1986 Legislative Session: 4th Session, 33rd Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, APRIL 14, 1986

Afternoon Sitting

[ Page

7711 ]

CONTENTS

Oral Questions

Expo 86. Mr. MacWilliam –– 7711

Casino gambling. Mr. Cocke –– 7711

Log exports. Mr. Lea –– 7711

Mr. Parks

Casino gambling. Mr. Williams –– 7712

Hotel evictions. Mr. Blencoe –– 7712

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

On vote 37: minister's office –– 7713

Mrs. Dailly

Mr. Williams

Mrs. Wallace

Ms. Sanford

Ms. Brown

Mr. Ree

Mr. Reid

Mr. Cocke

Mr. Blencoe

Mr. Rose

Mr. Nicolson

Committee of Supply: Ministry of Post-Secondary Education estimates. (Hon.

R. Fraser)

On vote 62: minister's office –– 7737

Hon. Mr. Nielsen

Tabling Documents –– 7737

MONDAY, APRIL 14, 1986

The House met at 2:08 p.m.

Prayers.

HON. MR. PELTON:

Mr. Speaker, in the precincts today are some 90 outstanding British

Columbia young men and women, grade 11 students at one of the better

high schools in this province — Maple Ridge Senior Secondary School.

They are here today in the company of Mr. Gordon Edmonds, director of

their class in school. I would ask all those present to make them

welcome.

MR. COCKE: I would like to point out that

today is the birthday of the Leader of the Opposition, and I would like

all members in the House to wish him a happy birthday.

MR. LEA:

With us at the Legislature today is a long-time friend of, I would say,

all of us, and that's Cyril Shelford, a former member. With Cyril are

two of his old friends, Mr. and Mrs. Rehill. Mr. Rehill and Cyril go

back a long way; they served together in Italy during the Second World

War, and they're here to watch us do it today. I invite you all to

welcome them here.

MS. BROWN: Visiting us from Burnaby today are John and Isabel Pihowich. I would like the House to join me in bidding them welcome.

HON. MR. NIELSEN:

Mr. Speaker, unless I'm mistaken — unless there's a mixup in dates — is

today not the Premier's birthday as well? Is it true that lightning

struck twice? I believe it is. And coincidentally we'd wish him the

best as well.

Oral Questions

EXPO 86

MR. MacWILLIAM:

Mr. Speaker, my question will be addressed to the Minister of Tourism.

The Expo opening ceremony, as all members know, features Their

Highnesses the Prince and Princess of Wales. We have learned this

morning that the Social Credit MLA for Maillardville-Coquitlam (Mr.

Parks) is in fact handling all final applications for special

invitations to this opening ceremony. Why has the responsibility for

allocation of the special invitations been transferred from the office

of the Provincial Secretary to the office of the member for

Maillardville-Coquitlam?

HON. MR. RICHMOND: Mr. Speaker, the member for Okanagan North obviously is privy to information that I am not.

MR. MacWILLIAM: I am glad that the minister recognizes that.

has also been determined that the member for Maillardville-Coquitlam

will be discussing the issue of invitations with his Social Credit

caucus. I would like to ask the Minister of Tourism why the government

appears to be playing politics with the official royal visit.

HON. MR. RICHMOND: I know not whereof you speak, Mr. Member, so I suggest

that perhaps you address your question to the Provincial Secretary (Hon. Mrs.

McCarthy), if that is where you claim....

Interjection.

HON. MR. RICHMOND: Since she is not here, if you like I would be happy to take the question as notice on her behalf.

CASINO GAMBLING

MR. COCKE:

Mr. Speaker, I would like to address a question to the

Attorney-General. The Vancouver police chief, Bob Stewart, has called

for a non-partisan gambling commission to monitor and regulate the

explosion of organized casino gambling in B.C. because of the fear of

other organized people being involved. Mr. Speaker, this is for profit.

Has the Attorney-General decided on behalf of the government to accede

to this request of the police chief?

HON. MR. SMITH:

No, it is a matter that we are concerned about as well, and Chief

Stewart's proposal is one that has a lot of merit. We will be examining

that, and I'll be responding to him. I think the fears of all are to

ensure that while we have recognized lottery activities and recognized

bingo activities, all of these yield money for very good community

causes and for amateur athletics. We are all very pleased to have these

moneys provided in our areas. Nevertheless, we have a strong duty to

safeguard that none of the activities get into the hands of organized

gambling and organized crime.

[2:15]

MR. COCKE:

Mr. Speaker, this is a happening that has just spontaneously struck the

province. The fact that the gates were opened is of great concern to us

— and the fact that this industry is noted for its unsavoury

characters. We're talking about organized crime. I just ask the

Attorney-General: has he decided to take care of regulations for the

industry, to take it out of the partisan hands that are now operating

it, and to take appropriate action to protect our community immediately?

HON. MR. SMITH:

The only thing that is sudden is the fact that this member has heard of

the problem. I don't think that it's sudden at all. It has been a

concern to the government for many years. I do not accept that it is in

partisan hands. It is in conscientious law-enforcement hands, which are

not partisan.

LOG EXPORTS

MR. LEA:

My question is to the Minister of Forests. Has the government decided,

in terms of its export of logs policy, to go back to a system where

logs that are surplus to the domestic use will be allowed to be

exported?

HON. MR. HEINRICH: Mr. Speaker, I met this

morning — and I have for the last two or three weeks, as a matter of

fact — with a number of people who are involved in the export of round

logs. Those primarily affected now are the market loggers. We had a

meeting this morning, which probably lasted the better part of three

hours, at which time they provided a great number of details. The

request that they

[ Page 7712 ]

made

of me was to reconsider the existing rules; they requested that a

committee be struck which would involve the market loggers who had not

been involved in the past and represented roughly 5 percent of the

coastal cut. They have requested that labour be represented on that

committee, the independent sawmill operators, a member from the

integrated operators as well as a chairman. I have been reviewing a lot

of material lately, and I am looking seriously at that request which

they made. They also made another request this morning for an extension.

think in fairness it must be said that this policy was introduced in

the fall of 1984, and they were all very much aware of what was going

to happen. March 31, 1986, came and passed, and now of course we have

seen considerable concern expressed by the market loggers, primarily on

the Island. I can't give any commitment with respect to reconsideration

at all until I've had an opportunity to examine that which has gone on

before and the present status of the position in which they find

themselves in.

MR. LEA: Mr. Speaker, supplementary

to the same minister. Why would the government not keep these people

working while industry, the trade union movement and the government

look for value-added jobs, as opposed to putting them out of work while

you look for value-added jobs?

HON. MR. HEINRICH:

Mr. Speaker, there is no easy solution to this problem, That is

recognized by the market loggers, and it's recognized by the IWA. I'm

now getting two views that are being expressed by the unions involved.

I recognize as well that the member has a valid point: there may be

room for resolution, and it's going to take a little while.

MR. LEA:

Is the minister aware that if this policy that's in effect now

continues, in my constituency alone we're looking at a direct loss of

250 jobs, with the multiplier effect of a further 500 jobs; that we're

going to be losing more jobs through this policy than if the pulp mill

in Prince Rupert closed down? Is he aware of that?

HON. MR. HEINRICH:

I am very much aware of the impact of the existing policy, with the

surplus criteria expiring on March 31. I'm very much aware of the

impact not only in Prince Rupert but also in North Island and in a

number of the communities. As a matter of fact, I don't need to name

them, but we all know what they are. I'm very much aware of it.

MR. PARKS:

I have a question to the Leader of the Opposition. In light of the fact

that he is on record with respect to opposing log exports, and in light

of the obvious loss of jobs that has been created by the cessation of

log exportation in this province, is the Leader of the Opposition...?

Interjections.

MR. SPEAKER:

Order, please. Before a question is ruled in or out of order, the Chair

must hear the question. However, hon. members, I would refer members to

the policy that suggests that the only possible area for questions to

private members would be to such members as chairmen of certain House

committees. In any case, questions on policy, even directed to

ministers, would not be in order and is one of the areas that is

recommended. Therefore I must decline the question put forward by the

member for Maillardville-Coquitlam.

MR. PARKS: On a

point of order, Mr. Speaker, are you suggesting that the Leader of the

Opposition is in fact not the leader of his caucus committee?

SOME HON. MEMBERS: Oh, oh!

MR. SPEAKER: Order, please. Hon. member, a valiant effort, nonetheless....

The second member for Vancouver East.

CASINO GAMBLING

MR. WILLIAMS:

Mr. Speaker, to the Attorney-General. The Vancouver police chief said

that this enterprise, i.e. casino activity, attracts unsavoury

characters. He indicated there is inadequate audit of their activities.

He indicates that only 35 percent of the profits go to charity. It is

apparent that government policy is to do through the back door what

they're unwilling to do through the front door. Is the minister

prepared to look seriously at what Alberta has done and not see this

gaming going on in our downtown hotels like we've never seen before in

British Columbia?

HON. MR. SMITH: Mr. Speaker, I

thought for a moment that the member was responding to the question by

Mr. Parks. I was trying to find a question in the comments that he

addressed towards me, and it would appear that there was a germ of one,

but I can tell the member that the policy of the government on lottery

funds and the operation of the Lottery Corporation has been to

expressly take strong safeguards to ensure that organized crime can't

get a foothold in this province. And it hasn't happened here. All over

the world where lotteries have been illegal, there have been those

dangers and those tendencies. These are not new. The original lottery

in Louisiana at the turn of the century was a well-known scandal

because of the prevalence of organized crime. All safeguards have been

taken here, and it has been run by the Lottery Corporation as a

government corporation, and we will not allow organized crime to move

into bingo or other operations. We believe that chief Stewart's caveat

to us is positive and constructive, and we'll take action on it.

HOTEL EVICTIONS

MR. BLENCOE:

I have a question for the minister responsible for housing in the

province of British Columbia. The crisis in the downtown east side

continues; the evictions continue; the human misery continues; and a

lack of action continues on behalf of this government. British

Columbians are deeply offended by this heartless policy of evictions.

They want action; they want compassion from this government. When is

this government and this minister going to take action on behalf of the

tenants in the downtown east side?

HON. MR. KEMPF:

To that member, the government has already taken action. Unbeknown to

that member, there is already a committee made up from government of

both the province and the city of Vancouver that's very much involved

[ Page

7713 ]

in that problem, and I would suggest he contact his friends in Vancouver to

find that out.

MR. BLENCOE:

We know what that committee was set up for. My question to the minister

is: how many evictions have to occur before this government will change

its policy and start to save lives and save human beings in the

downtown east side? How many people have to be on the street, Mr.

Minister?

Interjections.

MR. SPEAKER: Any further questions? The member continues.

MR. BLENCOE: There is legislation on the order paper, a private member's bill to deal with this.

MR. SPEAKER: Order, please.

MR. BLENCOE:

Will the minister advocate that that legislation come before this

House? Let's get some action on behalf of tenants in British Columbia.

MR. SPEAKER:

If the member does not have a question, we will be hard-pressed to

invent one at the last moment. Hon. members, the bell terminates

question period.

HON. MR. NIELSEN: Mr. Speaker, I would ask leave to call Motion 61, which appeared under the name of Mr. Parks in Votes and Proceedings

Friday last. I'll read the motion for the members: "That pursuant to

the provisions of the Ombudsman Act, this assembly recommends to the

Lieutenant-Governor that Mr. Peter Bazowski be reappointed as acting

ombudsman upon termination, pursuant to the said act, of his present

appointment to the office of ombudsman."

MR. SPEAKER: Hon. members, leave has been requested.

Interjections.

MR. SPEAKER: Order, please. Hon. member, the Chair is aware of the negative voice, and therefore the motion called cannot be put.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $207,950.

MRS. DAILLY: To pick up where we left off on Friday, we will take our time as usual.

Mr. Chairman, I would like to again deal with the subject which I've brought

to the attention of the minister for a number of years now without satisfaction,

and will continue to bring to his attention. I already have mentioned it earlier

in these debates, but I have a further reason for mentioning it to the minister

today. I want to discuss again with the minister the use in this province of

user fees. I have contended, along with many other people, that the user fee

principle is not only breaking down the universality of medicare but is causing

hardship to people in this province today.

have in front of me in the Blues the answers that the minister gave

during last week's debate. Before I refer to those specific answers. I

want to read into the record part of material — letters — sent to me as

recently as this morning to do with this matter. Because I think it

expresses far better to the minister the concerns that many of us feel

over this use of the hospital user fees in this province, I thought I

would, with the indulgence of the Chairman, just read sections of this

correspondence.

[2:30]

The correspondence I've received is from a war veteran. He says:

"Dear Mrs. Dailly:

"I know that you are concerned about persons not able

to pay co-insurance from their own resources. I am a war veteran who was injured

during service, and receive combined pensions totalling $870 per month, which

is just above the poverty level. I have added expenses, because I am an amputee

and cannot afford to pay demands from two hospitals for co-insurance, and my

medical coverage through DVA only became effective on November 26, 1985....

I am enclosing copies of the correspondence, and hope that you will protest

this to the government on my behalf."

And I'm taking this opportunity to do it now, so I can have it put on

record, just to back up what I've been saying earlier in the estimates to

the minister.

have a letter here from the Holy Family Hospital, which refers to this

bill owed by this particular gentleman. I certainly can have some of

the correspondence sent over afterwards. It says:

"We can only suggest that Mr. Isbister pay off his

account at a rate of perhaps $25 a month on his own, or with any help he could

receive from the Legion."

She is replying to a request, by the way, from the Legion to

help out this man.

"Unfortunately, these are trying times for everyone.

However, charges for patients" — and this is the line I'm particularly concerned

about — "having financial difficulty cannot be waived."

Yet

if we look at the Blues, the minister does state that there are cases

where he has allowed the waiving of these fees. I have the exact quote

from the minister, if I could just find it. I'm reading here: "One of

the reasons for bad debts could be because we do not pursue relatively

small amounts of debt owing with great vigour." That was one thing. But

there is another

section of the Blues, where the minister refers to the

fact that sometimes these debts are forgotten or written off. Now that

certainly doesn't connect at all with the letter which this man

received from this hospital.

Then he received a letter from

another hospital which he also had to attend. This is from the director

of finance of the hospital:

"We regret to advise you that unless the above named

account in the amount of $297.50 is paid within 30 days, it will be turned over

to a financial collection agency for attention. Because such attention may impair

your credit rating, you are urged to contact us immediately."

Attached to it is the bill, and at the bottom is how much it cost Medical Services for his stay there.

[ Page 7714 ]

Mr.

Chairman, the point I'm trying to make to the minister here is: here is

a man, a war veteran, who cannot.... He couldn't, up to the time when

he went to get help from the Legion. He was being plagued by demands to

pay these bills from the financial officer of the hospital, threatening

him with having a bad name for debt. Knowing this minister, I give him

credit for looking into cases — he and his deputy.

Even

though this bad debt may, I hope, be looked into by the minister and

his department and cancelled, or whatever you can do about it, the main

general principle here still remains: people in this province are no

longer being given the right of true hospitalization. Once you start

putting in user fees for hospitals and once the patient starts

receiving those kinds of demands for payment, you have broken down the

basic universality principle.

Now I know you might say:

"Well, what's $200?" I notice in one of the letters from the hospital

it says something about: "I'm sure you can afford the $25 a month." The

problem today is that too many people do not realize that if you live

on $800 a month and you have all the problems and costs of being an

amputee, particularly, and up to the time you got coverage you

simply.... That $25 a month means a lot to you.

Anyway, the point I want to make without belabouring this, because there are

many other things to bring up this afternoon not only from myself but from other

members.... I simply say to the minister: it is all right to say in this

House that people don't have to be plagued by these debts, that we don't

call them all the time. The point is, Mr. Minister, that some of the hospitals,

which are being financed by the public taxpayer, are still putting heavy demands

on people who cannot pay. In a way I can't blame the hospital. I have to

blame the minister. Either his message isn't getting through.... Even

if it is, I still have to blame the minister and his government for adhering

to user fees, which I contend break down universality.

Could the minister comment on this particular issue that I've brought up with regard to those letters?

HON. MR. NIELSEN:

Rather than relinquish the concept of user fees, minimum as they are, I

far prefer to refer to the specific incident and resolve that matter if

possible. The incident the member speaks of, and the correspondence,

relate to a person in a somewhat difficult position with difficulties.

We're more than pleased in those individual situations to review the

case and if necessary take direct action.

The user fees

have been a fact of life in B.C. for 30-odd years. It does not cause

hardship for a person when there is relief for an individual who truly

is suffering a great difficulty with finances. To average persons

required to pay the $8.50 a day, they are pleased to death that it only

costs $8.50 a day, because they've had experiences elsewhere or know

others who have had experiences elsewhere, and they recognize that it

is a minimum contribution to their cost of stay in the hospital. This

gentleman must have been in there for a considerable period of time to

have a bill of that size. No problem at all to speak with the hospital

administrators and make arrangements to take care of that matter.

doubt if that one situation, or even a couple, really argue very

strongly against the benefit to the balance of our society achieved by

the collection of that amount of money. It does provide the opportunity

of funding other benefits to people that are not covered by medicare at

all. It's a fact of life — $40-odd million or whatever is a lot of

money, and it can be used for other purposes in health care. Without

it, there would have to be reductions. I don't know whether members on

the other side are so opposed to user fees that they would like to see

the supplementary benefits and non-medical benefits gone because the

money isn't there. But in part, that's what user fees fund, to a very

large extent. They fund a significant amount of the non-medical

benefits that are found in our medicare plan in British Columbia.

this specific issue, there's not a problem at all. I'm not aware that

I've heard from the gentleman. Had I, I think we probably would have

resolved the matter before the member was aware of it.

MRS. DAILLY:

I did pay credit to the minister; I know he and his deputy will look

into this case. But again, of course, we have a very basic difference

here and will continue to have one. I regret very much that the

minister still does not see that the principle of user fees is

destroying, and will continue to destroy, the principle of medicare, of

the hospitalization and medicare in this province.

One

final word of debate on this. When the minister says, "Where are you

going to get the money from?" let's remember that already he is losing

that amount of money from the federal government at the time. And you

will get it back. I notice you said: "I've already asked for it back."

Was that just being facetious? May I ask this question directly to the

minister? You have already asked for the money back. Does that mean

that this government intends therefore to abolish user fees? I wonder

if you could explain what you meant in Hansard when you stated the other day: "We've already asked for the return of the money."

HON. MR. NIELSEN:

To be succinct: in various correspondence from various ministers to

various counterparts in Ottawa, we've told them to think rationally and

eliminate that nonsense of penalties and send our money back SAP.

MRS. DAILLY:

Mr. Chairman, I hope the federal Conservative minister will not follow

at all in that request from the point of view that obviously you want

the money back and you want to keep user fees. I hope the federal

Conservative government feels more strongly about universality than you

do, Mr. Minister, and hopefully they will.

Another word on

that, though I said it would be the final word. You did refer to "Where

are you going to get the $40 million?" Well, this government's always

able to pull money out of the hat somewhere for some of their projects.

I think that's a red herring. With this government I think it would be

more to the point if the minister simply admitted that philosophically

he believes in the user fee and obviously cannot therefore believe in

universality. I just want to get that out to the minister.

HON. MR. NIELSEN: Why did you as government have user fees?

MRS. DAILLY: I'd be glad to answer that. I believe it was a dollar.

HON. MR. NIELSEN: Why did you have user fees? Never mind the amount.

MRS. DAILLY: At the time we had them, I recall the government saying that their intention was to eliminate user

[ Page 7715 ]

fees.

I believe what the minister does not appreciate today is that you have

raised the user fee continuously since you've been in office, to a

point where it is indeed going to crack universality — and has already

with some people. I regret very much that the minister cannot open his

mind on this problem. If your government continues to increase them, we

have really broken up that fundamental principle, and I regret it.

The

other area I'd like to discuss with the minister — there's quite a

number of them — is an area that.... The minister was kind enough, Mr.

Chairman, to meet with me on this matter. At the time I certainly said

to him, "We're not going to make a great big public issue of this

matter," but I do think it's worth a debate in this House. It's a

matter that I think can be dealt with in a realistic, practical

discussion here, and that's methadone treatment.

The

minister certainly must have had as many letters and calls as I have

had on this matter, and I appreciate the time that was given to me in

his office with the people in charge of this new treatment facility.

But since leaving the minister's office I have continued to discuss

this matter with a great number of people, and I am sincerely of the

opinion — and it's not just my opinion, it's the opinion of people who

know far more about it than I do, including some doctors — that the

arbitrary, almost compulsory way in which these clinics are going to be

dealing.... I think the changeover of methadone patients from the

physician to the clinics is ultimately not going to be for the benefit

of the patient. I am particularly concerned about patients who are now

receiving methadone treatment from their private physician. Those

people — the majority of those that I've had an opportunity to talk

with — have most certainly been able to hold down jobs. As far as

criminal records or the like, which some of them quite openly admit

they have, they have never been inside a prison from the time of this

methadone treatment.

Many of these people are actually

becoming, may I say, nervous wrecks over the thought of this change and

this upheaval — that they now will have to go to the health clinic.

Their concern, as I have stated, is not just their concern; it's also

the concern of some physicians. I actually have a letter here from a

physician who has been in contact with the ministry. He prepared a

number of papers, I believe, and even worked for the government at one

time; I'm sure the minister knows who I'm talking about. In the

discussion paper which he prepared, I imagine for the ministry, this

doctor suggested interim measures — and these are the things I want the

minister specifically to comment on — whereby government could offer

help to private physicians treating addicts in return for some control,

with the object of allowing stable methadone patients the privilege of

private treatment while retaining new and poorly behaved patients in

government clinics.

[2:45]

Now

this is the position that I found myself arriving at before I received

a copy of this letter. If people now receiving methadone from their

private physician have not posed any problem, have shown a good record

of attainment since they've been there, why not leave them with the

private physician? I cannot understand why the minister could not

concede or.... Has he given consideration to doing that? This does not

mean we do not concede that maybe the government clinics have to be

there. I know you're already in action with them, but why should the

patients with the good record have their lives disrupted? Why should

they be arbitrarily moved out and sent to the clinic'? Why can they not

be allowed to stay there? I'd like a specific answer to that question

from the minister.

Before I sit down on that issue — I

think another colleague wishes to speak on this — I'm rather concerned

with some of the very strict regulations that may be applying on the

matter of mandatory withdrawal. But as I read this part of the letter I

think it would be better, for the sake of those involved, if I had this

discussion with the minister in private at some future time. So I'd

like a specific answer as to why people who are already on methadone

with their physician and have a satisfactory record, some of them over

ten years, can't be left there.

HON. MR. NIELSEN:

Many reasons, Mr. Chairman. This decision was made after extensive

consultation with the B.C. College of Physicians and Surgeons, the B.C.

College of Pharmacists, B.C. Medical Association and the Federal Bureau

of Dangerous Drugs as a joint advisory committee. Some of the reasons

which were considered with respect to what was going on in the province

of methadone distribution.... It was brought to the attention of the

joint advisory committee that there has been poor coordination between

private fee-for-service physicians and government clinics due to lack

of control, especially with regard to who should be admitted to the

program. In June 1985 the subject of methadone was investigated in

three separate coroner's inquests, convened as a result of death from

overdose of a combination of drugs, including methadone.

The

number of methadone users is unknown because many users are known to be

involved in double doctoring, using false identification. A significant

amount of methadone has been diverted to the street for sale on the

black market for $1 a milligram. Most private fee-for-service

physicians prescribing methadone do so in an unstructured setting.

Authorizations to prescribe are granted by the federal Bureau of

Dangerous Drugs in Ottawa. Theoretically a private physician should

adhere to federal protocols, but this is almost impossible to enforce.

The

private physicians do not have facilities for regular supervised urine

collection or supervised methadone dispensing at their disposal.

Neither do they have a staff experienced in the field of addiction

rehabilitation. Urine collections, if they are carried out at all, are

often haphazard and poorly supervised.

The federal

protocols are quite specific about the amount of methadone a patient is

allowed to take away from the dispensing area in multiples of a maximum

of 80 milligrams. The suggested maximum for stabilized patients is a

one-week carry, and carries of up to four weeks have been given by

private physicians. The treatment requirements have not been followed.

Methadone is intended for use as merely one phase in the treatment of

heroin. It is used to help addicts stabilize their lives, while at the

same time ensuring they have regular contact with the many other

services which are acknowledged as essential in the long-term treatment

of these patients.

If methadone is used under these

circumstances. It is essential that through constant surveillance of

urinalysis the treatment team is assured that the patient is indeed

free from taking other drugs and that they are taking the methadone

rather than diverting it on the street market. Methadone is one

treatment available to physicians in the treatment of heroin

[ Page 7716 ]

addiction.

The fact that patients are on methadone for many years shows treatment

failure rather than success. Statistics on outcome of methadone

treatment are difficult to assess, as there is no standardization of

follow-up methods.

Mr. Chairman, this question has been

before us for a long time. The system that was in place has not proved

to be satisfactory. In consultation, as I mentioned, with the College

of Physicians and Surgeons, the College of Pharmacists, the federal

Bureau of Dangerous Drugs, B.C. Medical Association and the ministry,

this new program was brought up. As far as I know, it has unanimous

approval of all.

So I am sure some individual addicts may

be upset, and I recognize that they do have trepidation, and they may

fear that their lifestyle as it has existed for some time will be

modified or disrupted. We believe that it is in the interests of

society that we have control over the dispensation of methadone. There

are too many side effects that have been brought to our attention, and

I think it is the Ministry of Health's duty to try to minimize the

effects on society in having methadone being dispensed in somewhat of a

haphazard way.

Please remember it was not just the ministry

but also medical organizations and others that recommended that this

system be in place in B.C.

MR. WILLIAMS: Maybe, Mr.

Chairman, the minister could advise us how he sees this being

delivered, then, and what patients that now get treatment from doctors

will face with respect to these clinics. Are they clinics available on

a 24-hour basis?

HON. MR. NIELSEN: The two clinics we are speaking of would be open from 6 a.m. until 10 p.m. seven days a week.

MR. WILLIAMS:

I met with an addict in my riding who has lived with this problem for a

dozen years, treated by a private physician. He has a truck-driving job

and since being on methadone has been able to lead a reasonably

fulfilling life, if you can call it that, in terms of carrying out his

job and carrying on with his family. None of us envy these situations

or are happy with them, but this is a person that has dealt with the

habit in this way for a dozen years. He happens to be a truck-driver

who makes a more than decent living, but he has to be up at 5 a.m. for

his truck-driving job. What does he do? He tells me that he gets up and

he's sick in the morning. He needs methadone then. Your clinic opens at

6 a.m. He's out of a job; it's as simple as that.

It's this

kind of narrow, centralized way of dealing with problems that you birds

over on the other side always find as the solution. The irony of

ironies; you people are the great centralizers in this province. Where

are the two clinics? Aren't they three blocks apart? One of them is on

8th Avenue and one of them is on Broadway. Now isn't that a great

service to the greater Vancouver region! You know, it's that kind of

narrow bureaucrat's answer and your kind of rubberstamp attitude,

instead of seeing these issues in very clear, human terms. This guy

clearly and simply is out of a job if you proceed in the manner in

which you are planning. Can the minister respond?

HON. MR. NIELSEN:

No problem at all. We have other people who are in very isolated areas

of the province who cannot possibly get down to the clinic on a regular

basis.

Those people are being taken care of on a one-by-one

basis. If your truck-driver gets up at 5 o'clock, let me know who he is

and we'll make arrangements so the methadone can be available for him.

We don't want him out of a job.

MR. WILLIAMS: You

know, I presume then that what you are talking about is daily control

over these people. Is that what you're talking about? Do you want daily

control over the lives of these people? The member for Burnaby North

(Mrs. Dailly) has said that it may be one thing if you're going to deal

with your new problems on the street, but these are people who are

leading reasonably productive lives despite the addiction. It doesn't

make sense to me to funnel them into this kind of entrance program.

You

know, there are serious academics, I understand, from Simon Fraser who

question what you're doing. So all of your bureaucratic agencies can

tell you what you like, but there are at least some outside academics

who say this doesn't wash and that it doesn't make sense. You've got

two clinics three blocks apart? Where?

Interjection.

MR. WILLIAMS: No, but you've got two in Vancouver; isn't that so — one on Broadway and one on 8th Avenue, a few blocks apart?

Interjection.

MR. WILLIAMS:

That's the minister, and he was the minister before. He's bringing in

the program. Don't you know if you got out of grade 11 or grade 12? You

figure it out.

HON. MR. HEWITT: Well, I know that I at least know what I'm talking

about. You just told us that you knew.

MR. WILLIAMS: You don't know if you graduated from grade 11 or 12, Mr. Minister of Education. I don't think I need your advice on anything.

MR. CHAIRMAN:

Order, please. The member for Vancouver East has been recognized. Would

all members when speaking address their comments through the Chair.

MR. WILLIAMS: Isn't it true, Mr. Minister, that the clinics in Vancouver are a few blocks apart?

HON. MR. NIELSEN:

The proposed plan would see two clinics, one adjacent to the existing

clinic on West 8th Avenue, and the other would be on Willingdon Avenue

in Burnaby. Presently it's at 525 West 8th and 307 West Broadway, I

believe. The other main one would be in Burnaby, but arrangements are

made depending on the individual. We have many now who go to our

clinics, and have been for many, many years. They receive their

methadone through the existing clinics. As these cases become known to

those people working with them, many arrangements are made to assist

them in difficulties they may identify individually.

that type of problem you mention with the truck-driver and his unusual

hours probably could be accommodated. As I mentioned, some addicts in

remote areas, and they are functioning in these remote areas, know they

can't possibly get over to a clinic regularly. In some cases they have

a prescription supplied to them on a bi-weekly or whatever — semi-

[ Page 7717 ]

monthly,

sometimes — supply. That need not necessarily be changed. It's a matter

of investigating the circumstances surrounding each.

But

there has been a significant amount of abuse associated with the

methadone, and we believe that this is the best way to try to get it in

a responsible dispensing manner. We will take into account an

individual circumstance, and we will try to tailor some plans to suit

those who have legitimate difficulties in attending such a clinic. Many

have done this for a number of years. I think it's probably in a ratio

of about five-to-one outside to in. We think it will provide a far

better handle on the problems associated with dispensation of

methadone, as I mentioned earlier.

[3:00]

MR. WILLIAMS:

It seems to me that the doctors are either responsible or they are not.

If they are not responsible, then there are their own professional

agencies, there is your ministry, and so on. If it's the doctors who

are being irresponsible, then deal with the ones that you've got a

problem with. This is an easier bureaucratic answer, it seems to me,

given your perspective. But given the problems of the patient or the

addict, it's something else again.

[Mr. Rogers in the chair.]

Again,

in the case of my truck-driver example, what about a person who is

actually taking two doses a day? That is, he isn't taking it just once

every 24 hours, he's taking it twice a day, and he has a job. So

there's this problem of getting up at 5 in the morning and being on the

job, but also needing further help later in the day. Does that mean he

has to go back to the clinic again? Again, it interferes with the job.

HON. MR. NIELSEN:

If an individual needed a couple of shots a day of this, and when they

returned to the clinic and the urinalysis indicated that they had not

consumed the previous dose, I imagine he'd be told: "You better come

back for each individual...." But if he's established a pattern of

responsibility, I don't see any difficulty in dispensing an additional

supply to the individual. But we have to develop some case records on

some of them, because we find a lot of methadone on the street. They

find, as I mentioned earlier.... Many of the doctors' offices do not

have individuals who are trained in a lot of these matters. It's not

just the doctor. If a person receives a week's or two weeks' supply,

the doctor has no control over what happens to that methadone. This is

a major concern to the law enforcement agencies as well. There is no

guarantee as to what happens to that methadone once it is in the

possession of an individual.

So I believe it's a matter of

testing the service, and I think we can work out problems for people

who have legitimate concerns and fears and difficulties. It's done now

at the clinic, and I don't see why it can't be expanded to most of the

responsible persons receiving the treatment.

MR. WILLIAMS:

I appreciate the minister responding, but it's disturbing when you hear

the minister say: "Well, I imagine blah, blah, blah, that this is what

will happen." Well. fair enough. That's clearly the way you see what

will follow. But by the lord, any of us who have studied bureaucracies

say, "Lots of luck, Charlie, lots of luck," because they often have

their own agendas inside these bureaucracies. The guy at the top....

Well, you know, maybe this minister has more impact — or his deputy;

that may well be the case. But still these people often have their own

agenda. It does seem to me that even if you wanted to monitor it, that

would make sense initially, as an interim step.

Say in the

case of my truck-driver example, if for two weeks he ended up showing

that he had to have this kind of help to deal with his addiction, and

you are satisfied about those volumes, then once that's established,

what's wrong with it being back in his physician's hands to handle

those kinds of volumes? That seems reasonable. You've then satisfied

yourself about the volume and the particular patient's problem on a

monitoring basis or on a sample basis instead of on a continuing basis,

in terms of the Big Brother thing. That's what bothers me. I don't

think we need a Big Brother solution here — the "Big Brother is

watching you" routine. These people have a miserable enough

circumstance without being handled by the state every day of their

lives. So what about an interim period where you might simply monitor

and review, rather than drawing the line and saying it's over?

HON. MR. NIELSEN:

We are starting out somewhere, and indeed we will be monitoring the

program. We will be developing policy with respect to individuals as we

go along, hopefully to improve it and make it more reasonable and

accessible and controllable. But as the member would know, Mr.

Chairman, depending on the individual, regular lab samples are

necessary to determine if the person is following the medication as

prescribed. We've had some pretty bad experiences where that indication

is anything but that. We also have had some history recently of private

physicians being known to certain addicts and being known to be very

liberal with their prescriptions and so on, and there's been action

taken. But it has turned into a very major problem of considerable

concern. I think it's necessary to get it all together again to get it

started, at least, and then if there are recommendations from some of

the people who are involved, either at the patient level or the

physician level at the clinics, then I'm sure we would consider an

individual who may have such a record that there is really no concern

or fear that the methadone will find its way improperly elsewhere or

that the individual will abuse the program. We want to start at the

beginning.

One of the things we wish to do is to identify

how many there are, and we would like to avoid duplication. We'd like

to avoid a patient perhaps going to several doctors for supply, to try

and get a handle on that and find out how many of these people there

are. But we don't intend to be overly arbitrary, nor do we intend to be

overly bureaucratic when it comes to that. We're going to be very

flexible and, I hope, very understanding with respect to the treatment

of these people. We want them to be as they were intended to be under

controlled methadone consumption in replacement of heroin, to avoid the

crime and street life that goes with the acquisition of heroin. I think

we're going to give it a very legitimate and honest effort to try to

gain a little better control over it, and Mr. Member, I can assure you

that we will be taking into consideration the individual's needs as

well as the system's needs. I think we can look forward to quite an

improved situation over the next period of time. At least we're going

to give it our best shot.

MR. WILLIAMS: Mr.

Chairman, it does seem to me that if you clearly have problems with

specific doctors, then you might deal directly at that base in terms of

those obvious problems for starters. That's not what you're doing.

Beyond

[ Page 7718 ]

that,

it seems to me that if you see this program the way you've just now

suggested, then the prospect of these people returning to a

doctor-patient relationship is still there. Could we have some

assurance from the minister to that effect, Mr. Chairman — that he

doesn't dismiss that possibility down the road?

HON. MR. NIELSEN:

I'm sorry, Mr. Chairman, was that the possibility of returning to

prescription by physicians? I wouldn't dismiss that as never happening.

I would not say that there may be patients today who have a good track

record and a good history where they could be accommodated by a

physician we know to be competent and — I shouldn't use the word

trustworthy, because I'm not suggesting others are not — competent in

that field. Sure, there's quite a possibility that it could be

accommodated in a relatively short period of history for that

individual. It's quite possible. I wouldn't dismiss it out of hand, no.

MRS. WALLACE:

Mr. Chairman, I wonder whether the minister is aware of the size of the

problem in some of the outlying areas, particularly central Vancouver

Island — the whole drug cult. It's a very severe problem in central

Vancouver Island. I took the occasion not long ago to meet with a

person who works as a counsellor in drug and alcohol, and I was

extremely upset at some of the things that he brought to my attention.

One

of my questions to the minister is: what makes you feel that the people

in the clinic will be any more capable of determining whether or not

the would-be acquirer of methadone has a urine sample that is in line

with what you're looking for? People who are anxious for drugs, either

for money or for personal need, are very devious. What are you

expecting those people in the clinic to do, actually observe the taking

of the urine sample right on site, which is not done by the medical

profession?

HON. MR. NIELSEN: Not always.

MRS. WALLACE:

Not always. Right. So this is why you feel that the observation in the

clinic will be more complete than it is with the medical profession.

What about a clinic in central Vancouver Island? What kind of facility are you going to provide there? That's another question.

guess a final question: I was interested that you mentioned the side

effects. We have methadone users in the valley who have been on

methadone for 15 years, and it does have very serious side effects. I'm

asking for a policy statement from the minister as to what the purpose

of this is. Is there going to be an effort to get people off methadone,

or are you just going to continue dishing it out?

HON. MR. NIELSEN: If we did, they'd stay on it for another 15 years.

MRS. WALLACE:

What is the policy? Is the clinic to be just a continuing thing of

doling out methadone over the years, or is there going to be some

definite attempt to encourage people to kick the habit? What about

Maple Cottage? What are you doing about that? Is that going to be

enlarged? Is it going to be utilized? What is the policy of the

minister relative to this? I think that's the question I would really

like an answer to.

HON. MR. NIELSEN: Mr. Chairman,

I'm sorry the member may not have been here at that time. That is the

concept of the clinic. These people are not just dispensers of

synthetic drugs, but rather specialists in this area, and they are

involved in many of the other treatments that are required to assist

people with getting off the habit — counselling and so on. The member

mentioned someone on the island with 15 years. That's the worst

possible example of an absolute failure of the system, where a person

has been on it for 15 years, possibly because he's just picked it up

and consumed it, picked it up and consumed it, with probably very

little counselling or treatment of any other kind from the person

dispensing the methadone.

I don't know what the numbers are

on Vancouver Island. That's one of the things we'd like to know. We'd

like to know how many methadone addicts there are on Vancouver Island

and elsewhere in the province. We have a rough idea of how many there

are, but we don't know in precise terms, and we hope to find out if we

can. We think there are less than a thousand in the province, but we

are not quite sure as to their precise numbers — maybe more than that.

It is very difficult to know — maybe 800 outside, I think; about 1,400,

I guess, in total.

But the staff at the clinics specialize

in this. They are staffed by physicians and rehabilitation staff.

Physicians still see all the patients, but they have far more expertise

in trying to get these people off. There has been some success in

getting some of them off methadone as well, from heroin to methadone to

nothing, although there is no reason to suspect that methadone is any

less addictive than heroin. But it is a different substance, as you

know. It is also permitted, so....

But we think it is going

to have a major impact on the negative sides of methadone treatment,

and we are going to give it a try to see if indeed it works, according

to the beliefs of all those people who are on the committee.

MRS. WALLACE:

The clinic facilities for central Vancouver Island — I had asked you

about that. What sort of facility are you going to provide, or are we

still going to be using doctors there? What is happening in that area?

HON. MR. NIELSEN:

We will not have a clinic as such on central Vancouver Island at this

time. We are experimenting with the two on the lower mainland first.

Whether the numbers would require one on the Island, I am not sure, but

we will be looking at the individual cases as they are brought to our

attention.

We will continue with the clinics in Prince

George, Nanaimo and Campbell River. One of those communities has a fair

concentration apparently, but it's Nanaimo, Campbell River and Prince

George for the time being.

[3:15]

MRS. WALLACE:

So the clinic in Nanaimo is going to continue. Does that mean that

people living in Ladysmith, Duncan, Mill Bay and Shawnigan Lake

requiring methadone will have to go to Nanaimo to get it, or will they

still be able to get it from their doctor in those areas?

HON. MR. NIELSEN:

I imagine they will have to go to the clinic. We're trying to get it

out of the doctors' offices as much as possible. I don't know what

distances may be. It's probably just as close for someone from those

spots you

[ Page 7719 ]

mentioned

as it is for someone in Richmond or Surrey to get to the clinic. I'm

not sure what the actual road miles might be. It may be a little

inconvenient; it may also save someone's life. Maybe we won't have

three coroner's inquests in February of next year dealing with death

from overdose of methadone and mixed drugs. I think it is important to

monitor this. We're dealing with a very serious problem. Maybe we can

keep some of the stuff off the street as well.

MRS. WALLACE:

The problem is that you are going to do exactly the opposite, because

with those kinds of distances there is going to be black marketing of

methadone like you wouldn't believe in those areas. There is going to

be a real pressure put on those people. Rather than going to their

doctor in Mill Bay or their doctor in Duncan or their doctor in

Ladysmith, they're going to have to get themselves in to Nanaimo once

or twice...well, every day, or every week, or at the best every two

weeks, from what you're saying. It just isn't going to work.

The

whole methadone thing will be abused, and there will be a tendency to

return to other hard and illegal drugs, and you will be making

criminals out of people as a result. It just isn't going to work in

that area if you insist that those people have to get in to Nanaimo to

the clinic, rather than letting them use their own doctor. It's going

to have exactly the opposite effect to what you are suggesting.

MRS. DAILLY:

Mr. Chairman, yes, I endorse what the member for Cowichan-Malahat has

said. I have had those concerns expressed to me also, just as she has

laid out to the House. That is why we feel that the government, perhaps

— maybe with the best of motives, I don't know — has moved upon this

thing without really looking at some of the serious ramifications of it.

noticed that in answer to the member for Vancouver East the minister

said — and we were pleased to hear it, of course — that maybe some of

these people, after careful monitoring and watching their pattern at

the clinics, may be returned to private physicians. It seems to me —

and this is my final word on it this time, Mr. Chairman — that we've

come right around full circle. The point that we are trying to make

today to the minister is that those who have a successful history with

their doctor.... And we accept the fact there have been some bad scenes

in some cases, but by and large the majority have successful histories.

Why

upset their lives? Why upset the life of that truck driver who has been

brought to your attention? Why upset the lives of many other people?

That's all we are saying, Why can you not follow some very strict

monitoring with those people? For example, I know right now they have

to be registered with Health and Welfare Canada when they're with a

private physician. A suggestion was made that the alcohol and drug

programs should also have a form of registration. All we're saying is

that we believe it would be better for these people's future and health

if they could be left with the private physician. I make one final plea

to the minister: kind of pull back, stop and look at that situation

with great care before these people have this terrible disruption that

we consider will not be for their benefit.

A final question

to the minister. I understand that some of the methadone addicts

involved have asked for a meeting. They had a meeting set up with the

former Minister of Health. Now that you are acting minister.... I

phoned your office, and I was wondering if you have been able to work

out an opportunity to meet with this group of people who would like to

meet with you.

HON. MR. NIELSEN: I haven't seen it

on my schedule, but I have no problem in meeting with any of these

people. If arrangements have been made, I'll certainly see them.

MS. SANFORD:

I certainly support the views that have been expressed on this side of

the House with respect to methadone, but I'm going to drop that topic

and move to something else.

I'm wondering, Mr. Chairman, if

the minister has any information about the hiring of ambulance

attendants to work during the period of Expo. I assume there are some

that are being hired to work onsite. I would like to know how many are

being hired, and how many of them are actually already employed full

time. There is some criticism about that.

HON. MR. NIELSEN:

Mr. Chairman, I really don't know the numbers. This is an onsite,

in-house ambulance service that Expo 86 is putting together. In fact,

the deputy minister was investigating this matter today, because it has

been brought to my attention that the requirements for qualifying for a

position through the Expo Corporation may be such — and I don't know

this to be absolutely correct; we're looking into it — that only

persons presently employed for the ambulance service may qualify.

MS. SANFORD: Full time?

HON. MR. NIELSEN: No, this would be on a part-time basis.

don't know yet. Let's see now. Is this today's date? Yes. Expo

emergency service. It was determined that they have a total of 151

employees; 77 are EHSC members; the balance are nurses of various skill

levels. EHSC employees hired by Expo are EMA-is, EMA-2s and EMA-3s. The

shift schedules at Expo are to be six hours in length. It says that

Expo and the region 3 management are exchanging shift schedules in

order that there be no conflict with employees coming to work in a

fatigued condition.

It was suggested — this is only a

preliminary response that it would appear, at least from the ambulance

point of view, that.... My own conclusion, although it may be

modified later, is that only people who work for the emergency health

services at this present time qualify under the conditions laid down by

Expo. That's what I believe at this time. So they would be, I presume,

on a part-time basis. It could be that some will be on vacation; I

don't know what arrangements have been made for that. But it would

appear that the Expo folks have established a standard of ambulance

attendant that is only met by those who are employed for emergency

health services at this time.

I've only just started to look in to this. That's just the preliminary information I have.

MS. SANFORD:

I thank the minister for his answer. While he's looking into that, Mr.

Chairman, I wonder if he would also look into some of the complaints

that I've been getting. A number of people currently employed by the

emergency health services are part-time employees and do not

necessarily live in that lower mainland area. They would like very much

to become full-time employees, and, as a result, have made application

to be employed so that they can

[ Page 7720 ]

fill

out a full-time

schedule rather than the part-time

schedule they're on

now. The hours they are working are currently flexible enough so that

they could spend some time working at Expo, as well as fulfilling their

obligation in the job in which they're currently employed. These

people, I understand, are not being considered, even though they are

EMA-is, EMA-2s or EMA-3s. They are being set aside because of the fact

that so many of the people who are already full-time drivers in the

Vancouver area are the ones who are being hired; so they are, in

effect, doing the full-time load for the regular ambulance service, and

in addition are being hired to do this extra time at Expo. I think

that's grossly unfair, in view of the high unemployment rate in this

province, and in view of the fact that there are a number of EMA-is,

EMA-2s and EMA-3s too, I guess, who would like to be hired full time.

These are people, by the way, who live on the Island and do have

accommodation in Vancouver with relatives, and they have made

arrangements so they could stay with them. They would like very much to

be considered for these positions. I hope it's not too late, because I

know that the interviewing has been done, and I hope that the minister

will be able to make some adjustments in the interest of fairness.

The

other thing that I would like to raise with the minister is one that I

was asked to raise under these estimates rather than under the MHR

estimates. It relates to the counselling services for sexually abused

children. Those children are now to be counselled under the

jurisdiction of the Ministry of Health, the mental health services

branch, and the information that I have that has been a great deal of

worry to me over the last period of time is the fact that these people

in the mental health branch do not consider the counselling services

for sexually abused children to be a priority. I know that there are

people in my constituency who have had trouble getting counselling, and

I cited one case under the MHR estimates in which the mother had been

waiting since last October to have her two children receive some

counselling, and I had to intervene in order to have it happen. I would

like the minister to ensure that that counselling is a priority in

every branch of his ministry.

HON. MR. NIELSEN: Very

briefly, I would agree. I would certainly encourage those responsible

for those offices, clinics or whatever, to consider that to be a

priority. I would be more than pleased to do an audit as to what kind

of delays, if any, have occurred, because I agree with the member. Yes,

I believe that type of counselling is essential, and it's essential to

have it started early rather than wait for the effects to become so

permanent they may not be modified later. I'd be more than pleased to

get some information on that and offer them that instruction.

MS. BROWN:

I'm going to use this opportunity under the minister's vote to discuss

preventive and community health. I have a number of issues under that

if the minister would like to prepare himself for this.

The

minister has said that prevention is the emphasis that the ministry is

going to be taking, that the recognition if we are talking about health

is that we should try to prevent people from becoming ill and place our

focus on that, rather than waiting until they are sick and in acute

care and start spending money on them. That is why I'm kind of puzzled

by what's happened to the budget in this ministry for preventive and

community health care, because, of course, community health care is

much less expensive to deliver than hospital or institutional care. It

seems to me that in terms of the fiscal feasibility, one would be

better off spending money in community and preventive medicine rather

than the other way around. Yet we find under mental health, for

example, that there's been a reduction in the budget. We find a

reduction in the budget for forensic psychiatric services, and under

community health care services there's been a reduction of $2.7

million. As far as preventive services is concerned, there has been a

picayune increase of $176,000. So maybe in responding the minister

would try to explain how they're going to place emphasis and reduce the

sums of money in the budget at the same time.

The reason

I'm having to ask this is that the other mystery that's occurred is

that the budget supplement has been changed.

Whereas in 1985-86 the

supplement gave us details of the vote — on the preventive services it

was broken down into program management, public health nursing, public

health inspection, health education, speech and hearing, nutrition,

dental programs, epidemiology, and so on — in 1987 under preventive

services we have two things: program management and field operations.

So we don't really know what's happened to whom as a result of this

redrafting. So I'm going to have to start out by asking the minister to

give me a breakdown based on the 1985-86 listing of the services

covered by preventive services so that I can have a better

understanding of where the money was reduced at the same time that the

emphasis was increased.

[3:30]

want to know, for example, what's happening to public health nursing,

public health inspection, health education, speech and hearing,

nutrition, the dental program, epidemiology, contributions to

municipalities, and so on. I need more details on that.

HON. MR. NIELSEN:

Mr. Chairman, we ran over this the other day and there's a number of

these.... . I guess we don't call them sub-votes anymore, but specific

items where there have been some reductions for a number of reasons. As

an example, in the forensic psychiatric services the decrease was a

reflection of the reduction in funds needed for the Young Offenders

Act, and a salary and benefit reduction equivalent to the actual

surplus in the '85-86 budget. In mental health services there was a 1.1

percent decrease due to a salary reduction equivalent to the actual

salary surplus in fiscal year '85-86, and also with reference to the

Young Offenders Act. The numbers have been changed.

The

member did not ask, but as an example, hospital equipment was reduced

somewhat because we had increased it for the one-time purchase of the

lithotripter at $3.2 million. So the reduction reflects that we're not

buying another one. Similarly, there was salary and benefit

over-budgeting of 22 percent in community physiotherapy. There was a

reduction in employees' benefits due to a salary surplus in home

nursing care, so there's a 0.7 percent decrease. In long-term care

facilities, a decrease of 2.3 percent due to a program transfer of 119

beds to the mental health boarding home program. The ambulance service

decreased 8.5 percent due to the fact that employee benefits were

double-budgeted in '85-86, much to the shame of someone; they were

caught and then modified.

So the programs that the member

is speaking of were modified because of bookkeeping changes from the

previous year, and in effect overestimating certain costs of unknown

factors at that time — salary and benefits that we did not have

[ Page 7721 ]

a firm handle on, but which have been adjusted for this year. That's what those reductions were about.

[Mr. Strachan in the chair.]

MS. BROWN:

Mr. Chairman, I wonder if the minister would reconsider going back to

the old format in terms of the supplement and giving us more detail. It

makes it easier on him during his estimates because we have the answers

and therefore there is no need to ask the questions. This modern new

way of putting everything under two headings is proving to be an

incredible burden on the minister, because he has to have all of this

additional information at his fingertips. We would appreciate it if we

could go back to the old 1985-86 way of dealing with the supplement,

which would give us all of the information that we need to begin with.

addition, I'm kind of surprised at the reduction in mental health

services at the same time as we're having this wonderful conference

here, and I'm not quite sure what this says about us. Maybe in

responding to my question there could be more detail about how we can

afford a reduction in an area which isn't really adequate. I understand

from a newspaper clipping that the minister has a probe in process;

somebody is looking at doing a review of B.C.'s mental health services.

When will we get the results on this, or are they now ready? And is the

minister interested in sharing them with us?

The other

thing I was concerned about is the whole area of public health boards.

There is a call from around the province for more funds for them.

According to this quote, B.C. health boards have served notice to the

provincial government that they need more money for public health

services. Looking through the annual staffing report of the central

Vancouver Island health unit, they talk about a reduction in home

nursing care and public health nursing — that has suffered — the

clerical support staff is in short supply, and increased illness among

clerical staff has created quite a severe problem, with staff having to

be juggled between different offices.

The Williams Lake

Tribune talks about shortages. The northern interior health unit talks

about shortages. Northwest B.C. talks about shortages, At the same

time, we're being told that cases of TB are increasing, as are a number

of the other illnesses that should be identified quite early and dealt

with, while staffing levels are not improving in any of these

districts. I wonder whether the minister could indicate.... I think

I noticed somewhere here a reduction in the public health vote. Was

there a reduction in the public health vote? I think there was a

reduction. Anyway, maybe he could explain and tell us whether any of

these boards are going to have the increase they are looking for.

dialysis. This is another service which, if it's funded and the home

monitoring can be done and the care can be done for support at home,

would save us dollars in terms of hospital care. Yet we are told that

there is an underfunding of nursing support for home dialysis. I can't

tell from either the supplement or from the estimate book whether the

ministry has moved to deal with this underfunding problem in terms of

home dialysis. Maybe the minister in responding can say whether that

has been done or not.

Diabetes. There is a need to extend

B.C. Medical coverage to cover blood-monitoring supplies. The cost of

blood strips, dipsticks, etc., is causing a hardship for many British

Columbians, from children to the elderly — because unfortunately

diabetes does not respect age; it can strike very young children as

well as the elderly. The cost of these supplies creates a hardship for

the family. Self-monitoring saves money, and again we've been told that

there is not medical coverage for this.

The major question,

in addition, that I want to talk about is a study which was conducted

by the native community in terms of alcohol and drug abuse among native

people. To quote:

"When a group of Indians

set out to examine alcohol and drug abuse among native people last

year, it opened a door into Dante's Inferno. But, unlike in the Italian

poet's Divine Comedy, the travelers were confronted with scenes of the

living tormented, not by a vision of souls after death."

goes on to talk about children 10 and 12 years of age sniffing Liquid

Paper, swallowing illegal chemicals, drowning their brains in alcohol

to get high enough to deal with their depression. The president of the

National Association of Friendship Centres said: "Nobody's doing

anything about it." The study also pointed out that many of the victims

are as young as five years of age.

The study came up with

some recommendations, and that's what I specifically want to ask the

minister about. It suggested that the provincial government establish

alcohol and drug education programs at school levels, targeting the

native students. It also suggested funding agencies to offer graduate

fellowships to natives training as alcohol and drug counsellors.

Thirdly, it suggested that financial resources be provided for the

development of community-based treatment facilities for rural and

isolated areas with urban natives.

What I'm specifically

asking the minister about, because I realize that there's nothing that

he can add to the horror which was outlined in this study, is: I'm

wondering what the provincial government has done, if anything, in

terms of those three recommendations.

HON. MR. NIELSEN:

I'm not familiar with that study. I'm sorry, if it's a recent study or

whether it's some time back.... We do have a tremendous amount of

discussions with the federal government with respect to the plight of

Indian people in Canada and in British Columbia, and a tremendous

amount of funding is made available. A tremendous amount of funding is

made available in Canada and in British Columbia to Indian people for a

variety of needs.

The recommendations by that study should

not go unheeded. I can't see why there would be any difficulty in the

discussions which I'm sure either have or should take place with

respect to that. The conditions among Indians on reserves and elsewhere

are not the best in Canada, and never have been, and nothing seems to

have been resolved to the point of solving the problems. We spend a

tremendous amount of time consulting with the federal government over

these issues, and I don't know why those would not have been

specifically reviewed. Perhaps they have been and not brought to my

attention, but I don't know whether I have that report. I'm sorry. It's

not the Alberta report, is it?

MS. BROWN: No.

HON. MR. NIELSEN: Yes, okay, but I could look at that later and see what has been done. A lot has been.

Interjection.

[ Page 7722 ]

HON. MR. NIELSEN:

Okay, yes. But those don't seem like unreasonable requests for those.

I'd be very pleased to review the matter and see what's been done.

MR. BROWN: What about my other question?

HON. MR. NIELSEN: Oh, I'm sorry. With respect to the mental health funding? Is that part of it?

MS. BROWN: Yes, and the dialysis.

HON. MR. NIELSEN:

Yes, I don't know of any underfunding at all in home dialysis. As far

as I know, that is not a problem and hasn't been a problem. The union

boards of health, most of them, have been reporting shortages of staff,

not because of a budgeting problem but because of recruitment problems.

I was in Terrace, I think it was; the last time I was there I believe

they had about seven positions unfilled, and they were actively

recruiting for them. We have a very serious problem when the union

boards of health get involved in recruitment of such people as speech

pathologists, audiologists and some specialists.

What we

have done for this year is to offer a bursary program that will provide

up to $5,000 a year for four years for students who go into these

subspecialties, or whatever they refer to them as, and are prepared to

work in areas where we need the people. It is a tremendous problem

trying to recruit people for those areas and to keep them there once

they have been recruited, because other areas open up and many of them

transfer. But it is common throughout all of the remote areas of the

province, where there is a shortage. We are the first to admit that,

and we recruit constantly. In some instances we have recruited for a

position in excess of a year and a half without success, and we have

asked in some instances that certain rules be waived so we may use

foreign graduates in those areas as a stopgap if nothing else.

is a real, ongoing problem. The union boards of health mention that

every year, and we recognize it. We haven't been able to resolve it as

yet.

[3:45]

MR. REE: Mr.

Chairman, I have received a letter from the Lions Gate Hospital in

North Vancouver, expressing a concern with respect to their

neurological rehabilitation daycare program. They have indicated this

program, which was implemented in 1980, is an important part of their

ambulatory-care service towards decreasing in-patient stays within the

hospital.

Through the program, they have referred many

patients to various community organizations on the North Shore, some in

North Vancouver, some in West Vancouver, to do followup treatment of

the patients at these community centres. Some of these centres are

dealing with seniors: Silver Harbour seniors' centre, the Margaret

Fulton adult day-care centre, the Stroke Clubs, fitness centres and so

on. Their concern, Mr. Minister, is that the handyDART system, which I

appreciate is not the responsibility of the ministry, is now

implementing some restriction and moving some of these out-patients or

these people that have been discharged from the neurological

rehabilitation day-care program so that they cannot get to the

community program and, as a result, may then have to be readmitted or

spend longer time in the hospital. What I am asking is whether the

minister could have some staff negotiate with the Provincial

Secretary's office to see what can be done to alleviate this shortfall

in handyDART services with people that will be taking the benefit of

this program at the hospital.

That, Mr. Chairman, is the

only thing I would really like to ask the minister. I would like to

make some comments, though, with respect to the hospital and medical

care in this province. During the past year, unfortunately — I received

a great education from it, but I am sorry I had to receive it this way

- my family had a great deal of benefit from hospital treatment,

hospital care, doctors' care in British Columbia. Last summer my two

sons, within a month of each other, were admitted under emergency

circumstances to the Lions Gate Hospital, and each spent approximately

a week in the hospital. My wife had extensive major surgery at

Vancouver General Hospital in January of this year and was there eight

or nine days.

I don't think there is any place in the world

that could possibly get the care and the treatment, the capability of

it, the extent of it, the care of it that we have in this province,

particularly in those two hospitals. With my first son, I felt a little

bit concerned when I took him to the emergency department, because he

was injured in a sporting accident. We sat and waited for quite some

time. Others came in — you might say there was a lineup — and got

served before us, and people get a little bit annoyed. We're used to

standing in lineups at Safeway or for ferries or other things. We sort

of think first come, first served.

My second son was

involved in a motor vehicle accident when he was riding his bicycle,

and he arrived in the ambulance service, which was excellent. They were

prompt. He had blood all over the place. I didn't know whether he was

going to live or die. The whole emergency service of that hospital was

on him in a matter of seconds. They had his serious injuries, which

turned out not to be too serious, looked after very quickly and very

promptly. In other words, he appeared to be critical, or if he had had

critical injuries he would have received the same. My first son's

injuries were not critical. The hospital attended those that needed it

immediately. The others weren't left waiting just to wait; they were

left waiting while others that were more critical were being treated.

But I also found with respect to my second son that the emergency

service at that hospital had specialists brought in in hardly any time

at all. They were communicating with them; they were available. Doctors

were available, and this was on a holiday weekend — Labour Day. This

sort of medical care is available to us in this province. I think we're

the most fortunate people in the world to have it available to us.

But

in these three times in hospital that I spent this year I talked to a

great number of patients, and since then have talked to other patients.

Usually in conversations you come up with.... They usually have

something a little bit negative that happened to them in the hospital.

You know, Mr. Chairman, I would suggest that 90 percent of the

complaints that I received were as a result of lack of communication,

and usually — and I'm not knocking the medical profession when I say

this — as a result of lack of communication by the doctor toward the

patient, in not keeping the patient informed of what was happening to

him, what was going to happen to him or what could happen to him. This,

Mr. Chairman, is not to take away from the doctors who provide, I

think, excellent medical care and excellent treatment to patients in

this province, but I think there's maybe a little bit of a lack of

bedside manner to a certain extent.

[ Page 7723 ]

can't help but commend the minister, who has been the minister of this

ministry for some time, for the extremely excellent care that we have

available in this province, which I think from personal experience in

this last year is second to none.

HON. MR. NIELSEN:

On the handyDART, certainly we'd be pleased to look into that, because

we'd like to maximize the advantage of the community services for these

people. I appreciate the member's comments about the overall service,

recognizing that indeed we are fortunate to have the health care

program we have in British Columbia, but recognizing that there is

always going to be room for expansion and improvement. But I appreciate

your comments.

MS. BROWN: There are two questions

that the minister didn't respond to that maybe he'd like to comment on

again, and that's the coverage for diabetes — extending medical

coverage to cover blood-monitoring supplies: blood strips, dipsticks,

these kinds of things — and also about redesigning or going back to the

old way of reporting next year rather than the new method that he's

using this year.

I want to talk a little bit about

physiotherapists. I don't know whether it was covered before or not,

but a survey which was carried out by our interns indicated.... Oh,

no, it was a 1986 hospital survey that found that almost 50 percent of

the hospitals surveyed were having difficulty recruiting

physiotherapists. The health manpower training study for western Canada

identified a need as far back as 1982 for additional physiotherapists.

seems, Mr. Chairman, through you, that there are two reasons for it.

One is that the University of British Columbia school of rehabilitative

medicine is not graduating a sufficient number of graduates to meet the

need; and secondly, there aren't sufficient immigrant physiotherapists

coming in either to help us meet the need. The first problem, to do

with the school of rehab medicine.... Certainly the number one way

to start with it is that in fact there were approximately 480

applicants last year to get into the school of rehab medicine, which

only takes 40 students and only graduates 20 students each year in

terms of occupational therapists and physiotherapists.

clearly that is not sufficient, and the first thing I'd like to suggest

to the minister is a recommendation which I know he's heard before, and

that is that we really need to look at the establishment of a second

training centre, possibly attached to a community college in the

interior of the province. That's the number one recommendation. That

would save, in cost terms, the students themselves having to move down

to the lower mainland to study, and it also would relieve the problem

which he mentioned earlier of finding graduate physiotherapists or

health professionals to go to areas outside of the lower mainland. So

I'd like to go with the number one recommendation, which is

establishing a second training centre. Graduating 20 physiotherapists a

year is just not good enough for the province.

The other

one is the requirements placed on immigrant physiotherapists before

they can qualify, and these are really quite bizarre, Mr. Chairman. The

way in which the Immigration Act operates and the requirements for

practising here.... An immigrant has to come to Canada, write the

appropriate exam, then leave the country and apply for immigrant

status, with the hope that this will be granted. Then by the time the

immigrant returns, hopefully the exam results would have been

successful, and then the immigrant will be able to embark on a

four-month residency under a licensed physiotherapist. This is really a

very convoluted way of doing things. I realize that medicine and other

professions have difficult criteria too, but I'm wondering whether

there isn't a streamlined way in which we could deal with immigrants

who have degrees in physiotherapy from other parts of the world, to

maybe make it less convoluted than this way of going back and forth

with it.

I don't support the recommendation that all

physiotherapists should come in and be permitted to practise; I don't.

I certainly think that some kind of supervision is called for in

testing their credentials to be sure that they measure up to the high

quality of physiotherapists who are graduating from UBC school of rehab

medicine. But I think there can be a simpler way of dealing with it

than the present one.

The other thing, of course, is that

there's a lack of funds for in-province training for some of the

students who would like to go through the system. I think that the

minister could address himself to that. But I think, even more

importantly, we really need to be able to graduate more

physiotherapists than we're doing at present.

I just have

one other small thing I want to touch on before going on to my other

major presentation. It's about the optometrists at Woodward's. I only

say this because the Woodward's store in New Westminster, which is the

one where the optometrists I know are.... I respect their work. A

lot of the seniors in Burnaby go there. They can go and have their eyes

tested, and then go into the little restaurant downstairs and have a

cup of tea and a muffin or something, and come back, and their glasses

are made. It just seems so convenient for the seniors. It seems so

convenient for everyone.

I find this decision really

strange. I realize it's an internal battle between the optometrists

themselves, and it's not something that was imposed on them by the

minister. But I'm kind of disappointed that the minister went along

with the recommendation that Woodward's be forced to phase out this

particular service. It was of great convenience to a large number of

people. It was a good, reliable service. They are top-flight

optometrists. I think it's unfortunate that the minister was forced to

take sides and go along with the decision that he did.

want to talk about a report that was done on the role of women in

health. This was done by the Canadian Advisory Council on the Status of

Women. The report pointed out that women represent 75 percent of the

workers in the health care system, but they hold only 17 percent of the

executive positions. The medical profession, mirroring society,

projects stereotypes which keep women subordinate and subjects them to

unnecessary interventions, such as over-prescribing of tranquilizers,

unnecessary mastectomies, hysterectomies, etc.

[Mr. Ree in the chair.]

The

reproductive function of women is controlled by medical technology, and

primarily male gynecologists and obstetricians. "Attempts by women to

reassert their control," this study tells us, "through health

collectives have been unsupported by government. Women's use of health

services are due mainly to reproduction, ageing, and natural functions

which seldom need medical intervention," which brings me to the one

issue which I raise every year, and I

[ Page 7724 ]

guess

I'm going to continue to raise it every year until the minister comes

to understand the importance of women's health collectives to the

delivery of community and preventive health services to women.

[4:00]

This

is a real opportunity that women have, without going through the

traditional health care system, of learning more about taking care of

their bodies and about taking care of themselves. In fact, what women's

health collectives do is save the government and the community at large

a lot of money, if we want to look at it from a financial point of

view. But more importantly, it helps women to do a better job of

remaining healthy; and it does this on a shoe-string budget.

seems to me, Mr. Chairman, that a minister who has articulated that he

is, and I know that he is, honestly more committed to health than he is

to sickness and does really believe more in prevention than in cure,

should recognize that the Women's Health Collective is an ally, and not

an enemy; that the work that the Women's Health Collective does is

important. The Women's Health Collective identifies for women a number

of areas in terms of ageing or reproduction in ways in which we can

prevent some of the illnesses which would eventually lead to being

admitted to hospitals or mental health institutions. Women's health

collectives also alert women to ways in which we can deal with

depression and other kinds of psychological and emotional problems

without having to overuse prescription drugs such as tranquilizers and

those kinds of things.

Women's health collectives did not

grow out of the traditional health services. Doctors, in particular

male doctors, male obstetricians and gynecologists, and people who

specialize in geriatric medicine, didn't set up women's health

collectives. That is true. It is outside of the traditional medical

hierarchy. It grew out of women, a lot of them doctors, recognizing

that women can take a lot more responsibility — and consequently a lot

more control — over what happens to our bodies as well as our minds,

and thereby do two things: live healthier lives and be able to make a

more positive contribution to society, and at the same time save the

community's hard-earned tax dollars from being put into treating

sickness and illness in the health care system. I am baffled,

therefore, by the minister's reluctance to fund this very important and

viable aspect of the community and preventive health field. Maybe the

minister has a genuine explanation to give us on this issue, so I am

raising it once again this year.

The Vancouver Women's

Health Collective is unique in that it does manage to get some funding

- not nearly enough — from the federal government. It does get some

assistance from the city, because they've allowed them free office

space; but they still need some core funding. I know they have invited

the Minister of Health, so maybe I could put this in the form of a

question. Has the Minister of Health accepted the invitation, which was

issued to him by the Vancouver Women's Health Collective last year, to

visit the premises and see what they're doing in the way of counselling

and education? The educational component of their work is what's really

important. They're not treating people there. They're not treating

women or illnesses, they're not delivering babies. What they're doing

is an educational job — health education. That's the part of the

government's budget that their funding should be coming out of.

They're

interested in expanding their services to a broader range. They want to

able to give the same kind of educational information to immigrant

women, and move even further than that — into the native communities.

So they are ambitious, but their ambition is based on a recognition

that the more we know about our body and how it functions, the better

care we take of it, and the better able we are to stay healthy and save

the community hard-earned tax dollars. So is the minister at this time

willing to look with approval on the Vancouver Women's Health

Collective in terms of their request for funding?

HON. MR. NIELSEN:

I know that no money has been allotted for them this year. We mentioned

last year that the reason for termination of their funding was that the

services they provided duplicated services and information which were

available through our public health units, family physicians,

specialists in certain fields. We felt that the services were being

provided through the regular programs for those who wanted to receive

them and there was no need for specific funding through the ministry

for the Vancouver Women's Health Collective, which is one of many

groups wishing funding to offer — no offence — their view. There are

many groups that would like to have similar funds to offer their views

on health care matters and we simply can't fund them.

The

member spoke earlier of the blood glucose monitoring test, which is not

included. The medical advisory committee of the ministry suggests that

there is relatively small proven additional benefit to the patients

with this test, and they have not recommended that it be included under

Pharmacare at this time. They advise, however, that they do authorize

expenditure of almost $2.5 million in needles, syringes, insulin, oral

hypoglycemics and other required needs for diabetics for the calendar

year 1984 — $2.4 million. But the view of the medical advisory

committee was that the glucose test itself had relatively small proven

additional benefit to the patients, so they did not recommend it be

included.

The method of reporting in the book I will pass

on to the Minister of Finance. They prepare it, and we supply the

numbers to go into the slots.

On the physiotherapists, I

believe the member's comments are in line with what we have been

recommending and what we are working on with the association. The

ministry has recommended the recruitment of physiotherapists who meet

the requirements of

part 2 of the act, which does not require the

four-month residency. The ministry has requested the association remove

any obstacles to the registration of foreign trained physiotherapists.

It is a very major problem. We also have advised the Minister of

Post-Secondary Education (Hon. R. Fraser) of the shortage, and we have

recommended previously that there be an increase in the class sizes,

and the ministry has recently announced the bursary program which would

award a $5,000 bursary for a one-year return of service to a designated

geographical area. We hope that that will have some effect.

But

we have been asking the institutions to expand their program, to please

produce more physiotherapists, and we are talking to the association

about trying to break down some of the obstacles that make it more

difficult for a foreign-trained physiotherapist to practise in British

Columbia.

The optometrists at Woodward's. I believe this is

the case the member is speaking of. The British Columbia Court of

Appeal by a two-to-one decision ruled in favor of the B.C. Optometric

Association upon the validity of regulation 36,

[ Page 7725 ]

which says a practising optometrist shall maintain a definite place of practice in the province.

"All premises from which an optometrist practises shall

be situate in such a fashion as to consist of a self-contained office or suite

of offices exclusively used for the practice of optometry, having a separate

and distinct entrance from a street or, where within a building, from a common

lobby, hallway, or mall; and in no case shall such premises be located within

or form part of a commercial retail store."

So their regulation is very specific, and the British Columbia Court of Appeal

ruled in favor of the validity of that regulation. Now we really have no choice

but to follow court orders, even though sometimes we may not wish to. I believe

there is a further appeal to the Supreme Court of Canada. I gather the case

has not yet been heard. But the court did rule on the validity of that which

would prohibit what you had mentioned.

MS. BROWN:

Mr. Chairman, I wish I knew what to do to get the Minister of Health to

understand that the Vancouver health collective delivers a different

service to a different constituency than the people who go to your

traditional public health clinics and to doctors' offices. So I am

going to try something new. I am going to invite the Minister of Health

to accompany me, the two of us together, to go and visit the health

collective on a date of his choice, at a time of his choice. Did the

minister say agreed?

Interjection.

MS. BROWN: Oh, I thought he was speaking on your behalf, Mr. Minister.

The

women who walk in off the street and go to the Vancouver health

collective, a number of them teen-age prostitutes, a number of them

adolescents who won't go to their doctors' offices, won't go to a

health collective.... A number of women who won't use those

traditional services are being served. Their caseload is large. They

are delivering a very important service, Mr. Chairman, and I think that

the minister has to take that into account. The service may be

duplicated, but we are dealing with a different catchment area; we are

dealing with a different constituency.

So I am appealing to

the Minister of Health again, in terms of the Vancouver health

collective, to take another took at their request for funding, and if

you want to have a visit with them before doing that, I would be quite

willing to accompany you, or if you want to go by yourself, I will give

you the address.

I just have a couple of things I want to

raise on the business of youth. Because I speak on community and

preventive health, I have this potpourri. The drinking age — I don't

know if anyone raised that before, but maybe you would like to comment

on that — but more specifically, Dr. Blatherwick's recommendation that

there be more counselling services for youth, and whether in fact the

ministry is looking at the establishment of this and generally what

your feeling is about the drinking age and what you are going to be

doing about that.

The other thing is the request for

tougher regulations in dealing with bulk foods to protect the public

from contamination, etc. Maybe the minister would like to comment on

that.

My final comment, of course, has to do with smoking.

Interjection.

MS. BROWN: I'm raising this one without the permission of my caucus.

The

number of public places that are voluntarily instituting non-smoking

areas is wonderful. I don't know whether the minister has any comment

to make in terms of beefing up the educational program on the dangers

of smoking and generally looking at increasing the number of

non-smoking areas in the public place to encourage the community at

large to rid themselves of this — to perform a death-defying act, I

think the burnper sticker reads.

My final thing is the request about redesigning the supplement. Are we going to get more details next year?

[4:15]

HON. MR. NIELSEN: Last first. I mentioned that I would pass the message on to the Ministry of Finance, who does design the form.

Smoking.

There has been tremendous reaction to community requests and also

municipal bylaws. I offer you an anecdote, which is rather interesting.

Last September the municipality of Richmond passed a bylaw which

prohibited smoking in — and they identified all the areas: reception

areas, elevators, taxi cabs, a great list — and they passed it and went

around to all of the community facilities and required that they post

notices with a $500 fine and have all of this posted. As time went by,

one gentlemen came by to our constituency office and told my staff that

we were in violation of the bylaw because we had not posted their

notice in compliance with the bylaw. I was advised, and I said: "Well,

I'm not aware of a bylaw." The municipality apparently wasn't aware

that under the act the Minister of Health has to validate the bylaw

before it's in effect. Oh, boy. Then of course by the time I brought it

to their attention, and by the time the deputy Minister of Municipal

Affairs reviewed the matter, I was no longer Minister of Health so I

couldn't sign their bylaw. But last week I finally signed it.

Now

I've told the municipal council of Richmond to resubmit it to make sure

it's valid, because I'm getting tired of these people blowing smoke at

me in hallways, elevators, back alleys and places like that. We are

involved in a pretty active program with respect to smoking. This one

that's known as "Decisions" is an attempt of mild peer pressure in the

grade 8 and 9 level — but not a stern lecturing style, a quite

different style — in conjunction with the federal government. We're

hoping it will have some effect; it's basically to try to persuade

younger people to make decisions on their own for their own reasons,

rather than being persuaded by others. There is a fair amount of that

going on, and a provincial awareness program.

The bulk food

issue. We've had very few problems recently. We had a large number a

couple of years back when there seemed to be an inconsistency at the

regulatory level from region to region. We seem to have ironed out many

of the problems, and it's working quite well. We've really had very few

complaints of late. There was some inconsistency; one municipality or

one public health officer would make certain demands and another would

not, so I think we've got it going pretty well.

The

drinking age. There have been recommendations made that the drinking

age be changed back to 21. It has not received that much attention and

pressure. I recall a survey taken some years back by the Ministry of

Consumer and

[ Page 7726 ]

Corporate

Affairs where they analyzed some of the history of those who are either

deemed to have or admit to have a serious drinking problem. Almost

without exception, most of them began drinking at around the age of 12

or 13. Most of them began drinking at an early age, and most were

introduced to alcohol at home.

There has been a lot of

information, but I don't know of any pressure or uniform attitude about

the drinking age being increased. I really don't. Now I'll make you a

deal, partly. I'm going to be tied up for some time with various duties

and activities, but to start with I'll have my deputy contact that

organization and have him get down there fairly quickly to have a

review. I'll have my deputy get down to see them probably within the

next couple of weeks.

Interjection.

HON. MR. NIELSEN: Well, sure. Then you and I can have lunch or something and save time.

MR. REID:

Mr. Chairman, just a couple of questions to the minister and his deputy

minister and his assistant who is sitting on the other side of him

there. Mr. Minister, we've talked a couple of times about the question

of long-term care, and I can say that in my early activities in

political life I got quite involved with the Kinsmen Club and we built

a Kinsmen Place Lodge while I was on the board in Whalley. At that time

it served the purpose, but since then the facility has attracted, as

normal, more attention than they can accommodate. I received on

December 18 from the Kinsmen Lodge a letter with some requests that I'd

like to refer to you and ask you to respond to if you would. They point

out recently some problems with assessments and reassessments of

current residents, and the delay in those assessments. They are

sometimes five or six months in getting reassessments, which in a

five-storey building creates major problems in reallocating the beds in

the facility. There's also the ongoing assessment problems with

Boundary health unit and the expediting of the requests for the

expansion of Kinsmen Place Lodge in order to provide 30 additional beds

that have been indicated by Surrey Memorial Hospital, as there is a

dire need in that location. So, Mr. Minister, I'd ask you to look into

that one first of all.

Secondly is another request, and I'd like to read you the letter from the Ministry of Health. It goes as follows:

"Thanks

for your letter of October 11 giving me the numbers of residents in

your facility and on your waiting-list and their residence. As we

agreed, the matter of approval of an extension of 50 beds as an

intermediate-care wing to your facility will be looked at once we have

experience of the new long-term care program to start on January 1."

That's dated October 24, 1977, signed by the minister of

the day. I have a more current letter — March 7, 1986 — from that same

organization, Evergreen Baptist Home, asking if we wouldn't take a look

at the program as it refers to long-term care need and the approvals

for those facilities which have proven they do have the ability and the

facility to provide long-term care for additional residents in a

community such as White Rock with its large population of seniors. The

job that Evergreen Baptist Home does in that community.... I would

encourage long-term care programming to look at providing these people

with the permission to expand and add the 50 beds, because they have

all the other facilities in that complex to accommodate 50 beds without

building the cafeteria/dining facility, the cooking facilities and the

activity centre already part of that complex. It's an incredible

complex and it should be given whatever assistance is available or

could be made available to add these 50 beds to that particular unit.

the same Evergreen Baptist Home there is another firm or organization

in White Rock which also tries to service that large predominantly

senior population, and that's the White Rock Come Share Centre, which

has a family home support program which operates out of the basement of

this Evergreen Home. They currently have had their numbers of day

clients reduced rather than increased, even though the numbers of

requirements continues to increase by the day.

So, Mr.

Minister, I'd ask you to give those serious consideration for

assistance. And the announcement for the expansion of the Surrey

Memorial Hospital on behalf of the first and second members for Surrey

would be certainly appreciated very shortly. We want to commend you,

Mr. Minister, for your diligence in your ministry, your vision, and

your approval of the much-needed facility in White Rock that you've

allowed to proceed. We've had many compliments, because that's been a

much-needed facility. But you could announce the one for Surrey

Memorial — within hours would be satisfactory to these two members, Mr.

Minister — and deal with those other two questions, if you would.

HON. MR. NIELSEN:

To the member for Surrey, I'd be pleased to look at the details of

those long-term care facilities he mentioned, and I will make a

decision very soon on that other matter. There have been a number of

announcements made recently with respect to various construction

programs. I mentioned earlier that I think it's $150 million in a year

or so. Surrey is growing very rapidly. We recognize that, and there's

quite a change in the demographics as well, so there's great need.

We'll have a look at it.

MRS. WALLACE: I would like to talk to the minister about extra billing.

Interjection.

MRS. WALLACE:

Well, yes, theoretically we don't have it, but unfortunately we still

do have it. And the minister can cast his mind back to a couple of

instances that I have brought to his attention, where the question of

tray service has been raised by a doctor in my constituency. I can't

imagine that it's an isolated case. I know of two instances where this

charge has been made in writing to the B.C. Medical Plan people. I have

a letter from Mr. Thorpe, who indicated that tray service charges are

not to be billed, that they are considered as part and parcel of the

premiums that doctors receive. Yet this doctor continues to bill tray

service. It's interesting to note that he has a poster in his office

put out by the Medical Services Association which lists sterilized tray

service as something that is not covered by the plan.

As I

say, it's bad enough to have this situation occur and to have the B.C.

Medical Plan people have to write to the doctor and the patient and

tell him that he can go and get his money. But what really hurts is

when a patient gets a letter that reads like this from his doctor:

"Dear Mr. Low:

"Following our recent conversation, I feel I can no

longer be regarded as your family physician."

[ Page 7727 ]

That

conversation, Mr. Minister, had to do with the fact that he had been

charged $5 for tray service, which should not have been the case.

"I would request that you find alternative medical

care. So that your care will not be jeopardized and to allow you time to arrange

this, I will continue to provide care as requested for the next two weeks. I

will forward your records to the physician of your choice if you would let my

office know who this will be."

[Mr. Strachan in the chair.]

Not

only was that the physician who looked after Mr. Low, but that

physician also looked after Mrs. Low. Mrs. Low is in a position where

she just feels she cannot change her physician. Her health is not good.

She's under special care. The physician has agreed to treat Mrs. Low,

but I can tell you, it has shaken the confidence of that family to have

that kind of letter coming to them. How can the medical profession

continue to override the law of the land? How can that be allowed to

happen? I suggest that the minister has been remiss in not ensuring

that the law is obeyed.

I understand that there has been a

lot of negotiation going on. There is presently a draft poster to

patients in hand that excludes tray service from the list of

exclusions. But what assurance do we have that that new poster is going

to be posted? What assurance do we have that there is not going to be a

continuation of this misuse of power by the doctors concerned? It is

misuse. It's flagrant disregard of the law. There is an absolute lack

of understanding on the part of the medical profession that that is

excluded.

[4:30]

I spoke to my own

doctor, who is a personal friend, about this, and he said: "Well, we

could do it, but we don't do it because we figure we get enough. But we

could do it." That was his feeling. He had been told by the B.C.

Medical Association, obviously, that charging for tray service was a

permissible thing to do.

Now $5 may seem insignificant.

It's not just the fee; it's the principle. And $5 is pretty significant

to an old age pensioner or someone who is really faced with living on a

very limited income. So I have a lot of concerns about this. I hope

that the thing is being looked after, that it is in hand, but if in

fact it is not followed up, I'm suggesting there are going to be more

and more Mr. Lows who are going to have to continue to face that

situation. I guess a doctor has a right to refuse to treat a patient,

but that is some flimsy right to refuse to treat a patient because the

patient has insisted that the law be followed. That's really what it is

all about.

Maybe the minister would just like to deal with that before I go on to the next topic.

HON. MR. NIELSEN:

Well, if somebody went by the buildings, say, at 32 miles an hour, but

the law says you cannot exceed 30.... If someone wishes to do

something, it has to be brought to our attention. We don't sit in

doctors' offices and watch everything they do. We expect to hear from

the patients. If they feel that they're being inappropriately dealt

with, we expect to hear from them, or from their member if their member

is advised. We can't sit in all 5,000 doctors' offices and watch what

they do with each patient; we'd probably be breaching the

confidentiality of the doctor-patient relationship anyway. So I see

nothing wrong with a person bringing it to our attention. And I suppose

a doctor has a right to fire a patient, as a patient has a right to

fire the doctor. We don't force them to see a doctor other than the

doctor of their choice; nor do we force doctors, I presume, to accept

patients other than patients they wish to work with. No problem

reviewing that. Medical Services Plan has taken the stance that tray

service is included in the fee, and they have for many years. We look

into these when they are reported. I think perhaps about the only

exemption would be if it's an uninsured service. We'd look into

anything like that, of course. But there are going to be people who

misinterpret language and regulations and laws all the time. Our

position and purpose is to respond to it once it's brought to our

attention.

MRS. WALLACE: Mr. Chairman, it was brought to that minister's attention some long time ago.

Interjection.

MRS. WALLACE:

That fellow. The answer I got back was from that short-termer that was

in there between you and you — a second answer which sent me the new

poster that's now been worked at. What I'm suggesting to you is that if

you don't let it be known to the medical association that this is now

to be allowed, and make that very clear to them, this kind of thing is

going to continue. And I don't think that's fair or just to the people

that are caught up in this trap, like Mr. Lowe, who has lost his

physician as a result of this. Sure, he has the legal right to do that;

whether he has the moral right to tell a senior citizen that he will no

longer look after him simply because that senior citizen saw fit to....

Interjection.

MRS. WALLACE: Well, I

wasn't in on the conversation either. The minister says he wasn't in on

the conversation. But I know Mr. Lowe quite well. Mr. Lowe went to

collect his $5, and that's what happened: he was told simply that he

would send it to him through the mail; that he would not give it to him

there. When it arrived through the mail, it came with a letter saying

that he was no longer a patient of that doctor. I have another case.

This one also deals with the medical coverage, but it's the dental

coverage in this instance. This is a woman who was born with a

congenital problem with her mouth; and it's gone on and on. She has a

bill now of something like $3,750. She's unemployed. To complete the

work required is going to cost something like $5,000. But this is being

considered as outside the coverage, because it's being considered as

sort of cosmetic. Apparently the only thing they will cover is if this

work is done in a hospital. I would just like to read excerpts from her

dentist's letter, which was sent to the chairman of the Medical

Services Plan. It says:

"This woman has been under treatment for four months.

Her present condition" — I'm not going to even attempt the words, the

medical terms — "...sensitive teeth, uneven bite surfaces, some facial

asymmetry, speech difficulties, and a fair amount of stress, combined

with jaw, neck and shoulder pain. Her narrow palate and upper jaw

growth deficiency, as compared to the lower jaw, is most likely

hereditary; this, in turn, caused the deviant

[ Page 7728 ]

swallow, because there isn't sufficient space for her tongue

when she swallows."

Then

he goes on to talk about the treatment he has given, and so on. Mr.

Bolton's reply is that the medical plan is controlled by regulation,

and among other constraints this legislation limits payment for oral

and maxillofacial surgery to that which is medically required to be

performed in a hospital. Therefore she's not covered. He goes on to say

that in view of her age and the limitations of coverage only to certain

defined severe congenital abnormalities, he can't cover this.

would suggest to the minister that this woman's age is, I would say,

somewhere under 40. She has a long lifespan ahead of her. She is

presently unemployed. She's been diligently looking for work. She's a

bright and capable type, but she has a very grave difficulty. Her

dentist has carried that bill for her. She's going to need further

bridgework. We really can't expect her dentist to put up $8,000 or

$10,000 for her; and she's not going to be able to pay for that.

What

I'm suggesting to the minister, and asking him, is: would he review the

regulations, to see if there could not be some reinterpretation or

change that would allow for this kind of work when it's done by a

dentist rather than when the patient is hospitalized for it? That seems

to be where the problem hangs.

HON. MR. NIELSEN: Mr.

Chairman, sure, I'll look at it. But it's been questioned before. If

oral surgery is required and it takes place in the hospital, it's

covered, because it's oral surgery.

You're talking of

dentistry and.... I imagine there is a lot of orthodontic work

involved in that. It is simply not covered under the Medical Service

Act. It is not deemed to be a medical service, but rather it is a

dental service, and it is not covered. I mean, the Medical Service Act

is for medical services. This is not deemed to be one, I presume, from

what you have described. Sure, I would like a copy of that letter. I

presume I have seen it. There have been many cases like that, but it

simply is not covered under the regulations now.

MRS. WALLACE:

Obviously it is not covered, because that is why she is not getting it.

What I am suggesting to the minister and requesting him to do is to

have a look and see if the regulations can't be modified to cover these

kinds of cases which are of a hereditary nature, a congenital nature.

That is really a medical problem. But the treatment happens to not

require hospitalization, when it is a medical problem. Surely those

regulations could be so worded that they would allow a person in this

kind of situation to be qualified and able to get that kind of support

that.... Just a hair's breadth of difference as to where the

treatment is done causes the difference in how the payment is made. So

what I am asking him to do is to have a look at that.

want to change the subject considerably. I want to go into public

health inspection, and the problems that occur in rural subdivisions

where there is no water supplied and the percolation tests are done by

the health inspector. We seem to be having a continuing problem there

where.... I have had letters back and forth to this minister and

the interim minister on this thing, and nobody seems to be really

reading what we're saying into this. They keep coming back to us with

the same old thing: "Well, they can put a septic field somewhere else."

What

happened there in that particular instance that I am talking about in a

small subdivision outside of Duncan was that obviously there was some

error made when the first percolation tests were done. Whether when the

lot was staked out the inspector got on the wrong lot or what happened,

I don't know. But when this person went to build their house, they

checked on the percolation, and of course the prospectus of the company

indicated that this had been passed by the health inspector.

went to get his building permit from the local municipality, and they

agreed to him putting in a house with a basement in the spot that he

had designated. The result was that when he put his basement down he

discovered that what he had understood to be the case with percolation

was all incorrect, absolutely incorrect. So now he's in the situation

of having to change his house plans. He's in the situation of not

having a spot to put his sewage disposal without hauling in some $2,000

worth of gravel, which incidentally is contrary to the regulations,

as I understand them.

You know, what he is told is that

there are alternative sites where he can put this, but the alternative

sites are no good either. The one site that they are suggesting is a

place where the gravel that is there was simply put there when they

were putting in the roads. The whole thing hasn't been properly done,

and what happens is that then, based on that health inspector's report,

the municipality accepts that, the company accepts it. I want you to

ensure that there will be more care taken....

Interjection.

MRS. WALLACE:

You can't guarantee no mistakes, but I don't think this is an isolated

instance. I think what we need to do is to have some different

procedures, some more careful procedures, for ensuring that one report

done prior to the prospectus being issued is checked through some way

to ensure that it is correct before all these other things are based on

that. Because you start on a false premise and you get completely out

of line, as has happened in this particular instance.

The

chap who's trying to build the house is getting nothing but a runaround

from this ministry and the local government involved, and of course he

can't do anything about the original owner in this particular instance.

They've gone into receivership. But even so, a court case would cost

more than his return would merit. It is a most unfortunate situation,

and all I am doing is calling to the minister's attention the need for

a little more care in how those assessments are made relative to

percolation: the time of year they are done, how they are done and the

care in making sure that they're done in the right place.

MRS. DAILLY:

Mr. Chairman, I wanted to bring up an area that hasn't been discussed,

I don't believe, and it is the area of midwifery. I think the minis