2000 Legislative Session: 4th Session, 36th 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)

MONDAY, MAY 15, 2000

Afternoon Sitting

Volume 19, Number 16

[ Page 15599 ]

The House met at 2:06 p.m.

Prayers.

Hon. U. Dosanjh: One of the most prominent and tireless advocates for educating young people about the dangers of tobacco is here today. Dr. Jeffrey Wigand is a former chief scientist and senior executive for the tobacco industry and the inspiration for the movie The Insider . He has formed a non-profit foundation called Smoke-Free Kids. On behalf of this organization, he travels the world sharing his inside knowledge of the tobacco industry with young people in the hope that this information will encourage them not to smoke. Will the House please join me in welcoming Dr. Wigand.

Hon. Speaker, I have one more introduction. I am very pleased to introduce one of the members of B.C.'s Teen Tobacco Team, Mitch Matthews, a grade 10 student from Port Alberni. Accompanying him is Kelly Dowling, the regional tobacco reduction coordinator for the Central Vancouver Island health region. The eight members of the volunteer Teen Tobacco Team and the 20 coordinators who work for the local health authorities advise the Ministry of Health on protecting kids from tobacco and support our tobacco strategy in B.C.'s schools and communities. They do a wonderful job. Please join me in welcoming Mitch Matthews and Kelly Dowling.

C. Clark: In the official opposition we are blessed with the services of Marc Coward, who's one of our legislative interns. He is from Burnaby, my hometown. His mother and aunts are joining us today, and I'd like to introduce them: Korlene Coward, his mom; Issy Tompkins, his aunt; and Lil Petrowich, another aunt. On behalf of myself and the official opposition, I'd like to tell all three "Happy Mother's Day."

[1410]

The second introduction I have is for two visitors from the beautiful and historic constituency of Oak Bay-Gordon Head, who are watching the proceeding with some care. One of them is Alex Dutton. She is currently studying political science at Queen's University in Ontario. She is accompanied by her mother, Jane Dutton. I ask the House to please extend a warm welcome to these two visitors.

I. Chong: I am also pleased to welcome 16 students from grade 11 at Lambrick Park Secondary School in the riding of Oak Bay-Gordon Head. They're accompanied by two adults and their teacher, Mr. Barber. I would ask the House to please make them all very welcome.

R. Neufeld: I have in the precincts today two residents of Fort St. John: Connie Surerus and Glen Kirkpatrick. Both are very hard workers in their community, specifically with the child development centre. They're here this afternoon to meet with the minister. Would the House please make them welcome.

E. Walsh: Though the Kootenay Ice are not here in the Legislature today, I know that they're here in spirit. This hockey team has worked hard and played very hard to be representing the Western Hockey League in Halifax on May 20 of this year at the Memorial Cup. I would ask that the House congratulate the Kootenay Ice with me. I'd like to add, too, that they're from Cranbrook. Did I mention that they're from Cranbrook? I'd like to ask all members in this House to please join me in congratulating the Kootenay Ice and to cheer them on at the Memorial Cup in Halifax, Nova Scotia, this year -- to encourage them and help them along in bringing the Memorial Cup home.

D. Streifel: Touring the precincts today, my wife Linda is back -- and, yes, Judith, she does have Mildred with her this time.

Interjections.

D. Streifel: Yeah. He saw my cat; the member saw my cat.

With her is her cousin Donna Noseworthy from Halifax through Newfoundland. She's a dietician-nutritionist, who was out here at a conference last week and has stayed over to spread some of that incredible Newfoundland economy in British Columbia. I bid the House to make them welcome.

Introduction of Bills

TOBACCO DAMAGES AND HEALTH

CARE COSTS RECOVERY ACT

Hon. M. Farnworth presented a message from His Honour the Lieutenant-Governor: a bill intituled Tobacco Damages and Health Care Costs Recovery Act.

Interjections.

Hon. M. Farnworth: I don't view tobacco addiction as a laughing matter.

Hon. Speaker, I move that Bill 15, to re-enact the Tobacco Damages and Health Care Costs Recovery Act, be introduced and read a first time now.

Motion approved.

Hon. M. Farnworth: This act is the enabling legislation which allows the province to sue tobacco companies to recovery health care costs, a right which was upheld by the Supreme Court of British Columbia's decision on the tobacco industry's constitutional challenge to the legislation. Contrary to the industry's claim, the court found that the underlying principles of B.C.'s legislation were constitutionally sound, with the exception of the provisions that sought to impose liability based upon corporate relationships. The judge found this one aspect to be beyond the jurisdiction of the province. On the basis of that one finding, the judge struck down the entire act.

Because of the Supreme Court's decision, the province is repealing the original Tobacco Damages and Health Care

[ Page 15600 ]

Costs Recovery Act and re-enacting the legislation with some modifications to address the court's concerns. In addition, the wording of several of the act's provisions has been changed to provide greater clarity.

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Our government remains firm in its resolve to seek accountability from the tobacco industry. The province of Newfoundland has decided to follow B.C.'s lead and has announced its intent to launch its own lawsuit using B.C.'s legislation as the model. B.C. and Newfoundland will be working closely together in pursuing health care cost recovery litigation, and we hope other provincial and territorial governments will join us.

This new act will allow the province to continue without delay its legal action to hold the tobacco industry accountable. I am pleased to be able to table this legislation today, and I move that this bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 15 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

SECURE CARE FOR

AT-RISK CHILDREN AND YOUTH

G. Campbell: In 1998 the Ministry for Children and Families released a report recommending holding children and youth who are in situations of extreme danger for up to 72 hours. Judge Gove supports secure care for our children; the B.C. Civil Liberties Association supports secure care; even the former Minister for Children and Families supported secure care. Yet we found this weekend that the current Minister for Children and Families says that secure care for our children is too controversial. My question to the minister is simply this: will the Minister for Children and Families tell us who is opposed to secure care for children and youth at risk in British Columbia?

Hon. G. Mann Brewin: As a matter of fact, there are some people who are opposed to it. I heard from a gentleman on the weekend about that. He has worked in such facilities, and he was not happy about what it might be. However, that having been said, I want to assure everyone that we have to provide a stable and secure environment for our young people, and we have to recognize that they get caught in abuse and difficult prostitution situations in some parts of our province. We must be working at all levels to respond to that. We continue to do that in this ministry and in this government. We continue to work on that.

The Speaker: The hon. Leader of the Official Opposition with a supplemental question.

G. Campbell: This is a problem that has been identified for years in this province. Yet incredibly, hon. Speaker, just this weekend the minister said she really didn't have any opinion or view on this one way or the other.

This weekend the Lower Mainland Municipal Association called for immediate action by this government to provide for secure care for our children. We know that there are countless families in the province of British Columbia who understand the urgency and the necessity for providing secure care for our children and youth in this province. Again my question to the minister is: what is the holdup? Why is the minister stalling on this matter, which has been so clearly identified as a matter of true risk to the children in the province of British Columbia?

Hon. G. Mann Brewin: I very much appreciate the question, and I appreciate the support that is in the community for such action. I take that very seriously, and I want to work on that and work with that to move forward in the direction of protecting children and keeping children safe. I'm going to be meeting with a number of people in the next couple of days and hope that we can move this forward very soon.

C. Clark: It's very nice to hear the minister read, from her prepared notes, comments about how it's difficult for kids being in situations where they're being preyed upon by pimps and predators. But the question we're asking today is: what's she going to do about it? That's the question we're asking. The secure care working group reported two years ago. Children are being lost to the streets every single day. In the Tri-Cities alone, there are 600 children who are addicted to crack cocaine and to heroin. Why should anyone in this House have any faith in her commitment to address this problem, when as early as yesterday she said she hadn't even formed an opinion about it?

Hon. U. Dosanjh: During the last four years we have made several improvements in this area. Firstly, we put together a prostitution team of Crown counsel and police officers that trained police officers right across the province, and Crown prosecutors, to make sure that johns and pimps of children are apprehended and punished.

Whereas in the previous eight years there were only eight charges against johns and pimps of children, in the last four years there have been 150 charges against johns and pimps of children in British Columbia. We also made changes to the legislation dealing with the protection of children just last year.

[1420]

G. Campbell: What about secure care?

Hon. U. Dosanjh: I'm coming to the secure care, hon. Leader of the Opposition. You'll have an answer.

Secure care in Alberta is still being monitored. We want to move in that direction, but we don't want to take a knee-jerk reaction. What I have heard is that they have picked up several dozen children. They have picked them up twice. I haven't seen any evidence to suggest that those children aren't back on the streets. They picked up one child 17 times. We want to move to deal with secure care, but not in a knee-jerk reaction -- "Because Alberta is doing it, we should do it."

C. Clark: It was two years ago that the government identified the problem and then identified the solution. They commissioned and got the report of the secure care working group which recommended moving to secure care. They sent the member for Vancouver-Burrard to Alberta to look at the program. The previous minister decided that she wanted to move to the program. Now the Premier is telling us that he wants to think about it a little more. My question to the Minister for Children and Families is: when is she going to do something about it? And where does she stand on the issue?

[ Page 15601 ]

Hon. G. Mann Brewin: We are moving actively on this, and the answer is: soon. There are some details to be worked out. We need to have some kind of a plan, and I'm sure the members of the opposition can't disagree with that. We need to have a plan on this.

In response to the second part of the question, my experience in municipal government in the city of Victoria alerted me very early on to some of these issues. I'm very familiar with the issues, and I want to see that what we put in place will work. I want to know that it will work. That's a really important part of it.

ADDICTION PREVENTION AND TREATMENT

SERVICES FOR CHILDREN

L. Stephens: Today the Kaiser Youth Foundation released a report calling for an independent substance abuse prevention and addictions commission. That report says that close to 90 percent of children and families in crisis are invisible to the Ministry for Children and Families when it comes to addiction prevention and treatment services, that there is a lack of focus and leadership, that minuscule prevention efforts . . . . With the shocking report's record, why is the ministry continuing to deny treatment services to help those children in life-threatening situations?

Hon. G. Mann Brewin: I was very interested in the Kaiser Foundation's report, and I want to spend more time . . . . I've instructed the ministry, of course . . . . Knee-jerk reactions are not always helpful. We need to be absolutely sure that we're well grounded in what we want to do and where we want to go with these issues.

Already the government has spent over $50 million on prevention and treatment services for addictions, and we want to just be absolutely clear where we're going with this before we move to the next step.

The Speaker: The hon. member for Langley has a supplemental question.

L. Stephens: Well, the whole province knows, and all the service providers in this province know, what's required. This Kaiser report also says that there is no clear provincial strategy, that there is inconsistent and unreliable funding. Furthermore, British Columbia leads Canada in the highest mortality rate for alcohol-related disorders, the highest rate of HIV per capita and the highest number of deaths per capita due to illicit drug use.

So will the minister tell us why, after four years since the creation of her ministry, services are getting worse for people with addictions instead of getting better?

Hon. G. Mann Brewin: Mr. Speaker, it's very important, I think -- as in some other areas -- that we all work together on some of these issues. I'm pointing out some of the complications of it . . . . It makes life more complicated. There's no question about that.

What we need to be doing is focusing on the programs we have, and we have a considerable number of programs in place. We spent over $50 million. We're going to have a closer look at how that's all happening, and we will be responding, as we have, with a comprehensive response in the near future.

[1425]

B.C. FERRIES SERVICE

E. Gillespie: Last week in this chamber we heard a lot of debate about B.C. Ferries. B.C. Ferries is an issue that is extremely important to people in my constituency, the Comox Valley.

The official opposition does not appear to appreciate the value of ferries to all British Columbians, not just those living on the coast. Opposition members have said that they want B.C. Ferries to be put on a sound financial footing. But on Tuesday the member for Kamloops-North Thompson objected to having such a dedicated revenue stream for ferries because it would, in his words, "suck money out of my constituents."

Hon. Speaker, my constituents don't object to the $65 million spent on highways in the member's riding over the past four years.

Interjections.

The Speaker: Order, members. Members, I cannot hear the question. Would the member please state her question.

E. Gillespie: The ferry service for my constituents is their highway. Liberals can't have it both ways. Can the minister confirm now that this government will continue to work to provide a stable, dedicated, long-term revenue stream to support ferry service to coastal communities?

Hon. J. MacPhail: It is interesting to note the nervousness with which this question is greeted by the Liberal opposition. On the one hand, they mock us when we declare that this corporation needs to be put on a sound financial footing and that we dedicate revenues to it. For the very first time in the history of this corporation, which began in the early sixties, this government has dedicated revenue sources from the fuel tax -- for the very first time.

And what does the Liberal opposition say? They mock us. Yet on the other side the member for Kamloops-North Thompson stands up and says that we're sucking money out of his constituents. Let me tell you: this side will continue to treat the B.C. Ferry Corporation as an extension of the highway system with the dedicated revenue.

And by the same token, we will continue to fund the member for Kamloops-North Thompson: the Bingo Ranch Road, $683,000; Monte Creek, $20 million; Badger Creek passing lanes, $1.5 million; Clearwater hub, $500,000; Kamloops highways, $20 million -- over $100 million into that member's riding. We will continue to show the non-partisan approach, and I hope they do as well.

GOVERNMENT HANDLING OF

WHISTLE-BLOWER ISSUES

M. de Jong: Today the government brought to town Mr. Jeffrey Wigand, who has received well-deserved applause for his role as a whistle-blower in exposing the tobacco industry's cover-up of the truth. It's interesting, however. The NDP and this Premier some to react far differently when they're confronted by whistle-blowers of their own.

We understand that the government has now settled the grievances of guards at Fraser Regional Correctional Centre.

[ Page 15602 ]

They were fired for revealing wrongdoing. Will the Attorney General confirm for the House and tell us how much it cost B.C. taxpayers to go through the grievance process and settle with our own whistle-blowers?

Hon. A. Petter: I'll be happy to take the question on notice and get the information for the member. Or he could come to estimates, and we could discuss it there.

The Speaker: The member for Matsqui has a new question.

M. de Jong: Yeah, a new question, Mr. Speaker. One individual, a gentleman by the name of Wayne Pasieka, got so frustrated with what was going on in his arm of government that he appeared on the television program "Fifth Estate" -- kind of the way Mr. Wigand must have felt before he went on "60 Minutes." Can the Premier explain the double standard whereby the NDP celebrates the accomplishments of one man who dared to stand up for the truth but castigates its own employees whose sense of decency and honesty compel them to do the very same thing?

[1430]

Hon. A. Petter: I think the member understands that when you take a question on notice, there's not supposed to be a subsequent question. But if that was a subsequent question, I'll take it on notice as well, hon. Speaker.

M. de Jong: New question. The Ministry for Children and Families, where employees within the government have dared to stand up, dared to reveal the facts that give rise to the untold number of stories about how children in this province are being let down by this government on a day-to-day-to-day basis. My question is for the Premier, who today lauds the approval and the attendant story of Mr. Wigand. How on earth can he, on the one hand, presume to applaud the work of that very brave individual and, on the other hand, have the double standard to defend the tactics of a government that attacks its very own employees when they want to do the right thing?

The Speaker: Members, the light is on to end question period. I will ask the Premier to give a brief answer.

Hon. U. Dosanjh: Hon. Speaker, I would challenge the hon. member to provide me with the particulars of the particular complaint about the Ministry for Children and Families, and I would be absolutely happy to provide him with a response.

The Speaker: The bell ends question period.

Orders of the Day

Hon. D. Lovick: I call Committee of Supply. In this chamber, we shall be debating the estimates of the Ministry of Health. In the small House, we shall be debating the estimates of the Attorney General.

The House in Committee of Supply B; T. Stevenson in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 36: ministry operations, $8,125,203,000 (continued).

[1435]

K. Krueger: The official opposition critic has given me the privilege of being able to ask the minister some questions related to my own constituency. I'd like to start off by asking the minister if he would update my constituency as to the status of the Clearwater multilevel health care facility. This is a facility that was promised to Clearwater by the previous MLA, a member of the government caucus, eight months before the last election.

It wasn't a premier-of-the-day vote-buying promise or a political promise; it was a business decision. The facility is sorely needed in Clearwater. People who ought to be in continuing-care beds in their own community instead find themselves in the Fraser Canyon, four hours away from their loved ones and friends -- when the roads are good. People very often languish and die early as a result. I've heard of people being yo-yoed back and forth, in and out of Clearwater, because sometimes the acute care beds are available for them there, and at others they have to be off in some distant place.

I'd very much appreciate confirmation from the minister that this hospital will be built and that we will very soon actually see construction commence.

Hon. M. Farnworth: I can tell the hon. member that the project has been approved as part of the province's consolidated capital plan and that it is proceeding as per schedule. Construction should start in the fall of this year.

K. Krueger: That's good to hear. According to the Electoral Boundaries Commission redistribution recommendations, the community of Chase will be in the Kamloops-North Thompson constituency after the next election. My colleague the member for Shuswap has raised the issue of a multilevel health care facility for Chase on a number of occasions. The fact is that even back in 1996, 29 percent of the population of Chase was aged 55 or older. Our communities tend to house a large percentage of people in their retirement years, and it's a crying need in Chase that this issue be dealt with as well.

Could the minister give us an expression of the intentions of the Ministry of Health with regard to the facility in Chase?

Hon. M. Farnworth: We recognize a need for long term care beds in your particular region of the province -- in the Thompson, but also right across the province. One of the things we're trying to do is work with the authorities to identify what their key projects are, and then we can move forward on a plan to meet the needs in terms of developing those particular projects. Right now that's what we're trying to do -- find out which are the key priorities -- and then we can move forward on them.

K. Krueger: I understand that to mean that there are no firm dates in mind with regard to a facility in Chase.

Hon. M. Farnworth: No, there are no firm dates at this particular point in time. What we have to do is identify which

[ Page 15603 ]

are the key priority projects. That means working with the local health authorities. If the THR, for example, feels that is a number one priority, I would be very delighted to hear that. Then that makes my job, in terms of which projects go ahead and which ones we can do the fastest to receive approval the quickest . . . .

[1440]

K. Krueger: I've heard the minister's answer with regard to Chase, and it sounded to me like a firm commitment for the facility in Clearwater to actually have construction commence this fall. Has Treasury Board approved the funding for the Clearwater project?

Hon. M. Farnworth: Yes, they have.

K. Krueger: The minister is right that continuing care is an issue throughout my constituency and certainly the Kamloops constituency as well. I've raised this issue in the House repeatedly, and it's one that generates more work in my constituency office than any other.

Recently the health board reported to me that they had 363 people on their wait-list for continuing care beds. The two major facilities in Kamloops, although they're quite large by provincial standards, barely house that many people -- a little bit more. But we have pretty well as many people on the wait-list as we actually have in facilities.

On top of that problem with placement, we have people occupying beds in the acute care hospital, Royal Inland Hospital, who really ought to be in the continuing care facilities. As a result, we frequently have a hospital that is plugged, and the surgery wait-lists rise as a result. Again, recently the health board reported to me that the wait-list was over 2,700 people.

The health board, which this government appointed when it ended the elected board process in Kamloops and region, set about firing administrators of the large facilities. Mr. Paul Chapin, who managed Royal Inland Hospital, was fired, and the resulting judgment in court for a severance package was half a million dollars.

Mr. George Cheyne, who was an exemplary person managing Ponderosa Lodge extended care facility and did many things that people point to as a model for how to get additional housing for seniors attached to continuing-care facilities and so on -- a really innovative, inventive man -- was also squeezed out, terminated, by the appointed health board and replaced by someone they chose.

A woman who had been appointed to manage Overlander Extended Care Hospital in a competition over another person, Claire-Anne Brodie, found herself abruptly fired and walked out of the building. Ms. Brodie was appointed in charge of continuing care at both facilities after. Ms. Brodie has appointed a woman named Louise Johnson, who had done consultations for our continuing care facilities about switching to a new mode of treatment which she calls gentle care, where purportedly the residents will be able to make more of the decisions about their own environment and what will happen to them each day.

Having apparently convinced the health region to proceed in that manner, she was then hired to run the programs.

I have had a deluge of complaints from staff, from residents and from the families of residents who are desperately unhappy with the changes at Overlander. The staff are union people who are terribly aggrieved by what's gone on there. They say the quality of care has gone way down.

The same administrators who tell me that it's a good thing to try and move in this direction also tell me that the degree of functionality of new residents is far worse than it used to be; they have much more advanced stages of dementia. They're telling me that they're receiving people who aren't nearly as capable of making decisions for themselves as they used to be, when people could literally walk in and say: "I'm tired of mowing my lawn, and I'd like to come to this facility." Of course, it'll never be that way again in British Columbia.

[1445]

So they have these much sicker people coming in, they have this huge backlog, and they have this dramatic change in management style. The effects have been awful, frankly. I have met with the health board and conveyed these concerns. They didn't seem to have any means of staff and residents actually funnelling these concerns to them without retribution being a prospect, at least in the staff's minds. I think they have now agreed that they should have an independent process for input.

[J. Cashore in the chair.]

The situation is just spiralling into chaos, it seems to me. Overlander Extended Care facility had been planned to be a much larger facility than it is. There was a plan for the addition of wings as the population made it necessary. One of those wings was actually built and shelled in, but it's never been finished. Now the administrators tell me that before they can finish it, they have to gut it, because the ministry standards have changed. They have to have many single-occupancy rooms in the facility rather than the ward concept, which would have provided for 28 beds there.

To local people this just seems like folly, because we have 363 on the wait-list. How can we possibly move backwards when we have this shelled-in wing for 28 beds?

I was told -- and it apparently is true -- that when the Overlander facility was built, a huge boiler was put in to service all the new wings as they'd be added. Before the boiler ever got used, the new administration decreed that it should go, and crewmen came in and cut it to pieces with torches and hauled it away, which is considered a reprehensible waste by the staff.

Things seem to be chaotic, with regard to the current administration of the facilities, the way staff issues are handled, the plans to redevelop rather than add to the facilities and even the upgrading of equipment. Staff are being hurt because they have to handle patients, where even in industry in British Columbia employers have long since gone to lifts and mechanical devices to keep that from happening to staff. Our average nurse's age in the province is 47, and people can't handle this physical workload. We should be doing everything we can to take that stress off their bodies by providing them with modern equipment.

So I'd like to ask if the minister has been briefed on the problems I've just outlined with regard to continuing care in Kamloops and the Thompson regional health region and what he's going to do about it.

Hon. M. Farnworth: I am aware of the issues that the member has raised, and I would like to thank him for raising them in the House during the estimates debate.

[ Page 15604 ]

The issue around continuing care is an important one. It's one that the ministry takes very seriously, and we are working on a strategy at this time to look at continuing care right across the province. I don't think it's any secret that continuing care will be one of the biggest challenges facing us as a province in terms of health care delivery, not just here in B.C. but right across the country, over the next coming decades as the baby-boom population works its way through the system -- and particularly in terms of the delivery of appropriate care for people when they need it. Long-term care, continuing care and home care are going to play very important roles in the system.

So I am aware of the issues the member has raised. I expect the Thompson health region to do its job to the best of its ability and the board to ensure that its obligations are met. I expect them to be doing that. We will have a strategy, and at the time it's released, I'll be happy to hear the member's comments.

K. Krueger: I would like the minister to commit to watch the staffing situation in Kamloops. The staff describe a climate of extreme fear in the extended care facilities. They say they are punished when they actually try to be participative in the way the facilities are being managed. They have given me evidence of that. The Health critic came up to Kamloops. I had offered to meet with them. I passed out an invitation by hand, gave it to people to pass out in the facilities and booked a room. I thought I might get a dozen people and was set for 40; 96 people came out to that meeting.

There was pretty much unanimity in the room as to the issues that were being presented to me. It was like something out of a sweatshop in some old country, not the way you would expect health care facilities to be run in British Columbia in the year 2000.

[1450]

Certainly the regional health board and the administrators of those facilities know that I am watching that problem. I am continuing to receive input from people. I think it would be helpful to the staff and to the residents and their families if they felt that the minister also had a particular interest in that. Certainly this is a government that means to be, and needs to be, friendly to the workers. Health care workers need to be shown that they are valued and esteemed. We know that they are; we know how essential they are to the well-being of British Columbians.

I wonder if I could have a commitment from the minister that he will ensure that the ministry keeps tabs on how those facilities are being managed and how the staff are being treated.

Hon. M. Farnworth: The ministry always . . . . We're in constant touch with our facilities and with health authorities throughout the province. The member is free to raise concerns with my ministry -- with myself, for example.

I don't think anyone working in a facility in British Columbia should be concerned about their ability to raise issues. If they want to, they should feel free to. There are a number of processes in place; they have their union that they can raise issues with, grievance procedures and those sorts of things.

There should be -- if there are not, there should be -- all kinds of union-management committees that they can have input into. Failing that, the good offices of their MLA, I'm quite sure, would be more than willing to raise complaints or deal with particular problems. As I said, our ministry is in contact with the health authorities, and we keep in contact with facilities as well.

K. Krueger: The staff had described to me what they referred to as a "gag order" that they were issued. When I asked them to produce a copy, they did. It was written on pink paper. They said: "That's no accident; it's the same colour as a pink slip, and a number of people who've tried to provide input have received pink slips."

I objected to this to both administration and the health board. Subsequently the staff described a three-page document -- also a gag order, in their words, but much more detailed -- that was circulated apparently to discourage the staff from speaking to me further. They often send their input to me anonymously and eventually end up identifying themselves to me. As I said, 96 people came out to that meeting, believing there was some safety in numbers. It's a serious concern. It's not the style of management that the minister or any of the senior people would expect to see in a facility of the province.

I will continue to raise these concerns to the ministry, and I'm counting on a response from the ministry, because it just shouldn't continue. I had e-mails and telephone calls just in the past two weeks while preparing for these Health estimates, confirming that even though I've been working on this situation for months -- and very publicly -- the problems have not gone away.

Does the ministry have an overall plan to deal with this issue of equipment being outdated and people not having the modern lifting equipment, and so on, that they ought to have to protect their fragile human nature as they try to cope with this as an aging working population?

Hon. M. Farnworth: There are a number of initiatives. The occupational health and safety agency within the ministry, is looking at that, and we are providing some concrete action in that regard.

In my discussions with the other provinces and the federal government about ways in which we can meet some of the challenges facing health care in British Columbia and indeed right across the country, one of the important things that I am advancing as part of British Columbia's approach is to try to see the development of a hospital relief fund infrastructure program that can look at issues around equipment and technology -- to take advantage of the advances in technology but also to look at equipment as a way of ensuring that we can deal with some of the issues that the hon. member has raised.

K. Krueger: I appreciate those points, and I don't want to belabour these issues, although my constituents would like to see me talk about them for days. It's that serious an issue up there. But there are, of course, 75 MLAs in this building, and other people need a chance to raise constituency issues also, so I'll move on.

[1455]

I'd like the minister's comment on the shelled-in wing at Overlander Extended Care Hospital that I mentioned. It's capable of housing 28 residents. It's already there; it's heated. I've gone and toured through it. It's used for storage of wheelchairs and things like that. But it could actually be finished, and we could take some of the stress off Royal Inland Hospi-

[ Page 15605 ]

tal. To its credit, the ministry -- although it took years to convince -- is working on opening an interim facility at Royal Inland to move some of the continuing-care people out of the acute care beds.

Still, we have this asset -- this wing -- that's substantially completed except for actually finishing it inside. If we finish it the way it was designed, we could have 28 people off the wait-list. I'd like the minister's commitment to try to advance and accelerate that project.

Hon. M. Farnworth: I understand the member's concern around the particular project. I give him my commitment to look into it and see if there are ways in which we can speed things along.

K. Krueger: University College of the Cariboo has a very active nursing program -- tremendous success in that. I was delighted to see that the government has come up with the funding to increase the spaces they will be able to provide to 80, including 16 at Williams Lake. That's great. That's what they were hoping for and what I intended to lobby for during this session.

One of the issues for the nurses -- who not only are a very aggressive lobby group but also, as part of their program, are trained to lobby people like me and come out regularly to visit me and talk to me about issues in the office -- is that while they're working through this program, which is a four-year bachelor's program now, they have to support themselves often at minimum-wage jobs being servers in restaurants and so on. It's frustrating to them, because they know that they could help take the workload off the staff in the hospitals.

As I mentioned, the average nurse's age is now 47 in British Columbia. A lot of nurses are so stressed out that they end up booking off sick, and that adds other pressure to the remaining people. The nurses certainly feel there's been a process which they describe as a casualization of their workforce, where health regions have gone to refusing to call them full-time people and just calling them in as needed. They sometimes end up asking them to work 12-hour shifts back to back -- preposterous things that just can't be good for anybody concerned. So all of that's going on to the regular workforce.

At the same time, we have these student nurses, especially when they're up to their third and fourth year of education, who could relieve a lot of the pressure on the existing nursing workforce. It's one of the few areas where people are educated at UCC where there isn't some sort of co-op program.

I would really like to see the ministry explore using those student nurses in the hospitals, both for their own development and to take pressure off the existing staff, and paying them -- it certainly wouldn't be full nursing salaries, but certainly they're worth a whole lot more than the minimum wage they're earning in the service industry establishments -- and thereby solve a whole bunch of problems at the same time. I'd like the minister's view on that.

Hon. M. Farnworth: The member raises a good point. It's one that we are looking at in terms of what the options are for dealing with the nursing situation here in British Columbia. We are working with the nurses to identify opportunities and how we can do that, including mentorships and receptorships and those sorts of things -- getting them into institutions earlier. So certainly, hon. member, I will take your comments and your suggestion under advisement, and we can put that into the mix as well.

K. Krueger: Just finishing up, then, with two points I'd like the minister to comment on. I mentioned this whole issue of standards in the facilities providing for fewer patients than the old standards did. It seems to me that if we move in that direction in British Columbia, where we have these wait-list problems everywhere and this huge population bulge, it's like a general stopping in the middle of his war to order redesigned tanks. It just doesn't make sense to change your facilities where they will house fewer people in continuing care, when in fact you have far more people on the wait-list than you can accommodate.

[1500]

The other issue has to do with management performance when problems occur such as I described in Kamloops, when an appointed board fires managers and then appoints its choices, and they begin delivering disastrous results such as the ones I've described. I wonder if the minister has or intends to have a system to review the performance of such managers and deal with them and the boards that appoint them.

Hon. M. Farnworth: I take it the member is, in part, referring to some of these comments around multilevel facilities and the problems that he sees or that he's concerned about. I think there's a number of points I need to make, and one of them clearly . . . . I mean, health authorities do need to be accountable for the activities that take place in the institutions in their particular region and the ones that they're mandated to administer. We can work with them on that and work with HEABC in terms of determining the types of standards that should be in place and frameworks and accountabilities -- how accountability should be measured. Those types of things we can do.

I also think there's another point which needs to be made -- that is, the critical issue in terms of the construction of the facilities and ensuring that we have in place the facilities necessary to meet the bulges coming through the population from the baby-boomers and the fact that people are living longer and the fact that people don't die from stroke the way they used to and don't die from heart attacks the way they used to. We're able to deal with illnesses much more effectively than we used to, and instead people are aging.

What is happening is that we are seeing the rise of a lot of age-related diseases and illnesses such as dementia, which the member mentioned a few moments ago. Those types of things place particular pressures on facilities in a way that we didn't see in the past. So those are the types of things we need to be focusing on in terms of long-term strategies.

That again comes back to one of the issues that I'm trying to advance in partnership with the federal government. An infrastructure program can provide more facilities, but in terms of the type of pharmaceuticals, those types of things all have to be brought to bear. It's not a question of: do this, and you'll solve the problem. I think it's a question of recognizing that there are short-term decisions that need to be made. We need to be looking at the administration and management of the facilities that we do have and also be looking at a long-term strategy recognizing that this is a big problem and that there's going to have to be some key decisions made. That's

[ Page 15606 ]

where I want the province to be -- in a position to make those with the resources so that we can put in place proper solutions.

G. Abbott: I want to follow up on a question about the Chase multilevel-care facility that my colleague from Kamloops-North Thompson raised. I want to ask a couple of questions around changes to the hospital facility in the city of Enderby. As well, I have a couple of questions on the proposals for multilevel care in the North Okanagan-Shuswap.

Let me begin by expressing my disappointment with respect to the minister's response to the question about a multilevel-care facility for Chase. The core of my disappointment is that when I've raised this with previous Ministers of Health, the answers have been rather more encouraging than the answer that my colleague received today. I know there was a delegation that met recently with the minister's immediate predecessor as Minister of Health, and there was a press release issued which was, it seemed to me, of quite an encouraging nature.

So I'm surprised, in the absence of something further coming out of the briefing book here, that we are back to the stage of simply identifying what the priorities are.

I'll remind the minister that Chase has been putting forward this proposal since 1993. They made a proposal to the then Minister of Health in 1993, which was of a detailed character. It was endorsed by the local governments, by the first nations bands in the area and by the union board of health of the day. They were quite encouraged by what the then Minister of Health had to say in regard to it.

[1505]

Another reason why I am very much disappointed in the minister's previous response is that the level of retired people in that Chase-Shuswap community is very substantial, although the village of Chase will be part of the Kamloops-North Thompson riding in the next provincial election. The North Shuswap area remains a part of the Shuswap constituency. I can tell the minister that in the North Shuswap, which hopefully will be accessing a new facility in Chase at some point, some 40 percent of the population is 55 and older.

The minister acknowledged, moments ago, the demographic bulge that's going to be making its way through. In very popular retirement areas like the Shuswap, that problem is going to be particularly pronounced.

I'll invite the minister at this point to advise me whether in fact there is something of a more encouraging nature that can be said about that facility. If there isn't, why was there a press release of that character earlier on this year?

Hon. M. Farnworth: In terms of the response that the member is looking for, as I said to the previous member, we need to know where it ranks in terms of the priorities, so that when decisions are made, the ones that are ranked the highest are the ones that should be getting the funding. That needs to take place.

Secondly, we recognize that there is a strong need for more continuing care in the province of B.C., and we're working to try and deal with it as expeditiously as possible. It means that not every project is being funded this year. We want to ensure that we can do them as quickly as possible. But part of that means working with the Thompson health region, in this particular case, and I need to get from them exactly where it is on their priority list.

G. Abbott: As I understand it, the Thompson health region and its predecessor organizations have endorsed this project. I'm not sure what more is required from them, but I'll leave that, for the moment at least, and move on to the issues around the Enderby hospital.

The minister can perhaps inform me a little bit more fully about what is contemplated for Enderby. My understanding is that the emergency

section of the hospital will be closed, that acute care beds will be closed and that they will be replaced by more multilevel-care beds in the facility -- the Enderby and District Memorial Hospital. Can the minister advise whether that

summary is correct?

Hon. M. Farnworth: Your

summary is basically correct.

G. Abbott: The city of Enderby has, I think, been quite responsible in terms of how they have managed what is often a very difficult and controversial issue in a community -- the closure of some aspects of the hospital. One of the reasons that they have been able to keep things together there, essentially, is the promise for more multilevel-care facilities. Can the minister put on the record here what the commitment on the part of the government is? What is the promise that is being made by the government, either on their own or through the health region, with respect to what's going to occur in Enderby hospital?

[1510]

Hon. M. Farnworth: We're waiting for their long-term plan to be finalized, and then it comes to us. Because they're doing the renovation, though, that does allow the potential for some extra capacity. But when that's complete, that will have to be ranked with the other areas around the province and in the region, in terms of how that capacity can be filled.

G. Abbott: Again, I don't think I take the comfort from that response that I would like to take from it. If the city of Enderby and district are going to be losing aspects of their hospital facility that they have enjoyed for, I think, close to 100 years -- if, for example, they're losing their emergency and the acute care beds -- am I to understand from the minister's response that there is no firm commitment being made on the part of government in recognition of that?

Hon. M. Farnworth: We want to work with them to ensure that they continue to provide services. The question is that in order to do that, we need the long-term plan for the future of how they see things in that particular area -- right? So we need to get that, and then we can start to move things forward.

I know there's going to be the demand growing in that area. You're going to need the long-term care -- those types of facilities and those types of beds. So I know that the demand's there. We just need the plan that says: "Okay, here's when we want things to start to come on stream." Once that's done, that can get into the hopper, and we can start to move things along. I fully understand the member's points that he raises about his area of the province, the Shuswap, becoming an increasingly attractive place for people to retire to.

It's more affordable than the Okanagan, for example, and more affordable than the lower mainland. That is going to reflect itself in the needs that government has to meet in his particular area. It needs to be done on the basis of a good long-term plan. Once that's in, then we can start to work on it.

[ Page 15607 ]

G. Abbott: That long-term plan, I'm assuming, is one that the ministry is looking for from the North Okanagan health region. Is that correct?

Hon. M. Farnworth: That is correct.

G. Abbott: One of the issues that is again causing some concern in the community around the change in the character of the Enderby hospital is what's going to happen with ambulance service. Is the level of service going to expand or contract? Obviously we're going to be moving people not to Enderby anymore but either to Vernon or to Salmon Arm. Is the minister conversant with that issue of ambulance service and what changes, if any, will be required as a result of the changes to Enderby hospital?

If you're waiting for the right staff, I can go on to another question, and we can come back to that.

[1515]

Hon. M. Farnworth: There are no changes planned in the ambulance service in his area.

I would ask at this time if we could take a two-minute recess.

The Chair: The House will have a short recess.

The House recessed from 3:17 p.m. to 3:19 p.m.

[J. Cashore in the chair.]

G. Abbott: There's a couple of other aspects about the changes in the status of Enderby hospital that I want to clarify, at least to the best ability of the minister here today.

Among the physicians who are now in Enderby or are associated with the Enderby hospital . . . . They do want to retain the opportunity for what I guess might be termed semi-acute care, where they put patients into Enderby hospital for observation overnight rather than have them moved to Vernon or to Salmon Arm, where there are rather more logistical difficulties in dealing with that. Is semi-acute care going to continue to be offered at Enderby and District Memorial Hospital?

Hon. M. Farnworth: Yes.

G. Abbott: I am pleased to hear that. While we're on a roll, is it correct that rehabilitation services will also continue to be offered at Enderby and District Memorial Hospital?

[1520]

Hon. M. Farnworth: I will look into the issue for the member, and I will get back to him with a definitive answer.

G. Abbott: I'll look forward to receiving a response on that issue. I do hope that the city of Enderby receives the satisfaction, which I think they really deserve, around the change and the nature of the health facility that's served them for a long time and served them very well. I do hope that we see some satisfactory answers to that.

I have just a couple of questions with respect to multilevel care in the North Okanagan health region, which of course includes the Shuswap. I think this is a huge issue for my constituency. As we've discussed previously, the number of retired that exist there is quite remarkable. Just looking at the current number of people in the North Okanagan health region who are over age 75, it's 8,722, which is, to me, a remarkable figure. The health region projects that for 2005, 10,712 will be over the age of 75. We are, again, just seeing the beginning of that great demographic bulge which is going to pose a huge challenge to the health care system in British Columbia in the years ahead.

One of the reasons why, obviously, this is a very big issue in my constituency and more broadly in the North Okanagan health region is that currently, even under our current circumstances, where we're probably perhaps 150 to 200 beds in deficit on multilevel care . . . . At this point 25 percent of the acute care beds in the North Okanagan-Shuswap are filled by long term care patients. Obviously that's not what the system was designed for. It becomes very expensive and very difficult for everyone involved.

I know; I had some personal experience with this. My father had a stroke a couple of years ago, I guess. He was stuck in an acute care bed for a time, very unhappy there -- not the right situation for him. He was lucky, as a veteran of World War II, that he was able to get a multilevel-care facility bed in a relatively short time. But I know that there are hundreds of people who have not been as fortunate and who are stuck in this very unfortunate situation of occupying an acute care bed when that's not the appropriate place for them.

I guess there are a number of questions which the minister could address pursuant to the problem. I hope the minister agrees with me about the character of the problem in the Shuswap and the North Okanagan. There's a high percentage of retired folks; the number's not going to go down; it's going to get bigger. We are already substantially in deficit in terms of multilevel-care beds. That is likely to continue. I guess the big question is: what are we going to do about it? How are we going to begin addressing that?

One of the areas that I hope the minister will address is the issue of public-private partnerships. Apparently, according to my friends in local government in the Shuswap area, there are a number of possible projects there of a public-private partnership nature that have not been able to proceed, because there appears to be either some discomfort or no finalization of the ministry's position around those kinds of partnerships.

The minister can perhaps inform me on this. I know that years ago we had a long debate about public-private partnerships in Municipal Affairs. I know that the minister was a keen proponent of public-private partnerships at that time. I don't know whether the same holds now that he's Minister of Health. But I do invite the minister to comment (

a) on the problem, (

b) on the solution, and (

c) on the potential role of public-private partnerships in that solution.

[1525]

Hon. M. Farnworth: I understand the member's interest in the issue and the fact that it will impact on his particular region of the province, as it will impact on a number of regions of the province. In my particular area, for example, in the community that I represent, only 6 percent of the population is over 65, and 25 percent is under the age of 14. It has a different set of needs.

[ Page 15608 ]

Clearly, in terms of the issue of the demographic boom and where people are retiring in the province, certain parts of the province will be impacted to a greater degree than will others. I think that it's a question of being innovative and identifying a number of solutions, not one specific one, because the problem requires different approaches for a variety of reasons.

First off is the level of care that the particular individual requires or may require. That means that in some cases acute beds are required; in other cases long term care beds are required. In other cases it may be something as simple as home care, having someone be able to stay at home and receive, two, three or maybe even five days a week, a visit from someone who can do the services that are required. That can ensure that an individual, a senior, can stay at their residence or at their home until such time as they require a higher level of care.

That's what we have to get to: a system based on that, which recognizes different levels of need, different levels of care. We have to be able to respond with that. If we take that approach of being innovative, then we will find that there's a range of solutions that are going to have to be put in place over the next few years to reach that goal.

Public-private partnerships, for example, in the provision of care facilities may very well be part of that equation. Those types of things are where we have to focus. One of the key areas is around innovation, in terms of making sure that (1) we get better use of our existing facilities, and (2) we are looking at a full range of ways of delivering the type of service that individuals require.

G. Abbott: I don't disagree with what the minister has said in terms of developing an appropriate recipe or an appropriate response to the different kinds of care that are needed in different instances. He's right. If we can provide care in the home, that works well in some cases. In other cases we may need more of an institutional character.

But going back to my own experience, my father had a stroke; he was incapacitated. It was clear that he was going to require long-term care. My mother certainly wasn't going to provide that; she couldn't. There was no way. Out there, there are hundreds, thousands or tens of thousands of stories like that across the province. Clearly we have to develop some way of dealing with the issue of multilevel-care provision.

The answer that I heard from the minister in terms of the public-private partnerships was that that might be one of the things that are being considered on a broader menu. Perhaps that's fair enough, too. But before I yield to other members who have equally important constituency questions, I just want to be clear. Has the ministry resolved in principle that public-private partnerships are an appropriate way to proceed towards the resolution of the multilevel-care gap in British Columbia?

Hon. M. Farnworth: They are an appropriate way of dealing with some of the problems we face within the province; they are not the only way. They are one of a number of things that could be used to alleviate some of the pressures that we face.

I think some of the key ones are around making sure that we're innovative in terms of how we use the existing facilities. The second is ensuring that there are levels of care out there to meet the needs of people in their homes and then to ensure that we can build the facilities for people who require that higher level of care.

These are issues that I have been raising with my colleagues in other provinces and with the federal government in terms of long-term care, home care, home support; those things are key.

As I said, the member raised the issue around public-private partnerships. They will also have a role to play, and the ministry will evaluate projects that come into the ministry on that basis. It's not just one solution; it's one piece of a much larger continuum.

[1530]

P. Nettleton: I have a number of questions of a regional and a local nature with respect to health care delivery in the Prince George region. For a number of months Prince George Regional Hospital's intensive care unit has been on alert, meaning smaller facilities in surrounding communities haven't always been able to transfer patients to PGRH. In that respect, health care officials in Prince George have suggested, particularly in recent months, that PGRH is not fulfilling its role as a regional trauma centre.

I would like to start by asking the minister for a comment on that point. What responsibility does the government have in ensuring the largest hospital in northern British Columbia is able to meet its role as a regional centre? Do you feel your government is meeting that responsibility?

Hon. M. Farnworth: We take the issue the member raises very seriously and particularly the ones around trauma. We have a provincial trauma plan designating that we have regional trauma centres in the province, and Prince George is one of those centres. We are also working very closely with the health board of the Prince George area to ensure that we can meet the needs of the hospital and the facilities in Prince George. It is something that we are actively pursuing.

P. Nettleton: I'm glad the minister mentioned the health board because Dave Richardson, the CEO of the Northern Interior regional health board, has said that the situation at Prince George Regional Hospital is "the most serious it's ever been." Those are his words.

The problems are serious: emergency room overcrowding, longer waiting lists and a shortage of nurses, doctors and specialists, to name but a few. A number of doctors came forward last week, in fact, to say that the city's health care system is in a state of emergency. Dr. Gault Wilson said: "Prince George is weeks away from a disaster." Other doctors say a typical surgeon can expect to spend about half of one day in surgery and the other four and a half days explaining to patients that there aren't enough staff for the operations they need and that they have a long wait ahead of them. Dr.

Bert Kelly says he has about 4,500 active charts in his office and turns away about six new patients every day.

The present situation has been one that's been a long time coming. The warnings were there. My question to the minister is this: Why did you choose to ignore the warnings?

Hon. M. Farnworth: I didn't choose to ignore anything, hon. member. In fact, I met recently with the board and physicians from the community of Prince George and am

[ Page 15609 ]

working very closely with them to deal with the issues that they have been raising. The issue around physician retention and training in Prince George and in northern communities is a serious one, as is the training and retention of nurses in northern communities. It calls for a concerted approach by government in terms of dealing with it. It is a situation that is not unique to this province but in fact occurs in rural areas right across this country and in the territories.

We have a significant role to play in dealing with that, and we are doing that through a number of efforts: (1) by working directly with the people, the physicians in the Prince George area and the regional health board; (2) by working with the BCMA, for example, in negotiating rural and northern agreements that can allow us the flexibility to deal with issues around physician retention in rural communities; (3) by working in terms of a nursing strategy that can increase the number of nurses that we are educating here in British Columbia and ensuring that there are places for them around the province, because that is an integral component; and (4) by working with the federal government to ensure that we have a strategy in place that recognizes that provinces can't deal with this particular issue in isolation.

[1535]

There needs to be a concerted effort of provinces working together to address the three areas that I've just talked about: physician shortages, nursing shortages and also transportation. There is a role there for the federal government to play not only with assistance in terms of training but also in terms of immigration, assisting people who want to come and practice in British Columbia or in rural areas to get recognition for their qualifications and their ability, and to gain access into Canada. There's a considerable amount of effort being put into doing this, and it is something that we are focusing a great deal of time on.

P. Nettleton: The Health ministry has agreed to provide locums to keep operating rooms running in Prince George this summer. This is at best a short-term solution, but the people of Prince George and other northern communities need a long-term plan.

Prince George physicians have provided the Health minister with a nine-point plan to address the crisis. The six doctors who submitted the plan have a combined residency in the north of 130 years, so it's important to note that they are speaking as concerned citizens of the north. They suggest that, without action, we will soon be airlifting large numbers of acutely ill and injured to other centres and running up even bigger waiting lists for urgent and elective surgeries.

The ball is now in the government's court. Will the minister explain what immediate actions he plans on taking to address these concerns?

Hon. M. Farnworth: The member is right. There are short-term solutions around the issues of locums. I think the member would be ill-advised to dismiss that out of hand, as that is something that will ease some of the pressure. But it is a short-term solution. However, that is often as important as developing a long-term plan, to recognize that there is a particular issue that needs to be resolved. How can we do that and take the immediate pressure off that? Locums are one way.

The second is to ensure that we have a long-term plan and strategy in place. I just outlined for the member that we are actively working on that on a number of fronts: first, with physicians and the health care community in Prince George; second, with organizations such as the BCMA, in terms of looking at a provincewide application; and third, by my efforts, on behalf of the federal government to address this on a national perspective.

We also need to recognize that, as I said, we have met with the physicians and the health care community in Prince George and identified what is one of the key issues in terms of dealing with a crisis that everyone recognizes, and that is around the supply of an anaesthesiologist. We are working in partnership with Prince George, the health authorities there, to identify a suitable candidate, and we are working to do that as quickly as possible.

P. Nettleton: In the recent provincial budget this government announced more student spaces at post-secondary facilities. We have seen press releases indicating that a given amount of spaces will be created in each of the university colleges in the interior. However, in some cases no new spaces or a minimal amount of new spaces will actually be added. In other cases some of those so-called new spaces already existed. How many nursing seats will exist at UNBC in Prince George next fall, and how many of those will in fact be new seats?

Hon. M. Farnworth: Part of the member's question is an overlap into the Ministry of Advanced Education and Training, in terms of the specific number of seats in each particular institution. But what I can tell the member is that there is funding in place for 400 new seats to be in place by this fall.

The impact of that is that we will be able to train actually more than 400 individuals, because some of the seats in fact are refresher courses, and so you get two for the price of one, if you like. So if there are 75 refresher seats, that allows nurses who are currently qualified to take the course, and they can then go back into the nursing profession. And you can do another one in the same calendar year. So in essence, if you have 75 of those seats, you in fact manage to put through the system 150 nurses, which will allow you to have more than 400 at the end of the day. So at the minimum there are 400 seats, but that hopefully will result in significantly more than 400 individuals.

[1540]

P. Nettleton: On another topic, the minister met with the delegation from the Nechako Valley in early April, trying to get the minister to address the need for a multilevel-care facility in Vanderhoof, which in fact would have serviced the entire region. Will the minister provide an update?

Hon. M. Farnworth: I'm pleased to inform the member that I met with the mayor and representatives of Vanderhoof and the former MLA -- his predecessor, in fact. They will be submitting a proposal to me, and I will be evaluating it. I gave them every encouragement that if there's a way we can find to do this particular project, I would certainly like to do that.

P. Nettleton: Well, I'm not sure why it is that they would have to submit another proposal, because the current proposal was rejected some months ago by the minister's predecessor. In any event, the people of Vanderhoof and the Nechako region have been lobbying for a multilevel-care facility for

[ Page 15610 ]

some 20 years. This capital project is the number one priority of the Northern Interior regional health board, but for some reason this proposal gets passed over, year after year, by the provincial government.

I would ask the minister: what answers do you have for the people who have been waiting for two decades for a multilevel-care facility, with respect to the proposal that has been placed not only before the Northern Interior regional health board but before the current government and the present minister?

Hon. M. Farnworth: I can tell the member that I had a very constructive meeting with the mayor of Vanderhoof and representatives of Vanderhoof, who are wanting to get this project up and moving. The scope of the project has changed since it was first being proposed, which is more than a decade ago. But I have told them: "Look, you know, I'm very interested in the project." I've told the mayor of Vanderhoof that I'd like to work with him to move it along, so that's what we're trying to do. They're working with the ministry.

You know, I have to say that I was very impressed by not only their commitment but the preparation that they have done. There's lots of questions that we can answer, that will able to be answered. But there does need to be some work done, and that's what is taking place, and that's what we want to see happen. As I told them: "Let's try and get this project moving."

L. Boone: I listened with great interest as my colleague was questioning the minister with regards to PGRH, which of course is my hospital as well. I'm aware that a couple of years ago, I think it was, the Minister of Finance and myself lobbied very heavily with the Ministry of Health to obtain regional funding for the hospital. I'm wondering if the minister can just advise the House again what that funding was, because I've forgotten. We did bring extra dollars to the ministry, to the hospital.

We gained assurance from the very doctors that the member talked about as saying that they were concerned about the hospital. At that time they were very jubilant and said that this would guarantee it -- that it would become a regional facility. Could the minister please advise us what that money was and what changes were expected with the hospital?

[1545]

Hon. M. Farnworth: The project is on schedule. Construction is now scheduled to begin earlier than planned -- August of this year as opposed to June of 2001. There was about $6.12 million in the budget for it this year.

L. Boone: That was with regards to the construction, which of course has been on our mind for a long time. But I'd also like to ask, going back to what the member for Prince George-Omineca asked about with regards to the proposal put forth by the doctors . . . . The proposal was going to cost about $25 million to $30 million. Can the minister advise us if that was the cost estimated for the proposal that the physicians brought to him? Is that the cost that they brought forth?

Hon. M. Farnworth: When I met with the physicians from Prince George, they left a proposal with the ministry in which they have outlined a number of ways in which they see the issue around physician shortages could be addressed in Prince George. It's done in a two-fold manner. One is to deal specifically with the issue in Prince George and how one could retain physicians in Prince George. Then it has also been costed out into how the program could be expanded across to northern British Columbia.

My ministry is doing the work on the exact costing, because we want to ensure that if we were to look at a proposal like this and expand it across B.C., we have an accurate assessment of the costs. I don't think that we would want to be looking at doing something in Prince George when it's maybe a model to take right across the province.

The second point that I would like to raise in regard to this particular issue is that along with this proposal that has been tabled by the physicians and the health community from Prince George, we are negotiating a master agreement with the BCMA which has an opportunity to address some of these particular issues.

The third point is that it may be possible, for example, to look at the northern and rural health care agreements that cover areas to the north and outside of Prince George that aren't covered at the current time. It may be possible to extend them to Prince George and deal with some of the concerns that the physicians raise in their particular proposal. We are examining the costs for the different services in the agreement, and that is part of the discussions that we are having with the health care community in Prince George.

L. Boone: I understand that the proposal they've brought forth also contains some suggestions for increases in their per-visit costs. I think we just signed an agreement with the BCMA, and I guess the question that I have is: did the BCMA at that time raise the issue with regards to difficulties some of the other communities have in attracting physicians and suggest a fee differentiation between them?

Hon. M. Farnworth: A physician resource plan is part of the framework agreement which has been negotiated. One of the key issues we have to keep in mind in terms of dealing with the situation in Prince George is that other communities in British Columbia face the same challenges in terms of attracting and retaining physicians to their communities.

What we want to do is make sure that (1) we are dealing with the situation in Prince George but that (2) the solutions we put in place can be applied to different parts of the province and recognize that there are significant issues and challenges to attracting physicians to northern and rural communities in this province and ensuring, in particular, that northern communities such as Prince George, which are major referral centres and trauma centres, have the critical mass required to support the service base of the regional area in which they are intended to serve.

That's one of the areas in which we are working very closely with the BCMA.

[1550]

L. Boone: I guess one of the concerns I have is that when I talk to my physicians in my area, they frequently say that the BCMA does not represent the north. Anybody that comes from the north knows that this is not an uncommon problem we have, in having any organization recognizes the difficulties from the north. My colleagues, I'm sure, understand that.

I guess my concern is: is there a process within the BCMA for them to negotiate regional differences? We are hearing that they're not representing their concerns. If they aren't representing their concerns, then there needs to be put in a process

[ Page 15611 ]

so that we're not constantly renegotiating side deals with . . . . Whether it be the northern docs or the rural docs or whatever it is, we ought to know that when you sign an agreement with the BCMA, that is an agreement which pertains to everybody and one that would be reflected in all of those things. It seems to me that the physicians in our area are saying: "No, the BCMA does not represent us, and therefore we feel we ought to be negotiating separately and on our own." That, of course, would not happen in any normal union, and let's be clear that this is a union we're talking about here.

Hon. M. Farnworth: I'm not in a position to comment on the internal workings around the BCMA. What I can tell you is that there is flexibility there, I think, so that we can within the ministry work with the physicians in Prince George, the health community and the health authority in Prince George to deal with the issues that are facing that particular region of the province. Second, we can work with the BCMA in terms of identifying some of the key areas around rural and northern health care issues and trying to attach importance to the resolution of those particular problems.

The fact of the matter is that we do have a rural agreement which they have signed on to. That is an indication, I think, that not only does the province recognize the issues around northern health care but that there is also a greater recognition within the BCMA around that. The agreements still have to be ratified, but think they're a good sound base.

The second is that we have to recognize that it is going to take a concerted effort of partnership between the province and the health communities in northern and rural areas of the province to solve these particular issues. That means local government, local health boards and community health councils. It means nurses working in these particular areas. It means the health authorities; it means the BCMA. It means a recognition of a sensitivity that the health needs of rural and northern British Columbia and the challenges facing them are not the same as those here in the lower mainland.

That's why it also means that we have to recognize and look at what's happening in other provinces in terms of rural areas and northern areas, that we have to recognize there is a role for the federal government and that there has to be a comprehensive strategy and plan in terms of dealing with issues in northern and rural B.C.

C. Hansen: My concern with what the minister has said on this issue surrounding the Northern Interior regional health board is that we've heard this all before. This government has now been in office for nine years, and we've had six Ministers of Health during that period of time. What we find is that each year there may be a different minister in the chair, but we hear the same kinds of stories over and over and the same kinds of response from the minister of the week. In this case, he's talking about what a nice meeting he had with the mayor.

Well, the mayors are angry, and I think people in this health region are angry. He's talking about how he's interested in the proposal and how he's impressed with the proposal. We've heard that from his predecessors time and time again. Over the nine years that the NDP have been in power, we have seen the delivery of health care in the northern interior deteriorate year after year. We are not seeing improvements.

I've got the update that came from the northern interior regional health board just last month. This is the government's appointed chair of that health board. I'll just read you an excerpt from this update:

"Regional health board chair Lorraine Grant says there are still more patients than we have spaces for, the ICU continues to be on diversion, and our staff and physicians are getting burned out from working in a state of constant pressure. 'Our staff and physicians are doing an incredible job of continuing to provide quality care to those in need, but the longer this continues, the more we are burning them out. There is only so long you can continue to manage in a situation like this.' "

This isn't a crisis that has started just since the minister was appointed to this responsibility. This is a crisis that has been growing for the last nine years. What we have seen is a failure of this minister and his predecessors in dealing with that kind of a problem.

[1555]

What is important, I think, is not the studies, and it's not the cordial meetings with the mayors. What's important is outcomes in that region. As my colleague from Prince George-Omineca outlined earlier, the CEO of that health region, Dave Richardson, has had some pretty strong things to say recently. He's talking about how that region ranks from one to 20, where one is the best and 20 is the worst. It says: "Of the health regions in B.C., the northern interior region ranks highest" -- like 20 -- "in cancer, diabetes and all causes of disease. It ranks eighteenth in pneumonia and influenza, motor vehicle accidents and chronic lung disease."

Yet what we're facing today -- which is not a new problem, not a new crisis; it is a crisis that has grown over the years -- is that they are now in need of recruiting 25 specialists, ten family physicians and 75 nurses.

What we have seen is a growing legacy of nine years of the inability of this government to deal with the very real human problems that we have in the northern interior health region. We have seen study after study. We've seen little announcements here and little announcements there, but as my colleague from Prince George-Omineca points out, what we have seen is a failure for a long-term strategy that's actually going to produce real, tangible results.

Hon. Speaker, in view of this government's track record on delivering health care services in the northern interior, I would like to move, seconded by my colleague from Prince George-Omineca:

be it resolved that the motion before the House to approve the expenditures of the Ministry of Health be amended by reducing the amount by $1.

[T. Stevenson in the chair.]

The Chair: The amendment reads:

Be it resolved that the motion before the House to approve the expenditures of the Ministry of Health be amended by reducing the amount by $1.

[1600]

G. Clark: Just a brief clarification. I think you said that his salary would be reduced by $1. Or is it reduced to $1? It may make a difference on the vote.

The Chair: By $1.

[ Page 15612 ]

Motion negatived on the following division:

YEAS -- 35

Whittred

Hansen

C. Clark

Campbell

Farrell-Collins

de Jong

Plant

Abbott

L. Reid

Neufeld

Coell

Chong

Sanders

Jarvis

Anderson

Nettleton

Penner

Weisgerber

Weisbeck

Nebbeling

Hogg

Hawkins

Coleman

Stephens

J. Reid

Kreuger

Thorpe

Symons

van Dongen

Barisoff

J. Wilson

Roddick

Masi

McKinnon

Dalton

NAYS -- 35

Evans

Doyle

McGregor

Sawicki

Kwan

Lali

Hammell

Pullinger

Bowbrick

Brewin

Boone

Orcherton

Calendino

Zirnhelt

Randall

Robertson

Sihota

Cashore

Smallwood

Miller

MacPhail

Dosanjh

Petter

Lovick

Priddy

Ramsey

G. Wilson

Farnworth

Waddell

Gillespie

Streifel

Walsh

Kasper

G. Clark

Goodacre

The Chair: Members, we have a tie vote, and I vote in opposition, in favour of continuing the debate that we have -- and of course, to maintain the status quo. The motion is defeated.

[1605]

R. Neufeld: I'll maybe wait a few minutes until some of the minister's staff arrive.

For the minister's information, I'm going to ask a few questions -- not a lot of them -- around Fort St. John General Hospital and multi-year funding and how they provide services in the Fort St. John hospital compared to some other hospitals. Mammography services is the second item in the north. I want to deal a little bit with mental health as it relates to my constituency. I want to deal with ambulance service in my constituency, air ambulance out of the northeast, and touch briefly on Hope Air, previously Mission Air.

I'll start with the multi-year funding for the Fort St. John hospital. I'm sure the minister is aware that we have received some money for Fort St. John hospital for capital expenditures this year. But one of the problems that has constantly been brought forward in the Fort St. John hospital funding is the need for some kind of multi-year planning.

At the present time what's happening -- and the minister can help me a bit with this -- is that the CEO tells me that the funding is on a yearly basis, and they have to get architects for a yearly basis and smaller projects. Those projects don't fit into the next ones, because we don't know whether the next year we're going to get the extension to that first project. So what they have to do is build in smaller units, and the efficiency and the actual end product is not conducive to what you want in the first place.

It leads to, I think, a lot of extra cost -- a lot of extra building cost, extra architectural cost and engineer cost -- when we could actually change that a bit. If we went into maybe even a three- or a four-year cycle in planning for capital expenditures it would actually, at the end of the day, cost the taxpayers of the province less and serve the people of the area much better.

[1610]

I just wonder if the minister could maybe go through that a little bit and tell me the reasons why we can't do that and why we wouldn't do those kind of things.

Hon. M. Farnworth: I can tell the hon. member that we are in fact moving to a multi-year funding capital plan for a four-year period, and that operating funding will be tied to that as well.

R. Neufeld: Has that just happened, then?

I'm going to go back a couple of years to the ambulance facility that was built in Fort St. John, and I know there were some different circumstances surrounding the ambulance garage. But had that ambulance facility been built in a multi-year planning cycle, it probably wouldn't have ended up exactly where it's at on the property. It would have been more wisely attached to the hospital, rather than being a facility unto itself, and facilitated other things such as a helicopter landing pad, which we used to enjoy in Fort St. John. We actually used it quite often, because of the kind of work that goes on in Fort St.

John, in the region -- in the oil and gas industry and the forest industry, where men and women are working miles and miles away from Fort St. John.

Many times ambulance services are provided by helicopter. We used to have a landing pad right at the hospital site. We no longer have that because of what took place with the ambulance service garage and those kind of things.

I don't want to go back and sort a whole bunch of that stuff out. But I just want to talk a little bit about why it would be better in that instance, which is a proven instance -- had we had multi-year funding, we could have done some of those things.

Could the minister tell me if that just took place, now that we're going to start the four-year multi-year funding?

Hon. M. Farnworth: I have to correct my answer to the previous question. In terms of moving to the long-term, multi-year funding for capital projects, that is in fact taking place, but annual operating funding is not yet tied to that taking place. That's still done on an annual basis and would require a change to the Financial Administration Act for that to happen.

R. Neufeld: When can we expect that change will take place?

Hon. M. Farnworth: That would be an issue that you would have to take up with the Ministry of Finance.

[S. Hawkins in the chair.]

R. Neufeld: I appreciate that. We'll carry on some discussions about that later, and I will write the minister for confirmation on when we can look forward to that.

[ Page 15613 ]

Talking about operating budgets brings me to the second part of the Fort St. John hospital, and that is the economy of scale that the Fort St. John hospital offers. I think the minister's staff is aware of a presentation made by Mr. Andrew Neuner to the staff about operating budgets and capital budgets not that long ago. He brought forward some quite startling statistics and gave them to me. One that surprised me . . . . It surprised me because of the efficiency that he demonstrated through the information he had been provided by the Ministry of Health that the Fort St. John hospital operates on -- yet it still seems to be thwarted in some of its operating funding to increase services.

[1615]

I'm sure the minister is aware that the northeast economy in the oil and gas industry is booming. It's doing quite well. The population of Fort St. John is growing steadily, as is the region around Fort St. John. In fact, if we compare the region to Peace River South and Dawson Creek, the city proper has 10,000 people. In Fort St. John the city proper has 17,000 people, with probably another 8,000 within a 15-to-20-mile radius of Fort St. John. It's growing by leaps and bounds and, I believe, needs some more funding to operate. The CEO told me that because of staff shortages, they may have to close some beds.

Some of the statistics he gave me were in comparison to the Prince Rupert hospital. The Prince Rupert Regional Hospital -- and I'm going to read this -- "operates on an almost identical budget, despite the fact that the Fort St. John hospital serves a greater number of patients." The dollar figure is about the same; in fact, I think it's hardly different at all. But the figures from the Ministry of Health said that in 1998-99, Prince Rupert hospital had a total number of 15,656 emergency room visits. Fort St. John's emergency ward had 27,000 -- a huge difference.

The number of births in Prince Rupert totalled 268 during the same time period, while Fort St. John had 476. Fort St. John's births are way higher than Dawson Creek, and in fact, it services, like I said, a larger area.

I wonder: is there room within the ministry where we can start adjusting some of those numbers? I don't know the particulars around either hospital, to be perfectly honest, but I do know that when I go by these statistics, it demonstrates to me that something's got to be wrong somewhere. If you take 27,000 emergency room visits to 17,000, that's 10,000 more -- that's almost double -- yet the money they get is the same. I don't know if it's because there are really good practices in Fort St.

John and maybe some poor practices in some of the other hospitals, but if you go to other hospitals of the same demographic area and about the same population anywhere in the province, Fort St. John comes out on top. Yet Fort St. John is thwarted all the time in trying to get some more funding to provide the service it has to, to a growing community -- a growing, young community, I might add. It's not just to the hospital; it's long term care; it's every facet of it; it's mental health. However you want to go through it, it seems as though that region has held constant and steady and cannot grow.

Maybe the minister can shed some light on why we're at that point in an area that's fast-growing, providing lots of money to the economy of the province and needs the services.

Hon. M. Farnworth: The member raises, some key points that I'll try and address -- some specifically and others in a general way -- because I think the issues are applicable right across the province and reflect part of the challenge that we face.

I met with the administrator from the hospital, Mr. Neuner, and members of the board a few weeks back, and they raised those very concerns with me. I have had the issue around hospital funding, in terms of population-based funding formulas, raised with me. Can we change it? I guess the short answer is: yes, we can change it. The longer answer is: what do you change it to? There are innumerable ways of coming up with a formula that takes into account all different types of things, such as demographics, location, distance and services provided. It's not a simple issue, because you change the formula to benefit one area, and that has consequences in another area.

[1620]

Having said that, what I would like to see happen is that we get a good handle in terms of our ability to refine the funding formula model, because it may in fact have to change over time and take into account changes that are happening in different parts of the province.

I think one of the ways that we have to do this -- and I've raised this with health care administrators from the Peace River country and also with health care administrators from different parts of the province -- is get much better information technology into our institutions and health care system than we currently have, so that we can start to compare, on an apples-to-apples basis, exactly the issues that the member is raising. We can compare what's happening in this facility in this part of the province and that facility in that part of the province.

We have in some places in the lower mainland, for example, within health authorities, hospitals operating on different information technology systems, and they can't talk to each other. They are in the same health authority. That's just unacceptable. One of the areas we're focusing on in terms of dealing with the issue that the member has raised is trying to make information technology a priority so that we can get a provincewide system. Then we can start looking at what are the inputs in Fort St.

John, what are the inputs in Dawson Creek and what are the inputs into hospitals in Prince Rupert, Vancouver and looking at who's doing what well and who's not doing what well. Then you can really start pinpointing and focusing. That's one of the key problems. Technology is such that I think you're going to start to see that.

One of the things -- and again I come back to this theme that I have raised in estimates -- is that other provinces are facing the same issues, and there's a recognition that the provinces have to work together on providing good information technology. The member talks about the efficiencies and the economies of scale that can come about through having, in this case, good information. The same thing is going to apply to the provinces as well.

The member's points are well taken, and it's something that we are trying to focus on. It is an area that I'm particularly interested in dealing with, because I'm convinced that in terms of the next, if you like . . . . We can make significant savings in terms of the health care systems and being able to redirect dollars, and ideally redirect them to efficient areas, by having good information technology that allows us to do that.

R. Neufeld: When can we expect that those kinds of things are going to start taking place and in what fashion? Can we actually see how the rubber hits the road, so that I don't have to come back here next year and ask the minister the same question? What plans are in place -- A, B, C and D -- and how are we going to accomplish those?

[ Page 15614 ]

Hon. M. Farnworth: There are some what you could call immediate, practical projects that we're working on. TeleCare -- self-care TeleCare -- is one way, in terms of introducing information technology. There are some health authorities that have some very good systems in place.

The second is that we're working on a proposal to look on a provincewide basis, at cost-sharing with the federal government. They have expressed considerable interest in terms of looking at how we might fund something like that not just here in B.C. but right across the country. They are in agreement with us that in terms of how we move things forward and how we identify where some of the key financial challenges, in terms of money going into the health care system . . . . In essence, where is it being spent? Greater accountability that will come out of that is around information technology.

So I would suggest that probably by the fall, you'll see a strong development of a plan on how we've going to achieve this.

[1625]

R. Neufeld: So I can look in the fall of this year for some plans and some kind of criteria and some idea of when we're going to get some of this stuff into place.

I would also like to ask the minister . . . . He talked earlier, in response to the member for Prince George-Omineca, about recruiting health care workers -- doctors specifically -- through immigration. The minister said that the ministry was spending a great deal of time on that. I wonder if you could provide this member the documentation or the work that has been done by the ministry in trying to work with the Royal College of Physicians, with the federal government and with immigration here in B.C. to be able to attract these doctors and to have their qualifications recognized within British Columbia. If you could provide that to me, I'd really be happy with it.

I've done a lot of work in trying to alleviate some of those problems, and if we don't run into it with doctors, we're running into some problems with psychiatrists in the northeast and those kinds of things. Maybe you could just let me know what you've done there.

Hon. M. Farnworth: We'll be happy to let the member know what in fact has taken place, but I just want to clarify one particular point. The issue around immigration is not the answer, in the long term, to our physician and nursing shortage in B.C. or indeed the country. I think the answer to those problems rests here in B.C., and it rests here in Canada. There is a worldwide shortage of nurses; there is the same shortage in terms of physicians.

In terms of immigration, there are countries with doctors who want to come here. But to be quite frank -- and I have said this -- I have ethical and moral problems in terms of taking physicians from other parts of the world where they're just as badly needed -- in many cases, more so. What we need to be doing is having a long-term strategy in place which results in the training of physicians here in British Columbia and the training of physicians right across the country and recognizing what the key specialties are that we're going to have shortages in, what the key areas of practice are that we're going to have shortages in -- and training them.

One of the ideas that I think we could be doing -- and I'm trying to advance it -- is looking at what the key areas are in the discussion we're having around the Peace River country, northern and regional areas. We should be looking at developing a significant component, for the sake of discussion, of rural and northern health care. Training physicians, GPs, whose . . . . When they go into medical school, their focus is around rural and northern health care, and when they come out of there, they've gone into the program with the expectation of practising in those parts of British Columbia. Their training has had a focus on that particular area.

That's one way of looking at it. The other is that, provinces have to stop poaching from each other. I think the provinces have to start to get together and start developing some interprovincial strategies in terms of how we're going to train and produce the physicians, the nurses and the health care workers that we're going to need in the country. If one is out doing it and training a whole slew of people, and the others are saying: "Oh well, good. B.C. is doing it, so what we'll do is get them into our province or vice versa." That's not going to help anybody.

There needs to be, a much better coordinated approach to this than has been done in the past. That's one of the things that B.C. is taking leadership on right now -- is the human resource issue in the current negotiations in health care with the provinces. We're looking at the cost drivers as they impact on the health care system, and this is one of the areas that British Columbia has responsibility for.

R. Neufeld: I appreciate that response. I don't disagree with the fact that we have to start training people within British Columbia and training them to deal with rural health care -- and specifically where I come from, the north or whatever you want to call it.

But in the interim, many of those doctors that we receive in the north -- from South Africa -- come from regions much the same, just a different country, and actually provide excellent service. Thank goodness that we have South African doctors, or we wouldn't have any -- regardless of what we've tried to date. That's a reflection not just on this government but through time. So it has been an issue and something that we have to deal with. I'll leave that issue.

[1630]

I want to talk about mammography services in the north. Again, it happened last year, and the previous minister was able to get a mobile mammography unit to Fort Nelson to deal with issues there. I have, again, another petition signed by about 460 women in Fort Nelson, requesting, again, that we provide the mobile mammography unit to go to Fort Nelson. The practice has been, last year and again now, to ask people to come to Fort St. John, Dawson Creek or those places to have that service provided. The minister, I think, knows that it's about a 500-mile round trip just from Fort Nelson.

Those aren't just the issues. There are people that live along the Alaska Highway, further north, who don't access . . . . It's another 300 or 400 miles to the Yukon border. But quite a few people that live in different communities, small as they may be, where the women don't have access to the service. If you go further, around by Watson Lake and down Highway 37, there's Dease Lake and Telegraph and all those areas that aren't serviced either, which are remote to what we think . . . . I don't think it's remote, because of where I come from.

Those people that live in those areas deserve to have some kind of service. I would hope that by now . . . . I thought

[ Page 15615 ]

after last year -- and we didn't get all the ladies through the process last year, because there wasn't enough time . . . . But I would have thought that by now -- or maybe there is by now -- we'd have something that says we're going to have something in place so those people on the Alaska Highway and Highway 37 can be serviced.

The letters I've received and the letter from the people at the screening mammography program of British Columbia to the ladies in Fort Nelson are telling them, again, to come to Dawson Creek or Fort St. John.

Can the minister tell me what we're doing so we can alleviate this problem and start providing this much-needed and basic service to these people?

Hon. M. Farnworth: The member raises, some important issues and, I think, important concerns. There were some problems with a particular unit last year. We are looking at replacing it, so that we can get the program up and running again. Hon. member, if you keep in touch with me, I'll let you know when in fact that is taking place.

I also think that the point should not go unremarked . . . . The concerns that the member raises come back to my comments a few moments ago. That is, there are some significant challenges in rural health care that need a co-ordinated approach between provinces. We have to do more of what we are doing now in B.C., and we've got to improve what we're doing. But you know what? I also think that we have to be working with the Yukon Territory, with northern Alberta and with the part of the N.W.T. that touches B.C., because we've all got the same problem.

We've all got the same issue, which is vast geographical area and sparse population. Maybe one of the things we can be doing is looking at that in a much broader context than just our own province and saying: "Look, there's a region here with a critical mass that can support services if we work together and take a more cooperative approach." That's one of the areas that we need to try and develop and push on. In terms of the overall context, that's one of the areas in which I see us going.

On the specific issue that the member raised, we're working on trying to get a program and the equipment to be able to meet the needs that the member has spoken about. If there's a way that we can get up to Fort Nelson, I certainly would like to see that happen.

R. Neufeld: I appreciate those responses. I am a bit surprised that we haven't done something about it before now, to be honest. I'm not trying to be critical or to point fingers or anything, but this is an issue that we dealt with last year with the previous minister. It doesn't take a rocket scientist to figure out that it's going to happen again the next year and that things have to be done. To be just starting to look at something now . . . .

I don't think you can buy this equipment or secure this kind of equipment by going to some other place; I'm not sure. I'm not sure about the kind of equipment that's needed for that service, but it is something that's important to northern women. It is darn important to 450-some that have signed a petition and have sent it to me and said: "Why are we still asking and begging for this basic service that you can get in Vancouver or Victoria or Kelowna or Kamloops on a constant basis?"

I just think that somehow we should be looking at it. I agree with a regional approach; I don't have a problem with that at all. There's Fort Liard in the Northwest Territories. There's Watson Lake -- although it's in the Yukon, that's probably a community that those ladies don't have access to either and have a long way to go to get that service.

[1635]

But for goodness' sake, let's start. Let's start a process that isn't just a band-aid from year to year. So I'll leave that. The minister can respond to that if he wants. It's something that is a bit close to my heart because of some of the things that have happened in my family. I would like to see us actually starting on something. I know the hospital boards in the Peace are working together to try and alleviate this problem, but it is something that the province has to get involved in too.

I'm going to run out of time here. I think my critic is going to give me, as they call it, the hook before long. So I want to go on to mental health just briefly.

To the minister: I have a report here done by . . . . I think Gerrit van der Leer is the name. It's the draft mental health plan for the Peace-Liard health region, 1998-2005. The interesting part that I want to read into the record is page 9. It goes back to what I said earlier about services in the north. I'm going to quote out of the document; it's page 9:

"The Peace-Liard health region presently receives $1,019,479 for community mental health services, which represents 0.64 percent of the total provincial budget. This is the lowest budget allocation among the 18 health regions. Based on demographic allocation, the region only receives 41.2 percent of its fair share.

"The region lacks many of the core services defined in the 'Best Practices' document for people with a severe and persistent mental illness. For example, this region is the only region without any residential care and family care home services.

"Throughout the consultation process it was reported consistently that the region has been undermanaged for many years, including lack of management and ongoing support from the macro-regional office in Prince George responsible for the management and development of mental health services in this region until March 31, 1997. It was reported that this region has often missed out on many opportunities."

Maybe the minister can just respond briefly to that and tell me what plan is in place to take care of this inequity in funding and this unfairness that's happening and has happened over a long period of time.

Hon. M. Farnworth: The member is correct. That particular region has been historically underfunded. That's one of the issues that the mental health plan is intended to address. In fact, some work has already started in terms of ensuring that that takes place in the member's area. There will be the framework of implementation that will be released later, in a month, which will further show what next steps are going to happen in terms of dealing with a particular issue.

My understanding is that there has been funding, I think, to allow five new beds into the hospitals in the area. We recognize that the northeast has been underfunded, and we are trying to take steps to address that.

[1640]

R. Neufeld: I'll be looking forward to those things happening. Just for the minister's information, that same document says -- and it breaks it out in the northeast -- "for services." And it's not just Fort St. John; I'm talking about Fort Nelson. It's left with nothing to speak of, other than a basic

[ Page 15616 ]

regional service. Someone trying to get a professional to go in there on a . . . . I don't even know if it's a monthly basis anymore; it's hard to get people in there. So Fort Nelson is not getting any services; Fort St. John at least gets some.

But if you look at the community of Dawson Creek, which has 10,000 people, it gets almost $293,000. Fort St. John, a community of 17,000, gets $35,497. And Fort Nelson is in there with much less than that. So there is some inequity in the whole province and within the region that has to be addressed.

I would like to talk a bit about the Ambulance Service in Fort St. John again. We've had some incidents, some mixups, with the Ambulance Service. I don't know whether the minister is aware or not, but I'm going to say again that we have two full-time staff in Fort St. John for the Ambulance Service, for a region, like I said, with a city of 17,000 and about 8,000 around it. In comparison, Dawson Creek -- 10,000 and probably about the same amount of people living around it -- has six or eight full-time ambulance staff.

We do have some problems in training, because we use part-time, and they're called on a part-time basis. I don't think a lot of them are terribly familiar with the community as a whole. We've had some instances where the response time has not been all that good. I just wonder if the minister would care to tell me if there is some program in place where we're going to start training people in the Fort St. John area or even look at maybe getting some more full-time people, because the area is growing so fast, so that we can provide good services to those people that require them.

Hon. M. Farnworth: I can tell the member that we are in fact, at this particular moment in time, looking at the situation in Fort St. John and the call volumes that are taking place and seeing what impact it's having, how to deal with it and what it's going to require in terms of resources to do that.

R. Neufeld: As the minister talked before about hospitals and I did about receiving funding call volumes aren't the total answer, sometimes, to what is taking place in the two regions. The area of Pouce and Dawson Creek has a lot more seniors homes that ambulance services are provided to on quite a regular basis, so they have a high call volume. Fort St. John doesn't have that many seniors homes, but they have a fairly high call volume for the region as a whole because of the activity that takes place.

I think we want to be careful on how we deal with the call volume in saying . . . . I think there're a formula that says: "If there are X calls, that's how many people you get." That isn't the way to deal with the issue there, and I think we have to look at it more in what those calls are about.

Hon. M. Farnworth: That comes exactly back to what we were talking about earlier in terms of utilization and why it's important that we get good information technology that allows you to look at data input and analysis. I couldn't agree with the member more.

[1645]

R. Neufeld: I have one last issue, and that is dealing with air ambulance service in the northeast. Before I say anything, I want to tell the minister that I think the air ambulance service provided in the northeast and to the whole province is great. I'm not taking it apart or anything. I think it's a service that's obviously greatly needed, and they do a good job. But there are some issues there that I think we can start looking at.

I requested some statistics, and it's interesting to see that although we talk about Alberta's health care system being so terrible, it seems as though that's where we fly all our people from the northeast. From Dawson Creek, Fort Nelson and Fort St. John the majority of people that are flown out for services by air ambulance go to either Grande Prairie, Edmonton or Calgary to receive their services in most cases, because Prince George is in the state as the member for Prince George-Omineca talked about earlier or Vancouver is too overbooked to be able to take care of the people.

But one of the problems that we have is the stationing of aircraft services within the province. At the present time, I believe and I'm told, we have advanced life support based in Prince George on a 12-hour shift per day. That's for all of northern B.C. That takes care of right over to Rupert and over on the other side to Tête Jaune and all of my area. They're on standby only 12 hours a day, and it's out of Prince George.

What happens is that we don't have the capability of handling the calls, so what we do is go out of province to get emergency aircraft from Alberta -- again, the place that has just destroyed medicare. Yet in Alberta . . . . I'm going to read to the minister. It's all in northern Alberta. "Alberta Health has at least six dedicated Airvac aircraft" -- that's advanced life-support paramedics -- "based strategically throughout northern Alberta communities in Grande Prairie, Peace River, Slave Lake, High Level" and so on. And they're based 24 hours a day.

That's in a province that's supposed to be destroying health care. We rely . . . . In fact, statistics will show that more air ambulance flights originate out of Alberta to come into British Columbia to pick up people and take them back to Alberta, actually, than air ambulance flights that originate out of B.C.

I would like to ask the minister if we couldn't look at maybe supporting . . . . If we do have to fly people, maybe we should start looking at supporting air ambulance service out of British Columbia. Why should the Ministry of Health be hiring aircraft out of High Level or Edmonton or Calgary or Grande Prairie on a steady basis when those facilities can be in place? There could be one in Fort St. John; there could be one in Fort Nelson quite easily. They could be staffed with life-support services and, in the long term, provide a better service to people.

Let's remember that in these communities in northern Alberta -- I know where those communities are, and I think the minister knows quite well where they're at -- they have about a 30-minute response time. It's not always that way in British Columbia. It's not because we don't have the best service that we can; it's because when it comes out of Prince George, and that plane happens to be busy in Prince Rupert, you've got to go to Edmonton or Calgary in the next province to try to find one that's available. Those companies don't pay taxes in British Columbia.

They just come in, pick the people up, take them back out and bill the medical service for it. I'd like to know if the minister would look seriously at starting to provide a better coverage in northeastern British Columbia.

The minister is aware, as I am, that the northeast is growing in the oil and gas industry. There are lots of people. It is an industry where people unfortunately get injured and have to be flown out -- very remote. I would like to see, along with the Ministry of Energy and Mines, which is promoting

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growth in the northeast, that we look seriously at providing a better air ambulance service to people in the northeast and actually utilizing British Columbia companies. There are some in Fort St. John that have been doing this flying for 40-some years and have been trying to be able to access this kind of service. Would the minister look favourably at revisiting how we provide air ambulance service in the north and maybe provide a better service to the people in the province and not cost us any more?

Hon. M. Farnworth: As I preface my remarks, I am just going to say . . . . I mean, I know the member keeps raising or has said a number of times how -- you know, knocking Alberta's health care system. I haven't done that, and I don't intend to knock Alberta's health care system. They have a very good health care system. I think what's important is the direction that we're going and how we're looking at meeting some of the challenges.

The member raises some important issues that certainly are worthy of looking at, in terms of how the transportation of patients to and from the hospitals takes place in the north. What we've got to recognize is that we need to be looking at two things: one, what the physician deems to be in the best interests of the patient, clearly; and second, I'd like to see us be able to provide more service here in B.C. But we have to look at how we're doing it and what some of the crucial factors are that we need to be taking into account.

Alberta has some unique advantages that we don't have in terms of the provision of air services. They have a significant northern population centred around Edmonton, which is something that we don't have in B.C. That provides a critical mass in terms of their servicing a number of their northern communities. I think that one of the things we need to do is to look at what services are required, and if we can service them from within British Columbia, we should be doing that.

The second point that I would like to deal with, and something we need to look at, is this issue of northern transportation and air ambulance in northern and rural areas of the province. It is again something where I think we need to look at . . . . You know, you've got the Yukon, and you've got the Northwest Territories; they all have the same problems. There's an opportunity there, I think, for either a more cooperative approach than has been in the past or a more coordinated approach than perhaps there's been in the past of dealing with some of the issues that the member raises.

Certainly I'm always open to looking at how we can make services better and whether there's a way we can deliver them cost-effectively and meet the needs of the people of the member's area. At the end of the day, it is a very distinct geographical region from the rest of the province that has some natural links to Alberta, just geographically speaking. At the same time, it's a growing region that's getting more and more of a critical mass that's going to give it the ability to support a greater array of services than it has in the past.

[1650]

R. Neufeld: I could go on with this for quite a while, but I think I'm going to wrap up and offer my services to the ministry in working on these kinds of issues. I can bring some players to the table that I think we should be looking at seriously. I don't know what the outcome will be, but if we don't try, I guess none of us will ever know. And we can stand here and talk about it next year, and it'll never happen. So I'll leave that. I appreciate the minister's response.

I want to do just two more things. One that I'm sure the member for Peace River South is going to deal with -- or maybe he already has, and I'm just not aware of it -- is the issue about having to have travel insurance when you go out of the province of British Columbia. I have a lot of people who live in Fort Nelson and Fort St. John who work on a pretty steady basis in the Northwest Territories and the Yukon in the oil and gas industry, which is all serviced out of British Columbia. I think, for their comfort, they should know whether they have to access some kind of extra insurance to be flown to health care services, if that's what's required at some point in their working career.

The letter from the B.C. Ambulance Service is pretty discourag