Manitoba Hansard — 13 April 1992 (Sitting 45A, 35th Legislature, 3rd Session)

35-3-45a

Manitoba — Debates (Hansard)

Third Session - Thirty-Fifth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 39-40 Elizabeth II Publlsh8d under the authority of The Honourable Denis C. Rocan Speaker VOL. XLI No. 45A - 1 :30 p.m., MONDAY, APRIL 13, 1992 Printed by the Office of the Queens Printer, Province of Manitoba ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Fifth Legislature Members, Constituencies and Political Aff iliation NAME ALCOCK, Reg ASHTON, Steve BARRETT, Becky CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOMIAK, Dave CONNERY, Edward CUMMINGS, Glen, Hon. DACOUAY, Louise DERKACH, Leonard , Hon. DEWAR, Gregory DOER, Gary DOWNEY, James, Hon. DRIEDGER, Albert, Hon. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim , Hon. EVANS, Ciif EVANS, Leonard S. FILMON, Gary, Hon. FIN DLAY, Glen, Hon. FRIESEN, Jean GAUDRY, Neil GILLESH AMMER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKE S, George LAMOUREUX, Kevin LA THLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS, Clayton, Hon. MARTINDALE, Doug McALP INE, Gerry McCRAE, James, Hon. MciNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROCAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STORIE, Jerry SVEINSON, Ben VODREY, Rosemary, Hon. WASYL YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITUENCY Osborne Thompson Wellington River Heights Radisson The Maples Kildonan Portage Ia Prairie Ste.

Rose Seine River Roblin-Russell Selkirk Concordia Arthur-Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas Inkster The Pas St. Norbert Elmwood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Aon La Verendrye Fort Garry St.

Johns Swan River PARTY Liberal NDP NDP Liberal NDP Liberal NDP PC PC PC PC NDP NDP PC PC PC Liberal PC PC NDP NDP PC PC NDP Liberal PC NDP PC NDP Liberal NDP PC NDP PC NDP PC PC PC PC PC PC PC NDP PC NDP PC PC PC PC NDP PC NDP PC PC NDP NDP

210 1 LEGISLATIVE ASSEMBLY OF MANITOBA Monday, Aprll 13, 1992 The House met at 1 :30 p.m. PRAYERS ROUTINE PROCEEDINGS PRESENTING PETITIONS Ms. Judy Wasylycla-Lels (St. Johns): I beg to present the petition of Cindy Le Blanc, Brenda T. Hemery, and Patricia Kerekesch and others requesting the Minister of Justice (Mr. McCrae) call upon the Parliament of Canada to amend the Criminal Code to prevent the release of individuals where there is a substantial likelihood of further family violence. READING AND RECEIVING PETITIONS Mr. Speaker: I have reviewed the petition of the honourable member for Interlake (Mr.

Clif Evans), and it complies with the privileges and practices of the House and complies with the rules (by leave). Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth: THAT locally controlled public housing with elected and appointed board members encourages democratic and accountable decision making; and Many housing authority boards included tenants on the board of directors; and Volunteers serving on boards made worthwhile contributions to local housing authorities by serving their tenants, their community and in saving taxpayers' money; and With no consultation, the provincial government fired 600 volunteer board members, abolished 98 local housing authorities, laid off staff and centralized purchasing and administration; WHEREFORE your petitioners humbly pray that the Legislature of the Province of Manitoba may be pleased to request that the Minister of Housing (Mr.

Ernst) consider reinstating local housing authorities with volunteer boards. *** I have reviewed the petition of the honourable member for Wellington (Ms. Barrett), and it complies with the privileges and practices of the House and complies with the rules (by leave). Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth: THAT child abuse is a crime abhorred by all good citizens of our society, but nonetheless it exists in today's world; and It is the responsibility of the government to recognize and deal with this most vicious of crimes; and Programs like the Fight Back Against Child Abuse campaign raise public awareness and necessary funds to deal with crime; and The decision to terminate the Fight Back Against Child Abuse campaign will hamper the efforts of all good citizens to help abused children.

WHEREFORE your petitioners humbly pray that the Legislature of the Province of Manitoba may be pleased to request that the government of Manitoba show a strong commitment to deal with Child Abuse by considering restoring the Fight Back Against Child Abuse campaign. *** I have reviewed the petition of the honourable member for Swan River (Ms. Wowchuk), and it complies with the privileges and practices of the House and complies with the rules. Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth: THAT locally controlled public housing with elected and appointed board members encourages democratic and accountable decision making; and Many housing authority boards included tenants on the board of directors; and Volunteers serving on boards made worthwhile contributions to local housing authorities by serving their tenants, their community and in saving taxpayers' money; and With no consultation, the provincial government fired 600 volunteer board members, abolished 98

210 2 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 13 , 1992 local housing authorities, laid off staff and centralized purchasing and administration; WHEREFORE your petitioners humbly pray that the Legislature of the Province of Manitoba may be pleased to request that the Minister of Housing (Mr. Ernst) consider reinstating local housing authorities with volunteer boards. *** I have reviewed the petition of the honourable member for Burrows (Mr. Martindale), and it complies with the privileges and practices of the House and complies with the rules. Is it the will of the House to have the petition read?

The petition of the undersigned citizens of the province of Manitoba humbly sheweth: THAT child abuse is a crime abhorred by all good citizens of our society, but nonetheless it exists in today's world; and It is the responsibility of the government to recognize and deal with this most vicious of crimes; and Programs like the Fight Back Against Child Abuse campaign raise public awareness and necessary funds to deal with crime; and The decision to terminate the Fight Back Against Child Abuse campaign will hamper the efforts of all good citizens to help abused children.

WHEREFORE your petitioners humbly pray that the Legislature of the Province of Manitoba may be pleased to request that the government of Manitoba show a strong commitment to deal with Child Abuse by considering restoring the Rght Back Against Child Abuse campaign. * (1 335) TABLING OF REPORTS Hon. Rosemary Vodrey (Minister of Education and Training): Mr. Speaker, I would like to table the Supplementary Information for Legislative Review, 19 92-93, Departmental Expenditure Estimates for the Department of Education and Training. Hon. James McCrae (Minister of Justice and Attorney General): Mr.

Speaker, I am tabling today the annual report for 19 90 of the Office of the Commissioner for the Law Enforcement Review Agency. INTRODUCnON OF BILLS Bill 77-The Liquor Control Amendment Act Mr. George Hlckes {Point Dou gla s): Mr. Speaker, I move, seconded by the honourable member for St. Johns (Ms. Wasylycia-Leis), that Bill 77, The Liquor Control Amendment Act (Loi modifiant Ia

Loi sur Ia reglementation des alcools), be introduced and the same be now received and read a first time. Motion presented. Mr. Hlckes: Mr. Speaker, in keeping with the rules, I would just like to make a very brief comment. As most honourable members are aware, it is believed that at least nine residents of Winnipeg alone have died in the past year due to the consumption of cooking wine. This situation is approaching a major crisis in Winnipeg's inner city. Although most people recognize the problem and its importance, to this point, there has been no legislative action to address the issue.

The amendment I am proposing will lend a partial solution to a very serious problem. This bill would amend the definition of liquor in The Liquor Control Act so that cooking wines or liquors with an alcohol content in excess of 19 percent would be under the control of the Liquor Control Commission. I look forward to the appropriate support from all members of this very important bill. Motion agreed to. Introduction of Guests Mr.

Speaker: Prior to Oral Questions, may I direct the attention of honourable members to the gallery, where have with us this afternoon, from the Grant Park High School, twenty-eight Grade 9 students. They are under the direction of Mr. Roseman. This school is located in the constituency of Crescentwood. On behalf of all honourable members, I welcome you here this afternoon. ORAL QUESTION PERIOD Abitibi-Price - Pine Falls Financial Status Mr. Gary Doer (Leader of the Opposition): Mr. Speaker, on March 27, I raised a number o1

April13 , 1992 LEGISLATIVE ASSEMBLY OF MAN ITOBA 210 3 questions with the Premier dealing with the financial situation of Abitibi-Price in that it was owned by the Olympia & York corporation, a corporation at that time, a couple of weeks ago, that was going through a lot of financial difficulties through overexpansion in London, United States, real estate in Canada and New York, a company that has owned the Abitibi-Price Corporation that has made profits for 50-60 years and now is in jeopardy through the statements of the holding company Olympia & York to close the plant down.

The Premier at the time, in Hansard, stated that there were negotiations going on for the takeover of the operation, the community-owned operation, but that he was at the First Ministers' meeting on the economy and he could not give us the details of the financial implications of the bankers meeting with Olympia & York today in downtown Toronto and the company operation in Manitoba. 1 wonder if the Premier could advise us on the financial situation at the Pine Falls operation relative to the Olympia & York developments of today. Hon. Gary Fl lmon (Premier): Mr.

Speaker, the meetings continue to go on, as the Leader of the Opposition has indicated. To my knowledge, nothing has changed. Abitibi-Price indicated close to a year ago that they would not continue in the ownership and operation of the plant at Pine Falls, that the pulp and paper mill would not be able to be �arried on under the ownership of Abitibi-Price, Jltimately part of the Olympia & York empire.

The efforts that our government have been mtting forward-and I met at least twice in Toronto vith the CEO and senior vice-president, Eileen lilercier, of Abitibi-Price with respect to ensuring that hey would provide for an orderly transition of sale 1f the corporation to a group led by the nanagement, which included the work force as part ,f the ownership and operation. 1 know that there have been countless meetings wolving people such as the member for lac du lonnet (Mr.

Praznik) in his capacity, and interested 1 it, the Minister of Industry, Trade and Tourism (Mr. >tefanson), other ministers of this administration, rith the people trying to put together the package rhich would allow other people to acquire the ontrol and continue the operations of the Pine Falls ulp and paper mill under different ownership. (1 340) De-Inking Plant Feasibility Study Mr. Gary Doer (Leader of the Opposition): Mr.

Speaker, the Premier also took as notice, on the same day, the status of proposals before the Western Diversification committee of the federal cabinet dealing with a proposal to have a de-inking plant operation as part of the divestiture and the takeover of the community-based group, a de-inking operation that could potentially deal with the recommendations that the government finds before it in dealing with the Clean En vironment Commission and a substitute for the fibre that may be necessary if the government proceeds with those recommendations. 1 was wondering today, given the fact the Premier took this question as notice, what is the status of the de-inking plant operation?

Will we receive any support from either the provi ncial or federal government, particularly the federal government because Western Diversification seems to us to be totally appropriate for this kind of change into the future? What is the status of that proposal? Hon. Gary Fllmon (Premier): As I indicated in response to that question a couple of weeks ago, it is the responsibility of the proponents to go to Western Diversification and to ask for their support.

I understand that has been done. 1 might say that our caucus met last Monday, as I believe the opposition caucuses met last week with the principals of the Abitibi-Price operation, including representatives of those who intend to be part of the takeover package.

We confirmed our continued support for the de-inking facility as part of that takeover. 1 would just indicate that the information we have been given by those who plan to take over or are in the process of seeking financial support for a takeover, I would hope, is no different than the information they have provided to the opposition caucuses, and that is that basically the operations of the Pine Falls pulp and paper mill would be in jeopardy and in fact the economics would be likely unfeasible if the recommendations of the Clean Environment Commission were adopted by this administration, regardless of the availability of some recycled stock in terms of the de-inking facility.

If that is different from what has been portrayed to the opposition caucuses, perhaps they could say so publicly.

210 4 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 13 , 1992 Mr. Doer: Mr. Speaker, we have a consu ltant's report, Bowell Consultants, which is well known by the government, a report that was comm issioned by the band in the area dealing with the fea sibility of the plant, a fea sibility study that took place even before the recomme ndations were recommended to the gove rnment from the Clean Environm ent Commission, talking about that this plant would not be viable, notwithstanding any recom mendations to the Clean Environment Commission, without a recy cling proposal and a de-inking proposal.

The government has its own studies that it has commis sioned dealing with this operation. I was wondering, given the fact the government has had those consultant reports for a number of months, whether the government will make those reports public so that debate going on about the jobs and the environme ntal commis sion reco mmendations and all the issues that are at stake-and they are very important-cou ld be deba ted in a full way, Mr. Speaker, by Manitobans dealing with these very important policy issues. Mr. Fllmon: Mr.

Speaker, I am not in possession of that report nor have I seen that report, but I do know from the briefings that I have had that the plant will require certainly equivalent availability of wood for the process to what it currently has. In fact, given the tremendous losses that were sustained in the forest fires of the 19 80s, much of the previously commi tted timberland has been destroyed by fires, and therefore , it is questionable as to whether or not the existing stock is sufficient for its viability.

That is why we have indica ted for quite some time now, certainly more than a year, that we are very supportive of and very receptive to having a de-inking plant as part of the overall takeover and restructuring of that operation so that they will have sufficient recycled stock to supplement what appears to be a shortage of new wood stock to the operation. Shoal Lake ProtecUon Minister's Communication Mr. Gary Doer (Leader of the Opposition}: Mr. Speaker, ! have a new question to the Premier.

The Premier and I had, again, a debate on March 2�r not a debate but a discussion about the Shoal Lake proposal for the mining proposal at Shoal Lake.

The Premier indic ated at that time that the government was pursuing a two-track strategy with Shoal Lake: one, the strategy of having a basin management system in negotiations with all the stakeholders, a strategy that certainly we support on this side-1 am sure all Manitobans support it; and a second strategy of monitoring the environmental processes that are taking place in Ontario that were announced by the previous governmen t and are being maintained by the existing government in Ontario.

We had been advised that Consolidated is changing its proposal to the province of Ontario, is looking at processing the ore offshore now as opposed to on shore. I was wondering whether the Premier (Mr. Filmon) has reviewed this proposal and whether he has commun icated to the Province of Ontario on the impact of the change in that proposal from the mining company, and what impact it will have on Manitobans, particularly those who rely on that water supply and on that basin for our drinking supply. * (1 345) Hon. Glen Cummings (Minister of Environment}: Mr.

Speaker, I would like the opportunity to bring the Leader of the Opposition up to date on the circum stances surrounding Shoal Lake. We have not had any of ficial com munication from the Province of Ontario regarding this proposal that the member raises.

Until we see something a lot more substantive than a report in the paper or perhap� some verbal suggestions about what could occur our position is, as it has been enu nciated for somE time, that we believe this should go through the mos rigid evaluation for the long-term protection of tha water and that at the same time we wish to procee( in co-operation with all of the stakeholders for � basin management plan. We have had discussions with some of the band1 in the area.

I personally spoke to the Ontaric Minister of Environment not very long ago, and unt we receive something more substantive, howeve1 our position is unchanged. Mr. Doer: Mr. Speaker, before the newspape stories and other commun ication on this issue, w' had also heard inf ormally that the mine was workin with the mining industry in Ontario to change the proposal. It is not a rumour. It is something ver specifical ly that they are looking at with the minin industry of Ontario. Mr. Speaker, has the mi nis ter, in hi commun ication with the minister for Ontario, pointe

April 13 , 19 92 LEGISLATIVE ASSEM BLY OF MAN ITOBA 210 5 out the precedent of the Montreal River flooding where mining ore taken from mines off the basic water supply was processed off shore, but through floo ding and other me ans, those toxic materials-and we certainly know that toxic materials could be involved in the mining of gold in the processi ng of gold-did come into the water supply in the Montreal River? Has he commun icated our objections to the reconfiguration of that proposal? Mr. Cummings: Mr.

Speaker, let me make it very clear, there is quite a signif icant difference between discussions in the industry and changes that they are putting forward, and I presume they will, or if they have not already, put some pressure on the Ontario govern ment. The Ontario government has not commun icated to us. Our position has been and con tinues to be that we want the highest possible protection for the area.

I do not disagree with the basis of the Leader of the Opposition's commen t, but I do not think he should be attempting to frighten the people of this province again by talking about possible leaching into the lake. We are not talking about anything of that natu re . We have not had any offi cial commun ication, and I want to tell you that we will be negotiating with Ontario for basin management, the strongest possible protection.

As a matter of fact, the regulations that we proposed and asked Ontario to consider as part of a basin plan are, I think, quite capable of providing the protection, but there is now issue on the Ontario side of the border as to how the management of a basin plan should be structured. That is the position that we are in today. Rather than ramrodding the Province of Ontario, we are waiting to work with them to devise a plan that I believe could well be visionary, Mr. Speaker. • (1 350) Manitoba Regulations Mr. Gary Doer (Leader of the Opposition): Mr.

Speaker, our questions are only intended to have the earliest warning possible for Manitoba, which I think is obviously the most prudent course for all of us, no matter what side of the House we sit on. I have a further question to the minister, and he alluded to parts of it in his second question. In September of 19 90, the government talked about draft regulations that they were putting out on the :leafing with the Shoal Lake watershed area. Even tually last year, 19 91 , the government did put )Ut draft regulations for public consu ltation. The regulations are still out for consu ltation.

The minister mentioned that Ontario is raising some concerns. Mr. Speaker, when will we have the regulations on the Manitoba side of the watershed that the government promised during the election and afte r the election so that we can have a consistent position in dealing with the Province of Manitoba? When will we have those regulations completed? When will we make them public, and will the minister make public all the interventions from various groups on those regulations in terms of the public feedback that he has received dealing with this water supply which is a water supply for all of us? Hon.

Glen Cummings (Minister of Environment): Yes, Mr. Speaker, I would be quite pleased to provide an update on the status of those regulations. We are quite prepared to proceed with proclamation of those regulations and implement them on our side, which is the only area that we have jurisdiction on, but we have received presentation from two bands on the Ontario side of the border who are looking to a broader cons u ltation and co-management responsibilities in regard to discus sions that they have had with their government.

They specifically ask that we delay the implementation of those regu lations while broader discussion occu rs. Mr. Speaker, I indic ated to them, in the interests of being co-operative and the best interests of working towards a larger manage men t and agreement plan for that area, that we would not proclaim those regulations, but I have reserved the right to do so or to take the strongest possible action on our side of the border, if it is required, for protection of the water. I would ask you, Mr.

Speaker, and anyone who is interested in this topic to remember that the only place we can regulate is on the Manitoba side of the border. We have some negotiation capacity, but we have to rely very heavily on the co-operation and the implementation of either a plan or regulations on the Ontario side. We still have some considerable faith that Minister Grier will work with us. There seemed to be some confusion for a short period of time as to whether the ministry of Native Affairs was going to assume the main responsibility or whether it was the Minister of Environment.

I believe that is now back in the ministry of

210 6 LEGISL ATIVE ASSEMBLY OF MAN ITOBA April 13 , 1992 Environm ent's resp onsibili ty, and we ar e proce eding to work with them. Health Care System Public Accountability Mr. Guizar Cheema (The Maples): Mr. Speaker, my question is for the Minister of Health. We all know that health care is bec oming more and more a serious challenge for all provincial Leaders. Mr. Speaker, we must live in the real world and not the fan tasy land of the New Democratic Party. In Saskatchewan, the NDP think that the health premium will save medicare and reduce the deficit.

The lesson for Manitoba NDP is that the negative views on health care will lead to NDP premiums and taxes. Inno vation and reform will save the health care, not the premium on health care. Mr. Speaker, the recent reports of overbilling by doctors have added to the doubts of the public mind whether the government is able to exercise any effective ac countability and any effective control in the way we spend $1 .8 bnlion for 1. 3 million people. Can the min ister tell this House what the government is going to do to help the taxpayers of Manitoba under stand where the $1 .8 billion is being spent?

Can the minister tell us how they are going to have more ac countability and explanation for the people of Manitoba to save medicare by reform not by premiums? Hon. Donald Orchard (Minister of Health): Mr. Speaker, I think the

preamble to my honourable friend' s qu estion underlines the very serious challenge that all provincial administrations are now fac ing to deliver health care . I have ofte n noted that from the comfort of opposition, New Democrats will always suggest more spending, less accountability and any number of fixes, that when they are in governme nt, they immediately strip away from their rhetoric and move to act ion plans which involve more management of the health care system.

There is no question that recent revelations, in terms of the medical review process and, in this particular instance, the request for repayment by the medical review commis sion of inappropriately billed services by three physicians, have raised a whole new series of issues around the basic trust that we have em powered in the billing syste m for fee-for-service physicians. Mr. Speaker, we have checks and balance in place. They may not be perfect.

They may not work 1 00 percent of the time, but clearly they have in this instance worked, and we are willing to listen to reasoned suggestions on how to make the system even work more, includin g-and I note, from at least media responses by the opposition, that they would be open to a legislative resolution of the diffi culty of disclosure of physicians, should that be necessary, given that maybe no other solution might emerge. * (1 355) Mr. Cheema; Mr. Speaker , will the min ister consider one positive idea?

Will he require that patients sign a form each and every time they see a doctor and also that patients receive a quarterly statement showing exactly what the doctor has billed the government on behalf of taxpayers? Mr. Orchard: Mr. Speaker, let me deal with the second sugg estion fi rst . In terms of each Manitoban receiving with some frequency, on an annual basis or even more frequently, a summation of billings made on their behalf, there are two issues here. There is, first of all, the cost of doing that.

I have to say that we tried something similar when I first came into government, and we did not have a great deal of positive feedback as to its utility in the overall health care system from those individual Manitobans rece iving their statements. However, I can indi cate to my honourable friend that any Manitoban wishing to receive a copy of their billed services, that request can be made of the Manitoba Health Services Commission and that statement can be made available to them.

On the first issue my honourable friend raised in terms of patients signing, in essence, what I would interpret as being billing forms, that is worthy of investigation, Sir. I am willing to very much pursue that suggestion on behalf of my honourable friend in the Liberal Party to see if there is a method by which the taxpayers, the patients and physicians can assure that services are appropriately billed as the system would ask us to assure. Mr. Cheema: Mr.

Speaker, all these ideas will improve our health care and save X dollars, improve accountability, and also give some assurance to the health care providers that they are not cheating the system. Can the minister agree that the government mus1 do a better job explaining how we spend our $1 .8

April 13 , 1992 LEGISLATIVE ASSEMBLY OF MAN ITOBA 2107 billion? Now will they launch an educ ation campaign to make sure the people know how we are spending their $1 .8 billion? Mr. Orchard: Mr. Speaker, again I take that suggestion from my honourable friend as a valuable suggestion. I know my honourable friends in the medi a were present, maybe not themselves personally, but were present today at a debate that all three of us had before the Manitoba Nur ses' Union, and some information was attempted to be shared there, Sir.

The whole Estimates process is one in which explanations are made as to how we expend our dollars. I can indic ate to my honourable friend that hopefully we will be able to provide a much more expansive detail of how current dollars are being spent, some of the challenges that face administrators, the health care system, political parties currently in government across Canada and to share along with that, hopefully, the vision that we have as government in ways in which we can see a positive reform of the health care system in Manitoba taking place for the benefit of the patient. CareerStart Program Funding Mr.

Leonard Evans (Brandon East): I have a question for the Minister of Finance. We have a very serious unemployment situation in the province of Manitoba. Two years ago, our unemployment rate for youth was 13 .5 percent in the month of March, and $7 million was allocated for the summer jobs program for young people, CareerStart. Now the rate has jumped up to 18 .6 percent, an incredibly high rate, Mr. Speaker, butthe government has cut the CareerStart program to $3.5 million.

Would the government, would the Minister of Finance, be prepared to bring the CareerStart program back up to the $?-million level that it was at two years ago in light of the very serious unemployment situation? * (1 400) Hon. Clayton Manness (Minister of Finance): Mr . Speaker, we are very mindfu l of the �n employmen t numb ers across Canada and =ertainly in the province of Manitoba and within the ::lassifications of youth and in other areas within our 'rovince .

That is why, at some of the last days, Nhen we were completing the budgetary process, we introduced yet additional funds and a couple of new youth program areas. That is why we restored the same level of funding as last year in CareerStart. What the member, of course , is trying to do is focus specific ally into some areas.

I would point out for him, for instance, that Manitoba, vis-a-vis a whole host of other economic indic ators, is doing as well or above national averages, and if he wants to, in subsequent answers to his questions, I could focus or give greater detail with respect to base rate settlem ents, buildin g permit s, busi ness bankruptcies, farm cash receipts, housing starts in urban areas, manuf actu ring shipments, personal bankru ptci es, private nonresidential investment intentions and the unemployment rate. I could give him the good news in all of those areas, Mr. Speaker, if he so wishes, in a subsequent question.

Social Assistance Employment Creation Strategy Mr. Leon ard Evans (Brand on Ea st): Mr. Speaker, I am asking a question on behalf of thousands of un em ployed young people in Manitoba. That is all. What are you going to do for those young people? That is all. Mr. Speaker, a supplementary question. Would the government contact the City of Winnipeg welfare department which has developed a Jist of work projects for welfare recipients and explore ways and means whereby the province could assist the city in providing employment and training for welfare recipients?

I ask that since more people than ever before are on municipal welfare in the city of Winnipeg and indeed many other municipalities. Hon. Clayton Manness (Minister of Finance): Mr. Speaker, mindful again of most of the comments the member has made, I can assure him that in very short order, there will be a full announcement made by this gover nmen t with respec t to youth unemployment, to programs put into place to deal with the program. I can assure him they will be far beyond some of the programs that the former admin istration had to deal with problems that existed during their tenure in government. Mr.

Speaker, those announcements, I tell the member, are imminent, and I just ask him to hold his position, if he can, for a few more days. Mr.LeonardEvans: Mr. Speaker, I look forward to the positive announcement, but I ask, I repeat, or I change my question a bit. I ask the minister-! am

21 08 LEGISL ATIVE ASSEMBLY OF MAN ITOBA April 13 , 1992 talking about all people on welfare in the city of Winnipeg and indeed other municipalities. Will this government be prepared to work with the City of Winnipeg and its welfare department in providing jobs and training programs for people who are now drawing welfare, do a very positive thing, something that we did before ? Let us do it again. Will you take that initiative? Mr. Manness: Mr. Speaker, I swear we have been through this movie before . It was just before Christmas. It seemed that at that time, the member was calling on workfare.

Of course, we are starting all over again. It is a very serious issue. I can indicate to him, the government will be making an announcement in very short order. I expect that the member will be very congratu latory of the efforts put forward by the government, that he will leap to his feet and congratu late the government for its effo rts. Human Resources Opportunity Centre Closure Mr. Gregory Dewar (Selkirk): My questions are for the Minis ter of Family Services. Recent statistics show that unemployment, particularly among young people, has inc reased once again-this time to record levels.

Will the Minis ter of Family Services now review the true costs of increased welfare funding associated with the shutting down of the Selkirk training plant, the true cost? Hon. Harold Gllleshammer (Minister of Family Services): Mr. Speaker, the member raises a similar question to the member for Brandon East (Mr. Leonard Evans) . I would remind him that we have maintained the CareerStart Program at last year's levels, and young people and employers across the province are enrolling in that program at this time. As the Minister of Finance (Mr.

Manness) has indicated, we have a new program which was announced in the budget, the Partners with Youth program. We will be bringing forth details on that in the near fut ure. Mr. Dewar: Mr. Speaker, what will this minister say to the over 500 Selkirk residents who signed the petition opposing the closure and the dozens of single parents and young people who are being shut out of training opportunities by this minis ter? Mr. Gllleshammer: Mr.

Speaker, this budget has seen a massive increase in the spending of Family Services far outstripping some of the estim ates of spending brought forward by people who work, I am sure, with the opposition caucus. We have an increase of almost 9 percent in the Family Services budget this year. We have some ongoing programs which assist with job creation, the Single Parent Job Access, the Gateway program, and the HR OCs and HR OPs. From time to time, we have to review the success of those programs and make necessary changes to more adequately supply the training for people who are looking for work in the 19 90s. Mr.

Dewar: Selkirk had a very successful program there. Instead of closing this centre and having to increase welfare funding, will the minister postpone the closing for a year while he has the chance to meet with organizations involved and review the cost savings of keeping the centre training the unem ployed? Mr. GIIIeshammer: Mr. Speaker, we have given a thorough review to our training programs, and I would remind the member that there are training programs coming out of other departments as well that will be working to assist Manitobans who want to get back into the work force.

We have looked very care fully at the programs and particularly the people accessing those programs who can also access the programs in Winnipeg and Gimli and access other programs that the government is bringing forward . 811170 Cost Savings Mrs. Sharon Carstalrs (Leader of the Second Opposition): Mr. Speaker, my question is to the Minister of Family Services. Behind the very poor unemployment statistics and the poor Manitoba economy are the men, women and children who have to live on social assis tance.

It is estim ated that for 19 91 -92, the increase in social assistance recipients will increa se by 34.9 percent, 37.6 percent in the city of Winnipeg, which represents 89 percent of all cases in the province of Manitoba. In Bill 70, the government wants to establish a one-tiered we Hare syst em , a system that we suppor1 provided it does not lead to a decrease in benefitl! for we Hare recipients, for the 89 percent of the cases who live in the city of Winnipeg. Mr. Speaker estimates of the cost savings to the province for thi! single-tiered system have been as high as $5.E million.

April 13 , 1992 LEGISLATIVE ASSEM BLY OF MAN ITOBA 210 9 Can the Minis ter of Family Services today tell this Hous e how much the province will pay by decreasi ng the benefits covered by the province in this one-tiered syst em? Hon. Harold Gllleshammer (Minister of Family Services): Mr. Speaker, the member of the Liberal Party brought forward a lot of statis tics, some of which we will have to look at because I believe they are somewhat questionable. At the present time, the provincial social allowance rolls take care of some 27,000 cas es, and on the municip al rolls, there are around 12, 000 cases.

What this legislation is going to do, and I am pleased that the member is going to support it, is allow equal access to the program, no matter where you live in Manitoba, and as well standardize the rates that will exist across Manitoba. At the present time, there is a group of officials from my department and also members of the SARC comm ittee that was established in 19 89 working on some of the details of the program, and the figur es that the member is looking for are not yet available. • (14 1 0) Mrs. Carstalrs: Well, Mr. Speaker, that is simply not true.

Many of the figur es are certainly very much available. The payments that are paid under the provincial system and the payments paid by the city are available. They have been paid for a number of years, so they are not hidden figures. Mr. Speaker, can the Minis ter of Family Services tell this House, what is the saving to the Province of Manitoba by the fact that they will be paying less to the City of Winnipeg for their share of the benefit package to social assistance recipients? Mr. Gll leshamrner: Mr. Speaker, the increase in our budget in social allowances this budget year alone is some $41 mi llion.

That includes the creation of a new program for the disabled. It includes an increase of 3.6 percent in the basic rates. It includes an increase of 3 percent in the shelter componen t of the social allowances as well as a flowing of the tax cred its on a more timely basis. Now the work that is being done by the SARC comm ittee and the department is going to establish a single rate. It is also going to establish a common eligibility for the program. The rates that are existing across the province today cert ainly are public, but they vary from one municipality to another.

In many ca ses, they are much lower than the provincial rate. What the SARC comm ittee and the officials are doing now is they are looking at the details of those programs, and probably by the end of May or June of this year, we will be able to come forward , when the legislation is passed , with the information on that rate. Mrs. Carstalrs: Mr. Speaker, it is estimated that in order to equal some of the benefits that have not been paid in the past, the province will have to put in a contribution of somewhere between $500,000 and $1 .5 million.

At the same tim e, they will decrease their benefits to the City of Winnipeg by some $5.6 million. Can the minister explain why he thinks it is an appropriate time for the government of the Province of Manitoba to get a $3-million windfall on the backs of welfare recipien ts ? Mr. Gll leshammer: Mr. Speaker, the information that the member brings forward is not entirely correct. We have increased the spending on social allowances in this budget by $41 million alone. There are going to be changes in the amount of social allowances that flow to recipie nts.

In many municipalities the social allowances at this time are a frac tion of what the provincial rate is. There are some that have allowances that are equal to the provincial rate and others where it varies on the higher side. We are working with the SARC committee to finalize these details. We are working as well, and hope that members will move the legislation along to bring this to a reality, and we will be announcing those rates some time probably in June, after this comm ittee has had a chance to do its work. Furnace Inspections Condemning Authority Mr. Jim Maloway (Elmwood): Mr.

Speaker, my question is to the Minister of Labour. Recent reports of heat exchanger failures in Flame-Master furnaces have caused widespread concern in the public of Manitoba. Hundr eds of homeowners in Gimli and Transcona, in partic ular, have been concerned that cracked heat exchangers are health threatening and must be replaced. The cu rrent system allows for good furnaces to be replaced at great cost, and it also allows for bad furnaces to conti nue operating. Has the Ministe r of Labour determined who has the authority to condemn furnaces?

21 10 LEGISL ATIVE ASSEM BLY OF MAN ITOBA Apri1 13 , 1992 Hon. Darren Praznlk (Minister of Labour): Mr. Speaker, first of all, a very good question from the member for Elmwood, certainly a very topical issue. As the member for Elmwood may be aware, the legislative scheme under which we are operating today is the same legislative scheme that has been in effect in this province for quite a number of years.

Under The Gas and Oil Burners Act, they require that designation of furnaces be approved, as prescribed in the regulations, under a particular regulation that I believe was approved in 19 87, which defined •approved" as being approved and listed by the Canadian Gas Associa tion which approved the furnaces in question. With respect to insulation, that is done by the gas company which is required by the legislation and regulations to supervise and install the fittings and to report back and register with the department, and those things, of course, have been done.

Regr ettably, in this particular instance, the Canadian Gas Association which certified this particular unit pursuant to the regulations and the act, there was a flaw in the heat exchanger cells that was not detected at that particular time, and hence we have the problem today. Mr. Maloway: Mr. Speaker, from the answer that the minister has given, he has still not told us who has the ultimate authority to condemn the furnace because there is major confusion- Mr. Speaker: Question, please. Mr. Maloway: Would he clarify and tell us who has the final autho rity, the gas company or the government? Mr. Pra znlk: Mr.

Speak er , of cou rse, th is Legis lative Asse mbly, through The Gas and Oil Burner Act, has the final authority in these matters under the act and legislative scheme that was est ablished in this province for some years. The authority for inspect ion has been designa ted to the gas company wh ich is respon sible for the installations of the particular furnaces in question. They, of cour se, have to certify and register with the department thatthe installation meets the regulation and codes. The member has made some refe rence to the furnace.

We put out an announcement a week or so ago after we received notice from the Canadian Gas Association on the furnaces. Anyone who has this particular model is encou raged to con tact either the gas company or the Department of Labour, and we will ensure that things are properly ins pected to see if they cont ain the cells that are flawed. Mr. Maloway: Mr. Speaker, it is fairly clear to me that there is major confusion out in the public as to who really has the authority. Mandatory Mr.

Jim Malowa y (El mwood): My final supplementary question to the minister is this: In view of the number of recent incidences of carbon monoxide poisoning and since the gas firm and the department only carry out inspections on request, is the minister prepared to bring in mandatory, periodic inspections for all furnaces in this province? Hon. Darren Praznlk (Minister of Labour): Mr. Speaker, the scheme which is currently in place requ ires the supplier of the gas to have a responsibility for the installation and to ensure that it is working properly. They are the providers of the fuel.

They have that responsibility under the act. Where there is any difficulty that occurs, in this particular case, the ins pection goes on. If individuals have some concern over their furnace, they have the ability to request an inspection, and we are pleased to oblige. I should just tell the honourable member, in answer to his questions, some very relevant information that I think is important to this matter. There was some concern about the costs, in the paper, about the $1 ,200 per furnace.

I understand that staff in the department have identified the sup plier of the cel ls that can be purchased somewhere in the neighbourhood of about $60 a cell. So the cost of ac tually rectifying this problem could be in the range, depending on the number of cells that have been affected in the furnace, at somewhere near a third of the price that has been discussed in the media. Mr. Speaker: Time for Oral Questions has expired. Nonpolitical Statements Mr. Jack Reimer (Niakwa): May I have leave to make a nonpolitical statement? Mr. Speaker: Does the honourable member for Niakwa have leave? Leave. Agreed. Mr.

Reimer: It is my pleasure to draw the attention of the House to the fact that members of the Laotian, Cambodian and Sri Lankan com muni ties are cele brating their respective New Years during the course of this week.

April 13 , 19 92 LEGISLATIVE ASSEMBLY OF MANITOBA 21 11 Recently, it has been my privilege to share in some of these New Year celebrations, and I have found them mo st enjoyable events. We , as Manitobans, take pride in our rich and diverse multicultural society. Each of us cherishes the freedom and the opportunity to express and to foster all aspects of our own cultural heritage, our own languages, our customs and our traditions. This openness and acceptance is fundamen tal to promoting unde rstand ing, mutual respect and harmony among all ethnocultural commu nities.

The diversity of Manitoba's multicultural mosaic, of course, also includes the obse rvances of traditional festivals and the cust oms or the practices associated with them. We are privileged to be able to share these special celebrations such as the New Year celebr ations with our fa milies. Through the sharing of all aspects of our cultures, we have come to realize both our differences and our sim ilarities. Reaching out in this way is the key to promoting the understanding, the respect and the equality that make our multicultural commu nity so strong and so vibrant.

I ask the mem bers of the House to join with me in extending our best wishes for a healthy, happy and prosperous New Year to the member s of the Manitoba's Laotian, Cambodian and Sri Lankan commun ities. Thank you very much. *** Mr. Guizar Cheema (The Maples): Mr. Speaker, may I have leave to make a nonpolitical statement? Mr. Speaker: Does the honourable member for The Maples have leave to make a nonpolitical state ment? Leave. Agreed. Mr. Cheema: Today, the Si kh commu ni ty throughout Manitoba and the nation will celebrate Festival of Vaisakh. Mr.

Speaker, it is one of the most important days in our cultural activities and spiritual activities. It was on April13, 1699, the 1Oth guru, Gobind Singh, created the Khalsa Panth by choosing five disciples of tested courage and ad min is tered them by holy water, prepared according to the set religious proceed ing, and blessed these five individuals to guide their lives on the basic principles of sacrifice, responsibility, account ability, acting for the good of others, truth, beauty and goodness. It was that day the common surname "Singh" and the five "K" symbols of the religion were given by the 1Oth guru.

The foundation of order of Khalsa, its growth, prosperity and contribution to human civilization, bear witness to the strength and vitality of the Sikh faith. The ideals and values set by Guru Gobind Singh and em bodied in the Khalsa-c ou rage, sacrifice and compassi on-remain as valid today in Manitoba as they were during the Vaisakh at Anandpur in 1699. Mr. Speaker, I would like to extend best wishes on behalf of myself and the memb ers of this Assembly to the entire Sikh communi ty in our province and this nation on this very important social and spiritual occa sion.

Let us pray for harmony, peace and prosperity for all people around the world. Thank you. * (1 420) Hon. Bonnie Mitchelson (Minister of Culture, Heritage and Citizenship): Mr. Speaker, might I have leave to make a nonpolitical state ment? Mr. Speaker: Do es the honour able madam minis ter have leave? Some Honourable Members: Leave. Mr. Speaker: Leave. It is agreed. Mrs. Mitchelson: Mr. Speaker, I would like to join with the member for The Maples (Mr. Cheema) in rec ognizing today, April 13, as a very auspicious day for Sikhs here in Manitoba and throughout the world.

We do know that it is the time for those of the Sikh faith to gather and rejoice in their spiritual and cultural heritage. So along with the member for The Maples and all member s of this House, I would like to join with the commu nity and extend good wishes to Manitoba's Sikh commu nity as they gather to celebrate the Festival of Vaisakh. Thank you. Mr. Doug Martindale (Burrows): Mr. Speaker, do I have leave to make a nonpolitical statement? Mr. Speaker: Does the honourable member for Burrows have leave? Leave. It is agreed. Mr. Martindale: Mr.

Speaker, it is my pleasure to rise and to recognize an important festival of the Sikh religion. April13 is Vaisakh day. On this day, in 1699, Guru Gobind Singh, the 10th guru, created the Khalsa Panth, the "Brotherhood of the Pure," by administering amrit, which is nectar used in the rite of initiation, from the same bowl to the first mem bars, the five beloved, and by instituting the five Ks, the symbols of the faith worn by all dedicated Sikhs. Each Khalsa brother is given the name "Singh" or "lion" and each sister "Kaur" or "princess."

21 12 LEGISLATIVE ASSEMBLY OF MAN ITOBA April13 , 1992 We would like to join with other honourable members in recog nizing this festival in their religion. I would like to add that I rece ntly visited one of the Sikh temples in Winnipeg and enjoyed very much their hospitality and learning more about their faith. While I am on my feet, I would also like to cong ratulate the Laotian, Cambodian and Thai commu nities as they cele brate New Years and hope that they have appropriate celebrations and that the next New Year in Canada is a good one for them and everyone in their communi ty. Thank you, Mr. Speaker. *** Mr.

Edward Helwer {Gimll}: Mr. Speaker, do I have leave to make a nonpolitical state ment? Mr. Speaker: Does the honourable member for Gimli have leave to make a nonpolitical statement? Some Honourable Members: Leave. Mr. Speaker: Leave. It is agreed. Mr. Helwer: Mr. Speaker, 43 years ago the Kinsmen Clubs of Mani toba started a trend motivated by the early successes of organizations working together with children with physical disabilities. The Kinsmen decided to sponsor Manitoba's first Easte r Seals Campaign in 194 9. The following year, the Society for Crippled Children and Adults of Manitoba was formed .

The society worked to improve the quality of life for the disa bled with a special em phasis on living independent within the com munity. In 19 85, a name change was in order to bring about a renewed focus on the person rather than the disability. The Society of Manitobans with Disabilities assists Manitobans with disabilities resulting from cerebral palsy, mu scu lar dystrophy, hearing impairm ent, arthritis, epilepsy, amputations and others.

Services provided include wheelchai rs, canes and crutches; in di vid ua l and fam ily counselling and support; occupati onal, physical and sp eech the rapy; and edu cati onal tr aining assis tance. Manitobans have long rec ognized the unique Easter Seal stamps that arrive in their mailbox at this time of year. The annual Easter Seal campaign is both a fundraising appeal and an awareness campaign. This year, almost 1 ,200 Manit oba children will benefit through Easter Seals. The slogan for the campaign is: Thanks for helping kids with disabilities.

The Easter Seals fund raising goal of $284,000 will only come about if Manitobans respond generously to this year's Easter Seals appeal. Today I rise on the first day of Easter Seals Week, April 13 to 20, to salute the work of the volunteers and staff working on the Easter Seal campaign, and I encourage all Manitobans to support the Easter Seals campaign. ORDERS OF THE DAY House Business Hon. Clayton Manness (Government House Leader}: Mr. Speaker, I would like to provide information on House business.

To begin, I would like to announce today that there has been agreement amongs t the parties that Thursday of this week will be treated as a full Thursday; that Monday next we will not come in to be in attendance, that we will take Monday next off, which is the 20th, Easter Monday, April 20; and Tuesday following, the 21 st, will be treated as if it were a Monday. I would seek leave, Mr. Speaker, on that one particular issue. Mr. Speaker: Is there leave of the House to take Monday off, it being Good Monday and treating the Tuesday as a Monday? That is agreed? Some Honourable Members: Agreed. Mr.

Speaker: That is agreed. The honourable government House leader, we thank you for that informa tion. Mr. Manness: Mr. Speaker, I would like to call the Standing Comm ittee on Municip al Affairs, to consider Bill 45, The City of Winnipeg Amendment, Mu nicip al Amen dm ent and Consequ ential Amendments Act, for tomorrow night, Tuesday, April14 , at 8 p.m. in Room 255, and also April15 , the day following, Wed nesday, at 7 p.m. , if necessary . Now, I would like to give a clearer

schedule with respect to other standing committees dealing with annual reports. There are going to be some changes from the list I provided last wee k: Tuesday, April 21, 19 92, 10 a.m., Standing Comm itte e on Public Utilities and Natu ral Resources to consider the 19 90 Annual Report of Manitoba Mineral Resources. Exactly a week later, April 28, at 10 a.m ., Standing Comm ittee on Economic Development to consider the Annual

April 13 , 1992 LEGISLATIVE ASSEMBLY OF MAN ITOBA 21 13 Report of the Manitoba Lotteries Foundation. Some of these may be repeats, Mr. Speaker. Tuesday, April 28, at 8 p.m., that is, after dinner, Standing Comm ittee on Public Utilities and Natural Resources to consider the '91 Annual Report of the Comm uni tie s Economic Development Fund. Wednesday, April 29, at 8 p.m., Stand ing Committee on Econom ic Development to consider the 1990 and '91 Annual Reports of the Manitoba Development Corporation.

Tuesday, May 5, at 10 a.m., Standing Committee on the Economic Development to consider the '90 and '91 Annual Reports of the Manitoba Energy Authority. Thursday, May 7, at 10 a.m., Standing Comm ittee on Public Utilities and Natu ral Resources to consider the '89 and '90 Annual Repor ts of the Man itoba Hazardous Waste Management Corporation. These are the changes. We would like to cancel the Standing Comm ittee on Public Utilities and Natural Resources that had been called and sched uled for Thursday, April 23, to consider the Annual Report of the Manitoba Public Insu rance Corporation.

We would like to resch edule that for two dates: Tuesday, April 28 at 8 p.m. and Thursday, April 30, at 10 a.m. to conside r the '91 Annual Report of MPIC. We would also to change the Standing Committee on Public Utilities and Natural Resources scheduled review of the Crown Corpor at ions Council scheduled previously for Thursday, April 23, and take it back a week to Thursday, Apri1 30, 19 92, at 10 a.m. in the morning. Again, that is to cons ider the Annual Report of the Crown Corporations Council. I have schedules of this, and I will provide it for your table staff . Mr.

Speaker: Thank you very much. • (1 430) Mr. Manness: Mr. Speaker, with those changes then of comm ittees, in announcement of the House, I am going to now move, seconded by the Minister of Northern and Native Affairs (Mr. Downey), that Mr. Speaker do now leave the Chair and the House resolve itself into a commit tee to consider the Supply to be granted to Her Majesty . Mr. Speaker: I thank the honourable government House leader for that informa tion. Motion agreed to, and the House resolved itself into a comm ittee to consider of the Supply to be granted to Her Majesty with the honourable member for St.

Norbert (Mr. Laurendeau) in the Chair for the Department of Health, and the honourable member for Seine River (Mrs. Dacquay) in the Chair for the Department of Family Services. • (1 440) COMMITTEE OF SUPPLY {Concurrent Sections) HEALTH Mr. Deputy Chairperson (Marcel Laurendeau): Order, please. Will the Committee of Supply please come to order. This afte rnoon, this

section of the Committee of Supply meeting in Room 255 will resume consideration of the Estimates of Health. When the com mittee last sat, it had been considering item 1. (

b) Executive Support (1 ) Salaries on page 82 of the Estimates book. Shall the item pass ? Ms.JudyWasylycla-Lels(St.Johns): Mr. Deputy Chairperson, I am wondering if I could put to this comm ittee the suggestion I made last week about moving directl y to the line dealing with hospitals. Over the weekend, since we last met, and at a large gathering of nurses this morning, we heard more concerns about hospital budgets and bed cuts, and growing concerns and worries about our hospital syst em.

I would therefore, again, make the request that given the urgency of the situation, given the indication from the minis ter that he is prepared to answer detailed questions on hospitals, if there would be a consensus to move to line 5.(

b) Hospitals and Community Health Services. Mr. Deputy Chairperson: As the committee is aware, unanimous consent would be necessary. Is there unanimous consent to move to line 5? An Honourable Member: No. Mr. Deputy Chairperson: No? In that case, we will resume with 1 .(

b) Executive Support. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I wonder, given some growing concerns in this area, if the minister is now prepared to indic ate what percentage increase each hospital will be getting, and I will start with each urban hospital in Manitoba.

21 14 LEGISLATIVE ASSEMB LY OF MAN ITOBA April 13 , 1992 Hon. Donald Orchard (Minister of Health): Mr. Deputy Chairperson, as I have indic ated to my honou rable friend, I will have appropriate staff available when we reach that line later on in the Esti mates process and would be pleased to share that information with my honou rable friend as available then. Failing that, what my honourable friend might consider doing is using this line of the Estimates under Executive Support with the appropriate staff that I have here today to deal with historic analysis.

My honourable friend was deeply offe nded at one point last week that I had instant answers almost for the memb er for The Maples (Mr. Cheema). That was not exactly accurate. It took a day to put them together, but they were an analysis of past spending which were answers that my research division can provide. Should my honourable friend have those types of questions, I would be more than pleased to deal with them. Failing that, my honourable friend can pass the ensuing lines, and we can get to hospital funding that much quicker. Ms.

Wasylycla-Lels: If the minister would like to table that inform ation, we would certai nly be happy to receive it. However, my specific questions today, as they have been for the past, I think it is 20 hours, have to do with current budgetary allocations for our hospitals. I am wondering if the minister could elaborate on an indication in the media this weekend that he in fact, at some point in the near futu re, would be tabling or releasing a comprehensive health care plan. Now, those are not exactly his words, but there was the suggestion through the media that there is a plan the minister is prepared to table.

I am wondering if he could tell us what kind of a plan this is, how comprehensive, and how soon we can expect that. Mr. Orchard: Not wishing to delay the time of the comm ittee, but I believe I have answered that on two di fferent occas ions in this comm itt ee, my honou rable member present, in response to questions from the memb er for The Maples (Mr. Cheema). Ms. Wasylycla-Lels: The me mber for The Maples-! will let him speak for himsei H11 ay feel he has had dissatis factory response.

I still do not believe we have had very much detail around the overall long-term comprehensive plans of this government for health care ref orm. I certainly would still be interes ted in knowing what that plan looks like and what is contem plated for the future under this administration. Let me ask specifical ly, since we still do not have the hospital budget informa tion, how it is, if, as the mi nister has indic ated previously, hospitals on average or in general will be getting a 4 percent to 5 percent increase, how is it that hospitals are now looking at cuts to their operating budgets?

I know the minister has talked about in the past the gap between what hospitals requested and what this government provided. I do not believe that explains any of the situations that we are hearing about. I would like, therefore , to ask how it would be even feasible, conceivable, that a hospital like Seven Oaks General Hospital, under a 4 to 5 percent increase from this government, would still find itself in a position of cutting $1 .2 million from its operating budget? Mr. Orchard: Mr. De puty Chair person, my honourable friend might refer to page 88.

In Resolution 71 , item 7 of the Health Estimates, the line Hospital goes from $892,463,800 in the Estimates we passed last year to $946,828,200 in the Estimates I am asking to be passed this year. That is an increase in funding for hospitals, not a decrease in funding to hospitals. My honourable friend wants to spend the next number of hours asking details on current hospital budgets. I will give her my same answer that I have given before , that we will deal with those when I have the appropriate staff here when we reach this line in the Estimat es.

This is not the only spending area that is important to the people of Manitoba. I realize the NDP are fixated on hospitals and hospitals only. They do not care about home care, mental health and its reform or any other area of the department, and they want to pursue headlong into hospitals because they think that is the only important area of the minis try. There are many others and we can debate them as we proceed through the Estimates. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, the minister knows that the NDP is not fixa ted on one particular aspect of the health care syste m.

The NDP is trying to deal with a very serious and pressing issue with respectto chaos and uncertain ty in our health care system generally, and part of the reason for that current situation of instability is the

April13 , 19 92 LEGISLATIVE ASSEM BLY OF MAN ITOBA 21 15 way in which this government has chosen to fund hospitals and the secrecy surrounding those plans. I do not think it would be terribly inappropriate and certa inly not with the mi nis ter's capability of ans wering today that question of how it could at all be poss ible for a hospital like Seven Oaks to be con templating that kind of cut to their operating budget if there was that significant increase that the minister refers to and that he has again referred to on the basis of page 89.

Could the minister indicate if all hospitals will be getting the same percentage increase , and if this increase that he refers to on page 88 and 89 is strictly for operating purposes or if it covers any capital expenditures as well? Mr. Orch ard: Mr. Deputy Chairperson, I can answer that question of my honourable friend when we get to the line, and when the appropriate staff are here, details can be made available. * (1 450) Ms. Wasylycla-Lels: I am sure the minister will appreciate the reasons for us continually asking these questions.

We keep getting new information and new pieces to this puzzle, and it is quite disturbing, and I am sure if we could piece it all together and get a sense of the overall plan, we might not be so concerned . It is cert ainly disconcerting to me and others that decisions are being made now by a hospital like Seven Oaks General Hospital with respect to their operating budget. By the time we get to this line, even if we moved on it by the end of the week, we would still be too late, Mr. Deputy Chairperson, and the minis ter's argument does not stand up very well, that we could not be addressing some of these issues.

The member for Inkster (Mr. Lamoureux) should knowthat even if we had moved imm ediately along, we still would not have been at hospitals bec ause, in fact, all of those major issues that the minister has refer enced, that the Liberal critic has referenced and that I care about as well come between this first line and hospital services. Communi ty care, home care , mental health services are all big topics, and they all come between now and the lines pertaining to hospital services.

I would like to ask the mi nister if he could elaborate a bit more on where I left off last week in Estimates and tell us about the process in terms of the Urban Hospital Counc il, when exactl y the next meeting of the Urban Hospital Council will take place, and what is on the agenda of that meeting? Mr. Orchard: I do not know when the next meeting is, and I do not know what range of issues are on the agenda, but they are issues important to the health care syst em. Ms.

Wasylycla-Lels: Could the minister indic ate when the Urban Hospital Council will be meeting to deal with some of these significant changes to hospital operations, consistent with the minis ter's indication that decisions hospitals make that will have an impact on other hospitals would, in fact, be vetted through the Urban Hospital Council? Could the minister indic ate when the issues of budgetary matters that spill over onto other hospitals and affect the syste m as a whole, when that meeting will take place ? Mr. Orchard: I would not suspect that this would be one single meeting. Ms.

Wasylycla-Lels: Is the minis ter saying, as he has suggested in the past, that he is not prepared to give us information about when the Urban Hospital Council will meet to deal with some of these very serious matters pertaining to funding and the future of our hospital syste m, as well as our commu nity-based syst em? Let me rephrase this so that the min ister clearly understands my question . On the one hand, the minister says that he will be inform ing the public and providing necessary informati on, as it is necessary and as it is pulled together.

He also has indicated that those matters of a signif icant nature will be reviewed by the Urban Hospital Council, but the minis ter will not tell us when the Urban Hospital Council might be meeting to deal with some of these major issues. How much longer will Manitobans be kept in the dark? When will they have an opportunity to see some of these plans and have some input? Mr. Orchard: Mr.

Deputy Chairperson, with all due respect, I think my honourable friend's mind has become an omelette, and she is attempting to reduce it back to the basic components of eggs and ingredients and is having a great deal of difficulty doing that. I have indic ated to my honourable friend the member for The Maples (Mr. Cheema), when he posed the question about public discussion, et cetera, that it is hoped that this process on reform

21 16 LEGISL ATIVE ASSEMBL Y OF MAN ITOBA April13 , 1992 of the health care syste m will be undertaken this month. I have indicated in responses to my honourable friend the member for St. Johns (M s. Wasylycia-Leis) that there are 41 issues currently before the Urban Hospital Council. Those 41 issues are not specifically attached to the discussion paper that we hope to have available to the public. Some bits, pieces, and parts are, because you do not approach the health care system with one discussion paper answering all the questions The system is too large and too complex.

I have indic ated in my answer to my honourable friend on Thursday last, where appropriate, we will use the res ources of the Health Advisory Network; where appropriate, we will use the resources of the Manitoba Centre for Health Policy and Evaluation; where appropriate, we will use the resources of the Urban Hospital Council to receive feedback on given issues.

The whole health care system will be involved in receipt of debate of investigati on into the reform plan that I hope becomes a public discussion paper-not only the Urban Hospital Council, not only a given union or professional group, but those who view the health care system from without and from within. Those are two different issues. Ms. Wasylycla-Lels: To pursue the egg analogy, if my min d is an ome lette, the minis ter's is scram bled. Alii am getting, and all that Manitobans are getting, is a very confusing message without any overall direction and plan being provided.

We are left only with the impression that there is no plan. We are sim ply asking for the minister to sort of unscramble all these words and codes, and let us know exactly, maybe not exactly, let us know in broad terms what he is looking at and when it will start to come together. He says that some studies will be part of this plan that will be released soon. What about all the other parts? What about the studies that the minister has em barked on and, in fact, to seem completed for other parts of the health care sys tem?

Why is it important for the minister to sit on those studies unless he is worried about information getting out to the public that might be constructively critical of the present system, not just this government but previous governments? Unless he is involved in some sort of management and damage control of a bigger problem, we do not understand, and people do not understand, why some of these studies could not have been released as they were comp leted. Why the secrecy?

I simply would ask if the minis ter could see fit to table, tomorrow if possible, any completed studies pertaining to our health care system so we could at least begin sharing that infor mation and having a dialogue. * (1 500) Mr. Orchard: Mr. Deputy Chairperson, at the risk of sounding antagonistic, my honourable friend is beginning to sound like a broken record . She always has to toss in her desired, hoped for, answered conclusion that our agenda is a secret agenda.

I might point out to my honourable friend that if it was not for the openness of the process and the wide distr ibution oftask force discussion papers, my honourable friend would be incredibly bereft of any issues with which to bring questions to the House. Every one of the questions I have received from the member for St. Johns is not predicated on origin al resear ch and un derpin ned with a knowledge of the syste m and a desire to convince government that the New Democratic Party agenda for change is the one that the government ought to embrace.

Every one of my honourable friend's qu estions is the resu lt of an inte rim report commis sioned by this government and widely cir cu lated. If it we re not for those "leaked documents," my honourable friend would not have an original thought. Now she is saying that it is a secret process. Well, that will not sell at all. But let me tell you, I am going to do something which is really unusual. I am going to share with my honourable friend just two statements which I think might put her mind at ease today.

The Canadian Medical Association, the Canadian Nu rses Association and the Canadian Hospital Association did a review of significant health care commissions and task forces in Canada since 19 83-84. It is my understanding that this report was released within the last number of months. It goes through an introductory period and it talks about some of the suggestions that they put together from looking at studies from every single province in the cou ntry of Canada. The first issue is financial resources that they dealt with.

It says in here, a few reviews expressed concerns over the decreasing rate of growth of fiscal transfers

April 13 , 1992 LEGISL ATIVE ASSEMBLY OF MAN ITOBA 21 17 from the federal government to the provincial governments received primarily by EPF. By and large, however, most of the comm issions seemed to accept this fiscal transfer si tuation and recom mended a number of initiatives that would en hance cost contr ols, fu nding rev enues, efficiencies and cost effecti veness.

Now, bank that statement by itself by a report done by the CMA, CNA and CHA rather indica tive, because today's debate with the MNU , I am sorry , but I said I did not hold out a hope that the fe deral government was going to miraculously solve our problem with more money. First of all the process, as identified in this, was started by a previous federal government, has been carried on by the current fe deral government, and should the New Dem ocrats be the federal government, would be carried on by them. They would not find the magic money that my honourable friend seems to think the federal government can.

That is what, basical ly, all of these su rveys are concluding, and is reprinted by the CNA, CMA and CHA. Here are two of the reco mmendations that I think are very im portant. First it says, im portant recommen dations to note are those with respect to the following directio ns: firs tly, reduce acute-care hospi tal beds, es tablish freezes on capital construction plans, refr ain from const ructing new hospitals, implement budget and salary fee freezes.

Well, that is a com pilation by the Canadian Nursing Assoc iation, Canadian Medical Association and the Canadian Hospital Association of the conclusion of studies done across the length and breadth of this country. Another recommendation which is an important one, given today's discussion: Incr ease the number of outpatient clinics as well as home care and co mmuni ty su pport se rvi ces. Provide additional funds for health promotion and illness injury and prevention, and subs titute in-home services for inpatient services.

Unlike previous eras, these proposals are not recommended as add-ons, but most importantly, many of the reviews rec omm ended reallocating existing financial resources to these alternatives. Guess what I announced in my opening remarks, now three weeks ago, as the plan by which we intend to reform the system ? Exactly that. My honourable friend persists in trying to divest herself of her omelette thinking. She had the plan laid out to her. It was further explained today. Every time we have been in Estimates and Question Period it has been further explained. We intend to move resources with the patient.

We intend to close acute-care beds in the teaching hospitals, for instance, move the budget with the patient. Guess what? Compilation of studies put together by the nurses of Canada, the doctors of Canada and the hospitals of Canada are sayi ng those conclusions are reached across Canada. Now, of course , that is not good enough for my honourable friend the NDP critic in opposition. All of those people across Canada are wrong. All the nurses across Canada are wrong. All the doctors across Canada are wrong. All the hospitals across Canada are wrong.

All the provincial governments across Canada are wrong, including the New Democratic government in Ont ario, the New Democratic government in Saskatch ewan, the New Democrati c gov ernment in British Columbia. They are all wrong. The only people who are right is Manitoba and the NDP in opposition. Well, I am sorry, Mr. Deputy Chairperson, but I have to say, give me a break. My honourable friend does not understand health care reform .

My honourable friend does not even understand politics that well because she seems to believe that she can try to create this issue of terrible things going to happen in the health care system and try to piggyback her election fortu ne on that. Well, let me tell you, the deeper my honourable friend digs herself into her adherence of deficits in hospitals-hospital is the only issue that is important to her because not one other question has been posed by my honourable friend in 17 hours, other than hospitals. They are the only thing that matter to the NDP in Manitoba.

She is going to find herself more and more alienated from policies of her soul mates in Ontario, Saskatc hewan and B.C. Now, that makes my job incredibly easy this year, next year, the year after and when we go to the election , because here we are going to have the NDP promising the world in the face of the reality of NDP governments across Canada hacking and slashing the syste m like it has never happened, never had done to it before , no t by a neoconser vative government in Saskatchewa n, but by the founders of medicare in Canada, the good old NDP in Saskatchewan.

My honourable friend, of course, is going to tell us, as she did last week, she disagrees with that

21 18 LEGISLATIVE ASSEM BLY OF MAN ITOBA April 13 , 1992 going on in Saskatchewan, but she does not tell us what she agrees with. At least I give my honourable friend in the Liberal Party credit, credit that he deserves and his party deserves . At least they are willing to say what they stand for, not just what they are against. You want to get on with Estimat es? We will talk about what you stand for, what we stand for, we will contrast them, and we will let the people decide. In the meant ime, keep on going against nurses, doctors and hospitals right across the length and breadth of the province.

They understand the syst em. They understand the challenges and they are going to work with governments like ours. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I will certainly acknowledge to the minister and to everyone else here that I make no pretence to know everything about our health care system and health care refo rm, that I have a lot to learn yet. I think I am qu ickly ge tting an un de rsta nding and appreciation for the main areas that need change and have asked questions about that over the last 17 hours.

We, as the minister knows from my previous commen ts, have not disput ed recommendations like the ones the minister has just read again. We have quarrel with how this government is apparently moving to implement those kinds of rec ommen dations. I use the word "apparent" because we do not have all the information, so it is a bit of guesswork on our part to try to piece it all together.

For example, we have raised concerns about the way this government budgets, and in fact, have suggested that maybe we are involved in a bit of a phony budgeting process from the minister and this government because in fact they may, yes, show on paper an increase in home care and that increase may in fact reflect growth in numbers of cli ents needing home care to the best of the government's ability to predict. We have no evidence and no sign that any of that money is going toward ensuring the necessary number of staff and resources and supports and equipment to meet that new clientele.

I think that is where we are getting at some of the roots of the problems when we hear from constituents in Swan River and Dauphin who have been told that they are being cut off home care or are being encouraged to turn to private companies, or when we hear from staff in the field who are being told their hours are getting cut back. I do not think that any of those stories we have heard about are exaggerated, just as those nurses who came forward this morning seemed to me to be very genuine and certain about cases thatthey were experiencing personally or had dealt with on a professional basis.

So there does seem to be something happening which would tell us that perhaps the government and the minis ter have some of the broad principles down pat and some of the right rhetoric, but may not be applying budgeting processes and programming exercises to meet those objectives and principles in a way where people's needs are met when they do go back into the home or into their communi ties after having been in hospital. Those concerns still remain.

If the minister would like to answer any of those at this time about the Home Care budget, I certainly have no objection to that being discussed before we get to the line. Let me ask another question of a very general nature before I ask some specifics on Executive Support, and that is, would the minister indicate today when we might see the estimates for capital expenditure for the Department of Health? * (15 10 ) Mr. Orchard: Well, I am hoping that the capital estimates will be av ailable at the time we reach Expenditures Related to Capital. Ms.

Wasylycla-Lels: Sorry, could the minister indic ate when that would be, which line? Is that on page 40? Mr. Orchard: Resolution 73. Mr. Deputy Chairperson: Expenditures Related to Capital are on page 89, Reso lution 73. Capital Construction is also under Resolution 69 on page 88, in the main book. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, I am asking the question for a couple of reasons. One, it is not exactly clear these days where capital estimates fall, because we now have a line for Capital Planning, we have a line for the hospital program .

There is a line for Hospitals and Commu nity Health Services, so it could be any number of those places, and I would just like an indication as to when the minister would like to deal with it and, secondly, to see if this time we can get some advance information and details of capital

April 13 , 1992 LEGISLATIVE ASSEM BLY OF MAN ITOBA 21 19 estimates before we get to that line so we can ask some intelligent, informed questions. Mr. Orchard: I always look forward to whenever my honourable frien d migh t ask inte lligen t questions. I have indicated that we can deal with capital at Expenditures Related to Capital, where there is a $57-plus-million request for expendit ure. The planning process under Capital Construction is found atthe top of page 88 as part of Resolution 69, wherein we are taking and dealing with the planning processes of each of these areas.

My honourable friend may wish to ask questions around changes, if any, to the capital planning process because the appropriate personnel under Capital Construction would, I hope, be here to answer those sorts of questions as to approach on the policy of government and what our planning initiatives are. In terms of the details, i.e., the capital budget, I think the most appropriate line for that would be Resolution 73. Ms.

Wasylycla-Lels: I apprecia te the minister indicating that, but I am wondering if he could make a commitment to at least table the capital estimates before we get to Capital Planning, so that we can put all of these different aspects relating to capital together and approach it in an overall way. I do not think it makes much sense-it is not going to make for a very intelligent Es timates process if in fact we are dealing with Capital Planning in isolation from the capital Estimates.

I think there should be a tie-in, and I would hope that the minister-! am just wondering if he could give us a commi tment today that he will provide us with the capital estimates before we get to Capital Planning. Mr. Orchard: Mr. Deputy Chairperson, I cannot make that com mitment today because if we were to get to Capital Planning this afte rnoon, I would fail because I would not be able to make that program available to my honourable friend.

I will make the best effort to provide the information my honourable friend wishes to have, but my honourable friend must appreciate that we are just now starting the Estimates process of expenditure review for the entire government of Manitoba. When we get to Resolution 73 on page 89, my honourable friend can take 20 hours putting capital into the context of the health care system that will have by that time been fully debated, and it would be just a simply marvelous opportunity for my honourable friend to share her complete vision of the system at that time.

I am under no constraints by my caucus to hurry and rush through the Estimates. If when we get to page 89, we need another 1 0 hours to discuss this as a system-wide approach , with capital in front of us as well as by then the budgets of hospitals and personal care homes, etcetera, I think we would be well employed to take that time at that time. Ms. Wasylycla-Lels: Let me just ind icate to the minister that we all have agreements to respect, and this is a co-operative legislative Estimates process .

Maybe the minister feels he can put a wrench into the works and suggest that we can tack on another 10 or more hour s to our Estimates for the Department of Health. I do not feel that is within my ability to say. I certainly think it would probably be a breach of agreements and arrangements made between our House leaders. I believe we can ac complish the objective of having a full and thorough and open debate if the minister would just give us a little more notice with respect to capital estimates.

I understand if they are not ready and he needs some time, but I am wondering if he could indic ate when they will be ready and if he could table them as soon as they are ready. Mr. Orchard: Mr. Deputy Chairperson, in my ongoing desire to be co-operative, I will make every effort to accede to my honourable friend's request in that I would table them as soon as they are ready. Mr. Guizar Cheema (The Maples): Mr. Deputy Chairperson, I just want to start this afternoon with-first of all, I want to discuss a few issues. We had a discussion at the Manitoba Nu rses' Union meeting this morning.

It was a very informative debate as far as I am concerned because I think it showed up, in my view, two things. First of all, it gave a chance to the nurses to let their views be known and, second , I think it became more clear to me that we not only have to say what we mean for the convenience of time, it has to be very consistent, and that is eventually going to show up. It was very difficult because you do not want to say things which you cannot deliver, and you cannot say different things at different times or different hour s of the morning or af ternoon.

I was disappointed in a few things, and I am sure as we

21 20 LEGISLATIVE ASSEMBL Y OF MANI TOBA April 13 , 1992 go along the debate, I will make my views known in a very informative way. * (1 520) I was quite disturbed and so were many other people in Manitoba when they heard the news from Saskatchewan. I think it is an issue worth discussing, the same way we discus sed Mr. McKenna's proposal. We said that was a very irresponsible and very ill-thought plan in the mind of many health care profe ssionals who think that the user fee is not the way to go, and that is the way we think, thatthe health premium is another form of user fee.

It is a tax on the poor, and with the 200 to 400 per fam ily, it is basic ally devastating. I think it was the most irresponsible statement coming out of any Premier's Off ice, and I hope they will change their mind. I sincerely hope they will rethink it because the image of Saskatchewan was that medicare started there, and you do not want to kill medicare where it started. It is the first time I have ever heard a government saying they want to reduce the deficit by having a health premium. I think a lot of people are thinking about that.

That is why we raised the issue this morning in the House, that we do not think the health care premium in Manitoba or a user fee of any kind is going to solve the health care problem . It is going to be a new approach , an innovative approach . Look through the same dollars and try to come up with a consensus. That I think was the basic intent of this morning's debate, and people there were very happy when they left. The nurses were very pleased that at least they had a chance to say things, and they got views. I think it was very good because they got first-hand informati on.

I think that is why the information package that the minister's off ice will deliver to them is very essential to reach the grassroots in the nurses' union who are the front line workers because they are the ones who are going to partici pate. I said many times today that without them, we will not be successfu l, and if we fail, they fail too. I think they are realizing that this is why there was not much outcry in terms of specific numbers through the hospital beds . Not one issue was raised from that specific point of view, which hospital you are going to attack or which service you are going to cut.

I think that message, in its own way, became very clear as far as I could detect , that the member ship was very, very reas onable with their questioning. Some of the people were very upset naturally, because of personal circums tances. Certainly it was difficult for us to pinpoint some of the things, but I think, overall, it went very well and I think they will benefit. That is another way of educating people, when they are going to talk to 500 or more union nurses and explain to them where each and every party would stand and where the taxpayers' money is going to go. That will help us in the long run.

I jus t want to put on the record our sincere appreciation from our caucus for that debate with the nurses' union and for giving us the opportunity to put our realistic views and a frank and open discussion on the table, so that when they vote next time in the election, they will know exactly where we stand today and where we are going to stand in the next provincial election. Mr. Deputy Chairperson , I raised this one issue this morning, and I want to go into a little detail on that.

It has not been a very good week for one of the health care professions in terms of the public perception that is there that there is severe abuse in the syst em. It is causing a lot of discomfort among the health care providers and also is leaving many doubts in the minds of the public that something is not right.

That is why we want the minister to look into the issue of more accountability to the public, to the taxpayers, because I strongly believe that in any profess ional life, nobody wants to cheat anybody, but if there is some problem, then if those individuals have to be put to a public test or a public scrutiny, so be it. I think that mess age has to be given by the Department of Health because it will help in both ways. It will not only help the profe ssiona ls, but help the public to know how their money is being spent.

Our first proposal this morning was that we should try to investigate when a patient goes to a particu lar office , whether he or she should sign a piece of paper indic ating that he or she was in the office , and that will serve two purposes in my opinion. First of all, it will make the patient know that tax money is being spent on his or her behalf. It will reinforce that this is their money and the thinking process will start. Second is that there will be accountability and also the fear that something is going wrong can be taken away because on a simple form it can be done.

April 13 , 19 92 LEGISLATIVE ASSEM BLY OF MAN ITOBA 212 1 It does not cost or add anything, maybe some amount, but not to a signi ficant degree, because many are billing to the Health Services Comm ission. I know personally that you have to sign, and the patient can sign on the same line. I do not think this is a major problem, or just have a simple paper in any office per day, and as the patients come, they should simply sign at the desk.

That does not cost anything, and then it will be up to the commis sion to look into that and maybe get a record on a random basis if they do not want to fully go into each and every visit. I think that will help. That will not be extra cost, because doctors are making the appointments anyway. We just have to get the signatures from the patients. If there is a minor, then the family can do it or the guardian can do it. I think we should look at it in the hospitals. Hospitals right now have a good system where a lot of things are checked and it is not that easy.

There is a lot of auditing going on internally and externally so there is less chance. But I think still, when a person leaves the hospital, he or she should know how much was spent on his or her behalf by the taxpayers of Manitoba. I think this is reason able. It is not restric ting services.

It is simply telling them this is a very expensive syste m, and what you have gone through, it is the privilege and the right. let us understand that we must keep the balance in that right and privilege and keep the responsible attitude, and that will help people eventually to understand how we are spending money and the best part of the educati on campaign. I do in my office. Once in a while I ask them-you have been in my office, it is costing so much money for you to visit. It surprises many people.

The second thing it will do, it will definitely cut any more expenses on more visitors to walk-in clinics, because once you are in one walk-in clinic you are going to go to the next office or next day, then you will think twice that something was done already. You had your tests done and then you will bec ome more responsible to take your record with you when you are going to see your own doct or. It will not be extra work to the physician. It will not be, because it can be done at the front desk.

It will definitely enhance some of the responsible attitude from the patient's behalf, because they would like to get involved. They want answers, and I think the balance can be achiev ed eventually. That will not cost any money, not a cent, because simply telling someone, Mr. So-and-So, your visit is costing this much, and I think that will help. Some people would say, so far I have not heard anybody complaining about that, but if we were dealing two years ago in health care that would have been a rationing. I think this is a reasoned approach now, because that is the way we have to.

As I said from the beginning of my remarks, there is no way that we can run away from the responsibility. When we go for everything else which is funded by the provincial government, we know we have to be acco untable, we have to get some information or sign some document. Why not the health care ? I would like the minis ter, when he is making inquiries about those things, to take everything into consideration and nobody can object, because it is a reasoned approach. You are not doing any wrong to any person.

Simply, when the patients are walking out of the hospital at the end of surgery, just sort of explain to them that this much was spent on their behalf and that will help. I would like to know whatthe minister thinks about these remarks. * (1 530) Mr. Orchard: Mr. Deputy Chairperson, let me start out by talking about this morning's debate at the MNU annual meeting. I think this morning was a good example of an appropriate form of discussion.

It started out with a different sort of a format proposed, and I am pleased that it was turned into a debate where we had the opportunity to present our views and our opinions and each to respond to prepared que stions that were given to us in advance; and, secon dly, they respond to questions from the floor. I think it provided a good opportunity for a little better understa nding of the kind of challenges that are before the syst em. I am going to be political this aft ernoon.

I was not at the debate this morning because I did not think that was a particularly useful thing to do when we are there representing our respective political parties. I think what the nurses of Manitoba wanted was some fairly clear answers as to what one might expect from this government and what one might expect from the respective critic's party should they be in government. I tried to be as direct as I could and provide as much information as I could to the questioners and

21 22 LEGISL ATIVE ASSEM BLY OF MAN ITOBA April 13 , 1992 to the meeting this morning. I think my honourable friend continued with what has been a rather risqu e, if I can put it that way, and rather refresh ing change in the way we approach Estimates and likewise tried to present the real world as the Liberal Party perceives it to be unfolding. I cannot say that that same sort of forth right discussion around the issues emanated from my honourable friend the member for St. Johns (Ms. Wasylyci a-Leis), and I am not being critical .

I mean, my honourable friend always deals with the issue as if it is only a political issue and tries to create the impression consistently, as she does in the House and at Esti mates, that the NDP is the only party that has any answe rs. Then when we point out the answers to my honourable friend as to what NDP parties do when in government, my honourable friend has the conve nient cop-out, saying: Oh, well, I do not really agree with what they do in Ontario just because they are NDP or what they do in Saskatchewan or what they do in British Columbia.

I apprecia te that that is the purely political response of the New Democrat ic Party when it comes to health care issues. Howeve r, that purely politic al respons e becomes ex ceedingly transparent to all those who obs erve. The only people who end up applauding thunderously are the good friends whom you may well have had there when you sta rted. I do not think that the meeting ended on the same note tha t it began .

I think ther e wa s a realization-and certainly that was expressed to me when som e nurses who were in atte ndance indic ated to me that they do not envy my position because, no matter what I do, I am always going to be wrong in the eyes of some observer, but they re-emphasized what came from the floor and what was the whole issue-or not the whole issue, pardon me, but a major issue back in January of 199 1. Nurses indicated to me that they have good ideas on how to make the system work better. They are looking forward to a forum under which they can share those ideas.

I hope to be able to conti nue to provide that. I have always said that, you know, the union at any time can suggest to myself as minister that a new initiative can be undertaken, and I will consider that very seriously. I say that because that is what we have tended to do. Today's suggestion by my honourable friend the member for The Maples (Mr. Cheema) , I will take very seriously because it is a suggestion made, if I can be so presumptuous as to put motives behind it, with motivation to try and make the system work better.

Because it comes from the Liberal Party and may well be a workable idea, I am not adverse to it. If we can reasonably implement my honourable friend's suggestion, I have absolutely no qualms about doing that. I have taken good suggestion from the memb er for The Maples in the past and will continue to in the futu re. I say that because that is the way the system has worked. When I was in opposition, Mr. Desjar dins, upon occ asion, took and implemented reasonable suggestions that I made.

The purely political ones that I made to him, he did not necessarily treat so kindly; neither do I when I get purely political suggestions from either of my critics. I mean, if we are in the game for political advantage, fine. Let us argue that out here and may the bes t person win. But, when I receiv e reasonable suggestions, I am going to investigate them, and if they are implementable, so be it, they will be.

Now, right off the top, in a quick call over to the commission, I want to tell my honourable friend and I want to give them this information so that you might be able to do some further thinkin g about it. Apparently other jurisdictions, and it has been sugges ted in Manitoba, have sugges ted for physician office visits that the individual patient sign off the card . Now here is one of the problems we have in implementing that or pursuing that in Manitoba: we are now approac hing 50 percent of our claims fr om physician offices being electronically sent to the co mmission.

So the paper in effect, if you will-the paper, if any, remains in the physician's office. Now, I can see an opportunity for benefit to have a signed piece of paper reside in a doctor's offi ce. It seems to me that it would accom plish what my honourable friend I believe wants to accom plish: first of all, to increase an awareness of the cost of this particular office visit and potentially the cost of maybe some dia gnostic testing that may be recom mended as a result of that.

So I think the purpose, even if the piece of paper with the consumer's signature on it did not go beyond the doctor's office, I believe it is pursuable.

April 13 , 1992 LEGISLATIVE ASSEM BLY OF MAN ITOBA 21 23 But I guess what I want to check out is whether this would be another paper shuffle, because one of the accusations that nurses make of the current health care system is that they spend between 35 and 40 percent of their time creating information, in other words, filling out forms, et cetera. That, they legitimately maintain, takes them away from patient care delivery. I would not want to exacerbate that in another part of the system.

So I have some questions that I would have to have satisfactory answers on, just on first blush with my honourable friend's suggestion. (Mr. Jack Reimer, Acting Deputy Chairperson, in the Chair) I simply make the commitment that I made to him in the House, I value the suggestion and it will be pursued. If ther e is a logical outcome and implementation that can come from that suggestion, I am quite willing to work with him and work with others, the MMA and the college, to try and bring it to fruition in our billing system. • (1 540) Mr. Cheema: Mr.

Acting Deputy Chairperson, I am quite aware of the electronic billing system. That is why we said that a separate sheet of paper which either can be kept in the office or can be sent on a random basis so that the department can check the way they are checking now, 5 to 7 percent billing back to the patient. Simply taking, say, for example, twice or three times on a month's billing and just making sure that everything was done, and the patient had some accountability.

That will cut some of the mailing that the department has to do now, about 7 percent of the cards are sent back to the patients for their signatures. If they do not agree with them, then they can call, and that saves quite a bit of cost. So I think one can eliminate that cost, and have this put in place which is more correctable because patients signed something that day, and something which has more bearing for the Medical Review Committee than this billing which goes out and is never returned back.

I think the Medical Review Committee will be very pleased with that kind of suggestion, because that will make their life much easier, cut out a lot of work for them. If they want to randomly check-now, last year we had passed this bill, then the Health Services Commission had the authority to go and they wanted to examine the known medical components and they can do that. I think, give more teeth to the bill and say this is a part of our law, and it will not hurt us. I think it will save us money. Then I want to also point out a few things which are very essential in terms of the Medical Review Committee.

The minister has brought the bill, that was on Friday, for amendments to make sure the names of the-is that not the bill? Mr. Orchard: Mr. Acting Deputy Chairperson, the legislation that was tabled on Friday, and I will explain it on second reading in the House, deals with the changes in authority required by the reorganization of the department. The issue specific to release of names of physicians found inappropriately billing by the Medical Review Committee has to be dealt with by a subsequent amendment. It is not part of the bill that is in the House right now. Mr. Cheema: Mr.

Acting Deputy Chairperson, I am sorry, I thought that was the intent of the bill as well, but I think we got the communication from the minister as well as from Dr. Ross, the MMA's president, and they are looking for something, a direction from the minister's office to make sure that these things-if there needs to be an amendment, it has to be brought in because right now the minister cannot release the name because if he does, then he has to simply resign, and his hands are tied. That is what the law says, period.

I hope that something can be resolved, and a fair conclusion can be made because the public out there is very suspicious, and as well, the physicians are very worried because they do not want to be part of a system where they have to be worried all the time, somebody is watching them, or they are doing something wrong. The other issue I want to discuss is the role of the Medical Review Committee because that is the major component of the whole discussion, and I think it is a part of the whole government's planning.

It is worth discussing because, as we know, our structure of Medical Review Committee to some extent may be outdated. Some of the statistics are five years or six years old, and some of the groupings which are done may not be appropriate in some circumstances, even though physicians can apply when they are asked to explain, and most of the time, problems are resolved. We have to look when we are making health care reform. I am asking the minister simply to adjust that kind of review committee with reform;

21 24 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 13 , 1992 otherwise, both will not be parallel. If we change one thing and do not change the medical review process, then we will be having a lot of trouble in a few years time, and everybody will have go through turmoil to adjust to the changing pattern of prac tice. So I hope that I am explaining myself and I will try it again. I think I missed a few points here. Mr. Acting Deputy Chairperson, what I am saying is that with health care reform , there will be changes in the pattern of practice-no doubt.

When we are going to shift more patients out of the hospital to the com munities, then more patients will end up in physicians' office s-no question. That is a given. We have seen in the past that there were some concerns about some quadrant of the city , that there was an aging population, and some physicians questioned the medical review's process, whether it was fair or not.

So I am simply saying the medical review process has to be fair in reflecti ng the reality of health care ref orm, and that means what is in there today in terms of how the visits are being made, what kind of tests are being done, and we should compare that with the national standard. That is not being done right now. We have some diff iculty there. It is a practical problem which has to be resolved before it is too late, because you do not want a total process in terms of everybody being questioned every second day which is not very productive.

I am just asking the minister to look at that medical review process and also to look at the structure of the comm ittee in terms of, it is all professions right now, and we respect the professional opinion, but then there has to be somebody other than the medical commu nity itself. That will clear some of the ill feelings in the community, that the doctors are policing themselves.

Basically, we wantto solve the problem, and what I am asking for is a fai r system which would not punish people or force people to do something they do not want to, also in line with the health care reform , so the role of the Medical Review Comm ittee may have to be modified. I am hopefu l, and I sincerely hope the minister will bring in a bill that will address some of the issues which are very real out there in practice . Mr. Orchard: Mr.

Ac ting Deputy Chairperson I apprecia te, first of all, my honou rable friend's clarification as to the first issue that got us in, the second one, that namely being the patient signing off in a physician's offi ce. That helps me to pursue the issue with staff . On the issue of the Medical Review Committee and the current controve rsy, as one of our renowned talk show personalities would say, the issue of disclosu re, I am prohibited. That is the way the law has been written, and you see that is what caused me some consternation when the issue came up 1 0 days ago.

For the life of me I could not understand why, given the relationships in the past when maybe a prior minister to myself might not have, with glee, released the names of errant physicia ns, if that was the finding of the Medical Review Commi ttee. It was at that point in time that I proceeded with an abundance of caution, because I believe Ms. Gigantes in Ontario found out very hard about releasing individual's patient recor ds. No matter how well intentioned that release might have been, it is cause for resignation from this portfolio.

In similar circums tances, a good friend of mine the Minister of Health in Nova Scotia, because I have gotten to know him over a couple or three conferences, he likewise had to resign under similar circums tances. So I approached the issue very ca utiously. The legal opinion I got around the legislation said I could not release the names and appropriately so, because the information that goes to the Medical Review Comm ittee is treated with the greatest of confid ence so that we do not com promise patient confidentiality in the course of an investigation.

The legislation is written very, very definitively to prevent that compromise of confidenti ality, and that is what has tied my hands. • (1 550) Now there is a second clause to The Health Services Insu rance Act, and that is that the information can be released to both the College of Physicians and Surgeons and the MMA.

It was on that basis when I received from the MMA the letter, I believe it was Thursday or Wednesday afternoon , I am not sure which, but last week, indicating they had no difficulty with the release of the informati on, I thought that we had our problem resolved, because with their concurrence of release I could have given them the narrowed informat ion. Alii am wishing to release, I think this is all the public wishes to know, is the physician's name, the amount of the billing that is being requested to be repaid, the period oftime under which the billing took

April 13 , 1992 LEGISLATIVE ASSEM BLY OF MANITOBA 212 5 place, and a simple description which would reflect the reason for the decision of the Medical Review Committee. I do not believe that com promises confident iality of patient records, et cetera, and provides the necessary or, I believe, the appropriate public inform ation, but I still cannot do that.

Now if we are unable to achieve a release process through the MMA, which we thought we had solved at the end of last week, then I may well be proposing some further amendm ents to The Health Services Insurance Act, because all I want to release, and I think all the public wants released, is the four pieces of information that I mentioned earlier. I do not want to get into any other area of inform ation, because I believe that would be inappropriate.

Yes, hopefu lly we can resolve it without legislation, but if it takes legislation and that can be crafted , which I have directed the department to do, then so be it. My honourable friend mentioned something which is going to be valuable if achievable, and that is in terms of development of some national standards for care. One of the anomalies that we have, I guess, in terms of health care delivery is the federal government has brought in the legislation called the Canada Health Act which mandates delivery of health care services in certain ways.

There are a number of services which are not to be compromised accord ing to the parameters of the Canada Health Act. Subsequent to that all, provincial jurisdictions passed parallel legislation which basically follows the Canada Health Act in basic intent. Here is the quandary. The federal government passes enabling legislation or, if you will, overall governing legislation in the Canada Health Act and then provides certain funds. The funding aspect, of course, has been "controve rsial," again, to quote that individ ual, rad io talk show fellow, the ann iversary man.

But the province is required to deliver the services and any difference in the amount of monies rece ived from the federal government we mak e up provincially. Okay, one can argue that that is reasonable in that if it was all a 10 0 percent federal dollars-boy, I would have a real heyday spending. I mean, you would be a folk hero. The Health minister would be the must desired portfolio in government, because you would have no end of someone else's money to spend, but that is not the case. We have joint funding responsibilities, and sole responsibility for delivery under certain guidelines.

Now, here is where it becomes diffi cult. Not every province offers the same range of services. I mean, we offe r the second or ma ybe the most comprehensive Pharmacare program in Canada. Ontario does not offer any coverage for Ontario families 65 years and under. I mean, there is no co-insured program like we have in Manitoba. Varying provinces have vary ing supp ort for con tinuing care, a home care program. They have varying degrees of support for the personal care home programs. All of that is allowable because the Canada Health Act, in essence, deals with physician services and hospital services.

Those are the two for which there are no user fees or additional revenue generation permitted, and those are the ones where they have established the portability, the accessibility, those parameters of the Canada Health Act to apply. The other systems they leave to the discretion of varying jurisdictions to determine how they are going to structure the delivery of those other programs like Pharmacare , like long-term care, personal care home programs like Home Care in the co mmunity. In establishing standards around physician care , I mean, my honourable friend's suggestion is a good one.

It is not a new one, but it is a most difficult one to achieve. The most recent body of investigation to suggest that to the Health ministers of Canada was the Barer and Stoddart report, where their suggestion-the one that caught all the headlines and attention-was the reduction in the enrollment of students in our medical schools across Canada. That one, naturally, was sort of a glitzy, sexy recommendation, caught all the headlines. But they made a whole series of other rec om mendations, I think close to 90.

Some of the more important ones were the establishment of national standards, so that one province cannot be played off against another province as being deficient in delivery. Again, to try to bring some uniformity across Canada so that the expectations of Canadians are the same, regardless of province of residence and/or visit, and they talked about change in method of compe nsation to physicians away from the fee-for-service model, where appropriate and where possible, a whole series of changes.

212 6 LEGISLATIVE ASSEMBLY OF MAN ITOBA April 13 , 1992 Now, I have to tell my honourable friend, I concur with his suggestion, and I concu r with Barer and Stoddart in attempting to come to grips with some semblance of national standards. It is particularly important, not only in the area of physician services, but critically important in terms of technology assessment and analysis. Because, man, I will tell you, that is one of the thor nies t areas I get to deal with-imagin g technology, CAT scan being the hot topic of today.

There is a growing feeling that if you are a hospital of anywhere from 13 2 beds up that if you do not have a CAT scan you are a second-class facility. But yet there is no indication that the CAT scan is the wisest next investment in any health care faci lity. It has an appropriate role, and we are at the national average in terms of service provision in Manitoba. Yet the system, as exemplified by individual hospitals, is wanting to significantly increase the number of CAT scans. Well, that is fine. That is one issue today called CAT scans. The next issue is MRI. We have one in the province of Manitoba.

The drive will be for a second one, and after that a third or a fourth. I was at a recent conference where some of the attendees were representatives of the major supply firms. One of them made the clear statement that by the year 2050 the most commonly used imaging modality will be MRI. It will replace the X-ray. I do not know whether that is right or wrong. But I can tell you that given today's relative cost of X-ray versus CAT scan versus MRI, boy, if we think we are having trouble financing the system now, take a look at what the problems we are going to have if MRI is the imaging modality by the year 2050.

The major concern here is that there has not been an opportunity for national standards settings, or even national investigation, as to whether the technology is appropriate. I mean, we went to this headlong rush, and I have to admit, I was part of it. As Health min ister three years ago, we made a comm itment we would bring in breast cancer screening through a province-wide mammography program. I believed, three years ago, that that was an appropriate utilization of new tec hnology. I have to tell you that some of my senior staff people in the department questioned it then, three years ago.

They said, is that the best investment of several millions of dollars in terms of health promotion and disease prevention? They thought that we could spend that money more eff ectively in other ways. Well, over the period of two and a half years, with two very expert groups taking a look at the process, we find that the technology is not the end-all and be-all. The resulting recommen dation to the province was that we delay the implementation of the scree ning prog ram , not effecti ng diagn ostic mammography but the scr eening program.

I will tell you that that piece of advice , three years ago I would have said phooey to anybody who said that was the wrong thing to do because I believed it was the appropriate thing to do because we are all sort of caught up in the ability of technology to solve every problem. We need to have more honest brokers, if you will, in terms of telling us what is appropriate technology, for what purpose, for what protocols and for what expected outcomes in improvement of health status. We do not have that. That is all part of the national standards that my honourable friend alluded to. We are going to get

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-3-45a
Type	hansard
Volume / chapter	35th 3rd hansardpdf 45a.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	3b3adf4b78bbf6d37c5413ca3823d68d58661e4b

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