1985 Legislative Session: 3rd Session, 33rd Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, APRIL 25, 1985

Afternoon Sitting

[ Page

5797 ]

CONTENTS

Oral Questions

Report on forest industry. Mr. Williams –– 5797

Mrs. Wallace

Mr. Lea

B.C. Hydro brain drain. Mr. D'Arcy –– 5799

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)

On vote 37: minister's office –– 5799

Mrs. Dailly

Mr Lauk

Mr. Reynolds

Mr. Cocke

Hon. Mr. Hewitt

Ms. Brown

Royal assent to bill –– 5815

Appendix –– 5816

THURSDAY, APRIL 25, 1985

The House met at 2:04 p.m.

HON. MR. GARDOM: Mr. Speaker, we're honoured today in having

in our gallery a Member of Parliament from the great state of Western

Australia. It has a population of about 1.8 million people and is

comprised of a million square miles, and I'd say there are great

similarities between that state and British Columbia both in

opportunities and problems. I think this gentleman has probably held

more port folios than any individual in this room, certainly in the

economic area. I'd like all hon. members to bid a most cordial welcome

to the Hon. Andrew Mensaros.

HON. MR. BRUMMET: I'm very pleased to have as guests in the

gallery today three gentlemen representing the Haida nation in the

Queen Charlottes, Messrs. Yaku, Guujaw and Miles Richardson. We've had

some very good meetings with them, and I would like the House to make

them very welcome.

HON. MR. PELTON: Mr. Speaker, in your gallery today is a long-time friend

and business associate of mine, Mr. Vern Seymour. I would be pleased if the

House would make him welcome.

HON. MR. RICHMOND: I would like to introduce to the House a hard-working

constituent from Kamloops, Dr. Tony Milobar, who is not only an alderman in

the city but also chairman of their task force on employment. I'd like the

House to make Dr. Milobar welcome.

If I might beg the indulgence of the House for just a few seconds, I

would like to point out to everyone that the third annual Dixieland

Jazz Party starts this evening in Victoria. I would like to

congratulate everyone who's had anything to do with it, and I would

heartily recommend it to the members, as a little jazz is good for the

soul.

MRS. JOHNSTON: Mr. Speaker, in your gallery today and in the precincts

are a number of people representing the B.C. health professionals' legislative

committee. I would like the House to please join me in welcoming Jan Rulon,

Marion Wright, Christy Amidon, Tim Roark, Jackie Napier and Harold Janzen.

MS. BROWN: Also in your gallery today are Theresa Kiefer, Janet Shaw

and Lynn Gary, who are members of Concerned Citizens for Choice on Abortion.

I'd like the House to join me in bidding them welcome.

MR. LEA: Mr. Speaker, I'd like to ask the members to join

with me in welcoming two other people who are in the gallery today:

Sherry Stewart from Kamloops and Tom t Finkelstein from North Vancouver.

Oral Questions

REPORT ON FOREST INDUSTRY

MR. WILLIAMS: A forestry research project at UBC with respect to our

basic industry, headed by Dr. Pearse, has just released the latest in a series

of major reports deploring the disastrous state of the British Columbia industry.

In previous sessions in the House the Minister of Forests has dismissed statements

from Professors Reed and Walters at UBC with respect to this crisis in our number

one industry. Now Sten Nilsson has made equally damning reports and has come

to similar, maybe even stronger, conclusions. Is the minister willing to admit

that he was mistaken in his judgment of Prof. Reed and Prof. Walters?

HON. MR. WATERLAND: Certainly not, Mr. Speaker. I've always

had the highest respect for Prof. Reed and Prof. Walters. I just don't

agree with them in certain things they have said, particularly when

they get outside their area of competence. Many of the things that

Prof. Walters said are absolutely right, as is the case with Les Reed,

and many of the things in this report are quite accurate and very much

in keeping with those things in the report I tabled in this Legislature

some weeks ago. There's nothing new in the report. The report states

that unless the industry in British Columbia invests in plant

modernization, in the latest technology, and addresses its attention

more to the marketplace they deal in, the industry is going to be in

trouble. The industry is doing that, Mr. Speaker. I have been saying

that for years and so have others. I have very little disagreement with

it, except perhaps the hysterical conclusions drawn from the report by

certain reporters and politicians.

MR. WILLIAMS: Areas of competence that this minister speaks

of.... Is the minister saying that they' re not competent to comment,

as they've done, with respect to this industry? Did I hear news

reporters correctly today when they quoted the minister's response to

Prof. Nilsson's report? Did I actually hear that response from the

minister on the air? Could he elaborate on his radio response on this

report?

HON. MR. WATERLAND: Mr. Speaker, I'm afraid I can't advise the member on what he heard on radio.

MR. WILLIAMS: I think it was a reference, Mr. Speaker, to

some kind of animal excrement that was the comment with respect to the

study and report. Maybe he could elaborate on his learned review of the

professor's study.

HON. MR. WATERLAND: Mr. Speaker, when I was asked if the

forest industry in British Columbia is in a state of disaster, yes, my

response was in a reference to that particular animal excrement.

MR. WILLIAMS: Vancouver's Alderman Bellamy said that in Spanish it's called el toro poo-poo, or something like hat.

The minister himself has hired these experts, and could he explain

the areas of competence that he thinks they have with respect to the

forest and range analysis that he just tabled?

HON. MR. WATERLAND: Some of the facts that the member refers to I think are el toro poo-poo,

Mr. Speaker, seriously, I'll respond to that one. When Les Reed, who

is an economist — and quite a competent economist — makes a statement

that we are practising liquidation of forestry in British Columbia, I

say he is mistaken. My opinion is supported by many professional

foresters in British Columbia, because we are practising sustained

yield forestry. And when Dr. Walters starts making remarks that

[ Page 5798 ]

are probably better in the area of competency of

economists, I say — and have said — that some of the things he's said

are in error. Many economists support me in that conclusion as well.

But I do have a great deal of respect for both gentlemen. In their

areas of competence they have contributed a great deal to the forest

sector in British Columbia.

MR. WILLIAMS: The minister has reconsidered his earlier comments and I think we should all appreciate that.

Professor Reed says our industry will decline 30 percent if we

maintain current practices, which we're doing. Professor Nilsson says

they will decline 40 percent. Can the minister indicate what steps he

will be taking to deal with this serious problem that we have on our

hands?

HON. MR. WATERLAND: Mr. Speaker, the member delights in

quoting numbers without any reference to exactly what those numbers and

percentages refer to. My analysis that was tabled in this House, which

was done by professional staff of the ministry, indicates that over the

next 100 years there will be a decline of approximately 14 percent in

the timber available to the forest industry, unless certain things

happen. Professor Reed has made certain statements that unless certain

things are done — and they're different to the conclusions that I have

drawn, and in different areas — something else will change by 30

percent. I'm not going to argue with the conclusions he drew, because

the things he was talking about are quite different than those I am

talking about. The member again is in error, Mr. Speaker. I have not

changed my opinions on the remarks that I made in response to some of

the things that the two professors stated.

MRS. WALLACE: Another question to the Minister of Forests. We

now have the current figures on raw log exports from B.C. They tell us

that in December 1984, 269,862 cubic metres of raw logs were exported,

and for the entire year of 1984, it was 3,322,242 cubic metres. This is

an increase of 44 percent over the preceding year — between 1983 and

1984. What immediate steps — and I stress immediate, because it is an

urgent problem — is the minister taking to halt this export of logs and

associated jobs which we could be creating here in B.C. by processing

those logs here?

HON. MR. WATERLAND: Mr. Speaker, I can't argue with the

member's statistics. I don't have those numbers at hand, but I believe

last year the export of unmanufactured logs from British Columbia was

in the order of 4 percent of the total volume harvested. I would remind

you also that there has been a policy in place for a number of years

which controls log exports from the province and which is a way of

determining what logs should be eligible for export. This policy, these

regulations, have been in place for many years, including the time when

that party formed the government. The same rules are being complied

with now as were being complied with then.

I have said in this House recently and publicly that I think those rules are

no longer appropriate, that they're being abused somewhat. Therefore last

November I announced a new policy to govern the export of unmanufactured logs

from British Columbia — a policy that will assure that if logs are exported,

it does have a very definite benefit for the province in many ways. I'm

afraid I can't go into the details of that policy here and now. Perhaps

a more appropriate time would be during my estimates.

So I have already taken action to correct what I see as parts of

that export policy that are not working the way they were intended to

work. This government, as was the case with that party when they were

in government, and the previous Social Credit government have always

tried to discourage the export of unmanufactured logs from British

Columbia.

[2:15]

There are some cases when perhaps the export of some types and species of logs

is appropriate. We will allow that, and our new policy recognizes that there

will be some exceptions to that in the future.

MRS. WALLACE: The minister says, Mr. Speaker, if I read him right, that

he's already taken action to correct what he says is a minor difficulty

with the regulations. It can't be a very minor difficulty when there's

been a 44 percent increase. When he says he's already taken action, does

he not realize that it is not yet December 1985, when his action takes place?

Can the minister confirm that this policy he is talking about initiating in

December 1985 will simply designate green standing forests as eligible for export?

That's something that has never before been done in this province, not even

during the Depression.

HON. MR. WATERLAND: The word "minor" in terms of problems was the member's word; I didn't use that term at all.

I don't think that you can state in a couple of moments, as you just

have, what the effects of the new export policy will be. I've discussed

this policy with all sectors of the forest industry in British

Columbia. They all agree that if we can make the policy work as it is

designed to work, it will be a great improvement, and it will

accomplish many of the objectives we have. This agreement to that

policy includes the members of the IWA, who have a very specific

concern about the export of logs.

MRS. WALLACE: Mr. Speaker, my first question to the minister

was: what immediate action would you take? He told us in reply to that

that he had taken action. Can he confirm that his action, even action

that he is proposing, doesn't begin until December 1985?

HON. MR. WATERLAND: No, I can't confirm that. The committee

that will be advising on the eligibility of logs for export has been

meeting regularly. It has now just about completed the terms of

reference of a method that it will be operating with, and I expect that

by the end of this month or early next month they will be beginning to

operate under the new system as the old system is phased out.

MR. LEA: Supplementary to the Minister of Forests. Would the

minister confirm that because of past export policies of round logs,

not only by British Columbia but by the United States and other

countries, Japan has had a supply of round logs that has allowed them

to put a capital investment into the sawmill industry, and that at this

present moment the industry in Japan has available to it approximately

a ten-year inventory of round logs ready for their sawmilling industry,

and that even if we were to cut round logs off right now, we couldn't

sell into that market because we've allowed so many round logs to go to

build up that ten-year inventory that they're sinking them in

fresh-water lakes. The past policy has

[ Page

5799 ]

almost made it impossible to have a policy now that will solve the problem.

MR. SPEAKER: Hon. Members, the purpose of question period is

to ask questions, not simply to bring information in the guise of a

question to the floor of the House.

HON. MR. WATERLAND: I can't confirm that fact; in fact, I

would think it very unlikely that Japan or any other jurisdiction has a

ten-year supply of logs. Even if they do, Mr. Speaker, a very small

percentage of the logs which Japan has comes from British Columbia.

Logs are available to most jurisdictions in the world from many

sources. I can't tell you what the statistics are for the percentage of

Japanese logs coming from Canada. But I will certainly make an effort

to get that information and bring it back to the member.

I have heard rumours that there are massive stockpiles of logs in

Japan. I have asked that question of people in Japan — both people in

the Japanese industry and people representing British Columbia in Japan

— and no one has ever been able to confirm that fact. In fact, they

think such a statement is rather silly.

B.C. HYDRO BRAIN DRAIN

MR. D'ARCY: To the Minister of Energy. B.C. Hydro has

terminated 3,000 employees in the recent past. The chairman now says

that hundreds more are to go. These new cuts are highly-skilled design

engineers who have built the best hydroelectric generation and

transmission grid in the world. Has the minister directed Hydro to

speedily investigate the validity of new industrial uses of electricity

and gas in order to stem this latest brain drain of engineers and

highly skilled people from British Columbia to other jurisdictions?

HON. MR. ROGERS: No, Mr. Speaker, we haven't. The question

should probably be phrased in this way: is B.C. Hydro going to keep

people on staff that it doesn't require? The answer to that is no. Is

it going to release people that it does need? The answer is no, we will

not release people that we do need. Yes, we are down from the peak of

employment that once occurred; that was a peak of employment that

occurred during the construction of the last dam. Many of those people

were people directly employed with the construction of the Revelstoke

project, and as the Revelstoke project nears completion those numbers

in terms of natural depletion would occur.

The chairman of B.C. Hydro announced yesterday an internal task

force which will deal with the reorganization of B.C. Hydro. Those

people will examine the various aspects and disciplines of how that

company worked when it was in the construction mode. Now that it is

changing to an operating mode with a very minor construction end, there

will be some adjustments. As much effort as possible has been made to

find other work for those people for whom we will not be having further

work in the foreseeable future at Hydro.

Hon. Mr. Curtis tabled the answer to a question on the order paper.

Orders of the Day

The House in Committee of Supply; Mr. Strachan in the chair.

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $206,025.

MRS. DAILLY: Mr. Chairman, I listened with great interest to

the Minister of Health's dissertation this morning. It was done very

well. He too has a beautiful voice, made and born for radio. There's no

question about it.

AN HON. MEMBER: He's got lots of charm.

MRS. DAILLY: Well, yes. However, I almost became lulled,

actually, into thinking everything was wonderful in the health world.

The minister made it appear as if there were no problems whatsoever in

our hospitals or with medicare or our whole health system — that

everything was under control, that everyone was pretty happy and that

the people who criticize were really headline hunters and maybe a few

naughty people in the press gallery.

Mr. Chairman, as the debate leader for Health, I want to disabuse

the House of the facts that everything is wonderful in the health

world. I regret to say it isn't, because as members of the House we

would hope that the people of British Columbia would be receiving good

quality care in the health system. Because of the government's

financial policies, which started in 1982 with heavy restraint on

hospitals and were skipped over very lightly by the minister this

morning, we are now seeing some very sad and often tragic results.

You cannot eliminate 3,000 staff from the health system and

eliminate 1,200 hospital beds and then say everything has continued

along and we still have a marvellous system.

Mr. Chairman, I want to say, however, that I am not here only to say

that the minister was somewhat erroneous in his facts today; I am here

also as a member of the opposition, along with my colleagues who will

follow me, to hopefully give some positive approaches to the health

situation today in the province.

Following my remarks and questions there will be other speakers

particularly interested in health, the member for New Westminster (Mr.

Cocke) and the member for Burnaby Edmonds (Ms. Brown). I want to deal

first of all with general comments on our approach and our concerns

about what's happening, and I hope that the minister will give some

positive reflection to it in his replies.

Interjection.

MRS. DAILLY: Yes, I will be short, and then I hope the

minister will reply, so we can keep the thing moving that way. I think

it's more interesting for all of us, Mr. Chairman.

The basic concern that I have is that it seems to me that your

ministry, although smoothly run — there's no question about it — still

lurches, as the rest of the government does, from crisis to crisis in

health care. You have problems with an overabundance of doctors in

certain areas, so in comes some heavy-handed legislation with no

consultation.

Interjection.

MRS. DAILLY: Well, maybe consultation. We'll accept you had consultation,

but I'm wondering how much of that input was observed and used by the minister.

[ Page 5800 ]

We also find that we have the problem in the hospitals of increased

costs. The NDP is quite aware of this, and we are not saying: "Just

keep spending and spending." Our problem with the present government is

that they do not seem to have any long-term planning. I've yet to hear

the minister give us some long-term objectives to lead us up into the

next century, because that's obviously the way any minister of health

would have to be looking today. I hope that when the minister replies

he will perhaps be able to show us that his ministry has been studying

changes and alternatives in health care so that the costs of health can

be contained to some degree while still maintaining quality care for

our citizens, because no one should be denied that right in this

province.

My concern is that in this particular area there does not seem to be

an overall plan. The NDP has recommended, along with the Health

Sciences Association of B.C. and other interested groups, that there

should be a health planning council set up under the ministry, where

consumers can also take

part in helping the government and the ministry

in their objectives on dealing with rising costs and providing good

quality care.

To date I haven't heard any moves on behalf of that ministry to

involve the consumers in this whole area. As one of my first questions,

I would like the minister to react to.... What about your long-term

objectives, moving into the next century? May I also ask him what his

reaction is to establishing a health planning council, with consumers

and other interested groups on it? We do hear from the other side of

the House a tremendous amount of criticism about the use, and perhaps

the abuse sometimes, by the health consumer of the hospital facilities

and medical facilities. Why not, on the other hand, involve the

consumer in working with the government and dealing with some of these

very critical problems? I would hope that would be another area that

the minister would react to.

[2:30]

The minister has mentioned — and there will be more dealt with on

this later — in past years the area of trying to develop alternatives

so people can keep out of the hospital if at all possible. Of course we

on this side of the House, along with many other groups, have advocated

the establishment of a network of community health clinics. There is no

question in my mind, from any studying I have done and from talking to

people who have been involved in them here and elsewhere, that this can

indeed save money and yet provide an integrated health care system in

one's community. I would like to know why the minister is not

supporting this, instead of doing the opposite, which is eliminating

them. So my next question is: has the minister had second thoughts

about the setting up and re-establishment of health clinics across this

province?

I think that in the budget, where it particularly made note of the fact that

senior citizens.... The population is increasing, and you face a real problem,

of which we all agree, in increased health costs because of this in our province.

My concern is that the ministry and the budget, as produced by the government,

just make that as a flat, bald statement, almost an acceptance that there is

nothing we can do: health costs are going to rise; it's inevitable because

of the increasing senior citizen population. My next question to the minister

is: why do you not — and are you going to — look at alternatives for the care

for our senior citizens which could perhaps contain costs and yet give the senior

citizens a much more fruitful life and existence?

I am very concerned about the long-term care: we still find acute

beds being taken up by people who should be in long-term care. You

mentioned a certain amount of increased moneys for long-term care, but

would you elaborate and give us some idea of where you're planning to

do this? At the same time, would you perhaps give us some specifics on

dealing with the care of senior citizens? What worries me is that the

senior citizens could perhaps be kept in their home far longer, instead

of ending up in a long-term facility, if you and your ministry and your

government would provide backup support systems.

I know the minister knows what I'm talking about. I'm talking about

increased homemaker services; I'm talking about increased community

services, to enable the senior citizen to stay in the community. Will

the minister tell us what he is doing about expansion in that area?

Actually, in the long run, it should avoid some of these increased

costs which the minister is very concerned about.

I have innumerable questions in front of me, but I think it's better

if perhaps I sit down now and wait for a response on those ones.

HON. MR. NIELSEN: Mr. Chairman, I think it's terrific that

everyone has a philosophy about health care; I suppose, if you are

academically inclined, that's probably what you'd spend your time

doing. The Ministry of Health provides health care. We are actively

providing health care for the three million people in British Columbia.

There are divisions within the ministry that work in the area of future

needs. It's an ongoing program by those people, who specialize in

ongoing needs by developing pilot projects, by reviewing the technology

which is coming to us today and which is expected to be with us in the

future, by working on committees and with committees of professional

medical people, by having consultants within the ministry who work with

a particular specialty of medicine to try to determine that which is

available today and may be available later — that which may be an

alternative to the methods applied today.

The member, in some of the comments, I think was embracing far more

than that which is the ministry's mandate — the provision of the health

system. As an example, the member was speaking of various alternative

forms of caring for seniors, some of which could be more of a housing

nature than a health program. We have developed some pilot projects for

seniors — activation projects. As a society, the philosophy we have

towards senior citizens in British Columbia is far different than it is

in many other societies. We have based our treatment for senior

citizens primarily on the institutional model — be it in extended care,

if that level of care is required, or intermediate care. The

intermediate-care facilities we have in the province now — it's very

difficult to describe them as institutions — are the ones which have

been built over the last few years, and they are extremely attractive

areas for seniors to reside.

I agree with the member that it would make good sense to try to keep

a person of advanced years in a home setting as long as possible,

provided such a setting allowed that person's health to be maintained.

We have literally thousands of requests from seniors who want to leave

their home to go into a long-term intermediate-care facility. We do

have an extensive homemaker or home service program. There are also

some very legitimate concerns about the well-being of a senior citizen

who may not be under some type of observation

[ Page

5801 ]

or maintenance on a regular basis. Many situations

are reported in which a senior citizen suffering from a health problem

and attempting to take care of it himself, or perhaps with the help of

a friend or relative, is also suffering some serious side-effects from

the health problem because of inability to maintain a certain medical

regime that has been prescribed;

whereas in intermediate-care settings

that is taken care of. So there is going to be a blend; there's going

to be a change.

Some of the other comments. We are constantly reviewing the health

needs of the people of British Columbia — at the medical level,

hospital level, public health level and so on. It's constantly

changing, of course. We are constantly reviewing institutional care

requirements in the province. The results have been seen over the past

few years with the new construction at various facilities: Eagle Ridge

Hospital, Victoria's Helmcken hospital, Children's Hospital, Grace and

a number of others; the intermediate-care facilities which have been

put in place and a great deal of other expansion. We are constantly

reviewing and trying to stay somewhat ahead of the situation. We are

never going to have a static situation where what we have in place will

serve us for all time. It's always going to be changing.

I think it's fine to get as much information as we possibly can, but

most of the activity of the ministry is activity now. We have

committees and review teams who are looking to the future, who are

thinking of planning. We are in constant communication with those

persons, in whatever discipline, who are responsible for the delivery

of health care. We are in constant communication with those who have

the academic bent toward future medical requirements. A health planning

council might sound all right. In part, that's what the Ministry of

Health is — making use of a tremendous resource of experts in the

community and elsewhere.

The member said that it is inevitable — I am not quoting her — that

there is going to be certain damage to the system if you close beds,

and so on. I think that began in 1982. We closed some beds, but we were

able to maintain the same level of service — basically the same number

of patient-days. We've been building more, we've been opening, we've

been remodelling and so on; but even today, as of April 17, in our

acute-care system 1,169 acute-care beds are open but not being used ––

1,169 acute-care beds available for patients. That was the survey taken

April 17. On March 4 there were 1,288 beds open and not being used.

That's not a criticism. There has to be availability of beds. If you

were to take the other 1,100 beds, or however many were closed, then

you would almost double that figure. In some instances it was the

correct thing to do — it had to be done. Even so, we have approximately

11,400 acute-care beds, and as of April 17 we had 1,169, spread

throughout the province, available for use. That's not bad at all. I

don't know whether we really need another 1,200 sitting there empty —

or 1,000 or however many it may have been,

I'm not going to argue that in the Ministry of Health, since you're

dealing with individual people who are suffering various problems, you're

going to have crisis. But not crisis to crisis. There are certain situations

which develop, for whatever reasons, and a crisis develops, and we respond as

best we can. That's the nature of the business. My goodness, we're dealing

with health, we're dealing with literally every person in the province,

and frequently in crisis conditions. We're dealing also with professionals

who themselves can undergo a tremendous amount of crisis because of the strain

and pressure of their profession, So you're going to get that. We accept

that as being part of the Ministry of Health's responsibilities and characteristic

of the work that's being done.

There's a tremendous amount of misinformation which is made

available on occasion — great exaggeration frequently. There is a

desire on the part of some people to accept, upon complaint. statements

which later prove to be incorrect. That doesn't prevent the scare from

already being felt by the people.

We have a very good health care system in this province. As everyone

knows, it's a very difficult province to govern and to service, but we

have an excellent system. The problems we have in B.C. are not unlike

the problems they have in every province. We offer a far more

comprehensive system than other provinces do. We have a good system. We

have dedicated people working in the system. We get relatively few

complaints when you consider the number of people who come into contact

with the system every day. Sure there are going to be individual

situations which can be identified. Complaints are going to be made. We

deal with the complaints,

[2:45]

I'll give you an example, Mr. Chairman. A very sincere lady in

Vancouver wrote a long letter to me complaining about the treatment of

a friend of hers in one of our hospitals. The complaints were: the

elderly lady's appearance to her friend wasn't what it should be,

basically because of her hairdo; the food the woman was being asked to

eat was described in some very unattractive terms by the person

complaining; the patient's bed was lumpy; there was garbage on the

floor: and a couple of other minor complaints.

We spent a lot of time investigating that. We found that the poor

soul's hair did not have the appearance this woman wanted because the

family insisted on doing her hair in the hospital; they refused to

allow a hairdresser. The mattress was lumpy; it was a therapeutic

mattress because the woman had a back problem. The food didn't look too

good because she was on an absolutely strict diet; that's what she had

to have. And the poor old soul had a habit of writing notes and

throwing them on the floor. So even though the complainant was

well-meaning, the observations were completely in error. I don't know

how much money it cost to investigate that, but she was receiving good

treatment. Perhaps a person not fully acquainted with her difficulties

read it differently.

We get a lot of complaints like that. Frequently they are completely

in error: sometimes they are absolutely correct. But, Mr. Chairman,

when you consider what we're doing in the field of medicine and health

in this province and what's available to our people and the kind of

treatment they receive, on balance we have a tremendous system. I am

quite prepared to accept individual complaints and try to respond to

them, but we have a job to do every day of the year. We're spending

almost $10 million a day, and I think the people of the province are

extremely well served.

MRS. DAILLY: I regret that the minister has obviously

rejected the need for any overall coordinating health agency for this

province with consumer involvement. I listened carefully to your words,

and it seems to me that you did not react to the kind of council that I

and many others who are involved in health in this province want. They

want an overall council with consumer involvement. The minister has

minor committees here and there.

[ Page 5802 ]

Look, Mr. Chairman, there is too much in the ministry that goes on

behind secret doors. The people who consume health have a right to be

involved far more in the decisionmaking. That is the whole point of

having a planning council with consumers on it. The minister can use

rhetoric and keep repeating that we have a great system, it's

marvellous, and there are a few things wrong with it. If he keeps

saying that long enough, maybe the critics will shut up.

Mr. Chairman, I can also pick out from volumes of letters and so on,

people who have written to me.... I agree with the minister: sometimes

you check up and there is no validity to the complaint. But I also want

to assure you that there are many complaints that are tragic and rather

sad. I'm just going to throw one out to you. I'm only going to ask the

minister to check the validity of it, because I cannot presume to know

if this report that I have is accurate. But I have heard that because

of staff cuts at Shaughnessy Hospital.... There are still old veterans

out there. For many years that hospital had a great reputation — I

know; my own father was there. But in the last few years that great

reputation is no longer there, and again I place the blame on

restrictive policies by this government.

Now here's the particular case I want to talk about. Because of

staff cutbacks I've been told that no longer are some of the old senior

patients taken for their baths. I think you would agree that bathing in

a hospital can be real therapy when you are there day after day in bed

or in a wheelchair. I have been told — and I ask the minister to please

check this — that because of staff time being cut, and staff shortages,

patients are wheeled in now to the bathroom area, stripped and hosed

down. I know that sounds like a dramatic thing to be saying. I cannot

validate it, but I would please say that if that is happening,

something has to be done about it. I ask the minister to get a report

to us about that situation. I was going to bring that up to the

minister perhaps at another time, but the minister brings out an

example of this poor old lady who wasn't.... You know, the complaint

wasn't valid. So in my turn here I want to give you a complaint that we

also hope is not valid. It would be a pretty tragic situation if it

were.

I want to get back to the financing situation of these hospitals and

also ask the minister's deputy — to give him a bit of time, because I'm

sure he's got a lot of things to do at this particular moment.... But

we keep hearing about the tremendous cost of health and it is; the

budget is over $2.6 billion — so I have a question which I know the

minister could not answer right at this moment, but his deputy....

Interjection.

MRS. DAILLY: Maybe he could. Yes, the minister could perhaps do it. Okay, here it is; I'll give it to you now, Mr. Minister.

How much of that $2.6 billion is made up of user fees? I want the

projection, if you can, for the coming year. How much is made up of

premiums which are collected from the people of British Columbia, and

how much are federal contributions? That's your non-Trivial Pursuit

question for the moment.

HON. MR. NIELSEN: My deputy is looking for the precise numbers of projections.

I can offer you some. The $2.66 billion — none of that is premiums; the premiums

are in addition to the $2.66 billion. The premiums bring it to over $3 billion.

The premiums anticipated for 1985-86 are $346 million. That's in excess

of the $2.66 billion, though, not part of it.

MRS. DAILLY: That's a 3 percent increase.

HON. MR. NIELSEN: Yes. Now, the user fees. We have the

numbers somewhere, but I believe it represents about $40 million. We

may have a more precise.... About $41 million, I think it is. And that

portion of the federal grant.... I'll just reserve on that, because as

you know it is a combined grant sent through EPF and I'm not sure what

precise amount of that grant is in the health side, but I will find out

for you.

MRS. DAILLY: I'll give the minister about a C for that quick

answer, but I want to ask him.... I forgot one more. Included in that

budget.... I wonder if you can tell me how much you estimate will be

raised by the new health surtax which has been imposed on the people of

British Columbia — the 8 percent surtax? How much do you expect to

derive from that tax for 1985-86?

HON. MR. NIELSEN: Well, Mr. Chairman, we do not collect

taxes. The Ministry of Finance is responsible for that. It's their tax.

I guess we'd just have to phone them and ask them what they believe it

will be. We don't see the money. Not really. I would have to find out

from the Minister of Finance how much money is anticipated being raised

by the surtax.

MRS. DAILLY: He is being literally correct. I can understand

what he's saying, but on the other hand I'm quite sure his department

must be very interested, when they are drawing up their budget for the

year, in knowing how much is coming in.

Interjection.

MRS. DAILLY: You're not, eh? You just go to the treasury and get whatever you want?

HON. MR. NIELSEN: The process we use — I'm not going to give

you any secrets — is primarily to determine what we require, and then

where it comes from is up to the Minister of Finance.

But I wonder if the member might elaborate on all these decisions

that go on behind closed doors that you were referring to. I'd be

interested in what you were talking about.

MRS. DAILLY: The first major one that comes to mind is the

negotiations with the doctors. That goes on for months and months. Then

suddenly out it comes and we're just told: "This is the agreement that

has been made." We don't know anything about the discussions that took

place. The consumer, who is vitally involved and pays the money,

doesn't know how it was reached. We get a few sketchy little details

after the fact. So I would say, why, if you had a health planning

council, couldn't it be involved with the ministry? Maybe it's a rather

sensitive negotiation, but I can't understand why it's always so

hush-hush until the final moment. I would say that's one major one.

The other thing that goes on behind closed doors and behind the

cabinet doors, which I suppose is your privilege.... I wonder again why

the health council members,

[ Page

5803 ]

if you had it, couldn't be involved. That's in

where you are going to build a hospital. I'm afraid that governments

have a tendency — and I'm sure this happens not only in this province

but in others — to make political decisions come first in the building

of some hospitals. I'm thinking particularly of the UBC science

hospital. We know that it's there now and that it's a beautiful

hospital; it's probably going to do much good — we hope — for the

province. I don't know if he was Minister of Health at the time, but I

want to ask the minister how the decision was made to allow the

Minister of Universities (Hon. Mr. McGeer) to get his way in building

that hospital, which appeared very affluent, at a time when many people

wondered about its location.

I also want to ask the minister: when it comes to making decisions

on what money should go into research and technology, which the member

for New Westminster (Mr. Cocke) wants to talk about at far greater

length, why is all that done in secrecy? Why don't you take the advice

of a number of groups of people? The minister himself admitted that he

went to Germany and saw some system he liked there, so he put it in. It

doesn't seem to me that that's a thing that should be done secretly or

behind closed doors. Those are the areas.

HON. MR. NIELSEN: Mr. Chairman, I just don't agree that some

committee is going to solve everybody's problems. It's one of the

responsibilities of government an the Ministry of Health. We're not

going to ask four or five people out there to form a committee and

solve all our problems.

The negotiations with the BCMA. They're a trade union and we're an

employer; we're negotiating. I don't know of too many labour

negotiations that take place in the public or bring in a committee to

resolve it. We negotiate with these people; it's straight

labour-management negotiations. And they're not too easy to deal with,

I can assure you of that.

Where to build a hospital. Madam Member, I can tell you I wasn't

Minister of Health when that UBC hospital went in. So that solves that

problem. The hospitals that I've been associated with over the last

number of years.... The last to open, I guess, was Eagle Ridge in Port

Moody. I know the person who applied most pressure to have that built

was our esteemed friend on the bench — a former member of your party

who pushed very hard for that hospital. Our present member for

Maillardville-Coquitlam (Mr. Parks) was chairman of the foundation

pushing for the hospital.

[Mr. Ree in the chair.]

The Helmcken hospital decision was made some years back as well, in

the Victoria area. That's not a political decision. It's not in a

riding represented by a government member. The Grace Hospital was built

fairly close to the old facility on a site which was available — the

Children's Hospital.

I suppose there are political decisions in giving considerations and

making decisions, but I really don't know of any flagrant examples. We

haven't approved any hospitals based on political priorities. I think

the hospitals which have been built have been built because of need.

We've been far more active in the last couple of years in the

intermediate-care area, and that's been spread around all of the

province. There's always going to be that suspicion.

I'm sure that doctors would have an entirely different attitude as to where

hospitals should go — preferably as close to home as possible.

[3:00]

AN. HON. MEMBER: Whose home?

HON. MR. NIELSEN: Doctors' homes. That was one of the big

arguments we had about UBC with some of the doctors. They simply didn't

want to drive out to UBC. Maybe it's hard to blame them.

Madam Member, I believe you asked a question earlier....

MR. LAUK: Spend a little more time on that one.

HON. MR. NIELSEN: That comes under vote 47,

Mr. Chairman, I did get some information about doctors' numbers and

consultation. I know the legislation is before the House, so I'm not

going to go into detail. But, Madam Member, we spent a long time with

the doctors with respect to manpower, as they refer to it: in fact,

that has been discussed for years and years. There have been a number

of reports. One was the Black committee report of '79. There was a 1982

study by the joint committee on medical manpower. The manpower question

has been a fact of life for years. Nothing was ever resolved.

We finally got together with the BCMA — not only the BCMA, but my

other friendly organization known as PARI. We got together with the

BCMA, the B.C. Health Association, University of B.C. medical school,

the College of Physicians and Surgeons and the Professional Association

of Residents and Interns. These were the people who asked to be

included on manpower committees. They were all represented, and I think

that's a pretty good bit of involvement by their profession. This was

the manpower committees; they requested to be on them. It functioned

for about a year. Somebody said.... They let it be known that a lawsuit

was going to be launched. These folks were told that they would be

included in the lawsuit, so they gave us notice that they were pulling

out. In fact, they not only gave us notice; they insisted that the

notice be delivered in a formal way so that it could be recorded,

because they were given legal advice to do so.

So they pulled out. We continued on, and eventually there was a case

in court. But boy, I tell you, we consulted. We consulted almost

forever to try to resolve it. There was a very wide range of opinion as

to how you resolve manpower problems. One of my doctor friends said:

"We have to start at the national level, at the training. We're

producing too many doctors." And I agree. It's expected we'll have a

surplus of about 6,000 by the end of the century. We're producing too

many — not we in B.C., but we across Canada. So he said: "That's where

we have to start." I said: "Fine, but what do we do about the problem

today?"

I couldn't agree more that we have to start where we're producing

the doctors — not only producing, but bringing other doctors into the

system. We spent a lot of time consulting with them. They weren't

surprised that I introduced legislation, because I told them well over

a year ago that if legislation were necessary, it would be brought in.

So they weren't surprised. They may have been shocked, but they weren't

surprised.

MR. WILLIAMS: Mr. Chairman, I ask leave to introduce a noted person in the gallery.

[ Page 5804 ]

Leave granted.

MR. WILLIAMS: I'd like to introduce Mr. Leo Nimsick, a

long-time member of the Legislature for Kootenay. Mr. Nimsick was our

Whip for many years, and if he saw the attendance today, he would be

using his whip indeed. Welcome, Leo.

MR. LAUK: I want to address some remarks to the minister with

respect to his role with the doctors, and without referring to any

legislation that has been tabled for second reading, I want to inquire

why the minister has flouted — or apparently flouted — the decision of

the chief justice with respect to the allotment of billing numbers.

The minister, if he received what I would consider adequate legal

opinion about the judgment, could not have in any way thought that the

judgment could be set aside by any legislature, because it was based on

constitutionality. It was based on common law civil rights, as well as

on statutory civil rights. Is he not aware that any legislative attempt

to thwart the chief justice's opinion is likely to meet with the

court's disapproval in a subsequent judgment and be set aside again?

The efforts made by the minister indicate a lack of confidence in the

courts and a lack of respect for the civil rights issue that was the

gravamen, the main portion of the chief justice's decision.

With that in mind, I would ask the minister to outline his attitude

and policy vis-a-vis the Ministry of Health in any kind of situation

arising out of the charter — that is to say, individual rights — and

out of the constitutionality of provincial legislation concerning

health.

HON. MR. NIELSEN: Well, I'm not going to enter into a debate

with respect to the constitution or the law involved, or the reasons

for the judgment of the chief justice. We too have lawyers who reviewed

the matter, and they offered certain opinions and developed what they

believed to be corrective legislation.

The courts have a role to play in our society. So do parliaments and

legislative assemblies. In part, the chief justice.... If you haven't

read the decision, I'd be glad to make a copy available to you.

Interjection.

HON. MR. NIELSEN: How many pages was it?

MR. LAUK: Quite a few.

HON. MR. NIELSEN: The chief justice cited certain absence of law and

wrote an opinion based on that. The lawyers whom we employ reviewed the opinion

and provided explicit authority to cover what the chief justice found to be

lacking. Mr. Chairman, we recognize the role of courts. A court must judge a

case based on the evidence they receive and the law as it exists. If the law

is found to be lacking, and they find that the law is lacking, that's their

judgment. But a legislative assembly has the authority and responsibility to

write law, to correct law or to amend it; otherwise we should perhaps let the

court write law for us, let them take over the role. It happens when you have

too many lawyers in your society — at least one too many.

MR. CHAIRMAN: On a point of order, at the moment, Mr. Member,

you might be just straying a little bit off from the estimates here,

when there is legislation that may be more on the point of the item

that was just discussed.

MR. LAUK: That statute, Mr. Chairman, I am sure will be

thoroughly debated by others in this chamber. But I'm raising the issue

of the chief justice himself and the judgment, not the legislation that

was introduced. I know that the Minister of Health says there's one too

many; I won't pass that along to the chief justice. I won't let him

know that you referred to him as one too many lawyers. It's our secret,

right?

Interjections.

MR. LAUK: No one else will report that: that the Minister of

Health thought that Allan McEachem is one too many lawyers. I'm not

going to repeat that. I'll never repeat it outside of this House, and

I'm sure everybody will respect that confidence: that the Minister of

Health insulted the chief justice of the Supreme Court of British

Columbia. No one is going to mention it, because, after all, it was in

the heat of debate.

But there is an outstanding problem: yes, the chief justice did

refer to the weaknesses in the legislation, and the minister did allude

to the length of the judgment. It was a lengthy judgment; it was a very

elegant one, by the way. But it also dealt very eloquently with the

mobility rights of Canadian citizens, and that a reasonable

interpretation of the charter of our new constitution, on mobility

rights, meant within the provincial jurisdiction as well as between

provinces. That's consistent. I'm sure that the lawyers who advise you

said it's consistent with American jurisprudence and similar laws, and

it's consistent with a reasonable

interpretation of that section.

That's the issue that I'm sure will be litigated. I certainly hope

it will be litigated, to establish that a provincial government does

not have absolute power within its jurisdiction to restrict, in a

democratic country, mobility rights with respect to employment and

residence.

When the minister says: "We're responsible for writing the laws...."

The way the British parliamentary system now works is by parties. The

party in control virtually dictates what goes on in a legislature.

We've got the charter; that's protecting individual rights against the

tyranny of the majority, as it was called recently in the Lord's Day

Act judgment of the Supreme Court of Canada. There's little doubt in my

mind that the Supreme Court of Canada is going to listen very

favourably to an argument that mobility and residential rights are

protected within provincial jurisdiction as well as between provinces.

MR. CHAIRMAN: Order, Mr. Member. I think we are straying a

little bit far from the estimates of the Minister of Health. Possibly

you could get back to that. As for constitutionality, we can do that

during the Attorney-General's estimates or the Intergovernmental

Relations estimates, but not directly on the Minister of Health's

estimates.

MR. LAUK: With respect, Mr. Chairman, I don't think we should

refine things so precisely, so we can't deal with.... The minister is

the one who dealt directly with this mobility issue with respect to the

doctors. I grant you it

[ Page

5805 ]

could occur to lawyers as well. Who knows what

other legislation will be coming up? Simply because the government view

themselves as the employer vis-a-vis the doctors.... This is an issue

raised by the minister, Mr. Chairman. He said that....

MR. CHAIRMAN: Be that as it may, Mr. Member, he may have been

a little bit outside of his estimates at the time he raised it, but

that does not mean that it is proper within the debate on the estimates.

MR. LAUK: Can I talk about the relationship between the

minister and the doctors, in the way he did, in terms of trade union

and an employer? Or would that be under labour relations?

MR. CHAIRMAN: I think the member is well aware of....

MR. LAUK: That would be under the Ministry of Labour? And mobility rights: that would be under the Ministry of Transportation?

I'll conclude by saying that the attitude that the Minister of

Health expresses is a very antidemocratic attitude. I personally was

not in favour of a charter in the constitution. I thought that lawyers

were being lazy and not using the common law, as the Attorney-General

did in the injunction on prostitution in the West End; he used the old

nuisance common law very effectively. But now that we have it, it's

there to protect individual rights, and I am one who believes in the

rule of law.

If the minister wants respect for his government and its power and

its ability to govern, he cannot flout the decision of the court when

it interprets that vis-a-vis the new constitution of Canada. That would

bring the law, the constitution or even the government into disrespect

to the extent that any law passed will be considered arbitrary and

dictatorial.

[3:15]

HON. MR. NIELSEN: Mr. Chairman, I'm sure that when the member

returns to private practice those sitting on the bench will remember

his kind words.

Mr. Chairman, unless legislative assemblies or parliaments are

prepared to give up their reason for being.... It's fine to say that

the way the British parliamentary system works today means the

government runs the House. They represent the majority. British

parliamentary system is recognized majority rule with respect to

legislative assemblies and parliaments. It hasn't changed; it's been

identified with the party name.... The system is still basically the

same, and legislative assemblies or parliaments have the authority to

write laws. Just because a judge or a court may find a law to be

inadequate or not explicit, it doesn't mean the process is wrong.

MR. CHAIRMAN: Order, please. Mr. Minister, I think the same

comments might be appropriate here, that if we get back to the Ministry

of Health estimates and....

HON. MR. NIELSEN: Fine, Mr. Chairman. I'll speak about that when the bill is here for debate.

MR. REYNOLDS: I won't be very long. I want to talk about some alternative

therapies, but also say before I get into that area that I just had the pleasure

of nominating the member for Maillardville-Coquitlam (Mr. Parks) as chairman

of the Health, Education and Human Resources Committee. I find it rather shameful

that not one member of the NDP showed up at the initial meeting, and the only

one who really had an excuse is the member for Burnaby North (Mrs. Dailly),

who as the critic for her party is sitting here asking questions of the Minister

of Health, who also had an excuse for not being there. I find it rather strange

that not one member of the NDP was concerned about these issues of health and

education and human resources, three major areas in this province — couldn't

even show up to the first committee meeting.

Mr. Chairman, I really got up here just to congratulate the....

AN HON. MEMBER: Is that member in order?

MR. CHAIRMAN: I believe the member is directing his remarks

towards the estimates. Mr. Member, on your point of order where you did

not rise, I might comment that the Chair does give a member a little

bit of leeway in the commencement of comments, to see the actual

direction of the comments.

MR. REYNOLDS: It's a

preamble.

I just want to comment and congratulate the minister in the area of

the alternative therapies. With respect to chiropractors, we've made

advances over the past couple of years, allowing the chiropractors

broader scope outside the spine, and also allowing them to use the

title of "Doctor." It was long overdue; I think it is a very

progressive step that the minister has taken. The fact that they are

insured under the medical plan is a very positive step and very

progressive. Naturopaths, podiatrists and optometrists: all three of

these occupations had their statutes amended to allow the use of the

title "Doctor." I think the minister is to be commended for that. I

bring these things up, Mr. Chairman, because so often we hear about the

things that we're not doing. But this province, if you really want to

look at the health care issue very closely, is very progressive and

very much ahead of many of the other provinces in Canada.

With regard to naturopaths, podiatrists and optometrists, we are the

only province to include naturopathic services under the Medical

Services Plan. Alberta does provide limited coverage under their

optional Blue Cross plan. We are one of only four provinces to include

pediatric services, and I think we are to be commended for that. The

minister should be commended, because he's been the minister for a

period of time.

Interjection.

MR. REYNOLDS: The second member for Vancouver East (Mr. Lauk)

asked who the author is. Well, the author is this member, who asked

this department of Health.... I am interested, like the member for

Burnaby North, and we've been out attending some meetings around this

province on alternative health care services. I've asked the minister

what he has done, and these are my notes, not his, but information

obviously came from his department as to which services are provided in

this province. I think it should be spelled out once in a while, the

positive things that are

[ Page 5806 ]

happening in this province. It's so easy to talk about the negative things.

Physiotherapists and massage practitioners: we insure both these

services. While most other provinces insure physiotherapy services,

we're the only province to insure massage practitioner services on a

referral from a medical practitioner. I think that's extremely positive.

The member for New Westminster (Mr. Cocke) put a private member's

bill forth with regard to acupuncture, and I would like to state that

I've spent many hours over the past couple of years with the

acupuncturists who visited my office here; and through the good offices

of the minister, who met with the acupuncturists, a committee was set

up. The committee includes representation from the Acupuncture

Association of British Columbia, as well as the College of Physicians

and Surgeons and the ministry itself. I'm hoping and I am sure that

some positive things will come out of that committee over the next

period of time. I think the minister and his department have shown a

very positive attitude — much more positive than other provinces in

Canada — toward alternative health care practitioners.

I would also like to talk for just a minute about health foods. We

know that the federal government has been raiding some health food

stores lately and taking the herbal tea and other things off the shelf

because somebody might make a claim somewhere that they cure cancer. I

think the federal government is wrong. I know the minister has talked

to his federal counterpart, and he might want to explain to this House

the attitude of the federal government in that area. With regard to

health food stores, I think people have a right to the materials

available in those stores. Why should they be taken off the shelf just

because they might become popular or because somebody might make a

claim that they cure something — if it's a product like a tea that does

nobody any harm? Some might say: "Well, it might give some people false

hope." I guess, Mr. Chairman, if somebody has a terminal disease

anyway, why not let him have false hope or something that may work on

that. I just see no rhyme nor reason why the federal government,

through its federal health agency, is taking certain things off the

shelves of health food stores. I think a lot of people agree with us,

and the minister might want to comment on his conversations with the

federal Minister of Health.

My main comment is just to congratulate the minister for the fine

job he is doing with these alternative care practitioners and to hope

that he will continue in that progressive manner, because there are

many other things that need to be done in those areas. We can't run at

them quickly, because health care is a very important thing. There are

many things I know his department is researching, and I hope they will

do a thorough job and keep on progressing at the rate they have been

for the last couple of years.

HON. MR. NIELSEN: On that area of alternative medical services, for

many years the various organizations representing chiropractors, podiatrists,

physiotherapists, massage practitioners and naturopaths suffered from the exaggerated

claims of some people who identified themselves as being one of those individuals.

Even today in certain areas of North America there are outrageous claims made

by some people who claim to be such practitioners — but really not in Canada.

I think the reason we don't suffer to the same extent in Canada is that

there has been a much closer association between governments and those associations.

They have a place, they do a job and they provide a service. We have very few

complaints; in fact, Mr. Chairman, proportionately no more than we receive from

those complaining about medical practitioners.

The federal minister has discussed this question of their rather

anxious people removing certain products from health food stores. The

last time I met with him I raised that subject, and he quite honestly

didn't understand why they were doing it — other than that, as the

member suggests, someone may have claimed that a certain product cures

a certain disease. Someone may have even put it on the label somewhere.

But I think they were reacting rather strangely with respect to some of

the materials they removed. The federal minister said he would look

into it, and I believe he has responded rather quickly and quite

thoroughly in reviewing this matter. I know there has been a lot of

discussion about that.

I would just like to say that when you consider the various services

which are available to insured members, British Columbia has the most

comprehensive health care system. Other provinces have fewer; some have

none. I think chiropractors were recognized 20 or 25 years ago, and

others have been. I think it was correct, in that we permit people who

have achieved an academic qualification through a recognized facility

to make use of their academic title. Chiropractors may call themselves

doctors of chiropractic; optometrists, similarly of optometry; and

podiatry and naturopathy. I think it's reasonable recognition. The

reason they were not permitted previously is that.... It simply said

that if you were not a medical practitioner, you couldn't call yourself

"Doctor" — unless you were a PhD.

The hon. member for Burnaby North (Mrs. Dailly) asked about

Shaughnessy Hospital a while back. She asked if it were true — I'm not

sure if she suggested it was — that patients at that hospital were

being asked to go without baths due to staff cutbacks. I am informed by

our hospital programs officials that they have communicated these

concerns to the director of nursing at Shaughnessy Hospital and have

been assured that standard bathing practices and facilities are in use

at the hospital. I'm advised that the allegation by the member that

some of our elderly patients — veterans — are being hosed down rather

than bathed is without foundation. They say there are instances of the

use of shower chairs in some extended-care facilities where residents

do not have the physical capability of being bathed in the usual

fashion.

It might be of interest as well that the staffing level at

Shaughnessy Hospital at March 31, 1984 was 1,798 full-time equivalents;

the average for the year to date is 1,782.

MRS. DAILLY: I appreciate the quick response on that

Shaughnessy question, because it is something we'd like to have

cleared. We certainly are pleased that you were able to give us

assurance that what was reported to me apparently is not going on. I

think we're all most pleased to hear that.

I would like to move on to another subject with the minister. Before

I do, I would like to agree with the member from West Van–Howe Sound

who spoke on the whole matter of alternative health care treatment,

which of course the NDP is also very interested in developing. As is

probably known by many, I believe the member for New Westminster (Mr.

Cocke) is working on — and has worked on — a form of umbrella

legislation, which he wants to discuss later during the estimates on

this matter.

I wanted to discuss with the minister something we've discussed before, but I think it's still current. It's something

[ Page

5807 ]

that really concerns not only the NDP, but many

other people: that is, the whole matter of user fees. I understand that

there's a difference of philosophy here. The Social Credit government

sees absolutely nothing wrong with imposing user fees, and yet the

people who are involved — the Canada Health Act, well-respected Judge

Emmett Hall, and many other respected health people throughout Canada —

reject the imposition of user fees.

I'd like to quote something from the Canadian Press, April 20, 1985 — pretty recent:

"British Columbia had its federal medicare grant

trimmed by nearly $2.7 million this month because of hospital user

fees. That's up from the original penalties of just over $2.5 million a

month. Health Minister Jim Nielsen said: 'The money's technically in

the bank at the moment. It's recoverable within a three year period. We

lose the use of it at this moment.' Asked if the province would recover

it, he said: 'Oh, possibly.' After three years? he was asked. 'I don't

know.' He said the province will continue to charge hospital user fees."

The people of British Columbia are having user fees imposed upon

them and at the same time it is costing everyone $2.7 million a month.

Will the minister now answer this question: are you planning to

continue this imposition of user fees? And would you also.... Oh,

somebody's already said "yes" for you. Would you also answer how you

could possibly expect to recover the money if you're planning to

continue to use them?

[3:30]

HON. MR. NIELSEN: Mr. Chairman, the policy of the government

at this time is to maintain the user fees in our hospitals. Presently

the acute-care charge is $8.50 per day. There is a $ 10 emergency room

charge, and there is a charge for day-care surgery of $8 a day. That is

the policy of the government.

The Canada Health Act, as the member would know, does not prohibit

user fees. It simply says that they will deduct that amount from the

transfer, and asks us to cooperate by letting them know how much money

is coming in through the user-fee system. It also says, under the

Canada Health Act, that if the method is changed to the satisfaction of

the federal minister — in fact, it's a very peculiarly worded act at

all; it comes down to the opinion of the minister on all these various

things — in a three-year period the money is recoverable. We are

meeting with the Minister of Health; all the ministers of health will

be meeting with him again on May 16 and 17 to try to make some sense

out of the Canada Health Act. I'm not convinced that some changes may

not occur which would alleviate this particular problem and eliminate

the concept of penalty.

So we haven't given up on that. Just because the federal government wishes

to be punitive or the former federal government wished to be punitive we don't

believe we should necessarily respond in a knee-jerk reaction. We think they're

wrong. You think we're wrong. That's the way it goes. The user-fee concept

is not new. It's been in British Columbia for 30 years. We welcome the NDP

government in Manitoba as part of the family of user-fee people. In April my

friend Larry Desjardins in Manitoba announced that the then New Democratic government

was introducing user fees for chronic-care patients at $15.25 a day. They have

accepted the need. They call it board and room, I think, but only because the

federal Canada Health Act does not penalize you for that particular user fee.

The Canada Health Act could be amended to permit a portion of acute-care costs

to be deemed to be room and board, as they do with long-term care or chronic

care. They could do that, and that would alleviate the problem. Technically

it's still a user fee, but it would be exempt from penalty under the Canada

Health Act.

[Mr. Strachan in the chair.]

As they said in the paper: when is a user fee not a user fee? The

answer: when it's imposed by an NDP government. User fees, I think, are

legitimate. They do not impose a financial hardship on the patients. If

the person is of no means, the user fee is picked up by Human

Resources. If the person cannot pay, they're not prosecuted, they're

not hounded. Most people can pay, and most people are very pleased to

be able to pay what is a relatively small amount.

MRS. DAILLY: Mr. Chairman, we've had this debate, so I don't

want to bore you particularly in repeating, all the arguments, but I

simply want to say to the minister that we consider it a tax on the

sick. The whole principle of medicare is being abrogated when you

continue to increase your user fees. We consider the user fee in acute

care to be quite different from the one in chronic care, although we're

very concerned that your chronic-care costs are continuing to rise.

I wonder if the minister could answer this one question on this

subject before we move on to another one. It is this: how can you

justify imposing a user fee on the citizens of British Columbia, which

works out to what now — over $60 a week — when at the same time you

have imposed an 8 percent surtax on the citizens? You are increasing

the premiums so that now you are getting over $340 million annually in

premiums. Part of the sales tax is to go for health costs. You are

getting money from the federal government. Why are you imposing the

user fee?

HON. MR. NIELSEN: Mr. Chairman, the user fee has been part of

our hospital system for years. The premiums have been part of the

medical system for years. The whole system is based on that. As you

know, we offer additional services in B.C. We just discussed it with

the member for West Vancouver–Howe Sound (Mr. Reynolds): chiropractic,

podiatry, optometry, naturopathy, physiotherapy. The money has to come

from somewhere. The people are not complaining about the user fees.

Only the NDP is complaining about user fees, except in Manitoba.

There is a difference between a user fee in long-term care and in

acute care. The difference is that the user fee in long-term care is

usually for life — every day of the rest of that person's life. Acute

care is an average of 8.8 days. The NDP is the only group of people who

can be identified as a group who are complaining about user fees. We're

providing the best health care system available. We are providing the

most comprehensive health care system in Canada, and we get no

complaints from people about paying $8.50 a day for an acute-care

setting. That's an average cost of around $380 to $400 a day. Chances

are they pay more for the cab to go home when they are discharged from

the hospital. It might pay for breakfast, but it doesn't pay for much

else.

MRS. DAILLY: I know over on the other side they were agreeing with you and the minister is shaking his head — he

[ Page 5808 ]

can't understand why the NDP doesn't see this.

There is somebody else who doesn't agree with it either, and he's a

conservative. It's Professor Bob Evans of UBC. Do you know one of the

reasons?

Interjection.

MRS. DAILLY: He's certainly not NDP.

I'll tell you one of the reasons that the majority of the people may

not be complaining: I don't think you'll find the majority of the

people of B.C. have had to face up to it yet. You must admit that a

minority are in your hospitals. Secondly, you have done a really good

job — I have to give you great credit — with the taxpayers' money of

selling a scare to the public: if you don't pay the user fee you're

going to lose medicare. Don't deny it. This is what has been going out

from the minister and from the Social Credit back-benchers, who are all

chortling there and backing him up right at this moment. You have sold

the people of British Columbia the idea that we are in such a desperate

state with the cost of health that unless they pay these user fees,

medicare perhaps will suffer or go down the tube. You've done a great

job of scaring them.

Let me quote what came from Prof. Bob Evans in front of the health

committee. The minister, knows about this. I think he followed him

later...the same one who had the hearings on the Canada Health Act.

They were talking about B.C. imposing these user fees. Somebody had

said: "Well, I guess they have to, you know, with the deficit and the

problems in British Columbia." To quote directly from Prof. Bob Evans:

"First, the deficit is partly contrived by elaborate

accounting. Second, to the extent that it is there, it's there as a

result of world economic conditions in the downturn. But third, B.C.

Railway and B.C. Hydro are building well ahead of demand. Everybody

said it was doing so at the time" — but they went ahead. "B.C. Transit

commission, the northeast coal problem.... The Japanese have decided

that since they're not building cars, maybe they don't need so much

coal. We have a whole series of projects which are imposing serious

costs on the B.C. government. They are looking around for a way to

justify the increased taxes to support earlier economic mistakes —

certainly earlier problems — and medicare, being the most popular

program in B.C., as in the rest of the country, makes a natural

stalking-horse for those taxes."

So what I'm saying to the minister is that this business of imposing user

fees is strictly a political strategy. I think it is most unfair. It is not

accomplishing anything as far as the government's finances go, because basically

that money.... We have no assurance of how much of it is going back into

health anyway. The people who are unemployed — yes, they're taken care of.

But I wonder if the minister and the other Socred members who are backing up

the minister would enjoy going to a hospital today with no money, knowing you're

out of work, not being able to pay, and yet being told: "Well, it's

okay, we'll take care of you." That's pre-medicare days, when people

were made to feel like second-class citizens. That is the issue. The minister

and the Social Credit government are destroying the principle of medicare. That

is the whole issue which somehow or other we can't seem to get through.

HON. MR. NIELSEN: Even the socialists who drafted the Canada

Health Act didn't agree with that. They outlined in the Canada Health

Act the five principles of medicare. It didn't say "user fees." User

fees are permitted under the Canada Health Act. It's fun to have this

discussion....

I believe Bob Evans is an economist, is he not? It's fine for him to

have an opinion. My God, we're not prohibiting people from having

opinions. It doesn't mean he's correct. The average length of stay for

a citizen in an acute-care hospital in B.C. is 8.8 days. For a person

who's in a long-term care it's probably for the balance of his life. We

are not imposing heavy financial hardship on anyone. If people go to

the hospital and can't pay the $8.50 a day, they don't pay it.

The $41 million, or whatever amount it adds up to in a year, is

utilized to expand the medical services to citizens. It is the money,

in part, that is used to provide additional programs. The people are

not complaining. They're not afraid of paying $8.50 a day. In fact,

many people write letters and say we should charge a lot more for the

service they receive. Many people have sent in donations to hospitals

in appreciation of the service. Many people shake their heads; they

can't believe.... They leave a hospital such as Children's Hospital,

and if a child's been in there for five days they receive a statement

that advises them that the cost of treatment on average for that

five-day stay is about $3,000; their cost is $40 or $45, whatever it

is. They appreciate it. They write letters and say thank God for our

system. Don't tell me those people are offended at paying $8.50. They

feel privileged to be able to take

part in a small way.

We disagree on user fees. You may be the only political group left

in Canada who disagree — that is, the B.C. NDP — because my friend in

Manitoba, Larry Desjardins, said user fees are only user fees when they

are applied to people who can choose whether to avail themselves of a

government service, whatever that means.

MRS. DAILLY: Just a final comment on it, because I know the

member for North Vancouver–Seymour (Mr. Davis) would like to get up. I

just want to say to the minister.... He keeps saying that user fees are

not illegal under the Canada Health Act. The point is that the people

involved in the Canada Health Act, and even the present Conservative

government, impose penalties for governments such as yours which insist

on imposing them in acute-care hospitals. So obviously it must be

abridging one of the principles — or two of them — of medicare. The

minister can say all he wants that it's not illegal and it's not wrong,

and yet he has to make the people of British Columbia pay penalties for

it. So someone is wrong.

[3:45]

MR. DAVIS: I want to raise two topics. One is the new health

care tax, the one that was introduced in last year's budget.

Essentially my question is: how much longer will all of us who pay

income tax to the provincial treasury have to continue to pay that

levy? It amounts to a substantial sum. The other topic relates to the

unique problems of the North Shore Union Board of Health. I gather we

have several boards of health in British Columbia. The services they

perform are funded differently than in the rest of the province. In the

rest of the province there are ministry health units, which are not

funded through local municipal government or any of local municipal

government's agencies.

[ Page

5809 ]

First, back to the special health care tax that we now pay. I gather

it's a couple of points on our income tax. It relates to the fact that

the federal government no longer pays 50 percent of health care costs

in this or any other province. I'm not one of those who bewails the

fact that the federal government no longer pays 50 percent of our

costs. The hon. minister has said several times that we enjoy the best

health care service in Canada. It's certainly the most comprehensive.

Its quality is high. And it is more expensive than other health care

programs in other provinces, because of its breadth and its quality. I

can't see the logic, looked at from a Canadian point of view, of the

national government, which incidentally is running a very substantial

deficit, automatically putting up half of the health care costs of the

wealthier provinces, British Columbia included, which can afford — if

one's looking at ability to pay, at least — to pay more for health care.

In order to entice provinces into medicare, the 50-50 formula was

invented, and it continued for some years. In the mid 1970s when the

federal government began to run increasingly into debt — to run

increasing deficits — it naturally looked at its large areas of

increasing expenditure, and health care was one of these. Health care

costs were rising much more rapidly Canada-wide than other costs. In

order to contain that runaway cost item, the federal government

switched from a 50-50 formula to essentially a per capita formula, one

which paid each province, on the average, the same per person that all

other provinces were paid. That way, it managed to put a lid of sorts

on its runaway costs. As a result, provinces with the steepest cost

increases found that they were no longer getting from the federal

government half of every dollar they spent on health care.

Provinces are fond'of claiming-jurisdiction in health, education,

municipal affairs, a number of other areas. But when it comes to

dollars, provinces feel they should get as many dollars from Ottawa,

regardless of jurisdiction. Health, I claim, and.... I think most

people looking at our constitution — certainly most people in this

province — would say that health is a provincial responsibility.

Initially, during the early days of medicare when provinces were

joining the national health care scheme — and British Columbia was one

of the first in — the 50-50 formula was, I think, a useful device, if

not appropriate.

But as health care costs rose, it was, I think, equitable that

provinces receive substantially a per capita payment rather than a

payment which reflected their wealth. So I personally feel reasonably

comfortable with the present formula, which is not 50-50.

The tax that was introduced last year ostensibly was to make up for

the fact that Ottawa was in default. Because it had moved some years

earlier off the 50-50 formula, Ottawa was in some way in default of

certain sums of money that were due to the relatively well-to-do people

of British Columbia, and they were due because the 50-50 formula in

some people's minds was deemed to continue to exist.

While we made those charges last year, while we invented a tax in order to

cover the gap pro tem until the feds came to their senses and paid us the 50-50

basis, is that now a perpetual part of our budget? Is the fact that we're

going to have to make up the difference between the old 50-50 formula and the

new — and I'll call it a per capita formula...? Is it now a permanent

feature of health costs in this province? Is the revenue that's likely to

flow to this province under the heading "health" from the central

government likely to continue to fall behind our overall expenses divided in

half?

In other words, is the 50-50 formula really a thing of the past, or

does the province still hope it can be revived? What discussions have

been held with the new government in Ottawa in the hopes that the 50-50

formula would be revived? What expectation does the minister have that

somehow we'll gain relief from a government that is $30-plus billion in

the hole, and from a government that is just as interested in the

people in the lower income areas of Canada as it is in the people from

the higher income levels?

I'd like a comment on that tax, because it's costing British

Columbians a great deal more than user fees, for example. It's a much

bigger item in our total budget. Is it a permanent fixture now, or is

it not?

Turning to the problems of the North Shore Union Board of Health, if

I can capsulize them, they are these. Because the Education budget of

the province is not rising as rapidly as the Health budget of the

province, the North Shore Union Board of Health, and I'm sure other

union boards of health in the lower mainland, are complaining that

they're not treated properly. They get their money via the Education

budget,

West Vancouver recently, as a result of a motion passed by the

school trustees, decided to cut their contribution even more than the

formula contribution, and presently the council of West Vancouver is

considering whether it will make up the deficit.

But nevertheless, the moneys flowing to the North Shore Union Board

of Health for the administration of a number of functions normally

carried out by health units is less proportionately than in other areas

of the province where the funding is carried out directly by the

Ministry of Health. I know that the simple solution would be to do away

with these remnants of the past — the continuation in a few areas of

local administration of health services — and to put all the areas of

the province on the same basis: give them all health units, fund them

all proportionately with the increase in the total Health budget of the

province, and not treat them — financially anyway now — as second-class

citizens who are tied to an Education budget and not to a Health budget.

In essence, there are two questions there, Mr. Chairman. Firstly,

how long are we going to continue to pay this additional health tax

because of a federal funding formula which is no longer 50-50?

Secondly, when are you going to rescue the North Shore Union Board of

Health from being a captive of the Minister of Education's budget,

rather than your own?

HON. MR. NIELSEN: To the member, thank you for the two areas of discussion. Let me respond first to the union board of health on the North Shore.

I don't believe there is anyone — at least that we've been able to

identify — who can truthfully and correctly identify the process that

has left us with what we have now vis-a-vis these local suppliers of

certain levels of health care, because it's all over the board, all

over the province. Not all over the province, but all over the Greater

Vancouver Regional District, the Capital Regional District and others.

It's been a source of a tremendous amount of consultation over the past

couple of years between Vancouver, Burnaby, Richmond, the North Shore,

New Westminster, the Capital Regional District and others. It is very

different than the rest of the province, and varies a tremendous amount

within a district. As an example, Mr. Member, preventive services — and

that's what we're dealing with, preventive services — we contribute to

the city of Vancouver 23 percent of the costs associated with

[ Page 5810 ]

their preventive services; in Burnaby we contribute

51 percent; Richmond, 35 percent; the North Shore, 45 percent. So as

you can see, it doesn't really make any sense.

The one element within these various percentages, however, is that

in some instances municipalities have taken it upon, themselves to add

a program to their health system, if you like. They add a program on

their own. So it modifies the percentages because their list of

preventive services may be broader than a neighbouring municipality's.

They may be providing a service that another municipality does not

provide — as an example, audiology. Some municipalities may provide

audiology services; others do not. But it should be far more

consistent. Through the GVRHD and others we are attempting to work out

a method whereby we can equalize, at least within the region to begin

with, and then perhaps see what we could do on a provincewide basis.

It's a big money item. It does involve a considerable amount of

money. I believe the estimate for GVRHD was about $9 million or $10

million on a yearly basis. We have been working on that, and the

assistant deputy minister responsible has had numerous meetings to see

if they can all agree. We don't have consensus yet even among all the

municipalities. But I agree with you; I think it is a remnant. As you

said, the union boards of health themselves are from an age gone by.

Certainly the financing formula is from an age gone by, and it is

something we are attempting to resolve. Your suggestion may be the

correct one. There is still a lot of local pride in those services and

they would like to retain them, but perhaps they do in some instances

suggest that they are an anachronism.

Mr. Member, you asked about the tax, which I'll respond to briefly.

As you know, the tax was introduced in 1984 as the health care

maintenance tax surcharge. The budget stated that the surtax would be

removed when federal health care funding is raised to an adequate

level. I appreciate that the word "adequate" is very subjective. What

does adequate mean? When will it be adequate? The federal contribution

toward our health costs is approximately 42 percent — that's medical

and hospital, the areas they share in; not our overall budget, but in

the areas in which we share medical services and hospital. The

chiropractor, the extended benefits and intermediate care are a

separate item entirely. So it's 42 percent.

I agree that when the federal government tried to persuade provinces to join

a national system, they offered a very generous fifty-fifty — 50-cent dollars.

Many provinces took advantage of that and built, and in some cases overbuilt

or overextended themselves. The federal government recognized that it was a

runaway system and that they had to bring some control. I don't disagree

with you that the concept of fifty-fifty is the only answer. That's a very

simplistic way, and it's perhaps a good way to introduce a system. We have

asked the federal government to consider not only the per capita grant — that's

really simplifying how the system works — but also the demographics of the region

and the province, along with raw numbers of people. Our argument is that British

Columbia attracts a large number of senior citizens, and the cost of delivering

health care to seniors is much higher. We'd like them to recognize that

senior citizens from the Maritimes, eastern Canada or the Prairies may move

to British Columbia — the Vancouver and Victoria area — because of the climate

and become an additional burden on the health care system. We support the mobility

of Canadians to come here, but we would like the feds to recognize that there

is an additional cost; and perhaps, if they did, if the demographics were taken

into consideration, it might come up to an acceptable level.

[4:00]

I'm advised that negotiations for the next EPF contract will begin

this fall, but the present agreement doesn't expire until 1987. So they

are beginning to negotiate next fall. I don't know when the federal

government's contribution will be adequate. The Minister of Finance

(Hon. Mr. Curtis) could probably offer an opinion on that in his

estimates. But, Mr. Member, I think there is a bit of room to negotiate

with the federal government with respect to demographics, to see if

that would help resolve some of the problems.

Your North Shore Union Board of Health thing is, as I said, under

very active review. I agree that it is not equal to all. We've been

looking at it very carefully, and we hope to be able to resolve it over

a period of time.

[Mr. Ree in the chair. ]

MR. COCKE: Mr. Chairman, I smile just slightly when I hear

that discussion. I recall some of the negotiations with the federal

government going back to 1971, '72, '73, '74 and so on. Of course, the

federal government's first offer — and I'm dealing just for a moment

with this whole question of financing — tied their contribution to the

gross national product. The gross national product in those lush days

was somewhere around 5 to 6 percent. The cost of health care was

increasing at a rate of something in the order of 13 percent. So

naturally all the provinces were a bit shy of that and resisted it.

Then along came Alberta and Ontario with their massive tax bases, and

they were talking about tax points and the grants. When the new B.C.

government took over in 1976, they fell right in with it, because at

that time we were a have province. They thought: well, as long as we're

in this great position, the Maritimes can sort of take a back seat and

so can the Prairies. We argued at the time that Ontario was pushing

this; that it was going to be unfair for people with a lower tax base.

Now I see that we're starting new negotiations. I certainly concur

that there should be new negotiations, but these are the kinds of

negotiations that should have been happening right from stage one.

Ottawa has been able to leave us with this particular heritage. I also

think that while there is the provincial responsibility, as long as the

feds are participating to the extent that they are, they should be

participating in a far more active way — not delivering services, but

participating in terms of planning. There's just too little of that

being done at the cooperative level — in other words, at the

federal-provincial level. Sure, the ministers of health meet and the

bureaucrats meet from time to time, but there isn't enough health

planning done in this country.

One other word, just before I get on to one subject that I want to

deal with, mainly in my first moment or two here, and that's the whole

question.... I listened to repartee going on between the Minister of

Health and the member for Burnaby North (Mrs. Dailly). She was talking

about "behind closed doors," and he was saying: "Show me some of those

closed doors." I'll show you a closed door — sitting right in that

corner. The kind of closed door that I find absolutely reprehensible is

when the Minister of Health tells the member for

Maillardville-Coquitlam (Mr. Parks): "Give us the appointments for the

Royal Columbian Hospital board, and they'll all be on." Not one of them

is living in New Westminster. Mr. Chairman, that's the kind of thing

that we see and absolutely abhor. Royal Columbian Hospital and Eagle

[ Page

5811 ]

Ridge, and all the rest of them, will suffer as a

result of that kind of decision-making. Those are the kinds of closed

doors I see.

Getting back to a much more friendly and affable situation, Mr.

Chairman, today the minister and some of his colleagues met with the

B.C. health professionals' association, and they made certain

suggestions about some kind of title protective legislation. I'm going

to ask the minister a few questions vis-a-vis this. I note that in 1980

the then Health minister, Rafe Mair, said that work on proposed

legislation had been going on for a long time, but added that he didn't

know when it would reach the Legislature. Well, it still hasn't reached

the Legislature.

Interjection.

MR. COCKE: The member for Maillardville-Coquitlam (Mr.

Parks) may find his tongue so that he can stand up and give a speech in

the House, and when he does that maybe we'll listen. Right now, from

his chair, he's making no sense whatsoever.

Mr. Chairman, this kind of legislation is required not for those

health professionals but for the protection of the people in B.C. Many

of them have become far more responsible of late years in terms of

their requests, because they have seen, because of past licensers that

have occurred, that it's a licence to exclude. It's the kind of thing

that is a real moneymaker. But that's not what they're asking for at

all. One of the things that I'm very gratified about is the fact that

they agree — incidentally, I wish that they would agree exclusively;

they say either would be acceptable — on either individual legislation

or umbrella legislation. I think the minister knows my feelings about

that.

As far as I'm concerned, umbrella legislation is the only way to go

with respect to this. We should include.... I'm not talking about the

doctors and the nurses and so on; I'm talking about this level of

professionalism. People included are the public health inspectors, most

of whom probably work for the minister; nutritionists; dietitians;

occupational therapists, which is a real irony if I ever saw one —

occupational physiotherapists have their own act and occupational

therapists don't — respiratory therapists, cardiology technicians and

speech and language pathologists. I see no reason that the kind of

legislation that they are asking for couldn't be very simply put

forward.

Of course the minister can say that there are all sorts of other

people that want that. But the way to protect the ministry in this

respect is through umbrella legislation, which incidentally leaves the

door open sometime in the future for other groups that have attained a

level of professionalism and are required by the health system to be

enrolled at that time. Other Canadian jurisdictions have gone for this,

like Alberta and Ontario. We all know that. The reason that they've

gone for it is because of the fact consumers can evaluate. Today, if I

want to hang up a shingle and say that I'm a dietitian or a

nutritionist or any other kind of ist....

HON. MR. NIELSEN: Insurance agent.

MR. COCKE: Yes, or even that. You know, one of the things about that

is the fact that they're doing it. They're doing it right along. People

are giving the impression that they have a lot more to offer than they really

have. I suggest, let them go through the hoops, go through the courses, be able

to meet the standards, and then be recognized. We're not saying we want

to get rid of caveat emptor at all. But once you have that, it is buyer beware

of anybody else that's trying to elicit their customers in those fields

— but they're going to have to use a different name to do it. I think it's

important. So at least then consumers can say that the government has given

us some kind of leadership with respect to how they, the consumers, can evaluate

whether or not they're going to be looking forward to the level of care

and service that they want.

Health care, I guess probably, along with many others areas in our

complex society, is becoming increasingly specialized. Because health

care is so tremendously important and because it's so sensitive in this

respect — that many times lives depend on the level of care that's

being offered — I think that it's time that we came into the new ages

with respect to this very simple, I would say, title protection. It's

certainly going to take some decision-making with respect to who comes

in and who's excluded, but I believe that it's time that that happened.

Standards are essential in health care. So I ask the minister, as

Rafe Mair was asked five years ago and as I was asked ten years ago:

when can we look forward to this kind of protection, not of those

people but of the public that we serve as legislators?

HON. MR. NIELSEN: I'd be very interested to know what the

member said ten years ago. However, we also heard from the association

today made up of the organizations the member for New Westminster

identified. Mr. Chairman, I think it was a very impressive presentation

today. There's been something very important which has been clarified

or altered in the last year. I had previously met with many

organizations and associations who represent health care areas, and I

think probably what caused some of the difficulty was the different

attitudes several of the groups had as to what they were after and what

they wanted. I think it's been clarified by them joining together as a

group — many of them at least — and zeroing in on title protection and

some other ability to discipline members or seek certain standards for

their own members.

Previously I had talked to some, and they did not necessarily have

the authority to speak for their association, but they took it upon

themselves to speak. They were seeking exclusive authority in certain

areas. They were seeking automatic enrolment in the Medical Services

Plan in certain areas. As I told the group today, I think their

presentation now has been clarified, and I think it's very supportive.

But I made it very clear that there were two points that had to be

understood. One was that it does not give them a monopoly or an

exclusive right to that area; nor does it mean automatic entry to the

Medical Services Plan.

The umbrella concept, I think, is by far the best of the two routes,

because it can be expanded. You can incorporate other organizations

into it, rather than as it was done in the past when it was strictly ad

hockery and whoever happened to lobby hard and long got the

legislation. But, Mr. Member, there is also, I think, something very

important for the citizens and for the organizations, and that is not

to imply, simply because they have some type of legislative protection,

that it suggests that they are approved by government. That's a bit of

a problem we were considering as well. We don't want people putting out

a sign that says "government-approved nutritionist," or whatever the

discipline may be.

[ Page 5812 ]

[4:15]

But I agree with what the member was saying in principle: that the umbrella

concept, the title protection idea and some of the other attitudes have been

well thought out, well planned and well presented. I would think, Mr. Member,

since it wouldn't be my bill, I don't believe — not if it's the

umbrella.... I don't think it would necessarily be my bill; it might

be one of the more legal ministries. I would think there would be every good

chance we would see that produced this session — I would hope. I think that

the point's been well made, and I would think that it's quite possible

we may see it this session — finally.

MR. COCKE: I sure welcome those words, Mr. Chairman. I would,

however, suggest that if you want to get it in this session you don't

make it outside the Ministry of Health. Why not have ministries take

responsibility for their own paraprofessionals, professionals or

whatever? Because if you do it the other way, paralegal people,

para-this, para-that, before you know it, you're in mire up to your

armpits. Let the ministries responsible look after their own particular

area.

I think there are significant numbers of people in the health field

who require this kind of legislation. I'm not suggesting to the

minister for one minute that this is endorsement. What you're doing

here by title-protective legislation is seeing to it that the public is

served to the extent that when they go to a dietitian they know they're

not going to a food faddist; when they go to an occupational therapist

they're not going to someone who has no training, nothing really to

offer.

Anyway, I'm really delighted that the minister has taken that

position, because we will took forward to that kind of legislation. The

minister can be assured that within reason we'll certainly support it,

because we feel that it is time. The frustration that has happened....

I noticed the minister was somewhat snide about the fact that nothing

happened when we were government. Let me tell you what happened. We

were three years and four months in government. Social Credit have been

in government for 30-some years. We'll be there again, Mr. Minister,

and it will be a lot sooner than you think. But that's neither here nor

there. The fact of the matter is, we just didn't have time. I'm not

suggesting that we didn't have some of the problems that you had until

recently. I believe that they have come up with a lot easier question

to answer than what we were asked before. Virtually every group that

came to my office were asking for the ability to license, the whole

comprehensive thing, put them in the same class as the College of

Physicians and Surgeons — and heaven help us, we don't need a lot more

of those colleges.

That's about the size of it. Anyway, I'm delighted. I don't know

whether my colleague wants to pursue the hospital situation, but I

think I'll let her pursue that, and then I have a few things that I'd

like to say about some of the areas that have come very close to me.

MRS. DAILLY: Yes, back to the hospitals. The minister

mentioned earlier in reply to a question that there were over 1,000

empty beds — I can't remember the exact number now; 1,700, whatever it

was — in the province. I guess he was making the point that a lot of

that press hysteria about not having enough beds was probably not

valid. But we didn't get a chance to carry on with that, and I'd like

to move into that discussion now.

I wonder how many of those beds are not in use.... When you say beds, do

you mean they have the correct staff for the bed? The whole thing? That's

what I wanted to know. That's answered that question.

I understand you have a five-year plan for capital projects. The

minister is laughing; maybe we can find out why. Oh, he has. Could the

minister then give us a list of the capital projects in order of the

priority in which you are planning to establish these? Have you got any

lists? We were talking before about long-term planning. It would seem

to me that if you're embarked on a five-year plan for capital, that's

good. Maybe you could give us some idea of your priorities and the list

of the projects.

Then I want to carry on and go into some more specific problems in

various hospitals around the province, because the minister has said

over 1,000 beds are there. There are empty beds, so there's something

not quite right here with many of the other materials that many of us

in this House have been receiving from different areas of the province

who were expressing concern about a shortage of beds. So perhaps we can

deal specifically with the minister to try to clear this up.

I'd like to start with the Prince George hospital. I think we all

know how important it is, and it's a very busy regional hospital. The

figures that I have point to the fact that there is a deficit held over

from last year, that they've already cut back beds and staff — as have

many, of course — and that they still have a long waiting list. It's

grown by 200 to 300, and last year it was 2,000. Can the minister

explain that situation in Prince George? Is it accurate? Are you

concerned about it? What's going to be done about it? Because the

Prince George one still keeps coming up.

I would also like to ask a question about the Surrey hospital. I

know that one of the members from Surrey is here. The Surrey hospital,

I understand, will have a deficit also from last year, which it will be

able to cover from the previous year's surplus; we are aware of that.

But apparently in Surrey there are 1,200 on the elective surgery

waiting list. As to Surrey, I'd also like to ask whether money is

available for their new emergency facilities. Actually, I'd like an

update on the Surrey situation, which is another area about which we've

had reports of some serious problems. This is another growing

municipality, of course, where this hospital situation could cause

severe problems, so I wonder if we can have the minister explain and

tell us how he feels about that. Has he any update on it.

In my own area of Burnaby we still have 33 beds closed. We

understand that there's more stress with staff, and absenteeism due to

stress levels and harder workloads. There's a gradual increase in

Burnaby Hospital elective surgery waiting list. I know that Burnaby

Hospital, similar to the other hospitals in B.C., still.... Maybe

you've sent out their information but to my knowledge, from when I last

contacted any of them, they didn't know what their grants were. I know

that most of them were down to the bone, so they are very concerned

about the new grants. Once again I'll ask the minister: have they been

informed of their grants to date?

I wonder, therefore, before I go on with further questions which are

too specific to give all at once, if you could reply on the five-year

plan, on what the situation is with the Surrey hospital and the Prince

George hospital, and on anything on the Burnaby Hospital situation.

HON. MR. NIELSEN: Mr. Chairman, we have attempted to have a

five-year plan for a number of years. Because of the recession, capital

projects came to a grinding halt. The five-year plan was, in effect, in

suspension, being

[ Page

5813 ]

retained on a five-year program. We have

approximately 50 major projects in various stages — some at only the

conceptual stage; some in planning — that have been requested of the

ministry from the hospitals in the province. The requests for capital

amount, I think, to about $875 million. We have not developed a precise

list in priority from 1 to 50, because we recognize that the size of

the project may have a bearing on its capacity to be approved, where

some are much smaller.

Prince George Regional Hospital. I'm not sure what the member was

referring to, precisely. I know I've received a communication from the

Prince George Hospital just recently — I don't have it before me — and

they advised me that they were doing very well and that they were very

pleased. They've had some difficulties, yes. As an example, Madam

Member, you mentioned about the vacant beds. On April 17 they had 31

available beds for patients, which is well over 10 percent of their

capacity, The Surrey Hospital, on the same day — and Surrey is a

growing and busy area — had 23, and Burnaby, a very good hospital, had

at the same time 35 available beds, approximately 10 percent.

The Prince George Regional Hospital has claimed that funding

restrictions did not recognize the high cost of their operating budget,

which resulted in a deficit in 1984-85 and prevented beds being

reopened to correspond with their surgical waiting list. The hospital

is rated at 350 beds. Because of fiscal reality in 1982-83, the board

decided not to open their rehabilitation unit and to operate at 286

beds. Additional acute beds were closed in early 1984-85 without

ministerial approval, which left 270 in use.

In February 1984 I approved the hospital's request to reopen 18

surgical beds and one operating room for three months with operating

costs covered by their surplus from 1983-84. The hospital was unable to

recruit staff so the operating room was open part-time. Thirteen beds

were reopened between April 1 and June 30 of that year. Additional

funding was also allowed for increased day surgery, but the hospital

did not achieve their anticipated workload levels. The hospital opened

12 additional extended-care beds on April 1, 1984, without required

pre- authorization. The ministry staff visited the hospital — this is

Prince George — and funding was approved for the balance of 1984-85.

Combined with a small upward adjustment for increased workloads, lost

ultrasound revenue and a reduction for unachieved day surgery, the

annual grant was increased by $206,000.

Mr. Chairman, I might add that this procedure, which was introduced

a couple of years back, has proved most effective. It is a quarterly

review of each hospital's operation by various teams or upon request of

the hospitals. This information I just offered you is an example of the

frequent results of the quarterly review; that is, an in-depth audit of

their operation, and modifications if they're required. In this case

the Prince George Regional Hospital picked up an extra $206,000.

[4:30]

In February 1985 the regional team again visited the hospital, and

an allowance of $60,000 will be added to the base effective April 1,

1985, to fund 200 additional surgeries a year. In addition the hospital

will receive $101,000 for unexpected inflation of medical surgical

supply costs in 1984-85, with approximately half of this remaining in

the base for 1985-86.

Prince George Regional Hospital is operating at a high occupancy in surgical

and medical beds. The surgical waiting time is increasing. However, waiting

times are not much out of line with other large hospitals in the province. The

additional surgical allowance of $60,000 should ease the situation. The hospital

is also one of the most expensive to operate in their peer group. We believe

the hospital can operate within their budget for 1985-86.

But, Madam Member, I believe the Prince George situation

specifically was responded to by the regional teams, by those who were

responsible for investigating, and I think they did a pretty good job

in resolving it.

Surrey Memorial Hospital has requested some modest redevelopment.

They've also asked for some new extended-care beds and acute-care

expansion, so Surrey has a large shopping list, as it is a growing

community, although many of the residents of Surrey are well-served by

surrounding area hospitals.

Burnaby Hospital does have a request, I think, for extended-care

beds. Burnaby Hospital has asked for a 125-bed extended-care unit.

That's their present request for capital. They're after extended-care

at the moment. But Burnaby Hospital's biggest request right now is for

a CAT scanner,

MRS. DAILLY: I thank the minister for that detail. I think

the hospitals out there will be pleased to get some.... Maybe you've

talked to them anyway; I don't know. But I'm sure that there's some

information there that may be helpful to them.

I would like to make a few more points, though, about the Prince

George area and the lack of physiotherapists. I'd just like to make a

point that the whole thing is very ironic — I'm sure the minister

agrees with me — that there was a suggestion of cutting back on

physiotherapists at UBC when at the same time they are desperately

needed in areas such as Prince George and elsewhere. I think the

minister would agree with that. I wonder if you have anything up to

date on that. Have you discussed it with the Minister of Universities

(Hon. Mr. McGeer)?

The other point I wanted to bring up with the minister is about the

Kelowna General Hospital. We understand that your ministry gave an

ultimatum to the Kelowna General Hospital to stay within its budget for

the fiscal year, or else. The executive director told the board members

in early March that it seems inevitable that we'll have to contemplate

major cutbacks in beds and services, and that it would be unrealistic

to think otherwise. Really, what I want to find out from the minister

is whether the situation is as serious as the executive director says.

Has it become common practice now for your ministry to deliver these

ultimatums, the same as are emanating from the Education ministry?

[Mr. Strachan in the chair.]

HON. MR. NIELSEN: Mr. Chairman, we offer the hospitals options, hardly ultimatums. We offered them a variety of options.

The situation in Kelowna is not as alarming as some people want it

to appear, Madam Member. It is also part of the bargaining. When we get

near that time of year when budgets are being established, some people

make much more noise than they would otherwise.

We have completed a line-by-line analysis of the Kelowna General

Hospital. That line-by-line analysis determined that the workload of

the facility justified a $400,000 increase in their funding allocation.

The line-by-line, which

[ Page 5814 ]

they requested, showed that they were justified in

seeking an additional $400,000 increase in their funding allowance.

Part of the problem at the Kelowna facility was that they were running

a deficit in excess of what we felt was reasonable. We believe they can

operate within their funding allocation for 1985-86, as a result of a

$403,000 increase in their funding allocation and some additional

efficiency measures which are to be implemented by the hospital. We

were there recently and advised them. Some changes were already made. I

think the Kelowna situation has settled down reasonably well.

Physiotherapy in the Prince George area. I'm told by my deputy that

we are actively recruiting to try to fill these positions. I agree with

the member, and I've made my point to the minister responsible for

universities. I think I said it in the House: physiotherapists,

audiologists and some of these other health care people are required in

certain areas of the province. We should at least attempt to train

enough to fill what we anticipate our need might be. Even though that

doesn't guarantee that they will work in those areas, it gives us a

better opportunity. I think the universities would be irresponsible to

cut back on those courses; if the universities wish to give me the list

of courses offered, I'll make other choices than those. We'll start

with political scientists: one of the categories of people we really

don't need too many of.

AN HON. MEMBER: Lawyers.

HON. MR. NIELSEN: Lawyers. Sorry. No offence.

Mr. Chairman, the physiotherapy. I agree, it's a double problem: we

don't train enough, and it's very difficult to recruit these people to

remote or northern areas when there is an opportunity for employment

elsewhere. It's very tough.

If the member for Prince George were here, I'm sure he would be

interested. One of the areas that has been suggested to us to relieve

some of the pressure on the Prince George hospital, because it is a

regional centre, would be to give very serious consideration to perhaps

upgrading and expanding the hospital at Mackenzie. So that has been

received from the member responsible for Mackenzie, the other member

from the Prince George area. We're looking into that as well. I think

that the situation is in reasonably good shape.

Did you wish to ask about a CAT scanner too?

HON. MR. HEWITT: I appreciate the invitation from the

minister. He's well aware that there are two proposals in my area. One

deals with a mobile CAT-scan vehicle that would provide service

throughout the area. With the technology today, I'm told by Dr. Karr

and other representatives of the medical profession that the vehicle,

the mobile CAT scan, can achieve equal quality to a stationary CAT-scan

piece of equipment, and it could serve the interior of the province —

the Okanagan Valley and, I would say, through the boundary country and

possibly into the Kootenays — providing regular service not only to the

hospitals but to the doctors in that area, and certainly to the

patients who need that service. I'd just like to support the efforts of

the medical association in my area, and the submissions that have been

made to the minister, asking him to seriously consider the possibility

of placing a mobile unit in the Okanagan.

Secondly, Mr. Minister, since I'm on my feet, I would also like to again

indicate my support for the establishment of a cancer clinic in the Penticton

area at some point in the future. We have a number of specialists at the Penticton

Regional Hospital dealing with cancer patients. The environment of the Okanagan

is, in my opinion, second to none. It certainly provides an area where not just

the patients, of course, could enjoy the climate while going through some pretty

traumatic experience, but their families as well would come to that area. I

think it's fair to say that the Okanagan is fairly central and could serve

that part of the province through from the Kootenays.

As I say, we have the medical expertise there, with a number of

specialists. Also, it's fair to say that statistics prove that cancer

strikes the elderly..