1991 Legislative Session: 5th Session, 34th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

FRIDAY, MAY 31, 1991

Afternoon Sitting

[ Page

12375 ]

CONTENTS

Routine Proceedings

Supply Act (No. 1), 1991 (Bill 8). Committee stage. (Hon. J. Jansen) ––

Mr. Perry

Mr. Clark

Ms. Marzari

Hon. Mr. Jacobsen

Ms. Smallwood

Mr. Barlee

Ms. Cull

Mr. Cashore

Mr. Rose

Hon. Mr. Weisgerber

Mr. Gabelmann

Mr. Jones

Hon. Mr. Dueck

Mr. Miller

Mr. Serwa

Hon. Mrs. Johnston

Mr. G. Janssen

Hon. Mr. Chalmers

Mr. Lovick

Mr. Zirnhelt

Hon. Mr. Parker

Mr. Smith

Ms. Edwards

Ms. A. Hagen

Hon. S. Hagen

Hon. Mr. Mercier

Hon. Mrs. Gran

Mrs. Boone

Hon. Mr. Dirks

Ms. Pullinger

Mr. Blencoe

Hon. Mr. Rabbitt

Hon. Mr. Bruce

Hon. Mr. Savage

Hon. Mr. Veitch

Hon. Mr. Messmer

Third reading

Royal assent to bill –– 12450

FRIDAY, MAY 31, 1991

The House met at 1:44 p.m.

[Mr. Pelton in the chair.]

HON. MR. WEISGERBER: I call committee on Bill 8.

SUPPLY ACT (No. 1), 1991

(continued)

The House in committee on Bill 8; Mr. De Jong in the chair.

On

schedule 1.

MR. PERRY: Mr. Chairman, I hope that the Minister of Finance

is feeling a little more comfortable now; he looked rather wriggly

before we adjourned. I hope all members have had a chance to relax

during the break.

I'm still waiting for an answer to that question, I see an official

from the Ministry of Health manoeuvring into position. Id like to

welcome the assistant deputy minister to the chamber and again pose the

question for which we are still seeking an answer. What is the average

waiting time for non-emergent cardiac surgery in British Columbia?

HON. J. JANSEN: Mr. Chairman, we're debating warrant No. 1 of

schedule

1, which is the cost of the BCMA settlement and the additional cost of Pharmacare.

If the member would like, I can explain how he benefited from the new BCMA contract,

in terms of the cost of the overall package and how that additional warrant

was generated in terms of that expenditure. That is what warrant No.1 of $142,600,000 is.

MR. PERRY: The wording on page 2 of Bill 8,

schedule 1,

warrant No. 1 is fairly clear. "To supplement vote 40, Medical Services

Commission and Pharmacare, to provide funding for costs arising from

increased service utilization and increases in the cost of drugs under

the Pharmacare plans...."

Of course, most members will know that cardiac surgery is paid for

under the Medical Services Plan; also some cardiac surgery patients

would receive benefits under Pharmacare. So clearly the questions of

fact that I'm trying to determine are relevant to this expenditure. I'm

simply trying to determine a matter of fact, which has been out in the

public domain as a question of fact since February 17 at least — that's

three and a half months now — in which the former Minister of Health,

who was at that time responsible for that portfolio and now is Minister

of Finance, and his staff have had a chance to examine the facts of the

issue. He has tried to pass off on some committee the responsibility

for figures which he attributed as fact in public and signed in a

letter to the Vancouver Province . I can draw no other

conclusion than that he is avoiding the scrutiny of this Legislature

over the fulfilment of the mandate he is now asking us to pay for. He

is asking the taxpayer to pay for it, of course, but he is asking us to

vote for that expenditure retroactively.

This concerns matters of efficiency. You will recall, Mr. Chair,

that in my response to the budget I spoke of the irony of that headline

in the budget speech about efficient government. This is what we're

getting at, in part. While the minister is considering that question,

maybe I can put to him a couple of follow-up questions. Will the

Minister of Finance tell us what the cost of export of patients to the

state of Washington for heart surgery was? How many patients have been

done? Is the program still continuing at this moment? What was the cost

per patient to perform that surgery, and how did it compare with the

average cost in British Columbia?

When he has provided us with those answers, perhaps we'll be in a

position to know how much that contributed to the present budget

overrun. Perhaps we'll be in a position to judge in a more enlightened

way as members of the Legislature whether those services could have

been provided more efficiently by running operating rooms at higher

capacity during evenings — nights, if necessary — or weekends in

British Columbia, instead of exporting patients to Washington.

HON. J. JANSEN: Mr. Chairman,

schedule 1 of warrant 1 is a

reflection of an increased cost for a service already provided. The

$142 million is to pay for the practitioners — the fine physicians and

surgeons in British Columbia — who have already performed the services.

This particular amount is retroactive to the contract settlement

effected. He, too, received a cheque under this warrant 1, as part of

his billings. It has nothing to do with the capacity of open-heart

surgery. It was a service already performed.

In terms of the open-heart surgeries performed in the United States,

we made agreements with a number of hospitals. The costs for each

hospital varied, because there was, as you know, an open-negotiating,

competitive position with the hospitals in the United States. The

proviso also was that we keep those figures confidential because of

that competitive nature. However, on a number of occasions when this

matter came up, I did indicate that the costs signed with the last

hospital were equal to, or lower than, those in Canada. That was

compiled by our own staff member, Dr. Neil Fatin, who gave me those

figures.

I should also say that the program was for 200 patients. The

compliments we got from those patients who took advantage of that

opportunity were very significant. They were very pleased with the

outstanding service and follow-up done by each hospital. It was an

opportunity for us to deal with the problem very quickly. Those in

British Columbia who needed the service were certainly appreciative. I

think that the entire 200 cases have been utilized. Maybe one or two

cases are left over, but essentially the program is complete.

MR. REYNOLDS: I have a bit of a problem with the member from

Point Grey taking this line of questioning. I have no problem with the

fact that he is a doctor and might ask questions in the House. But as

he is a practising doctor, I find there may be a conflict. The

[ Page 12376 ]

other side are the first to stand up if they think

any members on this side of the House are in conflict. It's a nice

cover-up you try and make for a member who was president of a company

and director of a company. That's another issue and the public can't

see that, so we can talk about that some other time.

I'm being very serious. You people over there love to talk about

conflicts. The second member for Vancouver-Point Grey says on his

public disclosure statement, which is a public statement....

MR. CLARK: On a point of order. Mr. Chairman, the member

knows he has to be in order. This is completely out of order. He would

know if he was in the House earlier that this had been canvassed by the

Minister of Finance. He would also know that this matter was brought

before the attention of Mr. Hughes, the conflict of interest

commissioner. He would know that there is no conflict-of-interest. That

has been ruled upon by the conflict-of-interest commissioner, so for

him to make the point here is, first of all, irrelevant and out of

order, and secondly, patently incorrect.

MR. REYNOLDS: On a point of order. Mr. Chairman, it's amazing

how the other side gets so itchy every time we want to talk about their

side of the House. The fact of the matter is that I wish that second

member for Vancouver East.... If it was anyone else who wanted to talk

about ethics and where they get documentation and facts from, I might

accept it, but on that side of the House — and I'll make my point — you

just take your time. You've got lots of voices over there. You want to

keep us sitting Friday afternoon until 2 p.m. when we usually quit at 1

p.m. You want to hold up the public's pay cheques. Just listen to this

side of the House every once in a while.

Mr. Chairman, the point of order is that the member on that side has

said that Mr. Hughes has said that this is all right. Mr. Hughes has

said that it's all right to be a doctor and serve in the House. He

hasn't said that it's all right to be an advocate for the doctors while

you're sitting in this House, and you're a doctor receiving a salary. I

have every right to ask my question of the Minister of Finance because

this member receives money from that vote, and I want to be able to

talk about it.

MR. CHAIRMAN: There's no doubt that we're all concerned about

irrelevancy as it pertains to the debate in the House and the matter

before us, and I would urge every member to be relevant to the item and

the discussion.

MR. REYNOLDS: I would like to ask the Minister of Finance I would say

again, I find the second member for Vancouver-Point Grey no different than a

teacher who can't be elected to a school board and vote for his/her salary

in the same district. It's no different in this House if you're a doctor

and, as I said, his form says he is substantially inactive in practice. But

I notice his form says he made $31,869 last year. Well, I don't think that's

being inactive. Certainly a single mother on welfare wouldn't think that's

inactive, and I would like to ask the Minister of Finance if his department

has looked at the fact as to whether somebody in this House should be debating

an issue when they receive a salary from the government. Again, I have no objection

to that, but you shouldn't be an advocate for your business when you're

in this House. If you NDPers don't know the difference between right and

wrong over there, that's your problem. You want to talk about this side

of the House. You and your leader don't know the difference between right

and wrong.

MR. CHAIRMAN: Order, please.

MR. REYNOLDS: You want to talk about what this side does all the time, but it sure hurts when.... You all squeal like pigs.

MR. CHAIRMAN: Order, Mr. Member. First of all I would like to ask the member to withdraw his last comment.

MR. REYNOLDS: I'll withdraw, Mr. Chairman.

MR. CHAIRMAN: Hon. members, let's be relevant to the bill

that's before us. I believe that it's not only important for debate in

this House; it's also important, as we serve the taxpayers of this

province, that we be relevant in the debate that is before us — Bill 8,

schedule 1.

MR. REYNOLDS: I would just like to suggest to the minister

that he not answer any questions from the member for Vancouver–Point

Grey until Mr. Hughes rules on whether we can be advocates in this

House if we're receiving money from the Crown. This member is receiving

money from the Crown for practising medicine; he shouldn't be an

advocate.

HON. J. JANSEN: Perhaps we can focus on warrant 1, which is

$142,600,000. It covers the cost of the contract won by the BCMA, the

additional costs of that contract and the additional costs associated

with the utilization included in that contract. I would urge the member

for Vancouver–Point Grey to consider the advice that he received in

terms of any conflict, and I will be pleased to continue the debate.

MR. PERRY: I was under the illusion we were discussing

Ministry of Health funding, not doctors' incomes. I thought we were

discussing funding which is intended to provide services to people, to

sick British Columbians — hopefully to improve their health.

Perhaps I should say in passing that the conflict commissioner has

ruled on all members' disclosure statements and has approved, to the

best of my knowledge, all of them. So I think the previous discussion

was largely irrelevant.

I have one further question relevant to the line I pursued earlier:

whether the Minister of Finance, the former Minister of Health, will

tell us what, if any, proportion of this expenditure relates to the

export of patients for cancer radiotherapy services. The former

Minister of Health, the present Minister of Finance,

[ Page

12377 ]

will, of course, remember that I encouraged him to

undertake that policy, there having been no alternative for providing

timely therapy at the time in British Columbia. I would like to know at

some point how much the failure to plan in the past has cost the

taxpayer. If it's more appropriate to ask that question under

schedule

2, if the minister will indicate that, I'll be happy to defer that

question until later.

HON. J. JANSEN: Mr. Chairman, I'll say it one more time. The

Medical Services Commission's additional costs were related to the new

BCMA contract. They were not related to any services in the province or

out of the province; they were for past service provisions. If he

billed fee-for-service, he would have got a cheque under this amount as

well. That's simply an explanation of warrant 1 - $142,600,000.

[2:00]

MR. PERRY: I'll just clarify that point. Is the Minister of

Finance saying that when patients have travelled to the state of

Washington or outside of British Columbia for the receipt of medical

services such as — I'll give two specific examples — a surgeon's fee

for cardiac surgery in Washington State, or a radiotherapist's fee and

any consulting fees of physicians who deliver radiotherapy to cancer

patients from British Columbia who are now exported to Washington State

? Are those fees not paid out of the Medical Services Plan budget?

Therefore is he correct in saying that they had no impact during the

last fiscal year on the requirement for an additional $142,600,000,

which is explained in this

schedule as being partly related to

increased service utilization?

HON. J. JANSEN: Mr. Chairman, the cost in this particular

vote was to do with the BCMA settlement, of which he is a member. It

has nothing to do with out-of-province claims, which are a separate

part of the budget and are not included in the special warrant.

MR. PERRY: I'd just like to pin down this issue so that there

will be no question of it in the future. In general, fees for medical

treatment are higher in the United States than they are in British

Columbia. Normally the Medical Services Plan pays, as a matter of

policy, for British Columbians who fall ill — for example, while

vacationing — in emergency conditions. To my understanding, British

Columbia pays through the Medical Services Plan the equivalent amount

of money that the service would have cost had it been rendered in

British Columbia.

The minister's answer implies that there were no additional costs due to

the export of patients, either for heart surgery or for cancer treatment, to

Washington State under the Medical Services Plan. Since those costs, by definition,

virtually had to have been higher than the equivalent cost would have been were

the service rendered in British Columbia, under what budget were those additional

costs absorbed? They obviously were not foreseen by the ministry at the time

of the estimates last year. Was there enough surplus in the estimates elsewhere

in the Ministry of Health budget to cover them, or have the figures been fudged

so they come somewhere in this schedule, which the minister is not disclosing?

Or are they hidden somewhere else in the budget? If he will give us the answer

to that question, then we'll know where we can pursue it under

schedule

HON. J. JANSEN: Mr. Chairman, I'll say it again: the BCMA

would probably find it offensive if I started to take out of their

settlement the cost of out-of-province care. The component in the BCMA

settlement is the component referring to out-of-province hospitals and

so on; that's included in a separate part of the budget. We can debate

that later on if you wish. We won't be able to give you the exact

amount, but we can certainly answer more of your questions at that

point in time.

MR. PERRY: I'll change to a slightly different line of

questioning, which is the Pharmacare component of this vote. The review

of Pharmacare estimates versus Pharmacare expenditures for the last

several years suggests that Pharmacare expenditures have been regularly

underestimated. It has been intimated to me that this was a standard

practice within the Ministry of Health budgeting process. In

submissions to Treasury Board, Pharmacare estimates were knowingly

underestimated, presumably in the preparation of election budgets, in

what were then thought to be election years — perhaps 1989-90 and

1990-91.

When I look back at the comparison of Pharmacare estimates with

actual expenditures for the year 1987-88, the Pharmacare estimate was

$155,990,000. That includes administrative costs, as do all the

figures. The $155,990,000, the actual expenditure for that fiscal year,

was remarkably close at $157,473,941 as published. For the next year,

'88-89, the Pharmacare estimate was $176,320,000 and the actual

expenditure was $183,393,320.

For the following fiscal year of 1989-90 a different pattern began

to emerge. In the '88-89 fiscal year we saw a budget underestimate of

$7 million compared to the real expenditure. For 1989-90 the estimate

was $191,831,000, and the true expenditure was $212,106,273. That's a

discrepancy of over $20 million. In the 1990-91 fiscal year just

concluded the Pharmacare estimate — of course the ingredient cost is

the significant part; these figures are the totals including

administration costs — was $223,996,653. The actual expenditure — if

it's been published — I've been unable to find.

I'd like to begin by asking the Minister of Finance for the true

total Pharmacare expenditure for the fiscal year just concluded on

March 31, 1991.

HON. J. JANSEN: The purpose of warrant 1 was to deal with the

additional costs — not the total costs — required by Pharmacare. They

relate to two things: existing products and their usage and price

increase, and new products. I can go through, or I can give the member

a copy of all the drugs and outline their additional costs. In some

areas there are 1,004, 1,015 and 1,583 percent increases. I can give

you a breakdown, but I would say that rather than me going

[ Page 12378 ]

through that, I can give these notes to him at later date and he can have a look at them.

The component breakdown of Pharmacare is: $29,500,000 additional

costs, of which $22 million is related to higher than anticipated drug

costs. Vasotec, for example, at $1,299,900, was a 69.41 percent

increase. Mevacor at $1,316,508 was a 66.26 percent increase.

I can go through them all. The other one is a $5.7 million increase

in higher than anticipated utilization. The balance is $1.4 million

related to the plan E deductible increase not happening. That is the

breakdown of the $29,500,000 which relates to Pharmacare.

MR. PERRY: I thank the Minister of Finance for his candour. I

am so eager to possess this knowledge that I request that he table the

documents now or perhaps send them over to me with one of the

messengers now rather than later. I appreciate the generosity of his

offer to perhaps spare me the weekend studying them, but I'd be

delighted to have them right now so we could pursue some intelligent

questioning during the

schedule 2 debate. I've been trying to get that

kind of information for months, and the Minister of Health has

previously stonewalled me on that. If I can assume the Minister would

be happy to either table or I see him shaking his head, but he just

offered me the information and I'd be delighted if he'd send it over by

courier.

HON. J. JANSEN: Mr. Chairman, the reason I was shaking my

head was the intimation that we were stonewalling. That's the reason I

was shaking my head. You don't read body sign language very well, Mr.

Member.

What I will do, because I don't have any copies of this if I give it

to the member opposite.... We can make arrangements for him to get it

at a later time of the day.

MR. PERRY: I apologize to the minister for misreading his

body language, and I thank him for the information. Perhaps when I sit

down I'll pop over and borrow the documents, photocopy them and return

them to him in the House, if that's agreeable.

The question then arises, Mr. Chair.... If I heard accurately, there

was a dramatic $29 million increase in Pharmacare funding in one year

over the budgeted amount. That means something like a $40 million or

$45 million increase over the previous year; that's roughly a 20

percent increase in the budget for drugs. I had previously heard an

estimate of 27 percent in the actual ingredient cost, which I found

very alarming, particularly because it would be very difficult to argue

that the medical benefit to elderly people served by Pharmacare has

increased 27 percent in one year. If anyone could work that kind of

improvement in health status in one year, I don't think they would be

sitting in this chamber. We'd have gone on to much greater things.

This leads me to a question that refers to the estimates debates from last

year, when the present Minister of Finance, then the Minister of Health, told

me I quote from page 11503 of Hansard for July 25, 1990 — 1 am quoting the Minister

of Finance, at the time Minister of Health, in response to questions of mine

about the rapidly increasing cost of Pharmacare — for example, concern over

a drug, Lovastatin, which had jumped from zero to $2.5 million in one fiscal

year. In the calendar year 1990 it had reached $3.5 million, according to Pharmacare

figures. It is a drug for which there is no proven benefit in the population

of people over 65, for whom it was being used under Pharmacare plan A.

[2:15]

The minister, in response to my question, said: "I recently

requested our Pharmacare advisory committee to carry out a detailed

review of the Pharmacare program, and they are now in the midst of

doing that. They have hired a consultant, and I have asked for the

review of the program to be completed, with recommendations within the

next eight months." That was July 25, 1990. By my quick

back-of-the-envelope calculation, eight months would have brought us to

March 25, 1991, so presumably he had in mind the end of the fiscal year.

[Mr. Ree in the chair.]

To the best of my knowledge, that Pharmacare advisory committee

report has not been published, so I would like to ask the minister:

what fraction of the $29 million increase in cost for Pharmacare that

we're being asked to support — what dollar amount — was for the

Pharmacare advisory committee? What were the per them fees for people

who attended meetings of the committee? Were the people who were paid

per them fees also salaried at the time, or in receipt of additional

salaries from government or government sources? Where is the report of

the Pharmacare advisory committee, which might have helped the province

to curtail those costs?

HON. J. JANSEN: The report that the member refers to — and I

can understand his interest in it — has not yet gone to the minister,

as I understand it. When it does go to the minister it will become

public. I'm sure the minister will release it.

Also, what I said earlier is that the people on that committee will

be paid the normal per diems. All of that information can be made

available during the estimates debate, which hopefully can happen next

week. We could start with Health, if you wish, Mr. Member, because I

know the staff are eager and willing to go. But we're going to work on

each and every item like that — it's going to take a long time.

I explained the $29 million; I hope that's sufficient.

MR. PERRY: Again, I am reassured to know that we shall have

the estimates debate beginning next week. In the meantime, could the

minister just clarify one remark in his last answer. Having been

Minister of Health up until April 2, 1991, can he clarify whether the

Pharmacare advisory report has been submitted to the Ministry of Health?

HON. J. JANSEN: I don't know if the report has been submitted. It could be in the mail. I don't know.

[ Page

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I'm just telling you that the report is not yet in the hands of the

minister. Once the report is in the hands of the minister, the

appropriate thing to do is to put the questions to him during

estimates. He will be here in estimates, and you can talk about that

report in detail. Let's not drag out this voting on warrant No. 1.

MR. CLARK: Just for the record, my colleague from Point Grey

has made an interesting point that drug costs for the government of

British Columbia have increased by, crudely, it sounds like $45 to $50

million, which is really a staggering increase. I'm reassured that the

ministry is reviewing that increase to see whether there's any

efficiencies that can be gained. It clearly is one of the largest

increases in any

section of the health care budget, which is one which

is increasing significantly.

I know the minister's asked me to keep talking, and I'm quite keen

to accommodate him. I just want to draw the people's attention,

although I understand the television's not on right now.... It's really

unfortunate, but I'll trust Hansard to record the remarks anyway. I

want to draw the attention of the House to what this warrant is all

about: $232,600,000 of overspending. Remember, there was a time many

years ago, a long time ago when I was a young child, when members in

that party used to complain about an overrun in the NDP administration

— a $232 million overrun. That's not chicken feed. That's a significant

overrun in two areas: Health and Social Services and Housing.

We'll get to Social Services and Housing in a minute, but in health

care the minister has taken great pains to say that the reason for the

increase — $142 million over budget in health care — is the settlement

with the doctors. So let me ask my first question and that is: was

there a budget increase for the BCMA settlement? You knew there would

be a settlement. Was there a budgeted increase, and how much of this

are you over budget? Because this deals with only how much you're over

budget. Did you budget for any increase in B.C. Medical Association

fees in the fiscal year in question?

HON. J. JANSEN: Yes, we obviously had a budget for a

utilization increase. That was put in the budget. As you recall, the

settlement with the doctors spanned three years, and it was a

retroactive payment relating to the previous year. So that was the

reason we had this significant overrun. It's very difficult to budget

for something when you don't know what the costs will be. We expected

that the negotiations would be complete earlier. Unfortunately, they

weren't. But that's the reason there's a three-year contract. The

settlement was in '90-91, and resulted in the additional cost I

mentioned earlier.

MR. CLARK: I'm glad the minister is being frank with the House and

has admitted that it's a significant overrun as a result of this administration's

not budgeting for increases — as a result, I might add, of the Premier getting

involved in the negotiations. You know, every time the former Premier was involved

in negotiations, there seemed to be fairly large settlements. That's interesting

for a government that pretends to be fiscally competent. We saw these large

settlements every time the Premier got involved. I might say that this minister

was the Minister of Health who was a party to that agreement.

Which brings me to the next subject which I'd like to discuss at some

length and that is the

section of this overrun that's attributable to

the doctors' pension plan, which was part of the settlement. Members on

that side, it's kind of interesting. It's $25 million cash for a

100-percent-taxpayer-funded pension for doctors.

The federal government has thrown out the tax loophole they tried to

use. I thought that would have been a life raft for this

administration, to finally be able to say to doctors: "We're sorry, but

it's not acceptable to the people of British Columbia that you get

special treatment and something that no one else can have." But the

government didn't say, now that it's thrown out and there's a tax

ruling from the federal government, that they could get out of the

deal, which is bad for taxpayers; instead, the government and this

minister is meeting with the doctors to see if they can concoct a way

to get around the tax ruling and continue to give the doctors their

100-percent-taxpayer-funded pension.

Mr. Chairman, an interesting point. We had a lot of discussion in

this House, and the minister was very proud of the wage control

legislation which has a little

section in it saying "ability to pay."

They won't sign contracts where they have the inability to pay. The

government has signed a doctors' contract for which they didn't have

the ability to pay, and they had to come in with a special warrant for

some $100 million to cover a doctors' settlement, including a juicy

pension deal, simply because they signed an agreement which they knew

they didn't have a budget for.

If anybody else did that, they would be up screaming about the law

and that there are wage controls, because they don't have the ability

to pay. If Ed Lien saw this, I think he'd reject it; he'd clearly throw

it out. They didn't have the budget for it. There's a $142 million

overrun in the health care budget, of which some $100 million is

because of a sweetheart deal with the doctors made by the former

Premier just before an election to try to buy their votes,

Let's talk about the doctors' pension. I can begin by asking the

minister if he will table the planned text for the doctors' pension,

because no one has yet seen the details of this lucrative deal except,

I suppose, the federal Department of National Revenue. No one in the

public has really been privy to this sweetheart deal. Would he

undertake to table in the House, or to at least mail to the members of

the opposite side, the planned text so that we can see the details of

the doctors' pension?

HON, J. JANSEN: Sometimes you really want a question asked in

this House, and I'm really pleased that I got the opportunity to have

it asked. First of all, let me say that the doctors' pension or

deferred income benefit plan, which the member referred to, is part of

the next

schedule for debate, but he has offered to talk about it now.

I would be pleased to carry on that debate

[ Page 12380 ]

if he wishes to do that, or he can indeed bring it up later on.

I did meet as early as last night with the BCMA, not to concoct

another deal but to talk about the implications of the ruling. At that

time, it was again pointed out very clearly that the Leader of the

Opposition in fact supported it.

I note that the member for Vancouver–Point Grey has left the House.

It is somewhat hypocritical that he too supported it but has now left

the House because he doesn't want to be red-faced. But supporting it as

a doctor and then standing up as the Health critic and defending this

whole opportunity for expenditure is really a terrible injustice. I

have not yet heard him say that for his fee-for-service entitlement, he

will not take advantage of this agreement. He supported it very

strongly, and again he's standing up in the House and talking about the

BCMA settlement. It's a total conflict of interest.

The request was whether or not we would table a copy of the document

in the House. Perhaps you should ask your leader, because he already

has a copy of the document. The BCMA gave him a copy of the document,

and all you have to do — four desks over, and he's actually there for a

change — is ask him. He can just send it over to you. You can have a

look at it, and then you can ask me as many questions as you have. In

fact you have it, Mr. Member. It's not part of this schedule. You

supported it in this House, flip-flopped around and now criticize it.

The ruling of the Department of Finance is that the benefit of the

deferred income plan has been changed so that the offset respecting

RRSPs is taken into consideration. It's entirely up to BCMA. You can

ask the member behind you whether BCMA and the membership wish to

continue with that plan. It is a lump sum payment of $25 million, and

it comes into effect on the very last day of the next fiscal year. So

that's the answer to your question.

MR. CLARK: The document I have seen with respect to the plan

has an old date on it. So I would simply like the minister to rise in

the House and say that the document that's been circulated, which was

drafted some years ago, is exactly the same document that the

government and the B.C. Medical Association agreed to this past year.

Could he say that?

HON. J. JANSEN: If the Leader of the Opposition showed some

interest and wanted an updated copy, he could have got it at any time.

Now you've registered the request. By all means, we'll get you a new

copy.

MR. CLARK: Is there a substantive difference between the updated copy and the copy that's been circulated?

HON. J. JANSEN: There is some change in the wording, but exactly the

same principles apply. And I should say that it may be that the entire plan

is in jeopardy at this time. I'm not sure what BCMA will do with it. The

BCMA are going to Ottawa next week to talk to the Department of Finance to get

further clarification on their ruling.

MR. CLARK: We've been told that the deal for doctors'

pensions won't result in future compounding. In other words, we've been

told that it's "only" $25 million a year — forever that is — and that

it's a flat, fixed fee. Can the minister tell us at what interest rate

his actuaries assumed the $25 million would be invested when the

government made this promise?

[2:30]

HON. J. JANSEN: We have to back up. You determine what kind

of a plan is available on the basis of a $25 million contribution. The

plan administrators will be in a position to determine the benefit

predicated on a $25 million lump sum payment each year — as I earlier

indicated.

MR. CLARK: The document in front of me now is dated June '87.

The minister has agreed it is the same document that has been signed,

presumably with a new date on it. This document does not contemplate a

fixed payment of $25 million in perpetuity — in fact, something

different from that.

I would like to ask some questions about that, because it's quite

critical. In terms of the deferred income that's to be paid, is it a

percentage of their billings or is it a fixed amount?

HON. J. JANSEN: As I said earlier, actuaries do the

calculations. They do it on the basis of a lump sum payment put into

the fund. The benefit accrual is related to the net earnings of

physicians and surgeons up to a maximum of $128,000 adjusted actual.

MR. CLARK: There's something missing here in the analysis.

It's obvious that if you're saying that if you receive a deferred

income as a doctor, it's based on your salary, it's capped and there's

been an actuarial analysis done. Let me ask the first question: has an

actuarial analysis been completed?

Interjection.

MR. CLARK: The minister has said yes. Was it on the basis of

the actuarial analysis that you determined that $25 million was

required to accomplish in year one what was set out to be accomplished?

HON. J. JANSEN: The plan is not yet in operation. Although

the accrual started April 1 of this year, the actual first payment is

not made until March 31, 1992. Also, I would ask that the member

perhaps bring this up during estimates, because at that time perhaps

the plan will have had some more indication of whether it will survive

the ruling.

MR. CLARK: Maybe the minister would agree that there's a bit

of a fib — I'm not going to accuse him of anything nefarious, but it's

impossible to say that it's a $25 million a year fixed fee. It's

impossible, unless there's some dramatic changes to this document. If we

[ Page

12381 ]

have 20 percent more doctors in the year 2000, does it result in

doctors' pensions being reduced by 20 percent, or does the government

have to pay more into the fund?

HON. J. JANSEN: When you do an actuarial calculation, you

ensure that the plan is funded in terms of normal growth and revenue

enhancement. Currently, we are getting our pension plans in the range

of 18 to 20 percent. That's our actuarial earnings, which are pretty

high, and the reason we have about $21 billion in pension funds

outstanding in investments. The reason they're so high is that we are

into an equity position on some of the pension funds. We were achieving

a return of 18 percent last year on our pensions funds, so it's pretty

significant. They're allowing for normal growth, actuarial

earnings...and a lump sum payment of $25 million is how the plan is

developed.

MR. CLARK: There's some doubletalk here. Since the unfunded

liability for the doctors' pension plan will depend on the number of

doctors, the amount of benefit promised and the rate of investment

return — that's what an actuary looks at — how can the government be

sure that the cost is going to be $25 million in perpetuity, and not

$26 million or $30 million?

HON. J. JANSEN: The member opposite apparently doesn't have

an understanding of how actuarial earnings are calculated and how

progressions are done in terms of earnings into the future. Present

values of that fund are outlined. There is a $25 million payment to be

made and you do a calculation to ensure full funding for a period as

long as you can, normally around 15 years. You look at what the benefit

will be, and you backdate everything.

I don't understand this question, and frankly, it seems to me he doesn't understand what he's asking.

MR. CLARK: The minister can confirm for the House, in looking

at and reviewing this, that

section 12.03 of the plan text anticipates

a deficit for the doctors' pension plan.

HON. J. JANSEN: If the actuarial earnings projections are

incorrect, the benefit is reduced. That's how it works. There are two

ways: you can show it as a deficit on the basis of your actual

earnings, or you can actually do a benefit reduction. The agreement, as

I recall, has a provision whereby there will be a reduction of benefit.

MR. CLARK: All I'm saying is that if it is $25 million a year

in perpetuity, then it contemplates an ever-reducing level of benefits

to doctors. If there are more doctors.... The minister is saying that's

not the case. Maybe the minister could table in the House the actuarial

plan that's been devised.

HON. J. JANSEN: We can get that information to him. I think we should

say as a proviso that the plan remains intact. But 20 percent actuarial earnings,

if that's what the actuaries use, takes into consideration the rate of growth

among the medical profession, the rate of growth in their earnings, the rate

of growth of investment return and the projected earnings at retirement. Those

are all things they look at. I'm not an actuarial expert, but if the actuarial

earnings calculations are incorrect, there is a corresponding reduction of benefit.

MR. CLARK: I just want to confirm that the minister said he would provide for me the actuarial opinion.

HON. J. JANSEN: The plan is a public document. I have no

problem giving him the plan. I can't speak for the Minister of Health,

but I would suppose he would do that. I'm prepared to give him that.

MR. CLARK: I appreciate that, Mr. Chairman, and I'll probably have more questions when I see it.

There's no question in my mind, when I contemplate this June '87

document, that it's linked to billings. There are a number of things in

here that make it theoretically impossible to have a fixed cap on the

payment over time, unless you're contemplating a decline in benefits

over time for deferred income for doctors. That seems to be clear,

unless there are some changes — unless it's contemplated that there

will be some increased payment from the Crown, from the government of

the day, to cover those unfunded liabilities, which I suspect is the

case. I suspect that it doesn't matter to this administration, because

they're not looking that far ahead.

It's clearly $25 million in year one, but what it will be five or

ten years from now.... It is simply impossible to believe that five or

ten years from now the payment for that lucrative doctors' pension plan

as contemplated in this deal will still be $25 million. It's

theoretically impossible with respect to the formulas in here, unless

it contemplates a decline in income and a decline in pensions paid to

those doctors.

I would like to ask one other question. If the deal was thrown

out.... Let's say that the current ruling stands and the $25 million is

saved by the government, because the BCMA chooses not to follow up on

it, because they are disallowed the double tax benefit that they were

seeking. Will the minister, as Finance minister and as minister

debating this today, commit in the House to a reduction in MSP

premiums? He has said on many occasions that the increase in MSP

premiums is directly related in part to payments to doctors for their

increased fees and to the pension plan. If the government saves $25

million as a result of this not going through, has he decided to reduce

the medical premiums accordingly?

HON. J. JANSEN: That question is out of order. The commitment

made with the BCMA was for a $25 million payment to a pension plan,

effective March 31, 1992. I think it's very unfair to the physicians

and surgeons of this province to suggest that we're going to break the

contract without having discussions with them. I'm surprised that he

would mention that.

MR. CLARK: I want to make it clear for the record that I have absolutely no problem — nor do other

[ Page 12382 ]

members on this side of the House — with the doctors of this

province receiving a pension plan, provided it is a pension plan with

the same rules as every other citizen in British Columbia has to abide

by. That means, for example, that they cannot contribute to their RSP

and get maximum deductions and get a pension at the end in the guise of

a deferred income plan, as the doctors tried to do. If it was exactly

the same as for every other citizen in British Columbia, who pays a

part of his own pension plan and whose employers pays a part, and who

gets no special tax treatment, then I'd be quite happy to stand in the

House and support a pension plan for doctors. In fact, that's not

what's contemplated by the government or the BCMA.

I don't blame the BCMA for taking the former Premier to the

cleaners. I do not blame the BCMA at all for getting a lucrative deal.

It's a lucrative deal that only this administration would negotiate.

With that, I would like for the benefit of the House — and I see the

minister here — to move to the second part. It's not a different vote,

Mr. Chairman. Mr. Chairman!

HON. J. JANSEN: Mr. Chairman, may I respond to the member

opposite respecting the plan. The ruling that has come from the

Department of Finance contemplates that there will be an offset for

RSPs. The new ruling does take that into consideration.

MR. ROSE: I'd like to get up on a point of order to tell the

House that I apologize for the behaviour of my hon. colleague for

Vancouver East, that he would cast reflections on the Chair. It

certainly wasn't our intention today to cause the Chairman a lot of

sleepless afternoons.

MR. CHAIRMAN: The Chair appreciates the member's comments.

The Chair will retire for the moment and go put his neck brace on and

relax on that.

[Mr. De Jong in the chair.]

MS. MARZARI: Now that we're all awake, Mr. Chair, the second

section of

schedule 1 refers to a $90 million overrun. It is described

as a supplement to vote 60 in last year's budget for the ministry

operations of Social Services and Housing, to provide funding for

unpredicted increases in the number of eligible families under the day

care program. I read this with some surprise; $90 million injected into

a day care program at the last minute because there was an overrun is

unprecedented in this province.

[2:45]

When I first came to this House in '87 and through '90, the child care

expenditures of this province amounted to somewhere between almost $50 million

and the $64 million that child care cost last year in B.C. The estimates for

1990-91 record a $64,167,000 expenditure. The estimates projected for this

budget year, '91-92, suggest that there will be $71,484,000 spent on child

care — a modest increase reflecting a modest program which is slowly increasing

through the years. If we were to chart this on a bar graph, we would see a gradual

increase in the expenditures on child care between '87 — probably between

'83 — and now. Modest increases, certainly very few new spaces being built,

certainly very few new people eligible to get their children into child care

and certainly not a great increase in the number of child care workers trained

and licensed to provide child care. But on this last day of the government's

attempt to get $5 billion through, we have in this

schedule — to top up last

year's budget — an overrun of $90 million for child care, which is more

than the total amount to be spent on child care for 1991-92. That would show

on a bar graph as an outstanding sum.

I think the House needs to be given some explanation of how these

unpredicted increases came about; how many new, previously undiscovered

parents suddenly became eligible for child care and day care; what the

existing budget for child care services actually is — and I would like

the minister to separate that from special-needs care, which is

incorporated in his budget and which has not been separated out for the

benefit of the public or the opposition; and how many parents are going

to be served in the upcoming year with the $71.5 million allocated for

child care and special needs.

HON. MR. JACOBSEN: I didn't want to interrupt the member, because I was sure she wanted to finish making all the good points that she had.

I want to start by explaining that the amount of $90 million is

correct, but the body of the motion is not correct. It's correct as far

as it goes. It says, "eligible families under the day care program,"

and it stops there. It should have said "and additional costs within

the GAIN program." I guess mistakes are made in different places.

Interjection.

HON. MR. JACOBSEN: And it's a substantial difference. For the

record, the overrun in the day care program was $6 million, and the

overrun in the GAIN program was $84 million. I'll talk about each one a

little bit, because I know that members opposite will want to know what

accounted for these increases.

First of all, there was $42 million as a result of increased demand

on our system due to the slowdown in the economy and an increase in

unemployment. Unemployment changed from 8.6 percent to 9.6 percent, and

that had the effect of bringing in a cost increase of about $42 million

to this ministry. I want to emphasize that none of the costs are really

as a result of program changes but simply an increase in usage. We have

the responsibility — and rightfully so — of making sure that we provide

for all people who are in need, so that's what we do.

In addition to that $42 million — that's half of the GAIN cost —

there was another $42 million in GAIN, which I think all members

opposite and members on this side of the House would be interested in

knowing about. Fourteen million dollars of that was directly

attributable, as best we could estimate, to changes in the federal

government UIC program. That amounted to a $14 million cost to the

province.

[ Page

12383 ]

In addition, and also to do with the unemployment insurance program,

we experienced an additional cost of $28 million that had to do

primarily with a backup of claims at the UIC offices. There was a flood

of claims for UIC benefits that the federal government was not able to

meet. We complained vigorously to them, because those people had to go

somewhere for help and they came to Social Services. As I said, the

cost of that to us was $28 million. There was an increase of 55 percent

in the number of people asking for social assistance while they were

waiting for UIC claims. This, of course, relates to the expenditures of

just a few months back. We complained about it, and remedies have been

taken, but at that point they were unable to provide the service to

operate their offices.

1 have to say that the $6 million overrun on the day care program is

a number that we're not entirely unhappy about. It's hard to estimate

what the usage will be, but the fact is that the people that used this

day care subsidy were, for the most part, single parents. Most of them

were women. They were people who had taken advantage of the employment

training and opportunities that we provide through the ministry to make

it possible for those people to get into the workforce and become

independent.

As a result of moving into employment from social assistance, we

assist them with providing day care in the transition period. Otherwise

they could not make the transition. Many more people took it up than we

had anticipated at the beginning of the year, and I'm pleased that

that's happened because many of these people are no longer dependent on

government services.

MR. ZIRNHELT: Leave to make an introduction, Mr. Chairman?

Leave granted.

MR. ZIRNHELT: In the gallery today is a resident of the

Chilcotin in the western part of my riding, Mr. Birchwater, who is a

journalist and a writer from that area. Please make him welcome.

MS. MARZARI: It's difficult to know whether to feel angry or

relieved. Even the Reader's Digest , which is a condensed version of

long stories — as you may know, Mr. Minister — at least finishes its

stories and in the space of a few pages manages to tell the whole story.

Here we have an expenditure of $90 million — last year's dollars. We have

a massive overrun. I seem to remember that some years ago, when the NDP was

in power, there was an overrun, and it received front page attention for weeks,

if not months. You're probably going to be talking about it throughout this

election — something that happened 20 years ago. Here we have a real overrun

that you claim was unexpected and unanticipated, and you make all this a typographical

error. Maybe it happened in the printer's shop, but you haven't accounted

for it here in

schedule 2 of Bill 8. You have four pieces of paper spending

$5 billion, and you haven't properly accounted for $90 million here on page

2 of that bill. It's unacceptable for this House to have received Bill 8

in this form. It's unacceptable that this had to come to the House for questions

to be put. To stand up and smile and say, "Oh well, we just didn't

complete the description of how that money was spent," is simply not good

enough — if we take accountability at all seriously in this House, which this

process shows we don't.

We have to do better than that. This government should be very

careful about claiming that $90 million is being spent on day care when

in fact it's being spent on unemployment insurance overruns passed on

from the federal government to the provincial government, which is an

issue in and of itself.

Coming back to the child care and day care provisions, I would ask

the minister then, with this $6 million overrun on child care, exactly

how much of this overrun and how much in his budget is actually

allocated to the provision of child care services separate and distinct

from special-needs care.

HON. MR. JACOBSEN: Just so the record is very clear on it....

I guess it would be nice if no one ever made a mistake, but mistakes do

happen, and it appears that the mistake took place in the printing. I

have a copy of the special warrant under the Ministry of Social

Services and Housing, which says: "To supplement vote 60, ministry

operations, to provide funding for unpredicted increases in income

assistance programs, caseloads and an unanticipated increase in the

number of eligible families under the day care program." So there was

one line left out. I've tried to explain that. I can apologize for it,

but I did not print the bill, and it was certainly not the intent that

it be left out.

The member spoke about the overruns and insinuated, if she didn't

actually say it, that it was poor management that we would have those

overruns. I think she would not criticize the $6 million for day care,

because she, along with many others, has been an advocate of more day

care. We are simply meeting a need and providing whatever money is

required to do so.

On the other $84 million that involved the GAIN program, I think

I've explained quite carefully that $42 million of that is a result of

changes in the federal UIC system or has to do with the way the

unemployment insurance program has been handled by the federal

government. I suppose that under those circumstances we would have the

option of either meeting the needs of these people or saying, "No, go

to the federal government, " which couldn't at that time meet their

needs. I think we had no choice but to care for these people.

There is $42 million in addition to that, above what we forecast.

That had to do with the downturn in the economy and increase in

unemployment, but again, it did not have anything to do with a change

in programs. I don't want to say that it's not nice to be absolutely

accurate if we can, but other jurisdictions across the country — I hate

to make the comparison again, but f 11 do it just so it's clear — seem

to be having similar problems. We have a $90 million overrun here, when

you take all things into consideration.

[ Page 12384 ]

I'm told that in Ontario it's expected that the overrun will be $1

billion. Just to help put that into perspective, they have about three

times the population that we have. So three times the population in

Ontario will generate approximately 11 times the overrun of British

Columbia.

I don't know that you can really say, member, that we're doing a bad

job. We put the money into the day care program to assist people who

wish to go into the workforce. It's a subsidy for those families. I

don't know that I have the information that you're asking for — a

breakdown between special-needs and other children — but the reason for

the overrun in day care was simply an extended usage.

[3:00]

MS. MARZARI: The minister is quite right. I am and we are

strong advocates for child care on this side of the House. In fact, one

might even ask why the overrun wasn't greater than $6 million for child

care, given the unprecedented need that we experience in this province.

I'm going to save for later in the

schedule my more substantive

questions on child care, such as the true budget, number of licensed

versus unlicensed facilities, the average wage of a child care worker

in the home and the average wage of a child care worker in a group

centre. Those are all questions which need to be asked in the purview

of the warrant which is about to come, but I have to comment before I

take my seat again that the minister has just come up with the very

arguments that I have been using against Social Credit when they have

accused the NDP in Ontario of having a deficit.

The federal government cutbacks in the Canada Assistance Plan and

equalization payment funds have created a situation for every province

across this land in which the provinces are having to pick up the tab

for social services, for housing and for poverty, whether it be

unemployment insurance or the Canada Assistance Plan. So, when you're

telling me that Ontario is paying $1 billion that the feds would have

paid last year, and we are paying $90 million in social services and in

GAIN that the feds would have paid last year, and when I consider the

number of jobs that Ontario has lost through the free trade agreement,

I must say that B.C. is not looking too dissimilar from Ontario

vis-i-vis the cutbacks here and the deficit that's being run up. So

just let me put that on the record for a brief moment there, Mr.

Minister, because I think for the first time your side of the House is

willing to recognize how the provinces have had to swallow federal

incompetence and federal cutbacks.

HON. MR. JACOBSEN: Just for the record too, I want to again reiterate

that the overrun in Ontario as compared to British Columbia is not three times

as much, what it is in population, but 11 times, so there's a huge difference

in that. I agree there are problems with the federal government picking up its

share of the cost of programs. I agree that that happens, but the other point

that I was careful to make.... You see, I suppose I'm much more gentle than

some of the members on my side. I made reference twice to the fact that our

cost increases were not as a result of changes in programs, but I didn't

elaborate. Ontario's problem is that they have very substantially changed

their programs, and that's what accounts for it, much more so than even

the failure of the federal government to put up its rightful share.

MS. SMALLWOOD: Mr. Chairman, Id just like to notify you that

while I have a lot of questions for the minister, I'll reserve them to

the other

section of the bill where it talks about future action.

[Mr. Pelton in the chair.]

Schedule I approved on the following division:

YEAS — 30

Bruce

Savage

Rabbitt

Mercier

Gran

Jacobsen

Chalmers

Parker

Ree

Serwa

Crandall

Vant

De Jong

Kempf

Veitch

S. Hagen

Johnston

J. Jansen

Messmer

Weisgerber

Dueck

Couvelier

Loenen

Reynolds

McCarthy

Peterson

Smith

Reid

Brummet

Michael

NAYS — 23

G. Hanson

Barnes

Marzari

Rose

Harcourt

Gabelmann

Boone

D'Arcy

Clark

Blencoe

Edwards

Cashore

Barlee

A. Hagen

Lovick

Smallwood

Pullinger

Miller

Cull

Perry

Jones

Zirnhelt

G. Janssen

On

schedule 2.

MR, CLARK: Mr. Chairman, we've agreed to do the health care

section of this warrant to accommodate, I assume, the staff the

minister has requested. So if we can wait for the staff to come in, I'm

sure my colleague from Point Grey has a few more questions germane to

this particular warrant in this schedule.

MR. PERRY: Before I begin I would like to welcome Mr. Foster

and Dr. Henderson back to the chamber. It's a pleasure to have people

with us who may actually have some answers to some of the questions I

intend to ask. I'm very pleased by the reassurances from the Minister

of Finance that we can expect to begin a more detailed debate on the

Health estimates, presumably next week. So I may curtail some of my

remarks and save some of the material. I'll try to bring up some of the

relatively urgent problems today, just on the small off chance that we

don't actually arrive at an estimates debate next week.

I'll begin with one which is relatively simple, and I hope that the Minister of Finance, recent former

[ Page

12385 ]

Minister of Health, may be able to reassure me that an answer is rapidly at

hand. This concerns the expansion of postgraduate training programs for physicians

in British Columbia. Some members may know, those who attended hearings of the

Royal Commission on Health Care and Costs in the interior of the province, that

a major issue identified before the royal commission was maintaining the

supply of family physicians and some specialized positions — such as surgeons

— to the more remote rural communities of British Columbia and even to some

of the less remote ones like Quesnel or Williams Lake. The Minister of Finance

will know from his former life that there have been some innovative proposals

from the UBC faculty of medicine, and that there is a constraint that, beginning

in 1993, there will be a requirement for two years of mandatory postgraduate

training for doctors after their MD before they may practise medicine in this

province and across the country.

On May 27 I received a letter bearing the same date from the present

Minister of Health reassuring me that the ministry is undergoing

discussions with the faculty of medicine at UBC to "... recognize the

urgent need to complete the planning and implementation process." The

letter states that further consultations are scheduled, but the

letter is in response to a letter from myself to the former Minister of

Health, who is now sitting here with us expressing concern that there

really — was some urgency to providing the initial stages of funding

for the expansion of postgraduate training programs.

[3:15]

Therefore, on receipt of this letter from the current Minister of Health, I

took the liberty of verifying the situation as of yesterday with the faculty

of medicine. I have before me a letter from the head of the depart ment of family

practice at UBC, Dr. Carol Herbert, pointing out that: "We need a reply

immediately in order to implement the two-year pre-licensure program effectively

to meet the needs of the province." I hasten to add that the word "immediately"

is very deliberate in this letter. I continue to quote:

"Start-up funds must be available July 1, 1991, or we will

be delayed a year, compared to other provinces, as UBC cannot responsibly start

programs without funding. Moreover, we still have no budget for rural

and remote training. In spite of success and seven of the eight trainees in

the family practice program remaining in small towns, all this year's group

intends to stay rural. The Chilliwack program started last year with ministry

one-year funding, but no funding for 1991-92.

"I have a congratulatory letter from" — she mentions

the name; I can't here, but it's from the present Minister of Finance

— "with respect to Chilliwack being a model program after he read our external

reviewer's report, a program which meets community needs."

But there's no'funding for it for the next fiscal year.

"Funding is urgently needed in 1991-92 to begin an exciting

residency site at St. Paul's Hospital which will address the disadvantaged

in the inner city, Chilliwack, rural and remote [programs]" — that would

be Prince George and other sites, potentially HazeIton, for example, specializing

in native health issues — "...and to initiate further faculty recruitment

and development in a timely fashion. We need start-up funds immediately, with

discussion over the larger budget and plan for postgraduate training as a whole

understandably continuing over the next months."

That's in effect a request for a rather modest commitment from the

Ministry of Health, so that this important health manpower issue can be

addressed. I wonder if I could request from the Minister of Finance the

information as to whether the interim supply that we're about to vote

on will cover that modest amount f funding so that the UBC family

practice and other raining programs can get on their feet on time for

the 993 two-year pre-licensure.

HON. J. JANSEN: I had hoped that the discussion respecting

the special warrant and supply bill for the next two months,

schedule

2, would deal with the urgent matters that are necessary for us to deal

with.

This question the member for Vancouver–Point Grey is putting forward

is an appropriate question and I don't mind responding to it, but I

really urge that member to think about asking that type of question

during debate of the estimates, when we can give him as much time

as he needs to deal with those questions.

I want you to know that my focus in terms of health are expenditures

is related to the patients and to the people of British Columbia. To

have him at the outset ask a question that relates to his colleagues

and the raining of physicians and surgeons, of which we already have

the highest number per capita in the country, is probably a little bit

inappropriate.

I can't speak for the minister, obviously, but I can tell you that a

decision has not yet been made. Perhaps during the estimates that

decision will be made. If you put that question forward when the

minister is here, and we have the extensive estimate debates, maybe he

can provide you with an answer at that point in time.

MR. PERRY: I think we can consider that notice is served for

when and if we do arrive at the estimates debate. I'm not quite sure

that the chair of the royal commission, justice Seaton, or members from

constituencies like Prince Rupert or Prince George would agree that the

question is so irrelevant as the minister seems to think.

Let's move to a question where there was, and remains, considerable

urgency. The government has moved with remarkable sluggishness, in my

view. Let's see whether in a matter of genuine urgency we can see any

commitment from the Minister of Finance, representing today the

Minister of Health, to actually accomplish something.

Last October I wrote to the then Minister of Health, now with us

today as Minister of Finance, urging him to consider the implementation

of immunization against hepatitis B for ultra-high-risk individuals,

namely intravenous drug users in the province. At that time it became

clear that the medical officers of health in British Columbia had

argued for such a program for at least four years previously, probably

as early as 1986. The ombudsman conducted, at my request, an

investigation into the question of whether administrative bias had been

exercised against intravenous drug

[ Page 12386 ]

users to discriminate against them in the provision of immunization

against a potentially fatal and often fatal disease. The ombudsman was

not able to establish that bias. Mr. Chair, the ombudsman did not put

witnesses under oath, and my information was at the time, and still is,

that had the ombudsman put witnesses under oath he might have obtained

a somewhat different story. In fact, I'm convinced there was evidence

that an explicit bias was exercised against intravenous drug users in

the ministry sometime in 1986 or'87.

However, that point was secondary. The key point was that in British

Columbia, as of 1990 if not earlier, we had an innovative

needle-exchange program which allowed public health officials the

potential to immunize ultra-high-risk street people against hepatitis B

infection. When that point was made by my letter of October 5, 1990, to

the minister, I encouraged him to act with alacrity, to commence an

immunization program for those people and to consider the merits of a

comprehensive, universal immunization program for neonates — something

which has become increasingly standard in the rest of the world and

which will almost certainly become a recognized world standard within

the next few years.

Mr. Chairman, I'd like to focus my question on the program for

immunization of ultra-high-risk street people. Approximately three

months after my letter of October 5, 1990, the Ministry of Health

announced funding of roughly $75,000 for the remainder of the fiscal

year for a program of immunization, as suggested. A contract was let

for a very modest amount of vaccine, and vaccine was purchased at a

price very close to the prevailing Canadian price. I had suggested to

the minister that it might well be possible to purchase at a much lower

price a larger volume sufficient to allow a broader program of

immunization. The minister chose to tender in a relatively modest

amount — in the range of a 3,000 doses initially, or perhaps 9,000

doses for the current fiscal year. If I recall correctly, the price per

dose was in the range of $25. The difference in price between the Merck

bid and the Smith Kline and French bid was in the range of 27 or 37

cents per dose — a very modest difference in the order of 1 percent or

less.

The last time I tried to ascertain whether the vaccine had been

delivered, after the burst of publicity last January, was a week or two

ago. I was told that no vaccine has yet been delivered to the street

needle-exchange program and that no immunizations have been undertaken

through that program. So, Mr. Chairman, we're now some eight months

after the initial notice to the ministry that it had been derelict in

its public health function and that it was missing a golden opportunity

to engage in one of the most cost-effective preventive measures

available in the world. So far there has been a lot of fanfare, but we

seem to have achieved virtually nothing. Can the minister assure us

when the vaccine will be delivered and whether the target of

approximately a thousand people immunized in the present fiscal year

can realistically be achieved?

HON. J. JANSEN: Mr. Chairman, again I hope that the member puts that

question forward during budget debates. I announced when I was Minister of Health

the AIDS strategy program; one part was the centre of excellence for viral diseases

at St. Paul's Hospital. I want to tell you that the AIDS strategy has received

international acclaim. We had Dr. Robin Hutchinson in Europe just recently,

at the World Health Organization conference. He was told that our AIDS strategy

is one that can be used as a model for all countries to follow. That's pretty

significant. We can thank our staff and our dedicated field staff for all their

work to put this plan into effect. Part of that program, as I said earlier,

was the centre of excellence. As well, I have announced earlier the creation

of the program of $300,000 additional money for hepatitis B infection immunization.

The cost of the series for that particular immunization is $75. If there are

problems in terms of the mechanics of the program, I hope that the member will

follow that up and present it as a question to the Minister of Health — I know

the staff have taken note of it — when he is here and does his actual estimates

preparation.

Again, I would urge the member to deal with some of the urgent matters respecting the special warrant.

MR. PERRY: The former Minister of Health made it quite clear

when he was the Minister of Health that he did not regard the

protection of street kids from hepatitis as an urgent matter, and it

still shows. I don't think he's learned anything from that experience.

HON. J. JANSEN: On a point of order, I find that comment very offensive. That's incorrect and I would ask the member to withdraw that.

MR. PERRY: If the minister finds it offensive I'll certainly withdraw it. I was simply making an observation.

I remember from last year's debate.... Some of this may seem like

déjà vu to you. The Minister of Finance did not enjoy my questions when

he was Minister of Health, and I think we'll have to agree to disagree

on what are matters of urgency to the people of British Columbia.

I'd like to raise another one which is representative of some of the

regional problems that we face. I've raised it before in this session

without hearing any discernible response from the Minister of Health.

There is a difficult situation affecting the people of Kaslo, where

much of the local population are elderly people who pioneered that

district. For example, I think of two people I visited in their home

last fall who are very severely disabled by cardiovascular disease. One

of them used to be the chief B.C. Tel operator in Kaslo, and the other

was a mining pioneer in that region.

[3:30]

These people have formed a society of hundreds of people attempting

to secure an intermediate-care facility in Kaslo. They have argued that

a facility is necessary for them because the geography of the West

Kootenays effectively isolates them from communities which may look to

Victoria bureaucrats to be very close on a map — communities like Kaslo

and Nakusp, Kaslo and New Denver, Kaslo and Nelson even, which

geographically are relatively close. If they were in

[ Page

12387 ]

Europe they might be half an hour or an hour apart on a train, but

in the geography of interior British Columbia they are sometimes two,

three or more hours apart and even more than that in a snowy winter.

One of the reasons that an intermediate-care facility appears

necessary is that home care support has been relatively inadequate in

that area. My information is that between the 1981-82 and 1988-89

fiscal years, the number of clients that would be in the Kaslo district

home support service area increased by 29 percent, while the overall

funding declined by 6 percent and the average hours of home care

allowed per client decreased by 47 percent. I have those statistics

from the Regional District of Central Kootenay, and those are the last

years for which figures were available for Kaslo home support.

I quote from a letter received from an individual involved in that

program in Kaslo, who writes on May 6 of this year: "The effect of this

situation is that only those persons who are eligible to receive the

subsidized service and accept the limited hours can be reached." He

also refers also to an increase in the price of home support which

makes it, at $19.81 per hour at the end of 1991, one of the most

expensive in the province. I continue to quote: "As home support moves

to a more paramedical role, the irony is that the service moves further

away from the needs of an increasingly aging population."

Mr. Chair, I went to Kaslo to investigate that situation and popped

into the local hospital, where I found evidence that the average bed

occupancy of a ten-bed hospital was about 2.5 — perhaps 2.7.

Effectively the hospital was very underutilized and potentially a place

where a few beds might be converted into intermediate care so that

these people could be looked after in their own home community.

I'm rather convinced, although I don't have the benefit of the

enormous staff that the minister enjoys that there's a real problem

which has not been met, and I'd like to ask the Minister of Finance,

who is representing the Minister of Health today: is there any plan, in

the $5 billion we're being asked to approve today, for at least some

planning study to meet the real needs of people in that aging

community? Maybe you can give us some even better news. Is there a plan

to increase the home support hours or to provide a conversion to a

small intermediate-care facility, or in some way to respond to the

desperate pleas that have been coming from the community of Kaslo to

the Ministry of Health?

HON. J. JANSEN: I'd like to thank the member for his

interest. It's the first time I've noticed his interest in Kaslo

intermediate care, and I'm very pleased. While I was Minister of Health

I did have significant representation from the member representing the

area, but this is my first opportunity to respond to his interest, and

I thank him for it.

First of all, let me say at the outset that the Minister of Health

is extremely committed to at-home care. I fundamentally feel — and I'm

sure the members opposite do — that at-home care is the most humane and

most compassionate type of care that can be given.

What we've accomplished in this budget.... I'm sure that during the

estimates, when the Minister of Health is here, he'll be talking at

length about the increase in available funding for home support

services. I should tell you, though, that the budget increase for home

support services increased this year alone by 16.1 percent. As well,

group homes for the handicapped, 32.2 percent; long-term-care

assessments, almost a 19 percent increase; residential care, a 15

percent increase. These are very substantial increases to reflect our

philosophy of providing at-home care.

I should also tell you the home nursing care hours that have

increased. The number of direct service hours being provided in '88-89

was 651,000. This year's projected actual is 845,000. The number of

clients has grown by 50 percent during that period of time — a very

significant growth that reflects our attitude. If there is sufficient

demand in a community for an intermediate-care home, the minister and

the staff of the area will sit down and provide that, because there are

situations, I agree, where we should have an institutional environment.

But as much as possible we should ensure that at-home care is provided

to enable people to stay in their own homes.

MR. BARLEE: The minister just mentioned sufficient demand, and that prompted me to address this subject as well.

In the south Similkameen region of British Columbia, there is a

small town like Kaslo. It is essentially a ranching community. It has

been hard hit in the recession; it has been hard hit for about 20

years. There is more than sufficient demand in that area for an

intermediate-care centre. This facility is really needed. Letters were

written by 1,100 people to the government. These were not form

letters; they were individual letters written by the people of that

area — a small town of just over 2,000 people.

The people of Keremeos require an intermediate care centre for

several reasons. It is kind of a separate enclave in that dry belt of

British Columbia. A lot of old families have been there for a century

or longer, and some of them are familiar names to this House. Frank

Richter's family came from there. The Williams family, the Lawrence

family, the Clifton family and the Barker family, and all sorts of

families, have been there for generations. They don't want to leave

this area, but there is no facility in this town. This particular town

has an unemployment rate of around 20 percent. The great things this

government has done for unemployment have not hit Keremeos. It has no

small industries, and the orchardists in that area are in dire straits.

They do need a facility like this. I feel that the government has

ignored their pleas — and I do say pleas — over the last two or three

years. Word keeps on coming back from the ministry that its criteria

are not being met. This government states that they're keen on

decentralization. The people in the Keremeos area who are now of the

age when they have to go into an intermediate-care centre have to go

all the way to Summerland. That's a round trip of about 90 miles. I

don't think the criteria of the Ministry of Health are the

[ Page 12388 ]

same as the criteria of these local areas such as Keremeos or Kaslo.

This ministry evidently was $50 million over budget on drugs last

year. They left $7 million on the table and yet they could not see fit

to provide an intermediate care facility for a town that really needs

it. It needs it on several fronts: economically, socially and for

health reasons. I wonder why that is not high on your list of

priorities. I think it should be.

HON. J. JANSEN: Those figures are not correct. Perhaps the

member would avail himself of Hansard in terms of the discussion on

drug overruns. The figure is much less than that. I don't think we want

to repeat that debate at this point in time.

Again, I want to welcome his newfound interest on this particular

issue. I know the Solicitor-General has been talking to me, again when

I was Health minister. Perhaps this minister has dealt with the current

Minister of Health. I don't know.

I want to again put on the record that I don't believe in

warehousing people. I believe that is a totally inappropriate way of

care. We believe very strongly in a compassionate at-home care program

and, as much as possible, that is encouraged and supported. I told you

that the increased funding is in the order an additional $20 million.

It's money well spent. The people who have the advantage of that

program thank us for that assistance and support, because without it

they would have to become warehoused.

I said earlier in my response to the member for Vancouver-Point Grey

that there are situations where there is a need for an

intermediate-care home. I would encourage the member to bring that

issue forward during the estimates which will come up next week, and

the Minister of Health will comment in more detail.

I'm here to talk about the general need for a continuation of

expenditures for the next two months to enable us to debate the

estimates. I would hope that you would ask the questions that deal with

the urgency of the matter in terms of expenditure.

MR. BARLEE: I question the use of the term "warehousing." I

don't think that really applies to people in the health system or about

to go into it Secondly, I question the minister's response. The letters

I have written to the ministry have been returned with the usual reply,

which looks like a form letter, which says that this particular project

does not meet the criteria of the ministry. I think the ministry's

criteria are far different from the criteria of the people in the area.

I think much more consideration should be given to small towns like

Keremeos and Kaslo. Not much doubt about it, they are not getting that

consideration.

MR. PERRY: My colleague is eager to participate as well, but I felt

I ought to interject apropos the minister's comments about warehousing of

people. I felt I ought to interject a note of reality. Id like to go back, simply

for the record, to that situation in Kaslo and read one further paragraph from

the letter I received, dated May 6, 1991. I'm not going to identify the

two individuals because they're rather vulnerable people. I'll simply

substitute as I read this quotation. It says:

"You remember the people

whom you visited last October? Well, the man has spent the winter in both Nelson and Kaslo

Hospitals. On one occasion his wife, who struggles on alone, blacked

out in the Kaslo Hospital parking-lot. On another, one of my neighbours

found her at home crying because her husband wanted to come home" —

that would be from Nelson or Kaslo Hospitals — "and she knew she could

neither have the help nor had the capability to look after him. He was

a mining pioneer and she, the chief B.C. Tel operator in Kaslo. What a

way to end their days."

What he's talking about is not warehousing. It's providing a

sensitive service which attributes to those two individuals the same

rights to live out a fulfilling life in comfort and dignity that all of

us take for granted. The member for Boundary-Similkameen and I are

arguing that the Health ministry has not been sufficiently sensitive to

the needs of those people who are the backbone of this province.

They're not like the Minister of Finance and I, people who came

relatively recently to this country. These are people who were actually

born in the Kootenay country and who built the country. They end up

unable to access services equivalent to what many of us in an urban

setting take for granted.

That's why we were asking the minister, in the absence of the

Minister of Health — who could have been here today; he knew we would

be debating these spending figures and chose not to be here today

That's why we're asking the Minister of Finance, who has recently been

Minister of Health, to indicate whether we can expect any increased

sensitivity. I don't suppose we can, but we're encouraging him to make

that commitment now.

[3:45]

[Mr. Ree in the chair.]

HON. J. JANSEN: On behalf of all immigrants who have come to

this country, I want the member to understand that I find his comments

extremely offensive, suggesting there are two levels of citizens in

this country: immigrants and those born here. Shame on you, Mr. Member!

That's really offensive. I want him to know that I take those matters

personally, as well. My parents came here 35 years ago.

In terms of the debate, however, I indicated earlier that the matter

of at-home care is an issue we give particular priority to. I also said

that as for the concept of institutionalized care, while I don't like

it, there are situations where it is necessary. We will continue to

meet those situations because, in my opinion — and it was reflected in

the budget document — seniors are a very important cornerstone in the

province. We intend to ensure that the budget reflects that priority.

MR. CHAIRMAN: The member for Oak Bay.

MS. CULL: Oak Bay–Gordon Head. My constituents in Gordon Head like to be remembered from time to time, Mr. Chairman.

I just wanted to ask about a health project that is of great concern to people in Victoria, and that's the

[ Page

12389 ]

Victoria Health Project. As the Minister of Finance — the former

Minister of Health — knows, the funding for this project was due to end

on March 31. There was some uncertainty from January until some time in

February, when additional funding was found to continue the project

beyond the end of the fiscal year.

However, I've looked carefully through the estimates, and I can't

find anything in the estimates book to show whether there is in fact

money allocated to the Victoria Health Project to keep it in operation.

Right now the various subprojects have advised me that they have a

tentative budget for this year. They have funding until the end of

June, but they are not certain of — their fate beyond that. I wonder if

the Minister of Finance could tell us how much has been budgeted for

the Victoria Health Project for this fiscal year.

HON. J. JANSEN: When this project was put into existence, Mr.

Chairman, we did it on the basis of a pilot project to see how

effective it was. Part of that experience was to measure output. We

were really concerned to ensure that we were indeed getting value for

money, how much value and whether we should be incorporating this

throughout the province.

When we announced that we were going to start measuring results, and

we hired a number of people to assist us with that objective in mind,

that caused a lot of consternation. There was some feeling that perhaps

we were abandoning the project. That was not the case at all. We said

that we're concerned about the project to ensure that we follow through

with the analysis in detail, which we've done with the assistance of

the consultant from Simon Fraser University, who I'm sure the member

for Oak Bay-Gordon Head is familiar with.

In the interim we announced that we were leaving the funding in

place, although we didn't have the results of any analysis. We have

ensured the stakeholders that we are prepared to continue with that

program. Again, it's a question that you should put forward when the

Minister of Health is here. I don't intend to commit him, but I can

tell you that when we prepared the budget, that was certainly the

intention. I don't expect that to change.

MS. CULL: I'm not sure whether the minister did not answer my

question because he doesn't have the answer, or whether he doesn't wish

to answer it, but I want to repeat it. I want to know if he can tell us

how much money has been allocated for this year for the Victoria Health

Project.

HON. J. JANSEN: The amount of money necessary for the

Victoria Health Project to continue is included in the special warrant

outlined.... I don't know which one it is. That's where the funding is.

If you want to — debate the global estimate for that particular

program, I suggest you hold off until next week when the Minister of

Health is here, and he can answer in detail what the total funding is.

MS. CULL: I take from the answer that there has been money included

in the special warrant for the Victoria Health Project, and I'm pleased

to hear that. During the estimates debate I will, be more than happy to pursue

questions about the entire funding for the rest of the year.

The budget speech made reference to the fact that there was going to

be more emphasis put on preventive health care. There was also a lot of

talk about expanding services to seniors. I would like to know whether

there is money in the budget to extend the Victoria Health Project in

two ways: (1) beyond seniors to others in the community who might

benefit from this community-based preventive health care; and (2) from

Victoria to other parts of the province where, again, it would be of

great value to people throughout B.C., as it has been here in Victoria.

HON. J. JANSEN: The model that the Victoria Health Project

contemplates has a lot of advantages, and through the B.C. Health

Research Foundation, we are looking at a number of different studies,

including native health, which incorporate the basic elements of the

Victoria Health Project. Again, it's a good question that you can put

to the minister when he's here debating his estimates.

MR. BARLEE: There seems to be a vast difference of opinion

between criteria at the local level and at the government level,

specifically in the Ministry of Health. I don't know how many more

letters. you need — 1,100 may not be enough. That is virtually

everyone in that district — in Keremeos, Cawston, Olalla and all

around. I could probably come up with 1,500 letters. I want to know if

there's allocation in the 1991-92 budget to provide intermediate-care

homes for places like Keremeos and Kaslo, in spite of the criteria that

the ministry lays down.

HON. J. JANSEN: Again let me express my appreciation to the

member for his newfound interest in this particular project. I cannot

recall him ever asking the question before. But let me say, Mr. Member,

that the question is a good one to put to the Minister of Health during

estimates. The funding in this particular budget — this particular

discussion — is to enable the Ministry of Health to continue funding

its operations. As for new programs such as you mention, in Kaslo,

Keremeos or wherever, you should save those things for the estimates

debate next week, when the Minister of Health will be here.

MR. BARLEE: That was an uncalled-for remark; it was

gratuitous. First of all, I have written the ministry, and the response

has always been the same. I indicated that previously: that it did not

meet the criteria. And you are continually asking for apologies from

the floor. Evidently you were not aware of those letters, and I think

you should be careful before you make a remark like that. It's

insulting to members on this side as well.

MR. G. HANSON: I ask leave to make an introduction, Mr. Chairman.

Leave granted.

[ Page 12390 ]

MR. G. HANSON: I'd like to invite the House to welcome a

number of elderly people from the Begbie Guest Home, who are here today

witnessing the debate. Would everyone please extend a welcome to them.

MR. PERRY: On the same theme, I note that there's still a

young gentleman from the state of Washington observing the debates in

the gallery, and I trust that we can rely on him to act as ambassador

and take back to his fellow citizens our appreciation for the

assistance that Washington has rendered us. I'm afraid I haven't got

his name, but he can hear us from here.

To pursue the Victoria Health Project briefly, it's a rare

opportunity to satisfy my curiosity from the former Minister of Health,

since he's here, in effect, filling that role today. Could he explain

why the evaluation of the Victoria Health Project began only after the

two years were completed, and why we saw advertisements from Simon

Fraser University placed in the newspapers in the last month or two,

attempting to hire staff to begin that evaluation process at the end of

the pilot project rather than somewhere closer to the beginning?

HON. J. JANSEN: Could I ask the member to continue the debate

on

schedule 2. We're talking about the Victoria Health Project and the

analysis of the Victoria Health Project, and I would ask that he defer

those questions, in fairness, until the Minister of Health is here and

can go into more detailed debate.

MR. PERRY: I know it's an embarrassing question. Evaluation

studies aren't done free of charge. They're paid for by the taxpayers,

and they will be paid for out of the money in this warrant. That's why

the question arises.

However, there are many other members on this side wanting to raise

questions. I'm just going to serve notice of one, perhaps for the

estimates debate, unless the Minister of Finance cares to answer it

now. I wonder whether he would take the question on notice for the

Minister of Health, or perhaps answer it now if he can.

MR. CHAIRMAN: Order, please. If the question is not

appropriate to

schedule 2, then possibly it's appropriate to question

period in the House. If it's appropriate to

schedule 2, then fine.

MR. PERRY: It is, Mr. Chair, I'm sure it's quite appropriate to

schedule 2. It's just going to be rather embarrassing for the minister.

Could he provide us with a list of the travel allowances of chief executive

officers and other senior administrators for B.C. hospitals? It is said that

some of them have exceeded in their travels even the high-flying former Minister

of Advanced Education, who was the leading cabinet minister in travel costs.

It would be interesting to have those figures, since the current fiscal year's

expenditures will be coming out of the

schedule 2 vote, at least for the next

four months. If he can't answer that right now from memory, I'd certainly

be pleased if he would take that on notice for the estimates debate next week.

HON. J. JANSEN: If I understand his question, he would like

me to quote from memory, for the 130 hospitals in British Columbia, a

listing by employee of all the travel allowances that they have taken.

I'm sorry, I have difficulty doing that. I don't know how many years

you want, but I have a little difficulty doing that.

The appropriate procedure would be, Mr. Chairman, for the member to

provide the name of the hospital that he is particularly interested in.

If it's the hospital that he's working at, then we'd be pleased to make

that available to him. If he wants to do it himself, there is a very

appropriate way: write the hospital board chairman. Each hospital has a

society, and they can provide him with that information. Or he can

write the Minister of Health and the Minister of Health can make it

available to him. You should outline which hospital you have some

concern about or, even better, which man or woman who is serving in

that particular hospital environment you wish to have a look at in

terms of their expenditure. If you can do that, we would be pleased to

give you the information.

MR. PERRY: A couple of other short snappers for the minister, Mr. Chair.

MR. LOVICK: It's okay. He missed the reference. It's called "Reach for the Top."

MR. PERRY: The first member for Nanaimo suggests that the

minister might not understand the reference to "Reach for the Top." He

was on "Reach for the Bottom," though.

The hospital community partnership fund, in the last fiscal year,

funded a grant of $179,000 to the B.C. Children's Hospital, which

allowed for an innovative program of delivery to blind children in

collaboration with the CNIB. The evaluation report has been very

positive on that program, and the CNIB and the B.C. Children's Hospital

wrote to the ministry in February requesting a renewal of funding for

the year which began last April 1, but have heard nothing. Can the

minister advise us whether there is any funding in this warrant of

$905,060,000 that will address that very modest request from blind

people in the lower mainland?

[4:00]

HON. J. JANSEN: I'm sorry. That $905,000,000 I have not yet

memorized, so I can't remember if we have put that money specifically

in the budget. But if he would like to put the question to the Minister

of Health when he is here and has all of his statements and

information.... If he specifically has an interest in that, we can take

that question on notice now and have that information made available to

him.

MR. CASHORE: Mr. Chairman, the minister has stated many times

that he would rather leave to the estimates which he is promising the

matters dealing with new programs, but my question has to do with a

[ Page

12391 ]

program that presumably has been ongoing, and that is the mental

health plan. Since my constituency contains Riverview Hospital, I would

like to ask the minister if he would comment on the progress of the

mental health plan, especially with regard to plans to deal with the

five mental health districts that it refers to and plans for dealing

with Riverview Hospital and the patients there now.

HON. J. JANSEN: Again I give the assurance that the mental

health plan funding is included in the supply bill. The mental health

plan, as I announced when I first became minister, is on track and on

time. I don't have the specific details in terms of the number of bed

units created, but I'm sure that can be asked again during the process.

I also wish to remind the member that when we did the budget, I

announced we would make available a legacy fund to deal with housing

for people with mental illness. That is a matter of very serious

concern. I have met with a number of groups and they've outlined that

concern to me. As a result, we did include that in the budget and I

expect it will provide significant additional housing for people with

mental illness. We will continue with that initiative.

But please, if you would, put the question to the Minister of Health

when he is here. I could try to find the information, but why not wait

until next week when you have the opportunity to ask him?

MR. CASHORE: Contrary to what the minister says, it certainly

is my reading of the mental health plan that it is not on track, that

it is, in fact, on hold, and the progress written into that plan the

way it was presented has simply not materialized. We have not seen

movement toward the establishment of the centres around the province

that it refers to.

On another point, I'm glad that the minister mentioned the legacy

fund with a view to the Riverview lands. I would like the minister to

advise the House what the plans for that fund are vis-à-vis Coquitlam.

Does the fund refer specifically to the creation of housing and also to

the costs of running the programs for ex-mental patients within that

housing? Or is it a fund that would be simply oriented towards enabling

developers to erect housing but that would not be tied to maintaining

appropriate standards?

HON. J. JANSEN: I had an opportunity to visit a number of

housing units and different housing models. I became aware,

particularly when visiting downtown Vancouver, of some of the

significant needs for people with mental illness. What I said in the

speech is that we agree that there's a need and want to do something

about it. We think the model we put forward is a good model to address

it in terms of funding. We will meet with the stakeholder groups that

have an interest in this particular issue. There are quite a few —

Friends of Schizophrenics is one. I have a lot of interest in it

because I feel very strongly that this is a need that must be

addressed. We will keep it on track.

The actual elimination of Riverview — the downsizing and the regionalization

— is, as I understand it, on track. But it is slated for much later than this

year — for 1993-94, I think. Again, put the question forward for the Minister

of Health.

MR. CASHORE: It's my recollection that when this minister was

the Minister of Health, he announced that there would be a centre of

excellence relating to schizophrenics. I would like him to update the

House with regard to that initiative, which he has announced on a

previous date.

I would also like to ask the minister, vis-à-vis the legacy fund, in

order to deal with the numbers of ex-mental patients on the streets,

does this mean that to find appropriate housing for these people we

must wait for the results of this legacy fund? Or are there funds

within this budget that will address the urgent needs of people who are

now homeless as a result of the deinstitutionalization process of the

mental health system and as a result of requiring decent, safe,

affordable housing? Is there money in the budget that will address this

pressing need?

HON. J. JANSEN: Let me be very clear. We have committed to

stay with the mental health initiative. It was a ten-year program. We

are on track. When I was still Minister of Health, I met with some of

the interested groups respecting this. They feel, however, that we have

to accelerate the provision of housing for people with mental illness.

I recognize that, so we are doing this as a supplement to the program.

If you recall, when we announced the mental health initiative, it

received international acclaim. Even the World Health Organization sent

a telegram indicating that this should be used as a model for other

countries to follow. It was a very good response. We intend to stay

with that. The Minister of Health can talk more about that later on.

His intention is to stay with that program. All we're doing with this

is enhancing that significantly with the provision of a legacy fund.

MR. CASHORE: Notwithstanding the point the minister made

about a world perspective on this program in British Columbia, I would

just point out that the Registered Nurses' Association of B.C.'s

magazine, Nursing B.C., May 1991, in reference to the downsizing, says:

"A wrench was thrown into the plan when the downsizing

occurred before all the necessary resources were in place and without

adequate preparation for nurses in many hospital settings. 'The people

who have really borne the brunt of it are nurses in the emergency

department ... there has been a big increase in the number of

psychiatric patients coming through, and the emergency departments are

having a great deal of difficulty coping with that." Moreover, not all

hospitals in the province have acquired psychiatric wards, which means

that patients who have psychiatric labels are placed on

medical-surgical wards."

I would like the minister to at least acknowledge that that is a

more clear reflection of the situation with regard to ex-mental

patients in this province.

HON. J. JANSEN: The need for additional facilities in hospitals is very clear. Is there any doubt that the

[ Page 12392 ]

load on psychiatric beds is very heavy? Let's not just relate it to

downsizing; let's relate it to growth as well. The statistics

concerning mental illness are very alarming. One in three in the

population have some form of mental illness. So we're very concerned

about that.

The replacement, though, bed for bed for Riverview, is accurate and

on track. The growth requirement beyond that is, however, something

that we have to address. I'm sure the Minister of Health will talk to

you about that when he does his estimates.

MR. ROSE: I guess it's along the same lines that I wish to

address one or two brief questions to the minister. He seems a bit

preoccupied at the moment, so I don't know whether just to proceed.

You're not trying to chew gum at the same time, I hope.

Anyway, there's an interesting little paragraph in the throne

speech, and I know we passed the throne speech debate — I'm aware of

that. But it says here: "There are a group of people who are having

particular difficulty in finding adequate accommodation." I don't think

there's any question about that, and that's been touched on here. The

concern for the shelter of the mentally ill is expressed — "... and we

intend to create a legacy fund from the proceeds of the sale...." This

is the crucial part — not that the other parts about care of patients

and out-patients that results in perhaps premature

deinstitutionalization aren't important, but that's for another debate.

The proceeds from the sale of properties at Riverview and Woodlands

sites in the lower mainland will help develop community-based housing.

What I'm interested to know is: will the community-based housing be on

those sites? And if so, what part of the sites? And does the sale of

Woodlands and Riverview properties include certain buildings?

Of great interest to the people where I live, since the government

sold all the land above this particular piece of excellent property in

1984 or 1985, Colony Farm, does this include the sale of Colony Farm?

Because the people in my neighbourhood or the people I represent will

be fascinated, certainly riveted and extremely interested by the answer

of the minister if it includes any change in the status that involves

property, urbanization or some other plan for that, at least the

Riverview-Colony Farm area. I wonder if the minister could enlighten us

on that one.

If he can't, then perhaps he could agree, before he springs to the

balls of his feet, to take it at least on notice, and when his ministry

comes up next week he can give a more adequate reply.

HON. J. JANSEN: The intention was that the mental health housing initiative

be in communities throughout British Columbia. That was the underpinnings of

the entire mental health initiative, that people would live in their own communities,

supported by their own communities — and that is indeed the wish of all the

agencies that have given input into the mental health plan. It was not the intent

to build housing on the site but to build housing throughout the communities

in the....

I should also say in reference to some of the other comments that the number

of Riverview beds has declined by about 156 from '87 to '91. About 156

beds have been taken out of service. During that same period we have increased

the number of beds throughout the province by 457, so there's been a fairly

significant increase, and it's outstripping the population growth. But again

I want to tell you that I believe that we can do much more here, and that is

why we have put that plan in place.

The intention is to deal with the Woodland site and the Riverview

site proper, because the site is too large for a new facility if it

were to be created at Riverview.

[4:15]

MR. ROSE: I'm interested in and agree with the fact that with

the number of patients, the Riverview site is perhaps too large. But

there are buildings and a lot of property there, as well as the Colony

Farm property. I want to know if there are any definite plans for the

sale of those properties, because that's what it says here: "The

proceeds from the sale of the properties at Riverview and

Woodlands...." I want to know what properties you plan to sell. You

must have to sell some in order to get proceeds, so therefore what are

they?

HON. J. JANSEN: I am reluctant to answer that question until

the Minister of Health is here, and if you could do it during

estimates.... It was my intention at the time to deal with the

Riverview site per se and the Woodlands site, not Colony Farm. That was

not part of it at all. I think the new Riverview, once it's built — and

I forget the exact number of beds — would have in the order of 350 or

400 beds, or something of that magnitude. I'm sorry I can't remember

the figure. That would be the new Riverview development, which is

substantially smaller than the 5,000 that the Riverview site was

initially designed for.

MR. PERRY: So many of us are bursting with questions. It's

been such a long time since we've had a chance to ask any in this

House. I'm going to content myself with one last one until next week,

because it's particularly relevant to the tenure of this minister as

former Minister of Health, and I suppose he has the ultimate authority

now as Minister of Finance to answer this question.

The assistive devices task force was formed two or three years ago

to advise the Ministry of Health on an interdisciplinary basis about

the communications needs of British Columbians who have severe

communication disorders. For example, I think of a young man who

appeared before the Royal Commission on Health Care in January of this

year and who is a student at Douglas College. I believe he is about 30

years old and he has severe cerebral palsy, which makes it extremely

difficult for him to communicate verbally. He had been able to

communicate by designing a handmade board plywood with symbols on it

which serves a rough communication function. He can type very rapidly

into a computer, so he can pursue his university or college studies

with a computer. But his great disability is communicating with

ordinary people in the same way that you and I take for granted.

[ Page

12393 ]

He attended the royal commission and pointed out that a device

costing about $1,000 — maybe a maximum of $3,000 — connected to his

computer could allow him to speak with a human voice — not a strange

voice but actually a normal human voice. He demonstrated that with a

rather inexpensive model — I think a $1,000 model — to the astonishment

of the royal commissioners.

The assistive devices task force had been studying that problem for

two or three years. I believe they t produced a report in 1989 which

received the endorsement of 14 assistant deputy ministers in the

relevant government departments. They proposed a solution to the

communication needs of somewhere around 3,000 such people in B.C.,

which was essentially to establish a non-profit society. It might have

been an extension of the Kinsmen society or the creation of a new

society which would purchase, maintain and recycle communication

devices so that people with this kind of disability could communicate

effectively with their fellow British Columbians.

[Mr. De Jong in the chair.]

The cost of this program was modest. I can't remember off the top of

my head, but it's in the range of $1 million per year, or perhaps $2

million or $3 million maximum. This government actually appointed the

task force and selected good people to be on it. They did their job

well. The assistant deputy ministers responded appropriately to the

task force, but nothing happened. Those people were obliged to take

their case in desperation to the Royal Commission on Health Care

because they were cut adrift, as the member for Boundary-Similkameen

puts it. They were essentially cut adrift and abandoned by government.

These are people who, by the nature of their disability, do not have

the resources to purchase these devices,

I was pretty hard-nosed, Mr. Chairman. I asked them: "If it's so

good, why don't you buy it yourselves, or why don't your family or

friends buy it for you?" Their answer is that people with that kind of

disability are often subsisting on GAIN and have marginal employment.

They literally do not have the resources, and had they the resources,

they would buy such devices as one of their first investments because

the utility is so great.

It baffled me to understand why a government would put so much money

into some extravagant, rather glitzy programs — jet travel and

advertising — and be so incredibly hard-hearted about these people, who

already have such difficulty to face in their daily lives.

I'm asking this question specifically of this minister because he

was minister throughout that period, and he's now got the purse-strings

in his hand. He is the man with whom the buck stops now. He has the

power to tell us that in this appropriation on which we're about to

vote, there will be the funds to proceed with an integrated program to

provide modern communication devices for those British Columbians who

really need them.

Mr. Chairman, I would be absolutely delighted — and I suspect you

and other hon. members would be pleased — if the minister would just

stand up and say yes. That is what I'm hoping to hear from him.

HON. J. JANSEN: Mr. Chairman, it's an excellent question. I

hope he saves it for the Minister of Health, who will announce new

programs either during or subsequent to his estimates. That's really

not germane o the discussion we are having today.

MR. CLARK: Mr. Chairman, I have to advise the House that to

expedite debate, since we're moving along very quickly here, we will

leave until next week the hundreds of questions we have about health

care underfunding, lineups for heart surgery and cancer treatment and

sending our British Columbians to the United States, when we can have a

full debate on the estimates of the Ministry of Health.

However, I'm glad our critic for health care has managed to raise

some of the important questions about the incompetence and inadequacy

of health care n this province under this administration.

I would inform the House, with the government House Leader's

approval, that the first item on the next page of

schedule 2 is the

office of the auditor-general, which we will refrain from debating as

well until the estimates arise.

We will move rapidly to the next

section of this warrant, which is

the office of the ombudsman, for some questions. Then I hope we can

move to the office of the Premier. I advise the members, the staff and

the Premier as to the direction we're moving.

HON. MR. WEISGERBER: Mr. Chairman, just for the information

of the many staff members who are waiting in various locations around

the buildings, I think it would be worthwhile to point out that we will

now go through

schedule 2 as they appear. For those who don't have a

copy of Bill 8, the ministries basically are listed as the ombudsman,

the Premier's office and then the ministries in alphabetical order.

I'm sure members on this side and perhaps some of the senior staff

who have weekend plans would appreciate some indication of how long you

intend to take. But that's something we will leave with you and let you

respond to in any way you see fit. Those in Transportation and

Highways, Tourism, etc. anticipate that some of these will move along a

little quicker than we were able to do with Health. But, Mr. Chairman,

you should be advised that in those few instances where the minister

responsible is not available, the Minister of Finance, assisted by

staff from the appropriate ministry, will be answering questions on

those two or three ministries where the minister is not present.

MR. GABELMANN: I just want to acknowledge to the acting

government House Leader our thanks for his cooperation in respect to

the way this is going. It will unquestionably speed up the process if

we continue in this very good-spirited debate.

[ Page 12394 ]

MR. CASHORE: Mr. Chairman, I'm sure that there is absolute

unanimous agreement on both sides of the House that the ombudsman in

this province does an excellent job. However the number of complaints

coming before an ombudsman is an indication of the state of the

province; it's one of the indicators that can be used, just as we have

indicators of weather or levels of ozone in terms of air quality. One

of the indicators of the quality of the long-term direction of a

government can be in the number of complaints about the carrying out of

public policy by a government and its agencies.

We have, for instance, in the most recent annual report of the

ombudsman a record 14,580 complaints. That was a 12.7 percent increase

in the number of complaints. Since 1986 the number of complaints coming

before the ombudsman has increased by one third. Given this marked

increase in the number of complaints coming before the ombudsman, which

indicates some of the problems we're having with regard to the ship of

state in this province, and recognizing that during the time that we've

had the significant increase in the number of complaints there has been

no increase in the number of full-time employees to deal with these

complaints, has the minister decided to increase the number of

full-time employees in the ombudsman's office to be able to deal with

this incrementally increasing workload?

[4:30]

HON. J. JANSEN: It's quite correct that the number of

complaints has risen substantially; in fact, we have 14,460. I'm not

sure what the difference is — 20 cases. There are two components to

that: cases that are within the jurisdiction of the ombudsman and cases

that fall outside the jurisdiction of the ombudsman. It's interesting

to note that the biggest increase has happened from last year to this

year. The number of cases within the jurisdiction of the ombudsman is

in the order of roughly 400 additional cases — still significant, and

it still puts a strain on their FTE complement. I can't give you the

information, because we're not here to debate estimates. I don't know

what the actual requested staffing was; I can tell you that the

staffing level remains constant.

I hope, though, that this question comes up when we do estimates and

that we can go into the ombudsman's office in more detail, because I

think it is important that we talk about that. It's very important that

the public has access to the office of the ombudsman. If their

resources are too strained and his role is frustrated, then I think

we're not accomplishing what we set out to do and denying the public a

public service. So the FTE complement remains at 38. The additional

staffing required relating to the new responsibilities for children and

youth will be staffed through a secondment from the Ministries of

Social Services and Housing, Solicitor-General and Health. Again, we

can give you more detail on that when we're dealing with the estimates.

MR. CHAIRMAN: Before I recognize the member for Maillardville-Coquitlam,

I would just like to advise all members that arrangements have been made with

the dining-room to remain open until the House adjourns.

MR. CASHORE: Mr. Chairman, I'm not sure that I understood the

last remarks of the Minister of Finance. The minister has said on many

occasions during this, debate that he looks forward to us asking these

wise and intelligent questions a little later on when we are able to

ask them during estimates. Since the minister is advising us to hold

these questions until estimates, what minister will be fielding the

questions?

HON. J. JANSEN: I think traditionally it's the Provincial

Secretary that handles the ombudsman; if not, it will be me, and I

don't have any problem with that. Again, let me be prepared for the

questioning, and I now have your question on notice. If it is me, I'll

respond with the intelligence that the question demands.

MR. CASHORE: I can assure the minister that I've been the

critic for the ombudsman since I came here. These estimates have always

been the second-last estimates to be dealt with, and it has always been

the Minister of Finance. I know in some Legislatures it has dealt with

committees such as the BOIE in terms of a place of reporting. We might

want to address sometime just how to have the ombudsman report to the

Legislature in a manner where there can be an all-party discussion with

regard to our supportive service. My point is that this legitimately

isn't one of the questions where we can say we will wait until we get

to estimates, because it is the same minister.

With regard to the fact that the minister has acknowledged in his

comments that an increasing number of the complaints fall out of the

ombudsman's jurisdiction, what has the minister decided to do with

regard to putting in place an infrastructure to deal with those

complaints that now fall out of the ombudsman's jurisdiction but

nevertheless represent a felt need on the part of British Columbians to

have their complaints dealt with? What is the mini