1974 Legislative Session: 4th Session, 30th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, MARCH 26, 1974

Night Sitting

[ Page

1691 ]

CONTENTS

Night sitting Routine proceedings Committee of Supply: Department of Health estimates On vote 78.

Mr. Morrison — 1691

Hon. Mr. Cocke — 1691

Mr. McGeer — 1691

Hon. Mr. Cocke — 1692

Mr. Wallace — 1692

Mrs. Jordan — 1692

Hon. Mr. Cocke — 1693

Mrs. Jordan — 1694

On vote 79.

Mr. McGeer — 1694

Hon. Mr. Cocke — 1694

Mr. Fraser — 1695

Hon. Mr. Cocke — 1695

Mr. McClelland — 1695

Hon. Mr. Cocke — 1695

On vote 81.

Mr. McGeer — 1695

Hon. Mr. Cocke — 1695

Mr. McClelland — 1696

Hon. Mr. Cocke — 1696

Mrs. Jordan — 1696

On vote 82.

Mr. McClelland — 1696

Hon. Mr. Cocke — 1696

Mr. McClelland — 1697

On vote 83.

Mr. Fraser — 1697

Hon. Mr. Cocke — 1698

Mrs. Jordan — 1698

Hon. Mr. Cocke — 1699

Ms. Brown — 1699

Hon. Mr. Cocke — 1699

Ms. Brown — 1699

Mr. Wallace — 1699

Hon. Mr. Cocke — 1700

Mr. Wallace — 1700

Hon. Mr. Cocke — 1700

Mr. McClelland — 1700

Hon. Mr. Cocke — 1701

Mrs. Jordan — 1701

Hon. Mr. Cocke — 1701

On vote 85.

Ms. Brown — 1702

Mr. Wallace — 1703

Hon. Mr. Cocke — 1703

Mr. Curtis — 1703

Hon. Mr. Cocke — 1703

On vote 86.

Mr. Wallace — 1703

Mr. McGeer — 1705

Hon. Mr. Cocke — 1705

Mr. Phillips — 1705

Hon. Mr. Cocke — 1706

Mr. Phillips — 1706

Hon. Mr. Cocke — 1706

Mr. McClelland — 1706

Hon. Mr. Cocke — 1706

On vote 87.

Mr. McClelland — 1706

On vote 88.

Hon. Mr. Cocke — 1707

On vote 89.

Mr. McClelland — 1707

Hon. Mr. Cocke — 1707

Mr. Fraser — 1707

Hon. Mr. Cocke — 1707

Mr. Wallace — 1707

Hon. Mr. Cocke — 1708

On vote 91.

Mr. McGeer — 1708

Hon. Mr. Cocke — 1708

On vote 92.

Mr. McClelland — 1708

Hon. Mr. Cocke — 1708

Mr. McClelland — 1708

Hon. Mr. Cocke — 1708

Mrs. Jordan — 1709

Hon. Mr. Cocke — 1709

Mr. Wallace — 1709

Hon. Mr. Cocke — 1709

Mrs. Jordan — 1710

Hon. Mr. Cocke — 1710

On vote 93.

Mr. Chabot — 1710

Hon. Mr. Cocke — 1712

Mr. Chabot — 1712

Mrs. Jordan — 1712

Hon. Mr. Cocke — 1713

Mr. McGeer — 1714

Mr. Wallace — 1716

Hon. Mr. Cocke — 1717

On vote 94.

Mr. McClelland — 1717

Hon. Mr. Cocke — 1717

Mrs. Jordan — 1717

Hon. Mr. Cocke — 1717

On vote 95.

Mrs. Jordan — 1718

The House met at 8 p.m.

Introduction of bills.

Orders of the day.

The House in Committee of Supply; Mr. Liden in the

chair.

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

Vote 77: public health services, general services,

$2,384,840 — approved.

On vote 78: public health services, aid to handicapped,

$898,992.

MR. N.R. MORRISON (Victoria): Mr. Chairman, I think this is

the correct vote to bring this particular matter up. I've

recently had a letter from a constituent of mine who is a

quadriplegic cerebral palsy victim. This particular individual

is getting up in years and at the moment is able to live at

home with the family. But the family also are getting up in

years and the father is very close to retirement.

One of the problems with this family which I'd like to ask

the Minister about is concerning the individual: as the family

gets older, it's very difficult for the father to carry this

individual upstairs. I think that in this vote there is an area

where aid can be made for this type of individual. They

particularly need the aid in the form of an elevator, or a

stair elevator of some kind, in their home, so that it will not

become necessary to send this individual to a hospital or a

special care area.

The second item which they're concerned about is financial

aid to defray transportation costs — that is, to and from their

home — for aid and other rehabilitation use. I wonder if the

Minister could comment. Is this the right place for that type

of aid?

HON. D.G. COCKE (Minister of Health): Mr. Chairman, I would

suggest that the Hon. Member refer the case. We have a sort of

a hazy line between the Department of Human Resources and the

Department of Health in this particular area. The division for

Aid to the Handicapped deals more specifically with assisting

in salaries of those people that are trying to rehabilitate — it deals with the blind and the deaf — and we also give a large

grant to the Opportunity Rehab Workshop in Vancouver,

vocational training for disabled persons.

We do, however, assist in motor-vehicle accessories for

people that are handicapped. I think if you would refer to the

department, we can certainly look into it.

We can take it up with the Department of Human Resources

too, if there's a necessity for some assistance in that area,

but we'd be certainly glad to look at it.

MR. MORRISON: Thank you very much; I'll do that.

MR. P.L. McGEER (Vancouver–Point Grey): Mr. Chairman, last

November the Minister was sent a letter by the leader of the

Liberal Party written by a Miss Donna Pistell, a physically

handicapped young lady with cerebral palsy who has written

articles about what it's like to be physically handicapped and

mentally alert in a society in British Columbia.

She writes a letter and raises the problems of the

handicapped people and says:

"I bring these problems to the attention of you and several

other of your fellow Members of the Legislature because

unfortunately the problems of the handicapped are not founded

by party policies, and because I feel there are many areas of

legislation that would help handicapped adults obtain

education, medical and vocational rehabilitation and

employment."

She talks about the unsuccessful attempts that she's been

through in obtaining training and employment. She talks about

the need for increased facilities in all facets of

rehabilitation, and draws attention to the fact that: "The

standard of assistance to the disabled of our province needs to

be brought up to that of even the poorer regions of the world."

One only has to read the eloquence of her language to realize

that this is somebody of rare mental capacity, though severely

physically handicapped.

I notice under vote 78 that the salary of the director of

the division for Aid to the Handicapped is a modest increase

this year to $15,500, considerably below the salaries paid to

all these bushy-tailed young executive assistants to the

cabinet Ministers.

I wonder, in view of the fairly modest amount of money and

the obvious diminutive position of the director of the division

for the Aid to the handicapped, relative to the exalted

positions of young executive assistants to the cabinet

ministers — all created since the NDP came into office — and the

many consultant jobs at $175 a day that go to campaign managers

and former candidates and so on, whether we haven't got our

values just a little bit twisted here, and whether the Minister

of Health might have some good news for the handicapped in

British Columbia regarding programmes for them in the years

ahead, because I don't see very much in vote 78.

I think the letter that this young lady wrote to the

Minister, to the leader of the Liberal Party and to other

Members of the Legislature is deserving of our

[ Page 1692 ]

sympathetic attention at the very least, and of some

aggressive programme at the most.

HON. MR. COCKE: I was suspicious, Mr. Chairman, as the Hon.

Member for Vancouver–Point Grey began his statement, that he

would be non-political, but he managed to dissuade me very

quickly so as not to disappoint me. I thank him for that. I

want him to be consistent always.

The fact that I have an executive assistant isn't a great

surprise in view of the fact that my predecessor had an

executive assistant as well. We don't go around screaming about

that. The fact of the matter is that they are a very necessary

part of the process, as far as we're concerned. I don't deny

that the salary of the director couldn't be adjusted and

shouldn't be adjusted and probably will, I hope.

In any event, I don't really think that that has that much

to do with the case you brought up. Certainly, between the two

departments, we are expanding. Now the area that you're talking

about, I believe, is probably best handled — at least I would

think it would be best handled — in cerebral palsy. Our

contribution this year is going from about $250,000 to

$335,000, roughly, from the Health department.

Now there is a bit of an overlapping in this whole question

of aid to the handicapped, what we do for the handicapped. My

colleague, the Minister of Human Resources, as I said before,

has a great deal more, really, to contribute in this area. We

try to participate in the rehabilitation area, the health

component, adding to a person's ability to produce as closely

as possible to a normal person. But, yes, we are improving the

contribution in this area and I hope that we'll go on improving

that situation.

MR. G.S. WALLACE (Oak Bay): I'm sorry if I missed the

Minister's answer. I wanted to raise the question of aid to the

handicapped in terms of people like quadriplegic patients who

can be so much more comfortable and happier at home than being

placed in an institution.

I have one such person in my riding, a 34-year-old

quadriplegic, who mentions that she's been very fortunate in

being able to live at home to "live at home with my parents for

my entire life instead of being placed in a nursing home or

another type of institution."

She mentions that there is no homelike residence or hostel

for people like herself. The only other alternative would be to

place her in a nursing home, which as you well know would cost

the government a great deal more than $213.85 a month.

I'm sure that the Minister is sympathetic towards the

situation. I just wondered if in fact, certainly in the urban

areas, there are any plans to provide this kind of facility for

a person who, unfortunately, cannot be at home.

She mentions, for example, that at the present time her

father is approaching retirement and, "Soon he will no longer

be able to carry me up and down stairs. I shall require an

elevator." She wonders whether or not there is assistance

available through any kind of programme of the Health

department or Human Resources to keep a person with this very

serious disability in her own home. Now, Mr. Chairman....

MR. CHAIRMAN: The same letter was read by a Member just

before you came in, and the answer given.

MR. WALLACE: Oh, I see. Will it be dealt with by Human

Resources or by Health?

HON. MR. COCKE: I asked that it be brought to my attention,

and we would take a look at it under Aid to the

Handicapped.

MRS. P.J. JORDAN (North Okanagan): Mr. Chairman, I don't

have the same letter, but I would like to ask the Minister...and I am sure he will be sympathetic to this, I recognize that

it is a problem. There are many instances in British Columbia

where people are injured in an accident, not always an auto

accident. I have one case in mind where a boy at the age of 21

was thrown from a horse that he was renting, and he was left

with residual problems, muscle spasms. He is on crutches, and

has some form of aphasia. In the ultimate situation his home

broke up and his wife and child left him. The real concern here

is that he has just received a court settlement of some

$30,000, and during the course of his rehabilitation it was

suggested that he prove his motivation by taking a physics

course for Grade 12, which he hadn't completed. This turned him

right off. I suspect it would turn most of us off, as a means

of proving our motivation.

While we were having trouble getting him interested in

anything but sitting in beer parlours, he suddenly became

interested in real estate, and he found a little house. He felt

he could buy this house, live in it with his sister. He could

hobble around and work on it; paint it, fix it up and sell it.

This seemed like a reasonably interesting experiment to try,

but the problem is: he is not eligible for any type of disabled

person's allowance as long as he has that capital.

I wonder if there can't be — or maybe there have or could be — negotiations so that accident victims, who are left with

residual injuries which interfere with their earning a living,

could keep their capital if there is an award by the court,

providing that capital is used in some way to help the victim

in a livelihood, and that it would not interfere with a

disabled pension.

[ Page 1693 ]

The insecurity they feel anyway is extreme, as I am sure the

Minister is aware, but to feel that they have got to go out and

spend that money to get the security of the state has a very

detrimental factor. I would hope that he would comment on

this.

The other area I would like to bring up is handicapped

people such as those with multiple sclerosis, or the

quadriplegias, who basically spend a good deal of their life in

hospitals. If they have no other income they are eligible for

the disabled person's allowance, or their hospital care, but it

ends up they only have about $20 a month comfort money.

One specific case that I ran into was in Cranbrook, where

this girl was 32 and had multiple sclerosis. She had her mother

and no other family. Her $20 a month just didn't go anywhere.

She wanted to buy little gifts for neighbours' children, buy

little presents for Christmas. She needed money to enable her

to go out at times, perhaps go to some sort of public activity,

so her comfort allowance wasn't enough. Her mother was on an

old age pension, and not able to help her.

There are a number of these people in British Columbia. What

concerns all of us, I am sure, is that they are on a comfort

allowance which is completely inadequate for women to buy

little perfumes and things like this, as well as the

necessities of life.

The other thing is: there needs to be more of an organized

recreational programme for these people in our hospitals. They

tend to be in the chronic care areas or in nursing homes, and

even though they have extreme physical problems and at times

some emotional problems, generally they are quite alert the

rest of the time. It is a very depressing environment for them;

they can't get out. They have to go to bed at nine o'clock.

They have to keep the television down. They don't see many

people.

I would hope that we could consider a programme for these

people. I don't suppose the volume is that great in the

province, but I am sure that the dispersal of these people is

great. If we could make funds available so that wherever

possible, even if we have to assist with gasoline and

entertainment tickets for some service group in the community,

to get these people out on a routine basis, not just Christmas

time or Easter time when people tend to be more thoughtful or

perhaps more aware of this.

The next point that I would like to bring up, and I am not

sure that this is the right place, is about Pharmacare and the

prescription drug subsidy plan. You have to vote this year for

it. Where has it moved?

HON. MR. COCKE: Pharmacare.

MRS. JORDAN: Under which vote?

HON. MR. COCKE: Human Resources.

MRS. JORDAN: Oh, I see. So this is not a matter of interest

to you.

HON. MR. COCKE: Health care and Pharmacare.

MRS. JORDAN: I wonder if I might bring this to your

attention as the Minister of Health. It directly relates to

health, in view of the fact that the vote is half gone, and

there is some reference to last year.

It is just the matter of diabetics who are allowed to have

assistance with their pills and insulin, but not with their

syringes and test tapes and vitamin pills and B12. This is

quite an expense; at times the expense is probably greater than

the insulin.

There is a very special need for assistance in this case for

people who may not be on Mincome, but in fact are on very

marginal retirement incomes. I would hope that the Minister

would consider putting forth a recommendation as Minister of

Health.

I have used the instance of diabetics, but also we know

there are coeliacs and many other chronic diseases where the

actual drug is only part of their routine needs as far as drug

supplies are concerned. Diabetics also sometimes have a problem

with bandages if they've got gangrenous problems.

Then just as a general comment to handicapped, Mr. Minister,

because anyone who has a chronic disease — diabetes, multiple

sclerosis, celiac disease — in a way is handicapped. With these

times of tremendous inflation in the food area, special diets

are becoming an increasing difficulty for many of these

families.

I would ask the Minister if we could entertain a programme

where there might be vouchers for diabetics, for example, for

special diet foods which are almost double in price. In fact,

in many instances they are more than double in price. Canned

fruits in a water pack are half the size and twice the

price.

They face a tremendous problem in diet. They have to eat

generally high meat diets, and that is extremely expensive

today. So I would ask if the Minister, in being brief and just

mentioning two illnesses, would consider this type of voucher

or certificate for people on special diets, to help them while

inflation is so difficult.

HON. MR. COCKE: Mr. Chairman, one of the problems with this

vote is that we tend to look at it as a kind of vote that you

find in Human Resources. Now, the young gentleman of whom you

spoke, if any help were available, and certainly I think that a

great deal of help should be available for that kind of person,

that would have to come under disabled persons in Human

Resources.

What we are talking about here in the division for Aid to

the Handicapped — as you know, having been a health person — is

to provide medical and assessment services, and to provide

medical supplies

[ Page 1694 ]

where possible. There is a possibility that that can come up

in part of the other things that you were talking about.

Also this is to provide grants to people who are providing

aid to the handicapped, such as the Opportunity Rehab Workshop

that takes a disabled person and tries to bring them back into

the mainstream, but not providing really the back-up resource

of money or housing or that kind of thing. The same thing for

the blind and so on.

Also there is a good deal of money put into vocational

training, directly in support of people who are handicapped. So

that young gentleman you spoke of really doesn't come under

this particular purview, other than if he were in need of some

specific kind of assistance, such as the elevator, or controls

for the car, or assistance in a direct vocation.

The multiple sclerosis area you spoke of was to some degree

part of another vote, but certainly a valid comment.

You're talking about the comforts allowance. Again, we don't

provide comforts allowance; they are provided in the hospitals

normally by the Minister of Human Resources (Hon. Mr. Levi).

There is certainly a need to look at that; inflation is here.

We've increased the comforts allowance for a great many people

in Riverview and in the other institutions in the province.

As far as recreational programmes are concerned, this is one

of the areas in which I feel it is terribly important to get

volunteers involved. We could spend almost as much as we spend

on care in this area. This is one of the areas where people can

participate and assist those people who are confined, those

people less fortunate than themselves, to a better quality of

life. I would certainly hope we can get a volunteer input.

Sure, we need recreational directors in these institutions, and

possibly we need more if we can't get the voluntary input. But

it is important to give people an opportunity to participate in

the needs of others.

As far as the diabetic supplies and foods, this is a matter

that we're certainly cognizant of — not only for diabetics but

others who have these kinds of needs. We are researching this

as best we can. The same people who have investigated the

possibility and finally helped us formulate the Pharmacare

programme are looking into some of these areas right at the

present time. Hopefully we can come up with a new programme to

assist people you describe.

MRS. JORDAN: I appreciate the Minister's comments. I was aware of the

vote I was talking under; I did it for a specific reason. So often when this

type of assistance is in terms of vouchers and certificates for diets of diabetics,

for example, as soon as we get into the Human Resources area, we get tied into

an income situation that's almost impossible to overcome. But I appreciate his

comments on that.

Regarding the handicapped in the hospital, I think one of

the problems is that somehow in some communities this doesn't

relate outside the hospital. I quite agree with you on the

tremendous need for volunteers. Really, they respond extremely

well. Perhaps a letter from the Minister to all the hospitals;

just a gentle reminder that there are recreational directors in

the community, offering them the advice or the encouragement to

contact specifically the recreational directors. This type of

volunteer service might not come through the hospital; it might

better be a part of the complementary programmes through the

recreational people.

I think very often what happens is that people in the

recreational field are just not aware that there are these

people around in terms of families who need assistance under

Human Resources, and recreation is part of that. There are a

lot of people who are in the hospitals who could benefit so

much from their activity.

If the Minister would be willing to write a letter to remind

them, and maybe talk to the Hon. Provincial Secretary (Hon. Mr.

Hall) and get him to write a complementary note through the

Minister of Recreation and Conservation's Department (Hon. Mr.

Radford), actually the Community Programmes Branch, we might

get a two-pronged reminder or encouragement to these people to

find out who is in their hospitals or who is at home and who

might really benefit from this.

Will the Minister do this?

HON. MR. COCKE: That is a good idea.

Vote 78 approved.

On vote 79: Public Health Services, development of

alternative care facilities, $350,000.

MR. McGEER: Would the Minister tell us what this vote

is?

HON. MR. COCKE: This vote is the development of alternative

care facilities. (Laughter.)

AN HON. MEMBER: A little more detail.

HON. MR. COCKE: This is an area where we are providing sort

of new programmes, an area where we try to innovate a little

bit. We are doing a study this year of children's dentistry,

and that's $198,800 for the whole province. That's the

programme I talked about the other day when my estimates came

up in the first place.

We look after a great many people in the province, providing

oxygen — about $75,000 worth of care in that particular

instance.

[ Page 1695 ]

Interjection.

HON. MR. COCKE: No. A lot of people who have to have oxygen

in their home just can't afford it. Under this vote we assist

in that particular area. My predecessor appointed a doctor in

Madeira Park, which takes part of the vote. The doctor that we

have appointed in Kleena Kleene is part of the vote.

This is an opportunity for us to provide alternatives to the

standard delivery service, a little bit of flexibility.

MR. A.V. FRASER (Cariboo): Mr. Chairman, I realize it is

important, but why is the vote practically cut in half from

$600,000 last year to $350,000 this year if it is that

important? Why reduce it $250,000?

HON. MR. COCKE: Because the great part of it was home care.

Remember, home care was a project to begin with. Now home care

has become no longer a project but an ongoing programme so

we've moved home care out of alternative care. What we try to

do here in this vote is to innovate a little bit and bring in

new programmes. Then, as those new programmes develop, if they

develop, they are moved to another vote.

MR. R.H. McCLELLAND (Langley): Just a little further

clarification, Mr. Chairman. I don't quite understand how great

a part home care could have played in this. I was looking at

the interim financial report. There was somewhat over $500,000

spent in 1973 in that particular vote and you've said a couple

of hundred thousand dollars to the dental programme.

HON. MR. COCKE: That's brand new, right now.

MR. McCLELLAND: But you mentioned $187,000 or something and

said it was in this vote.

HON. MR. COCKE: This year, not last year.

MR. McCLELLAND: Well, how much did home care take up? I

notice $500,000 spent. Home care this year is $1.4 million. I

think we need a bit more clarification.

HON. MR. COCKE: Last year home care was between $400,000 and

$500,000. There are new programmes in this vote this year. For

instance, that $198,000 was not in alternative care; that's a

brand new programme this year.

MR. McCLELLAND: That vote was almost all home care last

year.

HON. MR. COCKE: Last year it was virtually all home care, and that home

care now has been moved, as you've noted.

Vote 79 approved.

Vote 80: Public Health Services, Hearing-aid Regulation

Act, $15,000 — approved.

On vote 81: Public Health Services, grants for health

agencies, $800,000.

MR. McGEER: Is this the vote where family-planning clinics

are supported?

HON. MR. COCKE: Yes.

MR. McGEER: Well, Mr. Chairman, I'm an advocate of these

family-planning clinics.

Interjection.

MR. McGEER: Well, what vote should I bring it up under?

Interjections.

MR. McGEER: Can I ask the Minister what does come under this

that we can talk about? (Laughter.)

HON. MR. COCKE: I can name them if you wish. There's a great

many of them: Epilepsy Society, Heart Foundation, B.C. Medical

Research, Parkinson's Disease, Cancer Foundation, Medical

Services, United Church, Dietetic Association, Arthritis and

Rheumatism, Hemophilia Society, Public Health Association,

Dental Surgeons, Cerebral Palsy, Downtown Community Health

Society, Division of Otolaryngology, Division of Audiology and

Speech Sciences at UBC, Environment and Preventative Medicine

Association. That kind of thing, and there are a number of

others.

MR. McGEER: It sounds like a very important list. Why was

the vote cut this year from $813,000? I hate to think of any of

those societies you mentioned being cut this year. Were some

removed? Their costs are going to go up like everybody else's.

Was there a reason for cutting the grants?

HON. MR. COCKE: Last year there was an unalloted sum, and so

therefore we felt rather than keep a vote out because their

were unalloted sums we would just bring the vote into proper

perspective.

Oh, yes, there's just one other, I beg your pardon. Remember

at one time that we supported CARS rather large in this

particular vote. That's the Canadian Arthritis and Rheumatism

Society of G.F. Strong. But we brought that into BCHIS as an

insured

[ Page 1696 ]

service, a great part of it; so that was also a reason for

reducing the sums allotted.

MR. McCLELLAND: I just wanted to ask the Minister, through

you, Mr. Chairman, whether or not the agencies supported under

this vote submit budgets. Do you scrutinize those budgets and

approve them from budgets that are submitted?

HON. MR. COCKE: Yes, we sure do. One of the gentlemen

sitting behind me sometimes is looked upon as a bit of a

Scrooge, but he's very careful about budgets. You'll note that

the people we support are societies that have, generally

speaking, a long record of good work in the community.

MRS. JORDAN: Is this the one that provides funds for summer

camps for handicapped children and multiple sclerosis? Which

vote is that?

HON. MR. COCKE: It's not in my department.

MRS. JORDAN: That's Human Resources.

HON. MR. COCKE: Yes, that's Human Resources.

MRS. JORDAN: You don't have anything left. All you get to do

is pay the bills and don't have any fun.

Vote 81 approved.

On vote 82: community health services development,

$125,000.

MR. McCLELLAND: Well, there is a major change here — not

unexpected, I might say — in the elimination of the grant for

narcotic addiction treatment centres. A grant from $100,000 — $55,000 of it spent in the first nine months, as I understand

it from reading the interim financial report — but no grant

included this year. As I say, it's not unexpected, yet here we

are....

MR. CHAIRMAN: Are you on vote 83?

MR. McCLELLAND: On 81.

MR. CHAIRMAN: Vote 81 is passed; we're on 82.

MR. McCLELLAND: Well, we just missed the line, Mr. Chairman.

Would you mind if I speak about that for a moment?

MR. CHAIRMAN: Very briefly.

MR. McCLELLAND: Well, it happens quite often, Mr. Chairman.

I apologize for that, but it's too important not to be

commented upon.

We are in the midst of an epidemic of drug abuse in this

area.

HON. MR. COCKE: Well, Mr. Chairman, on a point of order.

That's been moved to the Human Resources department.

MR. McCLELLAND: Yes, that's what I want to talk about, Mr.

Chairman.

HON. MR. COCKE: It will come up under the estimates of the

Minister of Human Resources.

MR. McCLELLAND: I wish to speak about its absence.

HON. MR. COCKE: Its presence is still in your red book, Mr.

Member, with respect.

MR. CHAIRMAN: Order!

MR. McCLELLAND: All I wanted to comment upon, Mr. Chairman,

was that that vote was here last year. It's no longer here and

I regret that. It should still be here.

MR. CHAIRMAN: We're on vote 82 now.

MR. McCLELLAND: Just a minute, Mr. Chairman. I was given

permission to speak for a moment on vote 81. Now if I may

continue, I'll continue to speak on that vote until I'm

finished.

MR. CHAIRMAN: Well, you've asked the question. Order! Vote

81 is passed.

MR. McCLELLAND: Mr. Chairman, let's be a little bit....

MR. CHAIRMAN: Order! Order! I'm going to ask you take....

MR. McCLELLAND: Mr. Chairman, $513,000....

MR. CHAIRMAN: Will you please take your seat?

MR. McCLELLAND: $513,000, Mr. Chairman....

MR. CHAIRMAN: Will you please take your seat? There's no

place for two people to stand on this floor at one time and you

know that.

MRS. JORDAN: Sit down.

MR. CHAIRMAN: Will you please take your seat?

We have to have order in the committee if we are

[ Page 1697 ]

going to function. Vote 81 has passed. I allowed you to ask

a question. The Minister replied. We're on vote 82 and if

there's anyone wanting to speak on 82, I'll recognize them. If

you're on a point of order, make your point of order.

MR. McCLELLAND: Mr. Chairman, I asked permission. I've been

in this House a short time, the same length of time as you

have. Since that time...

MR. CHAIRMAN: Make your point of order.

MR. McCLELLAND: ...from time to time a Member will miss a

vote and the vote will go by. On each of those occasions the

Member has been given the opportunity to go back to that vote

and discuss it briefly. I've asked that same privilege and I

would ask leave of the House now to continue on vote 81 until

I've had the opportunity to question the Minister on that

vote.

MR. CHAIRMAN: Okay, you've made your point of order.

MR. McCLELLAND: I've asked leave of the House.

MR. CHAIRMAN: You'll have to ask leave of the House because

the vote has been passed.

Shall leave be granted?

Leave not granted.

SOME HON. MEMBERS: Oh, oh!

MR. CHAIRMAN: I heard "no." On vote 82.

Interjections.

MR. CHAIRMAN: On vote 82.

MR. McCLELLAND: My. Chairman, point of order. Mr. Chairman,

point of order.

Interjections.

MR. CHAIRMAN: On vote 82.

MR. McCLELLAND: Mr. Chairman, point of order.

MR. CHAIRMAN: Order! State your point of order and I'll

recognize the....

MR. McCLELLAND: Mr. Chairman, there was only one "no" vote

that was recorded and that Member was not in his seat and

cannot be considered a "no" vote.

Interjections.

HON. L. NICOLSON (Minister of Housing): Mr. Chairman, on a

point of order. I said no.

MR. CHAIRMAN: Order! Order!

Interjections.

MR. CHAIRMAN: Order! (Laughter.)

Interjections.

MR. CHAIRMAN: Order! Order! You're on vote 82. Shall vote 82

pass? On vote 82? Do you want to speak on vote 82?

AN HON. MEMBER: Oh, forget it.

MR. CHAIRMAN: On vote 82. Shall vote 82 pass?

Vote 82 approved.

On vote 83: local health services, $12,414,213.

MR. FRASER: I have several questions under vote 83 and I

don't know whether to take them one by one.

First of all, Medical Health Officers. As I gather from here

you've increased the bosses from 11 to 18, if I read this

correctly. Medical Health Officers, Class 3 — is that the way

to describe it? The reason I want to comment on that: that's

fine to increase at this level, but there are vacancies in the

province now, and my question on that would be, how many are we

short? How much of an actual increase is there? I happen to

know that you can't fill vacancies now at the director level in

some of these health units. So I'll move on to the next

one.

These are quite important people in these health units, as

I'm sure you'll agree.

Now under public health nurses, Class 2. There's an increase

on them from 16 to 17 and I suggest that that's not enough.

That's on page M69. Class 1 public health nurses increased from

293 to 300, and I would suggest that that's not enough there

either. There's virtually no increase there — 5 per cent or

something like that.

Boy, everybody is here now.

Interjections.

MR. CHAIRMAN: Let the Member continue his speech.

MR. FRASER: I hope you're keeping up, Mr. Minister, because

I'm quite concerned about this, that there should be increases

here and there aren't.

[ Page 1698 ]

Then we go to another vital part of a health unit: Health

Inspectors, Class 3. They go from 0 to 18, and these are the

high-priced fellows. Apparently we had none and then all of a

sudden we're budgeting for 18, and their salaries are $13,500 a

year.

Then we go on to Health Inspector, Class 2, which are the

important people, the people who actually do the work, the

field work. They're increased from 34 to 39. Then probably the

most important health inspectors of all, the Class 1

inspectors, who do the actual work. I notice that there's a

decrease there in the Health Inspector, Class 1, from 27 to 23

personnel, and I wonder why.

The last question I have under this vote — and I believe the

last question — is speech therapist, which I understand have

been in short supply for years. You have provided in here for

18 of them. My question is, are you going to hire anybody? Are

they available?

I have a recent letter from a health unit in the Cariboo. I

believe it's been going on for three years now that they've

been after a speech therapist. Your department has budgeted the

money and they can't get the bodies to fill the jobs, and

that's what I'd like answered there. Why budget for 18 months

when you know you can't get anybody?

HON. MR. COCKE: Well, Mr. Chairman, in the first place we're

short about four Medical Health Officers, and that's

unfortunate, but we budget for them. We want to fill the

vacancies at Dawson Creek and Prince Rupert, or wherever. We

fill those vacancies as we can get people to fill them — as we

do with speech therapists. You're quite right, Mr. Member,

through you, Mr. Chairman: there is a shortage of speech

therapists and we want more speech therapists.

One of the reasons that we're going into an expanded health

education programme in this province is so that we can produce

our own speech therapists. Up to now we've had to depend

completely on other areas of the world producing all of our

speech therapists. Generally speaking, we're trying our very

best to provide those people that are sorely needed in the

health care field.

You mentioned about the Health Inspector 3 — that we've gone

from zero to 18. The only reason there isn't an 18 in the other

column, Mr. Member, through you, Mr. Chairman, is because

they're the same amount. You'll notice it's the same budgeted

figure — no it's somewhat more — but the budgeted figure is in

the left-hand column, therefore it's the same number of Health

Inspectors 3. We're not hiring more bosses than we had last

year, we're budgeting for the same number. Generally speaking,

I think that answers your question.

MRS. JORDAN: Mr. Chairman, is this where you discuss

expanded public health facilities?

HON. MR. COCKE: Yes.

MRS. JORDAN: Well, I'd like to put in a plug for the people

of the North Okanagan Health Unit. There has been a great deal

of planning done and thought undertaken to meet the needs of

our area. We have a fine health unit building now which houses

mental health as well as public health, but it's just too small

and we're one of the most rapidly growing areas in the

province.

They are coming to you with a plan, in principle, where they

would combine Human Resources, public health, mental health

and, hopefully, education, not in the same building but in

terms of location. I don't really want to dwell on that aspect

too much. But as the people in the health unit say, if you

don't respond may the good Lord help us. They just cannot carry

on much longer.

They also suffer from a shortage of staff, but in this

instance we would prefer to go for the facilities first and

then we'll bug you for the staff.

There is a tremendous need for this. It has been on line for

about two-and-a-half years in terms of discussion. I would urge

the Minister to respond to this as quickly as possible. It's a

centre for a lot of our volunteer services. Also it would

combine another matter that I wish to discuss with you.

I see a lot of heads buzzing there, so I hope all your

financiers are telling you that it is okay to give the go

ahead.

It's not a casually thought-out programme; it's well thought

out. We, through time, have come to appreciate our unit and our

health officer as being highly responsible people.

Our other problem is that we are the second pilot project

area for home care, as you are aware. This came into effect

this year and it's working extremely well, but we also had the

home-care programme, which was....

HON. MR. COCKE: A traditional programme, and they're both

together now in another vote.

MRS. JORDAN: Are they? Well, I think they are in this vote.

The home-care programme is when the public health nurse goes

into the home and provides distinct services and care under a

doctor's orders. Then, as you know, the home-care project,

which relates to early hospital discharge, is again under the

doctor's orders, but there are a great many more benefits

available under the home-care project than there are under the

home-care programme. What they would like to do as soon as

possible, hopefully tomorrow when you get out of here, is have

permission to amalgamate these programmes so that the benefits

the patients receive under the home-care project would be

available to those who are receiving the home-care programme.

This wouldn't be setting a

[ Page 1699 ]

precedent. There's a programme starting in the Kelowna area,

and they are starting under the combined service approach

rather than the two separate approaches.

What happens is: you get people who are getting home care,

but they need bandages or some sort of physical equipment from

the hospital, and this is not covered. If you amalgamated

them, they could prevent duplication of service, give better

overall care to the patient on a cooperative basis between the

two groups. Also there would be great benefit to the patient in

terms of what they would qualify for under the B.C. Hospital

Insurance programme. I would hope that the Minister would

comment on this and, as I say, give it the green light tonight;

we're ready to go tomorrow.

HON. MR. COCKE: There are a number of areas in the province

at the present time where we are discussing expansion of our

health and mental health facilities. Your area is under very

active discussion at the present time. I would say it's in the

planning stage.

As far as the home-care programme projects, they are being

amalgamated; they're being weeded. We want to broaden out so we

can back-up the intermediate care as part of the whole

programme. I think that has been my announced direction for

some time, and we're just moving closer to it all the time.

MS. R. BROWN (Vancouver-Burrard): As you know, Mr. Minister,

through you, Mr. Chairman, Mayne Island in the Gulf Islands has

been trying for some time to get a full-time nurse. There are a

large number of senior citizens living on that island and

they've been trying to get by with a visiting nurse and some

volunteer public health nurse service, and it hasn't been

working out very effectively.

I know that they're supposed to use Saltspring Island as

their main base, but I also know that they've been in long and

detailed correspondence with you. I'm wondering whether you

have reconsidered their request and made some alternative

plans, not just for Mayne Island but for many of the Gulf

Islands which now have a lot of senior citizens as permanent

residents on them. Thank you.

HON. MR. COCKE: Mr. Chairman, Dr. Arneal is moving into this

general area. We're asking Dr. Ransford with the cooperation

of Dr. Arneal to have a look at that particular situation. We

have had a number of requests. We certainly have to think in

terms not only of a nurse, but we have to think in terms of a

facility. The number of facilities that we can provide staff

for across the province is a difficult thing to come to terms

with. In any event, we are taking a real good look at Mayne

Island.

MS. BROWN: The Gulf Islands have the additional problem of

wide stretches of water, and very bad weather in the winter.

This has a lot to do with the necessity for them to have their

own resident health staff. Thank you.

MR. WALLACE: Mr. Chairman, I'd like to just enlarge for a

few moments on the Minister's comments about home care. I get

the impression that this is sort of developing in a rather

piecemeal fashion. Correct me if I'm wrong, but we started off

with one or two pilot projects based on the assumption that if

you send people home from hospital a day or two earlier, they

could be adequately treated at home if the back-up facilities

were available. This was my understanding. I refer back again

to the Select Standing Committee of the Legislature that went

around the province last year — this was very much in favour

with people everywhere we went.

It was my impression that when the pilot project proved its

worth, programmes would be implemented in every community,

based on the same kind of reasoning that this saved acute

hospital beds and provided a quicker return of the individual

to the home.

The other principle which was supposed to underlie our

deliberations was that there should be scope for looking after

people at home so they never ever would have to go in the

hospital in the first place.

Now, I'm just getting a little impatient about us going

round and round the mulberry bush, always coming up with a lot

of lip service to the fact that this is what is good and safe

and economical, but we get so little detail as to when the plan

will start. Now I hear that we're going to start in Kelowna.

We've already had it in Victoria for a year or so. We've had it

in Coquitlam, I think it was, or Burnaby.

I just feel, Mr. Chairman, that it's like so many other

things government seems to do. It indulges in a great degree of

investigation and task forces and research and public hearings....

Interjection.

MR. CHAIRMAN: Order! The Member for Oak Bay.

MR. WALLACE: Yes, when you're finished Leo, do you mind?

I just think that this home-care business is another example

where the opposition can quite justifiably ask, how much more

investigation are we going to do before we put the plan in

action?

I think we could go on investigating and doing studies until

we are blue in the face. The fact is: home-care has a very

valuable, realistic, economic

[ Page 1700 ]

place to play in the total spectrum of services. I just

wonder why we can't have a uniform programme. In other words,

if it's $1 a day for hospital care, what's it going to be per

day for home care? Is it $1 a day, or $3.50 or what? Or has any

decision been made? I think we've reached the point in time

where this government should know which direction it's

going.

This sounds like my speech on education. But I really feel

that's a valid criticism and I'd like to ask the Minister.

I have had all kinds of correspondence with the Homemakers

Association. They are as eager as can be to get into this

integrated programme of service in the home. As far as I can

gather, there has been no uniform decision made. For example,

shall there be a uniform rate for the homemaker whether she is

in Prince Rupert or White Rock or Cranbrook or wherever? We've

got this integrated uniform approach to hospital service; why

should it be such a patchwork, piecemeal approach to home

care?

I think from the Minister's response to the Member for North

Okanagan, it would seem to me that we haven't yet reached that

transprovincial uniform programme. Could the Minister tell us

what hope there is for that?

HON. MR. COCKE: I have a great respect for the Member for

Oak Bay, but he gets too excited from time to time. He thinks

there is no direction in home care, chronic care, and so on. He

expects that what I have to do is take a magic wand, wave it,

and all of a sudden we've got programmes. Zap! You don't get

them like that, Mr. Member, and I have tried my very best.

Let me suggest to you that we have expanded and expanded the

home-care programme. Remember, we had three communities on that

programme. We began with New Westminster-Coquitlam, Victoria

and Kamloops. Now who do we have on? We have Coquitlam-New

Westminster, Victoria, Kamloops, Prince George, Vernon, Greater

Vancouver, Delta-Surrey, Kelowna and Nanaimo. Who are we

putting on this year? This year we are putting on Penticton,

Chilliwack, Courtenay-Comox, Port Alberni, Nelson, Langley,

Maple Ridge, Trail, Matsqui, Sumas, Abbotsford, Powell River

and Mission. All this is being added to the programme that was

started. You have to start some place and you have to go some

place.

MR. WALLACE: What is the financing in all these places? Is

it uniform?

HON. MR. COCKE: Uniform. Identically the same and it costs

nothing to the recipient.

Let me tell you what we delivered last year in estimated number of patient-days:

67,500 patient-days serviced last year. This year we'll be delivering 102,500

patient-days of home care. That isn't Mickey Mouse; that's a programme that's

ongoing. I want it to go faster; it will go faster. You will notice that we've

almost reached a crescendo now.

There are some areas in this province we have to be very

careful with with this kind of programme. It is very easy to

say we are going to deliver home care throughout the province,

but if you have to send the public health nurse 50 miles into

an isolated area....

MR. WALLACE: We've been through all that.

HON. MR. COCKE: All right, but let's just recognize that as

being a fact of life. That is the situation and the way it is.

I think we are moving fast enough. I would just like to move so

quickly in every area that it would make even your conservative

head race, or ring, or whatever.

But we just have so many ounces of oxygen that we can

breathe a day and so many people to serve the needs of the

people in the province.

MR. WALLACE: May I just ask one question? Is the home-care

programme not entirely based on having to prove that you are

saving hospital days? Have we got away from all the paper work

of saying that the patient is being discharged three days

early? Can I have a patient receive home care based on a

clinical need and not the supposed proof that they are leaving

hospital several days early? That was maybe all right for the

pilot project but I really think that again is something we

could dispense with. Can patients be treated at home without

first having to go into hospital to prove their need for home

care?

HON. MR. COCKE: That is part of the expansion we are trying

to implement now. I should say it is not wholly implementable

at this point.

MR. H.A. CURTIS (Saanich and the Islands): I would like to

discuss with the Minister the question of personal care of

facilities. It seems to me that this vote is not the

appropriate one, but the next obvious one is vote 97 and that

is very late in his estimates. Would he like to discuss that or

to respond to some comments?

HON. MR. COCKE: Under Hospital Insurance.

MR. CURTIS: Yes, okay.

MR. McCLELLAND: I just wanted to comment briefly and express

my appreciation to the Minister for the expansion of the

home-care programme. I would hope too, that that expansion

would continue to recognize that it is just as important to

develop a programme to keep people out of expensive

hospital

[ Page 1701 ]

beds so that that rigmarole that is presently necessary can

be eliminated as quickly as possible.

Generally with this vote I notice, checking into last year's

estimates, that there were healthy increases of public health

nurses last year but not quite so many this year — in fact,

quite a small increase. We also seem to be dragging our feet

this year on additional public health inspectors. Perhaps the

Minister could straighten me out here, or at least explain the

situation.

Out of the large increase of public health nurses last year,

not exactly but on a general basis was there trouble filling

those positions? Were you able to get all of the public health

nurses you wanted? Is the reason that there is a smaller

increase this year because perhaps all of those positions

weren't filled last year? I am looking at the 18 Public Health

Inspectors 3 who were in last year's budget again this year. Is

there some difficulty in getting these kind of people?

HON. MR. COCKE: No, they are all there.

MR. McCLELLAND: But they weren't hired last year.

HON. MR. COCKE: Yes, they were.

MR. McCLELLAND: Are there 18 more this year?

HON. MR. COCKE: No, I gave the same answer.

MR. McCLELLAND: I didn't know. I must have been out of the

House when you explained.

HON. MR. COCKE: Yes, you were. If there is no change in

number then that number in the left-hand column is left blank.

So there is no change in that number. There are still the same

number of No. 3s.

There would appear to be very little expansion of public

health nurses. We have transferred about 60 to the

decentralized programme in the Capital Regional District. That

will be part of their programme. Then we are presently

requesting another 29 from Treasury Board, and I am pretty well

assured that that 29 will be on deck within a very short

time.

There have been some problems with this particular estimate.

Because of that, I am in the process of asking for the

additional. There is no problem, I don't think, in getting

them, providing we can find the public health nurses. As the

Member opposite knows, that's not always that easy.

Interjection.

HON. MR. COCKE: Yes, they are being trained at BCIT. As a matter of

fact, we have a number of graduates of BCIT now working for us as public health

inspectors. The group you were looking at, of course, were the Public Health

Inspectors 3 and they are up the line from new graduates. But we are hiring

the graduates.

MRS. JORDAN: This is in relation to the three-way collision

course developing in British Columbia between the public health

nurses, VON, and the hospitals. Then a few inputs from the Red

Cross in other areas in this whole broad sector of home-care

and homemaker service. The main debate circled around who was

going to be the boss and whose position was going to be

usurped. On the surface, it looked like a stalemate on the

basis of professional pride. But I don't really feel this was

the case; I think the major issue was actually who was

providing the best service and how could they coordinate their

programme so that each played their role in the best interests

of the patients.

I would like to ask the Minister, without elaborating a

great deal on this, if he intends to embark on an overall

provincial programme as to who is the ultimate authority in

this whole area. Is he going to let it evolve, as it is on

various pilot project bases and new initiative bases, so that

in the greater Victoria area, for example, it might well be a

cooperative under the VON? In the North Okanagan, for example,

it might work out as a cooperative programme through public

health. Does the Minister intend to finally bring this to a

head with an ultimate leader in terms of direction? How does he

intend to incorporate the services of such people as the VON,

who are only in the lower mainland area and public health?

Just one other matter before the Minister answers that, and

this is in relation to another facility in the constituency I

represent. It is a diagnostic and treatment centre. I recognize

you are going to say bring it up under the other vote, and I

would be pleased to do that as long as the Minister would

recognize that we want to incorporate public health facilities

within this whole centre.

It is in the village of Lumby, and it's an area of

approximately 5,500 people over an area of 600 square miles.

There is a great desire to have a composite centre between

justice, family counseling, public health, and a diagnostic and

treatment centre. I am mentioning it now in case when I bring

it up the other time you would have liked me to bring it up

here. Where would you like me to discuss it?

Will you allow me to bring in the public health aspect

briefly at that time, Mr. Chairman? You're smiling very

benignly. Would the Minister answer my first question,

please?

HON. MR. COCKE: I'd be glad to answer your first

question.

I would suggest to you that these people that are

[ Page 1702 ]

delivering the services in the communities now are for the

most part getting married, and they're trying to complement one

another. A lot of these services are community-based. For

example, in the Capital Regional District the decision has been

made by that body that VON is being phased out, but they're

really being absorbed by the programme here.

I can't predict specifically who is going to be boss and

who's going to be underlying and all that. I suggest to you

that people that are delivering the service are very important

to the home-care programme, and there's a very important place

for all of them.

You were asking where to bring up diagnostic and treatment

centres. If you want to bring in the public health aspect,

under my vote would be the natural place because it overlaps. I

certainly would have no objection to the Chairman permitting

latitude on diagnostic and treatment centres.

MRS. JORDAN: In the greater capital region, with the phasing

out of the VON, what is to happen to these nurses who have been

serving under the VON? I'm sure they are very distressed about

this phasing out. I would hope this is being solved. Will they

maintain seniority and salary levels? Will they be absorbed

into the public health system under your department, or what

will happen to them? Will they just fade away?

HON. MR. COCKE: No, they are going to be working as nurses

in the Capital Regional District. I understand that if there's

anybody that was disturbed it was the people in my department

who were being phased into the Capital Regional District. They

were somewhat more disturbed than those people in the VON who

moved. So there was a marriage there — they're all working

together now.

MRS. JORDAN: They're all employed by the Capital Regional

District.

HON. MR. COCKE: Yes.

MRS. JORDAN: Their benefits, pension programmes and work

layouts are all couple in that.

HON. MR. COCKE: Yes, under the Municipal Act.

MRS. JORDAN: Will they be taking any decrease in pension

benefits and fringe benefits?

HON. MR. COCKE: No, they're guaranteed to meet the civil

service superannuation pension plan.

Vote 83 approved.

Vote 84: public health services, Division of Laboratories, $1,209,083 — approved.

On vote 85: public health services, Division of Vital

Statistics, $867,908.

MS. BROWN: Mr. Chairman, under this Division of Vital

Statistics I think there is a very silly little Act known as

the Change of Name Act. This Act was first introduced in

1960, and at that time it made it almost impossible for anyone

in this province to change their name for any reason

whatsoever.

It was amended in 1972 to allow most people with a certain

amount of maturity to be able to change their names. The only

people who were not covered by this amendment were married

women. The Act said that if a person is a married woman she

"shall not, during the life of her husband, make application to

change her surname."

In the spring of 1973 this Act was once again amended, and

the amendment stated that in the event of a divorce a married

woman was then permitted to change her name.

What I'd like to do, with your permission, Mr. Chairman, is

to present a message to the Minister of Health from the married

women of the province asking that this Act be amended to extend

to them the same kind of coverage as is extended to married

men.

MR. CHAIRMAN: Order! You're dealing with legislative

matters, and you should be dealing with the vote.

MS. BROWN: Mr. Chairman, I tried to discuss this under the

Attorney-General's estimates. At that time I was told to wait

and discuss it under vital statistics with the Minister of

Health.

AN HON. MEMBER: Introduce a bill.

MS. BROWN: I'm not introducing a bill. It is not necessary

for me to introduce a bill; I just have to bring it to the

attention of the Minister, which is what I am trying to do,

with your permission, Mr. Chairman.

MR. CHAIRMAN: You are supposed to be dealing with the

estimates of the department.

MS. BROWN: In dealing with your estimates, Mr. Minister, I

would appreciate it if you would take into account this message

from the married women of the province who are asking you to

once again amend this Act once and for all — in dealing with

your estimates, Mr. Minister.

Interjection.

[ Page 1703 ]

MS. BROWN: Would you speak to the married women of the

province? I'll give you the message to deliver to them.

MR. CHAIRMAN: Order!

MS. BROWN: All that I'm suggesting, Mr. Chairman, is that it

should be possible for a married woman to get permission to

have application for her surname to be changed, if this is her

wish and if her husband is in agreement with this. Thank

you.

AN HON. MEMBER: The husband can't change his name without

the wife agreeing.

MR. WALLACE: A very quick point, Mr. Chairman, on Vital

Statistics. One of the things that runs through the Foulkes

report is the fact that the difficulty in planning health

services in many ways is related to inadequate data. In

chapter

after

chapter the Foulkes report expresses the difficulty the

researchers had in coming to conclusions because data is either

not there or is poorly recorded and so on.

On page IV-C-20-11 it says:

"Throughout this part of the report we have made continuous

reference to the lack of reliable and comprehensive

information. Not only is there inadequate data collection but

also a lack of the use of contemporary methods of storage,

retrieval and manipulation. One of the greatest deficits, and

one that must be corrected as soon as possible, is the lack of

'linkage' of all major health records — for example, medical

care, public health, diagnostic laboratory and hospital

records."

I notice that vote 85 really does little more than provide

for salary increases and some increased office expense and

travelling expense and so on. I wonder if the Minister has any

plans. Could this be part of the Foulkes report which he could

take into account? There's no question that in planning future

services it makes a lot of sense to have the most up-to-date,

reliable collection of data and to be able to retrieve that

data quickly. I wonder if there's any immediate plans to try

and upgrade this department.

HON. MR. COCKE: Mr. Chairman, the Member for Oak Bay is

asking about future policy. My policy will be to certainly

improve Vital Statistics' ability to retrieve data.

Presently, however, I think you're underestimating a little

bit. You will notice there's an increase in office furniture

and equipment, and also in equipment rentals — more than double

in equipment rental. That's part of the question that you're

asking. I hope eventually to have the whole health care

programme — speaking in terms of Medicare, hospital insurance,

vital statistics and health services — with a proper data base. That's something that you just can't bring

about very quickly, but it is a priority.

MR. CURTIS: Mr. Chairman, following on with the comments by

the Member for Oak Bay (Mr. Wallace), complaints have reached

my desk with respect to the speed of processing various pieces

of information. This isn't purely related to retrieval of data,

but there is no indication here of significant staff increases

which certainly appear to be required. We on this side of the

House speak from time to time of the massive growth in the

government civil service, but there certainly appears to be a

need of this division of the Minister's large department for

additional people. Delays of two to three weeks have been

reported. I think that's an unreasonable length of time for an

individual to obtain a necessary piece of information from

Vital Stats.

HON. MR. COCKE: Mr. Chairman, there has been a need for more

staffing in this area, but it's not as much of a need as the

imperfect system that we have, and that's our biggest problem.

So we are trying to circumvent a little bit of that this year,

and certainly in the not-too-distant future improve the whole

system through a data computerized programme.

Vote 85 approved.

On vote 86: public health services, Division of Venereal

Disease Control, $303,913.

MR. WALLACE: This matter was raised in general terms under

the Minister's salary today. This is vote 86, Division of

Venereal Disease Control. I don't wish to go over ground that

was covered by the Member for South Peace River (Mr. Phillips)

but I think we do have as a society to take cognizance of the

fact that there is, if not a serious increase in the incidence

of venereal disease, certainly a potential that the increase

could become extremely serious.

As Dr. Elliott well knows, there is an emergence of

resistant strains, an increasing tendency for antibiotics to be

less than effective, even on the cases that are treated.

It seemed to me very impressive, in watching a television

show last night, regardless of whether we were talking about VD

or not.... I'm sure the Minister viewed this, since he took

part in the programme.

Anyway, Mr. Minister, it was very obvious, from the comments

of the young people who were interviewed, that for old cronies

like us the degree of sexual permissiveness which is continuing

in that young group in society was quite striking.

They made certain comments and talked in a remarkably

offhand way about individuals in their own school group who are

promiscuous with

[ Page 1704 ]

numerous members of the opposite sex, and so on. I'm not

here for one moment to moralize about that.

I'm just trying to say, Mr. Chairman, that it is very clear

that there is a tremendous degree...well, maybe not a

tremendous degree; but compared to former years or former

generations, the degree to which these young people are

indulging in intercourse is really quite striking and should be

recognized.

That's where the Department of Education comes into the

picture. I'm sure the Minister of Education (Hon. Mrs. Dailly)

is listening if she's not too preoccupied by the blandishments

of the party Whip.

Some things are important, but when we recess is not as

important as when we control the spread of VD.

But seriously, Mr. Chairman, it is a matter which must

concern all parents very much in this province, certainly after

watching that programme. We hear a lot in an indirect way of

the permissive behaviour of our young people, but certainly

that group who took

part in the interview last night spoke very

freely and demonstrated many of the shortcomings of our two

important areas for education. One was the home and two was the

school.

These young people attested to the fact that their parents

never talk about sex or sexual behaviour, and they never talk

about VD. The school programmes were discussed by the chairman

of the school board from Kamloops, and the Minister of

Education took

part in the discussion. But I'm sorry to say

that my overall impression from the programme was that none of

us really seem to be taking it seriously enough. I could be

wrong, but the feeling was that, yes, we're working on it and

we're making progress, but let's not panic — the sort of

attitude that things are not so bad that we need to get in any

kind of serious panic.

As the Minister announced, or as the public health report of

1973 states very clearly, there were 8,970 cases reported.

Previous experience suggest that that's about one-third of the

total, which means that we have somewhere around 17,000 or

18,000 people who have either been treated privately and not

reported, or else some

section of that 17,000 or 18,000 are

actively spreading the disease at this time.

The Member for South Peace River (Mr. Phillips) mentioned

that we live in a coastal area, but I really don't know how

much, specifically, that has to do with it when you look and

listen to these young people talking about the very

matter-of-fact way in which permissiveness obviously exists in

that age group. I don't want in any way to be misunderstood.

I'm not suggesting that every school child — I think they were

grade 12, as I recall, or 11 and 12 — all indulge in this

permissive behaviour. I'm not saying that for a moment.

I'm just saying that perhaps compared to a generation ago, it would seem to

me that at least the dangers of a considerable spread of venereal disease in

that age group does exist. These young people in their discussion also showed

how averse they were to discussing matters with their parents. One of them even

mentioned how apprehensive she would be about going to the doctor because the

doctor might tell her parents.

These are all very practical facts of life that we should

all try and recognize. I feel, judging by the comments that

were made about education and family life programmes in the

schools, that there is a tremendous potential for the Minister

of Education, in my view, not only to suggest, but to include

it as a compulsory subject in the curriculum of schools — the

family-life programme which, in turn, should include very

definite, unvarnished facts and figures about venereal

disease.

It's a little bit like the comment I made in our neglect of

the Indian people. They've got a rate of tuberculosis six times

the rate of tuberculosis in the non-Indian population, and here

is a disease which we have the power to prevent. We have the

power to treat it when it does occur, and we have the power to

prevent complications. Yet here in this so-called enlightened

society, with the money and the personnel and the resources, we

have an increase which I think is almost double the number of

cases in the year before.

Therefore, on that basis I think we have to do two things. I

think we have to start at a relatively early age in the schools

and have compulsory family-life programmes, which would include

this. I think to tackle the problem which is now existing, I

really believe, Mr. Chairman, the Minister should embark on the

kind of programmes which have occurred in the past, where

posters are displayed in public places, and the matter is not

just left for the individual to go seeking help, or seeking

information. The information should be there in the first

place. It's a public service which I think the Minister of

Health should undertake at this time.

One element which the Minister mentioned in his interview on

television last night was the fact that all doctors do not

notify cases. I accept that fact, having been a party to that

crime — if that's the word — myself. A doctor is often placed in

a very difficult position when a patient seeks help, and any

public dissemination of this patient's problem would be of very

serious detriment to the patient, never mind to the patient's

marriage and family. There's always the serious worry, or at

least it always was on my mind, that if the patient's private

problem became known even by a few other people in the

Department of Health, or even accidentally to the patient's

spouse, one could foresee the real danger of perhaps a marriage

getting into real difficulty.

So while I admit that all doctors do not notify cases of VD,

I think we should try and be understanding and realize that the

doctor does it for

[ Page 1705 ]

very strong reasons — at least, reasons which in his mind

are very powerful. On the other hand, the fact that there may

be a contact who is in the community untreated is an equally

serious situation. So I think the problem has to be tackled on

all three fronts.

The medical profession has to review the enthusiasm with

which it is treating the problem. The Department of Education

has to provide the necessary basic information in the schools,

and I hope that the Minister of Health will launch a programme

to let the community at large know that the problem is on the

increase, and make it very easy for the public to know where

help can be obtained.

MR. McGEER: Mr. Chairman, I want to support what the Member

for Oak Bay (Mr. Wallace) says. Some years ago in this House

the former Minister of Health brought in a poster. It was a

sexy redhead by a lamppost. Everybody made fun of it. I

remember writing a poem about this redheaded lass, and it was

published in the papers.

Interjection.

MR. McGEER: But that was the whole reason for the criticism.

That's why the poem came, because all the redheaded women took

offence.

But out of it all came a public awareness that venereal

disease had escaped again. It does tend to go through cyclical

phases, and of course the drug cult, the licentiousness which

is acceptable today in our society where it was unacceptable a

few years ago, has increased the opportunity for venereal

disease, once present, to spread.

Furthermore the opportunity is there to spread in a

different segment of society, to what we may have found three

of four or five years ago. I think the Member for Oak Bay has a

strong point when he stresses the social embarrassment that

accompanies some of these cases, which limits the amount of

detective work that can go on in chasing down the individual

contacts.

Under today's circumstances I would be very surprised if one in five cases

is reported. The significant thing to me, it seems, about the public health

report, is that most of the people who had gonorrhea and were treated for it

didn't realize they had the disease. Those are the people who will be most responsible

for spreading the disease. The statistics and the obvious suggestions that lie

behind those statistics — namely lack of awareness, the potential social embarrassment

because of the new socio-economic group that is being infected, the fact that

it is spreading into younger middle-class people — means that the public health

department has a problem of major proportions. Because of that, in my opinion,

we need to commence in British Columbia an all-out campaign to publicize the

fact that venereal disease is spreading in British Columbia.

There is a danger. In order to meet that danger people must

be aware that they may have been exposed to the disease when

previously they hadn't even suspected the possibility. For that

point to get across, you do have to start some kind of a

publicity campaign. This is what I hope the Minister will do,

recognizing that there is an ominous import to the statistics

that his department has gathered.

HON. MR. COCKE: Mr. Chairman, one of the weaknesses, of

course, in discussing specifics in the Minister's vote, and

then again working them over in the specific areas is that we

rehash my answers. I am not suggesting we are rehashing your

presentation.

We have agreed to put on a seminar with the Medical

Association. They have been most cooperative. There is going

to be a better reporting system in this province hereafter, and

there is going to be a better educational programme, and there

will be a better publicity programme in the area of VD. I

understand that there are a number of posters that were out

last year, too, Mr. Member. There will be a great deal more to

be said about the problem of VD in the not-too-distant

future.

We discussed it at great length in Ottawa. We are not the

only province that is being beset with this problem. The other

provinces are suffering similarly. As I said this afternoon,

the real problem — the worst aspect of this situation — is that

it is now no longer an over age 21 problem. Now it is getting

down into the 14, 15, 16 and 17 age groups. The Minister of

Education (Hon. Mrs. Dailly) is participating with us in

developing programmes for schools, and we are very serious

about the attack on the problem of VD in the province.

MR. D.M. PHILLIPS (South Peace River): I don't wish to

prolong the debate, because I had a fair amount to say on this

this afternoon. I certainly support the Member for Oak Bay (Mr.

Wallace) and the first Member for Vancouver–Point Grey (Mr.

McGeer) in their deliberations this evening.

I wonder if the Minister of Health would give consideration

to instituting in British Columbia tests for syphilis and

gonorrhea before marriage. In several jurisdictions in Canada

tests are taken for syphilis, but not necessarily for

gonorrhea, which is another test which is necessary. Many young

couples are getting married who are carrying the disease, and

one is not aware of the other. Consequently children are born

who carry the disease for quite some time. Would the Minister

give consideration to this?

He explained to me this afternoon that there was no such

thing as a regular injection for this disease so that we could

curb it for people coming to our border through the ports. This

would be one way we could do certain tests, and particularly

also when females go

[ Page 1706 ]

to doctors and have pap smear tests done, there are ways of

testing this. This is not being done, to my understanding.

There are several ways to diagnose this situation, and

diagnostic efforts could be one of the things that would help

cure this disease.

HON. MR. COCKE: I agree that testing is an important aspect

of the discovery of VD, but universal testing would be far more

advantageous than what the Member suggested. The group that he

speaks of is not the high incidence group, unfortunately. If we

did a jail testing possibly there would be a higher incidence.

It is not very easy to do a kind of testing programme that is

going to unearth the carriers of VD unless it is a universal

programme. I couldn't possibly think in those terms.

There was a time when this was done. It has been tested.

There was a time when Wassermann tests and other VD tests were

done prior to marriage, and it wasn't found to be the group

that had the high incidence.

MR. PHILLIPS: Mr. Chairman, I don't wish to prolong the

debate, but I did bring up this afternoon that we have in the

estimates tuberculosis control, an estimate expenditure of

$1,025,449. I don't feel that the incidence of tuberculosis is

near the epidemic proportions of venereal disease, as I pointed

out in statistics which I presented to the House this

afternoon.

Now, we have going through the Province of British Columbia

tuberculosis X-ray laboratories. Any person can go in and have

themselves tested, and X-rays taken to see if they have a germ

of tuberculosis. This is not near the epidemic proportions in

British Columbia today that I feel venereal disease is. Now,

why couldn't we have, going throughout the province, testing

laboratories where young people could go in, have blood tests

taken or whatever tests are necessary to diagnose the

problem.

The Minister said he wants to spend money. Again I point out

that he said it is better to find the disease rather than to

treat it, to diagnose the disease rather than to treat it. If

it is of the epidemic proportions...the Member for Oak Bay

said one in two, which he pointed out could be 20,000. The

Minister himself said there was only one in three, which would

put the proportions the same as I heard on television last

night at 30,000 cases in British Columbia.

I am sure that parents who have young people growing up in society today are

very concerned about this. The fact that it can go undetected is a real worry.

So maybe we should take another look at this. As I say, let's not hide it under

a rock. It's a disease that we must bring out in the open. We must talk about

it openly. We must educate, we must put it in our schools, we must put in on

television. I mentioned all of these things this afternoon. Mr. Member for Vancouver-Point

Grey — you weren't here — but let's bring it out in the open.

Maybe testing stations, where you go in and instead of

having your chest X-rayed you have a blood sample taken,

particularly for the teen-aged group, Mr. Chairman.

HON. MR. COCKE: Mr. Chairman, there are testing stations all

over the province. The Member knows that every health unit in

the province will provide a person with the test or the

information as to where that person can get the test. Don't

compare the TB vote with the VD vote. Don't compare one illness

with another. It's ridiculous. The fact of the matter is that I

have said in this House that it is a priority matter, and we

are paying particular attention to it. We have done a great

deal of work in this area, Mr. Member. Not by any stretch of

the imagination does it lack priority.

MR. McCLELLAND: One quick question. If I have missed it I am

sorry, but is there anyone on staff who is actively going out

into the high-risk areas and seeking out young people to bring

them into the health centres?

HON. MR. COCKE: Yes, we still have specialists in that

department — nurses who go out into the high-risk areas.

Vote 86 approved.

On vote 87: public health services, Division of Tuberculosis

Control, $1,025,449.

MR. McCLELLAND: Mr. Chairman, I notice in this vote that

there isn't any increase in staff for Pearson Hospital or in

this vote at all. As a matter of fact, I checked back into the

March 31, 1973, provisions and there was a total staff of 462,

so there would seem to be a decrease. Yet I've had a number of

calls from people at Pearson Hospital, Mr. Chairman, to the

Minister, who say that Pearson is desperately short of staff

and there are severe problems at the hospital because of staff

shortages. I wonder whether or not the Minister would care to

comment on the staff level at Pearson, what we're going to do

about it and whether it is necessary to bring it up to some

kind of better standard.

At the same time, Mr. Chairman, someone else called me and

said that the comfort allowance, while at all other places it

was $25, it was only $18.50 in Pearson. I wonder if that is

correct and, if so, why.

Another problem has been raised with me. I don't think it's

a serious one — at least not for us but

[ Page 1707 ]

perhaps for the patients it might be. They say that while

payday for everybody else in society is on the 1st and 15th,

they don't get their money until the 18th, and they would like

to know why they can't have their money at the same time as

everybody else. I realize it wouldn't be a problem from our

point of view, but from the patient's point of view, who only

gets a small comfort allowance, he would probably like to be in

that same position.

So first of all the staff, Mr. Chairman, and secondly the

comfort allowance.

MR. CHAIRMAN: Just before the Minister answers, I believe

that is vote 88. Could we pass 87 first, and then have the

Minister answer on 88?

Vote 87 approved.

On vote 88: public health services, Division of In-patient

Care, $3,747,795.

HON. MR. COCKE: Mr. Chairman, there is a recruiting problem

in some of those institutions and there's no question about it.

Pearson is in better shape now than it has been, but there are

recruiting problems as there are in other institutions.

As far as the comforts allowance goes, this is an allowance

that is administered by the Department of Human Resources. I

recall that they moved Pearson from $2 to $18.50, and I would

hope that if it is $22 or $25 elsewhere, then that department

will take a look as it. Certainly I would suggest that if it

isn't $22.50, which it might be by now, it could very well be

moved by the Minister.

Vote 88 approved.

On vote 89: public health services, British Columbia Overall

Medical Services Plan, $105,000,000.

MR. McCLELLAND: Mr. Chairman, I assume that the whole $50

million increase is taken up mostly in payments to doctors. Is

that correct?

HON. MR. COCKE: Yes, well, it's an increase...Actually

this is a shared-cost situation. It is a revenue vote and it is

not an expenditure vote like the others.

This vote doesn't tell the whole story of Medicare, I might

suggest. Medicare is a provincial-federal and individual

premium payment situation, so it really doesn't have that much

to do with what we are paying doctors, because the doctor is

paid out of a sum that is a lot larger than that — I would

suggest something in the order of a couple of hundred million

dollars, or close to it.

MR. FRASER: The Minister mixed me up. It doesn't take too

much doing, I know, Mr. Chairman, but could the Minister give

us the average that the doctors are being paid? This is a lot

of money. What we are looking at here is $105 million. Do you

average out what a doctor is getting? What is the average you

are paying a doctor per year?

Interjection.

MR. FRASER: No. I would just as soon the Minister read

it.

HON. MR. COCKE: Mr. Chairman, I'll ask the Member for Oak

Bay (Mr. Wallace) to give you an average. The average for a

general practitioner in the province is something in the order

of $40,000, I would think.

MR. WALLACE: I remember when this item came up last year I

almost fell out of my chair because nobody wanted to talk about

it, or didn't seem interested. I apologize for keeping on

referring to the Foulkes report, but when you read that Foulkes

report, we've got a no-health system. Everything's just a

shambles; we're not really going anywhere or doing anything in

the way of health services, according to this report. It's a

no-system. It's in such a state of disarray. For the Minister's

benefit I think it is reasonable that we should talk about

complete figures, and he's quite right that the annual report

shows that the total amount of money going to the Overall

Medical Services Plan is $166,876,394.

As I say, Mr. Chairman, I'm always surprised when we come to

this item in the debate. We hear so much criticism of the

delivery of health care services, and that there's so much

wrong with it; yet apparently this House sits here and passes

$166 million like it was peanuts. I think that there are many

things wrong — and I'm certainly the first to agree that the

service isn't perfect — I would always anticipate a very

considerable degree of debate on this, and the debate should

revolve around the fee-for-service system by which doctors are

remunerated.

One of the basic thrusts of the Foulkes report is that the

fee-for-service system is not the most desirable way in which

to remunerate doctors. For the benefit of the House, this is

what this vote 89 is all about — the money that is paid to

doctors on a fee-for-service basis. As we all know, the thrust

of the Foulkes report is to base the delivery of health care on

the community health clinic and Human Resource clinic, a

combination of these services, and I think to combine these two

services in one location is a good idea.

But it also repeatedly states or implies that this

fee-for-service system encourages the overuse of medical

service, both by the patient and by the

[ Page 1708 ]

doctors. If this is a convincing argument I would expect

various Members of the Legislature to take

part in a brief

debate on this. Is this a valid criticism? Is this what the

people of British Columbia think? From the comments our

constituents make, do they seem satisfied with the way in which

this very large sum of money is being spent to remunerate

doctors? And I would certainly like to hear some comments on

this because the thrust of the report is a salaried service for

doctors through the vehicle of the community health clinic. I

think we should have some community clinics in much the same

way as the Minister has initiated pilot plans on home care. 1

think it would be an excellent idea to set up salaried

positions in community clinics so that we have a comparison

between that new method and the method that we have here in

vote 89. I would be interested to hear the Minister comment on

that.

HON. MR. COCKE: Mr. Chairman, I was interested in the Member

for Oak Bay's remarks.

Vote 89 approved.

Vote 90: public health services, administration of cemetery

companies programme, $51,985 — approved.

On vote 91: public health services, Action British Columbia,

$125,000.

MR. McGEER: Mr. Chairman, we had a rather interesting

document tabled yesterday in the Legislature called "Leisure

Services in British Columbia." It was a report by Eric F.

Broom, and he had to say this on page 13 of that report:

"It would appear that Action B.C. represents a further

fragmentation of an already highly fragmented structure of

provincial government services to recreation. The terms of

reference of the organization, when interpreted in a recreation

context, indicate that its functions will largely duplicate

those of the Community Recreation Branch."

Now, Mr. Chairman, the Minister when we've got up to discuss

a number of votes this evening has said with considerable pride

that that belongs in Human Resources. It appears that he's

passing all of these programmes off to the other Ministers, and

yet here's one that the Minister has promoted personally. He

had the Premier taking time off from the Legislature to pedal

bikes all hooked up to wires, and so on, and yet the Minister

for Travel Industry (Hon. Mr. Hall) commissions a report which

says in effect that it is all nonsense, as it is just

duplicating the Community Recreation Branch.

Now, I'm all for the programme, but I'm not for duplication of government services.

I wonder if the Minister could tell us what his opinion is of Mr. Broom's opinion

and what should happen to this Action B.C. programme. I'm doubting whether we

should vote it, in terms of what Mr. Broom said.

HON. MR. COCKE: Mr. Chairman, it's a $125,000 effort — a

huge, monstrous, monumental effort. You remember last year that

Action B.C. put on what I consider to be a very worthwhile

conference which has got a lot of people interested in the

whole question of nutrition, of fitness and of a lot of areas

that are health centered. What Mr. Broom says is what Mr. Broom

says, and he says it to the Minister in charge of that

department, the Provincial Secretary (Hon. Mr. Hall). I'm sure

that I'll have some discussions with the Provincial Secretary

around this question.

This is a voluntary organization who are going to raise

funds of their own, and this is our participation. I suggest

that there is an area for a volunteer organization to provide

people of their same ilk with information as to where you can

look for particular aspects along this line — physical

activity, testing, nutrition, or whatever.

MR. McGEER: Mr. Chairman, in my question to the Minister I

really wasn't challenging the value of the general concept, but

the question had been raised — is this duplicating something

which already exists in community recreations? Even if it isn't

duplicating it, does it belong in the Health department or

should it be with Recreation and Conservation?

HON. MR. COCKE: Well, if it belongs anywhere other than in

this department, it belongs to the Provincial Secretary's

department, and that's a question that we are at the present

time debating. It certainly doesn't belong in the Fish and

Wildlife or Parks or whatever. In any event, I feel that it is

worthwhile, Mr. Chairman; otherwise I wouldn't have it in my

estimates. You have asked me; I say yes, it is worthwhile.

Vote 91 approved.

On vote 92: public health services, training in the expanded

role of nurses, $75,000.

MR. McCLELLAND: Mr. Chairman, once again I would just like

the Minister to explain what this vote will be used for and

what will this expanded role of nurses be. It's even a less

amount than Action British Columbia at $75,000.

I wonder if I might just appeal to the Minister at this time, in the interests

of keeping the people of British Columbia informed, to tell us why there was

$600,000 last year under "public health, research" in vote 81 and no money this

year.

[ Page

1709 ]

HON. MR. COCKE: That, generally speaking, is a federal

programme. Now they have taken over the whole programme and

therefore there was no need for provincial participation.

There's as much money in it, but it's purely federal now as

opposed to a federal-provincial programme.

Getting back to the training for the expanded role of the

nurse, the RNABC (Registered Nurses Association of B.C.) came

to us and said: "Look, we want to help nurses develop an

ability to do work beyond the work that they are presently

doing." The expanded role is sort of working as a paramedic,

sort of a half-doctor, doing what a doctor would normally have

been thought to in the past. The nurses wanted it, the Medical

Association agreed to it, the university nurses agreed to it

and so we agreed to finance the programme.

I felt rather than bury a specific such as this among the

votes of grants and so on, the best thing to do with it is to

make another vote. You've seen it and that's what it is. It's a

programme for training nurses in an expanded role.

MR. McCLELLAND: Supplementary, Mr. Chairman: is there a

programme set up for it? We have never seen any evidence of a

programme of this nature. Will the nurses take on-the-job

training? Will they go somewhere else? How is it going to

work?

HON. MR. COCKE: Yes, that's exactly it. The place of

training will be UBC, and throughout the province on a regional

basis. The course is going to be three months in length, if you

want specifics. There will be about 30 in the first class and

it is estimated that over a two-year period there will be about

200 trained. Generally speaking, they will be trained to work

with doctors in the community and assist the doctors in a more

sophisticated way than heretofore.

MR. McCLELLAND: Has there been any objection from the

medical profession or any legal objections, Mr. Chairman,

through you, to the Minister?

HON. MR. COCKE: No, none at all. As a matter of fact, at the

last meeting I attended, where we made the final decision, the

Medical Association was represented, the RNABC was represented,

the College of Physicians and Surgeons was represented, my

department and UBC were represented. Everybody was happy and

unanimous in their support of this vote.

MRS. JORDAN: Just following along on the Minister's words, has there

been any decision as to how these people are to be paid? Will they go on a fee-for-service

basis? Will they be hired by private clinics? Or will they be servants of the

government — civil servants under Public Health?

HON. MR. COCKE: The terms of reference they set for

themselves were that they would not be on a fee-for-service

basis but would anticipate a salary kind of proposition in the

future.

MRS. JORDAN: By whoever happened to hire them?

HON. MR. COCKE: That's right. In some instances, it will be

by communities: in some instances a group of doctors, for

example, might hire. That is the case in Vancouver now for two

or three of these people, where a group of doctors hires this

nurse to do specific work and they pay her on a salary basis.

That's what they plan to do.

MRS. JORDAN: I just wonder, while the research is going on into the

expanded role of the RN, if the Minister would make one thing clear. I listened

to some comments by the Hon. Member for Oak Bay (Mr. Wallace). I hope I didn't

misinterpret, but he was mentioning the problems of the increase in cost for

all services in the hospital. Without going into it we have a contentious issue

right now where the RN wishes to keep her differential between those she supervises

and herself. We get that layer and we get the layer for the expanded role of

nurses. Does the Minister foresee actually the phasing out of the registered

nurse in the hospital programme in British Columbia eventually

HON. MR. COCKE: No, I sure don't.

MR. WALLACE: I would just like to commend the Minister for

encouraging the specific training programme for the expanded

role of the nurse. I think the medical profession is very much

in favour of it.

I just wonder, though, is the programme in its initial phase

dealing mainly with the kind of aspects I mentioned already

this afternoon such as coronary care and renal dialysis, or are

we getting into the area where the nurse might be doing house

calls to do preliminary investigation of the patient's problem?

I would really like to know what are the initial limits to the

degree of training.

The second thing has been touched on already, but is it

anticipated by the RNABC that there will be any kind of

specific certificate or diploma awarded through this course? If

so, does that entitle the nurse to further consideration in

terms of her remuneration?

HON. MR. COCKE: I would suggest that it is not designed to

lead in the direction of the specialties you were outlining — renal, coronary or whatever. It is

[ Page 1710 ]

designed more to assist with preliminary diagnosis and that

type of thing, and also to help the people in the direction of

medical care, as is the case. We have the expanded role of the

nurse now throughout the whole of the public health service and

here we are introducing another

section of it.

MR. WALLACE: Does she get a diploma or what?

HON. MR. COCKE: I don't know. There will be some form of

recognition, I am sure. As far as remuneration is concerned, as

one makes oneself more valuable, one's remuneration grows.

MRS. JORDAN: Will she play a role in the hospital in some of

these particular areas such as ordering sleeping pills and

things for patients? Doctors frequently get calls in the middle

of the night to see if Mrs. Jones can have another sleeping

pill. It's really an exercise in futility but I understand it's

because of a legal complication. Will they be able to be on

call for this type of service? Will they be able to order

simple medication such as sleeping pills or a repeat order of

sleeping pills and do some of the simple procedures in the

hospitals as well as in the offices? And will there be an

insurance programme to cover them?

HON. MR. COCKE: Certainly under the Act at the present time

that would not be the case. They could not order any drug that

was prescribed.

MRS. JORDAN: Will you be altering the Act?

HON. MR. COCKE: No, I don't see that. They are not going to

be physicians; they are going to be nurses with the extended

role.

Vote 92 approved.

On vote 93: mental health services, general administration,

$4,130,828.

MR. CHABOT: This deals with mental health in British

Columbia. I don't stand in my place here and profess to be an

expert in this particular field, but I do want to say that

there is concern in the area I represent.

Interjection.

MR. CHABOT: The Minister of Highways (Hon. Mr. Lea) suggests

that he is an expert in this field. Maybe he should stand in

his place after I'm finished and express his point of view as

to the kind of facilities and the type of care that is required....

Interjections.

MR. CHABOT: I'm not suggesting he should be a patient. No,

I'm not suggesting that, but I think he should express his

opinion as to the type of facilities and the type of care that

is provided in this province.

I do want to relate just very briefly, Mr. Chairman, some of

the concerns that have been expressed to me by people within my

constituency and people adjacent to my constituency as

well.

On January 24, which is two months ago, the Minister

suggested to the Town of Golden that he would examine the

provision of additional mental health services to that

community. At the moment, in order to get psychiatric attention

and speech therapy, it's necessary for those individuals

requiring that type of care to travel 90 miles to Revelstoke to

get the facilities from a professional from the community of

Vernon, approximately 300 miles away.

I'm sure that if you take into consideration the type of

weather conditions that exist in that part of the country,

you'll realize the type of hardship which your department is

expecting the people of my constituency to take

part in. It's

virtually impossible in the winter months for people of Golden,

Parson, Spillimacheen or Field to expect to travel from that

community to meet one of the professionals from your department

in Revelstoke, which is 90 miles away, and expect to return in

one day.

I don't think that in British Columbia in 1974 that's good

enough for a growing area such as I represent in the east

Kootenays.

I think that there's a need for these services to be

provided not from Vernon, from a remote part of the Okanagan. I

think there's a need for these facilities to be provided from a

firm base in the east Kootenays — primarily from Cranbrook.

After all, the area I represent is part of the Kootenays, not

part of the Okanagan. Mr. Minister, you've got to recognize

that. You've got to adjust your facilities to be available to

my constituency from the east Kootenays and not from the

Okanagan.

MR. CHAIRMAN: Order, please. Is the Hon. Member discussing

mental health centres?

MR. CHABOT: Yes, it's probably a very foreign subject to

you, Mr. Member for Skeena (Mr. Dent) but....

MR. CHAIRMAN: Order!

MRS. JORDAN: Mr. Chairman, would you ask the Member to stop

psychoanalyzing the North Okanagan, please?

MR. CHAIRMAN: I would just point out to the Hon. Member for

Columbia River that vote 95 is the one that deals with

community health centres. Perhaps it would be more appropriate

to bring it up

[ Page 1711 ]

at that time.

MR. CHABOT: If you insist. I am discussing at the moment the

general administration of the department of mental health

services. If the Provincial Secretary, Minister of Nothing,

feels he has something to say about it, he can have his

opportunity after I sit down to discuss this particular issue.

Mr. Chairman, if you feel that I'm offending the rules of this

House by discussing mental health services and provisions of

health care in this province under vote 93, and that it should

be discussed under vote 95, I'll abide by your ruling.

I'm not one to offend the rules of this House. (Laughter.)

I'm one to abide by the ruling of the Chair. I suggest, Mr.

Chairman, that if you feel, in your heart, that I am offending

what is right, relative to the rules of this House, I'll take

my place at this time and discuss it under vote 95.

MR. CHAIRMAN: Thank you.

MR. CHABOT: Mr. Chairman, I'm not asking you to tell me

"thank you." I'm asking you to tell me whether I'm right or

wrong. Being a new Member in this House, from time to time I'm

subject to discuss a particular issue under the wrong vote.

However, I'm discussing it under the first vote which appears

in the mental health services estimates. If I'm wrong, I'm

sure, Mr. Chairman, you'll correct me.

HON. R.M. STRACHAN (Minister of Transport and Communications): You're

wrong as normal.

MR. CHABOT: In discussing this question of mental health

services, I'm rather surprised, Mr. Chairman, that the Member

for Kootenay (Hon. Mr. Nimsick) is still here, because it's 10:15 at night and usually that Member from the Kootenays goes to

bed at 10 o'clock. He must have slept in this morning to still

be here tonight.

MR. CHAIRMAN: Order, please! Would the Hon. Member return to

the vote?

MR. CHABOT: Yes, Mr. Chairman, I certainly will. I'm

discussing the provision of mental health care facilities in

the east Kootenays, which includes my riding and which includes

the community of Cranbrook.

There has been a fair amount of criticism from those people

that provide voluntary services to mental health care in the

east Kootenays in the community of Cranbrook. They're concerned

about the serious shortage of staff existing in the east

Kootenays.

The president of the voluntary Association of Mental Health Services of Cranbrook

said two months ago that the fact that there was this kind of lack of professional

help in their mental health centre was a disaster. He said this two months ago.

Yet the Minister two months ago suggested he was going to examine the situation.

That's a long time ago, Mr. Minister. The east Kootenays are growing. Cranbrook,

part of the east Kootenays, is the fastest growing community in British Columbia.

In all this province there is no community growing to the same degree as Cranbrook

is.

MR. D.E. LEWIS (Shuswap): Vernon is.

MR. CHABOT: No, Vernon doesn't even approach — or Salmon Arm — the type of growth that Cranbrook is experiencing at this

time. Yet there is a mental health care community there which

is practically void of professional help. There are no

psychiatrists, there are no psychologists and there's no

administrator. That physical facility was put into place in

1967. Since that time, seven years ago, we find ourselves in a

position with almost zero help. All we have is a psychiatric

social worker. Really, after the performance of the Premier in

British Columbia, who has confidence in social workers?

MS. BROWN: I do.

MR. CHABOT: You are one of the few. Most people have turned

against social workers since they've realized the Premier was a

social worker.

We do have a temporary type of facility there. We have a

psychiatrist coming in from Calgary one time a month. That's

not good enough to cover a community of approximately 100,000

to 150,000 people. That's not good enough. Yet the Minister in

the month of January suggested that he was going to provide

additional professional help for that part of British Columbia.

No wonder there's discontent in that part of the province; no

wonder there's a concern with a lack of cohesion and lack of

consideration on the part of the provincial government in

relation to provincial services for that part of this

province.

The voluntary mental health association in Cranbrook lays

the problem right at your doorstep, Mr. Minister. And they're

asking and they have asked what you propose to do about this

problem. You involved one of the Members from your department

to examine the problem — a Dr. Bridges. On January 10, 1

believe it was, Dr. Bridges had this to say:

"Dr. Bridges said Wednesday: 'The branch is acutely aware of

the need for a psychiatrist. With the approval of the Minister

we have taken quite unusual steps to get a fully trained psychiatrist for the east Kootenay unit.' "

On January 10 that statement came out. Yet we're still waiting in the east

Kootenays for these facilities

[ Page

1712 ]

and for this kind of professional help to be available.

On researching the subject further, to this very day there's no permanent replacement

for the psychiatrist, psychologists or the administrator for this mental health

unit.

We understand that your department has suggested or indicated that there would

be temporary help made available for a four-month period. As of yesterday, this

help is still not available. The people in the east Kootenays have been waiting

a long time. They have a right....

MR. CHAIRMAN: Order! Is the Hon. Member talking about the Cranbrook

mental health centre?

MR. CHABOT: No, I'm talking about the delivery of mental health facilities

and services in the Province of British Columbia, of which the east Kootenays,

I hope, are a part. I'm suggesting to you that there is a very serious lack

of professional help in the southeastern part of British Columbia.

In view of what has taken place, in view of the promises that the Minister

has made and in view of the promises made by people in his department, I wonder

what he is going to do, because the people of the east Kootneays are getting

short on patience.

HON. MR. COCKE: Mr. Chairman, we don't manufacture psychiatrists. We

try to motivate people and we try to suggest to people areas of the province

in which they could well serve the people's needs — as a matter of fact just

this past week a psychiatrist and his wife went up to look at that area — but

there's no way you can manacle a person to the area.

We do need team leadership, however — I agree with you — in order to develop

a team around him. We will have that team in that area, as I indicated in January.

But unfortunately, as I might have to indicate again in May, if we can't bring

it about and it's an impossible situation, then it's impossible.

There are a number of areas in the province where we need a great deal of beefing

up. I do hope that people will move away from the lower mainland, where there

is a much heavier concentration of this type of care, to the areas such as the

Kootneays an the north that really need the care of these mental health terms.

MR. CHABOT: Very briefly further on that particular subject, I failed

to say at the outset of my talk that I happened to discuss this subject matter

with the Minister either just prior to or early in the session. He was very

sympathetic to the cause of the east Kootneays. I don't want to leave the impression

that he was not concerned about the lack of these facilities in the east Kootenays,

but I certainly feel that I have a responsibility to again bring to his attention

the fact that these facilities are not available.

I'm not suggesting to you that the east Kootenays are a unique part of British

Columbia, though I tend to feel that it is. Certainly you do have, in many instances,

a problem in attracting professional people to certain parts of the province.

From my experience in living there for many years I have found that we have

had no problem in attracting doctors, optometrists and dentists in that part of

the province, which is a problem which has been experienced in other parts of

the province.

I think, Mr. Minister, that if you suggested to some of the psychiatrists and

psychologists who you are attempting to attract to this particular unit that

they visit the east Kootenays, I'm sure that they would find the place compatible....

AN HON. MEMBER: They would never want to leave.

MR. CHABOT: That's right, Mr. Minister. They would find it compatible

to family life and compatible to a great way of life as well. I would suggest

that when you do get inquiries from these types of people who want to come to

the east Kootenays you suggest to them that they go to the Kootenays, because

they'll love the Kootenays.

MRS. JORDAN: I'd like to follow through on the statements of my colleague,

the Member for Columbia River, because I think there's a very real problem.

It isn't sufficient for all of us to say that it's difficult to get psychiatrists

in these areas. We have to face the fact of why it's difficult to get psychiatrists

in outlying areas. There has to be some type of incentive programme.

I think basically most psychiatrists would agree that of all the professions

or specialties, probably the psychiatrist tends to be one of the most dependent

personalities on his peers. He's in a practice in which there's a fair amount

of consultation that goes on in terms of what he's going to do in treating his

patients.

This is a universal problem, actually. Psychiatrists just will not go to the

more remote areas. Once you get one, then it's not difficult to get two, because

they have someone to confer with and discuss their problems with.

Another problem is that in dealing with psychiatric patients, generally it's

a problem that has to be dealt with by the psychiatrists. Of all practitioners

in the non-metropolitan areas, they are probably the ones who are most subject

to 24-hour-a-day call. The obstetricians and the surgeons have their problems,

but basically the psychiatric patient is under the care of a psychiatrist, and

no one else will do. They tend to get upset late at night, due to family disturbances

or because they're on their own — and these are often underlying causes of their

[ Page 1713 ]

psychiatric illness.

So a psychiatrist who goes to a non-metropolitan area

basically has no life for himself or his family. All the

attributes of the area that the Member outlined are of no

benefit to people in this form of practice.

Mr. Minister, I would suggest that the government, in trying

to meet this problem, is going to have to offer greater

incentives. How is a psychiatrist to get away? A general

practitioner, no matter how well he practises, really is not

anxious to take over a psychiatrist's calls while he is away,

because they tend to be of an acute nature.

I think you're going to have to offer incentives in terms of

some kind of fundamental government subsidy. You're going to

have to allow them — I think it's already allowed — to practise

outside the public health clinic. The problem is that once they

get there they are combining a private practice and a public

health clinic practice. It just becomes too overwhelming.

It also seems to be a fact of life that once a psychiatrist

comes into an area there's a tendency for his services to be

utilized much more than people had anticipated.

I think also that there's another problem. I don't want to

speak unkindly of psychiatrists as a whole, but it has been an

experience of many remote areas that the psychiatrists that

they are able to attract turn out to be people who just cannot

function in that kind of environment. So often they end up

looking after their own problems. There's no recourse for the

medical profession or the people in that area once a

psychiatrist comes in to really come to grips with this

problem. I have one in mind which I will speak to the Minister

privately.

On the general matter of this vote, Mr. Minister, I'm very

disappointed in it. It certainly raises some questions. Just

running down the vote, code 202, travelling expenses for this

administration are held at $45,000 a year — $45,000 last year

and $45,000 this year. Surely if the Minister is intent in his

efforts to decentralize mental health care in the province,

there's going to be a greater need than ever for his staff to

travel and to be available on a consulting basis. I would also

have hoped that there might have been funds here encouraging

psychiatrists to move out into the area, at least on a

consulting basis.

Vote 019, "grants to University of British Columbia for

research," was $30,000 last year and $30,000 this year.

Mr. Minister, if ever a government needed to give grants to a

university for psychiatric research, I would think it was this

government. It's most disappointing unless these funds have

been moved to another vote, that the Department of Health is

not encouraging more practical research into mental illness as

it occurs in this province.

We have some serious problems growing in British Columbia.

One, which I mentioned under the

Attorney-General's vote and which should require some study,

is the great increase in popularity of guns. I would think that

this Minister should have at least doubled, if not tripled,

this vote. If, as the Minister of Finance (Hon. Mr. Barrett)

has said, we want to encourage universities to become more

involved in the practical aspects of life, surely in the area

of mental health research there's a golden opportunity for the

government to work with the universities to delve into some of

the problems that are confronting us today.

I'm well aware that the university has had its problems in

terms of the psychiatric unit, but there are many people on

staff in various areas of the university who are anxious to

make a contribution. They're absolutely hamstrung by lack of

funds.

I would hope the Minister would give us a reasonable

explanation why at this time he is decentralizing mental health

care, as started by the former administration, that you are not

placing greater emphasis in this area.

The same applies in vote 034 — Mental Health Care and

Training Grant, $300,000 this year. I assume this is for people

to take post-graduate training?

Interjection.

MRS. JORDAN: It's not? What is it for?

Interjection.

MRS. JORDAN: What is the vote for? Mental Health Care and

Training Grants, is this not grants for training of....

HON. MR. COCKE: Department of psychiatry at UBC, and it is

also for bursaries, and so on.

MRS. JORDAN: Well, again, in line with what I said, Mr.

Minister, and the fact that we have such an acute shortage of

psychiatrists — not just in British Columbia, there's an acute

shortage right across Canada — would be an opportunity to offer

an incentive to doctors who might well be interested in

specializing in psychiatry and offer them the opportunity to

have their post-graduate training paid for in part by the

government with the proviso that they come back for a period of

two or three years and work in a community health clinic.

If the Minister hadn't considered this, I would strongly

recommend this tonight, that there must be incentives if we are

going to get competent psychiatrists out into the community.

One way to do it is to approach our own UBC graduates who are

interested possibly in taking psychiatric training, and offer

them a financial contribution for their post-graduate training,

and put the string with it that

[ Page 1714 ]

they must come back and serve in one of the community health

clinics such as Pouce Coupe.

I just really feel, Mr. Minister, there is no other way you

are going to solve this problem when you examine the full scope

of the reasons why there aren't psychiatrists attracted to more

remote areas.

In vote 040, the development of new patient care programmes,

this is an increased vote, Mr. Minister, and I wonder if you

would comment specifically on what these programmes are. I

would assume that they are in relation to the decentralization

of mental health care in the province.

Also I would ask the Minister, under code 042, why the

assistance for the retarded is reduced from $550,000 last year

to $400,000 this year. My understanding is that, perhaps I'm

wrong, these are areas where there are grants to areas for the

mentally handicapped.

I'm trying to think of the name of the farm in the northern

part of the province that used to be federal agricultural

experimental farm that was taken over by the Association for

the Mentally Handicapped, and is now a residential home for

retarded children.

There is great hope in the Okanagan of establishing one of

these schools. Also there is hope in the Kootenays of

establishing one of these schools for the retarded. I would

hope that the diminishing of this vote is not an indication

that the government is drawing back on its assistance in this

area.

Perhaps the Minister would explain that.

HON. MR. COCKE: Well, Mr. Chairman, a number of items under

administration were brought up. Let me deal with the travel

expense first. You were indicating with alarm that we've

reduced the travel...or that the travel expense hasn't gone

up.

MRS. JORDAN: It held the line.

HON. MR. COCKE: Yes, it's holding its own. Last year we

underspent. There is no point in having more in the travel

expense if it is not being used. This is just for the

administrative travel expense, and so therefore we felt that

there was no point in increasing the allotment.

You know, you are talking in terms of a back-up for

psychiatrists. That's about the only way you can get

psychiatrists to operate in the areas away from the lower

mainland, I would think, would be to have them working in

pairs, because that is the big problem. That there is no

back-up service. You could offer them the moon, as far as

incentives are concerned, and....

MRS. JORDAN: Life is too short.

HON. MR. COCKE: That's right — life is too short. We know the direction

and, as I said earlier to the Member for Columbia River (Mr. Chabot) we just

don't manufacture psychiatrists.

MRS. JORDAN: Are you prepared to go into a back-up

service?

HON. MR. COCKE: We are certainly prepared to do everything

we can to beef up the community mental health services in this

province, and we are working on all sorts of different

ways.

We do have a lot more interest — I must confess that

psychiatrists are much more interested in working in the

community mental health centres than they are in the

institutions, so I think that in the long run that will help.

But we have to acknowledge the fact that there is a necessity

for the team approach, and by "team" I mean colleagues of equal

training.

Some of the areas that you were discussing, assistance for

the retarded — how come the vote went down? — because BCHIS and

Human Resources are picking up more of that particular area. It

was a back-up for Glendale and as we don't need so much money

therefore there is no point in putting in more money if it is

not needed.

The development of new patient-care programmes is the

Vancouver project. Now the Vancouver project has had a real

effect, in my view. Remember when I made my budget speech I

said, because we were looking at that time at the mental health

report, that there were some 2,000 people in Riverview? Now I

believe the numbers are down to 1,860-something. That is the

direct result of the fact that the community mental health

programme is beginning to grow and I should say is beginning to

really take effect.

MRS. JORDAN: Where are these people living as they move out?

Are they living in private homes?

HON. MR. COCKE: Well, they are living in the community. In

private homes, some in boarding homes, and they are generally

speaking living out, but with community support.

MR. McGEER: Mr. Chairman, just one or two things to echo

really what the Member for Columbia River (Mr. Chabot) and the

Member for North Okanagan (Mrs. Jordan) said. Mind you, I think

it is a big plus for some of these communities that they can

say 100,000 people and not one psychiatrist. There are so many

nuts in the Greater Vancouver area, there's a million people

and 158 psychiatrists or something like that to look after them

and t