1998 Legislative Session: 3rd Session, 36th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JULY 20, 1998

Afternoon

Volume 11, Number 25

[ Page 10195 ]

The House met at 2:07 p.m.

Prayers.

J. Cashore: In the gallery today we have two residents of Coquitlam: Joe and Ria Smeets. Would the House please join me in making them welcome.

Hon. M. Farnworth: I have the great pleasure today of announcing the arrival into the province on Thursday evening of my new niece, who is the daughter of my brother Robert and his wife Loni. She came into the world at nine pounds, and her name is Ryann Hannah Farnworth. I would ask the House to please welcome her to British Columbia.

I. Chong: Joining us today are two students from Royal Roads University, who are here to watch question period. They are Tom Hickman and Bryan Mathews. I would ask the House to please make them welcome.

P. Calendino: I will have to make this announcement in bilingual mode, as usual. In the gallery are two very good friends of mine who are businessmen. One resides in Burnaby North and the other resides in East Vancouver. They are Michele Castagno and Michele Di Trolio. With them is their nephew Mario Di Trolio, who has come from Italy to vacation here for four or five weeks. He is a recent graduate in economics, and he likes this country so much that he is going to come back to our province and register in graduate studies at one of our universities very soon. In Italian, with your permission, hon.

Speaker: A nome di tutti i deputati di questa Camera vorrei dare il benvenuto al signor Mario Di Trolio, appena laureato dall'università di Salerno in Italia, qui in vacanza per qualche settimana. I would like the House to make them all welcome.

Oral Questions

PROPOSED GAMING LAW CHANGES AND RIGHT TO SUE CROWN

T. Nebbeling: When citizens in this province feel that they have been wronged, they have the right to go to court and have an independent judge determine whether they are right or wrong. Madam Speaker, I believe that to be the hallmark of a free country. The NDP has now removed that right from a large group of citizens in British Columbia. I would like to ask the minister responsible for gaming if he believes that citizens must have the right to and sue the government if they believe that they have been wronged.

Hon. M. Farnworth: Apart from the fact that the question is out of order because there is legislation before the House, the fact of the matter is that citizens do have that right in this province and this country. Regardless of what legislation takes place, that right is still there through the constitution.

The Speaker: Hon. members, just for the record, it is indeed the case that a bill has been introduced for discussion, but the detail of it is subject to . . . . Some discussion can happen around the general topic but not around the detail.

First supplementary, the member for West Vancouver-Garibaldi.

T. Nebbeling: Well, the minister's answer was short. My problem with the answer, first of all, is that while Robin Hood stole from the rich, right now I think we see this government involved in taking from the poor.

Let me get this straight, Madam Speaker, and then I'll speak to the bill. We have a group of citizens who believe that they have been ripped off by this government since 1986. The NDP know today that they're on the wrong side of this issue, so they change the law and grant themselves immunity. I have a very simple question for the minister: does he believe that government should be subject to the same law as we are, or does he believe that this government is above the law?

Hon. M. Farnworth: For the last 12 years, since 1986 -- since the regulations governing gaming came into place -- gaming has operated in this province, and the regime under which it has operated has been accepted by charities, by government and by citizens right across the province. There was a lawsuit filed that called into question the way in which the Gaming Commission potentially was constructed and some of the decisions that were made. That is currently under appeal.

Right now there is nothing that stops any individual from taking the province to court on constitutional matters -- on the constitutionality of whether or not certain fees or licences should have been issued. Nothing in that has changed. What will potentially change is the ability of individuals to recover or take money from taxpayers, based on a technicality.

G. Campbell: During Dave Barrett's government, the NDP introduced the Crown Proceeding Act, which gave people the right to sue the Crown. Attorney General Alec Macdonald stood in the House and said: "We seek to abolish in British Columbia a relic of the medieval age when the King could do no wrong." To the Minister of Employment and Investment: how can he possibly defend an amendment which is eminently wrong -- an amendment which denies citizens their rights to access the courts?

[2:15]

Hon. M. Farnworth: Access to the courts is not being denied, hon. Speaker. In fact, as you've already heard, regardless of what does or does not happen, the court case may in fact continue. What is not the case is that when regulation was brought in, in good faith, in 1986 -- under which an entire gaming regime has now operated under five different governments . . . . The government is not going to allow, through a technicality of administrative law, the taxpayers of the province to be stiffed for up to $200 million.

The Speaker: First supplementary, the Leader of the Official Opposition.

G. Campbell: Let's be clear, hon. Speaker: what the court said was that governments had broken the Criminal Code of Canada. Former Attorney General Alec Macdonald also said the system where "the subject had to go on bended knee to ministers of the Crown to seek the right to sue the Crown has no place in modern jurisprudence." Let me try the Attorney General. Why is the Attorney General turning back the clock to deny citizens one of their most fundamental rights by stripping away their access to the courts?

Hon. U. Dosanjh: As my colleague has explained, there was an error made in the establishment of the Gaming Commission in 1986. The court in British Columbia said to us early

[ Page 10196 ]

this year that from 1986 to date, the government had been in violation of the Criminal Code, since it did not have appropriate authority. We want to make sure that we rectify that retroactively, so the government is no longer in violation of the Criminal Code.

Secondly, yes, there are actions before the courts -- on which I can't comment. But it is important for people to recognize that if the government can be sued for $140 million to $200 million, so can the charities for $1.4 billion to $2 billion. We as a responsible government and I as the responsible Attorney General want to make sure that if the taxpayers are protected by protecting the government's treasury, so are the charities -- no one person in British Columbia would be able to stand up and sue the charities to return all of the moneys back to government.

The Speaker: Second supplementary, the Leader of the Official Opposition.

G. Campbell: The government broke the law -- you broke the law. And an Attorney General is responsible for upholding the law, not for fixing it when it makes that better for him. The Attorney General is responsible for the administration of justice in this province. How can he, of all people, sit there and support an amendment which will deny people's access to justice?

Interjections.

The Speaker: Order, please.

Hon. U. Dosanjh: I said before that it is important to recognize that the court in British Columbia has said that from 1986 onwards, the government has been in violation of the Criminal Code. I as the Attorney General want to make sure that we rectify that retroactively to 1986, and we have done that. In the process of doing that, we have done two things. No one would be able to sue the government for $110 million or so in fees that the government received for administering the scheme and the like.

As well, if someone could stand up and sue the government, so could the charities be sued. If you have received the proceeds of gaming -- which was inherently recognized by the court to be illegal as a scheme in the first place -- whatever you have received can be asked to be returned, just as it can be from the government. I want to make sure and the government wants to make sure that there is a foolproof method of protecting the charities, so no one could stand up against any charity -- not just all of the charities -- or against the government and say that that money should be paid back.

G. Farrell-Collins: The Attorney General misses a point. It wasn't the charities that were accused and are in court for breaking the law; it's the government that has been in court for breaking the law.

On Friday we witnessed one of the most disgraceful in a long line of acts by this NDP government. If it wasn't bad enough that the government took the money from the charities in the first place, now they're going to stop them from getting it back -- a new low in B.C. politics. There's only one thing you could do that would be lower: if you took the money and funnelled it into your political party. That would be worse.

Can the minister of justice, the Attorney General of this province, tell us how he's advancing the right to justice of the citizens of British Columbia by bringing in this kind of amendment?

Hon. U. Dosanjh: First of all, as my colleague the Minister of Employment and Investment has already said, on the constitutional question anyone has the right to sue. On the technical administrative issue, what we have said is this: as a principle of law, one should understand that any proceeds from an illegal scheme -- be they proceeds to the government by way of licensing fees or be they proceeds to the charities by way of the proceeds of charities -- could be held to be illegally obtained, and kept. It is important for us as a government to make sure that that scheme is stable, that it is legal and that no one . . . .

Today we have someone who is suing the government. There are four million British Columbians. Tomorrow one of them could decide to sue a charity or a number of charities. These members would then stand up and say to the Attorney General: "Why didn't you foresee this? Why didn't you do anything about it?" We're doing it now. They should stop talking about it, and let's get on with the business of the House.

The Speaker: First supplementary, Opposition House Leader.

G. Farrell-Collins: So far it's only the government that's advocating this legislation. I haven't heard one charity in British Columbia stand up and say that this is the best thing that could ever happen to them. Can the Attorney General tell us: of the hundreds and thousands of charities in British Columbia, how many, and what percentage, have stood up and said to him: "Please bring in this legislation"?

Interjections.

The Speaker: Members . . . .

Hon. M. Farnworth: I guess the Red Cross might have something to say about that.

PREMIER'S OFFICE AND MLA'S CONSTITUENCY ASSISTANT

M. de Jong: It's the only government I know of whose response to being caught with their hands in the cookie jar is to expropriate the cookie jar. That's what they're doing.

I want to ask the Premier a question. The Premier spent over a week trying to avoid answering questions about the conduct of the member for Comox Valley. That member said that she met with officials in the Premier's Office to discuss the phony letters written by her CA. Can the Premier tell us the date that his office discovered what the conduct of the member for Comox Valley was, about the phony letters, and what he did to inform that member's constituents, who had been misled by her?

Hon. G. Clark: I'm delighted to answer questions on this matter, although I don't have the specific dates the member referred to. I think they were canvassed in the House -- or at least I read them in the newspaper, and therefore they must be true, of course. I'm delighted to answer about the member for Comox Valley. I want to be absolutely clear. The member's constituency assistant wrote a letter -- not under his name; under a pseudonym -- that was drawn to the attention of the member for Comox Valley. She discussed that with my staff, and she immediately took the appropriate action and dismissed the individual.

Interjections.

[ Page 10197 ]

The Speaker: Members, members.

Hon. G. Clark: It's a tempest in a teapot, and the members opposite are determined to try to divert attention from their inept performance in this House by going after the member. The member for Comox Valley acted entirely appropriately in dealing with her staff and dismissed the individual immediately. That's the end of the matter as far as I'm concerned.

Hon. H. Lali: I'd like to make a statement to respond to a question taken on notice on June 25 from the member for Peace River South.

The Speaker: Proceed, member.

TURNING LANES FOR HIGHWAY 97 NORTH INTERSECTION

Hon. H. Lali: A few short weeks ago the member for Peace River South asked, on behalf of Dawson Creek area residents, for a turning lane off the Alaska Highway into the Farmington Fairways golf course. I advised the member that I would look into the matter, and I did. The new lanes are being surveyed and built as I speak and will be paved this summer. I would like to thank my regional staff in Prince George for their very quick and effective work. I would also like to thank the hon. member for raising such a great question.

Tabling Documents

Hon. C. Evans: I have the honour of presenting the annual report of the Provincial Agricultural Land Commission for the year ending March 31, 1998.

The Speaker: There is another report here, from the Speaker. I have the honour to present the fifth annual report of the information and privacy commissioner for the period April 1, 1997, to March 31, 1998.

Orders of the Day

Hon. J. MacPhail: I call Committee of Supply. For the information of the members, we'll be debating the estimates of the Ministry of Health.

The House in Committee of Supply; E. Walsh in the chair.

[2:30]

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 47: minister's office, $469,000 (continued).

S. Hawkins: When we left off on Friday, I thought I was finished on the millennium bug, but I did have the opportunity to speak to a consultant from Silicon Valley over the weekend. Actually, he's now in San Diego. Because there are less than 500 days left to fix the problem, I'm wondering who the consultants are that the ministry has hired to help with the problem and when they started their work.

Hon. P. Priddy: The firms that we have been working with . . . . First, we've been working with Cipher Systems, which has been the central consulting company for us. We have also done specific projects around the year 2000 with IBM. As I think I mentioned on Friday, or whenever we last spoke about this, we have been leading the country in terms of our work. Along with the other provinces, we are now engaging DMR Consulting to work across the country with us and with the other provinces.

S. Hawkins: Does the minister feel that there will be enough technical support, with less than 500 days left till the millennium, to fix the problems that will be apparent?

Hon. P. Priddy: We believe that to be the case. We've been working within the ministry on the year 2000 project for over two years now, and we have quite a large working group with the regions to ensure that they have the technical support they need.

S. Hawkins: I note that with concern. Some of the other provinces perhaps aren't up to speed. Looking at Quebec, only 15 to 20 percent of the debugging work that was necessary had been done as of April. Apparently, Quebec says the total bill for dealing with their needs will be almost $200 million. I'm wondering how much money the ministry has set aside in B.C. to deal with this problem.

Hon. P. Priddy: If I understand the question correctly -- I think we did visit this once before -- the amount for the Ministry of Health internally is $11 million in terms of the total cost. The assessments from the regions are in the process of coming in. We will be able to cost those when the final assessments are returned to us.

S. Hawkins: Would the minister commit to giving us those assessments when they come in?

Hon. P. Priddy: Yes.

S. Hawkins: Is the minister comfortable enough to guarantee that not one patient will be harmed on New Year's Eve 1999 because of the millennium bug?

Hon. P. Priddy: I'm satisfied that all of the work that can possibly be done -- within the ministry, with suppliers, with technologists and within the regions -- will be done.

S. Hawkins: Am I to understand, then, that the minister isn't able to give a guarantee about safe patient care for New Year's Eve 1999?

Hon. P. Priddy: What I have said is that all the work that can be done will be done. Can any of us guarantee anything? No, I think that's probably unlikely. But I am confident that all of the technological issues . . . . All of that work with the consulting companies, the ministry and the suppliers, who have every bit as much interest in the health of patients as we do, will be done, and we will successfully transverse New Year's Eve.

S. Hawkins: I think the minister committed earlier to keeping the opposition informed of the progress that's being made. Certainly when the budgets or assessments from the health authorities come in, the opposition would appreciate those.

As well, just to clean up from last week, we talked about severance resulting from regionalization. The minister said

[ Page 10198 ]

that there was $6 million paid out in severance in the budget last year. My estimate of almost $5 million went back to 1993. So if the minister has given us an estimate of $6 million last year and I had $4-5 million from the year before, that's almost $11 million paid out in severance. I wonder if the minister can give us the total amount paid out in severance since New Directions and Better Teamwork, Better Care have been implemented.

Hon. P. Priddy: The total severance cost paid out since Better Teamwork, Better Care is indeed $6 million.

S. Hawkins: When I asked last week, the minister said it was $6 million in the last budget year. That was the answer that was on the record. Is the minister changing that now?

Hon. P. Priddy: No, that is the cost since the beginning of Better Teamwork, Better Care. I'm not aware of anything in the first three months of this fiscal year.

S. Hawkins: I will keep updated on that.

The next area I would like to explore is communications and advertising in the Ministry of Health. Can the minister tell us what the communications budget is and, out of that, what the advertising budget is for the Ministry of Health?

Hon. P. Priddy: We're just bringing another staff member in. I didn't hear the second part of the member's question; I heard the first part. If she could just repeat it, that would be helpful.

S. Hawkins: Certainly. Out of the communications budget -- if that is indeed where it is -- how much is the advertising budget for the Ministry of Health?

Hon. P. Priddy: I'm wondering if it's possible for the member to move on to a different area. It will take us . . . . We have most of our staff here, but since we haven't . . . . It's hard to predict. The staff person is on the way, but if we can move into a different questioning area, that would be very helpful.

S. Hawkins: I'm interested in talking about earthquake preparedness and seismic issues, then, if the Ministry of Health has staff to deal with that.

[2:45]

Hon. P. Priddy: A point of clarification. Is the member talking about the structural upgrading of buildings or an emergency preparedness kind of program? I'm assuming it's probably structural, but I need to know.

S. Hawkins: I would like to canvass both.

Hon. P. Priddy: If more information is required, I'm sure we can get it.

There are a couple of things that are happening. One of them, of course, is that when we do renovations or when new capital projects are approved, if they're not a sort of build-from-start, brand-new project, then seismic upgrading is done at that time. Secondly, since the total responsibility has been turned over to health authorities, we are now working with the regions to develop a plan for seismic upgrading needs across the province, region by region.

S. Hawkins: Thank you for that information. I was going to ask if the ministry had inspected the hospitals, if there were inspections done to determine their structural integrity in the eventuality of an earthquake -- particularly lower mainland, coastal and interior hospitals. Can the minister elaborate as to whether any of those surveys have been done and if we indeed have some information on that?

Hon. P. Priddy: The ministry itself has not gone out to do that; the health authorities have a responsibility to do that. They'll put forward -- and they'll continue to put forward -- their seismic requirements, both in the regional plans that are being developed for this issue and in their capital plans.

S. Hawkins: That's kind of difficult to know, then. I wonder if the ministry knows if the regions are going ahead and doing that -- if inspections and surveys have actually been completed to determine whether hospitals in earthquake zones are structurally safe -- and if not, what work they have to do to make them safe.

Hon. P. Priddy: There are two things, really. One of them is that the hospitals -- certainly the lower mainland hospitals, as the member has mentioned -- if they are of either recent or current construction, are certainly up to code in terms of seismic upgrading. My understanding from staff is that all of the hospitals in the lower mainland are up to code. I think there are two or three exceptions. The regions will be taking that into account in their capital plan, and we are prepared to act on that.

S. Hawkins: What is the time frame for the upgrades? The minister is telling us that some of the hospitals aren't up to par, that there were some surveys done and that they're not completed in all the regions that might be affected. What time frame is the ministry giving itself to ensure that the surveys are done, to see if the buildings measure up? Secondly, what is the time frame for making those improvements, so we have safe hospitals in the case of a major disaster? That is the place people are going to be taken if they're injured.

Hon. P. Priddy: There are plans underway to remedy that for the one exception that I'm aware of in the lower mainland, beginning this year. Secondly, when I look at some of the other hospitals that are not in the lower mainland but may also be in that zone . . . . The hospitals that occur to me are either in the process of being rebuilt or are being built -- brand-new. Those plans are actually in place, and the money to do that is committed. In terms of anything else that is assessed by regions, we will look at what their assessment is and then move as quickly as possible to do that. Primarily for the hospitals in the more earthquake-prevalent zones, we believe that that work is underway.

S. Hawkins: To get back to the question I asked: what time frame has the ministry given itself to ensure that the hospitals have reported in and the work is completed? Does the ministry have a plan for that?

Hon. P. Priddy: I can't give the member a specific date. Let me use an example. Port Alberni, for instance, is a reasonably coastal community, if you will, that has a new hospital being built. I can't tell the member the exact date that hospital will be finished, nor can I for some of these other facilities. What I am saying is that the work on these is currently underway, so as soon as those new hospitals and projects are finished, then the seismic upgrading has obviously been done, because they are being built to code. For the ones that are not part of new projects or something that's currently being built, we'll act as soon as we can on those, given our capital budgets.

[ Page 10199 ]

S. Hawkins: I wonder if the minister can tell me: for the hospitals that don't meet the standards, are the staff in the facilities aware that they're working in hospitals which have not been upgraded to meet earthquake standards?

Hon. P. Priddy: I couldn't speak for each and every staff member, but I would for sure say to you that staff in places like Port Alberni are more than aware that their hospitals do not meet the code. That's the reason they're getting a new hospital. As the new hospital is being built, they're aware that we've addressed that issue in their new structure.

S. Hawkins: For the hospitals that don't meet the standard . . . . Again, the minister is assuming that staff working in these hospitals know that their hospital doesn't meet seismic standards. I can tell you that I wouldn't know from working in a hospital if my hospital met the standards or not. I think that's something that is determined once the survey is done and once the ministry informs the hospitals. Certainly I can assure the minister, too, that I know that Port Alberni knows that they don't meet the code.

That hospital has been in the news for the last four or five years, and that hospital is late being built. I don't know how many times the announcement was made for that hospital to be built. They don't even meet Fire Code, but we'll get into that later.

I'm wondering: for staff who are working in hospitals that don't meet the code -- and we'll assume they know that the hospital doesn't meet the code -- can the minister tell me if staff have been trained to deal with the eventuality that in a time of crisis their facility might no longer exist? What kind of training have we given them to deal with the hundreds of patients that will be in the hospital at the time of the quake and the injured that might be coming to that facility in the event of a quake?

Hon. P. Priddy: All hospitals are required to have an emergency preparedness plan in order to meet their accreditation. I think there was an audit done some time ago that said there were some hospitals that did not meet that requirement as well as they should have. In point of fact, the ministry has worked with those hospitals to ensure that it's the case . . . . In that emergency preparedness plan, it is also a responsibility to look at the issue of staff response in that kind of an emergency, such as an earthquake. It's our expectation that health authorities and hospitals have the responsibility to do that.

I wouldn't be able to guarantee that all staff have had training but that's the expectation. We will do another audit to ensure that it has happened.

S. Hawkins: The minister is referring to an audit that was done before. Is that audit public information?

Hon. P. Priddy: That's part of an auditor general's report; therefore it is public.

S. Hawkins: I assume, then, that the minister is referring to the earthquake preparedness report that the auditor general released in December of '97. Let me quote from that report, because it's the reason I'm asking these questions. I was quite concerned when I read this report. On page 9, the heading is: "The ability of the health care sector to respond is of concern." Under there, the auditor general's team says: "Of the key support functions, medical -- the responsibility assigned to the Ministry of Health -- is the one of most concern to us.

There is not a systemwide plan for emergency preparation and response. This is particularly worrisome, as those hospitals who responded to our survey expressed a pessimistic view of their ability to provide adequate out-patient and care services after an earthquake."

That's why I'm asking the minister if staff have been trained for the eventuality that there may be an earthquake. We would have hoped that the ministry has identified those hospitals that aren't up to par. Are the staff trained to deal with that eventuality? Knowing how quick the government is to announce capital projects, but how slow it is to actually carry them through, I doubt that we're going to be seeing too many hospitals built in the next little while. So we would hope that the ministry would at least have a plan, for those that aren't upgraded, that the staff are trained and that there's a contingency plan in existence to move patients to working facilities in that eventuality.

[3:00]

Hon. P. Priddy: We take seriously, as always, the recommendations from the auditor general. The Ministry of Health's standing committee on disaster preparedness is addressing the findings and recommendations of the auditor general, presented about four or five months ago, I guess, and has been working on that. Terms of reference for managing the disaster preparedness process within the Ministry of Health have been drafted. We have planning in place to work with the provincial emergency program, to provide what the auditor general has referred to as lacking -- a systemwide plan for emergency preparation and response.

S. Hawkins: Well, I don't think I'm getting answers to my questions. I guess what I'm understanding from the answers is: "We're still planning. Staff don't have the training. There are hospitals out there that aren't upgraded. We haven't identified them, and who knows when they'll be done." I guess I'm just as concerned as I was in December; I am concerned today that there isn't a lot of movement on the auditor general's recommendations. But I could be wrong about that.

I wonder if the minister or the ministry's emergency preparedness team have planned a safe location where emergency supplies will be stored, perhaps to deal with the treatment of patients in case of an earthquake, because we know we will need those kinds of supplies when we treat emergencies and triage patients. Is there at least something like that set up now -- a safe location where we've stored emergency supplies?

Hon. P. Priddy: Two things, hon. Chair, if I might. In case of that kind of disaster, in particular if we're talking about an earthquake, there are some places that are clearly more at risk than others. Those hospitals would then draw on two things. They would draw on the support of other hospitals and on the federal government's emergency preparedness program as well.

Secondly, in order to be accredited, hospitals have a responsibility to prove that the staff in their hospitals have training. They must do that in order to meet the accreditation standards. So any hospital holding an accreditation must have been able to prove to the accreditation team that their staff was trained.

S. Hawkins: I just want to bring to the minister's attention the fact that the liquor distribution branch stores have all been seismically upgraded. It's interesting, because I remember that in other estimates, especially in Education, we asked

[ Page 10200 ]

the same kinds of questions about seismic upgrading and planning for an earthquake. I don't know what the priorities of the government are, but it seems to me that the liquor distribution branch stores were done first. Now we're finally getting to some areas of higher priority. Hopefully, the ministry is looking at improvements to that.

Getting into the details of the report, "Planning for Response" -- I'm on page 131 of the report -- the auditor general's team says: "The Ministry of Health . . . should give immediate attention to reviewing and, where appropriate, strengthening the ability of the health system to respond to a major earthquake . . . . " The minister tells me that they've set up a committee now to look at that. It says: "All ministries assigned key support functions should complete, without delay, plans detailing how they will carry out their assigned responsibilities after a major earthquake . . . . " Has the team gotten so far as to devise that plan?

Hon. P. Priddy: We received the report, as people know, in December 1997 -- just at the end of last year. Our staff have been actively working since then. I don't know if they've got as far as defining roles and responsibilities. I do know that they've looked at the 1992 plan, where the auditor general found that significant upgrades could be made, and they've taken that into account. Whether they've gotten to roles and responsibilities yet, I don't know.

S. Hawkins: The auditor general has a whole list of responsibilities that apply to the Ministry of Health. Another key one, I think, is to "develop a new communication strategy to ensure that the provincial response plan is known and understood by local authorities and response agencies . . . . " Is the ministry working on a communications strategy, or do they have one in place?

Hon. P. Priddy: Yes, we are.

S. Hawkins: There is also a recommendation about amending the emergency program management regulation, with respect to updating the B.C. earthquake response plan. I wonder if the minister can tell us what kinds of recommendations they have made for amending that regulation.

Hon. P. Priddy: Maybe the member could provide us with the name of the regulation, because staff here seem to think that it's the Attorney General's, not ours. But we could be mistaken, so we would be prepared to double-check.

S. Hawkins: It's called the emergency program management regulation. It probably is in the Attorney General's purview, but I would think that the Ministry of Health, in updating their plan, would have some input into amending that regulation too. Is the ministry not involved in that?

Hon. P. Priddy: Yes, we are. Because a fair bit of this falls within the Attorney General ministry, and some within ours and within other ministries as well, there is a cross-ministry committee to ensure that the input from each ministry is used as required.

S. Hawkins: Another one that I think is key, as well, is to "develop and issue a current emergency public information plan." I wonder if the ministry is involved in working on that as well.

Hon. P. Priddy: Yes, we are part of working on that with PEP. I think there was just recently a preparedness event that took place.

S. Hawkins: I'm also wondering if there have been any tests of any plans. Or are there any plans to do a test to see how prepared our emergency response system is right now?

Hon. P. Priddy: There has been one smaller one, I think, with PEP, but the last major test was a year and a half ago. We are in the process of planning more.

S. Hawkins: I'm wondering if the ministry, then, has a time frame that they've set for themselves for developing this earthquake preparedness plan and the communications strategy, and for getting it out to the public. Does the minister have time lines for a plan? When can we expect that plan?

Hon. P. Priddy: In terms of the larger pieces that the member is referring to, our commitment to the auditor general is to have a plan in place within 12 months of his report.

S. Hawkins: I had some concerns around information not received from the ministry when I asked for it. Part of that information was around business plans. I wrote to the minister in mid-May or late May, I believe it was, asking for business plans. I believe my colleague from Okanagan-Penticton, who sits on the Public Accounts Committee, has some questions around that issue.

R. Thorpe: I'd like to start by asking the minister this question: does the ministry issue an annual report each year?

Hon. P. Priddy: The ministry should issue one each year. However, I do realize that this year -- quite soon -- we will actually be tabling two: one for '95-96, one for '96-97. My belief is that they should be tabled annually.

R. Thorpe: In other words, the last one that was tabled in the House is the '94-95 report. I wonder, minister, if you could just take a moment and tell us why we would be so far behind. I believe you just said it was your goal or wish that we should file . . . . What systems or actions have you put in place to assure this House -- and, more important, British Columbians -- that annual reports will be filed on a timely basis?

Hon. P. Priddy: The first thing is that I'm ensuring that both the '95-96 and '96-97 reports are tabled in the next few days or a week. Secondly, I have given directions to the ministry that annual reports will be tabled on an annual basis. I expect to be tabling the first one from me by the next session.

R. Thorpe: I'm just wondering, because the '95-96 . . . . Those reports obviously must be ready if you're going to table them in the next few days. I wonder if we could get a commitment from the minister that perhaps they could be tabled tomorrow in the House, because obviously that's historical information. Could the minister commit to tabling those documents in the House tomorrow?

Hon. P. Priddy: Perhaps they could be tabled tomorrow. I'll work to ensure that they get to the House as quickly as possible.

R. Thorpe: I and the members here -- and members of the government side, I'm sure -- look forward to reviewing those reports later tomorrow afternoon.

But more importantly, or as important, my next line of questioning has to do with . . . . At a Public Accounts meeting

[ Page 10201 ]

-- I think it was on June 25 -- we were informed that business plans for regionalization were done on an annual basis. Really, we ended up finding out that it was an implementation action plan, rather than a multi-year business plan. Does the ministry prepare, on an annual basis, a comprehensive business plan for the ministry?

[3:15]

Hon. P. Priddy: Two things have happened. One of them, at least, I can certainly speak about since my time here. One of them is both a vision and mandate and a strategic plan for the ministry, as well as business plans for each division within the ministry.

R. Thorpe: Are those public documents?

Hon. P. Priddy: Many of those are public documents and have actually been quite widely used publicly. We don't publish the business plan for each and every division of the ministry, but there's no reason that the public could not apply to get it.

R. Thorpe: If I understand what the minister is saying -- that there is an overall strategic vision of where we're going or are attempting to go . . . . In our business planning for the Ministry of Health and the various programs that you would probably have subplans for, do you state targets? Are you working towards quantifiable, measurable targets as part of a performance management process?

Hon. P. Priddy: We do. Let me talk about two ways in which we do that -- one much more difficult than others. Certainly there are some things for which it's fairly easy -- I don't know about easy, but it's a least clearer -- to do those kinds of performance outcomes, if you will, or targets, around things like capital planning, meeting your budget and those sorts of things, which are at least quantifiable. I think the things that are a bit harder are the issues around personal outcome, patient outcome and so on. We do, wherever we can, make an effort to do that, hon. member.

For instance, we will often talk about one of the performance outcomes as seeing X number of people more a year in a particular part of the ministry. One that I'm currently working on is increasing immunizations by a certain percentage -- we're still working on that -- particularly in aboriginal communities. We certainly do those performance outcomes where we can. The part of performance outcomes that's always harder is that although you've seen 100 patients, you have to do the follow-through to know what the actual outcomes were for them.

I do know that Maclean's magazine -- I don't know where they did all their research -- felt that not only our budgets but our outcomes were better than any place in Canada.

R. Thorpe: Of course, we heard the Premier earlier today when he stated that it was in the paper; therefore it must be right. Now I guess what the Health minister is saying is that it was in Maclean's , so therefore it must be right, it must be true. But you know what? I bet you they didn't measure how good it could be or how good it should be. It may be the best in Canada -- and I have no idea what they did, and I don't want to get into another discussion, which I'm sure we're going to have later -- but that's not what I happen to be hearing in my part of British Columbia. Perhaps Maclean's didn't research the South Okanagan.

What would be the key -- the top five -- objectives that you want to achieve and that are in your business plan this year?

The Chair: I'll remind the members to please direct their comments through the Chair.

Hon. P. Priddy: The deputy and I did two lists, and they match. That's a good thing. Let me do this in two ways, if I can, one around principle and one around specific initiatives. Some of the principles that underlie the five initiatives I would pick would be access, quality, necessity -- are these required services for people? -- and affordability. Under quality, things like safety would be included in there. Moving on, then, to what I would pick as five specific initiatives, I would choose wait times. For me, wait times include emergency departments.

Much of what happens around wait times is based on what happens in emergency rooms, which is based on who's in the beds that people are requiring. So there are wait times, mental health, expenditure management, children's health -- our tobacco reduction strategy is only one part of that -- and community support, in which I include things like home care and the kinds of support people need in their communities. Many of these are linked together. If you can get support at home, you may not be in emergency; you may not be in a bed that is needed by someone else.

There are lots of linkages between these, but these are the five I'd select.

R. Thorpe: I thank the minister for that. I know that some of my colleagues are going to spend quite a bit of time on wait-lists, and I think they're going to spend quite a bit of time on mental health and children and community support. So let me just zero in here, if I could, on the expenditure management issue. We have the broad line that one of the five key, specific initiatives is expenditure management. Could the minister now take that key initiative and give us an idea of how that is implemented, managed and monitored?

Hon. P. Priddy: I wonder if the member can help me a bit here. Are you looking for specific examples, or do you want a broad statement?

R. Thorpe: I'll try to be a little bit more specific for the minister. I'm just following up on the five key, specific initiatives that you talked about. Now, what I want to try to do . . . . My colleagues are going to talk about many of the others, and I doubt that anyone other than perhaps me is going to talk in detail on expenditure management at this point in time. Now that we have that broad category, I want to take it and see how you manage that through your various programs. Maybe we could pick a couple of programs, and we could be specific.

Since I've got the budget here, how would you manage that in Pharmacare, for argument's sake, and regional funding for acute care? There are two examples, if the minister could just give us some detail on that.

Hon. P. Priddy: Let me deal with acute care first, if I may. There are a number of checks and balances in place. If I can do it chronologically from the beginning of the year, every health region receives a binder such as this, which says how people expect the budget to be prepared: the categories, how they're to look at that, etc. This is the first year they've received such extensive information. We also have a funding methodology committee, which provides advice to the ministry around budget allocation, looking at areas of need and how the budget should be allocated across the province.

Actually, I should have said the funding methodology committee first, then this information to the regions. The regions, then, on a monthly basis, submit their expenditures to us. We don't have to wait until the end of the year but are able to see that on a monthly basis and are able to monitor and manage that. We have

[ Page 10202 ]

provided far more detail than in the past about the principles the regions are to use around their budgeting and the categories in which they are to present that.

As regards Pharmacare, I'll give you what's here, and then I probably will make another comment or two.

Why do I always do this with you? Then I get the nudge from my staff saying: "How come you took longer answering his question?" It's because you're such a nice guy. It must be that -- right? -- just your personality.

We receive a breakdown on a monthly basis of all the eight plans that exist under Pharmacare. That's how we manage that on a month-to-month basis around the management reports. But the other ways we manage from an expenditure perspective within Pharmacare are, for instance, the use of the therapeutics initiative committee and the use of the pharmaco-economics committee. It doesn't just come to the ministry from a drug company, and we say: "Okay, we'll fund that one too. It seems okay.

Nice literature." It goes through the therapeutics initiative committee and the pharmaco-economics committee, who say: "Is this a drug that has had the trials to prove that it's therapeutically good for people, that it's economically good for people and for the Pharmacare system?" -- and so on. So in part, you do the management that way as well.

The other way is that we have a number of drugs that have been reference-base-priced, as well as generic drugs. From a business management perspective, I think those have saved significant money for Pharmacare.

R. Thorpe: If I could just ask a couple questions of the minister on Pharmacare. You mentioned eight plans. Back to the business planning side of the ministry on the subject of Pharmacare . . . .

Hon. Chair, I'm just wondering if we could have a little bit less noise over on the other side of the House while we deal with this serious issue.

The Chair: Hon. members, if we could just have a little bit of quiet . . . .

R. Thorpe: Would there be business plans or strategic plans for each one of the various eight plans within Pharmacare?

[3:30]

Hon. P. Priddy: The business plan tends to be around drugs and drug categories, as opposed to the individual plans, which I expect the member knows about -- plan A is about seniors and so on. The plans tend to be around the drugs and drug categories, as opposed to categories about people.

R. Thorpe: We hear about the rising cost of new pharmaceuticals and about new drugs coming out every day. We can't keep up with it, not only in British Columbia but around the world. I'd like to ask the minister two things. First, what kind of programs do we have to work with the various suppliers of medications to ensure that we as British Columbians are receiving the best possible medications we can, taking into account the affordability issue?

Secondly, as the world appears to be changing so fast, do we have any pilot projects where we're working with suppliers on some kind of a joint venture-type effort to reduce the overall cost yet provide better health care for British Columbians? Do we have those?

Hon. P. Priddy: Actually there are . . . . Oh good. I'm so glad the member for White Rock is here, because the project I'm going to mention first is actually in his riding. I'm sure he will know all about it, naturally.

We do have a project in White Rock with PMAC, which is the Pharmaceutical Manufacturers Association of Canada. I have a whole page on it, but let me just tell you a little bit about it. It's a project working with White Rock seniors around the utilization of drugs. Often, for seniors, part of the difficulties they sometimes get into is around how they take drugs and how they understand the issues of taking drugs. This project has actually been quite successful. This one started, I think, in July of '95, so it has been going on quite awhile and has been very successful. That's one example of where we're doing that with the drug companies.

We have two or three other initiatives that aren't quite signed yet, and we have some other trial projects, as well, that we will be doing with pharmaceutical companies. They are partners.

R. Thorpe: Thanks to the minister for that information. With respect to Pharmacare and some comments that the minister mentioned the other day -- probably last week -- what are you doing within Pharmacare to establish and implement a best-practices program?

Hon. P. Priddy: I think there are four pieces, and if I miss, my folks will help me.

One of them is that we pay the College of Physicians and Surgeons to monitor triplicate prescriptions, which is obviously about monitoring practice.

Secondly, we pay the therapeutic initiatives committee to do the work around the efficacy the drugs. They send out a newsletter to physicians, talking about the medications -- their use and the best way to use them.

Thirdly, PharmaNet is probably one of the largest ways to monitor best practice, if you will, because PharmaNet allows the pharmacist to know if a drug interaction could happen, which they wouldn't have available . . . . I'm told that it's one of the best databases in the world.

There's a fourth one; I missed it. In terms of the prescribing of betaferon, which is certainly used a lot by people with multiple sclerosis, we have a panel of physicians who advise us around best practice for betaferon and when it's best used.

R. Thorpe: With respect to the database the minister just mentioned, do we consider or have we ever considered advising British Columbians who receive what I think is almost a half a billion dollars -- $470 million -- of assistance with their medication how much they have received from the province with respect to medications?

Hon. P. Priddy: I'm informed that the cost breakdown, including what the patient has paid, the dispensing fee and what the province's share might be, is either on the container or on the printout that you get from the pharmacist. We don't routinely send them out, but you can request from your pharmacist a pharmaceutical profile for yourself, which, if you've misplaced that information, will give you the whole profile.

R. Thorpe: I believe that the estimates process is to solicit information and, from to time, to give back information. As a user of medication for my own health concerns, I'm appreciative. What I'm getting at, because we are talking here about

[ Page 10203 ]

the financial accountability section, is that it may be useful, as you continue to try to develop it not only within the ministry but within the citizenry of British Columbia, to consider saying to citizen A or citizen B, whoever they may be, that they are receiving, on an annual basis, this much. It may be helpful for everyone, because you and I both know, as at least one thing that we would share, that there's not a bottomless pit. I think that if we could do that, it may be useful in the longer term.

With respect to acute care, you talked about the funding methodology, the binder of how-to-do and . . . . Does the deputy need some medication?

Interjection.

R. Thorpe: He said: "Just what we need -- another project."

And regional funding . . . . Would a binder for the South Okanagan region, such as you have there, be available to us so we could go through and understand it better, instead of asking questions in isolation? I ask: would that be available, minister?

Hon. P. Priddy: It's public information. Your entire health authority has it. So of course.

R. Thorpe: With respect to the how-to-do binder, if I can, what kind of measurable goals . . . ? What would be the three key measurable goals we're trying to achieve in the next year as we implement this complex and multi-year program?

Hon. P. Priddy: Let me try this, and if it doesn't answer the member's question, you can tell me.

One of the things that you would find in this binder around expectation and outcome for the regions is the whole piece around performance monitoring, which is what you're asking about. For us it's reporting expectations as well. Within that, I can just highlight some for you. There's a whole list, and you're welcome to have it. One of them is to actually demonstrate progress towards regionalization objectives; identify potential risks and required action in relation to those risks, which would be a plan to address those; and ensure that policy requirements are met.

That may just sound like words, but we do need to be very clear, particularly during devolving to regions, that there are certain policy requirements that nevertheless are met, regardless of where you live in the province of British Columbia. One of the things that we . . . . I think we raised this last week. Within this monitoring and reporting, we expect the health authorities to report to their communities on the outcome and the work that they're doing.

From a business perspective -- both business and policy, I suppose -- we expect them to look at both short-term and long-term trends in their particular communities, show comparative performance and create incentives for good performance -- the whole performance of the health system that they're responsible for. There are others here, but if it's something different . . . . I suppose the ones I would add, though, are a bit more technical. They're around data collection or statistical collection and measurements that we expect of the regions: the development of aggregate population, financial service and personnel indicators, and routine monitoring, plus detailed audits and reviews.

R. Thorpe: I do thank the minister for her answers, and I do look forward to getting the binder and going through it in detail and following up on some of the points. But I'm not going to do that today.

[3:45]

Hon. P. Priddy: There are at least two ways that I would mention to the member. One of them is, I guess, part of how you can measure it from . . . . We obviously can't talk to every individual, but one of the ways you can measure that and fairly safely assume answers is by measuring the length of time it takes from the time someone enters the health care system to the time they receive whatever support or service they required when they came into the system, and how seamlessly they would be able to move through that system. Wait times would have an impact on that.

For some people, there isn't a wait time for the support they need when they enter and get their support within the health care system. We would measure part of it by when you go into the system and when you get the support you need, and whether you can move from service to service fairly seamlessly.

The other way we would get that from the community, though, is that every health authority has advisory committees that represent various components, if you will, of that community, and their responsibility as an advisory committee is to give that information back to the health authority, whether that's around seniors, aboriginal people or whatever. So that's also part of how you get a patient response.

R. Thorpe: I realize that we're going through the implementation of regionalization at this point in time. Do you do any random research follow-up with clients at the hospital or within the regional health . . . ?

Hon. P. Priddy: For the most part, hon. member, that is done through the health authorities, who do indeed do that. They do it with home care or home support. They do it and the hospital does it, so a number of services do that random survey and follow-up in terms of the service that people have received.

We have just recently been giving some consideration to doing some of that ourselves -- to be able to do a quality assessment and a report-carding.

R. Thorpe: I would ask, again going back to the comments last week on best practices, which is a program and a methodology that I personally endorse . . . . I think it's important that we establish some of those key practices and not only that we ask the regions to do that but also, for our own independent verification, that we have a program. I would look forward to hearing at some time in the future how we're going to do that.

With respect to children, you just mentioned a specific initiative. Would we have within our strategic plan an objective on childhood immunization? Do we know where we are today, and do we have a target?

Hon. P. Priddy: As the member may know, we have a joint responsibility around immunization, but because the health officer reports to me, we certainly have a policy responsibility. Yes, there are markers, and we know that there are parts of the province and parts of cities where we fall well below what I consider to be any kind of acceptable mark for immunization. We know that in aboriginal communities, and

[ Page 10204 ]

we know that in communities where there are high levels of poverty. I mean, people know that children are a particular concern and interest of mine, so it's one of the first questions I asked about, actually.

R. Thorpe: I would like to assure the minister that whatever I and my colleagues can do to assist in that area, we'd be pleased to do it. Children are special to all of us and should be very much a number one priority.

With respect, though, to the fact that you know of some areas of our communities where we have shortcomings and where we're not measuring up to our own goals and perhaps the minister's personal goals, can I therefore conclude that we have a listing by community and that we do know the levels of immunization for children in British Columbia today? Does such a list exist?

Hon. P. Priddy: I'm not sure you could always do it by specific community. You can certainly do it by region, and in some places you can do it by specific community.

R. Thorpe: I don't want to go through and dig all that out. But if the minister could commit to providing that detailed list to me, I would very much appreciate that. Would the minister do that?

Hon. P. Priddy: Absolutely.

R. Thorpe: With respect to expenditure management and funding methodology, I just want to spend a few minutes on this and ask questions. I'm going to use my particular area of British Columbia as the example. When we go through and look at the funding methodology for providing our Okanagan-Similkameen regional health board with $232 million -- I know it's subject to change, but in round figures it's $232 million -- do we use a broad-stroke approach, or do we look at the demographics of the various communities?

Hon. P. Priddy: To allocate new dollars, we do use a population-demographic formula to do that, but not on existing dollars.

R. Thorpe: It's always useful to ask questions, because you never really know what answer you're going to get. I wonder if the minister could explain to me what new dollars are.

Hon. P. Priddy: Any incremental dollars at all.

R. Thorpe: Again using my regional health board . . . . I'm going from sheets that were provided by the ministry dated April 16, 1998, so I'm assuming that, broad-stroke, they're fairly accurate. We went from $230 million to $232 million. Would the $2 million then be subject to an application of new or current demographics? Is that what we're saying? If that is the case, could the minister explain how we go through that?

Hon. P. Priddy: The money in Okanagan-Similkameen as well as the rest of the lift, if you will, for the regions was . . . . Yes, there was a population-demographic formula used for the entire amount of that lift. But people will have considered things like an aging population or communities that have a whole lot of younger children in them and so on.

R. Thorpe: I guess what we're doing here is applying a one-size-fits-all approach to all parts of British Columbia on the base amount. Would that be correct?

Hon. P. Priddy: No, it's not a one-size-fits-all . . . . I mean, the formula is a population-demographic one, but local health authority people look at whether you have more of an aging population in your area or somebody else has . . . . You know, aboriginal communities may have particular demographics that are very different, so those are taken into account on a local health authority basis.

R. Thorpe: But what troubles me, and what I don't understand -- and perhaps the minister can give me some more information to help me understand -- is that if you live in a particular part of the province that has a higher-than-average seniors population, and if the funding is only adjusted on the incremental base, you can never catch up. How are those kinds of inequities ever adjusted? How does that take place?

Hon. P. Priddy: I appreciate the question about how you do catch-up. But all of the increments over the last five years, which are several hundreds of millions of dollars throughout the province, have been based on the needs of a particular area -- on both population and demographics. Over the last five years, those several hundreds of millions of dollars have not been one-size-fits-all, but based on what the particular needs of that health authority are.

R. Thorpe: I thank the minister for that. I'll wait and go into some details in other areas with respect to that when we get to them. I'm just trying to mesh theory with the reality that apparently takes place in my community.

The fact that we're moving to an annual business plan and that in the next few days we're going to have tabled in this House two of the outstanding annual reports . . . . What kind of an ongoing report card to British Columbians are we going to have with respect to the things we're trying to achieve within the health care system in the province?

[4:00]

Hon. P. Priddy: In the first annual report that I will table at the beginning of the session next year, I expect the beginning of that . . . . While it will be an annual report, there will also be something of a report card in it. We will begin with a small number of indicators, but there will be indicators that we will actually have measured and reported out.

R. Thorpe: Do we know at this point in time -- perhaps not all of the items that would be on that report card -- what the ministry believes the key indicators would be for that report card? Could the minister share those with us?

Hon. P. Priddy: I'll just name a few, if I could, for the member. One of them would be simply how healthy British Columbians are, looking at the issues of mortality and morbidity. A second one is looking at the issues of access. Clearly,

[ Page 10205 ]

indicators are around wait times. Another one is looking at issues of appropriateness of service -- for instance, do people have to keep being rehospitalized? That's one of the issues we see around appropriateness. Those are three, anyway, hon. member.

R. Thorpe: I assume that that would be a provincial report card. Has any thought been given to also doing regional report cards?

Hon. P. Priddy: Yes, hon. Chair, and we will be working with the regions to collect that information. So it will be available not only provincially but also regionally.

R. Thorpe: I just want to thank the minister for answering my questions. I look forward to receiving some of the material we talked about. I'll turn it back to my colleague.

S. Hawkins: I thank the member for doing that part as well. I'll be interested in seeing the annual reports. The minister is probably well aware that the auditor general did have some concerns. I believe there was a value-for-money audit done on downsizing Riverview, which I brought up in the House before, and on mental health services. I believe it was the auditor general's feeling that the annual reports didn't always give the information that was needed to assess what the ministry was doing. That was certainly the case in the value-for-money audit that the auditor general had done in mental health.

I hope the ministry's annual reports won't be just a rubber stamp of words but, rather, will give us some detail on the programs and on the progress that the ministry has made over the last several years.

I should mention at this time, too, as I've mentioned before, that it is disappointing to not have those reports. This House holds the government accountable for the programs, the services and the quality of health care that patients and people in this province receive. When we don't have that kind of information . . . . Frankly, I can tell you that I'm disappointed. I've written to the minister and asked for all kinds of reports, and I've gotten nothing. We could have saved a lot of time so far in these estimates, on the kinds of questions that the member for Okanagan-Penticton had to ask, if we had indeed received some of the information that was asked for from the minister.

But we'll plow ahead. We want to go on now to some regional health issues. I believe the member for Surrey-White Rock has some concerns that he wishes to raise.

Hon. P. Priddy: I'm happy to go on to that, if the member likes. Our communications staff is here. If the member wants to return to the communications questions, we can do that.

S. Hawkins: I think I started off asking . . . . Yes, I will deal with the communications stuff, if the staff is here. I want to know what the communications budget is for the Ministry of Health and how much of that is allocated to advertising.

Hon. P. Priddy: The communications budget is $3.6 million. The advertising part of that is $2.1 million.

S. Hawkins: I'm sorry; I had trouble hearing. I thought I heard $2.6 million and then $2.1 million. Is that correct?

[E. Gillespie in the chair.]

Hon. P. Priddy: The total communications budget is $3.6 million. The advertising portion of that is $2.1 million.

S. Hawkins: Can the minister tell us what different areas the communications . . . ? I guess there's $1.5 million in communications. What does that cover, as far as Health ministry communications?

Hon. P. Priddy: The total is $3.6 million, just so I can be clear. The $2.1 million is . . . . I didn't know if I heard the member say $5 million. The total is $3.6 million.

Let me give you some examples of that. Tobacco public awareness would fall into that category. Our work on the information around organ donors and organ donor cards is part of that. Part of that was the hepatitis C look back, where we had to put out public information and advertise for people. Those are some examples of what would fall within that category.

S. Hawkins: I appreciate that. What I was asking was . . . . If the advertising is $2.1 million, and there's $1.5 million left in the communications budget, how is that allocated? How many staff and what kinds of value are we getting for that money?

Hon. P. Priddy: Of the remaining budget, $1.209 million of that is staff salary and benefits. That is 21 FTEs.

S. Hawkins: For the advertising part of the budget, what guidelines or policies are in place to guide the ministry in what kinds of advertising they do?

Hon. P. Priddy: If you will, the principles that underlie that are around public education and awareness. That's why, around the advertising, I gave some of the earlier examples of the tobacco reduction strategy, organ donors and hepatitis C.

S. Hawkins: What is the ministry's policy, then, on negative advertising?

Hon. P. Priddy: Perhaps the member could give me an example of negative advertising.

S. Hawkins: I would certainly like to do that. I hope the minister is aware that we hear a lot of concerns about the ministry spending money on advertising, and we learn it's now $2.1 million in the new budget year. A lot of patients call and write to me, and I have seen editorials in the paper, with respect to ministry advertising -- and certainly with respect to all ministry advertising. They say: "Spend that money" -- especially from the Ministry of Health -- "on health care and not on ads." It's one thing to say that there are public service and public awareness ads, which is fine. I agree with that too.

I think organ donor ads are great, because we know what kind of concerns there are about the lack of donors. So getting that message out is great.

But you know, when I see ads and certainly whenever the ministry does do ads with respect to, well, issues that perhaps are better left to interviews rather than ads . . . . I'm thinking back, and I have ads in front of me on the doctors' dispute with the ministry. You know, I've got this ad: "Health funding will increase $228 million in B.C. this year. The dispute with the B.C. Medical Association is over doctors' incomes, not health care funding." I'm wondering what kind of a public service or public awareness that is. The minister has the chance to do interviews.

We've seen the increase in public funding for health care in the papers and stuff. Frankly, when patients are waiting on waiting lists and are concerned about

[ Page 10206 ]

not getting treatments or tests or surgery when they need it, I think that when they look at the kind of budgets the ministry has for advertising, they want to make sure that they get the best bang for the taxpayer buck.

I recall the auditor general's report with respect to ministry advertising. He estimates that the government spends $2-3 million a month -- perhaps $25 million. That's just an estimate -- I'm sure it's probably well above that; that's what the auditor general is estimating -- with very little accountability for where that money is going. Couldn't that money be better spent?

What I'm saying to the minister is that I do get letters telling me to talk to the minister about this -- that the money should be better spent on patient services and patient treatment, rather than self-serving advertising by the ministry or negative advertising that doesn't serve anybody. I want the minister to comment on that.

Hon. P. Priddy: I think the things that I read out to the member a moment ago make up the largest total by far -- almost 90, 95 or 100 percent of the advertising budget.

On the advertisements that the member refers to, while I also get calls and letters -- I may get the kind the member gets, but I get different ones as well . . . . When the public is frightened by what they hear about what's happening in the medical system, they certainly have the right to make their own judgment about that, but we have a responsibility to also provide accurate information. Yes, the minister could do interviews, but I would suggest that it is probably not the most watched or best way necessarily to get information out to the broadest range of people.

The public does have the right to have accurate information about their health care system in order to make their own determination about the state of it.

S. Hawkins: The one thing we can agree on is that the public does have the right to accurate information. That's why it's sometimes misleading to see some of the ads that the ministry puts out, because I think they're just as one-sided as the ads that the other side puts out. Again, I don't know if it's the best use of health care dollars to do the kind of negative advertising in which the ministries, and certainly this ministry, engaged themselves.

[4:15]

When the minister talks about accurate information as a right for patients, I can think back to some of the reports that have come out of the Ministry of Health. Certainly one of them was the waiting-list report that came out last November, and that one was not received very well at all. In fact, the minister may recall that it was received by many as a cruel hoax, saying that the ministry's numbers were not correct, because patients certainly didn't have the experience of waiting the waiting periods that the ministry was saying they were waiting. In fact, they were much longer.

So we would hope that the ministry is providing accurate information when they are providing information to the public. But we can only hope, because in the past we haven't always seen that.

Again, as far as the ministry guidelines are concerned, public education and public awareness are two good goals to have. But I would suggest that . . . . Gosh, I don't know how to say this in a polite way. I'll have to think about it for a minute. But I don't think that fighting wars through the paper is the way to go. I mean, if the ministry is doing a good job of providing health care services across the province, they don't need to advertise. Patients will know that the ministry is doing a good job. Patients will know that they're getting the treatment they need when they need it.

Patients will know that they don't have to wait a long time. Patients will know that they won't be denied services. You don't have to advertise that you're doing a great job and putting this much more into funding and everything's okay now because you've got these wonderful ads in the paper, when we know that patients are being denied services in different parts of the province. Waiting lists are the longest for orthopedic surgery, for example, for patients in the north. We know that, and no matter what advertising the minister does, that's not going to change.

Some of the budget . . . . I can tell you, $2.1 million is a lot of money. It's a lot of money to me, and I'm sure that if you asked any patient, that is a heck of a lot of money. I think it's disgraceful to do advertising like what we've seen in the last few months for a budget of $2.1 million. When we see ads like that, that's when we get patients phoning us and writing us, telling us: "At a time when we have to wait long periods of time and endure bed closures and see health care in our regions screaming for, say, long term care beds, why is this happening?

Why is the ministry engaging in advertising like this?" So I bring that to the minister's attention, and I hope . . . . Obviously we're monitoring that. Over the next year we'll see if public education and public awareness are actually the two goals that are being followed when the ministry advertises.

At this time, unless the minister wants to comment, I will turn the floor over to the member for Surrey-White Rock.

G. Hogg: Well, appreciating that this year's estimates are to some degree based on the financial actuals of last year and recognizing that there are 52 health authorities in the province, I'd be interested in finding out if there is some estimate with respect to how many of those authorities came in on budget and how many were over budget in '97-98.

Hon. P. Priddy: The great majority of those 52 came in either on budget or with a small surplus. Some came in with a deficit. It's information that I'm not sure we have with us, but we'll get it to the member. But the majority came in on budget or with a surplus.

G. Hogg: I'd be most interested in finding out perhaps the five that had the greatest overexpenditure, that were the furthest over budget, and the areas that they were in if that's at all possible. Secondly, with respect to those that did have the shortfalls, how were the shortfalls accounted for or taken care of?

Hon. P. Priddy: We don't, as a matter of practice, fund deficit budgets. There is the odd case where people make a legitimate argument for the reason that they have been over budget for that year, in which case they can do one of two things. Many health authorities, although not all, will have a working capital, if you will. So it's money they have on reserve. They can either use that or include it in their next year's budget, but they're still expected to manage it.

G. Hogg: With respect to Surrey Memorial Hospital, which I think has been carrying about a $5.8 million deficit for a number of years, I wonder whether it is written off or whether it starts to accumulate -- how in fact its deficit is managed.

Hon. P. Priddy: While we are talking about health authority budgets, this is an individual facility, so it's up to that health authority how it manages that within its budget. But

[ Page 10207 ]

we have assisted Surrey Memorial Hospital in the past. Just so we have the correct numbers, while the hospital did project a deficit of $5.8 million for the 1997-98 fiscal year, it was actually later reduced to $2.3 million. As of March 31, 1998, the hospital reported an actual surplus of $514,000 due to the infusion of one-time funds.

G. Hogg: Do we have the amount of the infusion of one-time funds? How much was infused to turn the deficit into a surplus?

Hon. P. Priddy: We will have to check that. We don't have with us facility-by-facility . . . . My staff will get it and give it to the member.

G. Hogg: Perhaps when searching that, they can also look at . . . . It's my understanding that Surrey Memorial has been carrying a deficit for a number of years. In my time on the regional health board, I was aware of the deficits that Surrey Memorial was carrying. In many cases, there were one-time infusions. I wonder whether or not the base that will go to the authority will allow the base for Surrey Memorial to be brought up. Or will they continually be in a position of seeking one-time infusions year after year in order to get to the position where they can function within the framework provided?

Hon. P. Priddy: We have not done that to date, but the budgets are still coming in. We still have a few budgets to come. When those budgets are assessed, I will take that into consideration.

G. Hogg: I appreciate that you don't have the details and specifics, but I want to ask a couple of those and perhaps get the information at another point in time.

I know that the issue of severances for CEOs has been canvassed and discussed previously. With respect to the hospital in Surrey-White Rock, Peace Arch District Hospital, there were also a number of persons who left the employ of the hospital who were not CEOs but were at other director levels. I wonder if we can find some details with respect to the severance packages that were provided for those and how in fact those were funded.

Hon. P. Priddy: Yes, we will get that information for the member. My staff has made a note of it. Secondly, I think those were primarily administrative positions that were eliminated. Nevertheless, as a result, there are savings to the health care system as well. We'll get the member the specific information.

G. Hogg: With respect to capital purchases which may occur in any of the specific hospitals . . . . If I can, I'll use Peace Arch District Hospital as a reference point, which has a very active foundation and a very active auxiliary, which has been able to do very well with respect to their fundraising. Are there some limitations with respect to any of the capital purchases that this hospital may choose to make? Do they have to have some type of approval for those and for the operating costs through the regional board? What type of latitude does a foundation have in terms of making capital purchases for a specific area or a specific hospital?

Hon. P. Priddy: Certainly a foundation can buy any equipment that it chooses to buy. But if there are operating costs attached, then there must be some support and approval from the health authority to be able to operate it. So if there are operating costs attached, they must have worked with the health authority to get that agreement ahead of time.

G. Hogg: With respect, then, you're saying that a foundation is free to go ahead and make the capital purchases it chooses. However, if those are encumbered by some operating costs, then there would have to be approval from the regional board to allow the operating costs to be paid. If in fact the independence that is allowed for the capital purchase is . . . . If they are able to also provide funding for the operating costs for set periods of time, would that allow them to accommodate that type of process as well?

Hon. P. Priddy: While there may be exceptions -- which I can't think of -- for the most part that would not be the case. While a hospital foundation may believe that it has the money to operate it indefinitely, our experience is that that's not very likely to be the case. At some stage, then, if the foundation were unable to provide the operating costs for whatever financial reasons, people would certainly expect the ministry to be able to pick that up. So our general position is not to get into supporting capital if people say: "Oh, we can provide the operating money for it."

G. Hogg: With respect to areas such as South Surrey-White Rock where we have large population growth taking place, there's been some discussion over the past number of years with respect to funding formulas and allocations of resources based on some type of growth formula in order to ensure that the inequities of growth are starting to be managed and dealt with. Can the minister provide us with any further information with respect to how those formulas might be progressing, what their status is and what we're looking at in terms of that?

[4:30]

Hon. P. Priddy: I think the member may have heard my earlier comments that all increments over the last five years, which are hundreds of millions of dollars, have been allocated based on both population and demographics. People have also looked at a funding methodology or a funding formula that would look at those issues across the province. If you took the entire pie, if you will, or pot of dollars and divided it up based totally on population and demographics, that is possible to do. We're still looking at the funding formula.

But I think it's always important to remember -- and I have experience in this from education -- that when you do that, there are always people and health authorities that would have less money then they currently have, and that's not always an easy issue to deal with.

G. Wilson: My question to the minister . . . . If I can get the minister to visualize Texada Island for a moment, which is right across from Powell River and separated by a ferry ride, it is currently trying to resolve a situation with respect to the maintenance of their clinic. The minister will be aware, I think, that we have worked a long way toward getting resolution to financial arrangements for a physician; I think we're very close to having things wrapped up. Of course, this is a community that would very much like to make sure that the medical services provided for their community are maintained.

However, it seems there is an unresolved matter, and I think it has to do with the ongoing operation of the clinic itself -- that is, the cost of the clinic itself. We've run into a difficult situation, where it would appear the ministry's position is that these rural clinics are going to have to be picked up out of the general costs of the CHC -- or RHB in this case. Those costs are going to have to be borne out of a general budget, and yet there was nothing provided for that clinic in that original budget.

[ Page 10208 ]

I'm wondering if the minister might tell me whether that is the general approach the government's taking or whether the ministry recognizes that there is an obvious need for the maintenance of this clinic. We have a physician from New Brunswick who is prepared to sign on and come out and work in that clinic, but clearly we can't run it without some kind of money for nursing, ongoing maintenance and operating the capital plant itself.

Hon. P. Priddy: As the member knows, we have reached an arrangement around the alternative plan, and we have reached some agreement about funding nursing for the health clinic as well. I think the member's correct: we've made a fair bit of progress toward resolving this. I don't have an immediate answer for the member. In many cases, the work in the community clinic is funded by the physician as part of the practice. This is a somewhat different circumstance. We don't say to community clinics that they you have to fund it all, because it normally works in a different kind of way.

So while we have agreed to the physician's salary and the nursing service, my understanding of it -- and I haven't had this conversation with the member except a bit in writing -- is that the community clinic seems to see itself as needing an additional amount of dollars in order to cover the operating costs of the clinic. This is actually one of the better-funded clinics that we have this kind of arrangement with, but I'm still committed to working with the member to see if we can get resolution to this.

G. Wilson: I'm delighted to hear that. I don't think that Texada is the only place in the province that has this kind of problem. It's a problem we perhaps need to try to draft some basic guidelines or policy on in order for us to try and overcome in the long term what the community sees as an inequality between the services provided to the larger centres and those that are provided to rural ones separated by lack of transportation or, as in this case, by Malaspina Strait, which is crossed by the ferry.

For the last number of years, as the minister is aware, the islanders themselves have subsidized that clinic to the tune of about $45,000 a year. I understand that with the report coming out of the work with the northern doctors, there's a $20,000 potential nursing subsidy, which means we're really looking at a rather minuscule amount of money in the scheme of things. If we're looking at something in the neighbourhood of $25,000 in the larger scheme of government expenditures on health care, I think the minister would recognize that to be a relatively small amount of money.

Yet to the people of Texada, it makes the difference of being able to actually get a physician there, have that clinic operate on a long-term basis and provide security and stability to that community. So I am pleased to hear that the minister would be prepared to continue to work on this. It strikes me that there must be some way for us to get our heads together to be able to find that outstanding $25,000.

The difficulty is that we're running into some time problems here, because in order for offers to be acted on and contracts to be signed and so on . . . . We're running into a bit of a time crunch. I wonder if the minister might tell me if she has ideas as to how we might proceed on that outstanding $25,000.

Hon. P. Priddy: I don't have a particular solution currently. What I need to check on -- and I'm sure the member knows more about it; it's his community -- is what position the health authority has taken on this. I appreciate the time frame you're working under, and I'll direct my staff to work very quickly with you on this.

G. Wilson: I'm very pleased with what I'm hearing. I know the health authority is certainly 100 percent on board. We've worked very closely together.

I would like to say, just for the record, how much I've appreciated the work that has been done with Ministry of Health staff on this question, because this is an anomaly -- there's no question -- and it is something that is going to require a certain amount of ongoing attention.

If I could just draw the minister's attention to two other items with respect to Texada, then, the other is the matter of in-home care. We run into a difficult problem in the rural area when we have clinic facilities there and people who require ongoing treatment because they're seniors, they're retired, and they therefore need to have ongoing care. Texada is again in a unique situation in the sense that people cannot ordinarily travel for those services, and it's hard to get people to come to the island for the provision of those services unless they reside on the island.

I wonder if I might get some comment from the minister with respect to how we deal with these anomalous situations in isolated communities, especially coastal communities, where the provision of those services becomes more expensive by virtue of needing to put people into that position -- therefore they have to live there -- even though the amount of time that they would ordinarily spend would be the same as if they were in a larger community. In other words, there's an associated cost of having to reside in that area.

Hon. P. Priddy: It's hard for very small communities, and the member knows that. In this case, it's an isolated area that may not need full-time staff, but there doesn't seem to be any other way to get people there. I don't have any magic or immediate answers for this. I don't know if the regional health care team that is responsible for your area has been doing some work on this or not. If they have not, I will direct the staff to do that. You're right; it works very differently in different communities. If it's home support, sometimes the person will choose to live in a smaller community.

If it's home nursing, then the community probably isn't big enough to support someone to do that. I mean, it is really difficult, and you'll find different answers for different communities. If it's of any help to the member, I'll direct the regional team in your area to work with you on this.

G. Wilson: That would be excellent. I'd certainly offer my office as a way of trying to set up meetings, if that's needed. It may not be. I'm sure we have a very active team with respect to the health authority in Powell River and a very progressive group.

The minister did touch on the other part of the question, and that was on home nursing. I was also talking about home support. The home nursing situation in a rural community like Texada is extremely difficult, because it is a relatively small community. There are two primary settlements, I guess you would say: Vananda, as you come off the ferry . . . . I don't know if the minister has ever been to Texada, but if the minister hasn't, I would suggest that it might be an excellent place to go this summer. There's a wonderful little campsite with a very nice little beach, and there are no phones. You can get away; it's perfect.

Having said that, there is Vananda and then there is Gillies Bay, each one on opposite ends of the island. Those are the two primary centres. Many people in the rural community outside of those live even further afield. So it does become extremely difficult when you need home nursing because of

[ Page 10209 ]

(

a) the small population, and (

b) the dispersal of that population and how people are able to get to and from those services. Yet it becomes enormously disruptive to a retired couple who live there to have one uprooted and moved. It becomes a very, very difficult problem.

I do appreciate the minister's suggestion that she would send a team there. I would like to thank her, and I look forward to working with the ministry to make sure the community of Texada is properly served. I'd also like to thank the member for Okanagan West for the opportunity to raise these issues.

[4:45]

S. Hawkins: At this time I'm wondering if I can have a discussion with the minister over an issue I should have raised a little bit earlier when we were talking about advertising. Again, it's with respect to the relationship of the Ministry of Health with the physicians in this province. What I've seen and what patients have seen over the last few months and in the last year is quite disturbing. I talked about this war with the advertising, and I see a war of words. My assistant has just brought me an

article from a week or so ago: "Doctors Plan Media Fight Over Health Funding in B.C."

I don't think it serves patients in the province well for the government and the physicians to be having this kind of war. I think the minister would agree with me that it's not a great situation right now, at a time when we know that there are problems in health care and that we all need to work together. I think working together should be the key here. But we see this huge division and this rift forming between the Ministry of Health -- the government -- and the physicians in the province. I can tell you that it's not a healthy situation.

This is an issue that I get a lot of correspondence on. When the ad wars started happening, I got even more. In the last few months we've seen the rural and northern health crises, and part of the issue there was the availability of physicians in the province -- and certainly physicians in rural areas. Frankly, patients are concerned when the ministry and the doctors have, very publicly, the kinds of media fights and the kinds of stories that we've been seeing in the last six months or year. Patients are concerned. They think that the ministry should be working with health care providers.

I'm wondering if the minister can brief us on the ministry's and government's position with respect to working with the physicians to get some kind of resolve and some kind of healthy working relationship, instead of the war of words we've been seeing in the last year.

Hon. P. Priddy: I think the member is correct. Any such public discourse causes patients to worry. I would suggest that there has probably been a lot of public discourse, and if there's a war, it means there are two parties involved.

My personal commitment, since I have been here . . . . By the way, I think we need to be clear about this. I meet with physicians all the time from all kinds of different specialities -- individuals, my own physician. I don't think it's about individual physicians or a group of physicians. If we were to be frank, the public discourse has been between the organization that represents physicians, the public and perhaps the ministry or the government. I do want to reinforce that my individual contacts with individual physicians or groups of physicians have actually been quite positive.

I met early on with the BCMA. I think people know that my particular style is to work with people, wherever that's possible, to acknowledge where we have common ground. My last conversation with the current president of BCMA -- who I met with right after his election or appointment, whatever the process was -- was about ways we could move forward. We agreed that we might disagree on some areas but that we would move forward in a positive way and find opportunities to work together wherever we could. They actually offered specific examples of where they would be pleased to support the government on some current initiatives.

I think this is something we see across the country in all provinces. It means that everybody involved -- whether it's people in government, people in opposition, individuals physicians, the organization that represents physicians or the patients themselves -- has a responsibility to make sure that that relationship goes forward as well as it can. Will we disagree? I expect we will, but I think we can disagree in ways that are not harmful to the health care system and do not induce fear in patients.

S. Hawkins: I think what's happening is that we are seeing some harm to the health care system. Because of the disposition of the physicians and the relationship between them and the ministry, we see these RAD days starting, reduced activity days. I can tell you very clearly that I'm not a supporter of those. I'm not a supporter of anything that denies health care to patients. This is one issue that certainly does that, and I think that is a result of the ministry and the physicians' group not coming to agreement or not finding resolve for those kinds of issues.

The minister says that it's not individual doctors and it's not groups of doctors; it's the BCMA. Well, the BCMA is made up of those individuals and groups of doctors. From what I understand, those physicians are more united across the province than they've ever been, so the minister has to be talking about the majority of physicians in the province when she talks about the BCMA.

I am not happy to see that relationship. The minister tells us that she meets with the doctors and that she wants to work with them. I think that more than once in question period, when I have posed questions to the minister, there have been very accusatory types of comments, in my perception, coming from the minister and the government. I don't think that kind of discourse is healthy for patients, for health care workers or for front-line workers across the province.

Frankly, in reality we are experiencing a brain drain in Canada. We know that physicians are very mobile. I fear -- and patients fear -- that a lot of these workers will vote with their feet and walk out of the province. Certainly we have seen that over the last five months in the dispute with the northern doctors. We see towns in northern and rural B.C. that are now depleted of physicians. I don't think it's healthy to have that kind of relationship. Frankly, when I see an

article like this that says, "Doctors Plan Media Fight Over Health Funding in B.C.," I wonder what measures the minister is taking to work on these issues so that we don't have to see this war, which will apparently escalate later this summer and into the fall.

I also have to wonder . . . . If the physicians are planning a media war, which I think is what they're saying here, is the ministry going to match that dollar for dollar too? That's what we have been seeing, and I don't think that is good use of health care dollars. I've said that before. We've seen a group put in an ad; then the ministry puts in an ad. The ministry's ads, unfortunately, come from our tax dollars -- dollars that should be spent on patient services. The physicians' money, I

[ Page 10210 ]

understand, comes from money they have raised themselves, in their group -- from the union dues or the BCMA dues that they put on.

Interjection.

S. Hawkins: The member for Bulkley Valley-Stikine finally raises his voice. In his part of northern B.C., I can tell you that there are serious health issues and serious issues with respect to physician recruitment. I wish he would stand up, for a change, and speak for patients in that part of the province. I haven't seen him do that once this session -- not once this session. What I am saying is: stand up and stick up for those patients; stand up and stick up for those physicians in your area, who want working conditions . . . . They want to work with this government.

This minister says that the head of the BCMA wants to work with her. Is the minister going to take steps -- and what steps is she going to take -- to work with the physicians so we don't see this media fight and we don't see the ministry match, dollar for dollar, the media campaign that the physicians are going to start later this fall?

Hon. P. Priddy: I don't think it's particularly useful for patients or health care in the province to have physicians involved in a million-dollar campaign that I think will simply instil more fear and anxiety in patients. That's what the member has said, as well, and I agree with her. I would certainly call on . . . . I guess I would ask physicians to rethink a particular strategy that spends $1 million doing that.

Yes, the president of the BCMA did say he wanted to work with us, as I indicated I wanted to work with him. We have found at least a couple of ways to do that. If the member is asking, as I believe she is, what I can do, as the minister, to prevent this million-dollar media war campaign by the BCMA, I'm not sure what I can do. If the answer is that you write a cheque, then I'm not particularly in the position to be able to do that.

I've stated this before: this is the only province in the country that has had a health care budget increase for each of seven years. It's the only place in the country. We have the most number of physicians per capita, and we fund the largest health care cost per capita in the country. Do we have areas of concern? Yes. I think that some of those can be worked out with physicians. Some may require resources, but what I've heard so far from the organization involved . . . .

For me to be able to get them not to do that, which would be to fulfil all the issues they have, is simply not financially possible at this time. I'm not even sure if all of it would necessarily be in the best interest of the overall health care system in the province. But they have raised some issues that I think are important and that we will continue to work on together.

S. Hawkins: Is the minister concerned at all that physicians will leave the province, leave rural areas where patients need that kind of medical care, because of the so-called war between the ministry and the physicians?

Hon. P. Priddy: I would always be concerned if there were physicians either leaving rural or remote areas or leaving the province. The actual numbers -- the most recent numbers, and they are quite current -- would suggest two things. One is that we have more physicians who have come into the province in the last five years than have left the province. In point of fact, in British Columbia the population per physician is 510, and the national average is 545. We do have more physicians per capita than the national average -- than any place in the country.

I'm concerned when any one physician makes a decision to take her or his skills either outside the province or outside the community they're currently practising in, but it is their choice to do that.

S. Hawkins: You're absolutely right: that's their choice to make. A lot of them have walked. We know -- from the facts that I have, and I've said it several times -- that as of May there were 86 fewer physicians in rural areas than four years ago. We know that from January to the end of May, at least another eight physicians left rural areas as a result of the crisis. I don't think it's helpful to have the kind of relationship that the ministry has with the physicians. The minister says that it's just over funding and those kinds of issues.

I think it goes deeper than that; I think there is a lot of rhetoric -- perhaps on both sides -- and there is a perception on both sides that the other is the enemy. I don't understand that. I've heard the minister stand in this House and really put down this group of people. I really don't understand that.

I'll tell you that what I hear from physicians -- and certainly from patients -- is that there is a really negative response to the ministry on this kind of discourse. When the minister says that she and her government are doing everything they can . . . . I recall a meeting -- in April or May, I believe -- of the BCMA. Not one NDP member came to that meeting the physicians held here. That is absolutely not helpful. They brought their membership here -- 75 of them -- to meet with a matching MLA, and to have not one NDP MLA or the minister attend that meeting . . . . That is the kind of action that's going to create a deeper rift.

[5:00]

I don't think patients deserve that. Patients want to make sure that the government is working in their best interest, and if the government works in their best interest, they do that by getting along with the groups that serve patients. I don't think the ministry is doing a service. I think the ministry is doing a disservice by responding to ads that the physicians put in. Gosh, I don't know if I've heard this a hundred times: "If there were adults on both sides of the table, maybe we'd resolve this issue." I think both sides have to take the blame. Sometimes one or the other has to take the higher ground and reach out and see if there is a way of working through these very serious issues.

I think the minister can agree that there are very challenging issues in health care. Physicians are just as interested in helping resolve some of those as the ministry and the members in the opposition are. Frankly, when we meet with the physicians, there are certainly areas that can be worked on. It's not unreasonable to expect our health care leaders and the Ministry of Health to reach out to these people and see if there's something that can be done.

Again, I am very concerned about these RADs, reduced activity days, and their impact on patients and patient care and waiting lists. I think it's not getting better; it's getting worse. The longer the ministry lets this feud go on . . . . I think the minister should take a lesson from what happened up north. For five months patients were without service in their own communities. I don't think that was a proper way to deal with the issue, and we'll get into that when we talk about the rural northern health care crisis.

I guess I have to ask the minister what her plan is then, because it sounds like maybe she's waiting for the doctors to take the first step and back away from their media fight. I think both sides have drawn

[ Page 10211 ]

their lines in the sand, and I think it's probably going to play out. If doctors are planning a media fight, I'm wondering if the ministry is planning to match it dollar for dollar on advertising.

Hon. P. Priddy: Hon. Chair, if people are going to speak of rural health care later, I won't respond to those points now. I'll wait until the appropriate time.

I agree that health care leaders have a responsibility, and that includes all health care leaders. I have never expected the BCMA to "take the first step," which is why I met with the president of the BCMA almost immediately after I became minister. I have met with the current president as well.

There are clear areas of disagreement, and we're not sitting back simply waiting to see what physicians do. That's why we have done things like put $9 million more into cardiac surgery and procedures. Cardiac surgeons have said that's a huge issue for them; that's why we've put $8.5 million into that. That's not sitting back and waiting; that's addressing one of the really important issues that they've raised.

They raised the issue, as well, about orthopedic surgery, and that's why we've struck exactly the same kind of review panel for orthopedic surgery as we did for cardiac care, with the kind of outcome we've seen with cardiac care, which was $8.5 million. So we are taking action on a number of issues that are of concern to the physicians and which the BCMA has stated are concerns to them. We've taken some action, as well, on some of the continuing medical education issues that people have raised. We're certainly not sitting back waiting for the BCMA to either change its mind or do whatever.

We're working on the issues that we're able to, and we're moving them forward as quickly as we can.

I think if you were to ask the physicians in the north, regardless of whether they're in urban or rural areas -- and regardless of whether or not everybody is totally pleased with the Dobbin report -- those physicians would tell you that they have had incredibly open access to the staff in my office and to me. So I am quite willing to work with physicians.

S. Hawkins: I didn't hear an answer to my question, but I'll try . . . . I just want to respond to something the minister said. That was with respect to putting $8.5 million into cardiac surgery. I wonder who the minister or the ministry officials talk to when they make a decision like that. I understand that it was done but that there was no matching budget for the anaesthetists. So if there's going to be extra surgery done . . . . Apparently there wasn't budgeting for the anaesthetists' time within this waiting-list time. There seems to be a lot of things the ministry wants to do and is trying to do.

But what I'm saying is: talk to the groups that are actually going to be doing the surgery, the procedures, and managing those waiting lists and work with them.

Here's another issue -- that is, the whole waiting list issue. The ministry put out their report in November. The BCMA and a lot of patients, I have to tell you, didn't believe the ministry. BCMA did their own report and released that in February or March, I believe it was, and there was a huge disparity between the numbers. They were almost double the waiting-list times that the ministry and the BCMA gave. When I spoke to the physicians and asked, "How can we fix this?" they told me that they have been trying to sit down with the ministry to actually get the ministry's numbers.

The ministry has access to wait times through data in hospitals and in ministry offices. What is stopping the ministry from working with the physicians on the waiting-list issue?

It's nice to make this huge, wonderful announcement about $8.5 million more for cardiac surgery, but it's discouraging when we hear the next day that the anaesthetists aren't going to participate because there is no funding to match the time that they're going to spend on these extra surgeries. I have to wonder if the ministry is thinking that through. Or is the $8.5 million for both the cardiac surgery and the anaesthetists, so it's actually fewer procedures than the ministry is announcing? I'm hoping for the ministry to forge a better relationship with this group.

They are a group that has a huge influence on our health care system. The ministry knows that, and patients know that. It's not helpful not to work with them.

I heard Granger Avery, past president of the BCMA, tell the minister -- and he certainly told me -- that he is willing to work with the minister on the waiting-list issue. They have absolutely no access to data through the ministry -- none. So, again, these are the people who are managing the wait-lists, and I don't think we're doing a great job on wait-lists. Unless we start working together, we're not going to get there.

The question I asked the minister last time, before I sat down, was: if there is going to be this big media fight, is the ministry's plan to match dollar for dollar the media war that the doctors are going to start? And where is this money going to come from?

Hon. P. Priddy: Since we haven't even seen a media war -- just some stories about it -- I don't think I'm going to speculate on what the ministry will or won't do if that occurs.

I do want to correct some information, though, if I might. The number of procedures announced, at the time the $8.5 million was announced, was correct. What was incorrect was that there was no money in there for anaesthetists. There is indeed money in there to fund anaesthetists. The anaesthetists have refused to provide those surgeries because of another disagreement they have. We're negotiating with them and hope to have that sorted out quite soon. But there was money for anaesthetists budgeted in that $8.5 million.

S. Hawkins: I will be watching. Unless the ministry and the physicians sit down this summer and work something out, from what I understand and certainly from what the physicians have been telling the media, there is going to be an escalation in their media fight with the government. I want to tell you very clearly that I think it's wrongheaded for the ministry to be spouting the kind of rhetoric -- from the minister, from the Premier and certainly from members opposite -- that alienates this group.

Like I said before, it is a group that does have quite a bit of influence -- certainly enough influence to get their members to take reduced activity days, which will affect patient care. It has already affected OR times and waiting lists, and it has impacted on hospital emergencies. I don't think that's in the best interests of patients, and I hope the minister agrees with me.

I will be watching to see what happens in the next few months. I certainly will be watching to see how the ministry responds, because in the past -- and I always look at past performance for future indications -- the ministry has been matching the ads. Frankly, I don't think that's a good use of health care dollars, and patients don't think so either.

At this time, I want to go back to regional budgets. I'll start with the Okanagan-Similkameen. I think the member for Okanagan-Penticton did touch on that a bit, and the member for Surrey-White Rock did speak to the minister about some of the budget shortfalls in the different regions. I understand that the Okanagan-Similkameen region has about a $2 million deficit. In order to meet that deficit . . . .

Actually, the CEO wrote a letter to the member for Okanagan-Penticton, which he shared with me. I know that

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the ministry requires the regions to put forward a balanced budget. I understand that within the next year our region will have to absorb that $2 million deficit, and some of it has been absorbed through a surplus that was sitting at Kelowna General Hospital. The CEO has advised the member for Okanagan-Penticton in this letter that he expects the facilities to live within their approved budget, and frankly, it's not a nice picture. He wrote in his letter of March 4, 1998: "The financial picture for next year looks relatively bleak." It's not the kind of encouraging letter you hope to get.

He says, as well: "I have put all staff in the region on notice that it is our expectation that we will balance the budget in the next fiscal year. I am very sensitive to the fact that due to a lack of community resources, additional pressures are being placed on our acute care facilities which should more appropriately be addressed on the community side."

I know -- and the minister knows -- that there are huge concerns about the impact on acute care. We've seen bed closures. At least, in my community we've seen huge bed closures at the Kelowna General Hospital. It's almost laughable hearing the last minister stand up and say that there have been no bed closures and that some of the summer closures are normal closures. But I can tell you that every year I've lived in Kelowna, there have been bed closures at our hospital. We've got fewer beds than we did five years ago. We're seeing that over and over again.

We've got the longest wait-list in the province for long-term care. I know the ministry came through with 60 more funded beds, but there is still a huge need.

There was a story in our paper about two months ago, and the headline reads: "Cash Cure Needed -- Health Region Says It Needs Extra $7 Million." "The Okanagan-Similkameen health region needs a funding increase of $7 million this year if it is to maintain services at current levels . . . . " That's not very encouraging, either, because that tells me that in order for the region to balance their budget and provide services at current levels, they need to find savings somewhere. Hopefully, it won't be through patient care, but I'm afraid some of it is going to be patient care services.

They need another $7 million just to maintain services. That is quite a concern, I guess. The chair of the board, Pendharkar, said: "Part of the problem is that hospitals have been forced to care for extra patients, because there are precious few beds available in long term care facilities." We've known that and have raised that issue in the last few years in this Legislature. Again, the ministry did come through with funding for long term care beds. But we know that this need is still there; we know it's a huge need. I wonder if the minister would comment.

[5:15]

Again, I look at the bulletins that the regional health board puts out. One says: "Regional Budget Issues -- A Financial Crisis." Again, it is a concern to patients and to people who are working in the area. I've gone through some of the letters that have come from front-line workers in the region. They're very concerned. Nurses are concerned about cutbacks to nursing. We know that there are cutbacks in OR time. I understand that they're hoping to blitz some of the OR waiting lists at some time, but again it's all a matter of whether they can actually do it within the funding required.

When I talk about Kelowna General Hospital, I guess the other thing is that we have a new cancer centre there. Apparently there was a study done, and the cancer centre is going to impact a lot more on the hospital than was initially thought. Again, we are grateful for the cancer centre, because that means patients can be treated closer to home. But the cancer centre is going to draw a lot of resources from the hospital. I want to know what the minister's thoughts are on how this region in particular is managing with a $2 million deficit. They say they need $7 million more.

We've got the longest long term care wait-list in the province -- I believe there are 200 on the list -- and a regional health board that tells us we're in a financial crisis.

The Chair: Member, would you like to repeat your question?

S. Hawkins: I want the minister to comment on the situation in this region, where they're facing a $2 million deficit. They're asking for $7 million more just to maintain services at the current level. We have a regional health board that tells us we're in a financial crisis, and I know that we're not the only regional health board in the province saying that. We've got the longest long term care waiting list in the province; I believe there are 200 people waiting. It impacts on our hospitals, on our nursing services in the community -- on a lot of patient care. I want the minister to comment on that situation.

Hon. P. Priddy: I am aware that this board has submitted, I think, a $2.2 million or $2.3 million projected deficit. The health authority budgets are only just in -- well, most of them are in; we still have a few to go. The ministry will go through those budgets, make an assessment about those budgets and work with people, wherever it might be possible, around some of the pressures they've identified. The $7 million may be a projection of what people need to do or feel they wish to do, but the projected deficit is $2.2 million or $2.3 million. When all of our budgets are reviewed, we'll work with the regions on whatever pressure points we're able to.

B. Barisoff: I've just a few questions along the same line as my colleague from Okanagan West. The funding for long term care services in the Okanagan-Similkameen region is at a crisis level. The demographics of the area show that the number of people aged 65 and over continues to grow. We're probably in the neighbourhood of 365 beds short. We're using acute-care beds at $585 a day. I'm just wondering what steps the minister is taking to address this major crisis in the Okanagan-Similkameen area.

Hon. P. Priddy: I expect, within the health authority budget, that they have identified, as many regions have, the need for long term care, continuing-care beds and multilevel-care beds in your region. That will be taken into account when the budget estimates from the health authority are reviewed, and where we are able to help with those pressures, we will do so.

I think there is a real struggle in the province; there's no question about this. It's a bit like education. People, both elderly people and people with young children, move into an area, and it's often not possible to keep up with capital expansion at the same rate as people can simply move from one place to the other. I don't think there's any question about the need for beds throughout the province, given the demographic shifts that there have recently been and that there will continue to be as we see an aging population.

The other piece of this, though, is that while there's no question that there's a need for long term care beds -- continuing-care -- there's also a need for us to look much more creatively at the kind of support that's offered to elders in the community, so t