1973 Legislative Session: 3rd Session, 30th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, OCTOBER 30, 1973

Night Sitting

[ Page 1091 ]

CONTENTS

Routine proceedings

Medical Centre of British Columbia Act (Bill 81). Second

reading.

Motion to postpone second reading.

Mr. McClelland — 1091

Hon. Mr. Cocke — 1095

Mr. McGeer — 1095

Hon. Mr. Barrett — 1096

Mr. Williams — 1099

Mr. Wallace — 1100

Mr. Schroeder — 1102

Mr. Gardom — 1103

Mr. D.A. Anderson — 1104

Hon. Mr. Hartley — 1105

Mr. Smith — 1105

Mrs. Jordan — 1108

Division on motion to postpone second reading — 1108

Mr. Wallace — 1108

Mr. McGeer — 1111

Hon. Mr. Cocke — 1113

Division on second reading — 1115

TUESDAY, OCTOBER 30, 1973

The House met at 8 p.m.

Orders of the day.

HON. D. BARRETT (Premier): I move the House proceed to

public bills and orders.

HON. MR. BARRETT: Adjourned debate on second reading of Bill

81, Mr. Speaker.

MEDICAL CENTRE OF BRITISH

COLUMBIA ACT

(continued)

MR. SPEAKER: The Hon. Member for North Okanagan (Mrs.

Jordan) adjourned the debate.

MR. R.H. McCLELLAND (Langley): May another Hon. Member speak

for her?

MR. SPEAKER: Well, if the Hon. Member wishes to speak. It is

against the rules to speak from another person's seat because

they might be blamed for what you say. Hon. Members, if the

Member is not in her place we must proceed.

AN HON. MEMBER: Can we wait a moment, Mr. Speaker?

HON. MR. BARRETT: Mr. Speaker, could I ask leave of the

House to wait for a moment for the Member to…

MR. SPEAKER: I have another suggestion perhaps. That is,

with leave of the House the Hon. Member may be permitted to

speak, although she is not here when the bill is called. That's

the only way I can see that it can be done.

AN HON. MEMBER: Is she coming now?

AN HON. MEMBER: How come Bill 81 and not Bill 64?

MR. SPEAKER: Hon. Member for Langley, under the rules

government bills can be taken up in any order. Does the Hon.

Member wish to speak on the Medical Centre of British Columbia

Act ? Bill 81?

MR. McCLELLAND: Mr. Speaker, it concerns us somewhat that

the Minister was very brief in his comments in the opening of

the debate on this bill. He said very little. In fact the only

thing he really said was that the medical centre….

HON. MR. BARRETT: You weren't here.

MR. McCLELLAND: We now have a Hansard Mr. Premier, which I

read.

HON. MR. BARRETT: Oh! Courtesy of the new government.

MR. McCLELLAND: It didn't take me very long to read about what that

Minister said about this important bill. About the only thing he really said

was that this medical centre will be given some authority.

HON. MR. BARRETT: Vote against the bill.

MR. McCLELLAND: Some authority. It will be given all kinds

of authority, Mr. Speaker.

AN HON. MEMBER: Sweeping.

MR. McCLELLAND: This is far more, far more, Mr. Speaker,

than a simple little bill to run the Shaughnessy Hospital.

AN HON. MEMBER: Hear, hear!

MR. McCLELLAND: We didn't need this kind of legislation for

that, or to establish a medical centre on the site of

Shaughnessy Hospital.

Once again, Mr. Speaker, as is so evident in the bills that

this government has presented all through this session of the

legislature, we find them setting up some kind of colossal

bureaucracy, and this time for the overall centralization of

medical services in British Columbia.

AN HON. MEMBER: Ooh! Ooh!

MR. McCLELLAND: I had an interesting conversation today with

one of the people in the health services department of the

Province of British Columbia. He suggested to me at that time

that the local authorities could no longer be trusted with

their autonomy because they did it all wrong all of the time.

So now we must centralize medical care in British Columbia.

We're setting up a bureaucracy, Mr. Speaker, to intrude upon

all aspects of hospital planning in this province …

AN HON. MEMBER: Do you want Ralph Loffmark back?

MR. McCLELLAND: …a bureaucracy which is unparalleled in

this province, to intrude upon all aspects of medical and

paramedical education, and is intruding to some degree — and we

don't know how far because once again this is one of those

[ Page 1092 ]

deliberately vague bills — but intruding for sure on the

degree-granting institutions of this province.

When we talked in this House, Mr. Speaker, about the labour

bills, we were told that they could not be taken in isolation,

they had to be taken in concert with each other. We should have

been told the same thing about the health bills in this

province in this session because, like Bill 10, which was the

first major bill that was presented to this House — the

amendment to the Medical Services Act, this bill too, Mr.

Speaker — and I think that one of the few things that the

Minister said when he opened debate on this bill, he admitted

that this was umbrella legislation — has a far broader

implication than this government would have us believe. He used

the term himself when he opened debate, "umbrella legislation."

Not just a simple little bill to run Shaughnessy Hospital or to

set up a medical centre in Vancouver.

It would seem to me that because of this bill, Mr. Speaker,

the writing is on the wall for this province's hospital boards.

Their usefulness is certainly in jeopardy as centralized

medicine hits British Columbia with a vengeance. And the

writing, as well as being on the wall for the hospital boards

of this province, is probably on the wall for the doctors.

If you put Bill 10 together with this bill, Mr. Speaker,

then look at some of the comments of our province's health

tsar, Dr. Richard Foulkes, particularly his off-the-cuff

comments in the paper the other day where he talked about "the

end of fee-for-service" in British Columbia and the beginning

of "salaried doctors," Mr. Member for Oak Bay (Mr.

Wallace)….

AN HON. MEMBER: Oh, he's going into politics.

AN HON. MEMBER: He's quitting. (Laughter.)

MR. McCLELLAND: Oh, he's quitting. He knows the writing's on

the wall and he's getting out while the getting out is

good.

AN HON. MEMBER: He'll be long gone.

AN HON. MEMBER: Wait till Hyndman gets him.

MR. McCLELLAND: All you really have to do is listen to the

Cocke-and-Foulkes act and you find out where this province is

heading with its health education.

AN HON. MEMBER: Cocke and Folk.

MR. McCLELLAND: Act 3: Cocke and Foulkes.

AN HON. MEMBER: That's rude.

MR. McCLELLAND: No, that's not rude; that's vaudeville. No that's not

rude. No.

You know it might be nice to know who's running the health

department in British Columbia. Is it Cocke or is it Foulkes?

Who's running the health department? Where does your health

tsar get off blasting away about a shake-up in the civil

service? Did you give him that right to do that?

AN HON. MEMBER: What's that got to do…?

MR. McCLELLAND: Mr. Speaker, this has everything to do with

this bill because that's what this bill is all about.

HON. MR. BARRETT: Where's Ralph Loffmark tonight?

MR. McCLELLAND: Where does the new health tsar get off

blasting the civil service of this province? He says, "Oh,

Foulkes raised too the possibility of a shake-up among the

provincial civil servants to provide greater efficiency and

expertise in the health care system." The health tsar is going

to shake up the civil service just as the rest of the civil

service has already been shaken up.

AN HON. MEMBER: That's what you call acupuncture.

(Laughter.)

MR. McCLELLAND: He goes on and on, Mr. Speaker, announcing

health policy before this Legislature ever has a chance to

understand what has been happening in the last few months. He

goes on to announce all kinds of health policy and he ends up

by saying that all of these great and wonderful things that are

going to happen in British Columbia health care can be done

through policies and bureaucracy. That's the health tsar

speaking.

HON. MR. BARRETT: He's Don Phillips' twin brother.

MR. McCLELLAND: I wonder how far this new medical Act

Corporation will go, Mr. Speaker? Certainly it has exceptional

powers once again to get into all kinds of health-related

businesses. The question should be asked — and the question was

asked the other evening by the Member for North Okanagan (Mrs.

Jordan) — "What kind of businesses are you going to get into

with this medical corporation?"

section 8 indicates that the

corporation has its greedy little eyes on just about

everything.

AN HON. MEMBER: Heavy-hand business.

MR. McCLELLAND: Much more.

[ Page 1093 ]

MR. J.R. CHABOT (Columbia River): The iron heel.

MR. McCLELLAND: Mr. Speaker, much more than just a medical

research centre for the lower mainland of British Columbia.

AN HON. MEMBER: A vague blank cheque.

MR. McCLELLAND:

Section 16, Mr. Speaker, removes from this

Legislature — and the Premier can laugh all he wants; he's in

his jovial little manner; he doesn't have the opportunity at

the moment to get up and do his song and dance and his

vaudeville act but it's coming, I'm sure. Before the end of

this evening is over he'll do it again.

AN HON. MEMBER: Oh, yes.

Interjection.

HON. MR. BARRETT: No, I'm not in the leadership race.

MR. McCLELLAND: Mr. Speaker, it might be nice if this

Premier could understand that all we really want is for this

Legislature to have the right to make the decisions that are

right for the citizens of British Columbia.

This bill, in one of its sections at least, removes that

responsibility and that opportunity from the Legislature — the

right, for instance, to determine charges made for health care

in this province. It's like so many of the Acts that we've been

seeing before this session of the Legislature. We're taking

once again major considerations away from the realm of this

Legislature. And, Mr. Speaker, through you to the Premier,

that's sick. We must protect the rights of this Legislature and

not take them away.

The government that boasts so much about developing a

meaningful role for the legislators is emasculating that role

as fast as is decently possible.

Once again, Mr. Speaker….

MR. SPEAKER: Order.

MR. McCLELLAND: Who's that, Mr. Speaker? Who are you calling

to order now? Is it the Premier or the press gallery or…?

MR. SPEAKER: Not the Hon. Member.

MR. McCLELLAND: Thank you very much, Mr. Speaker.

AN HON. MEMBER: Name names.

MR. McCLELLAND: You know, if there's another thing that we've seen happening

in this session of the Legislature more often than anything else, it's the sort

of idea that we cut out the local influence in many of the things that we direct

in our lives. There's more proof in this bill that the local elected hospital

boards are being cut out of the action because of one

section in this bill —

section 19. The corporation that is going to be implemented in this province

is going to be given total power to interfere with local decisions.

We accused the Health Minister (Hon. Mr. Cocke) in the

spring of wanting to do away with local hospital boards, and he

protested very much about that. But this bill is the proof that

he doesn't really believe in local hospital boards. Nor does he

believe in local autonomy of any kind, because he really

believes that it's centralization, that it's Victoria, that

it's the Minister's office that knows best.

AN HON. MEMBER: State control.

MR. McCLELLAND: You know, it's funny; when the Premier was

speaking this afternoon — it's funny how often the state creeps

in. The Premier talks about "the state will do this,"

and "the state will do that," and "the state will do

something else." The Premier knows that what he really wants is

state control. And the Health Minister sure knows that what he

wants is centralization of all health services in British

Columbia.

This corporation, Mr. Speaker, has the power to impose its

will on every local hospital board in British Columbia. The

Greater Vancouver Regional Hospital District has been given a

role in this corporation. Some role! It can be a part of the

corporation but it sure can't vote. It's being emasculated.

It's a sop to the local elected officials. But they're saying,

"Don't vote; no, you will be a silent partner; Shut-up and

don't bother us."

It was thrown out only as a sop. You'll allow them on the

board but you won't give them a vote. What kind of government

is that? What a slap in the face to local elected officials!

And that minister stood here in the spring and said, "We want

to give local autonomy its chance. We want to give the local

hospital boards all the rights that they deserve.

And they say to the Greater Vancouver Regional Hospital

Board, "You can join our organization, but you can't vote."

It's a slap in the face; that's all it is.

HON. MR. BARRETT: Like Social Credit and Phil Gaglardi.

MR. McCLELLAND: The name of the game of this bill, Mr.

Speaker, is centralization, without a doubt: removal of the

rights of the community to decide what they would like, and

what direction they'd like to go to provide the health needs of

their community….planning its own destiny.

[ Page 1094 ]

AN HON. MEMBER: Bill 42 all over again.

MR. McCLELLAND: Sure, it's like all of the bills — not only

Bill 42, but every bill that this government has brought

forward, particularly in this session. Get rid of the local

autonomy, and turn the rights over to some centralized bureau

in Victoria, centralization….

Interjection.

MR. McCLELLAND: Don't feed me any more lines. (Laughter.)

Mr. Speaker, there's an exceptional quest for power in that

group over there. And they're certainly getting it quickly.

They want total power in the hands of the Minister, more often

than anyone else. And the Minister decides the direction that

his civil service is going to go. He emasculates the rights of

the local elected individuals. There isn't one statute that

we've seen in this session of the Legislature that doesn't

enumerate that concept.

HON. MR. BARRETT: Which ones have you voted against?

MR. McCLELLAND: We'd like to be able to accept your

assurances, and the Health Minister's assurances….

HON. MR. BARRETT: You'll vote for it anyway. Talk one way

and vote another way.

MR. McCLELLAND: This legislation doesn't promise anything

except the kind of programme that the Minister's public

announcements….

Interjections.

MR. SPEAKER: Order, please. Are the Hon. Members disturbing

the Hon. Member's speech?

MR. McCLELLAND: No, I'll just wait till they're finished,

Mr. Speaker — okay?

MR. SPEAKER: Please proceed, or let us hope.

MR. McCLELLAND: Thank you, Mr. Speaker. You know, we'd like

to accept the Health Minister's assurances that this bill does

what he says it does. But, you know, judging from the past

performance by this government, we don't trust your motives any

longer.

SOME HON. MEMBERS: Oh, oh.

MR. McCLELLAND: Because they've become extremely suspect. And until

we know the real reasons behind this kind of legislation, I don't see how we

can support this legislation. What I'd like to ask is that this government take

another look at this legislation. Move it over for now and allow us to have

a look at the Foulkes report.

AN HON. MEMBER: Hear, hear!

MR. McCLELLAND: Because this bill and the Foulkes report are

tied in together.

MR. D.E. SMITH (North Peace River): We don't want to read it

in the newspapers, piece by piece.

Interjections.

MR. McCLELLAND: You know, even the Liberals understand that

this bill and the Foulkes report go hand in hand.

AN HON. MEMBER: That's right.

MR. McCLELLAND: You've had the opportunity, Mr. Minister,

through you, Mr. Speaker, to study the Foulkes report. You know

what's in it, but we don't.

We expect to have the opportunity to read that report, but

we'd like to have the opportunity before we're asked to vote on

this kind of legislation.

HON. D.G. COCKE (Minister of Health Services and Hospital Insurance):

I haven't had the opportunity to read it either.

MR. McCLELLAND: Mr. Speaker, the Health Minister — the

vaudeville partner of Richard Foulkes — says he hasn't had the

chance to read that report. That Minister can't give us that

kind of nonsense because he has read the report, he knows

what's in the report and he's drafted this legislation on the

basis of that report.

AN HON. MEMBER: He co-authored it.

MR. McCLELLAND: Not only this legislation but other

legislation that's already been in.

We've been asked to hold off. In fact, the Premier sat here

earlier in this session and suggested to the Health Minister,

"If you need a little more time for the Foulkes report, take

it, fellas; we don't want it coming in before the end of this

session."

AN HON. MEMBER: Hear, hear!

MR. McCLELLAND: Yes. "We don't want these guys on this side

of the House to see that report before we get our legislation

in." The Premier said that, Mr. Speaker.

All we want to do is to see that Foulkes report so that we

can then analyse this kind of legislation with

[ Page

1095 ]

some degree of intelligence. For that reason, Mr. Speaker,

because we need to see that report before we can vote on this

kind of legislation, I would move that Bill 81, the Medical

Centre of British Columbia Act , be read a second time on this

day six months hence.

HON. MR. COCKE: Mr. Speaker, speaking to the amendment….

AN HON. MEMBER: Speaking in favour of the amendment….

HON. MR. COCKE: Speaking to the amendment, Mr. Speaker, that

kind of roadblock doesn't deserve any more than one or two

words, and those are that we cannot possibly support it.

SOME HON. MEMBERS: Why?

MR. P.L. McGEER (Vancouver–Point Grey): Mr. Speaker, I'd

like to say just a few words on behalf of this amendment from

the point of view of a medical educator.

All my professional life, with the exception of a brief

period when I was a research scientist in the United States,

I've been concerned with the subject of medical education.

I have a great deal of respect for the Minister of Health

and the job he is trying to do for the Province of British

Columbia, but I think that with this piece of legislation he

has made a monumental error. If it goes through in the form

that it is in tonight, all of what he has done will have to be

undone in the future. I'd like to explain my reasons for saying

so.

This particular Act places two incompatible objectives under

the aegis of a single, non-medical board. Those objectives are

to provide referral care and service and to provide education

at the same time. I know of no place in the world where these

objectives have been successfully pursued together, even under

the aegis of a professional board. What the Members of the

official opposition really need to see, as well as the Members

of the government, is not just the Foulkes report but the

Shortliffe report as well.

The Shortliffe report was something commissioned by the

Minister of Health and, even though it was presented to Foulkes

and his committee, the recommendations of that report were,

first of all, that the Shaughnessy site, which is to be

selected as the B.C. medical centre and to be under the control

of this super-board, should be only a regional hospital.

Although I haven't read the report in detail, I suspect the

reason for that was the disastrous experience occasioned in the

Province of Ontario when the Sunnybrook Veterans Hospital was

taken over by the University of Toronto for the purposes of

teaching.

Secondly, the recommendation was made that, for proper teaching as it should

be, an appropriate hospital should have been built on the University of British

Columbia campus where there is approximately $30 million to $40 million worth

of irreplaceable, basic medical facilities, including a library and all the

training facilities for the basic medical sciences.

Thirdly, the Vancouver General Hospital, which has been the

principal referral hospital for all the province of British

Columbia and contains residual skills of a kind not found in

any other hospital centre in British Columbia, should be

retained and strengthened for that referral purpose.

But regardless of the recommendations of the Shortliffe

report, the basic problem of the particular bill presented by

the Minister of Health is simply this: he has placed all the

power for education, whether it be for doctors, nurses,

dentists, or paramedical personnel of any kind, under the aegis

of this super-board which has as its president a pulp mill

executive, however able he may be. It has a hospital

administrator, an accountant, and a member of another

integrated forest company.

MR. SPEAKER: Excuse me for interrupting the Hon. Member,

but, as you know, the debate on a motion of this kind deals

with the advisability of the matter being read a second time

six months hence. You are apparently dealing with the merits of

the bill itself which could well have been done in

principle.

MR. McGEER: Mr. Speaker, please bear with me.

(Laughter.)

MR. SPEAKER: How long?

MR. McGEER: With all due respect, Sir, it's important, I

think, that all of the Members of the House as well as the

public recognize what is required to provide appropriate

education for people that we ultimately depend upon to save

lives and to preserve health. When you place this

responsibility in the hands of people appointed by the

government, who are non-professionals — and who in turn appoint

members of an education committee not defined at all in this

Act — but have the power to appoint or terminate people who are

not necessarily associated in any way with the skills that are

vitally necessary to doing this job effectively, what you're

effectively doing is placing in jeopardy the whole educational

system in a field where competence is just as vital as in

flying a jet aircraft.

HON. R.A. WILLIAMS (Minister of Lands, Forests, and Water Resources):

Oh.

MR. McGEER: Mr. Speaker, it's all very well for the Minister

of Lands and Forests to groan. You can

[ Page 1096 ]

afford to make mistakes in condominiums or pulp mills or

land zoning. (Laughter.)

HON. MR. BARRETT: Doctors bury their mistakes.

MR. McGEER: Yes, they do, Mr. Speaker. What we want to do is

develop a system where there are as few mistakes as it's

possible to have considering the frailty and the inevitable

errors that are occasioned by lack of human skill and lack of

judgment.

Mr. Speaker, I can only say that the training of medical

personnel is a very serious matter. Over many hundreds of

years, it has been marshalled very carefully in the hands of

people who are completely responsible and have had the torch of

education passed down to them generation upon generation and

have held to themselves, I think appropriately, the

responsibility for setting forth the circumstances as well as

the course of education that's appropriate to producing the

essential skills.

What this particular piece of legislation does, Mr. Speaker,

is to place in jeopardy that whole tradition because, quite

clearly, this is taken away by the terms of the Act. It's to be

placed in the hands of this super-board. This large medical

centre is to be placed under their direct control, as well as

the whole health planning of British Columbia which is to be

placed in their direct control.

What is clearly needed, Mr. Speaker, in the Province of

British Columbia now and in the future is to have a clear

separation of the educational responsibilities — which quite

properly belong with our medical schools and universities — separated entirely from the development of hospital and

referral services which can appropriately be placed under the

control of hospital boards. When you try and take education and

mix it, as this bill does, ill-advised….

HON. A.B. MACDONALD (Attorney General): Bring it into the

real world. (Laughter.)

AN HON. MEMBER: You don't believe that.

AN HON. MEMBER: He doesn't believe anything.

MR. McGEER: You could democratize the flying of jet aircraft

just as you can democratize the skills that go with heart

surgery, but it isn't likely to serve the passenger who depends

upon the ultimate development of those skills. That doesn't go

with control by lay personnel; it doesn't go with the kind of

super-board which is envisioned in this Act.

Mr. Speaker, I'm not really criticizing the Minister of Health in a way. I

think he's done an excellent job and I certainly admire his motivation. But

as far as this particular Act is concerned, Mr. Speaker, he has received bad

advice. If he doesn't seek better advice, if he doesn't bring in appropriate

amendments that will take into account the separate requirements of education

and service, then what he will succeed in doing is a disservice, not to the

medical profession or the nursing profession or the orderlies or all the paramedical

personnel who are responsible for looking after patients, but a disservice to

the patients themselves.

In the long run, by the passing of this Act and the

implementation of its intent, we are inevitably going to lower

the standard of health services that we can deliver in this

province. What will happen is that we will lower the level of

medical skills that we have available to offer to the people of

British Columbia.

Mr. Speaker, I don't care how much you set aside in the way

of financial resources for health care. If you lack the skills

that are required to deliver health care, then no amount of

money is going to cure the problem.

Of course, what ultimately happens to so many people in this

world is that they finally get to the point in life where they

themselves and the state of their own health have reached the

limit of available medical skills, and where they become the

victims of the work that should have been done in past times

and has not been done.

I just say in summing up, in supporting the amendment of the

Member for Langley (Mr. McClelland), that he has a great deal

of wisdom in bringing that amendment forward and that this

House would be well advised to inspect very carefully the

findings of the Foulkes report and the Shortliffe report. All

Members should search their consciences individually and ask

themselves this question: How best can we develop medical

skills in this province? What vehicle will achieve that?

If we fail to answer that question well, then we're going to

make the kinds of decisions in this House that will leave the

citizens of British Columbia shortchanged in their hour of

greatest need.

HON. MR. BARRETT: Mr. Speaker, I enjoy the opportunity of

speaking in this debate because, really, this kind of amendment

brings into focus the principle of the bill. In terms of the

last Member who spoke, we were given a series of opinions that

are based, frankly, on his work experience and his approach to

the profession and to medical practice as he sees it. I find

that somewhat different from what were nothing more than

insults to the Minister and insults to Dr. Foulkes from the

spokesman of the Social Credit opposition group.

AN HON. MEMBER: Arrrrgh! (Laughter.)

HON. MR. BARRETT: At least with the Liberal Party there was

a statement of reason why he would

[ Page 1097 ]

support this amendment, not based on invective or personal

attack. When we were in opposition, whenever there was any hint

of that kind of thing, the immediate government reaction was,

"There you are, attacking the civil servants." Some of you will

remember that standard device.

MR. McCLELLAND: What civil servants?

HON. MR. BARRETT: Now let's deal with the statements given to us by

the question raised by the former leader of the Liberal Party, Mr. Speaker.

I must say that, in my opinion, his arguments are based on an elitist view of

life. There is a presumption here on an élitist that only the doctors in the world

know what's best for the education of doctors and paramedical services.

The parallel that he's offering us is that only teachers

should be on school boards. That's really the parallel — the

suggestion that the board is made up of representatives from

the forest industry and from the community at large is an

impression somehow that those people, as competent as they may

be, can't make decisions about budgeting, about financing,

about administrative planning, or construction — that it has to

be just the élitist at the university.

I do not hold any brief for the former Minister of Health

(Mr. Loffmark) but I will respect him for one particular thing

that he tried to do, but was forced to knuckle under in that

struggle. He tried to take on the medical profession in some of

their worst aspects, in terms of their attempt to closet

themselves away from the rest of the community around their

planning. In that sense, Mr. Loffmark was attempting to break

out of the mould. He got trapped into the exchange that led to

his downfall in terms of that tape recording and the attacks on

him — which we played a

part in too.

But he had no support from his cabinet, and certainly no

support from the former Premier. But he did have support from

backbenchers who, down the line, spoke for the little people of

this province, asking for better medical services and better

health care delivery throughout the province — not at the centre of the University of British Columbia, but throughout

the province.

For years we have paid millions of dollars for a medical

school that, in my opinion, has deliberately kept down the

number of students going through that school. Only 80 students

last year. The amendment means that we're going to…. If you

delay this bill it may mean the continuation of the kind of

system that centralizes the control of that closed-union,

backward shop in the hands of a few doctors who haven't looked

forward for years in this province.

This Minister of Health has had more guts to tackle this issue head-on; and

even the newspaper columnists who've written about this approach have said,

"Well, he may not get political kudos for it, but at least he's had the guts

to make a decision that every previous Minister has shied away from."

I support him completely. Eighty students, Mr. Speaker, when

we should be graduating 160 medical students every single year…and only 80 in that closed shop. What is their monopoly on

such genius and training? I tell you, I've worked with doctors

too, and some doctors are dumb-bells, Mr. Speaker — just as

some social workers are dumb-bells and some lawyers are

dumb-bells.

Doctors do make mistakes. But the location of the medical

school isn't going to make the change in whether or not they

make a mistake. It's a question of facilities and the quality

of the teachers that's going to make the difference and, more

than anything else, the variety of experience of real life

outside of that university world.

I want to give you an example of what went on at the

University of British Columbia, and how the former government

was trapped into planning a mental health centre that was a

straight nonsense proposal. You want us to go back to that same

bag? I ask you, Mr. Member, to go back and examine what

happened when the mental health centre was built at the

University of British Columbia.

It was planned by doctors. It was sold by doctors. The

former administration, through Mr. Loffmark, finally gathered

itself together to oppose the opening of that institution

because at that time the rates for that hospital were

outrageously high. This bill is an attempt to move away from

that syndrome.

AN HON. MEMBER: Come back to the amendment.

HON. MR. BARRETT: Oh, yes. Come back to the amendment. You'd

give him leeway and him leeway, but you don't want to deal with

some facts related to that.

Interjection.

MR. SPEAKER: On a point of order?

MR. SMITH: Mr. Speaker, the House, except for you, gives no

one leeway in debate. The opposition did not give anyone leeway

in debate: the Premier, the previous speaker or anyone else.

It's yourself, as the person who controls the debate in this

House, who decides whether you will give leeway or not. No one

else.

MR. SPEAKER: I've tried to indicate to the Hon. Members that

they should direct their attention to the advisability of

delaying this matter of debate on second reading to six months

hence. The Hon. First Member for Vancouver–Point Grey (Mr.

McGeer) did not receive objections to his stand although I,

[ Page 1098 ]

Speaker, did object to the extent of his debate on what

amounted to second reading of the bill in principle. He

persisted, and the House seemed to go along.

I think it only fair on both sides of the House that if

we're going to apply the rules, they be applied strictly or

they be applied evenly: take your choice.

HON. MR. BARRETT: Mr. Speaker, the question of delaying this

means a delay in training medical students and a delay in

training paramedical students that are sorely needed throughout

this whole province. The question of centrally locating at the

university…and I refer you to the one decision that the

former Minister of Health was forced into — that psych centre,

that mental health centre, at UBC. It is totally unrealistic.

Hopefully it is going to be incorporated in this new medical

centre.

HON. MR. COCKE: It is.

HON. MR. BARRETT: I'm pleased to hear that, Mr.

Minister.

But the doctors at UBC came and sold the former

administration on a multi-million dollar construction for a

mental health facility in which there is absolutely no

relationship at this very day to the reality of mental health

services in the community in this province.

It is an upper-middle class resort, Mr. Speaker, that is

designed to teach student doctors about mental health

facilities that don't even exist in the Province of British

Columbia.

It is an anomaly in the total package of mental health

services and the delivery of health services. If we are going

to allow the continuation of that kind of élitist planning that

has no connection whatsoever with what's going on in the real

world, we would be failures as legislators, and any delay in

passing that bill would continue it.

Mr. Speaker, when a mother of five children suffers the

trauma of being deserted in Pouce Coupe in British Columbia,

and she is asked to come down and spend two weeks at the Mental

Health Centre at UBC, and be given her meals, and be given her

services on a training

schedule serving the training purposes

of that institution that bears no relationship to her social

and psychological problems as they relate to Pouce Coupe, then

we're spending millions of dollars that are totally unrelated

to the realistic experiences throughout this province.

I say that the doctors of this province must start to move

away from that centralist concept and get out into the real

world. This Minister has had the guts to say "That's how we're

going to approach medical service training in the Province of

British Columbia."

MR. McCLELLAND: The Minister never made the decision.

HON. MR. BARRETT: You know, Mr. Speaker…. "The Minister

never made the decision." You have not followed what has gone

on in the medical history of this province in the last 15

years. I hold no brief for Mr. Loffmark, but the one time that

he attempted to stand up to that kind of decision-making that

was made by vested interests in the medical profession, he was

hammered down. Only his backbenchers supported him — not a

single Member of his cabinet went with him.

Yes, yes, the Member that sits here in this House tonight.

How ironic. Mr. LeCours, who for years from Richmond fought on

this very issue as a grassroots Socred, and had the support of

other grassroots Socreds. But where is that great party

tonight, Mr. Speaker, on this issue? Six-month hoist! And what

does a six-month hoist do for the people in the north, the

Peace River that they talk about, and the Cariboo and the

Okanagan and Invermere? Mr. Speaker, I suggest to you that

this Minister of Health has given more leadership in one year

in getting health services going in this province than we've

had in 15 years under Social Credit.

Any attempt to delay this bill is a commitment to that old

walk-step concept that only the élite in our society know

best. Well I put trust in the ordinary people, Mr. Speaker. I

don't insult these board members, some of them from industry

and other walks of life, who give hours of their time

voluntarily to guide the development of better medical services

for the citizens of this province, and none of whom are NDP

members. Leading industrial figures who have been willing to

take this job on, none of whom are sympathetic to the NDP but

who have said, "Okay, you've called on us."

You tell me that Mr. Christiansen of Tahsis is an NDP

member? Mr. Speaker, I've got news for you….

MR. CHABOT: No, he's got bucks.

HON. MR. BARRETT: He's got bucks, eh? The most bucks are

over there in the Socred free enterprise education fund, and

you are not going to get near those, my friend, You can't tell me that these citizens who have come out from

their own walk of life, who have donated their time under this

Minister of Health, and who have said, "Yes, we go along with

it," and they have their years of experience…. I say

to you, Mr. Speaker, anybody who votes for this delay is

against the ordinary people of British Columbia, and we reject

it completely.

Interjections.

[ Page 1099 ]

MR. SPEAKER: Order, please!

MRS. P.J. JORDAN (North Okanagan): Hysterical maniac.

SOME HON. MEMBERS: Oh, oh!

MR. SPEAKER: Order, please! Will the Hon. Member kindly

withdraw that remark?

MRS. JORDAN: I beg your pardon?

MR. SPEAKER: Would you kindly withdraw that remark?

MRS. JORDAN: Which remark?

MR. SPEAKER: Your remark.

MRS. JORDAN: Which remark? I want to know….

MR. SPEAKER: You know what you said and I know what you said

and a lot of other people know what you said. I just simply ask

you to kindly withdraw it.

MRS. JORDAN: That the Premier acted like an hysterical

maniac, Mr. Speaker? If you insist, I'll withdraw it. But if

the people of British Columbia could have seen that performance….

MR. SPEAKER: Order, please!

AN HON. MEMBER: Come on! Try to be a lady.

MRS. JORDAN: I don't care. I'm concerned about the people of

British Columbia.

MR. SPEAKER: Order, please!

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Mr. Speaker,

I'd like to rise in support of this motion. I hope that a

matter as important as this can be dealt with this evening with

some degree of care because it is a very important one for

Members of this House — in fact for the entire Province of

British Columbia — as to whether or not this bill is read now

or some six months hence.

I listened with interest to what the Hon. Premier has to say and I was reminded,

as any first year student of philosophy recognizes, that if you establish a

false premise you can reach any conclusion. The Hon. Premier tonight, when discussing

this amendment, chose as his false premise the fact that the medical profession

are all elitists, that they have no concern with the medical services in the

Province of British Columbia and that to delay this bill would in any way continue

that existing situation.

HON. MR. BARRETT: Just that Member….

MR. WILLIAMS: The fact of the matter, Mr. Speaker, and the

reason that I support this amendment, is that the Hon. Minister

of Health, when opening this debate, did not in any way

indicate that the principle of Bill 81 was what was enunciated

by the Premier in his remarks a few moments ago.

The Premier seemed to indicate that this medical centre to

be established in the City of Vancouver under some new

administrative mechanism will suddenly remake medical education

in British Columbia, and allow the mother of five children in

Pouce Coupe to come to the City of Vancouver in this new

medical centre and somehow or other enjoy the kind of treatment

which she couldn't expect to receive in Pouce Coupe.

Mr. Speaker, this is the fallacy of what the Hon. Premier

said and of this whole legislation, because all that we are

going to create, if this is to be a medical training facility,

is another first-class, stainless-steel, chromium-plated

organization for the training of the medical profession within

the Province of British Columbia.

The Minister did not give us one glimpse of what will be

required if we are to have medical and paramedical people in

this province trained with the understanding and the

capabilities of carrying medical services to Pouce Coupe and

similarly isolated communities in the province. Not one word

did he say when moving the second reading of this debate.

As a matter of fact let us consider, Mr. Speaker, exactly

what he did say. In a page-and-a-half of Hansard , — and that

was how little the Minister thought about a bill which the Hon.

Premier says is so important that we deal with now — he

says:

In rising to open this debate I would just like to say what the

purposes of this Act are. The reason that we mainly felt it to be

absolutely essential was that the health services, as they relate to

education, were

having a great deal of difficulty.

He continues:

The health services as they relate to tertiary care were having

a great deal of difficulty, and we just…

and I ask you, Mr. Speaker, to pay attention to these words —

…knew of no other way than to tie the services together

under an umbrella organization that could best coordinate these activities.

We just knew of no other way.

Mr. Speaker, I agree with the Hon. Premier that the Hon.

Minister of Health has made significant advances in

investigating the need for new, modern and in some cases

experimental health care delivery facilities

[ Page 1100 ]

in British Columbia. He has done that, Mr. Speaker, with the

assistance of a medical doctor, a man who I understand is of

considerable skill in his field, and with the group that that

doctor has organized around him — I speak of Dr. Foulkes.

I don't criticize Dr. Foulkes. I think that every Member in

this House and every citizen of British Columbia should be

proud that a doctor would give of his time and of his energies

to undertake such a task as he has over the past year; and I

think the Minister must be proud of Dr. Foulkes.

But Mr. Speaker, if I were Dr. Foulkes and his group, and if

I had worked as hard as those men have worked, tirelessly, hour

after hour in helping to bring to this government a report

which would indicate the direction which health care delivery

would take in British Columbia for the future years, only to

find that the government had moved to establish a health

science centre located in the City of Vancouver before that

report indicating the new direction that we are to take in the

province was even delivered to the Minister and tabled in this

House, I would think that I had been betrayed. And this is a

good reason to defer the second reading of this bill.

If we are to embark upon a new direction of health care

delivery in this province which will serve the needs of these

outlying communities such as Pouce Coupe, who have been so

badly served over the years, and if as a companion to this new

system of health care delivery we are to have new and exciting

techniques in the training of medical and paramedical

personnel, then let us make certain that the medical health

sciences centre that we establish is going to be a centre

established in the full knowledge of what Dr. Foulkes and his

group are recommending to this government. And from the report

that this government is prepared to bring into this House and

support, we, the government and the people, will know that the

health centre we establish is going to be a necessary adjunct

to this new direction in health care that we are taking.

But no; the Minister says, "We just knew of no other way."

But if the Minister hasn't seen the Foulkes report, then how

dare he bring in this kind of legislation when it may not fit

with what Dr. Foulkes is prepared to recommend?

I agree with the Hon. Premier; perhaps the medical

profession has had its own way for too long, perhaps we have

been training doctors and dentists and other paramedical

personnel in the wrong way, perhaps we have been establishing a

group entitled to respect within our society, but a greater

measure of respect than in fact their talents deserve.

But if we are to go in this new direction, then let us do so on a sound basis.

Why else have we had the Foulkes group moving about the province except to come

back to the government and say, "Gentlemen, this is the way to go," and with

that, to come before this Legislature with a clear indication that this government

is prepared to follow the recommendations, in whole or in part, is prepared

to finance whatever costs that new direction may take, and is prepared to establish

the training facilities and the new direction in medical training that is necessary

in order to fulfill the health delivery care requirements which this government

is prepared to support.

It's easy to criticize this bill, and it's not appropriate

during the discussion of this amendment. But what we are being

offered by this government is their guess at what they think

will best serve the training of medical personnel once we

recognize what the new health care direction is going to be in

this province. We're guessing, the government is guessing, and

it's too important a matter for those people of this province

who are in need of care and those who will finance future

medical-care expense to take.

What's the rush? The Premier says that if we don't move now

we're going to lose all of the opportunity to train these

doctors. Mr. Speaker, if this government wishes to carry on the

necessary discussions with the national government to make

available Shaughnessy Hospital, if they wish to take the

beginning steps in organizing the administration of such a

centre in the hopes that it will be in accord with what Dr.

Foulkes recommends, they can do this. We have a department in

government whose responsibility it is to do such things. The

Minister agrees, I understand.

Mr. Speaker, let the Minister with his department take these

steps and, when he has seen the Foulkes report, when we have

seen the Foulkes report, when the medical profession has seen

the Foulkes report, and when the public recognizes the

direction that we're going in health care, then let him bring

in legislation which will ensure that future doctors, nurses,

psychiatrists, whatever the case may be, will be trained to

fulfill what Foulkes recommends.

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, I'd just like to

preface my remarks by heartily refuting the conclusion of the

Member for Langley (Mr. McClelland) that I've decided to leave

medicine for a while because I see the Foulkes' writing on the

wall. I would just like to regard that as just a typical remark

that often follows the happy hour when we come back at

night, Mr. Speaker, this is a very important bill, and I would have

preferred to speak on the bill itself rather than on the

amendment. But I find from past experience that usually when

the amendment is voted on, the bill will go through very

quickly. I prefer to make my comments on the amendment.

HON. MR. BARRETT: Like everybody else.

MR. WALLACE: Like everybody else.

[ Page 1101 ]

MR. SPEAKER: You won't be any more out of order than anyone

else, I guess.

MR. WALLACE: Mr. Speaker, this bill, I'm sure, is written

with the very best of intentions by the Minister and perhaps

with a real sense of frustration at the lack of apparent

progress in the existing structures which are available to

provide expanded health care delivery and also expanded

services to train people we need so badly.

A main emphasis of the bill is on education and a mention of

paramedical personnel. The Minister knows as well as anybody in

this House, and probably as well as anybody in the province,

that we definitely do need more doctors. I agree with the

Premier that the attitude of the former administration was

shocking. The attitude of the former Premier (Hon. Mr. Bennett)

was simply this: when we can draw on doctors from all over the

globe, why bother to spend tax money training your own sons and

daughters? This was a despicable, callous, indifferent attitude

of Premier Bennett — the kind of attitude that could draw

nothing but disdain from professional people and certainly from

this backbencher.

SOME HON. MEMBERS: Here, here!

MR. WALLACE: While I hesitate to heap invective — and I've

tried so very hard the four years I've been here not to do this — I have to say at this point and time that that was one of the

coldest, callous, inhuman decisions that man ever made, perhaps

second only to his attitude to the citizens of this province

who required chronic health care.

While I have grave reservations about this bill, I have no

hesitation standing here tonight and saying this represents a

great progress and a sign of hope and a better, human attitude

than ever existed with the former administration.

HON. G.V. LAUK (Minister of Industrial Development, Trade and Commerce):

Nice shot, Scott.

MR. WALLACE: Having got that out of my system….

Mr. Speaker, I realize that that kind of attitude only

defeats the purpose of trying to discuss this very important

bill in a rational and objective way.

I sense in this bill a real intention and a hope to answer

some of the problems facing British Columbia in trying to plan

the programme of health delivery services and the training of

the personnel required to provide these services.

I can only say that if you brought in this kind of bill relating to Victoria,

I would be right behind you 100 per cent. The planning, the delay and the shocking

indifference on the part of many people in this city regarding the planning

of hospital health facilities is nothing short of a disgrace. I don't know what

the answer is, but all I know is that in the 12 years I've been in this city

as a resident it would be easier to get blood out of a stone sometimes than

create facilities which everybody pays lip service to as being necessary but

nobody seems to be able to get the action going.

If the Minister, Mr. Speaker, is frustrated, so am I. And I

sense in this bill — much as there is wrong with it, with

respect, Mr. Minister; there's a lot that I would like to see

otherwise — some kind of despair in the bill saying: for God's

sake, let's get something done; stop talking and get some

action.

Frankly, if I might interject, I don't think it matters two

hoots whether we have the Foulkes report tonight, next week,

next year, or 50 years from now because I'm not sure that he

knows what he's talking about. (Laughter.) That's a personal

opinion based on off-the-cuff statements, and some of his own

interpretations.

But regardless of that, let's stick to the bill. I would

just say that this bill can be judged on its own merits,

regardless of the Foulkes report. The fact is that the bill

attempts to define a centre where highly specialized care — and

I must confess that the word "tertiary" was new to me. I

thought that tertiary treatment referred to sewage (Laughter),

but I understand it can also be applied to the highly skilled

level of care not available in a local or a provincial

hospital. But the highly specialized facilities that are

required should be developed in such a way to be a great pride

to all of us in this province and, in fact, in Canada.

I support the concept of trying to develop such a centre, I

have to wonder, however, if the Shaughnessy site….

MR. McCLELLAND: Point of order.

MR. SPEAKER: Yes, on your point of order?

MR. McCLELLAND: I understand that the Member doesn't want to

wait to talk to the principle of the bill but, Mr. Speaker, the

Member is talking to the principle of the bill and not to the

amendment. I would ask that the Speaker ask that he speak to

the amendment.

MR. SPEAKER: Well, I've tried to be as lenient as possible

because much of the discussion goes on around the principle of

the bill related to why it should be read six months hence or

why it should be read now. Therefore you inevitably plunge into

the debate on the principle of the bill. I would ask the Hon.

Members to try to relate their remarks, if possible, to the

advisability of the bill either being read now or being read

six months hence.

[ Page 1102 ]

MR. WALLACE: If I could have the right to speak to the

principle of the bill after the amendment, I'll be quite happy

to do it.

HON. MR. BARRETT: Mr. Speaker, on a point of order, it's my

understanding that your ruling was, when the same point was

raised with me, that because previous speakers in the debate

had also strayed, your approach was an even approach to all

sides of the House. By the time I had spoken, the pattern was

set in the debate that included the kinds of comments that the

Member is now making, that I made and the Member for

Vancouver–Point Grey made. I find that the point of order

cannot be well taken when implying that what applies to one

Member of the House doesn't apply to another. I say the Member

is thoroughly entitled to expand on his remarks right now.

MR. McCLELLAND: Either we have rules in this House or we

don't. As long as we have rules in this House then we stick by

them, and if there's an amendment before the House we speak to

the principle of the amendment, not to the principle of the

bill.

MR. SPEAKER: May I point out to the Hon. Members that it's

quite correct that we do have rules in the House. I pointed out

what the rule is, but when Members infringe upon the rule

there's another rule of the House that has always been applied

too. If one opens the door, the other can walk in too.

AN HON. MEMBER: Hear, hear!

AN HON. MEMBER: Yes, but it was the Speaker who opened the

door.

MR. SPEAKER: Order, please. It may be a criticism of the

Speaker; I agree with you that I should be criticized for

letting one side speak on wider matters and then not permitting

other Members to do so.

AN HON. MEMBER: How long does that go on?

MR. SPEAKER: Well, it usually ends up in this way: you

discuss the principle of the bill during your debate on the

amendment, and by that time you've exhausted yourselves when it

comes to the main part of the bill. So I certainly would ask

the Hon. Member to try to confine his remarks to a certain

extent at least, as some other Members have.

MR. H.S. SCHROEDER (Chilliwack): I hope the same lenient

attitude you've had for some of the other speakers….

SOME HON. MEMBERS: Oh, no!

AN HON. MEMBER: We want to stick with the rules!

MR. SCHROEDER: Since we are the only party that has not yet

spoken to the amendment I'm sure, Mr. Speaker, that the same

lenient attitude that I must congratulate you for will pervade

now during these next few moments.

MR. SPEAKER: I always believe that those who crave equity

should do equity.

MR. SCHROEDER: Thank you, Mr. Speaker. Maybe you and I could

have our debate outside, (Laughter.)

I'd like to support the amendment to have the bill read six

months hence. I'd like to just give briefly some reasons why I

believe the bill needs at least six months to cure.

I don't believe the government is secure at all in its

position or in arguments that it has presented for this bill

right now. I've listened to the Hon. Premier saying that the

reason why we need to have this new corporation and this new

location for a health facility is that the one that exists,

namely the one at UBC, is an elitist facility and that only 80

students per year are being graduated there, supposedly because

that's all the facility will accommodate. Then he suggests that

we need to get going immediately to change the location of the

facility, to shift the facility to another address in hopes

that this will take away its artist quality. He even suggests

that it may have some effect on someone who shifts all the way

from Pouce Coupe, Alberta. (Laughter.)

AN HON. MEMBER: Wha-a-at!

MR. SCHROEDER: Pouce Coupe, B.C. (Laughter) to use your

phrase, Mr. Member, I stand corrected.

But to dare to suggest that it will make a difference to a

lady with five children, whether she's transported from Pouce

Coupe to UBC or whether she's transported from there to an

address now known as Shaughnessy Hospital — will make some

difference to the kind of health care that is provided to her — is a ridiculous argument. If that were the only reason why we

should act now, I'd say that that's not reason enough.

Also, with all due respect to the Member speaking just

before me, to say "Let's do something now, we've waited for 15

years" — or 10 years, or 12 years or whatever the time was — "we've waited all this time to get some action, let's move in

any direction right now," is as ridiculous an argument

as the one I've just noted, because to move in any direction at

all is not necessarily to move toward your goals.

[ Page 1103 ]

AN HON. MEMBER: You could move backwards.

MR. SCHROEDER: When you don't know what the Foulkes report

is going to recommend, to move in any direction gives you 359

degrees chance out of 360 that you're going to move in the

wrong direction. Therefore I would suggest: why not wait until

we see the Foulkes report and find out what it recommends? Then

let's move in that direction. At least it gives us one chance

in 360 that we might be moving in the right direction if Mr.

Foulkes is correct in his recommendations. For the Hon.

Minister of Health (Hon. Mr. Cocke) to say that he has no

knowledge of the Foulkes report, and yet to say adamantly that

he knows what direction it is that he needs to move in, is also

incongruous. Wait till it comes in, as I say, and read it. It

may recommend the exact antithesis of the direction that we are

going.

One of the reasons why I would like to say let's wait six

months is because the government has suggested already that it

is not sure of its direction. The Minister, in introducing

second reading, was so brief in his remarks that it gave us

every reason to believe that he's not sure what direction he

needs to move in. When he is supported by the Hon. Premier, the

Premier stands, he shouts, he rants, he raves and he falls

suspect, because in the college which I attended and in which

we learned supposedly the art of public speaking, we also

learned this: whenever you haven't got much to say, then stand

up and yell as you've never yelled before. You may impress

somebody with the fact that you have convinced yourself.

AN HON. MEMBER: That's vaudeville!

MR. SCHROEDER: I say another reason why we need to pull the

bill and have it read six months hence is that the government

is not sure itself of its own direction.

I ask: what's the hurry? I would like to put my finger

perhaps on a sore spot. Isn't the real hurry the fact that we

have already committed funds that have not been provided for in

any Act of legislation to be expended in the month of November,

and that the reason for the hurry of this bill is that we've

got to make sure that we can stick to those commitments, and

that we have first to pass a piece of legislation in this House

to make it all possible? Isn't that the hurry?

AN HON. MEMBER: That's right.

MR. SCHROEDER: I'm just wondering if that isn't the hurry. In either

case, in any of the five instances that I have suggested, I see no reason to

move now. The Minister has already given indication in at least one other instance

that he has a tendency to jump the gun. I say, let's wait and see what those

who are knowledgeable have to say, and I'd like to give that credit to Mr. Foulkes,

although the former speaker doesn't believe that that's right. Let's at least

allow the man the credibility that he deserves and let's listen to his report

and look at it.

I say, Mr. Minister, that I appreciate your position,

through you, Mr. Speaker. I appreciate what you are trying to

do. I travelled the entire summer listening to people saying

exactly what you're trying to say, I know that there is some

sense of urgency to why we should be moving now and not waiting

forever, but let's move in the right direction.

I know that you're doing a good job. I know that you're

doing the best that you know how to do, but why not wait until

the advice of the learned people, the wise men, the elitists

even, give you what they have to say? I'm sure that both you

and I can learn from it.

MR. G.B. GARDOM (Vancouver–Point Grey): I very much

subscribe to the remarks of the last speaker. I think that he

summed up in an exceptional fashion the very crunch of this

argument.

You know the former administration, Mr. Speaker, would have

untold commissions, royal and otherwise. We had the Clyne

Commission on expropriation, the Morrow on liquor, the

Carrothers on public service and the Perry report on education,

but they would either never release the results or they

wouldn't act upon them.

This administration then takes a 180-degree turn and orders

reports, but it doesn't wait until they arrive and then it

decides it's going to bring in very innovative legislation

which could well superimpose upon the hearings, the studies and

the findings of their very own requests that they've asked to

come from the professional side, from the community, and from

Dr. Foulkes.

I would suggest to you, Mr. Speaker, that in both cases the

people who have been rooked as the result of this kind of

attitude to the use of public funds are the public because it's

their dollars that are being spent. They're not receiving value

because either the results of these extremely expensive

endeavours are not being received, disclosed, or acted upon or

the results of these very expensive endeavours are being

totally disregarded and legislation is being superimposed

before they can even come before the House, before the cabinet,

before the Ministers, before the Members of the government or

before any people in the Province of B.C.

The Hon. Member for Oak Bay (Mr. Wallace) recognized

extremely difficult problems in health care which I may say

were appreciated and recognized by all Members of the

opposition in years gone by. But it's rather peculiar to me

that the Hon. Member for Oak Bay has found it very easy for

himself to prejudge the results of Dr. Foulkes' report

[ Page 1104 ]

before it has even been before him or before anyone else in

the province.

I think that very valid reasons were advocated by the First

Member for Vancouver–Point Grey (Mr. McGeer) who just stated in

simplistic terms that we have to have the most available

professional skills. I also think that very valid attitudes

were enunciated by the Premier when he talked about élitist

abuse. There is perhaps élitist abuse in the medical

profession but that's not just common to doctors; we find élitists abuse in every level of society. Make no mistake of

that fact.

I think the very crunch of the argument, as I said at the

outset, is that we have the government requesting this

expertise, the government has total confidence, obviously, in

Dr. Foulkes or they would not have given him the mandate to do

the job, and you're absolutely pulling the carpet from under

him and all of the people who have been working many, many

months to try to come up with a valid direction to give

intelligence, to give some kind of basis whereon the government

can arrive at a pragmatic decision to act. You're ignoring all

of that. I think that's shocking and that is the reason why I'm

supporting the amendment.

MR. D.A. ANDERSON (Victoria): Mr. Speaker, the amendment is

very simple. It's a question of time. And the only point of the

amendment is for delay — a request for a delay of six months, a

traditional motion — but basically delay until such time as the

Foulkes report is presented.

The argument of the Member for Oak Bay was the only one so

far presented that made sense in terms of accepting this

legislation, because he doesn't believe in the Foulkes report,

he has no faith in Dr. Foulkes; therefore there is no need to

wait for any report to come forward. His was the only logical

position in support of this bill.

For the government to accept his logic and vote for this

bill would be, I think, an absurd situation, unless the

Minister would like to tell us that he knows in this area that

this is what Dr. Foulkes is going to recommend. That would be

the only other excuse which, of course, he has not given us;

indeed, he's said quite the reverse. He's said that he's not

seen the report and he doesn't know what's in it.

Interjection.

MR. D.A. ANDERSON: Well the fact is that you cannot separate

the two. The fact is that in this situation you can carry out

all the proposals made by the Premier or by the Minister

without the administrative re-organization that this bill

entails.

As far as the arguments put forward really we've seen nothing except the traditional

government approach: when faced with an argument that they cannot meet they

either attack the individual who put the argument forward or they attack the

individual's profession. This we saw tonight in the attack upon the University

of British Columbia, in the attack upon the medical profession, but still no

argument whatsoever directed to the need for speed to get this legislation through.

The Minister has indicated during this debate that pretty

well everything that this board can do in terms of changing

medical education in the province can be done by other

presently-existing means. There is no need for this board at

this time. Therefore the motion for the amendment, the motion

in favour of giving this bill a six-month hoist is, I think,

completely valid.

We can always bring forward legislation at another time when

the Foulkes report is available and we've had a chance to

examine it. But to bring this thing before us at this stage

really doesn't make any sense at all in terms of having a

rational acceptance of legislative proposals from the

government following an examination of the difficulties and the

problems.

It may be that the Foulkes report does suggest such a board.

I don't know. I've no idea. I can't tell. And I presume that

the Minister doesn't know either, from what he's said tonight.

But if it does put forward such a report what are we going to

do? Withdraw this amendment or have legislation repealing this

legislation that we're going to pass this evening if the

government has its way? Of course not. Apparently this is the

direction that the Minister of Health wants regardless of any

information that he may get from experts.

You know the argument that has been put forward about the

woman in Pouce Coupe is great stuff, but this legislation

doesn't deal with her problem. The argument's been put forward

that we need it to get 160 places in the medical school, but

this legislation doesn't give us those 160 places. This

legislation is a reorganization of a type which may or may not

make sense, depending on the acceptance of the Foulkes report.

To put it forward at this time, to ask the opposition or the

government backbench to accept this type of legislation in the

dark is, I think, a very foolish point of view.

We have to have the basic material before we can proceed.

This is the reason we in the opposition have, month after

month, accepted the excuses of the government when it came to

questions in the medical field, when it came to dealing with

chronic care and the year that's gone by when the elderly

people of this province have suffered badly as a result of

indecision in this area. We've waited, we've waited; we've

waited because of studies being done.

Now we see the government indeed say in this legislation

that delay is not necessary, and of course the argument is true

with everything else that's gone up to now. We feel that this

amendment to delay is

[ Page 1105 ]

necessary in the light of the lack of knowledge put forward

by the government, a lack of information put forward by it on

government intentions in the future. The excuse they've used is

the Foulkes report; therefore we think that there is no way

this legislation should go forward without the Foulkes

report.

HON. W.L. HARTLEY (Minister of Public Works): I think we can

summarize what the former Member and what the opposition has

been saying. They're asking for further procrastination.

In 1919 the Liberal Party of Canada promised Medicare. In

195 8 John Diefenbaker, a Conservative, set up a commission.

And 49 years later, 1968, we finally got Medicare. This is the

result of the sort of talk that we're listening to tonight.

They plead for the old people. How many people died bankrupt

because of the Liberal Party and this kind of talk for over 50

years? This young man should be ashamed of himself to get up

and speak the way he did tonight. Procrastinate, procrastinate,

procrastinate. After 50 years, hang your head in shame!

MR. SMITH: Speaking to the amendment which is basically an

amendment to read the bill a second time six months hence, the

opposition have looked at the bill and listened to the Minister

in the debate and in the remarks that he put forward when he

moved second reading of the bill. We have to come to the

conclusion that there can only be one of about three things

really that have affected the Minister and made him come to the

decision that he has with respect to introducing this bill at

the present time.

One is the fact that he may not, at the present time, know

of the full recommendations of the Foulkes report. But if the

doctor himself, as he has done in the last few weeks, released

information to the news media, then certainly as an appointee

of the government, the Minister in charge of this department

must know something about the recommendations that will at some

time be presented to him by Dr. Foulkes. If he has no

confidence in the doctor why did he appoint him to analyse the

situation and come back with a report?

One of the conclusions that we can come to at this particular point in time

is that the Minister is fully aware of the recommendations in the report, and

that this bill, to a greater or lesser degree, is based upon those recommendations.

If that is not so, then it must follow that the Minister knows the recommendations

and he would be embarrassed to allow those recommendations to be known publicly

before presenting this bill to the House. Therefore, the bill has come up at

this particular time at this session prior to the time that the man who was

appointed to look into this whole particular problem made his recommendations

to the Minister.

It doesn't matter how you cut it or slice it, Mr. Speaker.

In any respect, whatever the Minister's reasons, it is not fair

to his own Members and to the Members of the opposition to

bring this bill in prior to the time that the report has been

tabled for examination by all the Members of this House.

The Hon. Premier, in the tirade that we heard for a short

period of time this evening, referred to Pouce Coupe. He

pronounced it Pouce Coupe. The people who live there pronounce

it Pouce Coupe. Regardless of the pronunciation, it was nothing

more than a smokescreen or a balloon floated by the Premier

because, first of all, the facilities that the Premier referred

to will never be available in a community the size of Pouce

Coupe in the foreseeable future. So what does it really matter

whether the person who is involved in a particular problem had

to be moved by aircraft from Dawson Creek, the nearest airport,

to Vancouver or to Prince George? The time involved is

practically the same. So it is not an argument at all.

As a matter of fact, as the Hon. Member for South Peace

River (Mr. Phillips) knows very well, one of the most modern

medical facilities in northeastern British Columbia is in

Dawson Creek, which happens to be seven miles from Pouce Coupe.

Now if they couldn't handle the particular problems in Pouce

Coupe or in Dawson Creek, it is certain that that particular

lady with the five children would have had to fly to Vancouver,

to Edmonton or to Prince George to receive whatever treatment

was required. Really, in air time, it makes no difference, or

very little difference.

So it is a specious argument, Mr. Speaker, for the Minister

or the Hon. Premier to refer to that as a reason for bringing

this bill before the House at this particular time.

Interjection.

MR. SMITH: Expediate?

Interjection.

MR. SMITH: If the Hon. Minister would care to look it up in

a dictionary, there happens to be a word there of that

particular pronunciation and that particular spelling in the

dictionary, and it happens to mean the same thing as

"expedite."

Interjection.

MRS. JORDAN: Now you've learned something tonight.

MR. SMITH: Look it up in Webster's dictionary if you would

care to, Mr. Minister. It's there.

[ Page 1106 ]

Interjection.

MR. SMITH: It would seem to me, after all we have heard from

the government about their intention to draw information and

recommendations from appointed groups that they have appointed

in large numbers in the last 12 months, that certainly they

would want to know the recommendations of one particular Dr.

Foulkes before proceeding with this bill in this House.

We have heard a great deal from the Hon. Ministers — and

more so, I must admit, from other Ministers than from the

Minister of Health — about public participation, about input

and output and all the rest of the things that involve people

in the process of governing the Province of British Columbia.

After all, they were going to refer to expert advice and get

the expertise of people who were intimately involved in

whatever field we might be dealing with — in this case, the

field of medicine and health care.

It seems to me, Mr. Speaker, that the Minister either moved

very hastily, or he does know what was included or will be

included in the report that is about to be brought in by Dr.

Foulkes, and he based his recommendations and this bill upon

those recommendations before we had an opportunity to see it or

analyse it in this House.

It is not the first time that this has happened. As a matter

of fact, it is becoming all too frequent…

HON. W.S. KING (Minister of Labour): No doubt.

MR. SMITH: …with respect to the Ministers of the Crown

who like to sit over there and laugh and jest, particularly

when they are not even in their own seats. I suggest that if

you want to heckle me, go ahead and heckle me. But at least

have the courtesy to sit in your own seat, because this is part

of the parliamentary process. If you want to heckle, get in

your seat. If you want to sit there as someone who is just

observing, stay in the chairs at the back of the chamber and

let somebody who is on his feet make his point.

Mr. Speaker, in speaking in support of the amendment, it's a

mystery to me why the Hon. House Leader of the Conservative

Party (Mr. Wallace) would be so concerned and make the

statements that he did — at least, it looked to me — in anger

over the fact that this particular bill may be delayed.

I realize what his position has been for some time, and

nobody will deny that additional health facilities are needed

in the Province of British Columbia. But for the Hon. Member to

rise in this chamber and make the statements that he did

tonight can only lead me to one conclusion: that is, that he

may not agree with Dr. Foulkes. In that case, perhaps he, too,

has read the report, and this bill is based upon his

recommendations and no one else's.

MRS. JORDAN: In speaking to the amendment to this bill

which, in effect, asks that the bill be hoisted for six months

for study by the public and by people outside the so-called élitist realm that the Premier referred to, I would point out

a number of things.

One is that in the previous debate on this bill last night,

in speaking to this amendment, the Minister indicated that it

was a very simple little bill. At that time I pointed out to

the Minister that it was not a simple bill and that the debate

should be adjourned until we had more time to discuss it in

depth. This was a no-no situation. Yet when I began to point

out what, in fact, were the powers in this bill, and the powers

that were being conveyed outside this Legislature to the

Minister and to the board, then very quickly the Minister and

the Premier changed their minds, Mr. Speaker. I think that's

very commendable. They did accept a motion to adjourn the

debate so that we could discuss the bill in depth and, at this

time now, move an amendment to the bill.

It is with respect to that decision yesterday in the

previous debate, Mr. Speaker, that I would suggest that they

again examine the situation, and examine the input that has

been brought before this House by all Members of the opposition

as to what their concerns are. They have pointed out very well,

really, the weaknesses in the Minister's own argument or, in

fact, perhaps some of the points he didn't realize were

encompassed in this bill. We should lay the bill over — this is

not setting a new precedent — and reconsider it. This, in

itself, would be a commendable decision.

I think, Mr. Speaker, the actions of the Premier in this

debate, as the second speaker in speaking to this amendment,

are in themselves, without all the other input into the debate,

reason to hold this bill over. The Premier gave every

indication of confirming my statements yesterday as to what was

in the bill and, secondly, to pointing out very clearly that,

rather than being concerned about the genuine care of health of

the people in the Province of British Columbia and some type of

practical adaptation to the future in terms of economics and

the geography of this province, he is on a binge of a personal

vendetta.

He talks in terms of the élitist doctor. I wonder really

where he goes for his medical care. Because, indeed, there are

some !élitist doctors in this province, and some of them are very

well entrenched in the University of British Columbia. I would

be the last to deny this.

Some of them are very well entrenched in the Vancouver

General Hospital, and some of them were very well entrenched in

Shaughnessy, and there's a few well entrenched in various

hospitals throughout this province. But they, Mr. Speaker, are

very, very much in the minority.

[ Page 1107 ]

The majority of doctors in the Province of British Columbia

are, to quote a popular phrase, "very much where it is at."

They, Mr. Speaker, know what the practice of medicine is all

about and they know what the training for medical people is all

about. I speak in terms of nursing services and paramedical

services when I say this.

There is always a small, élitist group; but to wrap a

personal vendetta in the cloak of so serious a subject as

health care in the Province of British Columbia is wrong. I

suggest that the people of this province and the medical and

health care in this province are worthy of a much better

attitude than that. Everybody is entitled to something that

raises their blood pressure and everybody is entitled to get up

and react to that rise in blood pressure, but not when it

involves a serious decision such as we're making in terms of

this bill and this amendment.

If the Premier has these personal feelings — and I would

suggest they are probably not shared by the Minister of Health

(Hon. Mr. Cocke) — then he would be wise and it would be a

credit to him to sit down and examine the matter more

thoroughly.

There is some question as to whether, in fact, the Foulkes

report might not reflect a good deal of another type of élitist

attitude in the medical world, If we hoist this bill and if the

Foulkes report is brought in, the doctors and the nurses and

the paramedical services, who are where it is at out in the

field, Mr. Minister, in Pouce Coupe, in Fort St. John, in

Castlegar, in Armstrong, in Clearwater, in Quesnel, and the

very few that are on the Indian reserves or in the northern

reaches of this province, will have an opportunity to study

that report and to examine how it is going to relate to

practice outside the metropolitan area, or, conversely, the

doctor who is in the East End of Vancouver working on Hastings

Street. Let him have his input.

It's common knowledge around this province, both in and

outside medical services, that the Minister has already started

and is certainly anticipating extreme and radical changes to

the medical practices and the health care practices in British

Columbia. We don't want this type of action to presuppose the

report. We don't feel that the legislation should presuppose

the report, otherwise the report is of no value. If the

Minister and the health staff in the Province of British

Columbia knew the answers, why commission the report, why

commission the study?

Mr. Minister, you're looking very bored and very fed-up, but

you have a lot of responsibility on your shoulders. With all

due respect to you, you have kept out of trouble in the last

year, basically because most of what you're doing has been

smiling, listening and puffing on your pipe. That's very

charming.

But now, Mr. Minister, you are going to have to stand up, through you, Mr.

Speaker, and be accountable for your actions. It's all very well to stand on

pride and say, "I'm willing to be accountable," but you're not going to be

the loser, Mr. Minister, only in terms of an election; it is the people of British

Columbia who will be the losers if, in fact, you make a mistake.

The Hon. Member for Oak Bay (Mr. Wallace), in his statements

pointed out what has been a very serious problem in medical

care in British Columbia, probably in provinces across Canada,

certainly in England, certainly in other parts of the world:

the delivery of health care in the non-metropolitan areas is

vastly different from the delivery of health care in the

metropolitan areas.

The Member, with all due respect to him, who is indeed a

fine practitioner — I know he's respected by his colleagues — speaks in terms of problems of the Victoria area largely, with

the exception of chronic care. There are problems in Victoria,

and I've never been able to understand why they couldn't solve

them.

The danger in trying to bring in such sweeping legislation

to solve the problems of a small, élitist group in Vancouver

and Victoria is that a system around the province which has, in

fact, been highly satisfactory — and certainly can be improved — will be brought to a detrimental stage.

The Minister, I am sure, would not disagree that the general

health care facilities, with the exception of chronic care, and

the delivery of health services in a majority of areas of

British Columbia outside the metropolitan area are exceedingly

high. These regional hospital boards and these medical people

in the broadest sense have done an excellent job in working out

needs of their areas.

To subject them to the terms that may well be within this

bill of a corporate board in Vancouver would be the folly of

all follies in this province. The corporate mind, Mr. Minister,

is great in the board room and it's great in the forest but it

doesn't belong to any large degree in the delivery of health

care. The accountant is an accountant and the administrator is

an administrator. If you look in Germany, if you look in

Sweden, if you look in Manitoba when this corporate system of

the administration of medical care was adopted, it is the

patients who have lost out, not the doctors.

I'm a strong advocate of doctors, and if you want to put

them on salary, judging by all the other salaries you pay, it's

going to be fair. But what you're going to lose is the

patient-doctor relationship, the patient-nurse relationship,

the patient-nurse's aide relationship, and that is 50 per cent

of the practice of medicine, that is 50 per cent of the

guarantee of the patient's recovery.

In the places that I cited this board becomes subservient

and dedicated to the structure, not to the patients. It's a

Tinker-toy system where they tried to plug in every service and

every care, Mr. Speaker, into

[ Page 1108 ]

a nucleus. The only thing wrong with it is that there is no

niche for the patient in terms of human needs and human

expression.

Mr. Speaker, I'm convinced that the Minister himself is

deeply concerned about this. It is because of this concern on

our part that we again make the suggestion that the bill be

held over so that we don't make the same mistakes that have

been made in other areas. We do have an opportunity with such

sweeping legislation to have the input from the nurses and

doctors in other centres.

Interjections.

MRS. JORDAN: You know, Mr. Speaker, the Minister of Lands,

Forests and Water Resources (Hon. Mr. Williams) is so

intolerant and so unconcerned about the needs of the people of

British Columbia, why doesn't he resign? He never makes a

constructive contribution to the debate. He himself probably is

in need of some medical help.

Interjections.

MR. SPEAKER: Order, please.

MRS. JORDAN: Every logical reason has been put forth in

speaking to this amendment by all Members on this side of the

House as to why the Minister has nothing to lose, why the

people of British Columbia have nothing to lose. The Minister

and the people of British Columbia only have something to gain

by a close examination of the' report, how the report relates

to the report.

With this in mind, we do hope the Minister will accept this

amendment and will lay the bill over for six months and allow

this type of public and professional input.

MR. SPEAKER: The question is that Bill 81 be read a second

time on this day six months hence.

Amendment negatived on the following division:

YEAS — 14

Chabot

Richter

Jordan

Smith

Fraser

Phillips

McClelland

Morrison

Schroeder

Bennett

McGeer

Anderson, D.A

Williams, L.A.

Gardom

NAYS — 37

Hall

Macdonald

Barrett

Dailly

Strachan

Nimsick

Nunweiler

Brown

Sanford

D'Arcy

Cummings

Dent

Levi

Lorimer

Williams, R.A.

Cocke

King

Lea

Young

Radford

Lauk

Nicolson

Skelly

Lockstead

Gorst

Wallace

Rolston

Anderson, G.H.

Barnes

Steves

Kelly

Webster

Lewis

Liden

Stupich

Hartley

Calder

MR. WALLACE: Mr. Speaker, I would just like to make a few

comments on the principle of the bill itself.

We've already covered the fact that the bill intends to

improve teaching facilities and to coordinate the training and

the distribution of medical and paramedical personnel. If there

is one need in the health services field, Mr. Speaker, it is to

utilize each individual member of the team to his or to her

fullest capacity.

We needn't go over all the ground we've covered before about

the fact that many doctors do jobs which could be done by a

person with a lesser level of training. The whole idea is to

coordinate and integrate every member of the team so that the

fullest use can be made of all the time and money that is put

into training these people.

I certainly welcome the obvious evidence from the Premier

that we can anticipate a greater output of medical students in

this province. He mentioned the figure of 160, which I hope is

at least the figure that is being aimed at. I think it is very

distressing that the sons and daughters of residents of British

Columbia, who have something less than perhaps an 80 per cent

average, cannot obtain access to the medical school in their

own province. These are the facts.

The 1971 figures showed that anyone with an average below

about 79.5 per cent was unable to get into the medical school

at UBC. Some of the sons and daughters of B.C. residents

travelled far and wide to New Zealand and Britain. Not that that

is bad, but it adds expense…and I needn't go into that

subject specifically.

For anyone to wish to delay a move which will bring this

about is something I just cannot understand. This is one of the

very strong reasons why I voted against the amendment. While

there are many things in this bill on which I would like to

offer some constructive criticism, there are also aspects of

the bill which I strongly support. One of them is the point

I've just made: that it endeavours to speed up and enhance the

output of medical personnel.

One of the criticisms that I would offer, Mr. Speaker, and

which concerns me is that the bill doesn't really clearly

define the responsibility between the two particular functions:

that of this medical centre and the function of the Minister of

Education (Hon. Mrs. Dailly) through the universities.

[ Page 1109 ]

We do know that medical students are taught at the medical

school, which is an arm of the university. But this centre, I

guess, is going to be operated by a board of individuals who

would appear to have authority in the field of education and

training, authority which clearly clashes with the authority

already vested in the university and the medical school.

It may well be that the Minister has some clear

understanding of exactly how the authority and the

administration of this centre will function. But, as I read it

and as I re-read it many times and as I talked privately to

several people in the medical field in Vancouver, there does

seem to be this lack of understanding by any of these people as

to exactly how this medical centre will be vested with the

authority to train these people and the degree to which the

diplomas….

There's one

section where it mentions that it will award

diplomas and certificates upon completion of training courses

and so on. To me and to many medical people I've talked to, Mr.

Minister, through you, Mr. Speaker, there is some uncertainty

as to how authority and jurisdiction, if that's the right word,

will be delegated to this medical board as compared to the

authority already vested in existing educational locations such

as the UBC medical school. That is one point in particular, Mr.

Speaker, on which I hope the Minister would comment when he

winds up the debate.

I'm sure that the various people in the medical school and

on the teaching faculty must also be wondering exactly how many

levels of medical personnel are to be trained through the aegis

of this board. Or is it simply that the board will institute an

additional intake of medical students to already existing

facilities such as the medical school? If so, does this not

clash with the pre-existing arrangement under the jurisdiction

of the Minister of Education?

I recognize, Mr. Speaker, that

section 17 mentions that the

Minister will review and make recommendations in conjunction

with the Minister of Education. But I would hope that perhaps

amendments might be brought in to the bill by the Minister,

making a clearer definition of authority and jurisdiction in

the areas that I've mentioned.

The other big area which leaves me in some doubt and

apprehension about the feasibility of this bill is the fact

that, as the Minister well knows, there are regional boards set

up throughout the province to deal with the coordinating and

planning of hospital and health care facilities. Of course,

there is a regional board in the Greater Vancouver area, as

there is in the greater Victoria area.

I've already referred critically tonight to the lack of

progress by the Regional Hospital Board in Vancouver. But I

sense that progress is slow.

If experience in Victoria is anything to go by, there is a great degree of

delay and passing back and forth of resolutions between different layers of

authority and from subcommittee to committee, and committee to the board, and

the board back to the committee. There is just so much discussion and debate

which goes on that there seems to be, alas, too little action in the way of

creation of the needed facilities.

Now, all I am saying, Mr. Minister, is that I shake a little

bit when I read this bill because it seems that the bill is

creating just one super regional board. I worry about the fact

that if the regional board concept isn't working, does this

bill in fact hold out any better hope of action by creating yet

another board of planning and administration? In reading the

bill it seems to me that this super-duper board has a measure

of authority over the existing regional board, inasmuch as the

regional board can have representation without a vote. The

whole principle in setting up regional hospital boards was to

avoid duplication of facilities — the construction of

unnecessary costly facilities, let us say, in one area of the

region, to be copied by some other hospital, when in fact the

one facility in one location would have been adequate.

We all recognize this, Mr. Speaker, as a vital ingredient in

the planning of health care facilities. It is such an expensive

project, however you do it, that it goes without saying that it

has to be done on the most economic basis that is compatible

with meeting the needs of the sick people. That has been

attempted by setting up regional hospital boards, and

unfortunately this has not been a uniform success across the

province.

While, as I said earlier, I fully accept the Minister's

intent of creating more medical students and more paramedical

personnel, promoting the education of the public generally in

the health care activities and so on — this fitness seminar is

typical of the kind of thing that the Minister is doing to

bring this about, and this is very good.

What I would like to ask, and I wonder if the Minister would

enlarge on this when he winds up the debate, is: does this

board which he is creating not have all the inherent weaknesses

of the already existing regional hospital board? I'm not trying

to knock it. I hope it does work, but I'm a little cynical,

based on the experience of the last few years, that regional

boards have not fulfilled the hope and the concept on which

they were set up. This particular board seems to have even more

authority than the regional board and yet that very authority

is spelled out in rather general terms.

Again, in conversation with people in Vancouver, I find that

they are somewhat puzzled to know where the regional hospital

board will fit into the new structure which is being created by

superimposing this other board above the regional board.

A smaller point which came to my mind when

[ Page 1110 ]

reading the bill was the question of the ability to levy

charges. I just wonder if for such facilities as the ones that

are included in the board — the Vancouver General, the health

sciences centre, the Children's Hospital, the G.F. Strong Rehab

and the Cancer Foundation — there is to be any different

application of BCHIS coverage to these hospitals once they come

under the aegis of this new board, because….

HON. MR. COCKE: Scott, it's just a dollar a day or so, you

know.

MR. WALLACE: Well maybe, Mr. Minister, you could just cover

that point when you wind up the debate.

One of the other aspects of this that just bothers me a

little bit is the question of centralizing the development on

Shaughnessy, when in point of fact we haven't really got to the

happy stage of having negotiated an agreement with the federal

government. Again, I may be biased because of our experience in

Victoria, but the delay, the fiddling around and the sheer

frustration of trying to integrate hospital facilities in

Victoria would drive Solomon crazy. The fact that we have tried

repeatedly and persistently to tie in the Veterans' Hospital in

Victoria with existing facilities makes me wonder if a bill

like this should be so contingent upon acquiring Shaughnessy

Hospital, when we've had so little success in trying to acquire

the hospital in Victoria. Now that again may be a false fear

and the Minister might be able to tell us of a finite date that

has been arranged for takeover.

The other consequence of centralizing the centre on

Shaughnessy: I would hope the Minister is well aware that

despite the disadvantages of traffic and so on in the region of

the Vancouver General, it is not a matter of letting certain

established facilities at the Vancouver General run down or

deteriorate or to do anything but to get 100 per cent

performance out of existing facilities, and appear to be

suddenly going off in another direction to develop the

facilities at Shaughnessy.

While I don't wish to get back onto the subject of the Foulkes report, it was

the kind of comment that I mentioned earlier in the House which Dr. Foulkes

had made publicly that there could be such options as just leaving the old facilities

without much attention and start off somewhere else completely fresh. In some

of the figures that have been quoted — and again the Minister might wish to

correct these figures — one of the criticisms that was offered when the Vancouver

General Hospital wished to expand its facilities was that the figure of cost

would be $100 million, and possibly with traffic and parking problems and congestion

in the streets, and so on, this probably was not a good idea. But I do understand

that figures have been mentioned which vary from $130 million to $200 million

for the complete development for the Shaughnessy site.

Again, as a responsible Member of the opposition, I feel

that I should ask very clearly: does the Minister know what the

cost or the projected cost of the complete development of the

Shaughnessy site will be, and how will it compare to the costs

that were projected in developing Vancouver General?

To many of these questions, I realize, no one has a

specific, precise answer, but I think these are very relevant

points that any objective person would ask: First, the whole

question of conflict of jurisdiction in terms of education,

vis-à-vis the Minister of Education in universities;

secondly the conflict of jurisdiction or the diluting of

authority of the regional hospital boards. In an area such as

this where you're tying together five or six different,

separate facilities, it would be disastrous, I would think, if

there is any further division or any conflict, shall be say,

between the existing regional board and this new board. It

would be just one new level for the confrontation and argument

which would only slow down further the creation of facilities

and the training centre which everybody recognizes is

needed.

Thirdly, there is the question of cost. Is it going to be a

judicious use of dollars? Is it going to be more or the same

that would be anticipated if we simply developed Shaughnessy as

a provincial referral hospital but not a tertiary centre? The

word "tertiary" has maybe been confusing to some, and I think

we should make it plain that a tertiary centre is the centre

that seeks the most highly sophisticated and the most

complicated forms of surgical and medical illness in adults and

children, and the facilities to investigate them. I would like

the Minister to comment as to why indeed he finally chose

Shaughnessy in contrast to Vancouver General as being the most

suitable site to develop the most highly specialized kinds of

care and treatment available in this province.

These are questions, Mr. Speaker, which I think have to be

answered. I think that the whole question of whether or not

they can be answered now or six months from now is not as

important as the Minister explaining his philosophy and his

reasons for making a move in this direction and possibly also

giving us some idea about the recommendations of the Shortliffe

report, which I know he's been asked in this House many times.

He may, for one reason or another, choose not to tell us about

this Shortliffe report, but the sums of money…. If for no

other reason, we are debating this bill because we want the

best facilities to be available as soon as possible, and we

want to expand our output of medically trained and paramedic

ally trained personnel. But in so doing, and following what is

a very worthwhile goal, we are looking at very large sums of

money and we are looking at some very far-reaching consequences

in terms of the already existing administration set up to

[ Page 1111 ]

run hospitals in this province locally, regionally, and now

on a super-regional basis.

I think that perhaps the Minister would prefer to adjourn

the debate and give us an explanation, or perhaps he can tell

us in 10 minutes but I think the large sums of money that are

involved here should not be explained away quickly or lightly,

and I hope the Minister can give us some explanations.

MR. McGEER: Mr. Speaker, I'm going to have another try at

explaining to the Minister….

HON. MR. COCKE: Forget it.

MR. McGEER: "Forget it," he says. But I don't think

we can forget this, Mr. Speaker. Fifty years ago there was a

famous report on medical education which was produced by a

gentleman named Flexner. As a result of this report a large

number of medical schools in North America closed their doors

immediately. The reason was that they were turning out medical

personnel who were not trained to the standards of skill that

could and should have been achieved in North America. The model

that was followed in those medical schools is precisely the one

that we're slumping back toward with the concept of this

particular bill.

I can only emphasize to the Members of the House, through

you, Mr. Speaker, that the pursuit of educational skills is

different from the delivery of health services. I'm pleased

that the Member for Oak Bay (Mr. Wallace) recognized this fact

in the remarks that he made during second reading, but there

are other considerations too with this particular bill, Mr.

Speaker. The priority developments at this Shaughnessy site are

to be, first of all, replacing the children's hospital in

Vancouver; secondly, rebuilding the obstetrics unit which is

now at the Vancouver General Hospital; and after that, to

develop the remainder of the Shaughnessy Hospital site.

It's questionable whether the hospital facilities that now

exist on that site will be used at all in this renewed

development in the way that they're being used at the present

time. The costs are estimated to be at least $250 million.

Mr. Speaker, I mention these priorities and these costs because they are in

some conflict with what I understand to be the contents of the Shortliffe report.

The concept of the Shortliffe report was that one new hospital for educational

purposes should be built on the University of British Columbia campus, that

some relief should be brought to the hospital bed shortage in the lower mainland

by continuing the use of Shaughnessy Hospital as a community centre, and that

the delivery system should be improved by some upgrading — and I'm talking in

the order of $10 million to $12 million — by development at the Vancouver General

Hospital site. All of those developments which would lead to better training

of health personnel could be achieved with the expenditure of well under $100

million.

If we have S250 million to spend — and I believe we should

spend those amounts of money — then those funds should be spent

to provide facilities that do not now exist. Among these, Mr.

Speaker, are chronic care facilities in this Victoria area, in

the lower mainland and throughout the rest of British

Columbia.

On the priority list as well would be the initiation and

commencement of another medical school here in the Victoria

area. This development of a second medical school, the

development of chronic care facilities in this metropolitan

area and the metropolitan area of Vancouver, and the creation

of a superior teaching facility could all be accomplished in a

shorter period of time and with a lesser expenditure of money

than is contemplated in the Act before us this evening.

But, Mr. Speaker, above and beyond the economies that I am

describing here this evening, we have the fundamental and

overriding principle that delivery of health care and education

are separate objectives to be pursued by people who have a

separate mission in life. This basic principle was discovered,

if it had eluded politicians and others, with crystal clarity

one half century ago when that Flexner report was brought

forward.

Both the Premier and the Member for Oak Bay brought forward

an argument that I've been hammering away at each year that

I've been in this House, namely, the fact that in British

Columbia we are training far too few doctors. Something in the

order of 300 each year are licensed; only 60 per year are yet

being graduated, it will go up to 80; between 500 and 600

apply, of which at least 200 would make outstanding members of

the medical profession.

Mr. Speaker, I want to underline this particular point: the holdup has not

been on the availability of clinical facilities, particularly of the kind contemplated

for the Shaughnessy site — there are plenty of patients in hospital; the Vancouver

General Hospital is the largest hospital in Canada.

The problem has been the lack of basic science facilities on

the campus of the University of British Columbia. The most

obvious and conspicuous of these lacks has been a dissecting

room for human anatomy. Perhaps the most basic discipline that

every medical student goes through is dissection of the human

body so that they can learn at first hand the various parts

that make up a living being. Because we simply have lacked the

anatomical facilities it's been impossible to take more than

the number of students that are now taken into that medical

school, no matter how many applicants there are.

So when it comes to training doctors our lack has been a

ridiculously simple one, easily cured by

[ Page 1112 ]

providing the funds to build a larger anatomy-dissecting

theatre — not having beds with patients in them.

Our own students — talking about people from British

Columbia — who are unable to get into the medical school, if

they go to Mexico or Scotland or many other places who

themselves should be training more doctors, and they get

through those basic sciences and the dissection of the human

body in Scotland, then they can come back and have no

difficulty getting their remaining two years and their

internship and residency in the clinical facilities that now

exist in British Columbia.

So Mr. Speaker, I don't think that any Member of this House

or any of the two million citizens of British Columbia should

be under a delusion as to why we're turning out so few doctors.

It isn't a lack of the medical centre at Shaughnessy. It's a

lack of a dissecting room on the UBC campus that is large

enough to take a class of 150 students.

When that problem can be cured in such a simple fashion,

it's a mystery to me why the previous government or this

government has not moved with the few thousand dollars it would

take to correct this problem. I thought, Mr. Speaker, that the

remarks of the Premier this evening were particularly

unfortunate. I'm sure through lack of experience he attacked

what is recognized as being one of the finest mental health

centres in North America.

HON. MR. BARRETT: Oh, no!

MR. McGEER: The Premier may groan, but Mr. Speaker — and the

Premier should know this — there are people coming not just

from all over North America but from all over the world to see

that facility and to look at what it is offering.

HON. MR. BARRETT: An island in the middle of nothing.

MR. McGEER: Mr. Speaker, it's not an island in the middle of

nothing; it's a mental health facility set in the midst of one

of the finest basic science complexes that exist in Canada or

in North America. I think, Mr. Speaker, that it's about the

level of the mentality of the Minister of Lands, Forests and

Water Resources (Hon. Mr. Williams) that he'd equate that with

a parking lot.

Mr. Speaker, the Premier should know — indeed, had he done

his homework when he was Leader of the Opposition he perhaps

would have come and looked at that facility and understood that

that particular facility was to be the first major clinical

complex which was to be built on that site to complement the

already heavy investment that had been made in basic science

and library facilities as well as the instructional

resources.

HON. MR. BARRETT: Who cut out the services for children?

It was a professional decision by doctors because they

wanted to serve that middle class interest.

MR. McGEER: Mr. Speaker, that just shows you the kind of

class prejudice that plagues good decision-making on the part

of this government.

HON. MR. BARRETT: We don't have any children's facilities

because of that.

MR. McGEER: Mr. Speaker, the Premier is going to learn, and

I think the Members of this government will learn…

SOME HON. MEMBERS: Never, never!

MR. McGEER: …that you can produce in the way of

facilities what the financial commitment permits. It's all very

well to be smug and say that facility shouldn't have been

there, but then at the same time admit that it should have been

there and he'd have been happy if it had been there if there'd

just been more money spent so there were children's facilities

there.

HON. MR. BARRETT: Priority should have been for the

children.

Interjections.

MR. McGEER: That's what he keeps saying. Mr. Speaker, could

we have some order?

SOME HON. MEMBERS: Oh, let's go home.

MR. SPEAKER: Order!

MR. McGEER: The Premier is showing the kind of prejudices

that he's getting to be famous for in this House and he can go

ahead when he doesn't have answers and enter into these

hysterical attacks, which he is doing. The appropriate thing

for him to have done if he felt — and I don't disagree with his

feelings — that there should be children's facilities on that

site, and I think there should, then he can go ahead and

provide the money and they will be built.

Mr. Speaker, I never heard the Premier stating, when he was

the Leader of the Opposition, where these children's facilities

should be.

HON. MR. BARRETT: Do you want to stake your seat on

that?

MR. McGEER: I never heard him making any statements that

there should be this great medical centre at Shaughnessy.

That's all a discovery that he

[ Page 1113 ]

has made as a result of advice that he has got from the

Minister of Health, and we're not sure where he got his

advice.

HON. MR. COCKE: From votes, we are.

SOME HON. MEMBERS: Votes, votes.

MR. McGEER: But what we're doing, Mr. Speaker, is going to

spend a lot of money duplicating facilities that should be as a

priority spent in providing a medical school in Greater

Victoria and in providing chronic facilities that are now

lacking. Those moneys that are committed to education should be

spent where the educational result will be best — which is to

complete a hospital where the mental health facility was

constructed, where the basic science facilities are. If this

commitment is to increase the size of the medical class, which

he should do, then what he does is he increases the basic

science facilities that are available. Instead, what we are

doing is creating a monolith that will not succeed in any of

the objectives that the Minister of Health has set forth in

this particular bill.

MR. SPEAKER: The Hon. Minister closes the debate.

HON. MR. COCKE: Mr. Speaker, we've had an interesting and a

long debate on Bill 81.

MRS. JORDAN: It's after 11 o'clock.

HON. MR. COCKE: With your indulgence, I think I can do this

in a short time.

Mr. Speaker, I thought everybody here was really interested

in some answers and it's better to get those answers while the

questions are fresh in our minds. I think we are talking about

a most important subject and that subject is delivery of health

care together with education.

Mr. Speaker, I'm not going to deal too much with the last

speaker's discussion because he has a particular point of view

which, on this particular occasion, I just can't share.

Unfortunately, experts sometimes follow the old dictum. That

Member, for example, used two contrasting arguments: he used

one argument when he was arguing in favour of that amendment,

which came from somewhere, and I didn't particularly feel it

should be discussed in great detail because it merited no

discussion that I could see.

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: Mr. Speaker, it was a delaying tactic that was an unfortunate

thing and I'm glad that they're on the record as trying to delay the delivery

of a better kind of health care in this province.

Interjections.

HON. MR. COCKE: Mr. Speaker, the Member for Vancouver–Point

Grey (Mr. McGeer) discussed the whole question of the Foulkes

report — that is the medical care, the health care report — when he was discussing the amendment. Then he got into the

education-centre thing which is completely contrasting when he

was discussing the bill itself. Mr. Speaker, how can you go

along?

Then, of course, he said the only reason we don't have a

larger department at UBC is because we haven't got a big enough

dissecting room. I don't want to interfere in any way with the

university's autonomy, but I suggest to you that if they have

that problem there are ways they can look after the problem — maybe a priorizing on the budget or, on the other hand, how

about better utilization of what they've got? What about

nights? What about weekends? What about holidays and that type

of thing?

HON. MR. BARRETT: Summer holidays.

HON. MR. COCKE: Summer holidays — those long, long periods.

Mr. Speaker, there are many ways around this.

I want to deal with some questions which were asked by the

Member for Oak Bay (Mr. Wallace). The Member for Oak Bay, who

has a tremendous stake in this whole question of the delivery

of health care, asks the kind of questions that I think we

should have been dealing with tonight. I appreciate those

questions. Mr. Speaker, let me begin by suggesting some answers

to some of the questions.

He asked how the board will operate with the GVRD and what

will their relative position be. Let me suggest to you that

BCHIS and GVRD have already got together and are forming a

committee to deal directly with the medical centre.

Now, I want everybody to understand this, the medical centre

is not geographically Shaughnessy Hospital; the medical centre

is a group of health care facilities. It's G.F. Strong, that's

not on the Shaughnessy site; it's Vancouver General Hospital,

that's not on the Shaughnessy site; it's out at UBC as well

because it takes in the health-science centre psychiatric

hospital and all of those others. The children's hospital

likely will go on the Shaughnessy site.

But that is what this board is all about. They're to be

doing the building; they're to be doing the planning. Let's

hope that they can plan it properly. They have the best people

who can be brought into this particular area to do the job with

them and for them, even without Shaughnessy.

[ Page 1114 ]

If that little thing happens that some people over there are

praying for, that the federal government decides to change

their attitude…. And their attitude now is that they want to

get out of the…. The Veteran's Affairs Department wants to

get out, totally out, of the delivery of that kind of service.

Therefore we know perfectly well that they are going to be

dealing with us. We are at a point now where it is pretty well

a fait accomplis.

MR. PHILLIPS: Midnight legislation.

HON. MR. COCKE: Mr. Speaker, the Member also asked about a

certain matter of levying charges. Well, the levying of charges

is just the same as any other hospital has the right to do.

They can levy charges at so much a day. If it wasn't that the

medical centre board will be running at least some of the

facility directly for the time being — they'll likely have

their own separate board after, on the Shaughnessy site — but so

that they can levy their $1 a day charge, $2 emergency charge,

that has to be implicit in the Act. So we are just including

that just like it is in any other Act.

How much will it cost? We are suggesting that the likely

cost for the whole area…. Remember, we are not only just

talking about teaching hospitals — the Member for

Vancouver–Point Grey (Mr. McGeer) is seemingly only interested

in that area — we are talking about tertiary care of children.

We've been screaming for it. People have been screaming for

tertiary care for children in Vancouver — that's the high-level

care in Vancouver for the whole of the province. This is to

deliver care for that high-risk child, or at least the

high-risk proposition in Pouce Coupe — or Pouce "Coopey", if

you want to pronounce it that way.

AN HON. MEMBER: What about the kids?

HON. MR. COCKE: Those children will be getting their

hospital!

There were three different groups working around this

question but they could never get together. We've given them an

opportunity to get together. Don't forget that this board is

composed of people from all of those different facilities. We

are not going out and finding people. Where did we find our Mr.

Christiansen? We found him at the VGH. Where did we find

Donaldson? We found him at the children's hospital. Where did

we find Mr. Bibbs? And I hate all these big forces, but we

found him at the university, and so on, right down the line.

And they will have their children's hospital.

Mr. Speaker, the $130 million that you read in the paper is something in a

ballpark figure around what VGH was talking about. They were saying, "Look,

we've got to do it all here." We're saying that you can't do it all there; it

is far too congested. VGH is a huge edifice now. It's going to be a partnership,

and they are going to be part of the medical centre; they are going to be part

of the decision-making process. It's a great concept, Mr. Speaker. It's a concept

that has been developed by a great number of people in concert. It is nothing

to do with the Foulkes report from that standpoint. All those arguments about

"hold it up until the Foulkes report….

Interjections.

HON. MR. COCKE: Because I happen to be the person, together

with the Premier, who commissioned the Foulkes report. We know

what we asked for.

Interjections.

HON. MR. COCKE: We asked for a report on coordinating the

Department of Health, a system of delivery of care — but

nothing to do with this educational concept.

Interjections.

HON. MR. COCKE: Mr. Speaker, this report was done in

consultation. Now let me just go on.

Interjections.

HON. MR. COCKE: Mr. Speaker, I want to give you an idea. You

know, we've had a lot of discussion over there about how this

came about and we've also heard that there are a great many

people…a great many people over there indicated that

there's all sorts of outside people who are in conflict with

this idea. Let me tell you, we did our homework on this.

Interjections.

HON. MR. COCKE: Yes, we did. That's traditional with this

party; we do our homework.

Interjections.

HON. MR. COCKE: Just a minute. After I tell you one or two

things, if you vote against this remember you're voting against

the children's hospital, you're putting it back.