those pensioners, I must submit to the honourable member, Mr. Chairman, very truthfully and very sincerely that is not the case. What it is an attempt to do is to maintain the excellent Personal Care Home Program which was un iversali zed and insured by the previous administration and which this government certainly endorses, which represents a very enviable health program in Canadian terms.

There are only four provic es in Canada, in fact it may only be three. Is it three or four? There are only three provinces in Canada that have a universal insured Personal Care Home Program, and I know that the Mem ber for Seven Oaks as a former Health Min ister, recognizes the costs involved in maintaining that program. What has been carefully taken into account is the disposable income of pensioner residents and every effort has been made to protect that and to ensure that it continues to rise.

For example, looking at the disposable income of a single pensioner, we'll take the year that the previous government left office and this government came into office, 19 77-78, the disposable income of a single pensioner in that year was $70.16. In 1981- 82 it will be $1 28.38. For a married pensioner the disposable income in 19 77-78 was $59. 11 and in 19 8 1-82 it will be $80.02. Perhaps 1823 more sign ificant than that is the percentage of disposable income that is left to the pensio ner resident after paying the per diem . it has indeed, Mr. Chairman, I don' t deny it, at one or two points in the

schedule since the program came into effect in 19 73-74, been up in the range of the high 20 and lo w 30 percents for single pensioners and in the range of the high 20 percents for married pensioners, but those situations really had to do with aberrations that came about at the time when particular bonuses or improvements in the GI S - or one or another form of Federal pension - were introduced by the Federal Government and I might say that in most cases they wre associated with election campaigns.

In general the average over the range of the years of the program, for percent of disposable income remaining with pensioner residents has been in the range of the high twenties for single pensioners and the range of the low twenties for married pensioners, and the new rates maintain that level. The percent of disposable income in 19 81-82 availabe to single pensioner residents will be 28.7 percent and for married pensioner residents, exactly 20 percent.

The other indicator I'd like to just present for the consideration of the Honourable Member for Seven Oaks and the Comm ittee is the division of costs of the program. The residential charges, the residential per diems have consistently throughout the life of the program, with the exception of the early years when they were quite high, 19 73 and 7 4, when the program was being launched, they've consistently been in the 21 to 23 percent range and the government's share has been the other 77 to 79 percent. In 1981- 82 the resi dent's share will be 23 percent and the gov ernment's sh are will be '17 percent.

The total amount of revenue, accruing to the program in residential charges, that is unin sured income, that is the residential per diems in 19 81-82 will be $29.8 million and the total amount being pr ovided by the Manitoba Health Services Commis sion will be $97 million, for a total cost of the program of $1 26.8 million. When one considers that eight years ago whe11 the program was launched, the cost of the program was $1 6.9 million and this year it will be $12 6.8 million, I can only offer the justification that I've offered for the adjustment in the per diem residential rates. MR. MILLER: Mr.

Chairman, I kno w the figures the Mini ster is bringing forward and he can use percentages if he wants to, but the reality is this; the Parliament of Canada voted $35.00 a month. They've de termined that the thr eshhold of pove rty for pensioners is now at a new threshhold, it is a higher threshhold than it was before; that in fact OAS and GIS combined was inadequate and so in order to raise that poverty level they decided that $35.00 a month would be in order.

What your witnessing here though by an advance announc ement that is going to rise 50 cents per diem every quarter, you're going to have an increase to $1 .50 a day by January 1s t, from April 1s t to January 1s t; and of course April 1s t again by next year it'll be another 50 cents, it'll bring it to $1 1.75 from today's $9.75. I'm saying that rate of incre ase is more than what normal indexing would take and in fact, what the Minister is doing is staking out a claim on that $35.00 which Parliament voted , which they felt was a minimum amount necessary -

Tuesday, 17 March, 1981 and a very minimal amount, I think the Mi nister would agree - to bring people who's only incomes are pensions to some level which is considered at the poverty line. So even though this may keep his percentages in order, the fact is that we know that pensioners in this country are not doing all that well and people who have to depend on the GIS obviously were falling far behind and this was an attempt by the Parliament of Canada to just simply bring them up. it's my understan ding that it passed Parliament without a dissenting voice.

Everyone agreed it was high time and it was done; but what they' re witnessing is one level of government is making the payment and another level of go vernment is siphoning off, if not all of it, siphoning off part of it, because that $1 .50 a day which will be added to the cost at January 1s t amounts to $547.00 a year, which is far more than what the indexing is going yield. The indexing is nothing like that and really it does represent a substantial cut or a substantial slice of the $35.0 0 a month which Parl iament vot ed.

So although the Minis ter may like to keep his percentages in order, the reality is that these people are paying more and if I suspect that if they haven't voted that amount, the Minis ter would not have been able to come in here and say, well now it's going up 50 cents a day automatically. He'd have waited until indexing was announ ced and then made the adjustment acc ordin gly, retroactively, or to take place at the same time, the 25 cents a day or in some cases if the indexing didn't al low for it, perhaps even less.

But to an advance, say it's 50 cents a day every quarter, rain or shine, the only way the Min ister can do that and feel that what's he's doing he can get away with it, is because that $35.00 a month extra was voted for pensioners. MR. SHERMAN: Well, Mr. Chairman, I would have to concede the Honourable Member for Seven Oaks a point. Certainly if that $35.00 bonus to the GIS, which is the second in some two or three years - I remember going into the 19 79 Federal election campaign there was a $30.00 addition to the GIS announced in one block - he's correct.

We would have had to look very carefully at the rates because we really calculate our rates on the basis of the disposable incomes of the pensioner residents and without that additional block bonus to the GI S, there would have not been any flexibility with respect to that disposable income. Bu t we have worked to protect that and to ensure that it keeps increasing.

The only other point I would like to make at this time is that when we're talking about residents of personal care homes, we're talking as the member will appreciate, not about persons who would be considered in the category of people living on or near the poverty. The $35.00 GIS increase admittedly was voted by Parliament to improve the lot of elderly persons. Now, if it improves their capacity and ability to be residents in personal care homes, then that is improving their capacity and their lot and as the member knows, in personal care homes their needs are fully attended to.

There are some personal requir ements that one always has re gardless of ones age and that's the reason for protecting a certain amount of disposable income, but generally speaking residents of our personal care home s and our personal care home system live well and their needs are attended to. MR . MILLER: Mr. Chairman, what ha s to be recog nized is the term dis posable income. it's obvious as I say, that the Parliament of Canada felt that the disposable income of elderly people should rise in order to keep pace with inflation because their disposable income wasn't sufficient.

Now the Mi nister talks about disposable income. I realize that many of the costs of the personal care home are covered by the service; on the other hand there are costs to the individual in a personal care home - and I'm not talking about someone who is confined to a bed and really doesn't move out of the bed - I'm talking about many who are mobile; they're weak elderly; they are very elderly; they need the support of a facility but they are able to get around and they do have personal costs. They have to buy certain things on their own, not just entertainment, but personal needs.

They need money for family purp oses. If they hav e grandc hild ren they'd like to buy them a birthday gift and there is nothing wrong with that, but these things have all gone up in price, whether it's toothpaste or whatever, or kleenex. Those things are not necessaril y provided in all personal care homes. If you need a chiropodist, they come into the personal care home but you have to pay them. I know many of the women in personal care homes do, in order to maintain some feeling of dignity and feeling well, do have their hair done occasionally. These are all costly and those costs have gone up.

So to simply say well, they have more disposable income, therefore we should take more, is begging the question and ignoring the fact that the purpose of this amount was really to improve their lot, not just to help them stay put or stay level, but to improve their lot. The amount that is being taken away from them, I feel, out of the $35.00 a month is a very su bstantial amount and rea lly is taken advantage of, I'd say, somet hing at one level of government, and is being taken advantage of by this government. MR. DEPUTY CHAIRMAN: Line 2 - pass - the Mem ber for Transcona. MR.

PARAS IUK: I have a whole set of general questions I want to ask but I'll wait. I think we'll probably get back again to these Estimates on Thursday, if tomorrow we get into legislation and Interim Supply, although conceivably we might get back tomorrow. I am going to ask some specific questions again pertaining to the strike at St. Adolphe, and I raised them today with the Min ister. I think they are of a critically urgent nature.

I know the staff are here and I am wondering if the Minister might be in a position to answer them, or if he isn't in a position to answer them, I would think that if I raise the questions now he should be in a position to provide answers to these ques tions when we meet again probab ly tomorrow or certainly on Thursday. Fir st, the St. No rbert Ho mes Limited which operates St. Norb ert Home, also own St. Adolphe, and do they own any other private profit-making nursing homes? MR. SHERMAN: No, Mr. Chairman, they operate the St. No rbert Nur sing Home and the St. AdolphE 1824

Tuesday, 17 March, 1981 Nursing Home. and they operate St. Norbert Lodge, which is not a personal care home. MR. PARASIUK: Has St. Norbert Homes applied to the Manitoba Health Services Commission to build a new personal care home or to expand one of the existing ones? MR. SHERMAN: Yes, Mr. Chairman, they have applied to build a new one. MR. PARASIUK: Is this a replacement or is this just an expansion of more private beds? MR. SHERMAN: That's a difficult qu estion to answer, Mr. Chairman.

If it were approved and if it were to be built tomorrow, it would be an expansion; but as the honourable member well knows we're in a constant exercise in the system in terms of replacing old beds with new, and it could well be that at a certain point in that

schedule they would be beds that would be replacing old beds that were being cl osed down. But at the moment, and it's a hypothetical question because it isn't taking place, but at the moment it would be an addition. I don't know if that is very useful information, Mr. Chairman, because I repeat, it's hypothetical. MR. PARASIUK: I would think that there have been a number of groups that have made application to construct personal care home beds. Most have been given definitive answers from the Commission saying no. Has St.

Norbert Homes been told that they have not been given approval, or is their appl ication presently being reviewed by the Manitoba Health Services Commission? MR. SHERMAN: They certainly have been told that they are not approved in this year's program, Mr. Chairman, but as with a considerable range or list of applicants for personal care construction they have been told that they will be given consideration in the future. MR.

PARASIUK: I can infer from that, that they'r e on the current file - that they'r e not on the dead file, they'r e on the current file - and their situation is being reviewed by the Manitoba Health Services Commission. I know the Min ister has told us how private homes are paid. Can he indicate to us again, how are private profi t-making homes paid by the Health Services Comm ission for the services that they provide? MR. SHERMAN: Based on the numb er of beds in the facility, Mr.

Chairman, and on the categories of those beds in terms of levels of nursing care required. whether level 2, 3, or 4, they are paid an operating per diem. it's a calcula ted yearly budget, and I think I am correct in saying tnat they're like hospitals, paid 24 times a year; approximately every two weeks they get one twenty-fourth of the projected budge t for the year.

That twenty-fourthly bud getary payment is developed from an annual budge tary project ion, as I have suggested, which is developed on the basis of the operating costs of the home for the year. which is based on the number of beds and the category of those beds. 1825 lt is in the case of the proprietary operators, the median per diem that's paid to the non-prorietary operators, insofar as the operating per diem is concerned. There are actually two per diems paid.

There is an operating per diem and a capital debt repayment per diem, and the operating per diem for the proprietary personal care homes is the median rate paid to the non-proprietary homes. That way it's ef ficient and practical to maintain control in budgetary terms and in terms of commitments of expenditure by the commission. MR.

PARASIUK: I think that at some stage as we proceed in these Estimates we'll debate whether in fact that's an effective means of providing control from the government's point of view, especially when these private homes do not file audited financial statements and aren 't being requir ed by the government to do so. MR. SHER MAN: The pr ivate homes that have always been in the field up till now, have not filed audited financial statements. They didn't file them under the former go vernment or the pr esent government. MR.

PARASIUK: I think that if I'm raising points, I don't mind being interrupted by the Minis ter on a point of order, but if he just wants to debate with me, then I think he should wait until he has his turn, because I don't interrupt his comments with points of a debating nature. -(I nterject ion)- Okay, these are areas of debate and dispute. I have not said anything about the past. I am talking about what exists right now and what exists in the future, because what's happened now is that this government has shown bias and favoritism toward private corporations in the personal care field that wasn't shown before.

The bias was shown towards non-profit groups because it was felt that non-profit groups would provide health care for older people in personal care ho mes because of their love of humanity, not their love of a buck. I approve of that past policy. What's going on right now I disapprove of completely. When I find that the Min ister is saying they have some type of control, and he is saying the control is that the operating per diem will be the median of non-profit homes, he doesn't say anything about the capital debt per diem which is a different one.

I don't know if that's tied to the non-profit capital debt, because if there is no risk involved, and there isn't any risk involved with personal care homes because the waiting list is so large I have a headline saying that in Western Manitoba there is a waiting list of 500 to get into personal care ho mes - the government pays the per diems; the old age pension pays the residential per diem; obviously there is no risk so why should private operators be getting a profit on the capital facility, a profit on the capital debt per diem which is what they work into their books, and that's where we will debate that and have some very major questions to raise.

When I look at the Minister's statements regarding per diems, I take a look at St. Adolphe and I see that in 19 79-80 they had 42 beds and they got $320 ,000 from the government. I look at St. Norbert, 91 beds and they got $1 ,044,000; twice as many beds with St. Norbert but yet they get three times as much money from the government. That raises some very major questions in my mind.

Tuesday, 17 March, 1981 Fu rthermore, getting back to the whole point raised by my colleague the Mem ber for Seven Oaks, the government is going to the residents and asking them to pay an extra $2.00 per day but they're raising it, they're raising it over the course of a year and they have no qualms about that, and that really is going to be going to the private operator in this instance.

The private operator will be the person who will get that extra $2.00 a day, not the Government of Manitoba, not the Ma nitoba Health Services Commission, but this private operator is going to get an extra $2.00 per day from the residents. This same operator is saying to the workers at that facility, that he can't afford to pay them rates that are not comparable, but cl ose to those being paid to workers in non-profit homes. He was saying that would bankrupt him. Here we have the government imposing on the residents an extra charge of $2.00 per day on behalf of St. Norb ert Homes.

That's not the market operating, that's the government using its power to give an extra windfall profit of $2.00 per day to Mr. Brousseau.

I know that the non-profit homes don't get that windfall profit because the government says, we want audited financial statements from the non-profit homes and the non-profit homes supply the audited financ ial statements and the government very carefully goes through those financial statements to make sure that there isn't any surplus, to make sure that these non-profit groups, which are non-profit by definition, won't stash any of this extra $2.00 per day into their pockets or put it in the bank; but rather if there was any surplus these non-profit institutions would put that surplus back into the quality of care provided to the residents.

The government says, no, we don't want that; we want to make sure that we watch them very carefully. We don't want a surplus; we don't want anything that might enrich the program, so we are going to monitor them very closely; ask for, receive audited financial statements and we aren't prepared to do that with respect to St. Norbert Homes, either with respect to their operation in St. Norbert, or with respect to their operation in St. Adolphe. So, it raises a whole set of questions. Are wage rates for staff different in private profit-making homes as a rule, in comparison to non-profit homes?

Are they different for St. Norbert and St. Adolphe homes in relation to the other private homes. I think those are very important questions for us right now with respect to the strike situation. I asked this in the House but I ask it again because the staff are here. Are workers being required by management to work double shifts? That is are the y working in St. Norbert; being bused over to St. Adolphe and being req uired to work a double sh ift in one day; exhausting them, and I would suggest, lowering the quality of care, possibly to dangerous le vels especially if some people inadvertently fall asleep.

I'd like to ask the Minister and his staff, are maintenance staff from St. Norb ert Ho me being required to work as nurses aides when they work a double shift in St. Adolphe? And, if they are being worked or being forced or being required to work as nurses aides, do they have the qual ifications and the skills to perform functions that nurs es aides are required to perform? I'd like to ask als o if government health inspectors from the Mani toba 182 6 Health Services Comm ission are inspecting the premises on an ongoing basis?

I have to raise concerns that we brought up in the House today as to why it is that the health inspectors, presumably through their reg ular, I would have hoped, spot inspections of these facilities, weren't able to find out a number of problems with the facility itself in St. Adolphe that were subsequently found out by the Workpla ce Safety and Health Inspectors from the Department of Labour.

The Minister says they are not the same thing, and I object very strenuously to his statement there, because if the conditions are declared uns afe from a workers point of view, in terms of overloading of electrical wires, in terms of auxiliary heaters, in term of broken windows; if they'r e declared uns afe from worker's point of view, surely they are much more uns afe from a patient's point of view. The patients aren't as mobile in a Personal Care Ho me as are workers.

So, when Workp la ce Safety and Health In spe ctors raise objections, I'm astounded that the government isn't concerned as to why the health inspectors, in the first place, weren't able to find out those problems that exist in St. Adolphe which the Minister of Labour has acknowledged exists there. So then that leads to another question. What are the inspection pr ocedu res? Are Personal Care Homes notified in advance of inspections?

Because if they are notified in advance and I can tell the Mini ster that I have been asking a numb er of questions of nurses and health care workers in personal care homes and they tell me that they are aware, at least a day in advance, and management as management tells them that there will be an inspection the next day, so there was a scurrying to put the best face forward that subsequent day. I believe that that is not the way in which inspections should be handled.

I don't know of other groups that phone up a day in advance to tell, say, the hotels, the beer parlors, any other spots, that they are coming in to do an inspection, so put your house in order so everyt hing looks good. I don't think that's the way to proceed. Ther e mus t be some conc ern with ins pection procedures in that I look at the inq uest results for St. Norbert Home where a person wondered away last fall and froze to death. And the inquest, the judge, found that the death occurred because a door was not manned which to me implies understaffing, said there was a problem with file overcrowding.

I look at that inque st result and I say why does it take a judge to de ter mine that, don't we have inspection procedures that would have determined that in the first place and establish safeguards to prevent that type of thing occurring? Why do we need a judge to bring these facts out, after the fact, and if that was, in fact, the finding, as it was by the judge, what has the government done to ensure that the recommendations of that inquest are being met, not only for the St. No rbert Home but for the St. Adolphe Home and for other Homes?

So, my concern with this issue is that the Minister surely has to either be satisfied with the type of inspection that is taking place which allows him to say publicly that, although there are concerns, we are satisfied that the quality of care is sufficient or adequate at present in that facility. But all the evidence, with respect to inspections. seems to

Tuesday, 17 March, 1981 indicate that the inspections haven't been precise enough. And the word that we seem to be getting from other people, from visitors going in, from relatives going in, is that the qual ity of care is deteriorating; they have some very special concerns. I think that it's up to the Minister to ensure that the quality of care there is being provided and that the workers themselves are not being misused, are not being threatened, either those that are on strike or those that are working in St. Norbert Home, because to me that would be very serious abuses of our Labour Standards Act.

So, I ask the Min ister, is he satisfied with the ins pect ion procedures? Is he satisfie d with the quality of care? Is he satisfied with the quality of the facilities, if inde ed those problems pointed out by the Department of Labour inspector still exists? Is the Min ister satisfied that the conditions are safer enough now that the situation is under some more extreme pressure because of the strike? MR. SHERMAN: No, Mr.

Chairman, I'm not satisfied and that is why I responded to the honourable member and others in the House the way I did this afte rnoon and that's why I assured them that, through the Comm ission , intensive assessment of levels of care and quality of care is being pursued; and my colleague the Minis ter of Labour is acting upon and exhaustively examining the criticisms and the charges in the other area, with respect with the physical condition of the plant. I'm at something of a disadvantage, Mr.

Chairman, because the Honourable Member for Transcona has raised a welter of questions, all of them important, and it would take me some time to respond and unfortunately, as I advised the Committee yesterday, I have an unavoidable commitment this evening and I think we had an agreement that Comm ittee would attempt to rise at approximately 10 o'clock. MR. PARASIUK: I appreciate that we were probably going to break at 10: 15 . I did want to raise a number of points. I thought this would give the opportunity to the Min ister and his staff to look at these matters.

If we come back tom orrow afternoon I expect the Min ister to be in a position to respond su bstantively to the points that I've raised. If we don't come back to Estimates until Thursday well then he'll have that extra day in order to find out all the facts pertaining to the matter. MR. CHAIRMAN: Committee rise. SUPPL V - FINANCE MR. CHA IRMAN, Abe Ko vnats (Ra disson): Comm ittee will come to order. I would direct the honourable members' attention to Page 58 of the Main Estimates, Department of Finance. Resolution No. 61, Clause 1. General Administration, Item (

b) Executive:

(1) Salaries - pass the Honourable Member for Rossmere. MR. VIC SCHROEDER: (In audible) what the government did, what the pr evious Mini ster of Finance did and what we need money for now, is to give all of thos e people an extra $10 0.00 by 1827 increasing the minimum amount payable against property taxes from $225.00 to $325.00. it used to be that those who were in the upper income areas in this province received a credit of $225.00, they did not qual ify for any of the cost of living credits, they did not qualify for any additional credit for their property taxes.

This government chose to give those people an extra $10 0.00 because obviously these people, in the view of the people opposite, needed that money. I then gave the example of my secretary, who is earning something in the range of just over $1 4,000 a year, the head of a family, two children, certainly a person who would need some assistance as oppo sed to those in the $40,000-and-up bracket. She loses $30.00. Some win, some lose.

Senior citizens: Each one of them, every senior citizen in this province loses on the cost-of-living credit unl ess you can find a senior citizen who is not in receipt of any income whatsoever. And why is that? That is because the first part of the formula, the 3 percent of total exemptions hasn't changed, but the second part, su btract ing 1 percent has changed. lt used to be 1 percent of the taxable income and most of the senior citizens in fact didn't have taxable income and 1 percent of nothing was nothing. So what they got was 3 percent of their exemptions as a cost-of-living credit.

What these kind gentlemen did, was change that to make it 1 percent of family income, net family income, to be deducted; not only net income of the individual, but net family income to be deducted from the cost of living credit. As a result there are many senior citizens in this province losing up to $40.00, both the husband and wife and more on the cost of living credit; and that's at the same time that othe r people, the wealthy, are getting an extra $10 0.00. So all of us I suppose have some priorities in terms of tax shifts.

We thought that we were here to attempt in some way to more equitably, more fairly, distribute the goods and services amongst those who work for them in our society. Obviously the people opposite think that you are here to more inequitably divide the goods and services, and you 're doing a fine job of it. There has been a suggestion by one of your backbenchers, Mr. Chairman, that it was a mistake. They really thought they were going to help people by changing that formula. Some mistake. Sur ely no Min ister of Finance would admit that he was so non­ cognizant of what ha ppens when you change formulas as that.

Surely we will not have a Min ister of Finance saying, I didn't under stand the formula, I didn't under stand that the wealthy would receive an extra $1 00.00 and the poor would pay the $1 00.00 and some of them even pay more than the $10 0.00. Some pay less, some pay more and probably you 'll find some poor people who may even get a few dollars out of the deal, altnough I haven't seen any and I've seen quite a numb er of income tax returns in 1981 for the taxation year 19 80. So here we are, we have the Member for St. Matthews telling us it was a mistake.

We heard that on the radio, I heard it on Friday, it was CBC. He was on the radio saying, oh, I've talked to all those fine gentlemen in the front rows, of cours e that Cabinet has expanded right up into the third row now, so I suppose we have to refer to the entire

Tue sday, 17 March, 1981 group or at least to all three rows. He's been going around talking to you people and you people have been telling him no, no. that wasn't the intention. That's what he said. But we don't have anybody standing up here and saying. we're going to change this. we're going to rectify this. This wasn't fair. this wasn't what we meant. We haven't heard anybody standing up and saying that at all. So all we can assume is that this is just a continuation of this program of hit the little guy and build up the big.

That's what you're doing for instance with the car allowances with the Civil Service; put a sque eze on the little guy. give him more forms to fill out, make it a little more difficult to get by on his particular allowance and turn around and for yourselves, of course you don't want to do paper work. So what do you do? Do you give back the car and drive your own? Do you pos sibly leav e the car here on weekends or something? No. You say well, all of our expenses will be government expenses and from now on we, the Cabi net Minis ters. have no personal expenses and so you can forget about that.

So that's an interesting way of doing it. You do that at the same time that you're practically pulling kids out of universities because you're auditing them so closely. You'r e telling us, for your car expenses it's a bother. it's too much paper work, too much bur eaucracy, let's get away from this, let's simplify things. and from now on we won't show the $10 0.00 a month that we use in personal travelling to the hockey games, to other sporting events or whatever, we'll just throw that into the pot, no problem there at all.

But when it comes to a un iversity student you're asking them for receipts for food and that type of thing for three years back , then all of a sudden you're not worried about the bureaucracy. What hypocrisy. I really think that we deserve an explanation for what's going on there un less it is true that in fact what you are doing is simply shifting things back from those who have-not to those who have, because that is what it appears you are doing.

Again, over the next few weeks we will be bringing mor e examp les of income tax re turns to your attention to make it perfectly clear, even to the memb ers on that side, that people who are pensioners, people who are the working poor people on low incomes, people on middle incomes, people at $1 0. $1 5, 000 a year, are being hurt by that government. Of course there will be examples coming in as well of university students living together from ridings such as the riding held by the Minis ter of Finance.

I'm sure some students fr om his riding come to the universities here in Winnipeg and they possibly share accommodation and now when it's time to fill out the income tax return, they will find that the rules have been changed. The rules were changed so that only one of the two students living in one residence will be entitled to claim the property tax credit for the rental paid. That's what you've done to your own kids. Which one will it be? If they are not living together anymore. who determines which of the two students liv ing together will be taking that deduction?

If they both do, you have rewritten the law in such a way that they are breaking the law. That's what you did last year. I would like to hear you people stand up and de fend that. or change it, but that is the type of 1828 income tax return that will be coming before this House in the next few weeks. You people are going to have to either defend it. or change it, or stand up and admit that the Member for St.

Matthews was right and that you people didn't know what you were doing last year, that it was all a big mistake; that it was just another numb er of examples of the kind of inappropriate and poorly thought out legislation that you presented to the House last year. MR. CHAIRMAN: (1) - pass; (2) - pass - the Honourable Member for ln kster. MR. SIDNEV GREEN: Yes, Mr. Chairman, I make it a habit to give the Minister an opportunity to answer because if the Member for Rossmere's questions are intended to be dealt with or at least its charges are intended to be dealt with, then I would certainly yield the floor.

If the Min ister wishes to have the item continued then I do wish to make some comments, Mr. Chairman, on another feature of the line that is before us. Under the General Administration. the indication is that it provides direction, control and co-ordination of department programs and advises on government fiscal policy. Now, Mr.

Chairman, I intend to try to demons trate to the satisfaction of the public, if not to the satisfact ion of the Mini ster, that the Conservative administration has no fiscal policy; and that to provide money under the guise of giving money for the control and co-ordination of departmental programs and advise on government fiscal policy, is in effect to obtain money by the go vernment by false pretences, becaus e this govern ment, Mr. Ch airman, has ind icated on num erous occa sions, that it has no fiscal pol icy whatsoever.

The fiscal policy of the Conservative Government is to add up the expenditur es, to try to pare them as any government would do, to try to catch up this year for what they have pared last year, which results in, what is it, a 14 percent increase in expenditur es this year as against an alleged 10 percent last year, which came out 11 when it was finally over and an al leged 8 percent the year before.

That their program. which doesn't need any money voted to concoct, is to add up the figures of expenditures, to estimate the figures of revenue and to present that as the financial affairs of the Go vernment of Manitoba. Now, Mr. Chairman, that is no fiscal policy at all nor has the Min ister or the previous Finance Mi nister indicated that the government has a fiscal policy. The fiscal policy of the Cons ervativ e Opposition when they were trying to become the government, Mr. Chairman, was to reduce expenditur es and to elimina te the deficit. That was a fiscal policy, Mr. Chairman.

The first line of it was to elimi nate unnec essary expenditu res and the second line of it was to end deficits. No w when they came into govern ment, Mr. Chairman. the first thing we found out was that expenditur es were going up I can't remember the exact figure but I think it was in the neigh bourhood of $10 0 million - I had previously been told by somebody in the media that there was going to be a reduction of expenditur es from the previous year's expenditur es and I said, Mr. Chairman, and I told the media in advance, if that happens I will take my hat

Tuesday, 17 March, 1981 off to the Conservative government because that is impossible. There is not $30 million plus inflation in controllable expenses in the Budget of last year; and it proved to be correct, Mr. Chairman, because not only did the Con servatives come in without increasing expenditur es, con tinuing deficits, but in their first year they claimed, Mr. Chairman, claimed I use advisedly, to reduce taxes by $73 million. So, Mr. Chairman, the so-called fiscal policy of the Conservative government disappeared even before they had been in government one year.

They incr eased expenditures and they did not eliminate the deficit; and if you will remember, Mr. Chairman, they stopped saying that they were going to elimi nate the deficit. What they said was that they were going to reduce the deficit. Well, Mr. Chairman , which deficit were they going to reduce? Because the budgeted deficit of the previous year was $10 0 million on the capital side and roughly $30 million on the operational side, and the Conse rvatives went to the pu blic saying they were going to elimi nate that deficit. Not only did they not elimi nate it, Mr.

Chairman, but in short course of action they incr eased it. And this year, Mr. Chairman, we can look forward to the Conservative government doing one of two things, or bo th; they will either bring in a deficit in the neighbo urh ood of $200 million on capital and current account - because they have decided that there is no di fference between the two and they have elimi nated the distinction, although they would dearly like to bring it back to try to make their books look better - but there will be a $200 million deficit or an increase in taxes, Mr. Chairman, or both. I don't think, Mr.

Chairman, that this government is going to incr ease taxes because they have no fiscal policy. There is such a thing, Mr. Chairman, the Member for Lac du Bonnet ind icated that there is such a thing as having a deficit budget with the intention that somewher e along the way the expenditures that are incurr ed in deficit financing will be an investment, will bring the economy ar ound, and will result in income in future years. It is popularly known, Mr. Chairman, as the Keynesian theory of economics and really it's not such a new thing. Joseph practised it approximately 5,000 years ago.

He said that when there are good years he will take from the stock that is produced for seven years, the surplus, and put it away and then in the seven bad years, he will take from the surplus and distrib