Fourth Session, 42nd Parliament

(2023) OFFICIAL REPORT

OF DEBATES

(HANSARD)

Thursday, April 27, 2023

Afternoon Sitting

Issue No. 316

ISSN 1499-2175

The HTML transcript is provided for informational purposes only.

The PDF transcript remains the official digital version.

CONTENTS

Orders of the Day

Committee of Supply

Estimates: Ministry of Health (continued)

T. Halford

Hon. A. Dix

S. Bond

L. Doerkson

D. Clovechok

P. Milobar

M. Bernier

S. Furstenau

J. Rustad

Report and Third Reading of Bills

Bill 10 — Budget Measures Implementation Act,

Proceedings in the Douglas Fir Room

Committee of the Whole House

Bill 10 — Budget Measures Implementation Act, 2023

(continued)

P. Milobar

Hon. K. Conroy

M. Lee

Proceedings in the Birch Room

Committee of Supply

Estimates: Ministry of Attorney General

(continued)

A. Olsen

Hon. N. Sharma

M. de Jong

R. Merrifield

THURSDAY, APRIL 27, 2023

The House met at 1:02 p.m.

[S. Chandra Herbert in the chair.]

Orders of the Day

Hon. R. Kahlon: In the main chamber, I call continued debate, Committee of Supply,

Ministry of Health.

In committee room A, starting at 2:30, I call continued debate for the

Committee of the Whole on Bill 10, Budget Measures Implementation

Act.

In committee room C, I call continued debate on the Committee of Supply

for the Ministry of Attorney Gen­eral.

Committee of Supply

ESTIMATES: MINISTRY OF

HEALTH

(continued)

The House in Committee of Supply (Section B); J. Tegart in the

chair.

The committee met at 1:05 p.m.

The Chair: Good afternoon, everyone. I’ll call the Committee of Supply,

Section B, to order.

We’re meeting today to continue consideration of the estimates

of the Ministry of Health.

I now recognize the minister to move the vote.

On Vote 32: ministry operations, $28,526,258,000

(continued) .

T. Halford: Thank you to my colleague and friend the member for Prince

George–Valemount for allowing me to ask a question here on behalf of my

constituents.

I had a meeting with a mom who has a son that has struggled for a

number of years with addiction. That son has been on the streets. But

then he made the decision that he was going to come back home. He came

back home to White Rock, and he had some severe problems, in terms of

using. There’s some physical reaction. There’s obviously some…. There

was a very heavy mental reaction as well. Police came, and he was

transported to Peace Arch Hospital. He was admitted through the

emergency department. This is kind of where I want to go with this

one.

I’ve talked to the minister about this issue. It’s the mental

health and substance use facility at Peace Arch Hospital, which has been

completed. I’ve actually personally toured it in the fall. Large amounts

of that money was fundraised by the Peace Arch Hospital Foundation,

Surrey Firefighters Association, the White Rock Firefighters

Association, private donors and other organizations. They all put

forward their money to raise funds for this unit.

When I toured it, the beds were there, the paint was there, chairs

were there. Everything was there, plus a lock, because it wasn’t open

because they couldn’t staff it.

So this young man, taken by the police, had to go through the

emergency ward with police. Then, in one of the most difficult times of

his life, of his mom’s life, in a full emergency ward, to have to get

treatment…. Also, White Rock RCMP was in attendance there. And 12 feet

away is a completely brand-new facility that was locked shut. That’s a

hard one to explain.

I know that as of March 7, it has opened, but only partially

opened. What I’m looking for from the minister today is a commitment and

time frame on when. Mental health, substance use — it’s 24-7. There are

not set hours. But if there are set hours at this facility, that’s not

the best use of something that people have worked hard for, contributed

for, at Peace Arch Hospital. So when will this facility be fully

operational, 24-7, at Peace Arch Hospital?

Hon. A. Dix: Thank you to the member for the question. He’s correct. It was and

is a source of pride, as Minister of Health, that we were able to fund

that capital project at Peace Arch Hospital. Obviously, the significant

portion of funding was from our capital budget, and that was important.

We also had significant funding from the community.

I’ll say that the Peace Arch Hospital Foundation, as he will know,

is an extraordinary organization that raises a great deal of money. And

the commitment of the community, the whole community, to that foundation

is there. I’m proud that we were able to go forward with that project

and, really, like projects in Langley, at Eagle Ridge and in Abbotsford,

which were smaller projects than, say, a new hospital or a major

hospital rebuild but very significant projects, all costing in the tens

of millions of dollars.

[1:10 p.m.]

The member will know that the new emergency department opened in

October ’22. So when the member talks about a facility, it’s part of the

emergency department I think he’s referring to, which is the specialized

part of the area of the emergency department for people who present with

mental health and addiction issues.

It’s very important. It was put in there for a reason, as he says,

and I think this is a factor in every hospital capital project we make

with an emergency room — creating capacity and privacy for all patients

but, in particular, for patients living and going through a mental

health crisis, which would often be the reason why you would be in the

emergency room. The member cites the case of his constituent. I think

that’s important.

So it consists of two consult rooms. It consists of a patient exam

room, a seclusion area and a waiting area. It’s not a new facility, but

it’s an important part of the facility. I don’t want to suggest I’m

debating that. I’m just saying this is the emergency department as it

developed.

The member will know that there are two psychiatric liaison nurse

positions that are required to open the specialized area. They’re

approved. They’re funded, and they’re working to hire those people.

That’s not a date per se, though some action has happened already. As

soon as that happens and we have the staff in place appropriately, the

facility will be open, and the care will be provided in that

space.

It’s important to also note this is an extraordinary new emergency

department. I know he knows that, because I’m sure he’s visited there.

We didn’t have occasion…. Because this has not been a period for

announcements and maybe celebrations, as much as we’d like, we didn’t

open the new emergency department. At some point, I think, we should

have an occasion to come together as a community to recognize both

Fraser Health and the community on that question. I think it’s really

important to do that.

I know it’s a really important investment. It’s a critical thing

to happen. But I also want everyone who is served by the area to

understand that the emergency department cares, and cares well, in this

excellent emergency department for people who present, whether with

physical or mental health issues.

I know the member knows that. I agree with him that we want it

open as soon as possible. It’s funded. We’re actively recruiting. We’re

making some progress there. As soon as that happens, then the member

also knows that I will keep him informed of progress.

T. Halford: Thank you to the minister and staff for that answer. I will say,

yeah, I think a celebration…. It’s been…. I think the minister, with

respect, may be surprised what that reaction might be. I’ve known the

Peace Arch Hospital Foundation for a long time. I’ve grown up in that

area my entire life. The constituents there…. That was just one case

that I cited.

We are talking about, if it is a new facility…. Yes, it’s next

door to the emergency room. That’s all new build, right? It’s all new

build, but that is a separate component, separate access area, separate

corridor. I’ve gone through it. I have also gone through the emergency

department with my kids, and I’ve seen it shut. People don’t even know

it’s there. They now maybe know it’s there after March 7 because they’ve

utilized it.

I think what I’m asking for, with respect to the minister, is

that…. People from that community have opened up their wallets. People

have left legacy in their passing to the Peace Arch Hospital Foundation.

My grandfather, when he passed…. In his will was a donation to the Peace

Arch Hospital Foundation. It is very common in all hospital foundations.

But there is an expectation that if people make that commitment, the

government makes a commitment to them of when that will be fully

operational.

So March 7 was kind of opening period. It’s still that case. When

you go there and you’re experiencing a mental health episode, a

substance use issue, you’re not guaranteed you’re going to have access

to that. You may be put through emergency, where you don’t have those

privacy barriers in place that the minister referenced.

[1:15 p.m.]

I think my question…. Maybe it’s not as simple as I want it to be.

I think my constituents deserve to know when that facility will be open

24/7. Is there a time frame that this minister can commit to today that

I can take back to my constituents to say: “By this day, this will be

fully operational”?

I think that would be a source of pride for the people that went

out and fundraised, put forward their own dollars, to try and get this

facility up and running.

Hon. A. Dix: I’m not debating the hon. member on this. I think the people who

want to see that happen are people who want care, and that’s all the

people in the region, right? I know people who are fundraising for that

project because they advocated to me to fund the project. We did, and I

was very proud to do so.

I know the member supported that action. I’m not creating a

partisan issue in that regard. We were asked to fund it. We looked at

it, found the money at Treasury Board, got the thing funded. It’s built.

It’s completed. All of that is great work we did together. I know the

people who fundraised, because I know them and have worked with them….

Their concern isn’t anything about their dollars. Their concern is about

people getting the care that they need. That’s my concern, and that’s

our issue as well.

We’re working to get that done as soon as possible. That, in part,

depends on the hiring of people. We’re also looking at other options, in

terms of the composition of staff, to see that it’s open as soon as

possible, because it’s a critical part, I would say to the member, of

the emergency room.

It represents an innovation in the new emergency rooms such as the

one we just built in Abbotsford and in Langley and Peace Arch and all

the other projects. The most significant difference in many of these

facilities between what was built in the ’50s and ’60s and ’70s — when

they were often built — and now is the composition of the mental health

and addictions response. Too often, before that, they looked a little

bit like they were jails.

The member from Williams Lake knows that there’s a room at Cariboo

Memorial that’s often used for this purpose. One of the big changes that

will come, as we build that project, is that very change.

I agree with the member. We want to do it as soon as possible.

Fraser Health is making all the efforts to do so. Given that it depends

on people coming and doing that, if that happens tomorrow, it’ll be

tomorrow. If it takes a little bit longer, it will take a little bit

longer.

They’re also working very quickly to get that area — it’s called

zone 5 — of the emergency room open so that the full emergency room is

open for all the people of the region, from White Rock and from Surrey

and others who might present at Peace Arch Hospital, which is, as he

will know, a very popular hospital in the community and a very popular

hospital, as well, with people who are presenting. The addition of the

emergency room has made a big difference, and we’re working on that. I

appreciate his intervention.

S. Bond: I appreciate my colleague’s question on behalf of his

constituents. I am going to work through a couple of other MLAs who have

specific questions. Then I’m hopeful the minister can give me the

updates regarding emergency health services. I’m sure he wants to tell

me about the vote that I assume is completed.

Then I’m hoping we can keep up our breakneck pace to try to cover

off as many topics as possible this afternoon. I’m certain he will be in

short-snapper mode by the time we get through the rest of the afternoon.

I will cede the floor to my colleague from Cariboo-Chilcotin.

L. Doerkson: Thank you to my colleague from Prince George–Valemount and the

ministry for allowing me the opportunity to ask a question.

I’m sure the minister is aware of the situation that’s been

developing at Cariboo Memorial Hospital with respect to staffing,

particularly in our emergency department, of course, where there have

been near closures.

I think Interior Health has been able to, for the large part, keep

that open. They are temporary solutions that Interior Health has

introduced, and certainly it’s been a very serious issue for a while

now. Many doctors, many nurses and many constituents in my riding have

reached out to me, calling for the hiring of physician assistants and

also the rehiring of unvaccinated health care workers that are in our

community.

[1:20 p.m.]

This is a point that the official opposition has been trying to

make for almost a year — certainly, one that I agree with. I want to

know why the minister is so reluctant to hire these professionals that

are in our community and that are ready to go to work.

Hon. A. Dix: First of all, the member will know that it’s a provincial health

order, and unless he is suggesting that politicians overrule provincial

health orders, which — remember — represent the will of people in the

sense that we passed the Public Health Act in this Legislature. It was

passed under the NDP, amended under the previous government. It’s in

there for a reason.

One of the results of supporting our provincial health officer and

our medical health teams has been the extra­ordinary response in

British Columbia to the COVID-19 pandemic in every community, including

his own. I appreciate all of the support that he has given to those

efforts in the community. That’s where it starts.

I want to be clear. I support Dr. Bonnie Henry. So I’m not saying,

in this case, that it’s their decision and that it has nothing to do

with me. I support the decision. Why was the decision made? We were the

only jurisdiction in Canada to do it, to bring it in. It was done to

protect patients in hospital. It was done to protect residents in

long-term care. On both of those bases, I think it was fully

justified.

People ask about other jurisdictions. Other jurisdictions didn’t

do what we did. By the way, at the time, it was called for by the

official opposition as well as by ourselves. It’s something we worked on

together. That’s what we did.

We believe that those people most vulnerable — there really is no

dispute about the evidence here — to COVID-19 are people in long-term

care and people who are going through acute care hospitals. I think we

all agree on that. One of the reasons why we were able to reduce other

measures in those facilities a number of weeks ago — Dr. Henry was able

to do that — was that 100 percent of our health care workers are

vaccinated, have that protection and, by extension, support patients who

need that protection as well.

We have had the debate. I appreciate the member’s difference of

opinion, but we think the decision that British Columbia made in this

area, and in a lot of other areas where British Columbia led the way,

was the right decision, that it continues to be the right decision and

that we have to give priority to patients.

Because we’re trying to be shorter this afternoon, I won’t give a

long discussion of all the issues, but on nurses — a huge increase in

nurse training, new pathways to internationally educated nurses, a new

agreement with nurses. Just to say to the member for Prince

George–Valemount, I think they’re announcing that at 3:30. We’ll go

through that news in real time, but they obviously have been voting on

that agreement, which dramatically supports nurses, in particular in

communities such as Williams Lake, Quesnel, Prince George and

Kamloops.

What the agreement does is to support full-time, permanent nurses

in position. All of those actions we’re taking on nursing and then on

health sciences professionals — I won’t go over the success so far of

the new agreement with doctors — all of those are part of a health human

resources plan that is intended to address these issues.

We continue to take the strong view that B.C.’s leadership

position on the COVID-19 pandemic and the advice and the direction of

public health is the right way to go, and we’re going to continue to do

that.

L. Doerkson: I don’t want to give the minister any indication that I’m not

supportive of our nurses. Frankly, it’s quite the opposite. I’m trying

to support nurses and doctors that have reached out to me and that say

that the time has passed.

Now, I can appreciate that we did collaborative work a year ago or

more, but this is a critical situation in Cariboo-Chilcotin. We’ve seen

closures in our 100 Mile Hospital. I can appreciate that this is a

challenging situation. Again, doctors, professionals — people far

smarter than me — are asking, begging, for that extra help. We are in a

time when we are seeing very many health professionals take leaves, stay

at home sick, whatever the case may be. It’s creating even bigger gaps

in our hospital.

[1:25 p.m.]

This is no longer just an MLA from Cariboo-Chilcotin asking about

this. This is no longer the opposition party saying that we need this

help. These are health care professionals in my community that are

asking why the ministry is so reluctant.

Hon. A. Dix: Maybe I’m misunderstanding the member. If he’s suggesting that we

should overrule the provincial health officer and her responsibilities

under the Public Health Act…. I don’t think that’s what he’s saying, but

it sounds like that’s what he’s saying. I don’t want to get into a

debate about it; I just disagree with that. That’s all.

Part of the reason we responded so well to the COVID-19 pandemic

was these very actions that we took in B.C., which were balanced,

thoughtful and committed. With respect to nursing, just so we

understand: there’s no such mandate in Alberta. We increased the number

of registered nurses last year in B.C. by 6.3 percent; in Alberta, they

lost 0.7 percent of their registered nurses. We had an increase of 8.3

percent last year in our LPNs; in Alberta, that was 5 percent. They

don’t have a mandate. On health sciences professionals, it’s been 25

percent over five years.

The demand for nursing — this is absolutely true in Williams Lake

— is very high. There are also the views of the overwhelming number of

health professionals who are vaccinated. I mean 99 percent plus who are

vaccinated — 99 percent plus of nurses, 99 percent plus of health

professionals. A lot of people who want to ensure the protection and

safety of our most vulnerable people are them as well.

We take the position, based on the advice of Public Health, which

is led by Dr. Bonnie Henry but has a team of medical health officers who

are experts in this area and have surely led us well during the COVID-19

pandemic. This is a provincial health order, one that I support and that

we’re going to continue to have in place.

B.C. has led the country in recruitment of health professionals,

and we’re the only jurisdiction that has the requirements that the

member talked about. I don’t think, with great respect, the linkage, the

one he is suggesting…. In any event, we support the provincial health

order. It’s in place to protect the most vulnerable people in long-term

care and acute care, and it will continue.

L. Doerkson: Thank you, Minister, for the answer. I maybe will ask this in a

different way, and it will be my final question. Again, I’m appreciative

for the time.

We have had some very serious situations in Cariboo Memorial.

Certainly, the minister would know about a number of them. I won’t share

those here today, but the families that have been involved in those

situations are very concerned about what is happening. I’m saying that

so are the health care professionals. I want to be crystal clear this is

me asking on behalf of my constituents and my health care professionals

that work in Cariboo Memorial Hospital.

I guess my final question to the minister is: what would be the

mechanism that would trigger or allow the Health Ministry to bring back

these health care professionals that are currently

unvaccinated?

Hon. A. Dix: I would say…. I would be happy to share the numbers with the

member and the opposition. It’s actually a relatively small number of

health professionals across the province, considering that the order

basically applies to about 170,000 of them, more or less, who are in

those facilities.

It’s a lot of people, and 99 percent of them got vaccinated. By

their getting vaccinated, we have now a health care system that’s 100

percent vaccinated, which makes it safer for people in acute care

hospitals, safer for people in long-term care. That’s the priority of

people in public health: to ensure that safety and to ensure the highest

quality of care.

It’s not just one set of health care workers. Health care workers,

as a group, advocated for these changes, advocated for safer workplaces,

advocated to ensure that their patients and people in long-term care

received these protections.

I think it’s the right decision. We were the only province in

Canada to do it. It was hard, and I am respectful of everybody; I really

am. You’ve never heard me be critical of people who made very difficult

decisions in their lives — never — but I think those are the right

decisions, the ones we made in B.C., where we led the way.

[1:30 p.m.]

Other jurisdictions tried to do it, jurisdictions such as Quebec.

They ultimately didn’t succeed, but we did, be­cause we were

determined to protect the most vulnerable, and we had the support of the

people of B.C. in doing it. I think we still do.

I appreciate the issues raised by the hon. member. You haven’t

heard me; we had an exchange with the member for Prince George–Valemount

on this question earlier. I am not saying that the hon. member doesn’t

care about the most vulnerable. I do not believe that’s true. I’m just

saying: “This is our assessment, and this is why we made our

decision.”

To be clear, it is absolutely a reasonable issue for debate. But

again, I support the provincial health officer; I don’t expect this to

change. In response directly, I think, to what the member is asking —

“Is a change imminent?” — it is not imminent, because we’re still in a

COVID-19 pandemic. We still have our obligations. Having a health care

system that’s 100 percent vaccinated — that’s good news for patients,

good news for communities, good news, especially, for residents in

long-term care.

D. Clovechok: To the minister, I’m back. Thanks to our critic for the extra

time.

As the minister will know, I’ve been a staunch advocate for

transborder health care between Alberta and British Columbia because I

live in a border community. We’ve kind of canvassed this morning that we

are serving through Revelstoke, Golden — as a matter of fact, Golden has

a hot stroke protocol with Foothills Hospital — and then, of course,

Invermere and East Kootenay Regional Hospital, for that

matter.

Our patients have been blocked, in many cases, from going to

Alberta, and everyone has said that it’s a policy issue through the

Alberta government. I wasn’t satisfied with that, and as a result, I did

canvass, with great due diligence, Tyler Shandro, who was at that time

the Health Minister, and now, of course, Jason Copping. So I’ve become a

pain in their behind, asking questions.

I apologize if the minister didn’t get this letter, because my

intent was to send it to him. I do have a letter here from the current

Minister of Health. I want to read this into the record, and then I’ll

have a question. This is a quote from the minister:

“Supporting access to primary care, including to physicians,

particularly in areas close to provincial borders in rural Alberta, is

an important priority for the government of Alberta. The Alberta

government and AHS recognize the need to provide health care to those

beyond Alberta. A number of intergovernmental agencies, as well as

informal agreements, exist to support non-Albertans to receive the care

that they need in Alberta.

“Given the concerns that you have raised and recognizing the

opportunity to build from previous discussions, I have asked Alberta

health officials to connect with their British Columbian counterparts to

re-engage in this important matter. I look forward to the joint efforts

to ensure clear and consistent processes, across our health authorities,

to help residents in our border areas, your constituency, access the

primary care that they need.”

I guess that with that said, from the minister himself, it doesn’t

seem like there is a policy issue. I’m wondering if the minister can

tell me if those folks that the minister had asked to contact British

Columbian officials — their counterparts, as he said — has actually

occurred and what the results of those conversations were.

Hon. A. Dix: Thanks to the member for his question. I’ve had occasion to speak

to him before on this question, and occasion to speak to the member for

Kootenay East, my friend from Peace River South and my friend from Peace

River North, because this is an issue up and down the border and an

issue of concern to them as members. It’s an issue that I’ve raised

personally with Minister Copping at our most recent

federal-provincial-territorial conference on health. That was in

November.

In short, this isn’t a B.C. issue; it’s an Alberta issue. Alberta

made the decision, as you know, to restrict out-of-province ICU patient

transfers, as of September 29, 2021, because of capacity issues in

Alberta. That restriction has been removed for out-of-province ICU

patients, but there are restrictions, too, on non-urgent elective

surgeries that have been in place since January 2021.

It’s a capacity issue in Alberta. That’s the reason for it.

They’ve repeatedly said in private, in public that that’s the reason

that they’re having issues.

[1:35 p.m.]

They don’t want to use that…. With their challenges and their

surgical backlog — which was extended, much more seriously than ours,

under COVID-19 — they’re not able to open that space. That is their

position.

I would like them, and I have endeavoured to convince them, to

change that view. Here’s why. We live in a country together. A

significant surplus of Alberta patients get that treatment in British

Columbia. I have not responded to these restrictions in kind. I don’t

think the hon. member would want us to get into the situation where we

say no to them.

The real impact we see…. This affects his constituents more than

most. We’ve seen that cases of patients from B.C. in Alberta hospitals

have gone from about 3,000 to about 1,793 over the last few years.

That’s a real fact. They still take significant patients. The member

knows that. B.C. has basically stayed the same. It has always been more.

It’s about 4,000. So we’re more than twice as many Alberta patients that

we treat in B.C. hospitals as they treat in our hospitals.

If we were to get into a discussion of tit for tat, the losers

would be patients everywhere, in my view. That’s not what we’re going to

do. I don’t think that’s how we convince Alberta to change. What we have

to do, to work with them to encourage them, is to address those hospital

capacity issues they’re facing.

On most measures of wait times for surgery, we do better than

Alberta. That’s an achievement of British Columbia surgeons and nurses

and others. That’s part of the reason for the struggle.

As you know, the people of Alberta are in an election campaign. I

have been impressed by and I’m sure I will continue to be impressed by

the breathtaking promises that are being made in that election campaign.

I will not comment further so as not to intervene in any way in that

campaign.

I would just say this. I think that’s the right approach. I think

the hon. member would share my position on that — that we not do that.

We continue to serve Alberta patients because that’s what we need to do

in British Columbia. We continue to work with the government of Alberta

to take away that restriction that they put in place for their capacity

issues.

Believe me. Minister Copping and I have had this exchange. We

understand each other. They are facing some real capacity problems. They

had to make priority decisions, and this was one of them. I’m respectful

of that, just as I was respectful of and worked closely with Minister

Shandro before Minister Copping and will continue to do so.

It’s an issue that is of high priority for people on the border,

including for him and his constituents and the member for Kootenay East

and his constituents. We’re going to continue to work on

that.

Yes. We talk to them about it all the time. Some changes were made

with respect to ICU, and that’s good. I think we have to continue to do

that in a positive sense, encouraging them and cheering for them as they

address those hospital capacity issues and we’re able to go back to the

pre-2020 situation.

D. Clovechok: Thank you for that. It’s encouraging. I actually agree with

everything that you’ve said.

The question I have, though, is…. The current Minister of Health

in Alberta said: “Follow up with me if my people don’t get back to the

people in British Columbia.” I guess I’d like to know…. Has someone from

Alberta reached out, from a staff perspective, to discuss these issues?

Is it still on the table? Are those discussions still

ongoing?

Hon. A. Dix: Absolutely, yes. They have. This is an issue that we’re going to

continue to work on because we want a positive resolution. It’s

obviously important for people living up and down our eastern border

with Alberta, in all of the communities that we’ve talked

about.

It may not seem like a tremendous amount of cases. It’s

disproportionately…. If you look at that decline in the number of cases

served, which is about 1,800 in that period…. Well, that’s 1,800 people

not getting access to hospital services that did before and having to

get them in British Columbia and sometimes having to travel further.

Those are issues the hon. member and I are working on, as well,

together.

I think on those questions, we’re…. It’s a very high priority for

us to work with Alberta. It’s not really a technical question. They have

some significant challenges, and they have made some policy decisions.

It’s up to us to convince them to change that. I know that the hon.

member has done some of that work, I’ve done some of that work, and

we’re going to continue to do that.

[1:40 p.m.]

I won’t be interested in getting into a rancorous ex­change

about it. I think B.C. and Alberta have worked so closely together on

health care issues in recent years — on the Canada health transfer, on

coverage of prescription drugs, on biosimilars, all kinds of initiatives

that I’ve worked with Minister Shandro and Minister Copping

on.

I hold Minister Shandro and Minister Copping in very high regard.

We’re just going to continue to work together on it. I think it’s an

important advocacy question.

In the meantime, what we have to do, especially on emergency

health services — and we talked about this, this morning — is continue

to improve services and access for people in B.C. It’s good to be ahead

of Alberta on most measures of wait times, but we need to be lower. I

mean, if you’re on a surgery wait-list, you don’t really care what the

wait time is in Red Deer. You care about what your wait time is. That’s

what we have to work on.

P. Milobar: Thank you to the minister and our shadow minister, as well, for

giving me this time.

Just two quick topics. They probably won’t come as a shock to the

minister, either of the two topics.

Our obstetrics clinic in Kamloops, obviously, is under threat of

closure. They’re not taking any more expectant mothers, who are due,

after the next couple of months here. It means around 300 or so babies

expected to be born without that prenatal help — and then next year, if

the situation continues along, well over 700 plus. It’s a huge concern.

It’s a large geographic area. It’s not impacting just Kamloops. My own

two daughters went through the clinic last year, and it was an

incredible help to them.

Part of the problem is…. There’s going to be a ripple effect. My

understanding is if a woman goes to the emergency room, which is now the

advice…. After 20 weeks, operating policy is…. You are told to go up to

the maternity ward and not stay in the emergency room. Well, that’s

going to have a ripple effect into the maternity ward, as well, and,

obviously, impact the operations there. So it’s a massive, massive

problem.

We have a petition now. It’s well over 5,000 people that have

signed it. What people want to know is: is there a solution? If not,

when is there a solution? When will there be certainty that this clinic

will keep its doors open for all those expectant mothers and families in

the Kamloops and broader area?

Hon. A. Dix: Thanks to the member for his question. It’s a high priority for

me. It’s something I get updated on every day.

I think, overall, the work we’re doing with physicians, in terms

of a new contract and adjusting to new payment models, which is

important for them…. Those have progressed well. There’s a recruitment

side of that as well. We’ve made real progress on both of those

questions and, in particular, the discussions we’ve had particularly

with the community of doctors around the obstetrics clinic.

We’re positive about that. It’s a high priority for Interior

Health. There have been direct discussions. The doctors at the clinic,

others working at the clinic and Interior Health are working full-on

together to see that that care continues.

I agree with the member. It’s of the highest priority to us. The

member will know that some of these discussions are going on. They may

not be going on as we speak. They have been going on in the last few

days as well. I’m optimistic. We’ve got work to do together. Our goal is

a continuation and, indeed, a strengthening of services

there.

P. Milobar: I’ll end with…. Hopefully, it can be solved. It’s creating a huge

amount of stress.

I have a constituent. She has authorized me to talk about her

story publicly. I’m not going to name her. She’s high risk. She’s a

nurse. She understands that. She’s got a couple of high-risk

factors.

Her first appointment, which she was able to find, was in Salmon

Arm. So she’s having to start to travel an hour plus each way on a very

busy highway as the summer approaches. Based on her high-risk factors,

that should have been her third appointment, and it was her first. You

can imagine the other mothers, who are not medically trained, not

realizing the importance of prenatal care in some of those earlier

months of expectancy.

[1:45 p.m.]

The second question I have is, obviously, around the cancer

clinic. It’s a bit of a twofold. It was promised in the 2020 election,

very clearly, by former Premier Horgan. It was supposed to have its

doors opened by October of 2024. It’s still in the planning stages,

apparently. The former Premier had it already at Treasury Board, right

out of the gates. Then he had it at the business case stage. It seems to

be progressing backwards.

The long and short is this, though: people are tired of all of

that. They get the doors won’t be open in 2024. The concern right now is

that nothing seems to be able to be talked about publicly. Interior

Health, coming to the hospital board repeatedly, was unable to answer

questions, not because they didn’t have information, but they weren’t

allowed to share the information.

This has to be about the only health care project, capital

project, in the history of the province, that the government wants to be

so secretive about and continually say: “We have no information. We

can’t say. We can’t talk about things.”

IHA already owns land. It’s not a case of trying to acquire land.

We understand where it’s going. There has already been site prep done on

the property.

Why is there such secrecy around this project? When can people

actually expect to start getting some public answers and public

discussion about this project, and when will there be actual funded

dollars in the budget so that people have some certainty that the

project is actually moving forward?

Hon. A. Dix: I don’t want to be too philosophical. I promised shorter answers

this afternoon to the member for Prince George–Valemount. So I won’t be

too philosophical about the issue of capital planning.

This is not a new thing. It has been a source of frustration for a

lot of communities. Until projects are approved at different stages,

they don’t come forward, and the details don’t come forward.

My task as Minister of Health…. I appreciate the comments, and I’m

going to respond in kind. We can always have a political debate, but we

can probably have that outside and in the public realm. My job is to

deliver a cancer centre for Kamloops, and we are going to deliver a

cancer centre for Kamloops. We’re going to have…. Once we go out and

have the approvals in place and the plan in place, we’ll lay that out,

and there will be significantly more information.

I understand what happens with capital projects is…. This was true

for the Royal Inland project before the previous government went forward

with it. Until the approval comes forward, those discussions don’t take

place. We’ll be fully engaged, obviously, with the hospital district and

with the community on that question, and with the B.C. Cancer

Foundation, which is looking forward to provincewide support for that

project. They’re strong supporters of the project as well.

We’re proceeding in Kamloops. I hope to have more information

soon. My job is to deliver it, and that’s what we’re doing. Once we get

it delivered and get it built, it will serve the residents of Kamloops

for decades to come. That’s something that I think everybody in Kamloops

wants. It’s something that I want and something I’ve believed in for a

long time.

As we increase the number of cancer diagnoses in B.C. — we’re

expecting, in the ten-year cancer plan, from 30,000 to 40,000 — the

demands and the value of going forward and dividing and providing care

closer to home becomes greater and greater. That’s why the suburban

Metro Vancouver sites of Burnaby and Surrey are fully integrated into

those hospital projects. It’s why the Na­naimo project is a

priority, for a second centre on Vancouver Island, and why we’re going

forward in Kamloops.

I understand that people want it yesterday. It’s coming. It’s

something that we’re going to work on together and get done, and it’s

going to be a great thing for the people of Kamloops.

M. Bernier: Thank you to the member for Prince George–Valemount for the very

quick question I’m going to ask.

It’s an annual pilgrimage that I’m making to this minister. I’m

thinking the road to Damascus has come to an end, depending on the

answer I get from the minister right now.

Obviously, I do want to thank the minister. We’ve been working

together on the hospital project in Dawson Creek. He doesn’t have to be

philosophical for my response. It can probably just be a very quick one.

I’m just looking at where we’re at, for a timeline.

[1:50 p.m.]

I do understand. He does not need to get into the details of the

delay that we’ve had, which I understand. Northern Health has been very

open about some of the challenges with the procurement and the

work.

There was a commitment that we were going to have a groundbreaking

this spring. Spring is almost over. I want to know, basically, are we on

timeline, then? Do I get to have the minister up to my house for a

barbecue real quick this spring and summer? Are we going to be cutting

the ribbon and getting the ground broken and getting the hospital

finally underway in Dawson Creek?

Hon. A. Dix: Still aiming at the spring of 2023, which ends on June 21 or 22. I

always get those solstice things mixed up. But that’s the plan, just so

members know that.

I very much appreciate the ongoing support of the member, because

this is a case…. Sometimes people complain about capital planning in

hospitals. This is a case where we started with one project, which was

to do, essentially, a transformation of the existing hospital. We came

through that project and our work with the regional hospital district

and the community, and we’ve come through with another project, which is

a brand-new stand-alone hospital, which is going to be

fantastic.

The community has been incredibly supportive all the way through.

Indigenous groups — hugely supportive, as the member knows. I know it’s

not Mayor Bumstead; it’s not Dale anymore. But it’s….

Interjection.

Hon. A. Dix: Yeah. But we’ve had support up and down, and we’re going to build

the thing. We’re hoping to break ground in June, and I hope the member

will be there. We’re finalizing that RFP.

We went through the RFP process, and we weren’t satisfied. It’s

not just us that aren’t satisfied. This is a jointly funded project, so

it’s the local taxpayers’ money as well that’s in question. In this

case, it’ll be less than the original 40 percent, because we’re taking

on more of the extra, because there’s an increase in cost. We’re working

with the community.

It’s going to be an exciting thing. Again, once it’s built, it’s

going to be, I think, a huge factor for us in Dawson Creek — really help

us. Having a new hospital is a real act of confidence there, something

people have wanted for a long time. I’m proud of the work that we have

all done together to see that it happens.

S. Bond: I’m sure we’ll get to more capital. The minister can imagine which

one I’m going to ask about, because there are lots of people waiting.

That answer about the cancer centre — one must wonder if the minister is

just saving up those announcements. Maybe a snap election is in the

future. We could…. You know, lining them all up for the months

ahead.

If the minister, now, wouldn’t mind, let’s deal with the issue of

emergency health so that the very patient people that are here to

provide support to the minister will be able to be freed up to do other

work. Perhaps we can walk through the questions that I gave him before

the break. Then a very brief update on the nurses agreement, and then

I’d like to move on to the critical issue. I have a couple of…. I’m

going to ask one about something, and then I’m going to move to medical

imaging and cancer.

Hon. A. Dix: The first was on the ambulances. BCEHS has deployed 55 new

ambulances in 40 communities. I’ll give some of the regions, but I will

also provide the member with a list of communities. But just to say it’s

14 on Vancouver Island, 12 in the Fraser region, eight in Vancouver

Coastal, 13 in the Interior and eight in the North. And I can give the

community breakdown.

We have also, on advanced-care paramedics, added 18 advanced-care

paramedics across nine communities. Just to give the size of communities

that that has gone to — communities such as Campbell River but also

Williams Lake, Cranbrook and Fort St. John are communities in that

category — because I’m always interested in members who are listening

carefully to me.

We’ve also added five aircraft. One is a fixed-wing out of

Kelowna, the rotary-wing helicopter out of Nanaimo and fixed-wing

aircraft out of Prince George — three. We’ve also added 30 dispatch

staff in that period.

[1:55 p.m.]

We obviously regularly review the needs of communities. That’s a

key part of the process that we’ve been engaged with, including with

MLAs on both sides of the House. Some of that long-term planning work is

undertaken right now to predict demand and plan for what is needed now

and over the course of the next five years.

That’s a little bit on planning, where the new cars, the new

ambulances are across the province. We’ll have something to announce,

and I’ll be happy to brief the hon. member when it happens, about new

advancements in helicopter transport, which is really important to the

prov­ince. We’ll see an expansion of service, which is, if

anything, more important in the Interior and the North and parts of

Vancouver Island than anywhere else. That all is happening soon. So that

gives the member a bit of a breakdown on all of that.

With respect to the nurses question, perhaps what I can do, if

it’s all right…. The announcement will be made, I think, at 3:30. We

don’t have that information about what has happened yet. I’ll just stand

up at or around 3:30 and give that answer.

S. Bond: Sorry if I missed it.

What work is being done on what was described as bottlenecks in

training and hiring? That’s a significant issue, and it was raised,

obviously, by the ambulance paramedics and dispatchers. Again, I want to

put it in the context of people are…. They are grateful for what’s

happened, but what they need to do is see people on the ground more

quickly. So can the minister speak to that issue?

Hon. A. Dix: Let me talk about some of the actions to enhance recruitment that

have taken place recently. There’s been a simplifying and streamlining

of the interview process. Applicants are getting interviewed within 24

hours, where previously the timeline was two weeks. That’s a significant

advance.

Setting up pop-up and drop-in interview locations in various

locations throughout the province so that applicants can come in and

talk to someone, interview and fill out the application form at their

convenience.

Partnering with St. John Ambulance to establish a pipeline of

emergency medical responder–trained applicants that want to join BCEHS.

That’s obviously a group of potential ambulance paramedics.

Establishing drop-in interviews at training institutions to hire

applicants right out of school. That’s very important because there’s

actually, as the member will know, some competition for

paramedics.

Undertaking conditional hiring for applicants at various paramedic

levels who are awaiting licensing.

Of course, things such as attending job fairs and community events

to speak to applicants about joining BCEHS and interviewing the

applicant during the event, if they want to.

Putting in place a dedicated Indigenous recruiter — this is very

important — in communities around the province to make connections with

Indigenous communities, to address recruitment needs and recruit from

Indigenous communities for Indigenous communities.

In March 2022, to help recruitment, BCEHS implemented a dedicated

talent acquisition team. That team has increased, on the recruitment

side, from 8.8 permanent positions to 21 permanent positions. That’s how

we were able to achieve some of the things that I talked about earlier.

There’s also a robust, dedicated talent acquisition structure within

BCEHS with a dedicated manager and director.

[R. Leonard in the chair.]

We’re also working with individual communities to remove any

barriers for potential candidates. This includes helping with any

licensing issues and providing local EMR training and driver

training.

So those are some of the steps that have been taken. I appreciate

that people may understand those steps and want to take more steps, and

we’re certainly interested in that. BCEHS has dramatically increased its

recruiting capacity, and the results are very successful recruitment in

absolute terms but also the need to continue to do so.

[2:00 p.m.]

S. Bond: Thank you to the minister. Would the minister agree that there are

still 500 to 1,000 positions open?

Hon. A. Dix: We added a bunch of positions on April 1. Obviously, until they’re

filled, they’re vacancies. A lot of the positions that are vacancies are

currently filled with casual staff. So what’s happened is we’re making

the transition at the Ambulance Service from casual to permanent staff.

It’s not a question of there being 750 positions not being at work, but

there are 750 positions that are not filled at the Ambulance Service,

and a significant portion of that is the transformation we’re taking,

and they will be filled over time.

Some are what you would call not real vacancies but substantive

vacancies that we have to address. We’ve made real progress on that, and

next year, we’ll keep…. By adding positions and then by adding new

permanent positions, away from casual positions, we add that to that

total because we’re obviously adding to the size of the Ambulance

Service. That’s where we are right now, and I’d be happy to provide the

member with more information on that.

S. Bond: Thank you for that response. I don’t know if I missed it, but did

the minister provide me with an update on the review of looking at rural

and urban and how we actually are drawing from — using the Victoria

example — Sooke? Is there a review underway of the allocation of those

resources, the requirement that is pulling people out of smaller

communities? If there is, what is the timeline, and will the report be

made public?

Hon. A. Dix: Significant work has been done, obviously, with this hiring, and

the addition of all of these positions, mostly, are hugely in rural and

remote communities under the plan. But we also are looking out five

years as to what’s needed in different communities, and that work is

going on now.

As we make progress, obviously, both in the filling of vacancies

and the adding of positions across the province, we want to make

progress on that question. This is the regular…. This isn’t a special

review, but it is the work that BCEHS does with the ministry on a

regular basis. It was the basis for the very significant investment in

the rural and remote plan. Obviously, we need to keep looking at that as

the province changes over the next five years to make sure that we’re

adequately staffing both what are sometimes called urban and suburban

communities and their relationship, but also rural and remote

communities.

S. Bond: Thank you very much. I think the issue is that we just want to

make sure that we are anticipating what additional needs there are. I

think that making announcements and providing resources is critical, but

we also want to make sure that we understand what the circumstances are

today and what they’re going to be in the years ahead.

I want to thank the men and women who serve in this capacity, in

dispatch or paramedics across British Columbia. I’m very lucky to know

them in my community, and I know how incredibly hard they work and how

difficult it has been. There has been a lot of demand, and there have

been a lot of stories about people who call 911 and they don’t get the

response that one would expect in British Columbia. So there is more

work to be done. I think the minister has made that clear.

I just want to be sure that we are on the record in terms of

reminding the minister that there have been comments made about the

ability to manage during “the busy season.” We know that already we’re

seeing rising temperatures in the next few days. There are high

streamflow advisories. We have faced wildfires. We have faced floods. We

have faced the heat dome. I am hoping the minister and his team have

looked very carefully at the ability to provide some sort of surge

capacity.

[2:05 p.m.]

We talk about surge capacity in a lot of ways in the health care

system, but when people need help and dial 911, they expect an ambulance

to respond. They expect someone to answer the phone, not a recording,

and get the help that they need.

I thank the minister. I thank the staff that are present and the

work that they do every day. With that, I’m going to move on to the next

topic.

This one the minister is going to be less enthusiastic about

having a discussion about, but that’s okay. It’s my job. I want to

remind the minister that in 2021, in the estimates process, the minister

actually responded to my colleague about his support for the work of

committees. I want to read his quote back to him. He said at that time:

“I’m happy to take suggestions from the member with respect to select

standing committees, understanding, to some degree, their limitation but

also the possibility of their usefulness.”

I want to ask the minister, once again, to consider utilizing the

Select Standing Committee on Health to have what is a critical

discussion in British Columbia about the implications of Bill 36. I also

want to say on the record: the minister points regularly to the

collaborative approach that was taken in terms of consultation, the

beginning discussions. What we also have to point out is that that

collaboration doesn’t extend to seeing the legislation and understanding

the impacts until the bill with over 600 clauses hits the

table.

I have very significant concerns about the fact that there was….

The minister will say: “Well, you know, you asked questions of every

single line.” You bet I did, and I would have asked a lot more if I had

been given the opportunity to do that, which I was not given. I would

remind the minister that I managed to work my way through 233 of 645

clauses. As an experienced legislator, I can tell you that it was a bill

unlike anything I’ve ever seen before in terms of the magnitude and the

length.

I want to remind the minister of some of the concerns that have

been raised regarding the passage of Bill 36 by this government and the

Green Party. Here are some of the concerns: how boards will be

appointed; how the oversight body will function; when the act will be

implemented and on what schedule; how it will be implemented; and,

ultimately, who’s going to pay for the associated costs related to the

amalgamation; the specific mechanics of new complaints, investigation

and discipline processes; what will trigger fines, and so much

more.

We have heard, and I know the members opposite have heard, from

hundreds of health care professionals. While the minister can say there

was consultation, apparently there wasn’t enough or it wasn’t extended

broadly enough so members of the colleges actually had a sense of what

was going on.

I would remind the minister that debate was ended. The government

invoked closure. I am asking the minister today to ask the Premier to

bring the Health Professions and Occupations Act, which is known as Bill

36, to a debate or attach it to the Select Standing Committee on Health,

anything so that we can take a look at sections 233 to 645 and ensure

that there is adequate and appropriate discussion about the bill and the

concepts and the changes that are included in Bill 36.

Hon. A. Dix: The member suggests that I would say that she was asking

questions. I think I spoke about it in that debate, and I was answering

questions and engaged with her in that debate. I’m someone who believes

in estimates debate and believes in parliamentary debate.

With respect to Bill 36, I’ll just quickly run through the

process, just because we’ve talked about this. We had the Cayton report,

significant consultation, an all-party committee, more than 4,000

responses — the vast majority of them, 80 percent, by health care

professionals — that we all got to review, in that process. We did have

a subsequent consultation.

[2:10 p.m.]

In the meantime, I’d asked for and received the In Plain

Sight report, and there was substantial consultation that led

to, on the recommendation of the all-party working group and then a

First Nation’s significant changes to the way that we deal with issues

of discrimination and racism, changes that the member supported in our

discussion, because we debated, I think, through those

changes….

We had a debate in the Legislature. Ultimately, that was 47½

hours, which in my time in the Legislature, I believe, is an all-time

record. Part of what I tried to do is give time for debate. I’m not

going to get into a debate about what the opposition’s time in the

Legislature is. It’s time. I was in opposition. I remember it well. The

member was in government. She remembers it well.

In that case, there was support by the opposition at second

reading, but also basically a full round of second reading speeches, and

then we had a debate at committee stage. It was a substantial debate. I

always want — as does the member for Prince George–Valemount, when we

take on initiatives — as much support from all sides and from everywhere

as possible at any time.

This is a piece of legislation that we consulted on over many

years. We brought it forward to the Legislature. We had a very

substantial debate in the Legislature. It was passed by the Legislature,

and we are proceeding to implementation. I don’t think the member for

Prince George–​Valemount wants me to respond on all the specific

issues — although we can have that debate; I’m happy to do that — that

were raised around the legislation.

I think that this will be very good legislation for British

Columbia, but the process isn’t over yet. When you’re going from 15

regulatory colleges…. When I was Minister of Health, we started with 24,

and we’re down to 15, and that’s good news. That was done again. The

uniting of the nursing colleges, the uniting of the dental colleges —

that went from eight to two in those cases. Then the adding of the

College of Midwives, now the College of Nurses and Midwives was another

change. The amalgamation of some of the podiatric surgeons with the

College of Physicians and Surgeons.

We’ve come down, and there will be significant steps as we come

down to the six colleges proposed in the legislation. But I do want to

proceed. I want to proceed because the changes with respect to

anti-racism, the individual and collective responsibility for those

initiatives are an important part of the bill. The changes were needed,

called for in an independent report and then overseen and then engaged

in years of consultation, then brought forward to the House.

The bill was a big bill, and I acknowledge that. It was a big bill

for two reasons. One, essentially the sections on occupation replicated

the health care occupations, replicated the provisions on health care

professionals, and that added to the length of the bill. I suppose we

could have made it shorter by not adding the occupation component, but

we felt that was a good idea to ensure appropriate regulation of health

care occupations. That was an appropriate thing to do, and that’s what

we did.

Secondly, I believe strongly — and this is a case that hon.

members on all sides of the House have made, usually when they’re on the

opposition side — that we needed to have more in the legislation and not

in regulation. In other words, I think you should be more explicit in

legislation where you can than having enabling provisions in

regulations. That’s what we did, and that made the bill longer. I accept

that.

I’m always open to engagement. There is, of course, in the

implementation of such a bill, just on the creation of colleges, many

steps in front of us. We’ll continue to work with everybody on those

steps, continue to keep everybody, including the opposition, briefed on

that process and engaged in that process as we go through to bringing

the legislation into force.

I understand it’s a difference of opinion between the member and

myself, and I absolutely respect her bringing it forward here. That was

my approach to the legislation. My approach as a minister was to fight

and get a very significant opportunity to debate the legislation. The

legislation passed in the way that it did.

I’m also very proud of the legislation, very proud of the

collaboration that went into it from lots of members of the Legislature,

including the member for Cowichan and the member for Kelowna–Lake

Country, but others as well, because they involve their caucuses. As the

member for Prince George–Valemount knows, opposition critics don’t make

decisions without fully consulting their caucuses, as did I. I think

that was a positive process, and an example of what we could

do.

[2:15 p.m.]

Finally, I just want to say…. Sometimes this report gets thrown

around in the House, the one that was just completed on issues involving

substance abuse and the overdose public health emergency. I think since

we had that discussion on committees, the member will know that that

report took place. She played a big

part in that report, and I want to

acknowledge the work of the Select Standing Committee on Health and its

members.

I believe it may have been a special committee, but the member

will know that.

The Chair: Member, I just ask that you please connect your question to

the vote currently under debate, which is the Health estimates for

’23-24 of this fiscal year.

S. Bond: I appreciate that advice, Madam Chair. The minister answered the

question, which opens the door for me to continue to have that

discussion. He is not at all reluctant to answer the

question.

I simply want to remind the minister that an all-party committee

doing preliminary work that ends up shaping a bill does not mean that

the caucuses attached to that support the legislation. Until the bill is

actually crafted, and the implications of the work that is done are laid

out in the Legislature — that’s when parties make a decision.

Yes, there was preliminary work done, and it’s the same discussion

that we will continue to have in this House about all-party reports that

are tabled. Because I can assure you, I have very clear memories of what

happened when it came to the committee that I was a part of, the

Standing Committee on Health related to the opioid crisis.

We’re not going to talk about that today, but what I am going to

remind the minister of is…. If it took this long to bring a bill of over

600 clauses to the Legislature…. The debate was not complete. There is

no way the minister can characterize…. He can characterize it as “a

debate.” It was not a complete debate. I got to clause 233 of 645. Key

sections, especially regarding appointment of board members and

significant aspects of change, were not part of the debate that took

place.

My concern is…. I know the minister is an experienced legislator.

He’s been here a long time, on both sides of the House. The fact of the

matter is, if it’s taken this long, why on earth would the minister not

be willing to take the time to allow the questions to continue, to make

sure he got the bill right, and that there aren’t unintended

consequences?

People are concerned. Health care professionals are speaking up

across the province. So you bet this is an important issue to me. And I

understand the legislative process pretty well. An all-party committee

does not mean that when the bill gets to the Legislature that there is

an assumption we support it. We get the chance to debate it, look at the

clauses, look at the issues. I remain very concerned about significant

clauses that have not been debated.

I would ask the minister to think very carefully about giving

elected officials in this House the opportunity to continue that

discussion. It’s taken years to get here. How on earth could it hurt to

take a few more months to actually walk our way through that bill,

listen to the concerns that have been expressed and actually allow the

questions to be answered? In the end of the day, the outcome of the bill

would be far better received if that process was followed.

With that, I want to move on to medical imaging. We have heard so

many challenging situations. In fact, the minister knows that last fall

the B.C. Radiological Society proposed a number of solutions to address

the medical imaging crisis in B.C.

I’m wondering, in light of that: can the minister outline for me —

again, he can provide those issues to me later, with a chart or graph if

that’s preferable — the current vacancy rates for sonographers, medical

imaging technologists in general and cardiac; and how many med. rad

technologists does B.C. need to reach the national average of MRTs per

capita?

[2:20 p.m.]

Hon. A. Dix: Yes, the ministry has engaged with the B.C. Radiological Society

on some of these questions. I know the member….

I just wanted to say, finally, on the previous question, without

reopening the debate in any way on Bill 36, that since royal assent, the

Ministry of Health has held 40 consultation sessions with external and

internal stakeholders. That work continues — without getting back into

the discussion of Bill 36, which we could debate for a long time. But I

think, our positions…. In fact, we did: 47½ hours.

In any event, with respect to our actions and responses here, the

member will know on diagnostic care that this has been a major area of

focus since I’ve been Minister of Health. On MRIs, as the member will

know — I won’t repeat this more than once — we’ve gone from 174,000 a

year to 300,000 a year. And that result required an enormous increase in

the workforce. It was particularly felt in northern communities, where

the rate of MRIs had been particularly low. But every one of the

province’s communities, like Surrey in particular, benefited from

that.

On equipment, just to say that since I became Minister of Health,

two net new PET-CT scans; 17 net new MRI units; six net new CT scan

units; 297,000 MRIs, an increase of 121,000; 920,000 CT scans, an

increase of 228,000. We’re leading the country on MRIs. I don’t say that

in response to the B.C. Radiological Society. They’re part of what

achieved that, and it has been exceptional. That has involved, of

course…. We can talk about staffing. There is a very significant

increase in staffing and in training.

In terms of health human resources, just some of the aspects of

that. The response to a lot of the issues, of course, which were raised

by the B.C. Radiological Society…. Since 2019, the total number of

annual diagnostic medical sonography seats has doubled in B.C. from 40

to 80, including new programs at the College of New Caledonia, which is

a significant one, and Camosun College in Victoria. This is critical for

us to ensure that those machines in the North that we’ve added and those

hours that we’ve added have the supports they need.

The new sonography teaching clinic — and I was there not long ago

— operated by Island Health on the Camosun Interurban campus is now

operational. It’s the first of its kind in Canada, offering students

greater opportunities for clinical experience throughout their program

while also increasing ultrasound services in the south Island region.

Just to put it in context, in sonographers alone, a 21.5 percent growth

in the workforce over the last four years.

[2:25 p.m.]

We also have a new direct-entry MRI technologist training program

at BCIT that will ensure a steadier supply of graduates — that’s

important — and a bursary program for MRI technologists. When you have

ambitious goals and you’re No. 1 in the country in terms of MRIs, wait

times and the focus on those who are waiting the longest has had a

profound effect, you need a lot of MRI technologists, and that’s taking

place.

There are also new bursary programs, peer support, strengthening

clinical practice leaders in attracting more internationally trained

allied health professionals, which is equally important to the work that

we’ve spoken of before, for nurses and for doctors. I talked about the

net new CT scans, and all of this is in response of it.

As well, there are increased fee items for the community imaging

clinic, which is an issue for the Radiological Society. And we are, of

course, open to continuing the process together. They’ve raised those

significant HHR questions, and we responded to their suggestions, in

many cases, to advance those programs.

Of course, the great work we’re doing together reflects the great

work by both the members of the society and all those working in

diagnosis of all kinds in the province. It is not without challenges,

especially when you’re increasing the number of exams as we have across

the system. That’s good news for patients but really challenging at

times. And one of the main ways we’ve done that, of course, is to go

24-7 at many locations, and that requires staff. That’s why so much a

part of this plan was the training of staff.

S. Bond: I think I missed the part where we get the numbers of vacancies. I

understand, and I carefully review the additions that have been made and

look at equipment. What we need are people. When I look at the numbers

over the last two years, I understand that workforce shortages in

diagnostic services…. Vacancies are in excess of 10 percent for

ultrasonographers, general and cardiac.

I’m wondering. Does the minister, the ministry have specific

numbers by health authority, by region, by professional designation, of

vacancies?

Hon. A. Dix: If it works for the hon. member, I’ll pro­vide that

information for her. We have some percentage information, but that’s not

the number of vacancies. So rather than waiting for that, maybe we can

continue. Unless the member wants to wait for those answers.

S. Bond: No. I appreciate the offer of the information. We will move on,

and I will take a look at that number. My subsequent questions aren’t

reliant on getting the information right this minute.

I’m wondering. One of the things that was raised by radiologists….

And again, I know we’ve discussed this. When it comes to the overall

challenges we’re facing in health care, health care professionals and

labour shortages is the issue of retention. And I think it’s absolutely

essential that we focus on retention.

I’m wondering if there is funding in the budget under the health

human resources strategy provided for the retention of technologists

specifically.

Hon. A. Dix: We discussed this Tuesday. I think it was Tuesday. It was before

today. So what we’ve taken is a community-focused approach. So where

we’re seeing often the greatest pressure, as a percentage — not an

absolute number, but a percentage — is in the Northern Health Authority.

And all of those things that we discussed at some length, and I won’t

repeat, are for all professionals in that area.

[2:30 p.m.]

Say it’s the northeast, or say it’s Fort St. John. It’s not just

nurses. It’s also allied health professionals that have access to those,

what we call, retention supports — all of the measures we’ve talked

about in Northern Health to advance our workforce there. The reason for

that is we want to focus on areas of high vacancy as well. We’ve

obviously got to train everywhere, and we’re increasing the demand on

the workforce everywhere and the numbers in the workforce, so we need to

train.

Part of the focus of that has been on the North. We mentioned

Grand Forks before. In the case of that hospital and that facility, it’s

across workforce there — equally in Northern Vancouver Island as well.

And in the Mount Waddington Health District — same as there. The focus

of those cases is not on specific professions but on all categories of

workers. It’s community-focused as opposed to profession-focused in

those cases.

S. Bond: We continue to hear about the shortage of especially med lab techs

and others. And we know that it is absolutely essential that we sort

this out, because when we stop and think about the critical role that

these professionals play in the health care system more broadly…. It’s

been noted that diagnostic and pharmaceutical care drive more than 60

percent of all medical decisions, and they’re key to early detection,

diagnosis and treatment.

When we see shortages…. When we look at the numbers from 2016 to

2021, for example, vacancies for med technologists and technicians, who

play a critical role, has increased by 109 percent. If we’re going to

actually treat British Columbians’ health care needs in a timely way, we

need to solve this issue.

It is a matter of looking at a variety of responses, as I’ve said

to the minister frequently. Retention matters. We obviously have to also

train and look at expediting the credentialing process as

well.

I’m wondering if the minister is aware of and being thoughtful

about the potential to create inequity between health authorities and

community imaging clinics. It is really important, for example, that we

don’t incent one group of people who work, for example, for a health

auth­ority, at the expense of community health clinics, because we

will then end up simply drawing professionals from one group to another.

That doesn’t solve the problem.

Has the minister spent time, as…. The letter from the B.C.

Radiological Society pointed out that we need to be careful. I quote

from that letter. “Care must be taken not to create preferential

incentives for technologists to join health authorities versus community

imaging clinics, or vice versa, where one gains at the expense of the

other.”

Is that being taken into consideration when we look…? I understand

the minister is talking about geographic incentives, but we also need to

look at a more micro level that looks at where people are coming from

and how those incentives are impacting both community health clinics and

also the health authorities.

Hon. A. Dix: First of all, a key part…. There are really four components of the

health human resources strategy, and the training one is the key

component.

[2:35 p.m.]

When you add training spaces…. And this can be a challenge at

times. We have been, in many paramedic positions — we were just talking

about that — outbid in some ways by, sometimes, the natural resource

industries or others who need paramedics and will pay almost any price.

We have, of course, changed the way we remunerate our paramedics, and

that’s important. There is that element.

We are increasing paramedic training spaces. All of those

paramedics, of course, have the opportunity, just as we’re increasing

training spaces across the diagnostic professions and occupations. So

all of that work is going on.

On MRIs and, I believe, CTs, there are no private contracts. So

the public system is the public system. This is an interesting

discussion. There was a report by a group that claimed that we were

doing more private diagnostic care. We weren’t doing it at all. What we

were doing is more public care.

What was happening is the radiologists are paid by

fee-for-service, so we were paying for 130,000 more exams. And those

were going through fee-for-service to those groups of radiologists. The

group doing the report mistakenly thought that was private care. It’s

absolutely not. It’s absolutely inaccurate, but it occasionally gets

repeated. So I thought I’d mention that. That’s a small tangent. I won’t

have too many more.

Finally, just in response to the previous question, there’s an

element I missed. We do have some collaboration on recruitment and

retention strategies with the Health Sciences Association — an agreement

I can absolutely talk about, because it passed — for increased premiums

on occasions for difficult-to-fill positions.

A lot of that, though, is still geographically focused, of course,

for obvious reasons. I mean, the difference in vacancy rates as between

Vancouver Coastal and Northern Health is significant, even though there

are lots of challenges in Vancouver Coastal, including the cost of

living, and so on. But the real challenge is there, and that’s why those

premiums are provided there.

S. Bond: I want to ask a question specifically about wait times. I want to,

first of all, begin by better understanding what data is collected and

how it is captured. I understand that the government does have access to

wait times for diagnostic imaging for priority 1 through 5 examinations.

What I want to know specifically is: is the data correlated across

health authorities, and will the minister provide us with that

data?

I guess the root of that question, the reason I want to ask it

is…. Certainly, what we hear, and what we’ve been told, in fact, is wait

times are reported to be variable in var­ious…. The minister has

referenced Northern Health. In fact, we’ve referenced Northern Health a

lot during these estimates, knowing the geography and the unique

dispersion of services, all of those things.

I guess my concern is that where you live in British Columbia

shouldn’t determine either the quality or the timeliness of your care.

Maybe I’m used to saying that because of where I live. It seems like

we’re always having to make that argument. But I’m wondering, from a

data collection perspective, is it correlated across health ministries?

And I’m looking particularly at priority 1 through 5 ranked

examinations. Would the minister be prepared to share that?

Hon. A. Dix: Yes and yes.

S. Bond: I have to note that was the first time I actually didn’t make it

into my seat, and that is progress on the minister’s part. So thank you

for that.

I’m very, very concerned about hearing very recently that the wait

times for diagnostic breast imaging and biopsies, specifically in the

Lower Mainland but in health authorities more broadly, may be as high as

nine months. Can the minister assure me that it isn’t nine months, or at

least, if it is nine months, what on earth are we doing to bring those

wait times down?

[2:40 p.m.]

Hon. A. Dix: To go through, first, some of the wait-time data, perhaps, and

then to talk about some of the measures, we are taking steps to increase

the number of breast biopsies through a number of means.

Just in general on the wait-time data, we have two health

authorities that I have here in front of me, and we’ll get the rest for

the member. IHA and VIHA report wait times of between one and four

weeks, depending on the site. It’s one to four weeks, not nine months.

For those, we have significantly increased the number of exams and that

process. That’s roughly what that wait time is.

We also have taken action on the issue of breast bio­psies,

because that’s critically important when that circumstance comes about.

In B.C. at the Vancouver cancer centre — this is since the earlier part

of this year, and these are all in place now, these measures: 35

additional biopsies by booking evenings and weekends.

At Lions Gate hospital…. Lions Gate has started performing

stereotactic breast biopsies. That will result in an additional 200 per

year. At B.C. Women’s, additional radiology resources were added to the

site, increasing capacity.

For the longer term, up to three additional radiology fellowships

have been made available through B.C. Cancer and B.C. Women’s, because

we need to take steps now, which the first three were about, and we need

to continue to take steps to make sure that we have the staff and the

people available to provide the care that we need to provide.

S. Bond: It’s a very critical issue, and I look forward to seeing the data

on wait times from other health authorities.

The latest data that I have is that one in eight women in British

Columbia will be diagnosed with breast cancer in their lifetime. In the

view of many, the concern we’ve heard is that there just is a sense that

not enough is being done to make sure that women are getting screening

mammograms at recommended intervals.

One of the things I want to raise is the issue of more urgent

imaging due to higher risk or suspected abnormalities. One would think….

I know that several months ago, when I was meeting about that issue, the

waits at that time were over 2½ months — over three months for biopsies

and over a year for dense breast screening ultrasound.

I understand the minister is saying that we need more, and we

certainly do. That is a significant concern. I would very much look

forward to also having a better understanding of what the wait times

are, particularly for complicated situations and also for women who are

at higher risk.

One of the suggestions, I know…. I was trying to recall. It was

B.C. Radiological that suggested that we need to be looking at specific

codes for contrast-enhanced mammography, looking at complicated

mammography and how billing is done, related to more complex

situations.

[2:45 p.m.]

Again, I want to make sure, when the minister provides me with the

data, that there is consideration for the fact that there are

higher-risk cases. There are circumstances related to urgent

mammograms.

Could the minister just speak to that issue? I know it was raised

specifically with him in the letter from the B.C. Radiological Society.

I’m wondering what work has been done to address that issue.

Hon. A. Dix: I’ll talk about some of the work, because I think it touches on

the issues raised by the member.

First, on screening. People will know that a full one-third of

diagnoses for breast cancer come through the breast screening program,

which is an exceptional…. Obviously, the screening program is both

successful and could be more successful — around 260,000 screens a year,

and that’s about 50 percent of those eligible. So we can do better on

that. Clearly, earlier diagnosis is better always.

Secondly, we have to increase participation in high-risk and

underserved populations. In the cancer plan, we’re introducing

personalized screening invitations for established screening programs to

focus in on areas. For example, if we find a community where there is

very low uptake and low participation, we can make a specific effort

there to raise that up. I think that’s a significant and important thing

to do.

On screening and mammography result notifications, 94 percent were

sent within one week. That’s recent data. That’s from December of

So those are some of the things, and what we’re going to use and

are using is the mobile mammography unit deployed to communities where

there may be staffing shortages or need for other support to do

that.

In terms of diagnosis, for abnormal mammography screens — and this

is from 2021 — 90 percent were diagnosed within 8.3 weeks without tissue

biopsy. So those are some of the numbers. I’ll be providing the member

with more information on this later on.

I want to speak a little bit…. As you know, we became the first

province, in 2018, to provide breast density scores to patients and

their primary care providers following a screening mammography — in

October, 2018. This was an exceptional effort that was supported by

members on all sides of the House. I remember the current member for

Burnaby North and the previous member for Richmond East, I’m thinking —

she was the one that was the Speaker, at any rate; I think she changed

ridings a couple of times, but that’s what she was — and others who

advocated for that.

That’s a very important measure that I think has given more

information to women across B.C., and it’s obviously significant as part

of all of the research we’re doing. We need to invest more in research

as well, but we also need to increase our capacity in cancer

everywhere.

It is not acceptable to me, when diagnosis within recommended wait

times is in question, that we just continue to do that. I will seek out

every measure we can take to ensure that we deal with that at every

level, whether that level is the need to continue our work to bring more

ultrasound techs in, to radiation technologists, to everyone else. We

have to respond, and there will be no stone left unturned in doing that.

We will use conventional and unconventional means to make sure that we

address the situation.

We’re seeing more diagnosis of cancer right now, and we have to

respond to that with our will. It’s not good enough. A lot of the

changes we have in mind will continue to make things better in six

months, in a year, in a year and a half. But if you have a diagnosis

now, we need to get you care now, and I will not hesitate to use any

means necessary to reduce those wait times at every part of the cancer

journey.

We’ve got huge work to do over time, but we’ve got work to do now,

and like I say, there is nothing that I would not consider to make sure

we address issues of wait times for people living with cancer and people

seeking a diagnosis.

[2:50 p.m.]

S. Bond: I appreciate hearing the minister’s passion about that. As he

knows, when I asked the questions over the last few days about Wait One,

waiting to get your oncologist…. That is terrifying for people. I left

the briefing that I had feeling incredibly distressed. That’s the only

way I can describe it. I listened to the professionals who are — and I

will continue to say it to the minister — experiencing moral distress.

They want to do better but can’t. Imagine feeling that, knowing you have

a patient in a vulnerable situation, and the wait, Wait One, to get to

your oncologist is growing.

I’m going to get to cancer care shortly. First of all, when you

stop and think about organizations like the B.C. Radiological Society,

I’m sure they didn’t think they’d be spending their time writing

advocacy letters to the minister. They want to do their jobs, and here

they find themselves making the case for more technicians and making

sure we have the kinds of incentives that bring people to the profession

and, most importantly, keep the ones we have now.

I want to pursue with the minister…. He made comments about the

public system. I know the minister knows that there are community

imaging clinics, and those clinics are obviously privately owned, but

they provide publicly funded services. It is part of the public system,

but overhead costs are a significant issue. One of the things raised by

the Radiological Society — and this was as far back as October, if I

recall — was the fact that those CICs are really concerned about their

ability to continue to offer services. Heaven help us if that becomes an

issue.

Can the minister speak to the question of overhead support? We’ve

looked at that in terms of family practice and what we need to do to

alleviate some of the stress when you’re a family practice in

longitudinal care. Has there been any consideration given to the request

from the Radiological Society about emergency overhead

support?

Hon. A. Dix: I was referring earlier to MRI and CT, of course, and there are

other services provided.

The radiologists. There is a business cost premium that is part of

our recent agreement that applies to them for their public work. That

applies there as it applies to everyone else. Whether that meets their

request…. We’re meeting regularly with them.

There are some private MRI facilities in B.C. Obviously, they’re

not going to receive such a premium, since they don’t provide any public

work in that case. The radiologists themselves, in their public work, in

their reading of the exams…. There’s no point taking the exams if they

are not read, and there’s been a massive increase in work for that group

of health professionals. They would be getting supports there through

the contract with the Doctors of B.C.

S. Bond: I want to ask one further question with regards to this. As I said

to the minister earlier, we know how absolutely essential diagnostics

and pharmaceutical care is when you’re looking at early detection,

making sure that we have a diagnosis as soon as possible. The commentary

about the status of that situation has been very dire.

I appreciate the minister’s always optimistic outlook, but we also

have to recognize the fact that for people who are waiting, it is

excruciating, and for professionals who cannot provide care in a timely

way, it is excruciating. I think we need to regularly acknowledge that.

In addition to the list of things that have been done, there is more to

be done. We have certainly heard those concerns.

[2:55 p.m.]

I wanted to ask about medical imaging equipment — again, another

issue raised directly with the minister. Is there a mechanism where the

ministry looks at the percentage of medical imaging equipment in each

health authority that is beyond replacement guidelines? Has the ministry

done a full evaluation of medical equipment, across health authorities,

to determine what the gaps are and what the replacement requirements

would be?

Hon. A. Dix: That is very much part of the planning process. The member is

quite right. To give a sense of why it has changed as well…. MRI

scanners, in 2022, operated 4,542 hours per week. That’s 1,777 more

hours than they did in 2017.

We did two things. We significantly increased the number of MRIs.

Obviously, the new MRIs are new. So that’s good. In addition to that, we

dramatically increased the usage of MRIs and CT scanners. That will have

the effect, over time, if we…. We know, when we use things more, we’re

using up their life, the active life of the machine. We need to do

more.

An example of that is what we’re doing in Kelowna, where our

existing MRIs are 20 years old. They’re being replaced, but they’re

being replaced by a higher level of MRI, the 3T MRI. We just recently

announced that project with the Kelowna General Hospital Foundation.

Obviously, it’s an important thing.

We are using our MRIs dramatically more. It’s particularly true in

the Northern Health Authority. I don’t think there was a health

authority in Canada that had as few MRIs per population done when I

became Minister of Health. I just felt that was not on. It was not on to

just build out MRIs in other areas.

We’ve more than doubled that rate per 1,000 population. We were at

22 per 1,000 population in 2017. I think we’re at 46 now or something

like that. That makes a huge difference for people. It means they can

access that care in the community.

What was happening in the North, without those public MRIs and

even without private MRIs, which existed in bigger markets, was people

were doing, obviously, workarounds without diagnostics, and it was

affecting the diagnosis of people.

We expanded this program and added the net increase in MRIs, from

25 to 42 in five years — the new ones are, obviously, new — and the

increase in six CT scanners. A lot of that was focused on regions. There

are new MRIs in Fort St. John and in Terrace, for example, in the

Northern Health Authority. I think previously the only MRI was at

University Hospital in Prince George.

S. Bond: Thank you to the minister. The information I would appreciate him

sharing, should they have it, is the metrics that are used and the

measurement regarding replacement.

We’ve heard concerns. The minister has articulated new. What I’m

concerned about is old and the fact that we have, apparently, medical

imaging equipment that is beyond or soon reaching its lifespan. I would

like to be reassured that the ministry has a plan, has an inventory and

can move to manage those needs.

At this point, I’d like to give my colleague and friend the leader

of the Green Party the opportunity to take the next hour with the

minister.

Hon. A. Dix: Just a one-minute break.

The Chair: We’ll take a very brief recess.

The committee recessed from 3 p.m. to 3:01 p.m.

[J. Tegart in the chair.]

The Chair: I’ll call the committee back to order.

S. Furstenau: My first question. I’m delighted to have the opportunity to ask

questions of the minister.

With regard to the Telus LifePlus program, can the minister commit

to publishing, making public the Medical Services Commission’s report

that was written last year on the Telus LifePlus program?

Hon. A. Dix: What happens is that we heard the issue. The Medical Services

Commission takes action on that. So it reviews it, it investigates it,

and it takes action. The product of that investigation, ultimately, was

the injunction, which was publicly filed with the court, so it’s

available to everybody.

S. Furstenau: Just to understand, the minister says that the report itself was

publicly filed and is available to the public?

Hon. A. Dix: Well, what happens when you refer such a matter to the Medical

Services Commission…. They have a regulatory authority, so they weren’t

doing a report for me. They’re the Medical Services Commission, and they

have the responsibility for the enforcement of the Medicare Protection

Act.

Often in cases, what happens is that they work with providers to

bring them into compliance. There are a number of cases — indeed, some

that we’ve talked about in the House — where that has occurred. In this

case, they did some of that work and that review and sought information

from the provider of health services, which was Telus LifePlus. The

decision was taken by the commission to go for an injunction, and they

supported that injunction with information that they obtained through

that investigation. That’s the process of action there.

They weren’t doing a report for me. I was referring the issue to

them. Their responsibility is to take action to make sure that the

Medicare Protection Act is enforced, and that’s what they

did.

S. Furstenau: I’ll take that as a no.

I think that the question here is really around the role of

transparency. We are talking about a publicly funded health care system.

We’re talking about a public body. We’re talking about a government

working on behalf of the public. We’re talking about an issue that is of

great interest to the public, and that is the encroachment of

corporatization into the delivery of health care services in this

province.

Fundamentally, we’re talking about the role that transparency

plays in a democracy. I think that at every step those of us who are

elected representatives and those of us who work in government should be

considering the absolute and critical place that transparency

plays.

[3:05 p.m.]

When a report is made about our public health care system by a

public body, I think that report should be made public. I hope that the

minister will reconsider and recognize that this is about public

trust.

I’m going to move on to another topic. There are over 100,000

people in this province who have an opioid dependency. The chief public

health officer, the coroner, several experts, reports have all indicated

that one of the essential life-saving measures in response to this

public health emergency is expanding the access to safe supply. There

are fewer than 5 percent of people with an opioid dependency right now

who have access to safe supply.

Of everyone who is dying from the toxic drug supply, which

includes people who are not addicted to drugs, which includes people who

are using occasionally, maybe for the first time, we are talking about

less than 1 percent of that population. Every day six people die in this

province from a toxic drug supply.

My question to the minister…. He holds a lot of power over the

work of the Ministry of Mental Health and Addictions. Safe supply is

very limited in access in this province despite the ongoing, recurring

recommendations from the chief coroner and medical practitioners. Can

the minister explain what is causing the barriers to expanding safe

supply in this province?

Hon. A. Dix: Thank you to the member for the question. I was asking for

information, and perhaps for the purpose of the debate, we’ll just

provide that after the debate — about the number of people getting safe

supply, which has obviously gone up significantly over time, and the

number of prescribers, so we have that as a baseline of the discussion.

We don’t need it for this discussion now, but I just wanted to commit to

the member that I’ll get that information as soon as I have

it.

There are a number of issues. I wanted to introduce the deputy

provincial health officer, behind me, Dr. Brian Emerson, who obviously

does a lot of work in this area.

Some of the challenge in terms of providing safe supply…. We’re

working hard with the College of Physicians and Surgeons, obviously

under the direction of the Minister of Mental Health and Addictions, to

expand the number of providers, be they doctors or nurses, of safe

supply.

[3:10 p.m.]

What are some of the challenges? I think there are some challenges

within the community of doctors. Often these are off-label

prescriptions. We have to work with those prescribers to expand the

numbers and build their confidence so there are more people, who are in

the system, who are able to provide and prescribe a safe supply of

prescription drugs.

I think the efforts have been significant, and the results have

been what they are. This is a toxic drug emergency, and we see its

impact in our communities every day. Those programs are growing, but I

think a fair person would say not quickly enough. So it’s hard work with

the community of prescribers to ensure that there are more doctors and

nurses who are able to prescribe a safe supply in every part of the

province.

S. Furstenau: Two days ago I was asking the Minister of Mental Health and

Addictions…. She indicated that there are 4,800 people currently

receiving prescribed safe supply in the province. If the minister has a

different number, I’d be interested. That accounts for about 5 percent

of people that have an opioid disorder in B.C.

The minister indicates the College of Physicians and Surgeons and

prescribers…. What barriers exist within the Ministry of Health to

expanding safe supply beyond 5 percent of people with an opioid

dependency?

Hon. A. Dix: There are two sets of barriers, I would say. I know that the

member had this discussion with the Minister of Mental Health and

Addictions. Some of these barriers are the same barriers that have

existed historically with OAT as well. On both but, particularly there,

on the side of those receiving the treatment. So if you, in some

cases….

I’ll just give you an example, with respect to OAT. It is

frequently what happens in methadone programs, which affects their

success. This is different than prescribed safe supply, but in some

ways, the hesitancy is the same. There are impediments for people

staying with the program.

When I was diagnosed with type 1 diabetes, I was given a drug

that, if misused, could potentially kill me. I went home, and I was able

to get trained and use that drug for the rest of my life at home. I use

it four times a day. If you’re on an OAT program, often you can’t visit

a friend in another city and continue to get access to that

drug.

[3:15 p.m.]

Part of the challenge, I think, in the prescribing of that

process, and why I think we need to be very cognizant of the success,

is…. We have to, I think, even when it’s challenging, learn to trust

those in these programs more, to succeed on that side equally. This is

true with prescribed safe supply. From the user point of view, I suspect

this is the case.

Again, the Minister of Mental Health and Addictions is more

current than me, but I think it would be the case that many people see

the multiple visits to a prescriber or others as barriers for them.

Equally, when you’re using, say, hydromorphone…. People may want, or are

wanting or using, a drug such as fentanyl. There is a challenge

sometimes with the attractiveness of such an option to them.

On the prescriber side, there’s still, I think, work to be done.

There’s significant…. What we need to do on that side of things is to

break down some of those barriers. There’s hard work being done by the

Ministry of Mental Health and Addictions to go through those and to

break those down for prescribers.

I do think there is a challenge on both sides. If we’re committed

to prescribed safe supply, and we certainly are committed to prescribed

safe supply, as an idea and as a proposal, we have to expand the number

of prescribers, perhaps expand the number of public clinics that are

providing it, in addition to doing it through our system of primary care

in the province.

Equally, we have to listen to those who are going to use the

program and use the prescribed safe supply and make sure that we are

effective in ensuring they have access and are going to continue to stay

with the program. Ultimately, we want to succeed.

This is equally true, and I know the member didn’t ask about it,

with OAT programs. It’s a reflection I’ve long had. We have to consider,

anyway, as we go forward with those programs — while the drugs are

changing, those programs are fundamentally the same — finding ways to

increase the level of adherence to a program that we invest a lot in

but, also, that people who are using OAT, in that case, are trying to

use as well.

I think it’s both ways. We’ve got to work with the prescribers.

That work is happening. We may have to provide more direct public access

and find other forms to increase confidence on that side. And we have to

keep working and listening to people who are seeking prescribed safe

supply so that it becomes more accessible to them.

S. Furstenau: I’m heartened to hear the comments, particularly around the

impediments that people experience when they’re in these programs. We

heard a lot about that in the Health Committee and the fact that the

programs were actually preventing them from being able to do other

things, like have work, visit, carry on regular lives. I think that this

should be….

I’m heartened to hear the minister recognize that is an important

barrier and impediment to the success of these programs and to the

success of people accessing what is, essentially, given the conditions

that we’re in, a life-saving program.

I’m going to go next…. I have a lot of topics that I’m going to

try to cover today.

We have a long-standing and very critical shortage of

psychiatrists in the Cowichan Valley, particularly psychiatrists who can

help with youth. I’ve been meeting with psychiatrists since I became an

MLA in 2017. I’ve been meeting with different psychiatrists because they

don’t last very long in Cowichan. They leave because of difficulties in

working in the Island Health system, they leave because of a lack of

resources, they leave because of a lack of accountability within Island

Health, and they leave because of high caseloads.

There are, across Island Health, 56.2 filled psychiatry positions

and 20.4 vacant FTE psychiatry positions. Cowichan, in particular, has a

significant deficit. I’m wondering what the minister and his staff’s

plan is for expanded capacity of psychiatrists in Cowichan, particularly

those who can serve youth in the community.

[3:20 p.m.]

Hon. A. Dix: First of all, we’re increasing the number of psychiatrist training

positions under the postgraduate medical education. That’s important. I

was going to get the exact number…. I was going to give the one off

memory, and then I thought: I can get the exact number in the next five

minutes. So I’ll wait for that.

That’s an important step. We’ve got to train more people, and

that’s clear.

Also, I would say, secondly, I’m reflecting on this and, just on a

personal note, one of the really outstanding psychiatrists in the

province, Dr. Paul Waraich, who is a dear friend of ours, passed away

recently. Part of that process was the number of people who…. He died in

his late 40s of cancer. It was brutal, and it was brutal for his

patients, who counted on him. He’s an important person. He worked out of

Burnaby Hospital in the Vancouver region. Just the number — what happens

when we lose a position, and that has happened in some cases.

I think the other part of it that we have to do is to work with

psychiatrists, and the community of psychiatrists, about their overall

role. We’re building out team-based health care across the health care

system. There has been a sense of isolation of psychiatrists from other

mental health professionals and the rest of the health care

system.

We need to increase the numbers but also better integrate

psychiatrists. Working with them, of course, is not something I’ll be

imposing on but, in fact, working on team-based care throughout both the

sometimes-called physical health system, or the health care system in

general, and the mental health system, so that we’re building out

team-based care.

That’s important as we build out. If you look at the many

initiatives and the huge expansion of beds that is being proposed and

put in place by the Ministry of Mental Health and Addictions and has

been put in place…. If we’re going to build out team-based care, we’ve

got to build out health care teams that we can fund and put in place

quickly for what is a public health emergency as we build them out. So

using and building out teams in mental health care is also

important.

Absolutely, more funded positions, more training — all of that is

required. The good news in B.C. is that when we train doctors in B.C.,

they stay in B.C., which is important. When we’re increasing training

spaces on a distributed model, it means we’re actually increasing the

number of doctors that are not going to go somewhere else. That’s the

evidence. We are the best at retaining our own doctors. That’s good

news, but we’ve got to do more of that.

So there is an increase in positions. But as well, I think we have

to build out team-based care and provide more supports and a sense of a

team around psychiatrists as they’re providing care in every part of the

province. That will improve their satisfaction but also the quality of

care.

S. Furstenau: I appreciate that response from the minister. I’m hearing about

the drive for team-based care all over the province and particularly in

the form of community health centres. I’m also hearing about barriers

and impediments to communities or to teams of doctors, nurses, nurse

practitioners coming together, wanting to create community health

centres and often not feeling the level of support that they’d like to

feel from the ministry.

Can the minister provide his stance on community-led health care

initiatives like community health centres, run by not-for-profit boards,

that are — they have examples of them around the province — doing very

good work? Does he see this as an important part of the solution to

primary care in this province?

Hon. A. Dix: Thank you to the member for her question. I think I have been one

of the strongest supporters of community health centres. The proof is in

what’s happened.

[3:25 p.m.]

If you look at the West Shore, two major community health centres

started in recent years, either started or starting. The one in Sooke

was based on a primary care network model that we put in place around

the medical clinic in that community. We made the first step a few years

ago that’s bolstered and increased access to team-based care in that

community. Now it’s being built out as we make the capital contribution

into a full-fledged community health centre. I think it’s a great model.

I’m very proud of what we’re doing in Sooke.

Equally in Colwood, that was a call…. I was NDP Health critic in

2007. There was a call for that clinic then. Year after year, it never

happened. Now it’s happened. Luther Court in Victoria happened. Island

Sexual Health, a full-fledged community health centre, happened, and

that’s just in the Victoria area, those four.

In my community in Vancouver, in the east side of Vancouver,

there’s RISE, which happens to be about 125 metres from my apartment.

But that’s okay. I’m not a patient there. I’m not a patient enrolled

there. But that was built out of the work of the Collingwood

Neighbourhood House, which is an important community organization in the

Collingwood neighbourhood and was a community organization that had…. It

is about a $6 million or $7 million community organization that was able

to take on that $3 million, build a community process, a new community

health centre there.

The Lu’ma Health Centre in the east side of Vancouver at Nanaimo

and Grandview Highway, which, in that case, is a First Nations-led

health centre. And there’s the Lu’ma housing complex. I really recommend

it to the hon. member if she’s looking at these models to take a look at

what they’ve done. We partnered there with the First Nations Health

Authority and Lu’ma Housing on a community health centre that combines,

obviously, health activity and health care services and traditional

healing services in that community.

We’re doing that in Williams Lake, and we’re doing that in

Sts’ailes. I was just in Rutland, a new community health centre coming

there. A new community health centre in Lake Country, in part at my

instigation. Our colleague from Kelowna–Lake Country has been a big part

of those efforts as well in those communities.

I believe fundamentally and structurally, and the member and I

have talked about this before, that we needed to move away…. To have a

growth of community health centres in B.C., we needed to move away from

the fee-for-service model, and we’ve done that in a breathtaking way. As

of today, over 2,900 doctors have joined the new payment model in B.C.,

moving away from fee-for-service, which is a significant and

extraordinary change. And 450 of those didn’t practise under the billing

code of longitudinal family practice last year.

This is changing the model, and I think it reflects the changing

view of doctors.

Though the old community health centres that we remember, REACH

and Mid-Main…. They were in part expressions of an idea of services and

community activity that was part of what I’d like to call, because I

guess I’m part of it now, the old left. They came forward, and they’ve

been extraordinary. In the case of REACH, we’ve added an urgent primary

care centre. In the case of Mid-Main, capital funding to allow them to

relocate and grow. Those are significant and historic ones.

Every single community health centre that exists in the province

was in trouble when I became Minister of Health. Every single one of

them has got funding to support their activities. But I believe the new

model.

We won’t just see an increase in community health cen­tres

but a dramatic increase in community health centres in the next year or

two because of the new model, which is the structural change we needed

to the health care system to allow the development of community health

centres. They may start off just as multidisciplinary, team-based health

care. But once you establish essential service in the community, they

can bring in other services, as neighbourhood houses do. I think that

model really works.

I’m pretty excited about what we’re doing, particularly here in

metro Victoria, but of course, on the east side of Vancouver as

well.

S. Furstenau: Good to see so much excitement about community health centres. I

just want a bit of clarification on the minister’s vision for community

health centres overall. There are the models that are community health

centres that are accountable directly to the community, led through a

local not-for-profit board. Then there are the urgent primary care

centres, which is a very different model that is run by the health

authority.

When the minister is talking about the growing number of community

health centres, does he see that as fundamentally community health

centres that are run by local community not-for-profit boards as opposed

to being part of the health authority structures?

[3:30 p.m.]

Hon. A. Dix: Well, I believe in public health care too. So I don’t think…. I

think it’s a good thing that there are health authority–owned and

–operated health centres around the province. That’s a good thing.

Amongst the private clinics, of course, most doctors’ offices are

essentially…. You call them private, for-profit clinics, but they’re

privately held, and it’s a public insurance system they get paid by.

Community health centres would be a not-for-profit model on that basis.

We need to do both.

Of the urgent and primary care centres, a number of them have been

partnerships with existing providers, such as Medical Arts in Nanaimo,

for example — which the member will be familiar with — who started the

urgent and primary care centre there, for example. We used an existing

thing, because recreating it wouldn’t have made sense. They were already

downtown. They were already providing great services. They were already

doing team-based care. Expanding that out made a lot of

sense.

There’s a group of doctors in Prince George on urgent and primary

care where we did the same thing. At REACH, we funded the Community

Health Centre to do an urgent and primary care centre.

I think we need to do both, but all of the centres that I was

referring to are with local boards. Before 2017, there was a very small

number around the province. There’s one that the member will be meeting

with, I think, in Kamloops, called STEPS, which started in 2017-18. If

you look at all of those, those are all local board–based community

health centres, non-profits.

I think what’s going to change, and what has changed, is that

there was a long time when doctors in the local clinic, their doctor’s

office, would sell their list when they retired. That market doesn’t

exist any longer, and we’re in fact supporting doctors through that

system, as we would support another structure.

If you’re supporting the infrastructure, that can much more easily

happen as part of the agreement with a non-profit board, and a lot of

young doctors would prefer that. They want to practise medicine. They

don’t want to do business. That was different. There’s a structural

difference. For a long time, as the member knows, that wasn’t the

position of doctors and nurse practitioners.

The other thing that’s happened is just the broad exceptions of

team-based care. We’ve made a significant change on the scope of

practice of pharmacists. That would have been quite controversial a few

years ago, and it has not been controversial. We’ve added, I think,

32,000 medication adjustments a month since we started with just one

element of that in October.

So I think there’s a broader support for team-based care, growing

support for team-based care, which is fundamen­tal to the

community health centre model — the change in the model of payment,

which is dramatic and seismic in, I think, creating more opportunities

for community health centres.

That’s why communities like Rutland and Lake Country — including

not just East Van in Victoria and the West Shore but Rutland and Lake

Country and communities such as that — are going to be encouraging

community health centres, as, I think, are doctors, nurse practitioners

and health professionals. I think this coming year is going to be an

exciting year, and we’re going to see more and more growth.

S. Furstenau: Does the minister see psychologists as part of that team-based

care, and physician assistants as part of that team-based

care?

Hon. A. Dix: I think I didn’t quite hear the last part. I heard

“psychologists.”

S. Furstenau: Psychologists and physician assistants.

Hon. A. Dix: I think I went through the numbers — I won’t do it again, because

it’s all on the Hansard record — of the makeup of primary care

networks, which is our fundamental organization and support for the

expansion of team-based primary care. Urgent and primary care centres

are a small part of that, 410 FTEs and 1.7 million visits, so not

insignificant.

Those are a significant part of care, but if you look at how we

built out team-based care through primary care networks, those proposals

came from the community, and then they were approved by the Ministry of

Health. We’ve gone forward, and the share of allied health, which is

disproportionately mental health and addictions…. Often counselling

services and others use the word “share,” because in the Fraser

northwest primary care network it’s the agency SHARE, which the member

will be familiar with, that’s providing part of that. We see some of

that on the West Shore as well.

[3:35 p.m.]

More than 200 of the some 1,500 FTEs that have been added through

primary care networks are addressing mental health and addictions, so

the team-based care in those settings is doctors, nurse practitioners,

nurses and allied health professionals, which are a variety of groups

but really focused on mental health and addictions and then, beyond

that, pharmacists and others. So that can be part of it. Certainly the

mental health part of that is important.

We had a discussion on physician assistants yesterday, and I can

repeat that and say that the issue of their scope of practice is under

review by the College of Physicians and Surgeons. My guess is that the

focus would be less on primary care and more care on the acute side, if

they come through that process, and there may be a place for

that.

When we’re looking for the broader solution, like with associate

physicians, I think the number of potential associate physicians in B.C.

right now is about 450, and they have a wide scope of practice, somewhat

equivalent but not quite with nurse practitioners.

With physician assistants, it’s in the 30, 40, 50 range because we

don’t train physician assistants in B.C. They’re only trained in

Manitoba and Ontario. That’s something to be considered but probably not

fundamentally in primary care, probably more broadly in acute care and

support, maybe emergency room doctors.

S. Furstenau: Given that I have such a limited amount of time, I’m wondering if

the minister would be so kind as to keep answers as brief and succinct

as possible.

I will parse through those answers later in Hansard,

because they are lengthy. I want to talk specifically….

My colleague, Saanich North and the Islands, had some very

specific issues, nursing at Lady Minto Hospital. The recommended

nurse-to-patient ratio, based on the care provided, is often cited as

being 4 to 1. The Lady Minto Hospital on Saltspring Island has

experienced patient-to-nurse ratios of 14 to 1. Nurses have a moral and

ethical obligation, personal commitment to a patient’s well-being, and

they have been told to call 911 in the case of an emergency.

In a situation like this, where a hospital has a ratio like this,

does the minister think that it’s safe for nurses and doctors to keep a

hospital open that’s so understaffed? The question my colleague really

wants answered is: what was the gross expenditure at Lady Minto Hospital

over the last four years? If it’s going to take a while, we can get that

sent to us later, as well as the question: how many hours in overtime

have been logged by nurses?

Really, for the minister right now, my question is: does he think

that it’s acceptable to have hospitals with that kind of ratio