Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MAY 27, 1997

Afternoon

Volume 5, Number 10

[ Page 3685 ]

The House met at 2:05 p.m.

L. Reid: Hon. Speaker, I have an announcement and an introduction. I'd like to commend the B.C. Liberal opposition on their very fine performance this morning on the Big Bike Ride. The Heart and Stroke Foundation indicated that we indeed are leaders in fundraising, and I would like to tell them that we have done a very fine job.

I'd also like to take a moment to introduce two dear friends of mine in the public gallery. Dorothy Hamilton and Kathie Hamilton are visiting from the riding of Delta South, and I'd ask the House to please make them welcome.

G. Bowbrick: Joining us in the gallery today are a group of 20 grade 11 students from the Sigma program at New Westminster Secondary School and their teacher Ms. Martens. I ask that the House join me in making them welcome.

M. Coell: In the gallery today is a grade 8 student from Bayside Middle School in my riding, Steven Fissel. He has been here all day; he was here listening to the Health estimates this morning and says he very much enjoyed them.

Hon. J. Pullinger: Today I have the pleasure of introducing to the House a friend, an individual who has been active in the Cowichan Valley for a long, long time. He's a provincial emergency planning volunteer still, was a municipal politician for years, had a huge amount to do with developing recreation centres around British Columbia and is a longtime New Democrat who provided hours and hours of volunteer time to people like Tommy Douglas, Bob Strachan, Barbara Wallace and, happily, me. Would the House please help me welcome John Cannon.

R. Thorpe: It's with pleasure that I rise to pass congratulations on behalf of myself, the member for Delta South and our caucus to Alan J. Barnard, comptroller general, who has served our province for some 15 years. He's given very generously of his time and talents to the Financial Management Institute, the Institute of Chartered Accountants and the Society of Management Accountants. He is recognized across Canada as a mentor in the financial management community. He was recognized yesterday in Victoria and won the Financial Management Institute award for 1997. I ask the House to join in passing congratulations to Alan.

C. Hansen: The community of Quilchena is not in my riding of Vancouver-Quilchena. Quilchena golf course is not in my riding. But Quilchena Elementary School is, and today we have 25 grade 5 students from Quilchena Elementary School and their teacher, Patti Baldwin, and five parents. Would the House please make them welcome.

G. Plant: Today in the gallery is my sister Marnie Plant from Vancouver and her very good friend Kim Bartlett from Montreal. I ask the House to please make them welcome.

Hon. J. Cashore: It's with some sadness that I point out that the Minister of Education would rather be somewhere else today, given that it's his thirtieth wedding anniversary.

Interjections.

The Speaker: I hope you'll notice I'm giving everybody an opportunity to vent preparatory to question period.

Oral Questions

USE OF CONSTITUENCY OFFICE

FOR FEDERAL ELECTION CAMPAIGN

G. Campbell: Yesterday we learned from the Minister of Small Business, Tourism and Culture that she had closed her constituency office in Ladysmith and loaned it to the federal NDP for the duration of the federal election. When constituents call the Ladysmith office, they are told by an answering machine to call the constituency office in Duncan, but when they call the Duncan office, they are told by a second answering machine that the Duncan office is closed until three days after the federal election.

My question to the minister is: can the minister tell the people of Ladysmith-Cowichan why she has decided to suspend constituent services and her duties as an MLA until following the federal election?

Interjections.

The Speaker: Order, members. Minister of Health, on what matter?

Hon. J. MacPhail: Responding, as House Leader, to the question being out of order.

The Speaker: Minister, if this is a point of order, I would ask you to take your seat for a moment, if I might.

We don't normally entertain points of order during question period. The standard practice, of course, is that ministers do indeed only answer questions falling within their area of ministerial responsibility. Yesterday, however, we saw the minister's willingness to answer. If the minister is still willing to answer, then the question is acceptable.

Interjections.

The Speaker: Excuse me, members. Members, please! West Vancouver-Garibaldi, please!

The assumption I am making is that the rules of the House belong to members, and if the opposition is prepared to overlook the rules to ask a question and the government side is willing to respond, then I will entertain the question. I am therefore deferring to the minister, should she wish to answer.

Hon. J. Pullinger: I indulged the opposition yesterday by answering a completely out-of-order question. I'm not about to allow them to continue asking completely out-of-order questions that I'm not prepared to answer.

G. Campbell: It's difficult for me to understand why the minister would answer the question one day and plead the Fifth the next. However, the Speaker's rulings on these matters have been unequivocal in the past. On September 28, 1995, the Speaker ruled that "under no circumstances is the constituency office to be used for political or election campaign purposes." My question to the minister is: did the minister consult with or lobby the current Speaker to find out that the previous Speaker's rulings had been ruled out of order?

R. Thorpe: We already know that the federal NDP candidate has moved into the minister's constituency office in Ladysmith. This office, if it's paid for by the taxpayers, is filled

[ Page 3686 ]

with equipment and furniture paid for by the taxpayers. Can the minister tell us today: was the taxpayers' equipment moved out of the office before the federal NDP member moved in?

Hon. J. MacPhail: Just for the advice of the House, as Government House Leader, there is an avenue where this is properly explored. We do have a conflict-of-interest commissioner in place, and allegations such as this have been made before to the conflict-of-interest commissioner, can be made today and can be made tomorrow. Clearly this is not the time, in question period. There are good issues, I assume, that the opposition can bring forward.

[2:15]

The Speaker: I would hope the next question would be in order.

Interjection.

R. Thorpe: Perhaps you should listen.

Mr. Speaker, the former conflict-of-interest commissioner Ted Hughes was clear in his constituency office review. Mr. Hughes said every attempt must be made to make everyone feel comfortable in entering and doing business in the constituency office, without the semblance of political partisanship. Can the minister tell us how the people can enter this office in Ladysmith without the semblance of political partisanship when it bounces back and forth between her and the NDP like a yo-yo?

USE OF CONSTITUENCY NEWSLETTER

FOR FEDERAL ELECTION CAMPAIGN

J. Weisgerber: My question, too, is to the minister responsible for Small Business. I want to try and frame the question in the context of tax dollars coming from the small business community and other British Columbians. The minister's recent MLA's report features a large page 1 photograph of herself and Garth Mirau, the federal NDP candidate.

The minister is quoted as saying: "I don't think it should come as a surprise to anyone that I'm supporting the NDP candidate." This newsletter was distributed to the voters of Cowichan-Ladysmith and paid for by provincial taxpayers, including the business community -- the small business community. Will the minister tell us why she is willing to fritter away B.C. tax dollars campaigning for a federal candidate?

The Speaker: Government House Leader.

Hon. J. MacPhail: Again, on behalf of all the members in this House, there are . . .

Interjections.

The Speaker: Order, members, please. I must hear what's being said. Sorry, Government House Leader.

Hon. J. MacPhail: . . . avenues in which these matters can be addressed. If allegations are being made, there's an appropriate way to make those allegations. I would suggest to the opposition -- all opposition members -- that they make the allegation in the proper format, and it will be reviewed.

The Speaker: Peace River South, with the caution that clearly we are wildly out of order at this point. I would ask him to conduct . . . .

J. Weisgerber: Well, a supplemental to the Deputy Premier. We know the NDP are desperate to elect some members in British Columbia. We also know that that desperation shouldn't be funded by B.C. taxpayers.

Mr. Speaker, the member for Malahat-Juan de Fuca did the minister one better with his newsletter. He managed to get a candidate on each page of the mailer sent out by B.C. tax dollars.

The Speaker: Could we have a question?

J. Weisgerber: Will the Deputy Premier instruct the federal New Democrats to pay for the cost of these bogus mailers sent out by his member in the middle of a federal election campaign?

Hon. D. Miller: I'll tell you, if there's one party that's desperate in this federal election, it's the Reform Party, which would risk dividing this country . . . .

Interjections.

Hon. D. Miller: There is a principle. If any member in this House feels that there has been improper action on the part of another member, there is a process to follow. It's in the interests of all members of the House that they follow that process. These questions are clearly out of order.

USE OF MINISTERIAL STAFF

FOR FEDERAL ELECTION CAMPAIGN

G. Farrell-Collins: The minister is right. There is a principle . . . .

Interjections.

The Speaker: Order, members, please.

G. Farrell-Collins: The principle is that you don't use taxpayers' money to get yourself or your friends elected.

I'm shocked that the minister won't get up today and answer questions. Not only did she close her two constituency offices, but she has closed her mouth in the Legislature.

Interjections.

The Speaker: Order, members. I'm sure we're all anxious to hear the question.

G. Farrell-Collins: I'm sure, hon. Speaker, you'll remember well that in 1983 they were heady days for the NDP in Nanaimo and Ladysmith. Dave Barrett was still leader, Dave Stupich was in the Legislature and the Nanaimo Commonwealth Holding Society had not yet gone belly up.

Interjection.

G. Farrell-Collins: There's a question, hon. Speaker. At a September 29, 1983, meeting at the Ladysmith Legion, the Sam Guthrie Club discussed forming a commonwealth holding society in Ladysmith.

The Speaker: Member, can I caution you? We've allowed considerable latitude here today.

[ Page 3687 ]

Interjections.

The Speaker: Order, members, please. The question seems to be wildly out of order, so I'm going to caution the member to please try and redirect it.

G. Farrell-Collins: I'll ask a very simple question of the minister, and it relates to her office. As a minister, she knows well that she has an executive assistant who spends time in her constituency. Can the minister tell us whether that person is currently on holidays or on a leave of absence?

Hon. J. Pullinger: Clearly the opposition has no real questions, because these are wildly out of order.

G. Farrell-Collins: There was an edict delivered to this House by the previous Speaker, someone we all had a great deal of respect for, Mr. Emery Barnes. It was clear in his edict that at no time should staff be working on campaigns unless they were on a leave of absence. Can the minister tell us whether her executive assistant in her riding is on holidays or whether he or she is on a leave of absence?

Interjections.

The Speaker: The member for Chilliwack.

B. Penner: Thank you, Mr. Speaker.

Interjections.

The Speaker: Order, members. Members, I can't hear the question, because people on the questioner's side are making too much noise.

USE OF CONSTITUENCY OFFICE

FOR FEDERAL ELECTION CAMPAIGN

B. Penner: The B.C. Liberals have received a copy of an e-mail sent to the Minister of Small Business by an irate constituent. That constituent has been trying to contact the Minister of Small Business but has not been able to do so. Mrs. Betty Douglas of Ladysmith is upset, according to her e-mail, that the minister's office has been given over to the federal NDP during an election campaign and while the legislative session is only halfway through.

Can the minister tell us why she is putting the interests of the federal NDP ahead of the interests of her Ladysmith constituents by closing her office during an election and during a legislative session?

Hon. J. Pullinger: The members opposite are abusing this House. These questions are all out of order. They should have respect for the rules.

Interjections.

The Speaker: Chilliwack, I hope this question is in order, because the last three or four simply have not been.

Interjections.

The Speaker: Order, members. Let's find out.

B. Penner: I hope that all ministers will conduct themselves in an orderly fashion during this election campaign. We certainly haven't seen that.

This morning the minister was quoted in the Nanaimo Daily News : "When they phoned me and said, 'Can we have our space back?' I agreed." Can the minister tell us exactly who in the federal NDP called the minister's office and asked for their office back, and whether or not she discussed this arrangement with the legislative comptroller's office before agreeing to this arrangement?

The Speaker: Is this a point of order, Government House Leader?

Hon. J. MacPhail: Hon. Speaker, this is just to note that a question, oral or written, must not inquire whether statements made in a newspaper are true. Just in case they didn't know . . . .

The Speaker: Excuse me, minister . . . .

Interjections.

The Speaker: Order! Members, we seem to be in a rambunctious mood this afternoon.

USE OF MINISTERIAL STAFF

FOR FEDERAL ELECTION CAMPAIGN

R. Coleman: It is my understanding that the funds that pay for staff within a ministry are governed by the public accounts and the Ministry of Finance of this province. If that is the case, then the question that was posed -- and I'd like to pose it again -- is: we have paid staff on holidays away from a constituency office who are employed by a ministry . . . .

Interjections.

The Speaker: Let's hear it.

R. Coleman: The question is very simple: are those staff on holidays or are they on a leave of absence during the election campaign? I think it's a fair question; it should be answered by the minister.

Interjections.

The Speaker: Alas, the bell ends question period.

Interjections.

The Speaker: Members, please. Don't you think that we could as least extend courtesy to the Clerk and hear him?

Orders of the Day

Hon. J. MacPhail: In Committee A, I call Committee of Supply. For the information of members, we'll be debating the estimates of the Ministry of Municipal Affairs and Housing. In this House, I call Committee of Supply. For the information of members, we'll be debating the estimates of the Ministry of Health.

[ Page 3688 ]

The House in Committee of Supply B; G. Brewin in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 40: minister's office, $462,000 (continued).

K. Krueger: We didn't seem to be getting anywhere just before lunchtime. The minister made some comments, and she and I spoke in the hall afterwards. It's evident that there was a kind of breakdown in communication between us, because my sincere intent . . . . I know from various conversations with her over the past year, and certainly during estimates last year, that her intent, too, is to help the victims of addiction in the province, whatever form that addiction takes. Certainly this is the ministry with the largest budget; it spends the greatest amount of financial resources.

It employs huge expertise, and it would want to draw on the expertise available through British Columbia universities.

[2:30]

My intent -- I should just clarify this for the House -- in the following questions is to deal with addiction in general, not just gambling addiction, although there are a lot of cross-addictions that take place. Very often the victims of gambling addiction also become victims of alcohol addiction and drug addiction and tobacco addiction, and their families likewise are victims. The ripple effect of these addictions is vast: a great number of British Columbians are grievously affected. This is how a lot of people die badly in British Columbia: through addiction.

I'll just read a quick quote from the UBC study, which is also a UBC proposal to establish a centre for addiction studies here in B.C., a state-of-the-art centre of excellence for British Columbia, one that I think we'd all be proud of. They say:

"In order to target the problem of addictive gambling, proceeds from gaming could be dedicated toward a new centre for addiction studies. Such a centre could be built on the existing expertise in addictions and treatment in the University of British Columbia's psychology department. A university-based centre of excellence in addictions would integrate research and interventions that have proven effective across addictive behaviours.

With respect to pathological gamblers, the new centre, in conjunction with the existing full-time psychology clinic, would provide integrated services for the high proportion of addicted gamblers who present with dual diagnoses. Moreover, the centre for addiction studies could provide additional much-needed services across the range of addictive behaviours. For example, B.C. is the only province that does not mandate assessment and treatment of individuals arrested for driving under the influence. Currently, it is estimated that 60 percent of drunk drivers in B.C. reoffend.

"The existing UBC psychology clinic is capable of delivering a broad range of addiction services in an extremely cost-effective manner. Outreach programs undertaken in collaboration with colleagues at other universities in B.C. -- i.e., UVic, Okanagan College, UNBC" -- they left out UCC, but I'm sure they didn't mean to, because we've got experts there as well -- "would ensure that trained specialists are available throughout the province."

What a good situation, hon. Chair.

"Available facility expansion and additional resources would be required to give the new centre its inception."

They provide an action plan. I thought this sounded wonderful. I took this action plan to the Health minister; I spoke with her assistant about it, and spoke with her about it personally later.

I know the Health minister is concerned; I genuinely mean that. I know this whole House is concerned. My colleague from Richmond-Steveston introduced a private member's bill recently, which I trust we'll have the opportunity to debate in this House, dealing with this issue of repeat offenders -- thinking particularly there, I think, of alcohol problems on the roads. For many years I investigated motor vehicle collisions. We didn't even call them accidents anymore, because they're predictable. When people drink and then go out and drive, these things happen, and there are grievous results.

We've all known of, if we don't know directly, families who are terribly impacted by this awful antisocial behaviour of drinking and driving.

Drug addiction leads to the same situations, and gambling addiction, as it brings families to ruin and brings on other problems -- substance abuse and so on -- also brings on that type of problem.

My question is a direct one to the minister: Madam Minister, you have the business case; you have the business proposal. I don't think you dispute that UBC is a centre of excellence and has experts available. What have you done about this proposal? Are you willing to fund a centre of excellence, a centre for addiction studies, at the University of B.C.?

Hon. J. MacPhail: Hon. Chair, I understand the approach the hon. member is taking. Nobody's motives are in question here whatsoever. I appreciate the member's concern; I appreciate his recognition of concern by everybody in this House. But addiction programs, alcohol and drug programs, once again, have moved to the Ministry for Children and Families.

The Chair: I recognize the member for Vancouver-Mount Pleasant.

J. Kwan: I seek leave to make an introduction.

Leave granted.

J. Kwan: Visiting the gallery today -- actually, they have just arrived -- are 46 members of the Renfrew Park Community Centre, seniors and adults. They are constituents of the Premier, from Vancouver-Kingsway, and they are accompanied by Ms. Leung. I would like to ask the House to please make them feel very welcome.

K. Krueger: Perhaps I could just get a point of clarification from the minister, then. If the responsibility for addictions has been entirely assigned to the Ministry for Children and Families, does that include single males, men without families, who are addicted? Are they under the care of the Ministry for Children and Families?

Hon. J. MacPhail: Yes.

K. Krueger: Clearly, I will be putting these questions to the Ministry for Children and Families. Certainly the B.C. Liberals advocated incorporation of all of Mr. Justice Gove's recommendations. We were delighted to see the establishment of the Ministry for Children and Families. We believed that that ministry would then take over responsibility for children from the five different ministries that were involved and thereby eliminate the problem with lack of communication and the kind of silo effect between organizations -- all in the interest of protection of children.

The negative effect, if there is one, of moving in that direction and creating a kind of superministry might be a

[ Page 3689 ]

breakdown in communications between ministries on important issues that affect other people. So, for the record, I'm really concerned about the men who develop gambling addictions and other addictions, and whether or not they will, by necessity -- with funding limitations, staffing limitations and so on in the Ministry for Children and Families -- be more or less left to fend for themselves, because of course that's disastrous and there will be disastrous consequences for children, families and all of us, and certainly for those men themselves. So just a word of caution there.

I'll more or less wrap up my discussion of this study. If I could just include a brief

summary in the record:

"The costs of addiction, including pathological gambling, are staggering, resulting in more deaths, illnesses and disabilities than any other preventable condition."

This is a B.C. expert writing, Dr. Julian Somers:

"Significant progress can be made to prevent and treat addictive behaviours, utilizing an array of treatments in conjunction with broad expertise in mental health. By committing a fraction of the proceeds of gaming to the assessment and treatment of problem gambling, the government would help to ensure that potential costs of this disorder are minimized. In addition, by committing gaming revenues to a new centre for addiction studies, vital services would be made available to a wide range of British Columbians and would effectively apply the expertise and resources of an existing centre of excellence toward the needs of the general public."

I'd just like to make the point here, as I'm moving toward concluding, that UBC has a facility for this. They require some renovation funds; they require ongoing staffing funding; they request $1.239 million -- and they're specifically asking for it from gambling revenues -- to cover the whole first year, including the building costs. They believe they can then run the centre for $839,000 per year after that. They make the point that the full spectrum of addictions places an immense burden on Canada's health care system.

So, if I'm not out of line in asking for it, I'd appreciate the minister's commitment to urge the Minister of Employment and Investment to channel some of the funds from gambling revenues into the creation of this centre for addiction studies at the University of British Columbia, in the interest of her own ministry. I wonder if I might have that commitment.

Hon. J. MacPhail: I was part of the executive council that formed our policy on gambling. I fully support that policy and all of the investment that we'll be making in that.

K. Krueger: Well, the policy that the minister has just raised is still a bit of a mystery to me. I've been waiting breathlessly. A certain amount of funding was mentioned.

The fact that it was assigned to the Ministry for Children and Families was certainly mentioned. I've asked for a briefing from the Minister for Children and Families; it hasn't been forthcoming. I believe the reason is that things aren't in place. I cannot fault the Ministry for Children and Families for not having something in place, because I believe they are overwrought and overworked. They have the urgent and pressing issue of the deaths and abuse of little children around this province to deal with. They're throwing their resources into that battle, and rightfully so.

Interjection.

The Chair: Member, sit down, please. Hon. Minister of Education.

Hon. P. Ramsey: Thank you, hon. Chair. I've been listening to the debate this afternoon with some interest. It seems to me that we're compounding the sin we began in question period. This has little relevance to the estimates of this ministry. I'd ask the Chair to call the member to order and ask him to address questions to this minister on the responsibilities of her portfolio.

The Chair: Thank you, hon. member. I'm sure the member will take that into account.

K. Krueger: Before I respond, hon. Chair, there's a member who'd like to make an introduction.

J. Sawicki: I ask leave to make an introduction.

Leave granted.

J. Sawicki: Thank you to the hon. member who had the floor for giving way. I would like to welcome students from Douglas Road Elementary School in my constituency, a class of grade 4 and 5 students, with their teachers, David Barry and Connie Bradley, and several parents. This school is particularly relevant, because it's the school that I attended when I was their age. So I'm pleased to welcome them. Finally, along with welcoming the class, I'd like to welcome my legislative assistant, Anne Paxton, who while I'm here in the chamber has entertained this class during their visit this afternoon. Would the House please make them all welcome.

The Chair: I recognize the member for Kamloops-North Thompson, with the caution about relevancy.

K. Krueger: Hon. Chair, I'm astounded that the Minister of Education would pipe up and interfere in a matter that, really, I don't think he knows much about and has no business intervening in. The Health minister can certainly speak for herself, is very capable of that and has expressed a personal interest in these issues on the record and a personal commitment to me to deal with them.

This is how people die in British Columbia, Mr. Education Minister. People die because of addictions. People pump China White into their veins on Welfare Wednesday, and they die. People die because of gambling addiction. Women are going to commit suicide because their husbands become problem gamblers and pathological gamblers. That's happened in every other jurisdiction in North America where this kind of stupid program has been introduced. It's ignorant and repulsive and regrettable that a minister would stand up and intrude on a debate when it's none of his business, frankly, except that he ought to be as concerned about it as any other British Columbian.

This is a problem for the Health ministry. The Health ministry has one-third of the funding of the B.C. provincial budget. People are going to be sick because of gambling expansion. People are already sick because of gambling addiction, alcoholic addiction, drug addiction, tobacco addiction.

The Health minister has told us in the throne speech that she intends to bring on litigation against the tobacco industry for its dangerous and addictive product. We know that gambling expansion is going to create those same problems. We know that gambling is addictive and that people suffer terrible consequences in their lives because of it. This Health minister, who is suing the tobacco industry -- or said she's going to -- is one day going to have to take the defence stand,

[ Page 3690 ]

speak for this government and this ridiculous mistake made in 1997, whereby British Columbians become gambling addicts, and face those consequences and those very words that apparently are going to be in the . . . .

[2:45]

The Chair: Hon. member, take your seat, please. We are at the present time debating the estimates of the Ministry of Health. As the minister has said, addiction issues are the responsibility of another ministry. I recommend to the hon. member to refer questions to the Minister of Health on health issues.

K. Krueger: When the province of British Columbia is ultimately sued by the victims of gambling addiction, and in the statement of claim the plaintiffs say this minister used those words with regard to tobacco addiction and the effects on her ministry of this dangerous and addictive product, and throw that precedent forward -- her very own words -- in bringing a claim against this province, what will her answer be?

S. Hawkins: If I may, I'd just like to go back to some of the issues that were raised this morning, which I had some questions on, and just clean them up a little bit. One was an issue with respect to the role of the provincial health officer and the medical health officer. This was pertaining to a water issue in a member's constituency. Certainly that's an issue in my riding right now. I'm sure it's an issue in some ridings, some communities across the province, as the spring runoff is high.

We had some problems last year with Cryptosporidium , and I heard a member saying this morning that in their community, water was tested for giardiasis and for Cryptosporidium . Is this something that the medical health officers in their own public health branch monitor on an ongoing basis? Or is this something that they're directed to do? Can I get some guidance on that?

Hon. J. MacPhail: From time to time in the summers, outbreaks of water-borne disease occur across Canada and in B.C. These are usually caused by animal feces in the reservoirs and can be prevented by ensuring that drinking water is adequately disinfected. There have been problems with water quality in certain areas of the province. The medical health officers are working to resolve the problems as they arise.

Medical health officers have been working toward the objective of chlorination of drinking water. However, there has been some resistance to chlorination in some areas. The medical health officers are attempting, and see this as a priority in their duties, to solve the recurring issue by educating people about chlorination and by taking non-legal actions to ensure compliance. However, if in their professional opinion they feel that the water quality is suffering because of non-compliance by a water purveyor, they can certainly take the next step, which is legal enforcement. They do so at their discretion.

We know that there may be a problem in very small communities, those that are under 200, in obtaining funding for infrastructure improvements. But we are working with the Ministry of Environment, Lands and Parks to ensure that these options are put in place.

Then, of course, we do have -- as I think is the case that was brought to my attention by the hon. member for Okanagan West -- the issue of enforcement of safe water regulations on reserve land that's federally regulated as well. We are working with the federal medical health officers to ensure that they are working toward compliance and assisting there, as well.

A risk assessment model for community water systems is being developed. That is so they can assist the regional staff to assess the public health risk associated with the wide variety of variables affecting public water supplies. Some of those variables are source water characteristics and water treatment options. This capability will assist health units to prioritize the actions on a regional scale as well as on the individual waterworks basis.

S. Hawkins: I thank the minister for that. The provincial health officer, then, has local medical health officers underneath his or her office's purview. This medical health officer works with the public health department in their local community. Who do they report to if there's concern of an outbreak? What are the lines of communication? Who gets the message if there is a problem with the water or if they're monitoring the water?

Hon. J. MacPhail: The medical health officer is required by legislation to enforce the safe water regulations. As we have discussed before, he is administratively accountable to the regional health authority, but in his technical and clinical competencies, he is responsible to the provincial health officer.

S. Hawkins: Is there some funding for the water testing? Does that come out of the Health ministry, out of the provincial health officer's budget or out of the Ministry of Environment?

Hon. J. MacPhail: As stated this morning, the purveyor must do the testing. The purveyor is the one responsible for the water, so they pay for the testing. But the auditing of the safe water is done by the medical health officer, and that is provided for in the health authority's budget.

S. Hawkins: I think I'm getting a clearer picture here. The member for Kamloops-North Thompson was talking this morning about this issue in his riding, and there seems to be some confusion on when the testing started and who was actually paying for it. It stopped -- it wasn't being done -- and then the city was asked to pick up the bill. There seems to be some confusion. The city didn't even know that the water was being monitored, and the tests were $350 weekly. That's why I'm trying to get a sense of who is responsible.

If it's a public health issue, is that something that perhaps the office should have made the city aware of that they were doing? Or is this something that the health unit has a budget for, and when they run out, they make the city aware of it?

There seems to be some confusion in this case. I know I'm just bringing it to the minister's attention for the first time, but can the minister give me some guidance? Did something fall between the cracks here, and the city should have been aware of it? Should the health officer have made the city aware and perhaps the funding for the tests should have been cleared up before it ever stopped?

Hon. J. MacPhail: We haven't been made aware at all of the situation the member for Kamloops-North Thompson describes, so we'll look into it. It is the purveyor's responsibility to collect the sample. All samples are tested for free. The laboratory test is free through the B.C. Centre for Disease Control, so there's no cost there. I can only assume it's around

[ Page 3691 ]

the issue of collection of the sample. It is the purveyor's responsibility, and we do the auditing. If there has been some miscommunication around that, we'll certainly look into it. It hasn't been brought to our attention until now, and we will do so.

S. Hawkins: I'll let the minister know that it was the south central health unit and the city of Kamloops. So that's something I'm sure will get some attention. Can we be made aware of any other areas, if the ministry is aware of tests presently being conducted or concerns around drinking water because of Cryptosporidium or giardiasis?

Hon. J. MacPhail: Testing is done throughout the province on indicator organisms -- the bacteria -- but the testing for Cryptosporidium and giardiasis is very expensive. We in British Columbia actually lead on it because of the nature of our terrain. Those tests are done by consensus in the profession when there is an indication of an outbreak. The other tests are done routinely and uniformly throughout the province.

S. Hawkins: The issue does come very close to me, since I contracted one of those bugs last year. I know we have had a boil advisory in our community already. It has been taken off, and we just hope that there is continued testing, because it is the seniors and people who are ill who are most susceptible.

Yesterday we talked about the AIDS strategy. The minister did give me a document, and I'm wondering if it's the right one. The header is: "Community Recommendations for Action through 1999 to 2000." It says: "Towards a Provincial AIDS Strategy." This doesn't seem to be the AIDS strategy. Is it still being worked on? This document seems to be a compilation. Apparently, there were communities and groups that were brought together to come up with recommendations, and there seem to be numerous recommendations. I'm wondering if there's a strategy to look at these to see which ones will be implemented on a provincial level.

Hon. J. MacPhail: It certainly is a living document, just as the whole provincial AIDS strategy has evolved over the course of the last five or six years. As we discussed yesterday, this is a discussion document to update the next steps. It is all the strategic elements brought together by all the stakeholders. Moffatt Clarke has been hired to discuss with the community the order in which we implement, understanding fiscal constraints but also understanding the health priority in this area.

S. Hawkins: My understanding is that it's still being developed and that Mr. Clarke -- who is the expert consultant who has been hired by the ministry -- is working with groups to implement these recommendations. Could I just ask, if he's on contract, when he will have this completed by?

Hon. J. MacPhail: Moffatt Clarke is on an exchange from the federal . . . . He is a federal employee, but he's on secondment to us. He is well into his work. The initial exchange is for one year, but it can be extended. What is happening is, of course, as this . . . . I mean, it truly is a living document. Things get changed. Well, priorities change as certain aspects of the document are already implemented. A plan of what the remainder of the strategy is till the turn of the millennium will be announced within the next month or so.

But certainly it's my view that any strategy has to be flexible enough to meet the changing nature of the disease, as the information -- always anecdotally believed to be true by our B.C. experts, but now confirmed -- is that the intravenous drug user population is at greatest risk. We have to keep our plan flexible enough to make the changes to target the highest-risk population, as necessary.

[3:00]

L. Stephens: I ask leave to make an introduction.

Leave granted.

L. Stephens: In the gallery today are grade 7 students from Simonds Elementary School in Langley, together with their vice principal Mr. Bennett, and 17 parents. Would the House please make them welcome.

S. Hawkins: I appreciate the minister's comments, and I do realize that priorities change. This is an issue that has been getting a lot of attention from public health-oriented groups. We look forward to the announcement in a month, and we look forward to seeing the combination of Mr. Clarke's work in the way of a more focused strategy.

I have another question pertaining to the tobacco strategy that the minister has put in place. Can we get an idea of what has happened around tobacco reduction programs in the last year and what we're doing for children in this province?

Hon. J. MacPhail: If I could just get some clarification . . . . We did go into detail on this. Was the member absent for that? I'll just quickly review it, but it is on the record.

It's no secret that we're working on a strategy around tobacco issues that will be announced very soon. Currently our program is almost $2 million. The focus of our strategy is around reducing tobacco use by young adults, particularly young women and girls. It's done through the schools, but mainly through health organizations such as the B.C. Cancer Society and the Heart and Stroke Foundation.

In terms of the children, I'll just go over that. There are also programs targeted specifically to adult women, but for children there's Supporting a Smoke-Free Generation. These are initiatives encouraging communities to identify local concerns regarding tobacco use by children and to work with young people themselves to identify strategies for change. The "KidZone" series on Knowledge Network looks at tobacco use in youth and the strategies to help them say no to smoking, and there are school and community-based smoking prevention programs for children and youth.

S. Hawkins: I've been running between the two Houses, and I apologize if the minister had to repeat herself.

I'm encouraged to hear that. That's an issue for young people that's close to my heart.

Perhaps I missed this too. I hope I didn't, but I know the ministry has launched a hepatitis C program to find the people that may have been affected and infected by blood transfusions. I wonder how successful that program is so far, and if we can get an update on that. I also wonder if the minister could give us an idea of what was budgeted for that program to track the people that were affected.

Hon. J. MacPhail: Let me start to do this from memory. The budget is around $5.5 million. That's what we're estimating for it, but, of course, it does literally depend on the uptake as a result of the notification program, because there are

[ Page 3692 ]

physicians' fees and laboratory costs that arise from people taking the notification and having the tests done. We started the program on April 14, 1997. There are two major components. One is the notification of the more than 50,000 people that we can actually identify through hospital blood bank records who have received a transfusion prior to June of 1990. We know that hospital records go back to approximately 1985, so those letters of notification went out. One of the benefits in what is a very serious health issue is that we've got a database that is across hospitals now.

It's really the first of its kind -- a database of blood transfusion recipients that is now the model for other jurisdictions that may move forward on the hepatitis C notification program.

The other part of the program is an education program where it's not only advertising posters and print materials but also notifying physicians about the issue, as well -- a mini-education program for physicians. It is interesting that we had unprecedented cooperation from the hospital blood banks to provide the patient data. And for the member's information, our campaign is going to be repeated now, because the uptake from the notification is certainly not as intense as we would like. So we're going to start the public notification campaign again in the coming days.

S. Hawkins: I appreciate those comments as well. In the blood advisory report that the minister received earlier -- I guess it was last spring -- there was also a recommendation about the slow virus, which was the Creutzfeldt-Jakob virus. I remember the news stories around that and the effects on patients who may have had transfusions. Is there something in the plans for education or awareness that the ministry has funded for that as well?

Hon. J. MacPhail: The advisory committee recommended that there be no public notification on the matter of Creutzfeldt-Jakob disease, because there was no evidence that it was transmitted through blood transfusion. However, they did say . . . . And we did put in place an information hotline around CJD. The hotline gives information on Creutzfeldt-Jakob disease, and it also instructs callers to write to the blood recipient notification project if they require more information on CJD.

We also requested hospitals to develop lists of persons who received blood or blood products identified by the Canadian Red Cross Society as having been donated by persons suspected or known to have developed Creutzfeldt-Jakob disease.

S. Hawkins: At this time, could we raise some questions on the Medical Services Commission, if the staff is here? I received a draft breakdown from the ministry staff, and I have a document in front of me that I believe is . . . . It's dated May 9, 1997. It gives a detailed account of estimates for this budget year. I wonder if the staff is familiar with the document that I received and if they can confirm that the numbers for the MSP are the same or if they have changed. It was a document dated May 14 that was brought to my attention.

Hon. J. MacPhail: Yes, I too have the document, and yes, it is essentially the same.

S. Hawkins: The MSP contributions, then, for all the different areas that it services, are on there, and there is an increase for BCMA fee-for-service. Is that an increase over last year, or is that including the money that was . . . ? Well, I wouldn't think it was the money that was put in last year. Is there, then, a deal being done with the physicians? And does that include the amount, or will it be topped up again at the end of the year?

Hon. J. MacPhail: There are two factors in the 4.9 percent lift. One is the announcement that we made, I think in April, of a 2.4 percent increase in fee-for-service payments to physicians. And then also, the inclusion of the special warrant around medical . . . . If the member remembers, we had a special warrant that resulted because negotiations for fee-for-service . . . . Negotiations between the BCMA and the government had not yet been completed at the time of the budget for '96-97, so what was in the blue book was an estimate of the negotiations.

We then completed negotiations, which were literally higher than had been estimated in the estimates prior to the completion of negotiations. The combination of this is a restated amount for '96-97 that includes the special warrant, plus the 2.4 percent lift for '97-98.

S. Hawkins: The agreement made with the physicians -- is that on a yearly basis?

Hon. J. MacPhail: Like any other contract, there is a time limit or there's an expiry date on the contract that varies. The one currently in effect expires March 31, 1998.

S. Hawkins: There is also a physician benefits fund. I wonder if the minister can explain what that is.

Hon. J. MacPhail: The fund includes benefits for physicians: their pension plan; continuing medical education, CME; the physician disability insurance; and then the Canadian Medical Protective Association insurance -- liability insurance.

[3:15]

S. Hawkins: Is there any thought to regionalizing physician services and transferring those costs out to the regions? Is that something that's . . . ? Because I know we're talking about utilization and we're talking about . . . . I know that the regions and the hospitals have had discussions, and some of them have so-called manpower -- femalepower -- plans in place. I know there's been discussion around this. I believe this is a program the minister is retaining right now. Is there thought being given -- are there proposals being looked at -- to perhaps regionalize these services so we have a better idea of where the services are being utilized?

Hon. J. MacPhail: Certainly the Medical Services Plan payments to physicians are being retained by the ministry. Frankly, there are no plans at this time to regionalize the payments, but I know that neither side -- neither the ministry nor the B.C. Medical Association -- in any way precludes those kinds of discussions. We haven't reached an agreement to say, "Pinky swear, we'll never do it nor will we ever request it," but there are no plans at this time.

S. Hawkins: Pinky swear -- I'll hold you to that.

Last year in estimates we also canvassed a little about deinsurance of services. At that time I believe there were skin moles, warts and that type of thing being deinsured. Can the minister tell us what's been removed from the

schedule this year as far as deinsured items?

Hon. J. MacPhail: Nothing.

[ Page 3693 ]

S. Hawkins: I understand there is a committee that looks at how deinsurance is going to occur. I believe it's a committee . . . . I believe it's the MSC in consultation with other groups. Perhaps the minister can just explain how that works.

Hon. J. MacPhail: There is a joint protocol steering committee comprised of the B.C. Medical Association and the Ministry of Health. That committee examines issues of utilization, appropriate utilization or changes in utilization, across all medical services funded under the Medical Services Plan. That committee would be the one that would examine any proposals for deinsurance. The ministry is not putting forward any proposals for deinsurance, and to date I'm not aware of any that the BCMA has either. But that would be the appropriate body.

S. Hawkins: There was a projected savings, I believe, of $7 million last year -- that was the estimate -- from removing warts, moles and skin lesions from MSP. Did anyone track the exact amount, or can we get a figure of what the savings were?

Hon. J. MacPhail: The savings are $7.1 million in terms of what we had been paying and are no longer paying for with that deinsurance initiative, which is . . . . Anyway, you know what it is.

S. Hawkins: That was from last year, I would assume.

Hon. J. MacPhail: It was put in place October 1, 1996, but those savings are annualized as a result of our experience from October until now.

S. Hawkins: I have a bit of a concern about how the deinsurance process works, because right now it is made with the Medical Services Commission and a group that bills for it. The public -- meaning those at large who use the service -- really are not involved, unless there is a process where they can become involved or if the ministry has a process where they can become involved. If services are going to be deinsured, is there a way that it's vetted before the decision is made?

Hon. J. MacPhail: Actually, the Medical Services Commission has three publicly appointed members representing the public interest. I met with the Medical Services Commission in the spring and certainly was very heartened by the advocacy on behalf of the public that the three and, really, the whole commission bring to it. There is no question that there are vested interests in six of the nine appointments. But the three publicly appointed members are highly qualified and certainly see their role as in the public interest -- just as we do in this Legislature, in maintaining . . . . I certainly see myself as representing the public interest, as I know the member opposite does as well.

S. Hawkins: As a consumer of health care in this province and as someone that represents people, I think people have to realize that they have to be more responsible with their own health and with the services they utilize. It's important that, if we can, at least some responsibility be placed on the consumer.

It would be important to somehow involve them in the process that does involve deinsuring a service, if it does exist. You know, perhaps the public could be involved in discussions -- in letting us know whether they're services that perhaps they feel we shouldn't or should be paying for. It just seems that sometimes these decisions are made without input from the people who actually use or overutilize the service. So it's just a suggestion I'm throwing out. If there was a way to involve people, it might be useful.

Something that I'm very keen on is making the health consumer aware of the services that are utilized and the expenditures that go into it. Get their input on whether they actually think it's important for our health care system -- taxpayer-funded -- to be paying or not paying for certain services. I don't know if the minister has a comment on that.

Hon. J. MacPhail: I think it's a point well taken. We are moving forward in that direction. It's interesting how regionalization is lending itself to some pilot projects in this area. For instance, there is one exactly as the member describes. It's called the self-care project. It was initiated this fiscal year; it's between the Medical Services Commission and the capital health region. They're testing a demand management strategy, really, through self-care education aimed at reducing unnecessary use of medical services. It's directly aimed at the consumer, with consumer participation.

Then there's another pilot that's called the high school curricula pilot project. It's a joint initiative between the Ministry of Health and the Ministry of Education. We're developing a curriculum module for high school students about the health care system, basic self-care, appropriate points of access and use of medical services. Then, as a result of this pilot, we're testing the value of this long-term strategy, really, for influencing the future culture of health care consumerism in British Columbia.

The last pilot project is around emergency room use, which is testing the effectiveness of educating the public about appropriate use of hospital emergency rooms and after-hours medical care. It will be used to evaluate its success in a particular region and then see its application elsewhere in the acute care sector.

Those projects are funded out of this year's budget. I too look forward to seeing the results of them. This probably will form the annual reporting through the regionalization process.

S. Hawkins: Interesting study -- I look forward to the results of that one, too.

Another initiative that the ministry undertook last year, I believe -- it was in concert with the BCMA or the physicians' group -- was: how many visits to a doctor would be paid for? Over and above a certain number of patients a physician would see, they would get a reduced rate, or they would not get paid for many visits. I believe the policy was more for -- I want to say McDoctor clinics -- the walk-in clinics that sort of mill patients through. I'm wondering if the ministry has tracked this, and what kind of a success they feel this policy was.

Hon. J. MacPhail: Yes, we are tracking this. This will be part of the discussions with the B.C. Medical Association, in negotiations with them. The actual claim restriction was implemented October 1. The services that exceed $47 per day are paid at a discounted rate of 50 percent, and then claims exceeding $65 per day are not paid. We are tracking this. We share the information with BCMA, but we can also make it available -- the success of it -- on an annual basis as well.

S. Hawkins: There was also a policy that went into place -- that I know we're going to have discussions on in the

[ Page 3694 ]

Legislature at a later date as well -- with respect to designating areas of the province where physicians could practise and receive full benefits or half benefits or 75 percent benefits. This gets back to the northern issues. I understand that the recruitment and retention rate for physicians in the north is very, very low; they have trouble getting them. Now, is this policy working? Have we tracked that? Have we encouraged more? Has MSC actually tracked this to find out if we're encouraging people as a result of this policy?

Hon. J. MacPhail: Yes, and we will have a good chance to discuss this in legislation -- Bill 21, Medicare Protection Amendment Act, 1997. Anyway, it has been in place since October 1, '96, but the interim physician supply was introduced in 1994, as well.

[E. Walsh in the chair.]

Just a couple of statistics. There are physician supply measures numbers. The numbers given to physicians that are part of the physician supply program are called physician supply billing numbers. There has been a steady increase from 258 in 1994-95 to 354 in 1996 -- as the interim measures were in place -- and in '96-97, 386. Of the 998 new physicians enrolled with Medical Services Plan since the measures were introduced in 1994, 266 entered practice in overserved areas and were issued 50 percent or 75 percent billing numbers. Most of those physicians are supplying locum services in urban centres.

[3:30]

Of the remaining 732 new entrants, 125 physicians have been recruited to rural and northern communities eligible for the northern isolation allowance. Of these, 91 continue to live and practise in these small communities, three are providing locum services in the same communities, 25 are no longer licensed to practise in British Columbia, four have left the province and two have moved to major centres. That's the tracking, and we will continue to track and adjust on the basis of the success of the system.

S. Hawkins: I wonder if the ministry also keeps track of whether these positions are going to the poorly serviced areas. Are they B.C.-trained doctors? Are they Canadian-trained doctors, or are they out-of-country doctors? Does the MSC keep track of that?

Hon. J. MacPhail: The numbers that I gave you include B.C.-trained doctors as well. Just for the record, now and through the next four years, all B.C. medical graduates get 100 percent billings; their fees are not reduced. That's part of the physician supply program. The numbers that I gave you in terms of location in the NIA communities include B.C. graduates, as well.

S. Hawkins: The reason I ask is that I know there was a policy that was going to be put into place, effective this June, not to allow out-of-country physicians to have medical licences. I wonder if the ministry was aware of that. The Royal College, actually, was advocating that, and they were going to review it. I know that northern communities depend on physicians from other countries to come and service some parts of the province that I suppose other doctors are not going to. Is the ministry involved in advocating for these communities, to allow for those physicians to come as the need is required?

Hon. J. MacPhail: Actually, that was a federally initiated policy. We actually took immediate action to urge the federal body to stop moving toward that initiative, and in fact they did. The policy is now stopped, for all intents and purposes. The former Minster of Health wrote to them, and I did as well, saying: "Please don't do this. It will unalterably affect communities such as Fort St. John, just to name one." So they stopped. Our policy actually is very generous in terms of allowing out-of-country physicians to stay in a community and give that community some stability in its medical services.

S. Hawkins: I was up north, as well. There's certainly a good quality of life there, if a physician and his family get to enjoy it. A lot of times, the community tells me, they can entice them up there and show them the beautiful country. But as far as giving them time off, the help isn't always there. Was there something in the ministry's initiatives that dealt with that problem? Does the ministry have a locum service or other initiatives that they use to help doctors get some relief up north, or in rural communities?

Hon. J. MacPhail: Yes, the B.C. locum program covers that very important issue for physicians. The B.C. locum program provides for the ministry to fund a locum in a community that has three physicians or less, up to a per diem of $600, for a physician to go in and give relief to the physicians in the community. We pay for that program, and it is meeting with a great deal of success.

S. Hawkins: When was that program implemented? If you have them available, can I just get some stats on how many times it was accessed and was successful?

Hon. J. MacPhail: The program was initiated in June of '96, so it's relatively new. There are currently six locum physicians participating in the program. The program has been operating at this status for ten months. Respite locum services have been provided to 19 physicians living and practising in 13 small rural communities. There have been a couple of requests for locum assistance that haven't yet been met by the program, but in order to address the shortfall of a couple of requests, we're actually recruiting more locum doctors for the locums, as well.

S. Hawkins: Is the locum program restricted to only certain parts of the province that get that benefit? Can I just get an idea of which parts specifically get that benefit?

Hon. J. MacPhail: It's called the northern and rural locum program. It's for northern and rural communities with three or fewer full-time physicians and is eligible for northern and isolation allowance.

Did the member ask to what communities does it apply?

S. Hawkins: No, that's fine. My understanding is that it is a very . . . . I don't want to say narrow. It's a very good program, but it doesn't always hit the communities that are crying for help. Maybe the physicians need to work out their call schedules a little better amongst themselves, too, I suppose -- work out their needs. In some communities where there are more than three and one falls ill or whatever, sometimes that program doesn't always kick in as fast as they and their patients would like. But it's encouraging to see that a program like that is in place and is being accessed.

Just for interest's sake, down on one of the line items is a reserve account. Can the minister explain what that is and what the money is used for?

[ Page 3695 ]

Hon. J. MacPhail: The reserve account was the result of negotiations in the last couple of years. There was money in the Medical Services Plan that was guaranteed, that would stay there and be used. Even when we put the hard cap in place on the Medical Services Plan payments, the money that was in the Medical Services Plan became a reserve account. It was agreed upon that that reserve account would be drawn down before physicians had to go to proration. That account has been drawn down to the extent that the agreement requires that there be a remaining $4 million left in it.

There is still that $4 million left in it, but it can be used again until its expiry, until it's empty, before proration of Medical Services Plan fees starts.

J. Weisbeck: The member for Langley asked a few questions a couple of days ago on midwifery, and I'd like to ask a few more if I could, please. I've been sort of kidded by my colleagues, who are asking: why would I be interested in midwifery? Having been a practising dentist for 25 years, I very often had my female patients say that they'd rather have a baby than have a root canal, so I feel somewhat connected to this.

Actually, my interest probably lies more in the efficiency part of it. Especially with our limited health care dollars -- and I'm pleased to see here the former minister who was responsible for bringing in this program -- why would we get started on this whole thing? What was the demand out there? What's the motivation behind developing a college of midwifery, other than to give an option?

Hon. J. MacPhail: Really, in western medicine we're one of the . . . . Well, even within the context of western medicine, the North American jurisdiction is one of the last to legalize midwifery. It's an extremely important medical service, but it has also been a medical service where highly trained health care professionals other than physicians can provide certain aspects of pregnancy, labour, delivery and postpartum care.

There are certainly quality-of-care issues, where the intensity of service that can be given by a midwife in a very cost-effective way meets the needs -- a holistic approach to the health care of not only the mom-to-be but the child as well in a very cost-effective way. It can be the least intrusive method in the birth experience, and it's also very safe, healthy and certainly in demand by a great number of families.

The bylaws of the College of Midwives were approved on April 2, 1997, as I said earlier in the estimates. We are publicly funding discussions with the Midwives Association of British Columbia. The College of Midwives of British Columbia regulates the practice of midwifery, they're defining the scope of practice for midwifery, and they designate a reserved title for the practitioners.

J. Weisbeck: I am told that probably approximately 5 percent of women would prefer to have their babies with a midwife. If this is actually the case, would you in time be assigning patients to midwives to fill up their schedules? Do we take away that choice?

Hon. J. MacPhail: No. It would be by family choice entirely.

J. Weisbeck: I also would like to know whether or not there is a rural or an urban sort of designation area. Are you trying to promote midwifery among rural areas, or are you going be confining them to the larger centres?

[3:45]

Hon. J. MacPhail: I just want to make it clear that I support midwifery 100 percent but that in no way am I promoting it. It is a health care service by professionals that will be offered as a choice to families.

The college will be responsible for regulating the practice of midwifery and ensuring that safe health care facilities and the registered midwives are in place, and they will do that no matter where the midwife is going to practise. But certainly there is no restriction. Once the regulations, the safe practices and the scope of practice have been met according to the College of Midwives, midwives will be able to practise throughout British Columbia.

J. Weisbeck: Regarding the College of Midwives, you said they are regulatory. Are they also disciplinary?

Hon. J. MacPhail: Yes.

J. Weisbeck: I'm assuming that, obviously, midwives have to be trained somewhere. What schools will we recognize? Do you see in the future that we will have universities, for example, offering a course in midwifery?

Hon. J. MacPhail: The college establishes the training program for midwives.

J. Weisbeck: I'm interested in a comment made that the B.C. system will probably follow the Ontario model. So I'm interested in the employee benefits. What are their salaries? The comment was made that they'd be making between $60,000 and $70,000 per year. What would their benefits be? What would their hours of work be?

Hon. J. MacPhail: We're currently in funding discussions with the Midwives Association of British Columbia around compensation and benefits.

J. Weisbeck: So you can't give me any idea what sort of costs are involved? You're telling me that this is a cost-efficient service. How do we know that?

Hon. J. MacPhail: In just the same way that we engage in funding matters with every other health care profession in this province, except dentists . . . . We are in negotiations on that funding right now. We have allocated a budget -- I discussed this earlier in estimates -- and we're now in the process of allocating those funds.

J. Weisbeck: But you made a comment that it's more efficient, cost-efficient. How can I know that unless I'm given some sort of number as to what it's going to cost per birth?

Hon. J. MacPhail: I said cost-effective, and certainly we will be making . . . . As the funding agreement has been negotiated, we'll certainly make that public.

J. Weisbeck: I'm told that the cost under our current system is about $800 per birth. This includes all pre-, intra- and postnatal care. I'm also told that the midwives will be responsible for -- if they're following the Ontario model -- 40 births a year and will have to assist in another 40. So basically, they're in charge of 40 births a year at a cost of, for salaries alone, $60,000 to $70,000, plus their benefits. So I'm trying to get these numbers in my head here, that this is supposed to be more cost-effective than our current system. To me, they don't

[ Page 3696 ]

add up. I mean, it looks like by using midwives it is triple the cost of bringing a baby into this world as compared to our current system.

Hon. J. MacPhail: As I have explored this before in estimates, the funding discussions are ongoing. I certainly will make them public at the time the agreement is reached, just in the same way that the BCMA funding is a public document.

J. Weisbeck: There's been a real emphasis on home deliveries. Obviously there's a risk factor involved, and I would like to know what sort of coordination or integration they have with the ambulance services when it comes to handling any emergency that might occur.

Hon. J. MacPhail: We have a home birth demonstration project, as required by the midwives' regulation, to determine and implement effective administrative arrangements for midwife-assisted home births. Major components of this project will be the development of protocols with the B.C. Ambulance Service for emergency transfer of women to hospitals and the monitoring of all planned, registered, midwife-assisted home births for a period of two years.

J. Weisbeck: In some jurisdictions they have some sort of a helicopter service where they can bring patients who have an emergency to the hospitals. Do you see that sort of thing happening, and what would be the cost of such a service?

Hon. J. MacPhail: Well, we have a Medivac program and certainly under the B.C. Ambulance Service, we can discuss that. If the member wants to engage in the estimates around the B.C. Ambulance Service, we can do that. That's available throughout the province on the basis of medical need.

J. Weisbeck: There seems to be a move in some areas that the midwives would replace the RNs. Is this going to be happening in British Columbia?

Hon. J. MacPhail: No.

J. Weisbeck: I think they are currently talking, as well, about the medical doctor seeing these patients for the first trimester. Is that correct?

Hon. J. MacPhail: Sorry, I didn't get that.

J. Weisbeck: The medical doctor will be seeing the patient, or the future mother, for the first trimester. Is that correct, or does the midwife have that patient for the whole term?

Hon. J. MacPhail: The College of Physicians and Surgeons was involved and has agreed upon the regulations for the practice of midwifery, so the whole nature of care surrounding the moms and babies has been well attended to, in terms of the integrated health care professional approach. But to answer the specific question, the midwife can give care throughout the entire pregnancy, unless there is a clinical decision that a physician is required or through the choice of the family.

J. Weisbeck: I understand that B.C. Women's Hospital has the only hospital-based midwifery program. The five part-time midwives delivered 144 babies last year. What was the cost of that?

Hon. J. MacPhail: I'll get that information for you.

L. Reid: Previous Ministers of Health and Elizabeth Cull, when she was minister . . . . She and I had many discussions regarding the aboriginal program and whether that would extend to midwives in the province. The discussion we had at that juncture was about prenatal and postnatal health for aboriginal women. Both she and I agreed that that was a significant issue, and a number of the discussions we had surrounding midwives in British Columbia looked at having a significant specialized component of the midwifery program to extend to the aboriginal population.

I'm not clear if this minister has covered, perhaps in a status report, where that program is today. I know that there was such a commitment for it -- probably three and a half years ago -- and if the commitment is valid, the program should have some results that would be worth reporting on. Would the minister kindly comment?

Hon. J. MacPhail: Yes, there's a committee on aboriginal midwifery that is set up within the college to deal with the registration requirements and the standards of practice for both traditional and non-traditional aboriginal midwives. The committee consists of aboriginal people appointed by the board in consultation with the aboriginal community. The home birth demonstration project includes an aboriginal midwifery component. Of course, now that the College of Midwives has been set up, they're responsible for aboriginal midwifery initiatives.

L. Reid: I appreciate the minister's comment. However, what I'm looking for is a specific status report. I appreciate that the committee has been set up, but if indeed this project is getting close to four years of age, I would assume that's probably been the case since we had the initial discussions. How has the aboriginal population been assisted by access to aboriginal midwifery? How many aboriginal births have been assisted by midwives? Has the committee had a productive influence on that process? Those would be my questions.

Hon. J. MacPhail: If there's a specific request about the performance of midwifery services on reserve . . . . Is that the question? I can just report that the Nuu-chah-nulth community hosted a consultation with aboriginal communities in January 1997 to discuss the further development of aboriginal midwifery. That's the basis. We're moving forward at a pace that fully involves the aboriginal community. The report from that was submitted to the College of Midwives in March 1997 and transfers the responsibility of this whole thing to the committee on aboriginal midwifery. So that's the status report.

K. Whittred: I ask leave to make an introduction.

Leave granted.

K. Whittred: Seated in the gallery this afternoon are students visiting Victoria and the Legislature from Sutherland Secondary School in North Vancouver. There are nearly 100 students here today to observe the workings of the Legislature. They are accompanied by their teacher Mr. MacKenzie and their principal, Mr. Green. Would the House join me in making them welcome.

L. Reid: Just prior to the introduction, the minister suggested that the Nuu-chah-nulth nation hosted a consultation. My rendering of that would be that they held a meeting. I'm

[ Page 3697 ]

interested to know if anything else has transpired between the initial discussion of an aboriginal committee on midwifery and today. My rendering of this discussion is that it has probably been three and a half or four years since the initial discussion.

I'm trusting that we are well beyond having hosted a consultation, which I see as yet another meeting on the process. Indeed, I'm looking for some kind of accountability benchmarking discussion on whether the introduction of midwifery into the aboriginal community has had a positive impact -- not whether they held another meeting. How is this ministry going to evaluate it, first off, from a cost-benefit analysis perspective, and second, from a performance perspective? Is this indeed improving the pre- and postnatal health of aboriginal moms and babies?

Hon. J. MacPhail: Well, midwifery services on reserve are subject to the same regulations as anywhere else, but there was a traditional . . . . As has been previously discussed, aboriginal midwifery practices have existed with or without our approval. These included the use of traditional herbs and medicines, and the management of home births on reserve by aboriginal midwives who practised prior to regulation. That status hasn't changed.

What has changed is as the member outlines. There is a traditional midwife from a first nation who is on the College of Midwives board, and indeed, the aboriginal community itself has met in a formal way -- as I outlined in January '97 -- and made recommendations. So that is what has progressed.

I might say that this is not the movement forward around getting midwifery regulated, registered and up and running. That has not moved with lightning speed. There have been roadblocks in the way that have been substantial, and some of the queries in the House today have highlighted those roadblocks. Nevertheless, we are well on our way, and what now formalizes the process around aboriginal midwifery practices is that there is a committee of the college dealing specifically with aboriginal midwifery.

[4:00]

L. Reid: I'm intrigued by the minister's comment that the status of midwifery on reserve has not changed. I was hoping that it had -- that indeed, the level of intervention on behalf of the government would result in improved midwifery services and hence in improved medical outcomes, and that these babies would be healthier.

One of the original discussions we had was around low birthweight infants, that having decent prenatal care would assist in that. Is the minister standing today and saying that that hasn't changed, that there has been no dramatic improvement? That concerns me, because this process has been ongoing for quite some time. If the minister is prepared -- and I trust that this is valid -- to stand and say that the program is a good thing, that it is improving the outcomes for these babies, that fewer infants are dying at birth or dying before they reach one year of age . . . .

We've always had the discussion in this Legislature about poverty being a significant determinant of health. One of the reasons that we believed mightily in the midwifery program was because it would provide that level of support and intervention to pregnant moms so that they would be doing some decent things in terms of caring for their pregnancy from the outset. So it doesn't warm my heart that the minister is saying the status hasn't changed. I want the minister to be able to stand up at some juncture in this Legislature and say that the medical outcomes, the health outcomes, for those babies has dramatically improved as a result of this intervention.

I truly appreciate the minister saying that in the past aboriginal midwifery was practised without regulation. No question. That was the case in many parts of the world. But if we're going to commit to regulating the exercise, are we also committing to evaluating the outcomes?

The minister is well aware that I have a real concern around accountability, not just for this program but for all programs that government delivers. Is there some mechanism in place? Can the minister perhaps provide a time line when indeed performance will be evaluated? Are we getting X number of infants born on reserve who are of a dramatically increased birthweight this year over last? That's the kind of information I'm looking for, and I would be pleased to receive it at any time.

Hon. J. MacPhail: When I say that the status hasn't changed . . . . The formal regulation of midwifery on reserve is taking place at the same pace, and they are subject to the same rules and regulations of the college now -- on reserve and off reserve.

But what has changed is that the community itself is now part of the college. There is a formal aboriginal midwifery committee of the college. They have identified the issues for the college subcommittee to address. I can certainly make those issues and that report available to the member. That's the report dated March of 1997. Certainly aboriginal midwifery issues rest with the College of Midwives now. There's not a separate health care system for people who live on reserve. That was what I meant by the status. But I certainly can get that report for the member.

Also, the provincial health officer's report of last year -- the conclusion of the last calendar year -- is being released very shortly. As always, the provincial health officer spends a great deal of time on aboriginal health issues and will be addressing this matter as well.

L. Reid: I thank the minister for the clarification. I appreciate that there is a similar, if not identical, set of regulations in place, whether you're born on reserve or off reserve, that will regulate midwives in the province. Perhaps the information is in the material that the minister has just promised, but at some future point I would like the information that talks about how many midwife-assisted births there are in the province: how many on reserve, how many off reserve and whether or not that has resulted in an improved outcome for any child in this province.

Are we seeing improved health status as a result of this program? That has to be the question, no matter what the health program.

That kind of information hasn't been received today, hasn't been debated in this House. The answers don't appear to be available today. I accept that, but at some point, in terms of the number of births and the number of improved outcomes as a result . . . . That was the original discussion. That was certainly the discussion when the home birthing demonstration project was discussed. What are we doing? How could we do it differently? Will it result in improved outcomes? I don't think the answer is available. If it is, I welcome it. If it's not, just give me some indication of when we might expect that.

I know the home birthing project discussion has been ongoing again, probably for about four years. At some point I trust there will information published that says: "These are the

[ Page 3698 ]

number of births we assisted with, this is the outcome we wished, and this is the outcome we achieved." The member for Delta South talks repeatedly about benchmarking and talks about accountability questions. He talks about reporting back to the taxpayer how best to achieve some kind of outcome that's understandable to the public. Would the minister kindly comment?

Hon. J. MacPhail: The point is well taken. Those evaluation benchmarks will be put in place, and we will provide you with that information. The member asks when. On April 2 the regulations became official. We are going to provide annual reports, and I would expect that we will be able to provide that kind of evaluation for part of this year at the end of this fiscal year.

L. Reid: I thank the minister for that. As well, I would ask if the information on the home birthing demonstration project could be included, because I think the questions are equally valid.

I have many, many questions on accountability and benchmarking and the like, and I will return to this debate at a later date. I thank the hon. minister.

[G. Brewin in the chair.]

A. Sanders: I rise to continue the questioning on midwifery in British Columbia. I've listened intently to the debate of the members here in the House -- and specifically of the member for Okanagan East, who I felt asked some very important questions about midwifery and did not get the answers that he required. Therefore I will take up some of those issues again in order to clarify them for the record.

When we look at midwifery, the minister has mentioned that North America is one of the last bastions to not have midwifery. In terms of midwifery being recognized, this is in fact the case. For the minister's information most of the RN staff we have in a lot of the smaller locations in British Columbia are British-trained nurses -- as we do have many British- or European-trained physicians -- and many of these people are trained midwives who practise in British Columbia as registered nurses.

Having been one of those individuals who worked in a more northern location than most of us are used to, I can tell the minister that the majority of the nurses I worked with on the maternity floor -- in the hospital in Quesnel, for example -- were midwives, and they were excellent.

I have nothing but good things to say about midwives. They provide an excellent service; they provide alternative care; they provide a choice for our patients; they provide the possibility for home births. All of these things provide options for us. But those options must not be confused with cost-effectiveness.

We're in a circumstance at this point where cost-effectiveness has become the buzzword for every ministry. In the area where I'm spending more of my time, which is Education at this point, cost-effectiveness and accountability are the terms that keep coming up over and over again. In terms of health care in the last two decades -- especially the last decade -- cost-effectiveness has been the mantra for everyone, from the minister all the way down to the patient. Although some people have been forced into the role more than others, it certainly has been a motivation and a vector for changing the direction of how we even do health care in B.C.

So if we're looking at midwives, it's really important for the public to recognize that we're not talking about cost-effectiveness. In fact, there is probably more information to suggest that the introduction of midwives will increase the cost of medical services in British Columbia. There are a lot of questions the public wants answered around that above and beyond what studies are being done.

What the public wants to know with our health care -- which everyone claims to see as spiralling out of control, taking up approximately 26 percent of our GNP -- is if we are actually in a situation where we're going to be paying more for midwives, and if we are, should we know that? Those questions need to be answered by the minister, and they need to be put on the line for people to be able to formulate further questions more effectively.

In my view, midwives are on the agenda. They have come on the agenda under an NDP government. I don't think there's any coincidence about that. I think they've come on the agenda because of lobbying groups -- and I have no problem with that at all. I think they've come out because women are looking for more choices. Often having been themselves born in and then treated by what was a traditionally paternalistic model, they are wanting more control over things like reproduction. It's about women wanting options and recognizing that women can develop options, can lobby for those options and can get them through the appropriate methods within government.

Our responsibility here, hon. Chair, is not what we think as individuals, women, patients, doctors, taxpayers and government politicians. I think our option is reality. I think our option in this House has to be to look at the actual facts, not to tarnish those facts with any opinion from my point of view or from the minister's.

The thing that has to be asked and has to be answered about the issue of midwifery, when we are introducing a new program into a system that is straining under the costs, is: does the minister actually feel in her heart of hearts that midwifery will decrease the cost of reproductive care for women in B.C.?

Hon. J. MacPhail: I maintain that midwifery will be a cost-effective service. It is done on evidence-based medicine. Certainly, the stringent questioning applied to midwifery services should be and will be applied across all health care services now, with our performance measures. The health outcomes will be measured, as the member for Richmond East recommended as well. But just the same way that evidence-based medicine has to be balanced with what is affordable in the system and what is required in the system -- just as physician practices have to and just as the range of health care provider services has to -- the same will apply to midwifery as well.

Certainly, I'm heartened by the comments from the member for Okanagan-Vernon about why the demand for midwifery has perhaps come about. But let's be clear. The practice of midwifery in this province is coming about at a snail's pace because of the concerns raised by other health care professions around the issues that the member herself raises. We're moving at a snail's pace so that we make sure all those issues are addressed. We worked very closely -- and it took quite a long time -- with the College of Physicians and Surgeons to get agreement on the bylaws of the College of Midwives of British Columbia.

Members opposite and I had this exact conversation last August, at which time I thought it was imminent that the College of Midwives would be set up -- and here we are. It wasn't until April 1997 that the College of Midwives was set up, because of the concerns, some important and some

[ Page 3699 ]

unfounded, of other colleges -- particularly the College of Physicians and Surgeons. We have reached agreement on moving forward with the College of Midwives.

We are currently engaged in funding discussions with the Midwives Association of B.C. As with all health care professions, utilization is important. There is no health care profession in recent years that has ever said to us: "We're unconcerned with the cost-effective methods of our health care." We, too, know that that has to be a factor. It's one factor, though.

[4:15]

A. Sanders: It is one factor, but it is a factor that's very important for us in this House at this time, because a lot of what we talk about is couched in that term. It's important for the public, who takes the time to listen to these debates, to know that we're talking about choices; we're not talking about overall costs. In fact, there is ample evidence to show that any time we introduce a new program of any kind in medicine, we increase costs to the overall services by providing that alternative. An example of that would be by increasing the number of beds that are available for renal transplant.

I remember talking, in a different role, to a minister of a former government of British Columbia. He was cross because he found that the number of people who were in dialysis at St. Paul's in fact went up, not down, with increased renal transplants. The fact was we were improving people's quality of life by giving them dialysis earlier so that they were able to work, able to function, able to live relatively normal lives at an earlier stage of renal failure, as opposed to the fact that if we operated and transplanted a bunch of kidneys, these people would all automatically go away.

If we introduce a new program in British Columbia, be it midwifery or anything else, we are going to increase our costs in the health care system. That needs to be the framework in the nineties around which we look at every program; that is, any new medical service, any new health care service of any kind.

Some of the things that I'd like to bring up with the minister in terms of the actual costs of midwifery need to be looked at. I propose that midwifery will cause a cost increase in the system, thereby making prenatal, antenatal and postnatal care more expensive. I also propose that this is not a project that will result in cost savings. Thirdly, I'd like to look at some of the areas in terms of where some of these costs that I have not heard mentioned from the minister are important.

The first one is malpractice insurance. In British Columbia right now, if you are practising the care of women in pregnancy and labour, you pay a fee called malpractice insurance. For the average family doctor in British Columbia, the amount of malpractice insurance comes out to roughly ten deliveries. What that means is that for doctors doing maternity care, they must do ten deliveries and be paid for those ten deliveries by MSP prior to starting to make any income doing maternity care.

As we all know, if anyone follows Ontario, malpractice fees are rising substantially, to the point that many practising obstetricians in some of the eastern provinces are no longer taking patients in labour. They are simply doing gynecology, cancer care, etc., because of the exorbitant malpractice fees surrounding birth and labour.

My estimate for malpractice insurance is that for those people who continue to deliver babies in the nineties and into the year 2000, malpractice insurance premiums will rise. I believe, based on settlements that are being made, that they will rise substantially. This is a whole area that no one I have heard, in government or otherwise, has talked about in terms of who is going to insure the midwives, who I feel are putting themselves in a very dangerous situation -- especially in home births, for example. Who is going to pay the midwife malpractice insurance?

Will it be -- as is the case with our present practitioners who deliver babies -- that they pay it out of their MSP billings? Or will it be that the government pays the malpractice insurance in addition to the block salary that the midwife would get?

Hon. J. MacPhail: The College of Midwives has identified an insurer who will provide malpractice insurance. It's the same insurer that provides it to midwives in Ontario. The compensation, if any, for malpractice insurance is part of the funding discussions that are going on right now with the Midwives Association of British Columbia.

A. Sanders: Could that be clarified a little bit more? Does that mean that out of the block salary that the government would pay a midwife, they will procure their own malpractice insurance from this association? Or does it mean that you and I as taxpayers will provide that amount of malpractice insurance as part of their package in terms of benefits?

Hon. J. MacPhail: Well, this is an item that's part of the negotiations on funding arrangements that we're in with the Midwives Association of British Columbia. It's not unlike compensation for any other health care provider. This is our position: we will provide a level of compensation to a midwife for her to perform her duties. Both parties recognize that there are certain factors that affect the provision of duties, one of which is malpractice insurance.

What is discussed is not that we'll agree to a level of funding and then malpractice insurance being considered separate and apart from that; it will be part of the package of compensation. What is still up for discussion, though, is the size of the amount being given to a midwife on an annual basis. But both parties agree that part of the compensation has to address the issue of malpractice insurance.

A. Sanders: This is an incredibly important point, because what we have now is a system where family practitioners pay their own malpractice insurance -- and, as I said, to the tune of about ten deliveries prior to starting to break even. We have the introduction of a new College of Midwives, which I believe -- and I may be incorrect here -- would be somewhere along the line of nurses, where they are employed by the government and work in governmental facilities. This is an additional ancillary cost that would be above and beyond the hospital insurance.

If this is the case and this is part of the package deal, there will be people in British Columbia who will want to know exactly how much we're paying for what we're getting. I think this is one of those cases of looking at the insurance policy and not reading the small print. You find out that not only are you paying a salary of $70,000 to bring in a new service, but you bring that in with a 30 to 35 percent benefit package, which is pretty common for a unionized worker in the health care system, and that has already got your net over $100,000.

And then you're going to bring in a potential for another $5,000, $10,000 . . . ? Who knows how malpractice will go now that it's partly under the legal system. Will this come in to be a considerable expense for the delivery of a baby that we were already delivering?

I think that this particular aspect of the circumstance is very, very important. If you then combine that with the fact

[ Page 3700 ]

that unionized employees within the health care unions now work 36 hours a week . . . . I can tell you that the average family physician or obstetrician working in a northern community, which is exactly where we would need midwives, is not working 36 hours a week. Therefore, for a $70,000 salary for a 36-hour week, we are going to have some problems in terms of increased cost. In fact, we would probably require two individuals to replace the one family practitioner to give midwifery services on a 24-hour basis. I wonder if that particular aspect of hours of work has been discussed between the college and the government in terms of midwifery.

Hon. J. MacPhail: I was fascinated by the description of negotiations. I know that you're just speculating and that it's imaginary in the way you describe it . . . . It's hypothetical, I should say, not imaginary. Certainly what I have said is that the compensation for midwives will be total package compensation and will be announced publicly. These matters are under discussion right now. All of the factors in delivery of a service are under discussion.

Just a half hour ago we were discussing the special benefits fund of the Medical Services Plan. I know that the hon. member is very concerned that the public be aware of the costs of our midwifery, but I think it would come as a surprise to the public that over and above the $1.5 billion we pay to physicians, there is an additional $55 million in benefits, $16 million of which goes to malpractice insurance for physicians.

So rest assured that we will make sure that the compensation to midwives is made public, in just the same way that I think it should be our responsibility to let the public know the compensation for other health care providers that are not . . . . When I go to a doctor, that fee-for-service that the doctor receives does not reflect the full value of the money that he or she is being compensated for. There are pension benefits, continuing medical education benefits and malpractice insurance benefits that are outside the fee-for-service.

We know what we're doing when we negotiate compensation packages. Rest assured that we will make sure that the public is fully informed of the costs of midwifery.

A. Sanders: I'm pleased to discuss the special benefits fund for the B.C. physicians at this time. I'll just do this briefly, because it's not my target of interest at this point.

This special fund was set up by the government in negotiations with the B.C. Medical Association in lieu of payment raises that they were owed. It is a circumstance where there is additional funding that goes beyond MSP, and the government does pay part of the insurance premium. The part that I was referring to from family doctors, in terms of medical malpractice insurance, was the part that was not paid by the government.

The part that is not paid by the government is the equivalent of the ten normal deliveries that would be instituted and carried through. It is not the

part covered by the government; it is the part above and beyond that, which comes out of the practitioner's pocket. I am happy to compare that in any form to that of the midwives, inasmuch as we need to know what we're buying. We need to know what we're getting.

Quite frankly, I don't care who does the delivery. There will be many, many physicians in British Columbia who will welcome the midwives and welcome staying in their beds at night as opposed to doing acute deliveries. That's not the point here. The point is not personal between my interests in health care as a physician and the option of midwifery.

What I'm trying to get to are the facts. What I'm interested in is a cost comparison between those facts -- not between groups and not to drive wedges between people. What are we really getting for our money? We are bringing in a new service at a time when we're telling people that they can't go to a lab in their medical building half a foot down the hallway, because we need to have cost containment. And yet we're setting up multimillion-dollar new programs without the raising of an eyebrow.

I think there's some problem here, and that's the issue that I'm addressing. We need to talk about these issues as people who are responsible to our constituencies not just in terms of their choices -- because I truly believe they should have choices; all of us should -- but in terms of what they're going to pay for their choices. If they don't know what they're going to pay for their choices and don't know the full picture, then they don't know what they're getting into, and the answers they give to our questions cannot be termed in terms of their reality because we haven't given them the facts.

That, to me, is the responsibility of being in the official opposition or in government: to let people know prior . . . .

[4:30]

One of the problems this government has had is letting people know after the fact: "Here's our program; we're going to start this new program, and here are the consequences." People come in and say: "When do I get to talk about this? When do I get some input?" We're back to the oxymoron of NDP consultation. People need to know the facts. I feel that that's our responsibility no matter what side of the House we're on. And this is the time. This is the only time -- when you're bringing in a brand-new program. It's moving at a snail's pace.

Well, I say: "Good." I say "good," because I wish a lot of other things that we had instituted in many areas had moved a little bit differently in order to have that consultation start before the money was spent.

In terms of midwifery, there are some things that I'm interested in as an individual in the community who welcomes and anticipates the midwives moving into my community. In terms of low-risk deliveries, my understanding is that the midwives will be working in hospital doing low-risk deliveries, and home deliveries will be done on a pilot-project basis. I'd just like to briefly ask the minister if my understanding, from what I heard in the previous discussion, is in fact the case.

Hon. J. MacPhail: Yes, we just discussed this earlier. All of this is established by the midwives regulations, part of which includes a home-birth demonstration project. We just finished discussing that.

A. Sanders: Would the minister tell me where that project will be?

Hon. J. MacPhail: That's currently being decided. I'll let you know as soon as it is decided.

A. Sanders: Will this be one location, or will it be several satellite locations?

Hon. J. MacPhail: That is one of the things that's being decided.

A. Sanders: What are the criteria on which that location will be ascertained?

Hon. J. MacPhail: I guess this will be the second time, if not the third time, we've discussed midwifery. The staff is not present, but I'll get that information for you.

[ Page 3701 ]

A. Sanders: I looked through Hansard before coming here, and I know that this question has not been asked, so I will be quite . . . .

Interjection.

A. Sanders: The question about where the facility will be has not been discussed or answered. I'd be interested to know that, because there are some important implications of that.

If you go to European countries, for example, where there are home deliveries, the reality that many people may or may not recognize is that in many European countries first babies are always born in hospital. It is only subsequent babies that are born at home. First babies are always considered high risk; they are never considered low risk. That is because of factors such as pelvic disproportion that have not been tried.

Nevertheless, assuming that this pilot project will be second deliveries that will be done at home, there are a number of things that the typical European maternity hospital would have in order to be put on top of the list for the site or the location -- for clearance. A similar example would be when we as a country apply for Commonwealth or Olympic Games. They will evaluate our facilities and decide, after the politics is over and the dust has cleared, whether we have the ability in that location to in fact put on that event with the appropriate number of buildings and transportation systems and so on.

Nevertheless, if you look at the European model, most of the hospitals that do home births are equipped with a chopper pad near the maternity floor. There is an ancillary neonatal intensive care unit or staff that can provide neonatal intensive care, and there is an adult trauma specialist or area.

One of the things that hasn't been clearly discussed, for my benefit, is the fact that delivery not only involves a baby and the baby's well-being, but it also involves a mother. Many of the underlying conditions that people get in trouble with with their babies haven't got much to do with the baby at all, but have to do with problems that arise from the delivery itself and the post-partum period.

My question to the minister is in terms of the negotiations for the pilot facility. What are the criteria on which those will be outlaid? Have those types of criteria that I have just mentioned been previously brought to the minister's attention?

Hon. J. MacPhail: As I said, the staff are not present. I'll make sure they're aware of all of your questions and your concerns in this area. I'll get answers for you on it and perhaps provide the advice that you're offering as they move forward on establishing the policy around this. It's very useful. But let's be clear: we're moving forward at a snail's pace. Nothing's in place yet, so your input is appreciated and can be listened to.

A. Sanders: Out of a very particular interest, what opportunity for consultation does the public have in terms of the implementation of services at this point?

Hon. J. MacPhail: The College of Midwives is establishing all of this. I'm unaware of public consultation with any colleges for any health care provision. If the member would like to make a recommendation in this specific case, that would be interesting. But I'm unaware of it in other areas.

A. Sanders: Where would an individual receive an interim document on the status of the circumstances for midwifery at this time?

Hon. J. MacPhail: I'll make available all the documentation that we have.

A. Sanders: I would appreciate that documentation from the minister. I would be very interested to have the opportunity to look at this in a constructive way, as I feel it's an important program. It is also something that I look forward to in terms of service for my patients. But I also look forward to understanding the reality and the actuality of the incorporation of this new service into the larger picture of health care.

At this point I'd like to close the discussion on midwifery, from my point of view, as I feel that the questions I have asked have either been answered or are pending.

I would be interested in just canvassing a couple of areas from my own riding, in terms of the issue of MSP funds. I believe that the member for Okanagan West had questioned the minister on this earlier. I've had a number of letters from patients who had concerns over going to the hospital and having to pay tray fees for the removal of benign lesions. I wonder if the ministry has placed any thoughts in developing an overall letter that hospitals around the province could give to patients.

Those could be read by the patients and understood, rather than having a lack of communication between staff and the hospital and the patient. Has that particular thing been thought of or brought to the minister's attention?

Hon. J. MacPhail: I can certainly put that suggestion to the BCHA for their consideration. If they wish to adopt a cross-hospital policy, I'll certainly put that forward to them.

A. Sanders: I think there's some need for direction from government on that. We are responsible through a tripartite commission, which is the B.C. Medical Association, the government and the public. We are responsible, as a group of three groups coming together, to convey that information to patients. As an MLA, I have found -- very, very commonly -- that patients coming into MLAs' offices in the area where I live are very concerned and confused about these kinds of issues.

If there were some cross-province incentive, where the government centrally gave a prototype for the hospital nurses, ward clerks or whoever it is in that out-patient facility to provide this information as to why it is, then we would probably save a lot of people a lot of time and do a lot to undermine the confusion, and sometimes the anger, that develops and finally makes it to the MLA's office, which I do not feel is the appropriate place for these things to occur.

In terms of other areas of deinsurance, I listened with some interest to the conversation earlier on deinsurance. This minister was talking about incentives for deinsurance coming from clinical practice . . . . I think there is some confusion there. I hope to offer the suggestion that deinsurance, which means that there are services we paid for last year that we're not paying for this year, in terms of -- at this point -- benign warts and things like this . . . . If you have to have your wart removed, in 1995 you could have had it taken off; now you pay for it if you're over 16. This has come through cost containment within the service.

Again, I think this goes back to what we were talking about in terms of buzzwords for health. We have to decide what we're going to pay for in British Columbia. And with the collective wisdom of government, those providing primary care and the public, we have decided that these skin things are no longer covered. It is not that they are clinically less significant than they were previously; it's that we can no longer afford under the system to do everything for everybody.

[ Page 3702 ]

When we're looking at deinsurance, it's very important to not leave the impression with the public that these things have somehow been devalued. It is that the money is not there and that in order for us to pay for all of the important services that we have, we move on and do that, and not sacrifice the services that are very, very important for us to have.

My question to the minister is: in terms of deinsurance for the year '97-98, through the tripartite commission and through the collective wisdom of that commission, what other ancillary items do we anticipate will be deinsured? What is the total dollar value of that deinsurance anticipated to be?

[4:45]

Hon. J. MacPhail: I just answered this about an hour ago. There are no plans for deinsurance.

I would like to again give my point on the benign lesions. The clinical advice we received . . . . We had discussions about this last year in estimates, in anticipation of the deinsurance, and now we actually have eight months of experience in deinsurance.

The BCMA gave us full assurance that the delisting involved no medically necessary service. They continue to say that, and the proof is in the pudding of eight months of experience. Where a medically necessary removal is required, it is paid for -- and in fact, the charges are being made.

S. Hawkins: I just want to canvass a few more issues under MSP. Last year we spoke about patients who go out of province. Again, I've received a lot of letters over the last year from patients who either can't acquire treatment in the province and have to go out of province or are sick elsewhere and want to collect. One thing I hear from a lot of seniors is that when they go out of province, MSP pays $75 a day for medical care.

I wonder if the minister has been approached about increasing this rate and what the province's position is on out-of-province care for people who travel out of province -- out of country, I believe it is. Sorry.

Hon. J. MacPhail: Yes, just to . . . . I'm sure this was just a slip. When one goes out of province, the plans are covered. But when one goes out of country . . . . I have met with the Snowbird Association, who are suing us over this issue. Certainly I have communicated to them that we are spending our health care dollars in British Columbia, in Canada, and there are no plans to change that.

S. Hawkins: There was an issue, as well -- I've received several letters from around the province -- of patients who have acoustic neuromas, which is a tumour on the hearing nerve. The minister may or may not be aware of this. These patients can get a very specialized surgery in the United States. It's called a gamma knife; it's a radiation beam. The alternative, the procedure here, is through another radiation machine called a linear accelerator. The benefits of the gamma knife are that it's more precise and it preserves the hearing.

I know the ministry has, through different advocates approaching the ministry, been able to fund some patients out-of-country for this gamma knife surgery. It is costly, but a lot of these people are young. They have work that they want to pursue, and they certainly want to preserve their hearing. I'm wondering if the ministry has a policy on this and if the ministry is funding patients for this procedure.

The Chair: While the minister is working out a response, I recognize the member for Chilliwack, who is rising to make an introduction.

B. Penner: Yes, hon. Chair. You show remarkable mental telepathy. I am rising to seek leave to make an introduction.

Leave granted.

B. Penner: It's my pleasure to introduce a group of grade 10 students, numbering close to 25, from Sutherland Secondary in North Vancouver-Lonsdale. I met with them a few moments ago, out on the front steps of the Legislature. They are here today with their principal Mr. Doug Green, as well as a grade 10 teacher, Glen MacKenzie. Would the House please make them welcome.

Hon. J. MacPhail: Thank you for the question. It is interesting that this issue has been examined by the B.C. Cancer Agency, which advises us on such treatments. There is a consensus statement developed, in which open microsurgical excision is considered the treatment of choice. However, in the context of that, the Medical Services Commission has recently put in place a policy where, when the treatment is recommended as the medically necessary treatment, we will fund the treatment in Seattle at the U.S. rates. That has been a recent decision of the Medical Services Commission. In fact, four out-of-country treatments have been paid for very recently. So that's the new policy in place.

S. Hawkins: That's heartening to hear. Can the minister tell me who exactly makes the decision whether it's medically necessary and whether the patient will have the gamma knife or the linear accelerator? Who recommends that to the ministry?

Hon. J. MacPhail: The B.C. Cancer Agency neuro-oncology team, which is a team of specialists in neurosurgery and central nervous system radiotherapy, makes the decision about provision of this treatment.

S. Hawkins: So if it was suggested to a patient that they have this procedure, would they have to access this team, then? Because sometimes the decision is made in a specialist's office. Is this a team that would review the case and make the presentation?

Hon. J. MacPhail: The attending physician acts on behalf of the patient, and the attending physician contacts the team of specialists through the B.C. Cancer Agency.

S. Hawkins: What other kinds of treatment are being funded for out-of-country procedures? What other out-of-country treatments are we paying for?

Hon. J. MacPhail: The general policy is that medically necessary services that are not available in British Columbia or elsewhere in Canada are funded at the U.S. rate.

S. Hawkins: I wonder if the minister can tell us what we spent last year on out-of-country treatments.

Hon. J. MacPhail: There was $14 million spent interprovincially and $3 million spent out-of-country, and that's been consistent over the last couple of years.

S. Hawkins: When we fund patients out-of-province, are we paying our provincial rate or are we paying the provincial rate for the province where they get treated?

Hon. J. MacPhail: I want to make sure I get this answer right, not to have an influence on the federal election. We have

[ Page 3703 ]

a reciprocal agreement with every province except Quebec. We have no reciprocal agreement with Quebec. So the hospital bills us, then we pay at the B.C. rate. But with other provinces it's a reciprocity arrangement where we pay their rates.

S. Hawkins: When a patient brings back a claim, what's the process that the patient has to go through to get reimbursement?

Hon. J. MacPhail: In the vast majority of cases there is no patient involvement. The physician providing the service bills directly to the Medical Services Plan. That is part of the reciprocal agreement. But in the odd case the patient may deal directly with MSP, in which case the bill is submitted, and then MSP checks and verifies the claim and pays.

S. Hawkins: Constituents of mine and other people around the province write and tell me that they have travelled and incurred costs and submitted them. I'm just wondering what they have to prove to get the reimbursement, because they have their doctor's bill and they have what they've incurred as an expense. Oftentimes they are writing to us, and, of course, I forward this stuff to the ministry. What exactly do they have to prove to get their reimbursement?

Hon. J. MacPhail: The Medical Services Plan gives the person in receipt of the services a form that lists all of the documentation, and the form lists the requirements. It's really one-stop shopping. Again, I emphasize that it has to be an insured service that's covered. They then submit the form with the receipts, and MSP takes over after that.

S. Hawkins: Last year we talked a little bit about premiums. I think the minister informed me that we were one of two provinces in Canada that pay premiums. Of course, in a strange way the premiums are conforming to the Canada Health Act, because it falls under the publicly administered format of that principle. I know that . . . . Well, I don't know. How much do we collect in premiums each year in this province?

Hon. J. MacPhail: It's approximately $860 million.

S. Hawkins: I know there's a shortfall. There's some that doesn't get collected. What's the shortfall that we bill but don't collect?

Hon. J. MacPhail: We want to get you an exact number. We're ballparking it now, but we can do that in the course of today.

S. Hawkins: I was just asking my colleague how we decide how much everybody pays, so I'll ask the question. Some people who can afford don't pay. Is there a graduated premium system according to means? How is that determined?

Hon. J. MacPhail: Yes, there is. It's called the premium assistance. Below a certain income level . . . . Based on $19,000 plus how many dependents you have, you pay no premiums. There are over half a million people in the province that pay no premiums at all, and beyond that it's whether you are paying a single, couple or family rate.

[5:00]

Hon. J. MacPhail: It is an interesting debate, and I would offer a personal opinion here that I might get killed for by the Minister of Finance. Medical services premium payments are one of the more regressive methods of collecting payments as well, because it's a flat rate. It's not income-based. Having said that, about three-quarters of medical services premiums are paid by employers. Many of those premiums are paid as a result of collective agreements. There's been a give-and-take in that way.

Conversion to another system of collection is complex. It's certainly one that is the topic of discussion amongst many governments. For instance, the Ontario government actually moved to a payroll tax. Was it Ontario that moved to payroll tax? No, others have a payroll tax system. We have been advised by our business groups that we should not consider doing that. Other governments have actually introduced a high-income surtax -- Ontario being the recent one -- to pay for medical costs. So the debate does . . . . I mean, we are always cognizant of how to make our tax system fair, and this is one area that is examined. But really, there's no change anticipated currently.

S. Hawkins: Again, there's a bill before the House that will be debated. But there's a sense that fairness is not in the system, the way it is right now. I think the m