Social Services Committee

2009-05-06

Newfoundland and Labrador — Committees

May 6,

The Committee met at 9:00 a.m. in the Assembly Chamber.

CHAIR (Collins): Mr. Minister, before we begin, do you have any people

with you this morning that were not here at the last meeting that need to be

identified?

MR. WISEMAN: Yes, Ronalda Walsh, who is Director of Communications. She

is joining us for the first time today.

If you also notice a bunch of empty seats, I have a deputy minister and two

ADMs out today with the flu, and it is not Swine. Another deputy is actually

working on the Swine file. Any expertise they would have brought this morning, I

apologize for their absence but it is unavoidable. If there are some questions

that I cannot answer for you that ordinarily they would, I will again undertake

to provide the information for you later.

CHAIR: Ready for questions?

The hon. the Leader of the Opposition can start off?

MS JONES: Thank you, Mr. Chairman.

I thank you minister and your officials for making some more time available

to us to finish these Estimates.

Under

section 3.1.01., which is where I think we ended the last time. We did

not quite get through that section, but that is related to the Regional Health

Authorities and the services they provide in the Province. Were there any

increases in the base budgets for the health boards around the Province this

year?

MR. WISEMAN: This year the total base increased by $163 million.

MS JONES: Do you have a breakdown of that per board?

MR. WISEMAN: The amount per board, the Eastern allocation this year is

$968,899,209; Central is $243,972,516; Western is $241,215,763, and

Labrador-Grenfell is $116,174,478.

MS JONES: I am just wondering about the $163 million.

MR. WISEMAN: The distribution of the new money?

MS JONES: Yes.

MR. WISEMAN: Okay. You want it broken down by individual board, didn't

you?

MS JONES: Yes.

MR. WISEMAN: Okay. I have a

summary by program area, but let me get it

for you by board. I will forward that to the Chair for distribution.

MS JONES: Okay.

I might have asked you this question last time, but I did not see it in my

notes. What is the accumulated debt of the boards now?

MR. WISEMAN: That was one of the things I distributed for you this

morning, actually.

MS JONES: Okay.

MR. WISEMAN: Let me go to my copy here.

MS JONES: I seen something about $118 million

MR. WISEMAN: One hundred-and-eleven million.

MS JONES: Okay, that is what it was.

MR. WISEMAN: That was one of the grids I distributed this morning.

MS JONES: Okay, good.

MR. WISEMAN: On that grid, when you get it, it breaks it down by each of

the authorities.

MS JONES: Okay.

In terms of the separation of the two departments now, will that have any

impact on the board's service or structure, or is that just going to be divided

per government structure? Do you know what I mean, because right now Child,

Youth and Family Services all fall under the authority of the health boards.

Will there be any change in how those services are provided or delivered in

terms of that mechanism?

MR. WISEMAN: I think I might have indicated to you the last time that we

are very much in the preliminary planning stages of and the new minister,

Minister Burke, has a team with her. We put in place a transition team to make

that transition from Health and Community Services over to the new department.

There is not a lot of detail that I can provide for you today because a lot of

it is being worked on. To start speculating a little bit prematurely about what

that might look like I think would create some anxiety by some staff,

potentially, and maybe by some of the clients.

Clearly, what we are trying to do here is to make this transition seamless

for the clients that are being served. That is the critical consideration.

Secondly, to do this in a fashion so that it does not create a lot of anxiety

for staff. Any time you announce a change in structure, a change in how you are

going to do things, or a change in potential employers, there is always those

number of questions that staff would have and we are trying to address those as

we move through.

Those people who work in the Department of Health and Community Services, as

a line department of government, will move over to the new line departments.

That is kind of a given. How that rolls out into each of the authorities, we

understand, clearly, that the responsibility for the delivery of the programs

and services will rest with this new department. The direction will come from

that new minister, and that department will provide the leadership in that area.

Obviously, if today the Regional Health Authorities are responsible for the

delivery of those services than there is going to be some impact at the health

authority level. It would be premature for me to speculate today what that might

look like. There are some obvious ones potentially that could happen, but I

would rather have the new minister roll out what the new department's structure

would look like because now we are going from four Regional Health Authorities

to a line department. I would leave that to her to roll that out for the people

of the Province and for the employees involved. We have put together the

transition team. It includes some people from the Human Resources and the Public

Service Secretariat who deal with some of those HR type issues.

As we speak today, there is no change on the ground at any one of our four

authorities with respect to how services are delivered. That was a critical

first consideration for us. We are hoping that in the not too distant future the

minister will be in a position to provide some initial commentary as to the

findings and the views of the transition team and some time sequencing of those

changes that will occur.

MS JONES: I guess my only concern around this, because I do agree with

separating it and having a separate department. I think it is a good idea and it

needs to happen. I guess my only concern is from an administrative perspective

and a physically located or base perspective is that those things could end up

costing us more money but not improve the services on the frontlines to people.

That was my only concern, because now where it is all done under the Regional

Health Authorities most of them are incorporated in spaces within those health

care facilities and so on. So you got into that additional cost of building

buildings, opening new offices and having a different administrative regime for

supervision and so on. That would be my only concern. Any new monies that were

going to be spent, I would prefer to see it spent in programs and services in

frontline delivery.

MR. WISEMAN: Now that I know the basis for your question, there is, in

this year's budget - and I think we addressed it the last time we met - there is

money this year to focus on programs. So there is investment this year in

programs and services and that is earmarked in the budget itself.

Ms Michael asked a question around the money for transition because it was

buried in a big chunk of money there. It was a couple of million dollars that

was set aside to facilitate a transition. It was done intentionally so as not to

take - because you know there is going to be some cost associated with making a

transition over. There are some of the obvious ones that we think about. The

transition team, for example, will be engaged in the transition piece but we

believe the operation will need to continue so we need to fund up to be able to

support a transition team to make sure this is done seamlessly. We wanted to

ensure that there was none of those transition costs pulled from the programming

side and that is why that figure was allocated, purely for transition.

The issues around the on a go-forward basis, right now today the new

department is not out running around looking for new office space to move every

one of those people out into new locations. Many of those current operations are

within Health and Community Service offices. Some of them are in offices that

are shared by mental health or addictions or community health nursing but they

have their own separate space within the four walls of a building. We have

talked about this whole piece of co-location and how that might continue. It is

not an uncommon thing to find in many office buildings, a variety of companies

exist in the same office buildings here in the city or anywhere for that matter.

So it is quite conceivable that Child, Youth and Family Services could co-locate

within buildings that are now leased by or owned by Health and Community

Services. In the transition plan, there is no immediate plan to start now

running out and every where we have a location with Child, Youth and Family

Services to acquire a new space in that community or in that region.

MS JONES: In the Estimates there is a vote for allowances and assistance,

normally what is that money used for?

MR. WISEMAN: Under this heading here?

MS JONES: In 3.1.01., it is over $9 million.

MR. WISEMAN: That would have been, the changes associated with that - for

example, we have the Medical Transportation Assistance Program is in that area

there, bursaries that we provide to physicians and dentists. The supplements and

bursaries that we provide to early childhood educators are in that category and

we have some money in that category for some human resource workforce planning

initiatives.

MS JONES: Okay.

Your debt expense, what does that refer to?

MR. WISEMAN: The debt expense actually, you should be familiar with

that one.

MS JONES: I might be.

MR. WISEMAN: That is related to the Port Saunders and Burgeo and St.

Lawrence buildings that were built as a part of I do not know what kind of

financing arrangement there was. They were built by the private company, and

government is servicing the debt.

MS JONES: Oh, the public-private partnership.

MR. WISEMAN: Lease purchase - that is the terminology - the lease

purchase piece that were built as a part of a block a number of years back.

MS JONES: Okay, so that is the amount that goes to pay the debt on it, or

the lease on it, is it?

MR. WISEMAN: That is right.

MS JONES: Okay.

What were the leases on those facilities, twenty years or something or

twenty-five years?

MR. WISEMAN: I am not sure. I can find that out for you. I was not being

cynical when I said you should know that, but that was something that was done

by a former Administration that was subject to some public criticism.

MS JONES: I remember it, but I do not remember the details of it.

MR. WISEMAN: It was quite a long time, twenty or twenty-five years, but I

will find out exactly for you.

MS JONES: So it was Grand Bank?

MR. WISEMAN: No, Port Saunders, Burgeo, and St. Lawrence were the three.

MS JONES: Okay.

MR. WISEMAN: They were all done about the same time; they are part of the

same agreement. If I am not mistaken the same company got the three of them,

didn't they?

OFFICIAL: (Inaudible).

MR. WISEMAN: Yes.

MS JONES: It must be a good concept; you are doing the same with ferries

now in the Province. Your government is doing the same thing with ferries now,

lease back agreements with the private sector.

MR. WISEMAN: I will let the Minister of Transportation comment on that

one.

MS JONES: I do not know if it is a better system or not. I guess the only

thing is, it was a means where you did not have to produce a lot of capital cost

up front and you could still get the service, but over the long term I do not

know if you pay a lot more money for it or not. Have you guys done any analysis

on that?

MR. WISEMAN: We have not done it as a department, no; we have not had any

reason to. The investments we have made in recent years, we have been able to

make those investments from cash flow, and we have had the benefit of having

some money to be able to do all those capital investments without having to look

to alternate ways of financing it, but when you start financing it seems like it

becomes - can become - I should not say it becomes but can become, extremely

expensive in the long haul.

MS JONES: Are these the only three health facilities that are being

leased in the Province?

MR. WISEMAN: There are office spaces we have around the Province. The

Health and Community Services Department would have a couple of spaces in St.

John's that it leases. Then each of the four health authorities, for some of the

community-based programs, would also have some leased space around, but in terms

of the community health clinics and hospitals and long-term care homes, these

would be the only three that would fall in that category.

MS JONES: When it comes to renovations of health facilities in the

Province, do the boards have to have the approval, or do they get block funding

and they decide where they want to do renovation work? How does that funding

work?

MR. WISEMAN: What happens in the budgetary cycle, the health authorities

identify what they need, and their estimate based on it for the maintenance of

the building, capital upgrades. If there are specific projects that are large

dollar amounts like, for example, this year there are renovations being done

to St. Clare's Emergency Department, and renovations being done to the Cancer

Centre, and the order of magnitude is around $3 million, I think it is, for each

of them. These are larger ticket items, and they would have come in for a very

specific request for that, and we would have dealt with it through capital

funding rather than a maintenance and operations budget.

Generally, the boards manage their own maintenance and repairs. Last year, we

would have had a block identified that would have been given to the boards as a

result of a report by the fire commissioner wanting to make some upgrades. That

was a block of money that was allocated, that was dealt with as a part of the

approval process; it was earmarked for those projects. In addition to that, we

would have given them a block of money that they would have used to carry out a

bunch of renovation projects.

I say renovations, but it might be upgrades to the systems that they have, so

it is not necessarily building on or expanded or remodelling; it is making

improvements for safety reasons in lots of cases.

MS JONES: The report that was done on the health care facilities in the

Province back a year-and-a-half or two years ago, I think it was maybe a

year-and-a-half ago talked about the renovation work that was required for the

Waterford Hospital and St. Clare's. I think it was ten different facilities that

were included in the report. I am just wondering where government is in that

strategy to deal with that infrastructure work. I am assuming what you are doing

with the two you just mentioned was part of that, but

MR. WISEMAN: Referring to it as a report, I just might want to qualify

that a little bit. What you are referring to, Eastern Health had a software

package that they use for building maintenance. It is a software package that,

really, every electrical and mechanical system and every wall that has been

painted and every fixture is entered into the system. When it is entered into

the system, you identify it as a date of acquisition, or the date that the work

was complete. Carpets got laid, so you lay carpet today and if it should wear

out in ten years' time then it is in the system as being acquired today, laid

down today and the expected date of replacement is a date plugged in there. It

is a tool used to manage their day-to-day maintenance operations of their

physical plants that they have. It is not a report per se, as someone going in

and doing an audit and summarizing what is in place today, but it is a tool used

ongoing. That is the nature of the document that you are referencing. In that,

Eastern Health are able to identify and forecast what their projected

maintenance and repair costs are going to be over a period of time.

What we are doing now is, through last year's budget and particularly in this

year's, providing the capital money - not just capital, necessarily, but the

funding necessary for them to carry out that kind of work.

The money we allocate, there are a couple of things for consideration. I know

last year we had some discussion in the House here around whether it was enough,

and whether we should be dumping more in given the order of magnitude.

We have to recognize a couple of things. One is capacity of the system to be

able to do a certain amount of work. Eastern Health, for example, at the Health

Sciences might have $30 million or $40 million worth of work to be done within

the four walls of St. Clare's, but St. Clare's still has to operate while they

are doing that, so they will do a piece of work in one location and then be able

to modify their operations to seal off that area while it is being done. When

that is done they will move onto another area, so there is only so much capacity

within any one of our buildings to be able to handle so much work at any time

without completely shutting the service down.

What we are trying to do is to fund them at a level that is consistent with

the capacity they would have to actually carry out the work. This year, the

total investment in maintenance repair, Jim, was $40 million? This year it is

$40 million, and last year it was somewhere in the order or magnitude roughly

around the same thing, if I am not mistaken. They have the capacity to be able

to do that kind of work or that level of work, and that is where we are funding

them.

MS JONES: Actually, I am just noticing now under

section 3.2.02 - not to

skip over Health Care Facilities, it looks like last year you budgeted a great

deal of money that did not get spent as well. That is where that line item would

be, I guess, is it?

MR. WISEMAN:

Section 3.2.02?

MS JONES: Yes.

You budgeted nearly $40 million last year that you did not spend.

MR. WISEMAN: You are looking at 3.2.02.05?

MS JONES: Yes.

MR. WISEMAN: I just want to separate out here the piece - this deals with

the health facilities equipment. This is a capital piece. So this would be the

announcements for the new long-term care home in Corner Brook, the construction

costs. The maintenance repair piece is back under the operational piece, under

the previous

section we are dealing with. So the capital pieces for the major

capital projects are in this

section 3.2.02.

MS JONES: Okay.

MR. WISEMAN: Included in the Grants

section over here under Health

Authorities is where you will find the $40 million for the maintenance and

repairs. That is an operational piece and it is included in the operational

grants for the authorities.

MS JONES: Okay. In this section, under 3.2.02., it is for new capital

infrastructure?

MR. WISEMAN: Now we are into the capital piece of work. Actually, even

though I illustrated it as a piece of work being done, the St. Clare's project

and the cancer project would be in this

section right here because they are $3

million projects. So that would have been included in this capital.

MS JONES: Okay. So last year you did not spend the money, why was that?

MR. WISEMAN: It was a cash flow issue. What we do is we do a let's use,

as an example, last year in Corner Brook long term care. In the budgeting

process last year I believe we forecasted that we would have that project pretty

well concluded in this calendar year. So our cash flow would have been to

deplete - whatever that was leftover in that project we would have said we are

going to spend it in this fiscal year we are in. We are now finding that work

did not progress as fast as we thought and now we are forecasting that rather

than finish up the long-term care in Corner Brook in what was meant to be

December of 2009, is now going to be some time into the first quarter of 2010.

What you are looking at in 3.2.02. is not the value of the projects in

question but the cash flow requirements for those projects in this fiscal year.

We include in our fiscal forecast the value of the whole project but then we

we will use it as an example, we are talking about Corner Brook. Corner Brook

long-term care, we had forecasted to spend $4.5 million in 2008-2009, and we are

on target for that but we thought that was going to wrap up the

OFFICIAL: (Inaudible).

MR. WISEMAN: I have the wrong one; I am sorry, wrong line. Here it is

here.

We have forecasted to spend $32 million and we are only going to spend $23

million as an example because of a cash flow demand, but the total value of that

project was about $80 million.

MS JONES: Yes. What is happening with the Hoyles-Escasoni project, to

replace that complex?

MR. WISEMAN: Those buildings will be similar in design and there will not

be many changes actually, I should say, to what is in Corner Brook. What we are

doing is we are going to be constructing two new homes, two separate buildings,

and the model we are using is the long-term care home in Corner Brook. We are

about to - in the coming weeks we should be concluding an exercise that will

allow us to identify and announce the site where they are going to be built.

There have been site assessments done on a variety of locations. So we should be

in a position in a couple of weeks to announce the location of those. We want to

be able to proceed around that same time then to appoint a design consultant to

work with us and manage the project.

The intent would be, if we stay true to our targets here, we want to be in a

position to call a tender for some site work this year and because the design,

the substantive piece of the design work is now already done because of the

Corner Brook piece of work, that we are going to model these after the one in

Corner Brook. So we should be able to start physical construction of the

building then in the spring.

MS JONES: Yes. Now, that will not increase capacity? That is just

replacing the existing capacity will it?

MR. WISEMAN: There will be some increase in capacity. It is not just a

bed for bed; there will be some slight increase in capacity.

MS JONES: Can you tell me what it is?

MR. WISEMAN: Some design considerations are going to be - because

remember I said we are going to replicate what we have done in Corner Brook in

terms of the building design? There were a couple of changes because - in Corner

Brook, for example, they have a wing that has been dedicated to the university

there. That is the research piece there, and they have taken some of that

building. There are a couple of other provisions for certain services in Corner

Brook that will not be in this facility here, but yet, at the same time,

Hoyles-Escasoni also has a young adult population that Corner Brook does not

have. So that will require some programming adjustments. Before we start talking

exact bed numbers we need to look at the programming changes and the

implications on beds then.

MS JONES: How many beds are in the Corner Brook one, the long-term care,

the new one?

MR. WISEMAN: Does anyone have that number?

(Inaudible) the number is about two-thirds, but I just want to make sure that

I give you the exact number because in the discussion around the long-term care

in Corner Brook - because there was these dementia bungalows that were built.

There was a total number that was being used in describing the capacity that was

going to be in Corner Brook but that number included the dementia bungalows. I

do not have break it out for you before I gave you a definitive number.

MS JONES: Okay.

MR. WISEMAN: Over 200.

MS JONES: The one in Corner Brook, was that increasing the capacity of

the existing facility at all?

MR. WISEMAN: I think the very marginally, but some.

MS JONES: Okay.

What is the status with Clarenville and Goose Bay for the opening of those

facilities?

MR. WISEMAN: The Clarenville residents have moved into Clarenville.

MS JONES: Okay.

MR. WISEMAN: Goose Bay I understand is progressing on target, and they

are forecasting to be finished by the end of this calendar year. Corner Brook

is, as I said a moment ago, that is now moved out into sometime in the first

quarter of the calendar year of 2010.

CHAIR: Excuse me, Ms Jones.

I was wondering how many, if you have further questions on this subhead, how

many more questions you have? I am just trying to get some direction here as to

when to go to the next speaker.

MS JONES: Okay, just a couple of more on this same topic.

MR. WISEMAN: Maybe if I could just I have the figure for you for the

home in Corner Brook. We went from 225 beds to 236, with a net increase of

eleven beds. I knew it was a small number.

MS JONES: What about in Clarenville and Goose Bay, can you give me the

capacity of those facilities?

MR. WISEMAN: Clarenville is forty-five, Goose Bay is fifty.

MS JONES: Is that an increase or the same?

MR. WISEMAN: No, Clarenville is new, and that replaces a fifteen-bed unit

that was contained in the hospital. So that is a thirty-bed capacity increase.

In Happy Valley-Goose Bay, it replaces Paddon, and I do not know what that

number is. I can get that for you.

MS JONES: So will the Paddon home close now? You are not looking at

maintaining both facilities are you?

MR. WISEMAN: No.

MS JONES: The Clarenville facility must be pretty popular. I have already

gotten a call from someone who cannot get in. Which tells me, for a new

facility, they must be filling up pretty fast, right?

MR. WISEMAN: They started two weeks ago by moving the fifteen patients

that were in the wing in the hospital out there, and then they were going to

start gradually filling the other beds a couple a day. They were not just going

to move in thirty people all overnight. So I am not certain if they have moved

everybody in. There was a process that, they had a team of people involved in

identifying the residents who would move in. There were some who were already in

existing long-term care homes in other communities but they wanted to get back

closer to their hometown, and some people who had been cared for in the

community by family members who needed a level of care consistent with that

facility had moved in from the community. So they had a team of people

identifying who would move in through that kind of process.

MS JONES: Okay. That is the only new projects, well not the only, but

that is all the new projects around long-term care in the Province right now is

it? Is there any expansions going on anywhere?

MR. WISEMAN: This year's budget would have also included some money to

identify land in Carbonear to replace the homes that are out in Conception Bay,

and that process will start soon to identify a piece of land now that we have

done that and started the initial planning stages. Again, planning timelines for

that facility will not be very long either because the intent was when we built

Corner Brook, as to look at Corner Book then as a model to define how we would

proceed and construct others. If you ever get an opportunity to tour the

facility you would recognize that it is a four-storey building but inside each

floor they are communities, they are pods of units. So if you need a 200 bed you

just knock off a storey and take off a pod. If you need fifty or you need 100

you can it is designed in a fashion that allows you to adjust size or height.

If you wanted to have an additional fifty beds you would add on another storey.

If you needed less than fifty beds you just come down to a single storey. There

are scales that you can achieve here by using that model and that concept. So,

all future long-term care homes will be built along that model.

What we are doing in Hoyles-Escasoni, for example, is the things we learned

from the construction process in Corner Brook and some things we have learned

now as a result of new insights gained in how we provide programs and services

will make some of that minor tweaking of the plan for Corner Brook and do it

here in Hoyles-Escasoni. If we learned some new things from that exercise we

will tweak the plans again and that will define what we do in Carbonear.

MS JONES: Okay. Is there any expansion - the other part of my question -

to long-term care facilities that already exist in the Province?

MR. WISEMAN: Well, if you look at what we have, when we finish this

exercise here now we will have a new home in Happy Valley-Goose Bay and we would

have had a new home in Corner Brook. The new home, relatively new home in Grand

Falls-Windsor, I think it is about maybe six or seven years old, and we have

done some major renovations to the one in Lakeside, in Gander; with the

renovations we have done to the new addition in Clarenville, Hoyles-Escasoni,

two buildings there, and Carbonear. That is what we have on the radar screen

now.

We are having some discussions with Eastern and ourselves around the other

long-term care homes in St. John's and some of the potential upgrades or

renovations that might be necessary for those. We have made some significant

investments in the last couple of years and we are on target to make some big

investments again for the next three years in those three new homes, two for St.

John's and one for Carbonear. We just want to make sure that the facilities we

have now, because some of them are old, and that is why we are replacing

Hoyles-Escasoni, that is why we are building a new one in Carbonear. The

facilities we have are replaced with, if necessary, more current buildings. If

existing structures have need for upgrades then we will do them.

Lewisporte is the other one. As I was walking across the Island I passed by

the intersection and did not go down to Lewisporte, but we are doing a

redevelopment in Lewisporte as well.

CHAIR: Ms Jones.

MS JONES: Yeah, that is it on that.

CHAIR: Ms Michael.

MS MICHAEL: Thank you very much, Mr. Chair.

I am asking a question about 3.1.02., simply because I cannot find out in my

notes, and we have been looking. So if I have asked this already, I apologize. I

do not know if I asked for a breakdown of the grants and subsidies, which of

course is

MR. WISEMAN: Yes, that is in that package this morning.

MS MICHAEL: That is fine. Thank you very much.

MR. WISEMAN: Yes, got that for you, $2.8 million I think it was, wasn't

it?

MS MICHAEL: Okay. Yes, thank you so much.

So all my questions then have to do with the next two sections, and I will

try to get through them quickly.

Section 3.2.01., because there is such an increase in the Property,

Furnishings and Equipment, which is the only line here for expenditures. Could

we have an explanation?

MR. WISEMAN: 3.1.01?

MS MICHAEL: 3.2.01.

MR. WISEMAN: I am sorry.

MS MICHAEL: The revision last year was almost $20,000 over, not quite,

$17,000 over the estimate and this year it is going up again. What is covered in

there, Property, Furnishings and Equipment?

MR. WISEMAN: Fifty million dollars of that is the medical equipment that

we provide in each of the health facilities. Last year, you might recall, we

announced some $50-odd million that we spent last year. The year before that we

spent some $48 million, I think it was; $42 million or $48 million?

OFFICIAL: Last year?

MR. WISEMAN: The year before last.

OFFICIAL: Forty-eight.

MR. WISEMAN: Forty-eight million, so this is a part of our investment to

ensure that what we have is the most current medical equipment that is

available.

MS MICHAEL: Okay.

I just wanted to check on that.

My next questions are all related to subhead 3.2.02.

MR. WISEMAN: Okay.

MS MICHAEL: Some of them have been answered. I think I definitely have

the answer to 05; I have been taking notes on what you have been saying.

With regard to the Purchased Services, subsection 06, last year that was

slightly over budget. What is covered in Purchased Services, and why was it

slightly over budget last year?

MR. WISEMAN: As I said a moment ago, this

section here is a reflection of

the cash flow requirements that we need to manage the capital projects that we

have announced. You notice, interestingly, lines 05 and 06 for the budget last

year and the budget this year, the Estimates.

MS MICHAEL: Yes.

MR. WISEMAN: The figure is split, and it is kind of an arbitrary

splitting because we are building buildings, and associated with the

construction that we have already announced just to back up a little bit, when

we were building a building we called a tender for Corner Brook, for example,

long-term care, and it is going to cost us $70 million or $80 million. The

contract is awarded, and then annually we have to make progress payments toward

the construction cost as the building is progressing.

MS MICHAEL: Right.

MR. WISEMAN: Some of that cost is for the purchase of services, for

professional services that we may have had, and some of it is the payment of the

supplies for the contractor, so it is kind of split.

MS MICHAEL: Right.

MR. WISEMAN: At the end of the day, the total cost of the project is

consistent with what the tender was. How it washes out in terms of what got paid

for professional services and what got paid for purchased services is all a part

of that bundle. It is not necessarily a scientific, refined process. All we know

is that this is the fixed price, this is what we are paying at the end of the

day, and it is broken down into those two expense categories.

MS MICHAEL: I fully understand.

MR. WISEMAN: That is why you would end up with variances like the one

last year, for example, where you see there was a $39 million budget forecast

for Professional Services but at the end of the day we spent $2.2 million.

MS MICHAEL: Right.

MR. WISEMAN: If you look at the way the building is progressing - I am

using Corner Brook as my reference here I said earlier that the building was

thought to be finished, or forecast initially to be finished, by the end of the

calendar 2009. Now we have moved that out. So, at the end of the day, those two

numbers will reconcile for Corner Brook as they will for the other projects.

MS MICHAEL: Thank you bookkeeping.

With regard to St. Clare's, and the renovations that are happening there,

will the ER increase capacity or will it just increase the effectiveness, the

services that are offered?

MR. WISEMAN: As I understand the project, it will increase capacity. We

cannot do it here today, but, if you would like to have a sense of that, I can

have the officials in the department show you the schematic as to how that

renovation will do, because what they are going to do is - you are probably

familiar with the Emergency Department of St. Clare's.

MS MICHAEL: I am.

MR. WISEMAN: You go in through that back door and, as you come in through

the door, to your right there is a waiting area and to your left is where you go

down to the diagnostic area. What they are going to do is enclose some of that

area so they isolate out the entrance area, because when you come in now you are

smack into the emergency department; there is very little distance there. They

are going to make some changes so that you have a better entry point, but also

to take in some of that waiting area and to incorporate it inside from the

treatment area so you will have greater capacity inside the treatment room and

you will have greater privacy.

MS MICHAEL: Great.

I would be interested in seeing a schematic with the numbers.

MR. WISEMAN: We could do that, yes.

MS MICHAEL: Thank you very much.

With regard to the Waterford, I think in the budget it is $200,000 going into

some work to be done on the Waterford Hospital, which obviously is nowhere near

what the Waterford Hospital needs done to it. What are the long-term plans,

Minister, with regard to Waterford?

MR. WISEMAN: You might recall, last year I announced that we were going

to do a complete study of acute care services in St. John's. When we define

acute care, we are talking about what is taking place at the Health Sciences

site, the St. Clare's site, the Waterford site, and we have the rehab site down

on Forest Road. These are the buildings that we currently provide acute care

services in now, and does one of us know the company that is doing the acute

care study in St. Johns?

OFFICIAL: Agnew Peckham.

MR. WISEMAN: Agnew Peckham is a consulting company which is now working

with Eastern Health to do an analysis of not just current capacity but current

facilities, but also then do some forecasting for us about what the acute care

needs will be in St. John's in the future. St. John's recognize that there are

tertiary centres here, but then there is a secondary level of care and service

that we provide to the people of the general area, and what kind of facilities

we will need to provide those services from.

At the end of this calendar year coming up in 2009 the intent is that they

will have a report for us with a series of recommendations and options for the

redevelopment of acute care in St. John's. I am looking forward to reading that,

because obvious you have just identified one site, the Waterford, which has been

around for a long while; it is a physical structure. There are parts of that,

that well outdate any of us in this room and it goes back many, many years, so

the building, physically, has served its time, and it has done an admirable job,

but there are some real glaring difficulties with that building.

MS MICHAEL: There are.

MR. WISEMAN: What will happen, I suspect, when we get this report - I

have asked, as well, as we are proceeding along this way, because we will no

doubt make a series of recommendations on a number of fronts, whether it is

mental health, whether it is some of the tertiary services we provide, how we

utilize the facilities we now have, but what other facilities might we need?

What renovations should or could take place to those that we have?

When we get this report in at the end of next year, the end of this calendar

year we are in now, I suspect we will have some big decisions to make around (

a) what it is we are going to do, but then, when we decide that, how we sequence

it, because we need to make sure we continue with services while we are making

any changes. That will be a major piece of planning work.

Clearly, it will be important for us to start doing some of that in the next

budget year. We will have to report in this calendar year, which will give us

some ample time to make some decisions about doing some work next year. The fact

that we have started the study piece means that we recognize we have an issue

and we recognize that we have to deal with it. We need to be better informed

before we make decisions. We are committed to redeveloping the acute care piece

in St. John's.

MS MICHAEL: It is not a serious comment but I cannot help saying that I

do hope the planners are looking at the postage stamp parking lot for that

hospital. It is very frustrating.

MR. WISEMAN: Actually, it is interesting you raise that because yesterday

Tony Wakeham, the ADM who sits behind me, and I were having some series of

meetings with officials in Transportation and Works as part of what we are doing

with the parking spaces down at the site of the Health Sciences.

MS MICHAEL: Right.

MR. WISEMAN: Trying to find parking spaces for everybody is a challenge.

Everybody wants to get near the building, to start with; it is always a

challenge. Parking is a big issue.

MS MICHAEL: In there it is really bad.

MR. WISEMAN: We have not, as a society, come to grips with using public

transit yet. Everybody wants to take their own car. Everybody wants to park next

to the building.

MS MICHAEL: I think the problem there is that historically the building

was not used for day services and for the services that are now in the building.

MR. WISEMAN: Exactly.

MS MICHAEL: I think that is the big problem there, and they did not

expect a whole lot of visitors, either, for the people who were in that

building.

MR. WISEMAN: Generally, they did not; you are absolutely right.

MS MICHAEL: I think that is what is causing the big problem there.

With regard to Waterford, and I think I am right in saying it is $200,000

that has been earmarked for some work there this year on the building, what

exactly is that $200,000 going to be used for? Do you know? If not, you could

get that information to us.

MR. WISEMAN: Actually, it was just pointed out to me then, the $200,000

figure, you are taking that from where?

MS MICHAEL: From the Budget. I thought that, in the Budget I do not

have it in front of me I remember when there was a listing of different

projects for the hospitals.

MR. WISEMAN: Yes, okay.

MS MICHAEL: I thought it was $200,000.

MR. WISEMAN: That would have been a very specific piece of work that we

announced this year, but the other piece goes back to the question your

colleague asked about that report that was done, or that profile that was done,

on the state of buildings in St. John's.

MS MICHAEL: Yes.

MR. WISEMAN: Because there is about $700,000 being done at the Waterford

this year growing out of that profile.

MS MICHAEL: Okay.

MR. WISEMAN: The $200,000 that was in you are talking about the Budget

Speech, they had announced $200,000?

MS MICHAEL: Yes, that is my memory where it is from. That is why I said I

am not sure. Maybe it was the $700,000 that I heard, if $700,000 is earmarked to

deal with

MR. WISEMAN: You can continue with your questions, if you want, and Mr.

Wakeham will go through his notes to see if he can pull out that $200,000

reference so you will know what that is as well.

MS MICHAEL: Okay, because, with regard to the study that was done, there

were things that were earmarked, different things that needed to be done to the

building, some very practical things: the exits, the emergency exits, the

windows. We all know there is a huge list.

MR. WISEMAN: There are some things in the fire commissioner's report on

the Waterford, too, if I am not mistaken.

MS MICHAEL: Could we have a listing, then - not to give it today, but if

you could get it to us - of what is being earmarked for this year in terms of

continuing the upgrading that was recommended?

MR. WISEMAN: Yes.

I am just reading a note here now. The extension of the sprinkler system at

the Waterford, the contract has been awarded for that, so some of that

(inaudible) might be upgrades to the Waterford.

MS MICHAEL: If we could have a breakdown that would be great.

MR. WISEMAN: Yes, we could do that.

MS MICHAEL: Okay, thank you.

That is it, Mr. Chair. I think all of my questions have been covered between

what Ms Jones asked, and my own.

CHAIR: Thank you, Ms Michael.

Ms Jones.

MS JONES: Thank you.

Under furnishings and equipment, can you give me an update on what the status

of the PET scan is for the Province? I know there is money there, but I just do

not know where it is.

MR. WISEMAN: Planning work is started, I guess, is the short answer. In

the acquisition of a PET, there are two things involved here. One is, there is a

physical space issue; we need to build on to the existing building, and that

will be done adjacent to the bunkers that were installed a couple of years ago

for the Cancer Centre, in that general area there.

MS JONES: Yes, that is right.

MR. WISEMAN: There is an individual who has been engaged to assist us

with - the acquisition of the technology is one thing, but there is another big

piece of PET scan that is a regulatory piece. There are a number of regulatory

agencies and bodies who are involved in giving you permission to install these

units. Then, a part of that piece, a part of the work that person is doing, is

facilitating that process while at the same time assisting with and providing

the input into the design considerations for the use of the unit.

That is where we are right now with that piece.

MS JONES: Okay, so you are not anticipating getting very much done with

it again this year, then?

MR. WISEMAN: The design work is progressing, and we are trying to

position ourselves so that we can tender to start doing the building piece this

year. We want to try to make sure that we are in the position, if we can, by the

end of 2010 or the first part of 2011, to be able to take delivery of the

system.

MS JONES: Okay.

What about the cyclotron? Are you going to do that as well?

MR. WISEMAN: Yes, it is all a part of it.

MS JONES: Okay, so it will all be done part and parcel.

MR. WISEMAN: Yes.

MS JONES: I do not know if you announced what kind of PET scan you were

going to buy. Did you do that, or have you decided?

MR. WISEMAN: No.

MS JONES: You have not decided yet, have you?

MR. WISEMAN: No.

MS JONES: Okay.

The MRI for Central Newfoundland -

MR. WISEMAN: You might recall we had indicated that we had engaged an

outside group to come in and to prepare a report for us. I have that now, and I

want to be in the position to bring a recommendation forward to my colleague

some time in the next week or two and then be in a position to make the

announcement.

MS JONES: You have been a long time trying to get that MRI.

MR. WISEMAN: It is a big decision.

MS JONES: It must have been five years now, isn't it?

MR. WISEMAN: An important decision. People will be well served when

MS JONES: What kind of report did you have done? What was it the health

authority do it or it is external?

MR. WISEMAN: No, there were three individuals from Nova Scotia who were

engaged to do the report for it.

MS JONES: So you are in a position now to make the announcement anytime

soon?

MR. WISEMAN: Well, I have not had a chance to do an analysis of the

report yet. When that is done - after I finish with it, I would then need to

bring it to my colleagues in Cabinet and make a recommendation to them and then

make the announcement after that.

MS JONES: Are you guys planning any other MRI equipment for any of the

other facilities in the Province?

MR. WISEMAN: What we are doing now is we are trying to - it is a good

question actually, because we are trying to determine what an appropriate level

of service is for MRI. There are a couple of things happening. There are new

applications for MRIs. As technology advances, you are now able to use MRI for

different things with certain adaptations made to it.

The second thing, which is advances of research and better understanding of

diagnostic services, you know clinicians are coming up with different ways to

use MRIs. So what we are doing now actually is kind of an information gathering

process to better understand what the demands are for MRI in the Province. We

can obviously look at wait times and all this stuff as one measure but the other

things we need to better understand is what the future holds. How will MRIs be

used in the future? Will there be many more modalities for it, and if that is

the case than what should be the level of service we need in the Province?

The other thing we are looking at is what should be the level of operation in

terms of hours. I think now the one in St. John's is operating at sixteen hours

a day or something isn't it? And the one in Corner Brook is close to the same

thing. So we need to consider modalities as being one and what that holds for

the future. Secondly, what would be the normal hours of operation that we should

have these systems running? That will help inform us then as to whether or not

we need another one, two more, and where should they be. That is a piece of work

we are undertaking right now actually.

MS JONES: In St. John's, are there two MRIs or more?

MR. WISEMAN: There is, yes.

MS JONES: Two is it, and one in Corner Brook?

MR. WISEMAN: One in Corner Brook.

MS JONES: That is the only ones in the Province right now?

MR. WISEMAN: That is the three we have right now, yes.

MS JONES: The other one is on the dialysis equipment. I mean it has been

an issue of course for Labrador West, for the Southwest Coast of Newfoundland, I

think Port aux Basques area. There were some concerns raised on the Burin

Peninsula about the waitlist around the one unit that is there and increasing

capacity. Where is that to on the radar of government looking at those

particular cases?

MR. WISEMAN: Dialysis is a difficult issue to try to manage here. I do

not know if you saw a program on CBC last night.

MS JONES: Yes, I did, actually.

MR. WISEMAN: Yes. So you would have listened to a nephrologist talk about

the uniqueness that we are in some respects, that we have a high incidence of

end-stage renal failure. The growth in patients who need that service has been

significant in the last ten years, and there are multiple causes for it. In the

long term we need to be able to better manage those conditions that contribute

to that, quite particularly diabetes. Many of them have diabetes as a core

morbidity. The other thing is cardiac difficulties. These are all things that if

better managed can improve not only the patient's quality of life, but also,

too, reduce the demands for such services as dialysis services.

One of the things that we have not done in the Province, is we have not

accepted or embraced the use of home dialysis to the extent that many other

jurisdictions have done. So, in as much as when people need that kind of

service, it is a natural thing for patients to want to get the service made

available to them close to home. That is reasonable, I understand that.

When you look at the growth in having dialysis services in an institutional

delivery, versus home delivery, our growth is more rapid than the rest of the

country. We have, I think the figure was 15 per cent of those who are on

dialysis are at home dialysis. Commentary that would have made last night, I

think, was that the nephrologists are saying that 50 per cent of those on

dialysis are candidates for home dialysis. So, whether it is not knowing the

benefit of home dialysis, not knowing how it works, whether it is the fear of

being there on a machine and not having support around you. There might be

multiple reasons why people may not want to.

The interesting thing about us in this Province, people involved in providing

the services provide an overview of the options that people have, and people

make choices. Other jurisdictions, for example not other, I should not say

that. Nova Scotia I will speak about. They, as I understand, in their province,

it is not necessarily an option. If you are a candidate for home dialysis, that

is what the public system provides for us. So that is what is available for you.

We need to, as a part of this analysis that we are doing right now, because

you are right, there have been a couple of communities that have mobilized

people within the community to look at the need for dialysis service in their

region. I am not saying that these communities should, or should not have it,

that is not my commentary. My commentary is that before we rush out and start

building new, and renovating buildings to start establishing dialysis units,

buying the equipment necessary and training the staff that is necessary, we need

to sit back for a moment and have a better look at where this going. Because if

you look at the growth pattern in the last ten years and where we have gone, if

you reflect on the population profile of the Province, we are on target to

continue that progression.

We will continue to have discussions around buying three more chairs, four

more chairs, pushing out walls and renovating buildings to add more space for

dialysis if you do not change your thinking around what it is we are doing to

provide the service. We all know the service has to be provided. That is a

given. It is going to maintain someone's life. If we have methods to do that,

which is - we have a hemodialysis that you can provide for in an institution, a

hemodialysis that you can provide for in the home, and also peritoneal dialysis

that you can provide for in the home. Do everybody who is involved in this

understand the benefits of both and how each of these things work?

My assessment now is that we have not placed a lot of emphasis on the

education piece around home dialysis to ensure people better understand it. The

other piece, I acknowledge too, is that if people are going on home dialysis it

is important for them to have the supports that they need to be able to do that.

So, there is a fear factor that is coming into here, and how do we manage that

and how do we deal with that? What kind of clinical support is provided to those

individuals who are at home? What kinds of home support services, if necessary,

are provided? What kind of technical backup is provided, because it is a machine

and machines malfunction? So if it happens, what do you do? Who do you call and

how quick can they get there?

There is that piece of work that is in this equation that we are now looking

at. So it is not a simple solution of saying: yes, the people of Port aux

Basques can raise $50,000 so therefore we should have it because the units only

cost x number of dollars and we are prepared to buy it ourselves as a community.

That is fine. That is a piece of this, but the bigger piece here is how are we

going to provide dialysis services long term? It is not necessarily, as we heard

last night, in having it in some institution is not necessarily the only way to

do it, and there is some question about whether it is the best way to do it.

MS JONES: Yes, I saw the program last night. Actually, I was a little bit

surprised because of the level of dialysis that that patient was receiving. I

did not even know you could get it at home.

MR. WISEMAN: That is right.

MS JONES: And I am sure that there are a lot of people in the Province

who feel the same way.

MR. WISEMAN: There was an interesting story in The Packet out in

Clarenville last year. Actually, I think it appeared in The Telegram ,

too, if I am not mistaken. There was a lady who told her story; she was on

dialysis in Clarenville. It is not a long distance from Come by Chance to

Clarenville, but it is a thirty minute drive every day and she could not drive.

She was on it for a couple of years. She decided, then, she was going to try to

do home dialysis, and she was delighted with the big change it had to her life.

She now had greater flexibility. She did not have to worry about getting out in

a snowstorm in the middle of winter and driving to Clarenville, and worry about

who was going to drive her and who was not. She is now at home. In fact, if I am

not mistaken, the story cited her as having said that she is now so comfortable

with it that she goes to bed at night time and hooks herself up. It is part of

her daily routine now at home. She has the freedom and flexibility to live a

life that does not anchor her to a taxi or a car or someone driving thirty miles

each way for three days a week.

I think there was a gentleman on last night who is getting home dialysis as

well, who told his story. We need to do more of that, because the critical

thing, as I said - and I want to repeat it, because it is important - we have to

make those services available to people. That is not a question here. How we do

it, and how they get to better understand what their options are, is what is

really important here.

MS JONES: You said that you had some numbers around the growth pattern of

people depending on home dialysis. Can you share that information with us?

MR. WISEMAN: Yes, I can get that for you.

MS JONES: The only other question I had is with regard to the mammography

equipment commitment last year to change out all the old equipment and replace

it. Is that project completed? Have all the changes been made?

MR. WISEMAN: What we did is we went to tender for one package. In fact,

we did a lot of that last year actually. Historically what was happening, each

individual health authority was doing their own thing, buying their own

equipment and spending their own allocation. Last year we did something very

different, actually; we pulled all of that together. We bought a couple of CTs

last year. We tendered one package, and one authority was charged with the

responsibility to do the spec, go to tender, acquire it and distribute it. We

did the same thing with mammography. I understand that all of them have been

acquired. Tony, that is correct, isn't it?

MR. WAKEHAM: (Inaudible).

MR. WISEMAN: It is all included in one tender. The tender has been

awarded and closed. One of them happened to go in Clarenville, and I know that

one has been delivered and they are in the process of installing it now. So they

are in the process of either being installed or - because the tender has been

awarded for all of them. How we did that, actually, that tender last year was to

include digital mammography, which would then eliminate all of the analog

systems that were in the entire Province.

On that point, by the way - I am sure you would be keenly interested - back a

month or so ago I was over in Corner Brook and the radiologists had their annual

convention. There was a lady there from Ottawa who was one of the resource

people they had brought in for one of their education events. She came over and

introduced herself to me, because she wanted to make a point of congratulating

us on having made the decision to forgetting numbers the conscious policy

decision that we were going to have only digital mammography machines in the

Province, and no other province in the country has done that. Many jurisdictions

are still using the old analog systems.

MS JONES: Yes.

MR. WISEMAN: She was quite impressed when she heard that story while she

was there, and wanted to let me know that. It is a significant issue for the

women of the Province.

MS JONES: Absolutely, yes.

Those are all the questions I have.

CHAIR: Ms Michael.

MS MICHAEL: Just one quick question, Mr. Chair. Thank you.

I want to thank the minister for giving us the materials that we received

today in response to some of our questions, and I look forward to getting the

rest of what you will be providing us.

Since we now have this in our hands - and I am really happy to see that you

have provided us with the information on temporary salaries in the department -

I think, as I look through it very quickly, and this is without much

information, I can see why some of them are temporary; but some of them, very

quickly, like clerk positions, a couple of communications managers, et cetera, I

would look at and say: Why is that temporary?

Some other departments have told us they are evaluating looking at temporary

positions that maybe should be moved to permanent. Are you going through the

same thing?

MR. WISEMAN: Just as a comment on that, by the way, I was really

surprised at this year's budget process, how many of these temporary positions

had accumulated, but there are a couple of things you might want - because I

suspect, given the fact that you made that comment then, because it is a

question you have asked of other departments, what is interesting in this

process, though, are two things I have found. One was, you might recall over the

last two or three years there have been significant increases in the number of

positions created through the budgetary process.

MS MICHAEL: Right.

MR. WISEMAN: The way the system works is that once a position is created

in the budget, until it gets formally classified through a classification

process, and assigned a number, then it remains in the temporary budget

category.

MS MICHAEL: Right.

MR. WISEMAN: So you may have gone out and recruited the person, and the

person has a permanent job - they are not going anywhere - however, from a

budgetary point of view, they are in that budget category.

MS MICHAEL: Right.

MR. WISEMAN: The second thing is that some of the people who are in

there, part of their salary is budgeted as permanent and part of their salary is

budgeted as temporary, and it has to do with their placement on their salary

scale. So, if someone is hired into a brand new position and the salary scale

has a range of $50,000 to $70,000, the starting salary is what is plugged into

the permanent budget and the remaining salary is plugged into the temporary

budget. Don't ask me to explain it because I cannot tell you.

MS MICHAEL: That would explain to me why

MR. WISEMAN: Every department is the same, so if that stood out as you

went through these Estimates as a big number of every department there are a

number of explanations for it. The two I just gave you, there is not a lot of

rationale for it but it is fact.

MS MICHAEL: Right, but that second one explains one thing I am looking

at, which is the Director of Family and Child Services with $11,605 under

temporary and then, in brackets afterwards, 2009-2010 increases. That is an

example of what you are talking about.

MR. WISEMAN: You would have to ask some accountant that question. I do

not know why they do it that way.

MS MICHAEL: I would never ask accountants questions. I hate their

answers.

MR. WISEMAN: Even more than ministers?

MS MICHAEL: So next year we will probably see some of these moved over to

permanent, then, especially because of classification?

MR. WISEMAN: Yes, that is right.

MS MICHAEL: Thank you.

Thank you very much, Mr. Chair.

CHAIR: Do any of the Committee have any more questions?

MS MICHAEL: I want to thank the minister and his staff; they have been

very helpful.

MR. WISEMAN: You're welcome; our pleasure.

CLERK: Subheads 1.1.01 to 3.2.02 inclusive.

CHAIR: Shall clause 1.1.01 carry?

All those in favour, 'aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, 'nay'.

Carried.

On motion, subhead 1.1.01 carried.

CLERK: Subheads 1.2.01 to 3.2.02 inclusive.

CHAIR: Subheads 1.2.01 to 3.2.02 inclusive.

Shall these carry?

All those in favour, 'aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, 'nay'.

Carried.

On motion, subheads 1.2.01 through 3.2.02 carried.

CHAIR: Shall the total carry?

All those in favour, 'aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, 'nay'.

On motion, Department of Health and Community Services, total heads, carried.

CHAIR: Shall I report the Estimates of the Department of Health and

Community Services carried without amendment?

All those in favour, 'aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, 'nay'.

Carried.

On motion, Estimates of the Department of Health and Community Services

carried without amendment.

CHAIR: I would like to thank the minister and his officials for their

attendance this morning, and for their co-operation for the second part of this

two-part meeting.

This concludes the meetings of the Social Services Committee. I would like to

thank all the members, on behalf of Chairman Hutchings, for your co-operation

and attendance.

I now look for a motion to adjourn.

MR. LODER: So moved.

CHAIR: Moved by Mr. Loder, seconded by Mr. Kent.

All those in favour, 'aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

This meeting is now adjourned.

On motion, the Committee adjourned.

Document details

Collection	Newfoundland and Labrador — Committees
Citation	2009-05-06
Type	committee
Volume / chapter	committees_standingcommittees_socialservices_ga46_2009-05-06.ssc.health_20__20community_20services.htm
Language	en
Format	html
Source	PROVINCIAL
Identifier	321e5851331641ae4d56cc42112900be13da5e72

Source file is stored in the law ingest library (html).