2004 Legislative Session: 5th Session, 37th 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)

WEDNESDAY, MARCH 10, 2004

Afternoon Sitting

Volume 21, Number 12

CONTENTS

Routine Proceedings

Page

Introductions by Members

Tributes

Dennis Alphonse

Hon. G.

Bruce

Speaker's Statement

Rules for questions in question

period

Introduction and First Reading

of Bills

Environmental Management Amendment

Act, 2004 (Bill 13)

Hon. B.

Barisoff

Statements (Standing Order 25 B )

Coalmining in B.C.

W. McMahon

Traffic circle at north end of Lions

Gate Bridge

R. Sultan

Alderson Elementary School

H. Bloy

Oral Questions

Suspension of Liberal MLAs and

membership in government caucus committees

J. MacPhail

Hon. C.

Clark

J. Kwan

Management of Point Ellice House

S. Orr

Hon. M.

Coell

Services for aboriginal youth in

Vancouver

R. Nijjar

Hon. C.

Clark

Policy for volunteers at Mount St.

Joseph Hospital

J. Kwan

Hon. C.

Clark

Committee of Supply

Estimates: Ministry of Health

Services (continued)

J. Reid

Hon. C.

Hansen

G. Hogg

J. Kwan

P. Sahota

K. Johnston

K. Manhas

D. Jarvis

J. Bray

R. Lee

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Agriculture,

Food and Fisheries

Hon. J. van

Dongen

P. Nettleton

J. MacPhail

B. Penner

V. Roddick

R. Masi

D. Jarvis

B. Lekstrom

[ Page 9329 ]

WEDNESDAY, MARCH 10, 2004

The House

met at 2:01 p.m.

Clerk of

the House: Pursuant to standing orders, the House is advised of the

unavoidable absence of Mr. Speaker.

[J. Weisbeck

in the chair.]

Prayers.

Introductions by Members

H. Long:

Today in the galleries I have three friends and constituents from the Sunshine

Coast. I want to introduce in the House today Mr. Cam Reid, the mayor of

Sechelt; Ray Parfitt, the city planner for Sechelt; and another friend, Kevin

Davie, who is the chair of the Sunshine Coast Forest Coalition. I'd like this

House to make them very, very welcome.

[1405]

Hon. C.

Clark: We are joined in the gallery today by Delphine Charmley. Delphine is

a dedicated foster parent in Nanaimo. She is among the thousands of people in

British Columbia who have adopted special needs kids into their homes. She is

one of the reasons our ministry has been so successful in making sure there are

more loving, permanent homes for adoptive children across British Columbia.

Trumper: Today in the House we have three representatives from Scotiabank

who, I might add, I think paid about $500 to have lunch with me. Jack McKinty is

the district vice-president of Vancouver Island. Purdy McDonald is the branch

manager of the main branch in Victoria. Also with them is the manager of the

bank in Port Alberni, Dewayne Parfitt, who was the president of the very

successful B.C. Winter Games just a week ago. Would you please make them very

welcome.

R. Masi:

It's my pleasure today to introduce four outstanding young people whom I had the

pleasure of having lunch with today, along with the member for North

Vancouver–Seymour. These people are: from North Delta, Miss Tina Shaw, Miss

B.C. International; accompanied by her friend Sarah Iman; and from Abbotsford,

Miss Nicole Cichanovich, Miss Fraser Valley; and from South Surrey–White Rock,

Mr. Canada, Darren Storsley. Darren will be representing Canada at the Mr. World

contest to be held in Shanghai in May. Will the House please make all these

young people welcome.

Hon. J.

van Dongen: I am pleased to introduce to the House today four visitors: Dr.

Elmer Stobbe and his wife, Wilma, and also their friends Steve Humar and Millie

Humar. I might just mention that Dr. Stobbe is an agrologist. He taught my

ministerial assistant Blake Lyall all about weed control at the University of

Manitoba in 1974. I ask the House to please make them all welcome.

Tributes

DENNIS ALPHONSE

Hon. G.

Bruce: Today I rise on a sad note. The Cowichan Valley and indeed the

province lost a leader this weekend with the passing of Dennis Alphonse. Dennis

had led the Cowichan tribes as chief for many years. He was credited with

building bridges between the Cowichan tribes and the rest of our community. He

actually helped catapult the Cowichan tribes onto the provincial and federal

political map by co-founding the Union of B.C. Indian Chiefs in 1969 and the

Assembly of First Nations in 1980. I would ask that the House join with me in

offering our thoughts and prayers to the Alphonse family and the Cowichan tribes

and everyone whose lives have been touched by this quiet, gentle leader.

Speaker's Statement

RULES FOR QUESTIONS

IN QUESTION PERIOD

Deputy

Speaker: Hon. members, I have a brief note to read on behalf of the Speaker.

have reviewed the Blues relating to yesterday's oral question period,

and several matters arise which require comment by the Chair. The broad

principle applicable to question period is that for questions to be in order,

the questions must fall within the administrative responsibility of one or

more ministers of the Crown. Superimposed upon that basic principle is that

one minister may answer for another, or indeed no minister is obligated to

answer at any time.

"As

questions related to internal caucus proceedings clearly do not fall within

the administrative responsibility of any minister of the Crown, such questions

are out of order. When, however, caucus procedure impacts upon the spending of

public funds, we have a different set of guidelines. Caucuses have a funding

formula which can be affected by the numbers in any particular caucus. At the

same time, it must be pointed out that those funds are payable under and by

virtue of vote 1, for which no minister of the Crown has a designated

responsibility.

"Indeed,

vote 1 falls squarely under the jurisdiction of the Speaker of the House,

subject to motions of or directions of the Legislative Assembly Management

Committee, which is chaired by Mr. Speaker.

"Under

the longstanding practice of the British Columbia House, the Speaker is not

able to answer questions during question period, nor does he speak in

Committee of the Whole when vote 1 comes before the committee for scrutiny.

Detailed questions in relation to the financial provisions of vote 1 have

traditionally been thoroughly examined by the Legislative Assembly Management

Committee — or its predecessor, the Board of Internal Economy — in that

committee. It should be noted that the Leader of the Opposition is a member of

that committee and that the minutes of that committee are filed in the House

on an annual basis.

[ Page 9330 ]

[1410]

"Any

member of the committee may ask the Speaker to convene a meeting for the

purposes of inquiring into matters relating to vote 1. The Speaker does his

very best to accommodate any such requests. The net result is that during

question period, questions relating to internal caucus matters are not in

order, as they do not fall within the administrative responsibility of any

minister of the Crown.

"Questions

such as the Leader of the Opposition's second question yesterday relating to

financial implications to vote 1 arising from caucus actions are in order, and

while in theory should be directed to the Speaker — who, for the reasons

stated, cannot answer in the House — could be answered with the minister's

consent, taken on notice or directed to the Legislative Assembly Management

Committee."

Introduction and

First Reading of Bills

ENVIRONMENTAL MANAGEMENT

AMENDMENT ACT, 2004

Hon. B.

Barisoff presented a message from Her Honour the Lieutenant-Governor: a bill

intituled Environmental Management Amendment Act, 2004.

Hon. B.

Barisoff: I move the bill be introduced and read for a first time now.

Motion

approved.

Hon. B.

Barisoff: This bill is the second phase of a multi-phase Environmental

Management Act review that started with the enactment of the Environmental

Management Act in the fall of 2003. The interim phase addresses two parts of the

act,

part 2, "Prohibitions and Authorizations," and

part 4,

"Contaminated Site Remediation." Cleaning up contaminated sites means

returning them to productive use in the communities that need them.

Amendments

part 4 will accelerate the redevelopment of contaminated sites, returning

them to productive use and restoring opportunities in communities that need

them. They build on the province's expert advisory panel on contaminated sites

by reducing needless overlap and establishing best practices.

Finally,

these amendments lay the foundation to address other issues such as liability,

dispute resolution, appeals, cost-benefit analysis and phase 3, which the

ministry plans to implement in future legislative sessions.

Amendments

part 2, "Prohibitions and Authorizations," deal specifically with

the code of practice. Codes of practice were introduced as part of the

Environmental Management Act to allow government to focus more effectively on

activities that pose the most significant risk to the environment. These

amendments ensure that the codes operate as intended.

Hon.

Speaker, I move that the bill be placed on the orders of the day for second

reading at the next sitting of the House after today.

Bill 13

introduced, read a first time and ordered to be placed on orders of the day for

second reading at the next sitting of the House after today.

Statements

(Standing Order 25

b) COALMINING IN B.C.

McMahon: I rise today to talk about the importance of mining, particularly

coalmining, in British Columbia. Mining is one of the longest-standing resource

industries in B.C., once the backbone of economic development in the early days

of this province. This is particularly true in the Kootenays.

Unfortunately,

some groups, including the party to which the members opposite belong, don't

want to see this industry revitalized. In particular, they don't want to see

coal used as an energy source, claiming it's a dirty energy. In fact, these

groups would prefer that we say no to coal and, in turn, say no to jobs, no to

families and no to renewed opportunity in this province.

Last week,

on a day marking B.C.'s victory in the Sumas 2 energy plan, the NDP issued a

news release suggesting that the government's energy plan will lead to increased

greenhouse gas emissions and that coal is a poor energy choice.

We're

looking at innovative opportunities of extracting coalbed methane, and we're

supporting 16 green energy projects throughout the province. One of those

projects is taking place in my constituency, the South Cranberry Creek power

project in Revelstoke.

I would

like to set the record straight on coal burning and the coal industry. Coal

energy is affordable and increasingly clean with the advancements in

clean-burning coal technologies. The coal industry has taken a leading role in

funding research that will help decrease emissions, recognizing that a healthy

environment will benefit business in the long run. New research is showing that

it may soon be both possible and economical to use coal as a clean energy source

that will actually produce fewer emissions than burning many clean fuels.

[1415]

The coal

industry has been the largest segment of the mining industry, employing

thousands of British Columbians. Despite what some would like us to do, we

cannot turn our backs on a resource that has the potential to create jobs and

fill our energy needs.

TRAFFIC CIRCLE AT NORTH END

OF LIONS GATE BRIDGE

Sultan: My constituency of West Vancouver–Capilano is gateway to the Sea

to Sky corridor and the magnificent mountains of the 2010 Olympic Games. Olympic

Games visitors will leave beautiful downtown

[ Page 9331 ]

Vancouver, glide past the manicured rose gardens of Stanley Park, across the

beautifully renovated Lions Gate Bridge and hit the wild-west thicket of

tumbling tumbleweed at the north-end traffic circle. The unkempt, uncut,

dandelion-infested traffic circle at the north end of the Lions Gate Bridge

reminds one of that neighbour who spends more time looking after his grow op

than his front lawn. Good grief. Is this the proud face of North and West

Vancouver?

Rotary to

the rescue. After enduring this horticultural scandal for too many months,

president Kevin Conway of the West Vancouver Rotary Club and president William

Randall Fowle of the North Vancouver Rotary Club proposed that their

organization join forces to improve, beautify and maintain the traffic circle.

The Minister of Transportation quickly agreed. Installing a small Rotary sign

will be a modest price indeed.

Rotary

clubs are famous for global philanthropy, for vaccinating hundreds of thousands

of children in Third World countries, for building homes for the dispossessed

and for uplifting civic life everywhere. These folks take their organization

seriously. Don't show up for three meetings, and you're in big trouble.

Thank you,

Rotarians. It is wonderful that you've taken time from your humanitarian efforts

around the world to devote a little bit of time to restoring beauty to our

communities right here at home.

ALDERSON ELEMENTARY SCHOOL

H. Bloy:

I rise today to talk about great news coming from a new school in my riding.

Alderson Elementary School recently held its grand reopening. This new school

was built on the site of the original French immersion program in British

Columbia.

This new

school was built for a cost of $3.7 million and opened to 167 students. The

school was built to house 240 students. At the ceremony that evening that I

attended, I advised all the parents there that our Minister of Education was

doing his bit to fill up schools, having just given birth to their third child.

I did challenge the parents. I challenged all British Columbians to keep our

educational system full.

What a

great evening we had. The community gathered in the gym. Students were there

with specially designed T-shirts, along with their parents. Teachers, past and

present, and neighbourhood residents came for the reopening of this new school.

The festivities were started with four students acting as emcees for the

evening: Dylan Wasney, Joey Smith, Diana Negrabee and Jeremy Lohier. The whole

student body provided entertainment for the evening, and they gave tours of the

school. Their principal, Ms. Louise Wunderlich…. You could just see the smiles

on the children's faces and the excitement in their eyes and the dedication to

her teaching and directing the school. It was a great evening. Melissa Hyndes,

who is chairman of the school district, and I unveiled the plaque to open this

new school. Education is alive and well in this province.

Oral Questions

SUSPENSION OF LIBERAL MLAS

AND MEMBERSHIP IN

GOVERNMENT CAUCUS COMMITTEES

MacPhail: I want to put the Premier's new-era election promise of openness

and accountability to the test. Government MLAs not only sit in caucus, but they

also sit on government caucus committees, which the Premier has said over and

over again are a key part of government policy-making. The Premier makes the

appointments to these committees. We know from estimates debate that the

committees are staffed by public servants, and the expenses — other than the

chair — are paid out of the consolidated revenue fund.

In fact,

the Premier's own website highlights the participation of MLAs on these

committees. Presumably, any government MLA suspended from caucus would also be

suspended from any government caucus committee he or she sits on.

[1420]

Has the

member for Burnaby-Willingdon ever been suspended from his caucus and the

Government Caucus Committee on Education? If so, what was he suspended for? To

the Deputy Premier.

Hon. C.

Clark: The member is trying to get at questions about matters that occur in

caucus. If she had a caucus, I'm sure she wouldn't want to share information

that goes on there either. It isn't appropriate for the floor of the House. As

you said earlier, Mr. Speaker, if she has questions about the financing of

caucus, she is entirely at liberty to use her right as a member of the

Legislative Assembly Management Committee to call a meeting of that committee

and raise some of the questions she has raised here.

Deputy

Speaker: Leader of the Opposition with a supplemental question.

MacPhail: While government caucus committees were controversial in that the

chair was paid out of vote 1, the government caucus committees are paid out of

ministers' budgets, and they're staffed by public servants. The Deputy Premier

is pretty much out of touch. British Columbians have a right to an answer. The

opposition has been told that the member for Burnaby-Willingdon was suspended

for financial improprieties related to an overseas trip. I am simply asking the

Deputy Premier if this is true. I'm not asking the Deputy Premier to divulge

confidential caucus discussions. I simply want a straightforward answer to a

legitimate question.

Again, is

it true that the member for Burnaby-Willingdon was suspended from caucus and

from the government caucus committee on which he sits?

Hon. C.

Clark: Mr. Speaker, this member is very clearly trying to raise a matter

which she knows is a confidential matter of caucus. She's trying to raise it on

[ Page 9332 ]

the floor of this House, despite your earlier ruling. I think what she is

trying to do is raise something she very clearly should know — if she doesn't

know — is out of order.

Deputy

Speaker: Leader of the Opposition with a further supplemental.

MacPhail: It was the government Whip that opened this can of worms the other

day when he confirmed that other Liberal MLAs have been suspended from caucus

with no public notification or explanation. The Deputy Premier may not want to

answer the questions. She may want to hide behind the ridiculously secretive

rules her government caucus operates on, unlike any other caucus. But by

stonewalling the public, she is seriously undermining the credibility…

Interjections.

Deputy

Speaker: Order, members. Let's hear the question.

MacPhail: …of this government with the public. We're not asking her to

reveal the content of internal caucus discussions. Caucus has a right to assume

that those debates are kept private. We are simply asking her: if caucus members

have been suspended from having a role in caucus and in the development of

government policy through government caucus committees, what charges were they

dismissed on? Why won't the Deputy Premier live up to the campaign promise of

her government and give British Columbians the answer?

Hon. C.

Clark: Mr. Speaker, she says she isn't asking me to divulge things that have

gone on in caucus that are subjects of confidentiality, but that is exactly what

she is attempting to ask me to do. She does have other avenues to seek that

information. As you pointed out, she is a member of the Legislative Assembly

Management Committee. As a member of that, she has a right to be able to call

those meetings and have those discussions in that venue if that's what she

chooses to do.

J. Kwan:

The Premier has said over and over again how important the role of the

government caucus is in developing government policy. The government, the

Premier, had extended that by creating these government caucus committees. The

government caucus committees are funded by taxpayers. They are staffed by

ministry staff.

[1425]

The Deputy

Premier can't have it both ways. British Columbians have a right to know if the

behaviour of their MLA meets the test of the public's confidence. Obviously, the

Deputy Premier believes that constituents who elect a B.C. Liberal MLA don't

have the right to know if they are being represented by a B.C. Liberal MLA. Why

is the Deputy Premier denying British Columbians their democratic right to know

who sits in government caucus committees — who is part of the government

caucus and who is not, and who has been suspended from government caucus

committees?

Hon. C.

Clark: Since our government took office, we have done a number of things

that I think made British Columbia a leader in transparency. We now have fixed

election dates. We are the first jurisdiction in the country to do that. We also

have a system of free votes where members are allowed to express their views on

any number of issues.

We also, I

think most importantly, have created the Citizens' Assembly — the first of its

kind in this country — where a group of citizens who are randomly selected

like a jury will be able to go out and talk about what kind of electoral process

they would like to see operate in British Columbia. It is the first time any

government in our country has stepped forward and said that although we

recognize the system works for some of us, it may not work for everyone. We want

to make sure that citizens of British Columbia have a real say in reshaping

democracy and that British Columbia leads the world.

Deputy

Speaker: The member for Vancouver–Mount Pleasant with a supplemental.

J. Kwan:

The government promised openness and accountability. It's the first time that

this Premier, that this government….

Interjections.

Deputy

Speaker: Order, please. Let's hear the question.

J. Kwan:

It's the first time that government created government caucus committees, funded

out of ministry budgets and staffed by ministry public servants. Sooner or later

the truth has a way of being reviewed, so I'll give the Deputy Premier another

chance to come clean before — and not after — we discover who it is that has

been suspended from caucus.

Can the

Deputy Premier tell British Columbians what Liberal MLAs have been secretly

suspended from government caucus committees and from the government's caucus,

and what they were suspended for? Why is the Deputy Premier trying to hide this

information?

Hon. C.

Clark: Mr. Speaker, I've attempted to answer that question a number of

times, the exact same question that has been asked. You made a ruling at the

beginning of this question period that the kinds of questions she is looking for

answers to are not in order in this House, but having said that, I will

reiterate this.

This

government has everything to be proud of in our record in openness and

transparency. We have everything to be proud of in inviting citizens to be part

of reforming our democratic process. We have every-

[ Page 9333 ]

thing to be proud of when we say members who are elected, whether they're on

the government side of the House or the opposition side of the House, have a

right to air their views. They have a right to represent their constituents.

They have a right to vote freely.

We have

everything to be proud of when we made those changes. We have everything to be

proud of when we have changed our government from the bad old days — from the

decade of the NDP, where we saw a government reeling from fast ferries and

scandal after scandal, a government that was reduced to two seats in parliament

— but nonetheless, a government that's prepared to say we want to change our

electoral process to make it one that is absolutely reflective of the wills and

wishes of the citizens of our province….

MANAGEMENT OF POINT ELLICE HOUSE

S. Orr:

In my riding of Victoria-Hillside we have very few heritage properties, so what

we have are precious to us. One such property is Point Ellice House. Last spring

this heritage site went through an RFP process to find a partner to handle the

day-to-day management but failed to reach an agreement with a proponent. Almost

a year has gone by, and many of my constituents are worried, as am I, that this

heritage home will no longer be open to the public. That would be a travesty.

Can the minister please tell me what is being done to guarantee the continued

operation of Point Ellice House?

[1430]

Hon. M.

Coell: As the member knows, Point Ellice House is the final capital region

heritage site to go through the devolution process to a community-based

organization. It has been a lengthy period of time. We actually, in the last few

days, have found a partner that we're very proud of.

The Capital

Mental Health Association, which the member may be associated with or know of,

is going to be the community-based partner for Point Ellice House, and they're

going to have a unique operation. They're going to hire professional staff.

They're going to have qualified contractors to do the day-to-day operations. But

added to that, their clients are going to become part of the day-to-day

operations, so they'll see some on-the-job training. It's really a win-win for

Point Ellice House, for the government, for the devolution process and also for

people with mental illness in the capital region, who have another opportunity

for volunteerism and for job training and placement.

SERVICES FOR ABORIGINAL

YOUTH IN VANCOUVER

Nijjar: My question is to the Minister of Children and Family Development.

Children who are victims of physical and sexual abuse and exploitation need a

safe place to go to be kids. The Urban Native Youth Association claims that it

provides the only facility to shelter sexually exploited youth under the age of

16 and that they are being forced to close. What is the ministry doing to

protect and provide refuge to children who need a place to go?

Hon. C.

Clark: First of all, the accusation that the member repeated isn't true.

There are lots of safe beds for kids in Vancouver, and there will continue to

be. We want to make sure those are available for them. What we're talking about

here is a lot of kids between the ages of 12 and 14, and some as old as 16.

There are emergency shelter beds that are available for those kids that are in

families, where those children will be safe and supported.

We want to

make sure that families are preserved as much as we possibly can, but when kids

aren't able to stay safely in their families, what we want to do is try and find

safe places in families for them in their communities. In Vancouver what we did

is that we went through a discussion-consultation project with the community…

Interjection.

Deputy

Speaker: Order, please.

Hon. C.

Clark: …and with the first nations and aboriginal communities as well. We

agreed with the focus on family preservation, and we're actually adding $400,000

to the budget for servicing the needs of aboriginal kids in Vancouver as a

result of that consultation.

POLICY FOR VOLUNTEERS AT

MOUNT ST. JOSEPH HOSPITAL

J. Kwan:

The Premier has fired the former minister of state for multiculturalism. There's

been no new appointment to date. I think that is a statement about how this

government values multiculturalism.

Mount St.

Joseph Hospital is a hospital designed to serve the multicultural community. The

volunteer policy at Mount St. Joseph Hospital has been changed under this

government's leadership. The new policy dictates that if you do not speak

helping seniors keep active. To the Deputy Premier: how does this new policy

help promote multiculturalism, and how does that serve seniors in British

Columbia?

Hon. C.

Clark: Our government is committed to making sure that the needs of

seniors…

Interjections.

Deputy

Speaker: Order, please.

Interjections.

Deputy

Speaker: Order, please. Let's hear the answer.

[ Page 9334 ]

Hon. C.

Clark: …and the needs of multicultural communities in British Columbia are

respected and met. Our government represents a broad breadth of people from

across British Columbia…

Interjections.

Deputy

Speaker: Order, please.

Hon. C.

Clark: …from backgrounds around the world and from different languages and

different cultures. Our caucus is, I think, one of the most broadly

representative caucuses that British Columbia has ever elected to its

Legislature, and we have everything to be proud of in that.

I'm

delighted to be able to represent a community where a large number of people

come from places outside of Canada. I think that's true of many people in this

House, and our government is going to continue to make sure British Columbia

benefits from all of the enrichment that people from beyond our shores bring to

this province and this country.

[1435]

[End of question period.]

Orders of the Day

Hon. G.

Plant: I call Committee of Supply. For the information of members, we'll be

debating the Ministry of Health Services estimates in this House and, in the

other House, the estimates of the Ministry of Agriculture, Food and Fisheries.

Committee of Supply

The

House in Committee of Supply B; H. Long in the chair.

The

committee met at 2:38 p.m.

ESTIMATES: MINISTRY OF

HEALTH SERVICES

(continued)

On vote 25:

ministry operations, $10,404,260,000 (continued) .

J. Reid:

My question is with regard to chelation therapy. I know that the minister and I

have had some discussions around this. The concern is partly with the cost

savings that potentially could be realized through alternate forms of medicine.

[1440]

I think we

have an understanding that at this point in time, in trying to manage the costs

of the health care system, this isn't a good time to try and introduce more

treatments. At the same time, we recognize that alternative forms of treatment

can be beneficial not only for savings to the health care system but also for

the health benefits of people who are interested in using alternative forms of

therapy.

personally believe there are savings possible to accrue in that way, but I

understand from the doctors who are practising chelation therapy that they still

feel a certain threat to their ability to practise without being imperilled in

some way. In believing there is a savings, since I believe there is a savings to

the system, my question is whether those doctors indeed have some ability to be

protected against any repercussions by practising chelation therapy, and in what

way. If so, should we be encouraging the use of alternative therapies to save

dollars within the medical system?

Hon. C.

Hansen: As the member will recall, there was legislation we passed in this

chamber — I believe it was in 2001 — that made it very explicit that the

College of Physicians and Surgeons could not undertake an investigation of the

practices of a physician solely because they were practising some form of

alternative therapy. I think that does give the physicians who are looking at

practising alternative therapies the protection they need. Certainly, it is an

initiative that was supported by the college as well. I think it does provide

the kind of protection that many of these physicians are looking for.

G. Hogg:

There has been some discussion with respect to scopes of practice regarding

opticians and optometrists. I know there is a process in place that is leading

us to some type of resolution with that. There was some discussion within the

field regarding some type of spectrograph that does the analysis of sight and

then some issues where prescriptions were being sent out of province to be

filled.

Can the

minister tell us what process we have outlined in terms of bringing those issues

to resolution regarding the refractory machines and the issues around that? What

process have we put in place with respect to consultation and coming to some

type of resolution?

Hon. C.

Hansen: This has been a very interesting file because it involves brand-new

technology that has been developed. Our role as a ministry is to look after the

interests of the patient and to put patient safety as the top priority. There

are obviously all kinds of new technologies that get introduced to the health

care system, and we have to make sure that there are at least processes in place

to ensure that patient safety is put at the top of the agenda.

With regard

to this particular technology the member refers to, there have been extensive

consultations involving opticians, optometrists and ophthalmologists. There have

been volumes and volumes of inputs that we have received. We still have not come

to any conclusions as a result of those consultations, but we are reviewing

that. We hope it will lead to appropriate

definitions of scope of practice and

procedures that should be followed by these various health care professionals

with regard to this new technology.

[ Page 9335 ]

[1445]

J. Kwan:

I'd like to pick up from where my colleague the member for Vancouver-Hastings,

the House Leader for the opposition, left off with the Health estimates. The

area I'm going to start canvassing with the minister is around dental services

— cuts particularly.

I have

before me a newsletter dated October 2003 from the Association of Dental

Surgeons of British Columbia. Let me just put a couple of the quotes from this

document on the record. Then we'll begin questions with the minister in this

area. The newsletter reads:

"Waits

to Significantly Increase for Dental Surgery at Children's Hospital.

"With

wait-lists currently at four to six months for dental surgery, B.C.'s

Children's Hospital has announced plans to cut one of two operating room

dental chairs in November, increasing wait times to over a year."

It goes on

to read:

"More

than 2,500 families affected by the chair closures sent letters of concern to

the Minister of Health and BCCH in the spring. Following this, BCCH agreed to

meet with the ADSBC — the Association of Dental Surgeons of British Columbia

— to develop criteria for admission to the hospital for treatment under

general anaesthesia, in addition to discussing access to care alternatives for

children no longer meeting their criteria."

Then the

article goes on to advise that "dentists donate $250,000 worth of free

treatment. Participating dentists around the province provide more than $250,000

worth of free dental treatment during Community Dental Day on April 29."

Let me just

stop there and ask the minister the questions in terms of the cuts impacting

dental services to children. Could the minister respond to the association's

newsletter, particularly with respect to the increase and its impact on

children's dental services?

Hon. C.

Hansen: This initiative has been designed to identify what the most

appropriate venue is for a particular procedure to take place. I think in the

discussions we had with the member for Vancouver-Hastings yesterday or perhaps

the day before, we talked about the move generally across the health care system

to make sure that our operating rooms are used in the most appropriate way.

[1450]

In other

words, procedures that need to be done in an operating room should be done in

the operating room. If procedures can be done in other clinical settings, then

our goal is to try to find the most appropriate clinical settings. What they

were able to determine after extensive evaluation is that the number of

procedures that were being done in operating rooms on children for dental

surgery…. We did not need to do the number of surgeries in the operating rooms

that were being done, and many of them could be more appropriately done in other

clinical environments.

Part of

this initiative is to make sure that these dental surgery procedures are being

done in the most appropriate environment. In some cases that means that instead

of the operating room, it's being done in other independent facilities.

J. Kwan:

If that were the case, then in theory the wait-lists should not go up. However,

as identified by the Association of Dental Surgeons of British Columbia,

wait-lists are going up, and the wait times are increasing to as long as a year.

If the theory the minister puts forward rings true, then wait times and

wait-lists should not be going up, but they are. What that means is there is

demand for this service, and the government is cutting the service in any event.

This is at Children's Hospital.

I know of

another situation, in fact. My community office is on 1st and Commercial Drive.

It so happens that right upstairs is a health clinic. I've never actually known

the real name of that clinic. It's just right upstairs. I think it's called the

north health clinic. Right upstairs, the dental services for children, their

staffing has been reduced as well. I spoke with the staff upstairs in terms of

their concern, particularly in our community, where a lot of the children don't

have access to other dental services. They talked about wait-lists as well.

The

minister's answer actually can't ring true in terms of the reality here and what

the experts in the field are saying.

Hon. C.

Hansen: I'll read out a portion from this briefing note, which may help the

member. In June of 2003 there was a task force established. It was jointly

established with the Association of Dental Surgeons of B.C., Children's Hospital

and the Ministry of Health Services. The task force has agreed upon admission

criteria for the dental surgery services at Children's Hospital. What this means

is that children aged four and under, who have other health problems that might

complicate the procedure or anaesthetic, will continue to receive dental surgery

at Children's Hospital. This is in keeping with Children's Hospital's role as a

hospital providing tertiary and specialized care for the children of B.C.

[J. Weisbeck

in the chair.]

J. Kwan:

The minister has just put on record the changed criteria for who is eligible to

access dental surgery through Children's Hospital. With that knowledge in mind,

the Association of Dental Surgeons of British Columbia put out this press

release, which reads: "B.C.'s Children's Hospital Cuts Care for Dental

Surgery. Over one-year delay for treatment; care denied for others."

decision by B.C.'s Children's Hospital to close one of two dental operating

chairs November 1 will translate into hospital waits over one year for children

suffering from oral pain and infection, according to the Association of Dental

Surgeons of British Columbia. The association also warns that children who do

not meet new criteria may find themselves without alternatives for care.

[1455]

"Approximately

1,800 children are currently seen each year at Children's Hospital for dental

treatment

[ Page 9336 ]

under general anaesthesia, with wait times of between four and six months.

The ADSBC says that one dental OR chair must now serve an estimated 1,100 to

1,300 children who meet newly established criteria" — which, by the by,

are the criteria the minister just put on record. "These are children with

weight and age considerations, identified co-morbidities or who are eligible for

MSP-covered dental treatment."

Then it

goes on to say that while private facilities may be able to accommodate some of

these children, the facility fees — ranging from $400 to $600 — make this

option unviable for low-income families — the population segment most likely

to suffer from poor dental health. The dental association is advocating for a

public-private partnership where the Health ministry pays the facility fee for

the displaced children in private clinics.

I can

accept to a certain extent that some of the children who may be on this

wait-list could go elsewhere, but I would not accept that all the children on

this wait-list could go somewhere else. Nor do I accept the answer that the

minister had given — that the new criteria changed and therefore, in theory,

the logic follows that the reduction in dental chairs is necessitated because

the demand is not there.

If that

were the case, then the number of kids and the wait times for kids waiting for

dental surgery would also reduce. If it were the case that other options were

available — private institutions or whatever the case may be — the wait

times would also reduce the situation. The wait-lists would also be reduced.

That is not reality. The minister's answers do not address the concerns that

have been raised by the Association of Dental Surgeons of British Columbia.

I would ask

the minister to offer another answer that actually addresses the concern or,

alternatively, offer to look into the budgeting situation there — I presume it

is an issue around budgets, because oftentimes that's what drives the issues —

and actually commit to ensuring that there is adequate budget to meet this great

demand.

I can tell

you, as well, that I'm lucky, actually. I'm very lucky, because I have

relatively good teeth. They're relatively straight, although my husband every

now and again tells me the bottom one is kind of crooked. He starts to blame me

when…. Our daughter's little teeth are starting to sprout out, and they're a

little bit like this. He says: "That's you, not me. That's you." But,

you know, that's my husband.

I can tell

you that the importance of teeth affects a person's confidence very much so. In

fact, in the long term for people in terms of job opportunities…. In the

downtown east side community I know there are a lot of people trying to get

basic, entry-level jobs. They oftentimes meet all of the requirements until they

smile. Their teeth are less than perfect or less than adequate, I suppose, in

some ways in terms of the presentation that the employer would like. That's

caused problems for people's employability. A study has been done on that front

as well, especially in the tourism trade, where those kinds of skill sets, if

you will, and health-related matters are very important.

If the

minister can't adequately address the reasons why the dental chairs are being

reduced because there's lack of demand for it, then I would ask that he commit

to ensuring that there is enough funding to accommodate the demands. We need to

address this issue early on in age, as it has a lifelong effect for people in

the future.

[1500]

Hon. C.

Hansen: I think the comments that the member just made sort of reinforce the

comments I made earlier around the appropriate use of operating rooms. There are

certain dental procedures that are covered under the Canada Health Act, which

are considered medically necessary and require surgery to be done in an

operating room under a general anaesthetic. Part of this change that is taking

place is making sure our operating rooms are being used for dental surgery that

is medically necessary under the Canada Health Act and does require an operating

room environment.

appreciate very much the comments the member is making about the challenges

low-income families have to get access to dental care so they can have straight

teeth and a smile they're proud of, but those are issues that I think go far

beyond the issues specific to the Ministry of Health Services.

Obviously,

the Ministry of Human Resources has programs to provide assistance for dental

services, and there may be other ministries that are involved as well. When we

talk about the obligations of the Ministry of Health Services when it comes to

dental programs, we are talking about services that are required under the

Canada Health Act. Those surgeries would have to take place in an operating room

or in a hospital environment and would be considered medically necessary

according to the Canada Health Act.

J. Kwan:

In fact, the Ministry of Human Resources, for adults particularly…. I'm not

talking about children. The process for a person to get dental service is

unbelievable. You literally have to be dying from tooth decay or infection or

some horrible thing, and even then you might not be able to get the dental

service you require. I cannot underscore how difficult the process is for people

to get dental service.

That's from

direct experience in my former life as an advocate and in my current life as an

MLA with constituents who continuously have these problems. I'm not raising that

matter with this minister at this point. I'm raising the matter related to

children and the notion of dental surgery.

The

minister suggests that because of new guidelines and criteria that have been

set, only people who actually need those surgeries should then be referred to

the hospital for these procedures. As I said, the logic would follow that if a

substantive number of people don't need the surgery, then the wait times as well

as the wait-lists…. The numbers and the people should go down, but they're

not. What the Association of Dental Surgeons of British Columbia is saying is

that the wait

[ Page 9337 ]

times have gone up — in fact, gone up by double, to over a year from six

months.

It doesn't

make sense, in my view, to reduce the dental surgeon services at Children's

Hospital. If the demand is down, then in theory one would be able to process and

deal with these surgeries more quickly, but that is not so.

Having set

that aside, while I appreciate the notion that only the people who require

dental surgery should go to the hospital to get dental surgery, I don't believe

that all of the people who are being denied under these new criteria are people

who don't need it. It has been highlighted by the Association of Dental Surgeons

that because of the facility fees, which are as much as $400 to $600, for the

people who are referred elsewhere…. This also would make it not viable for

low-income families, because they can't afford it.

They're

asking the government to engage in a partnership with them to pay for the

facility fees for these displaced children — for the people who no longer

qualify to go to Children's Hospital for their dental surgery. Will the minister

commit to looking into this issue and engaging in a discussion with the

Association of Dental Surgeons of British Columbia about that?

[1505]

Hon. C.

Hansen: The task force I referred to earlier that was struck in June of last

year, it's my understanding, completed its work around the standards and the

access policy just within the last few months. I haven't got exactly the date

they completed their work. It may have been after that letter she read. But now

that we have had a few months of experience under this new access policy, I

think the member's suggestion is a very good one. I will undertake to make sure

officials in my ministry follow up with the association and with Children's

Hospital to make sure those access standards are appropriate. If not, we'll look

at changing them.

J. Kwan:

Thank you to the minister for that commitment. I very much appreciate it.

Okay, then.

Let's move on to the next issue. The Canadian Society of Intestinal Research

sent me a letter. It's dated October 2003. As the minister can appreciate, some

of these letters are a little bit old because people have sent the letters in

anticipation that we would be in the House in the spring. These are the issues

they have raised with me. The letter reads:

"'The

B.C. Pharmacare Cutting Patients First': a provocative headline, a provocative

new health policy. The effort to save money is a necessary one. No one

disagrees. However, simply cutting patients off their medications 'to save

money' is both cruel and dangerous. It is called therapeutic substitution. It

is about forcing patients to switch to cheaper medications or pay the entire

cost of treatment themselves. Patients are being harmed. The evidence is seen

daily in doctors' offices in the form of diarrhea, vomiting, persistent

coughing and gastric bleeding. These are the insidious side effects that are

happening when patients are forced to switch from medication that had

stabilized their health condition to a cheaper version."

It goes on

to say how people are paying a higher price for cutting costs, etc.

I want to

turn to the document they sent to me with the letter. It's a document entitled

The Inside Tract , a bimonthly newsletter published by the Canadian Society

of Intestinal Research. There is an

article in it, and some of the highlighted

areas I want to put on the record and canvass with the minister. It reads:

"Instead

of improving the chances for sick people to conquer illness, B.C. Pharmacare

is making it more difficult for them to get the medications they need. It's

called therapeutic substitution, and 50,000 British Columbians covered by

Pharmacare who suffer severe stomach ailments are learning firsthand just how

hard-nosed the government can be when it comes to cutting costs.

"One

highly effective class of medications is called proton pump inhibitors, PPIs.

Until recently doctors could choose for their patients any of the five drugs

in the PPI class, and Pharmacare covered the costs. That all changed on

January 15. Now Pharmacare will only pay for the cheapest one. Patients on any

one of these other four in the class now have to pay the entire costs of those

medications themselves. To make matters worse, the costs they incur are not

deductible under Fair Pharmacare."

I'd like

the minister to address this issue. I understand the whole thrust of trying to

use the cheapest medication where it does not have side effects, where it does

not negatively impact the patient. I certainly support that. But in the case

where it does have negative impacts — and it's for the doctors to decide what

those impacts are — the doctor should be able to choose for their patient the

medication that does not have the impacts. If they choose the medication that

happens to not be the cheapest one or if they deem that medication is needed for

their patient, then that medication should be covered. As the situation is now,

they're not covered. I would like the minister's response on that.

Hon. C.

Hansen: The member does leave me a little bit confused, because my

understanding is that she is a very big supporter of the reference drug program

that we have. The whole principle around therapeutic substitution still leaves

more latitude to physicians than the reference drug program does. I am a little

bit confused in terms of where the member is coming from — from a

philosophical perspective or a broader policy perspective.

[1510]

Having said

that, let me address the issue around the proton pump inhibitors. The most

common drug used in this class is one that is over 20 years old. Often when we

have new medications that come out, they're usually newer but are also more

expensive. What happened in this case is that a new product called Pariet came

out, and that new drug is actually less expensive than some of the other

medications that have been around for a longer period of time.

I guess the

one thing that's important to underscore is that there is absolutely no evidence

that shows that Pariet is less effective than any of the other proton pump

inhibitors that are available on the market. What

[ Page 9338 ]

we said to physicians in the province is that they can prescribe whatever

they want. You know, as long as a medication is approved by Health Canada, they

can prescribe it, and their patients can buy it at pharmacies in British

Columbia. The question comes back to: what is it that the Pharmacare program

should pay for?

What we

have said is that because the evidence shows that Pariet is no less effective

than any of these other medications but is about 40 percent less expensive, we

will put that as a first line. Patients need to be able, first of all, to try

other procedures — H2 antagonists, as I think they are referred to. Then if

they cannot manage their GERD, gastroesophageal reflux, if they're not able to

manage that condition with the H2 antagonist, they can prescribe one of the

PPIs.

What we

have said is that the PPI that should be tried first by the physician, if they

want Pharmacare to pay for it, should be Pariet, and if that doesn't work for

any reason…. Like, we know there is a very small percentage of patients that

do have reactions to the chemical makeup of any one of the five proton pump

inhibitors. Doctors will often try one and, if the patient has any kind of

intolerance to that, then will try a different one. The patient may have a

better success on a different one.

If for any

reason a patient is one of that small minority that may have an intolerance to

Pariet, then yes, the physician can then prescribe any one of the remaining four

more expensive PPIs available. In addition to that, we also gave the authority

to the gastroenterologists in the province that if they had a patient who had

been stabilized on one of the older medications, they could authorize that

patient to stay on that older medication and not have to try Pariet if they had

the possibility of any kind of complications from just shifting from one to

another.

This has

been, I think, a very good approach. We've been able to provide a newer

medication to British Columbians. We have been able to cover that under

Pharmacare, and we've been able to do it in a way that reduces the cost to the

Pharmacare budget and, therefore, frees up that budget for other cost pressures.

At the same time, if there is any particular need that can be demonstrated that

a patient needs one of the other four products, then the physician is free to

prescribe those once they've been able to demonstrate that Pariet is not

effective for any particular patient.

J. Kwan:

The minister's answer differs slightly from the information contained here,

which is the issue. I want to be very clear and be on the record that I do

support the reference-based drug policy. It was started under the previous NDP

government, and I do support it very much. But the former policy…. Well, maybe

it still is the policy. It sounds like it might well be still the policy. That

is that where patients are impacted negatively with a cheaper drug and that is a

determination made by the doctor, the doctor can…. And I have helped,

previously, constituents go to Pharmacare and get, through Pharmacare processes,

the other drug authorized, paid for and covered under Pharmacare under the

previous administration.

So you're

not stuck. You know, you are not just made to take the cheaper form, even though

it is negative for you. Even though it has negative consequences for you and the

doctor says no, this shouldn't be and you should use some other drug, that's

covered. But from the way it sounds, it sounded to me like the situation here is

that a drug is not covered under the Fair Pharmacare.

[1515]

If that's

not the case, then it is important to note that if the doctor deems for the

particular patient negative consequences on the reference-based drug — in this

instance around proton pump inhibitors — then the doctor can write another

prescription for another drug to negate the negative impact, and that would be

covered by Pharmacare. If that's the case, then great, because the other

information that goes on in the document here reads that the policy is unique in

Canada. No other province in the country forces patients who are stabilized on

one medication to switch to a cheaper medication regardless of serious health

consequences that can result.

What I

think I just heard the minister say is that no — and particularly for patients

that have been a long time on a particular drug — you would not force them to

switch to another medication if the doctor, through the doctor's evaluation,

says that by doing that it would cause this person negative health consequences.

If I understand, that is the government's policy, and that is how it is being

applied, and when there is a switch it is paid for by Pharmacare. Then I'm

satisfied with this. So let me just get that clarification.

Hon. C.

Hansen: I'm glad for the opportunity to clarify this. What we are saying is

that the gastroenterologists who are caring for those patients who have the most

complex conditions in terms of gastroesophageal reflux — GERD — have the

ability to grandfather those patients that have been stabilized under one of the

other medications.

If a

patient is on a proton pump inhibitor as a result of a GP's prescription, then

they would have to…. They could continue on whatever they were on, but it

would not be covered by Pharmacare unless they try this new proton pump

inhibitor called Pariet. If the patient shows any kind of intolerance to Pariet,

then the physician can get a special authorization for that patient to be put on

any one of the other four.

Some

people, for example, will be familiar with a medication called Nexium, and

Nexium we were able to approve at the same time, but it was never listed until

we made this change. Now it is listed not as a first-line proton pump inhibitor,

but as a second-line. So if a patient shows any kind of intolerance to the

Pariet, then yes, the doctor can apply for a special authority to put their

patient on any one of the other four proton pump inhibitors, and it would be

covered by Pharmacare.

J. Kwan:

Okay. That's good clarification, because I think it is important that if the

doctor deems a particu-

[ Page 9339 ]

lar medication has ill effects on their patient, they should be able to

prescribe another, and that should be covered by Pharmacare. I'm glad to hear

that.

Okay, let

me move to another issue. This is an issue related to…. Oh, actually, sorry.

Let me just ask this issue. I almost forgot.

I just got

this faxed to me from my constituency office, and it is from a constituent. I

had written a letter, by the way, to the minister on March 5 regarding this

situation. This is regarding somebody by the name of Penelope Antonio Estaccio,

who is appealing the MSP plan. Here is the situation with this particular

person. The minister might not have read my letter, actually, that I wrote to

him because it was rather recent. Let me put the situation with this person on

the record.

[1520]

The letter

reads as follows:

"I'm

Penelope Estaccio, a live-in caregiver from the Philippines. I arrived in

Canada on July 6, 2003. Within a week of my arrival I enrolled in the Medical

Services Plan of B.C. The benefits coverage started on October 1, 2003. I was

diagnosed with colon cancer on September 26, 2003, and underwent surgery on

the same day. I was admitted to Vancouver General Hospital. I'm presently

undergoing chemotherapy treatment at the B.C. Cancer Agency.

"The

bill for the surgery and other expenses from September 26 to 30, 2003,

amounted to $8,764.13. Much as I desire to pay this bill, I'm unable to do so.

I'm out of work, in pain, suffering from my illness and uncertain about my

future.

"Through

donations from my church and the Filipino community, I was able to gradually

pay part of my bill, and the balance is now at $7,003.16. I have no way of

paying for this enormous bill. It is for this reason that I contacted West

Coast Domestic Workers Association. I understand that they are appealing for

my benefits coverage to start on September 26, 2003, so that the balance of my

hospital bill would be paid for by MSP of B.C.

"It

will be a tremendous relief for me when my hospital bill will be resolved. I

can then concentrate on getting my strength back to fight this illness.

came to Canada with the hope that I can provide financial assistance to my

parents through my income as a nanny. Instead, I'm now worrying how to pay my

enormous hospital bill and struggling to cope with my illness. "I do not

have any relatives in Canada to care for me, so my mother had to come here

under a special permit from Citizenship and Immigration Canada. Fortunately,

she was able to ensure donations to pay for her fare. "Despite the

generous help we have been receiving, my family continues to be burdened with

this unexpected strain on our limited financial resources. I'm humbly

appealing for your benevolent support. With great hope, I am relying on your

favour to grant this appeal.

"May

God richly bless you."

This was a letter written to the appeals department of MSP. My information is

that this woman actually just missed the qualification for MSP by one week.

understand that there are rules and things established, but in this situation I

would ask the minister to please intervene with the appeal situation — this

woman only missed the qualification by one week in terms of the time period

required — and given her grave situation at the moment, for the government to

consider forgiving her hospital costs of $7,003.16.

Hon. C.

Hansen: I have not had a chance to see the letter yet that the member has

sent to me. Certainly, I can empathize with what this lady is going through. We

certainly have some of the best cancer outcomes anywhere in North America, and I

am sure she is getting excellent first-class care for her cancer.

I am not

able to go into the details of her particular situation. I will follow up on it

with the ministry. I know there are cases — they are very unusual — when we

are able to waive the wait period for MSP coverage. I will certainly follow up

with my staff to see if this is one of those cases, and I will report back to

the member as soon as I can get an answer on that. It won't be during the

estimates, but I'll try to get back to her as soon as I can in the coming days.

J. Kwan:

In fact, I was mistaken. It is a less than a week by which she missed the time

period. She was approved for coverage effective October 1. She was admitted to

the hospital for emergency surgery on September 26. Her days in the hospital

were from September 26 to 30. She would have gotten coverage on October 1. So

it's less than a week; it's within four days.

I certainly

hope to hear good news on behalf of this individual from the minister. I

understand the minister only just…. Actually, I know how the processing of

letters goes sometimes. It probably is not on the minister's desk yet, so I

appreciate that. I will await the minister's response.

[1525]

Let me then

turn to issues around the first nations health area. I should just advise the

minister that this

section I'm canvassing with the minister is on a whole bunch

of case-by-case, constituency-like issues. They're sort of all over the map in

terms of what area they fall on, so my apologies for that.

This was a

letter written to the Premier on January 23, 2004. It is a letter from the First

Nations Summit Chiefs Health Committee, and it is signed by Chief Doug Kelly.

The letter reads as follows:

"The

First Nations Summit represents those first nations participating in the

treaty negotiations process in B.C. In addition to treaty initiatives, the

summit also appoints chiefs' committees to address important social and

economic issues. Recently, summit leaders renewed the mandate of the Chiefs

Health Committee. The primary role of the Chiefs Health Committee, also known

as CHC, is advocacy to ensure that first nations health issues are addressed

with appropriate policies and services from Canada and B.C.

"Earlier

this month the CHC decided to develop and carry out a comprehensive advocacy

strategy that includes lobbying, media relations and direct action. We are

concerned about your government's effort to reduce the provincial deficit on

the backs of the poor. The provincial health officer's annual report 2001

states: 'If you are an aboriginal person living in British Columbia, your

standard of living is likely to be 20 percent below the provincial average,

based on measures such as income,

[ Page 9340 ]

employment, educational attainment and housing adequacy.'

"On

September 17, 2003, we witnessed your apology to First Nations Summit chiefs.

We heard you commit your government to reconciliation with first nations. We

hope that our commitment is honourable and that your cabinet ministers will

seek opportunities to put your lofty promise into action.

"We

remind you that your provincial health officer also recommended that your

government 'establish provincial and regional targets for achieving comparable

health status between the aboriginal population and other British Columbians

or specific aboriginal targets, where appropriate. Hold ministries and health

authorities accountable for progress towards these targets and for

coordination with agencies that serve the same populations.'

"We

seek the assistance of your good offices to bring together key cabinet

ministers from your government to consider and plan your action on your

provincial health officer's recommendations from his report of 2001. We look

forward to a prompt response to begin taking action to address the health

status of first nations and aboriginal peoples in B.C."

On the

basis of this letter I would ask if the minister would commit to meeting with

the CHC, the Chiefs Health Committee, to listen to their concerns and to work

with them to develop a strategy in addressing aboriginal health outcomes.

Hon. C.

Hansen: The short answer is yes. In fact, that meeting is already scheduled.

I will be meeting with Chief Kelly this Friday.

I certainly

have had a very good and constructive relationship with his predecessors and the

first nations health committee generally. Also my colleague the former Minister

of Health Planning, who had responsibility for the aboriginal health file, had

meetings on a fairly regular basis with first nations leaders around aboriginal

health.

In addition

to that, the leadership council — that's the council made up of the CEOs of

the health authorities with senior staff from the ministry — have met with

first nations leaders on health issues. There was a health forum we had that had

a whole component to it around aboriginal health. In addition to that, there

have been annual meetings chaired by the Premier for the First Nations Summit

— the forum with First Nations Summit and the cabinet, the joint meeting

between the chiefs and cabinet ministers. That has happened annually and also

has a health component to it.

[1530]

I'm not

sure if I mentioned this earlier in the debates, but I was in Toronto about six

weeks ago now in my capacity as chair of the provincial-territorial Health

ministers this year and co-chair of the federal-provincial Health ministers,

along with the federal Health minister. We met with the five major national

aboriginal organizations, and at that time we got the agreement of all of those

aboriginal organizations around a framework for developing a comprehensive

health policy for aboriginal communities. It was truly a historic meeting,

because as I understand it, it was the first time all of those national

aboriginal organizations had come together to agree on a way to move forward

with respective provincial, federal and territorial governments.

Finally, I

should mention the provincial health officer's report that the member referred

to. It came out in 2001. We are following through on the recommendations in that

report. I found that report was both good news and bad news. The bad news was

that the difference between health outcomes in aboriginal communities and

non-aboriginal communities was far too wide. The good news in the report Dr.

Kendall produced was that the gap has been narrowing, so we are making progress.

In terms of infant mortality rates, for example, if you go back to the time

frame at the start of his report, there was a huge difference in infant

mortality rates between aboriginal and non-aboriginal populations. Now that has

been narrowed to the point where they actually think those two rates will meet

very soon in terms of the decline. It has come down very significantly in

aboriginal populations as a result of some of the very focused programs that

have been put in place.

There is a

lot of work to be done, and I very much am looking forward to my meeting on

Friday with Chief Kelly. Hopefully, we can find ways to continue the progress

that is being made.

J. Kwan:

Thank you for that update. The information we've received is that as of February

26, no meetings were set. There was no response from the Premier's office or

from any of the cabinet members, so I'm glad the minister has now set up a

meeting with Chief Kelly and will work on those issues with his committee.

Let me ask

about another issue with the minister. This is relating to transsexual women and

men in the province needing corrective surgeries and basic health care coverage.

Issues have been raised both in my office and in my colleague's office, the

member for Vancouver-Hastings, around MSP coverage in regard to transsexual

women and men in need of corrective surgeries and basic health coverage. The

issue has also been raised that the government closed down the gender clinic two

years ago and has done nothing to replace it to help those in need.

[1535]

As well,

the individual who wrote advises that many British Columbians have been waiting

for two years for any word and that there is a comprehensive report with

recommendations before the minister responsible on this matter. I would like the

minister to address this issue on behalf of this individual who has written to

the opposition.

Hon. C.

Hansen: I gather there have been waiting lists for these procedures for some

time. What has happened, I guess recently, that has caused some people to become

anxious about this is that the Vancouver coastal health authority has gone

through a process of re-evaluating how these services are provided. Whenever you

go in to take a new look at a particular

[ Page 9341 ]

process, it does raise all kinds of questions as to why it is being

re-evaluated. Basically, what the Vancouver coastal health authority is trying

to do is find ways of making sure that procedures can be offered in a way that

meets the needs of the individuals involved.

There has

been a fair amount of consultation, I understand, with the transgendered

community in Vancouver. There have been presentations that I understand they

have made to the Medical Services Commission. The objective is to develop the

kind of protocols that would ensure those who should get access to these

procedures can get access, thereby ensuring it is as timely as possible.

I do have

some more information that is apparently being sent in to me. It may take some

time. I may be able to come back to this once I have the rest of the briefing

notes on this. That's the extent of what I have available to me at this time,

but I would be pleased to come back to it later.

J. Kwan:

What's the status on the gender clinic that was closed two years ago? Are there

plans to open a clinic somewhere else? The community is waiting to hear. Aside

from the issue on the wait for corrective surgery, does the minister have

information on the clinic?

Hon. C.

Hansen: I expect to have a briefing note on this that I will be able to

refer to in order to try to answer those questions. I haven't got the specific

answers the member is looking for.

J. Kwan:

When the minister gets the information, he could provide that.

Let me move

on to issues around HIV/AIDS. I wrote a letter on October 29 to the then

Minister of Health Planning regarding the report on priorities for action in

managing the epidemics HIV/AIDS in British Columbia, 2003 to 2007. The then

Minister of Health Planning wrote back to me on December 17, 2003.

[1540]

I raised

with her concerns about the lack of action with respect to the recommendations

contained in that report. I have received several letters from people in the

community around this area particularly. As an example, one letter I received

was from the B.C. Persons with AIDS Society in which they advised that they're

very concerned with the lack of action in this matter. They feel that after

reviewing the document, the BCPWA prepared a response called Shifting

Priorities to address the concerns with serious and pertinent issues not

adequately addressed in the provincial draft. Their response was submitted to

Warren O'Briain as the point of contact for the ministry.

Since then,

I have written to the minister asking about the status of this situation,

particularly with respect to the response from BCPWA. I don't know. The minister

probably doesn't have this document, Shifting Priorities , from BCPWA, so

let me just put on the record what they have highlighted as some issues.

In the

document, they have highlighted that additional funds are required. It reads:

"One

of the major concerns the B.C. Persons with AIDS Society has with the workshop

draft of Priorities for Action in Managing the Epidemics: HIV/AIDS

2003-2007 is its implicit assumption that all of its commendable goals can

be achieved without a significant infusion of new dollars into the effort.

"BCPWA

believes this assumption to be misguided at best. Given the ongoing incidence

of new infections — which, even if reduced by 50 percent, will still number

in excess of 200 annually — the higher cost of new treatments, including new

forms of antiretroviral medications and new treatments for hepatitis C, and

the increased costs inescapably associated with most of the 'key strategies'

proposals advanced in the key document, status quo funding will guarantee

failure.

"Substantial

new funding in addition to that already in place must be made available by the

provincial health ministries if the goals set out in Priorities are to

be accorded any chance of attainment."

Then it goes on to read:

"'The

Assumption of Status Quo Funding.' One of the most remarkable things about Priorities

is its somewhat coy but nonetheless thorough refusal to discuss money. It does

include heartening and, if anything, understated assessments of the costs to

be avoided through effectively addressing the HIV/AIDS epidemic, but it is

close to silent on the question of how that effective work is to be financed.

"The

assumption of status quo funding is nowhere baldly stated in Priorities .

It is, however, clearly implied."

Let me stop

there. There are some other passages I would like to put on the record. What is

the minister's response to this?

[1545]

Hon. C.

Hansen: To address the specific point the member is making around the

funding for HIV/AIDS programs, I know that across the whole spectrum of health

there are all kinds of pressures, obviously, that call out for more funding in

particular areas. I know that if we were to double the budget we have before us

for the ministry from the $10 billion to $20 billion, we could spend it all and

still have, I'm sure, ideas of opportunities where people would think more money

needs to be spent. I certainly recognize that programs for HIV and AIDS are very

important and need to be resourced.

In shifting

the funding from the ministry centrally, which used to be to the health

authorities, one of the things we did was make sure the funding level got

protected. So while we were not seeing increases, at least we were also ensuring

that there were no overall reductions in those funding levels at all.

I can

report to the member that in January of this year, what was then the Ministry of

Health Planning provided a $250,000 one-time grant to the B.C. Centre for

Disease Control for a revamped HIV/AIDS prevention campaign specifically aimed

at gay men. I think there has been that new money made available in addition to

the funding that had been there previously, which is being maintained.

J. Kwan:

Yes, I understand there are pressures everywhere for more dollars to be spent. I

do understand

[ Page 9342 ]

that. We won't get into that debate about spending priorities with

government, because we won't get anywhere on that.

I do want

to focus here, because I believe this was actually on World AIDS Day when the

Premier made a comment. I don't have the exact day on the document here, but I

do believe it was on World AIDS Day when the Premier made a comment that

acknowledged the concerns about not having enough resources for AIDS prevention

programs in the province. There was such a comment made by the Premier in

response to the B.C. Centre for Excellence in HIV/AIDS when they raised this

matter.

Of course,

BCPWA has raised the issue because in the document it does not allow for the

opportunity to talk about funding. If we're to realistically address the issue

— and I think BCPWA is dead-on — then you have to talk about resources. The

document itself is a good one in that people look at it with hope. BCPWA says

this about the document itself:

" Priorities

contains much of great value. Its analysis of the development and trajectory

of HIV/AIDS epidemic in B.C. and of the devices that have emerged to combat it

is thorough and accurate. Its stated goals, if achieved, would substantially

alter the epidemic and would improve the lives of many thousands of British

Columbians, while saving many thousands — perhaps tens of thousands — more

from a life mired in personal battles against this still incurable and

ultimately fatal disease. The key strategies it advances, if implemented, will

all but certainly secure those goals."

So I would

ask the minister: why wouldn't the document allow for discussion of resources

and funding? I understand the need for competing demands, but if you don't even

allow for that discussion…. If the status quo is the way to go here, well,

then we're setting it up so the goals set out in that document would not be

achieved. We're setting it up for failure right from the start.

[1550]

That would

seem to me to make no sense. Government has invested energy into producing this

report. The community has invested their energies into this area. I think there

needs to be a discussion to allow for funding and the resources that are

required in order to achieve these goals. I acknowledge that the minister says

there was a one-time funding of $250,000, but that's another matter. It does not

fall into the issues around the report and, I might add, is not nearly enough to

really try and achieve the goals — if the government is, in fact, sincere

about trying to achieve the goals.

Hon. C.

Hansen: I would just give the member a bit of information I have that may be

useful. The provincial health officer estimates that we spend over $100 million

a year on programs related to HIV/AIDS prevention and treatment in the province.

About $12 million of that is for contracted community-based HIV/AIDS services,

including AIDS organizations, consumer groups and needle-exchange supplies.

I know the

aspect that the member is referring to is the actual community-based

organizations like BCPWA. I know the excellent work they do. That is an

important dimension of it, and clearly, as we can find resources for additional

spending in the health area in the years to come, certainly that aspect of

community-based services and community-based education programs would have to be

one of the priorities we try to cope with in the future.

I wish I

could say to the member that we had a whole bunch more money that we could pour

into it in addition to the $12 million that's already going into those

community-based programs, but we're certainly anxious to make sure those are

maintained and that we try to get the best value we can for those dollars that

are available.

J. Kwan:

Maybe I can offer this for the minister. Perhaps the minister will agree to meet

with BCPWA to talk about their concern with respect to resources in this matter

and perhaps work with them to try and see how government can develop a strategy,

a long-term plan, in coming up with the resources — I know there have been

many long-term plans on this issue over time — to work with them to see how a

strategy could be developed in terms of resourcing the recommendations in the

document the government had put forward — priorities to achieve that goal.

Perhaps that might be a starting point to get towards addressing HIV/AIDS.

I think in

the minimum, for the government to show that they're sincere, you can't put out

a bunch of recommendations and say: "Oh well, oops, we don't have the money

to fund it, and so status quo." The document actually asks for

additional…. Well, no, the document does not ask for additional resources, but

it asks for additional actions. Without resources, those actions obviously

cannot materialize.

Hon. C.

Hansen: This is a file I've had just for the last six weeks now. To the best

of my knowledge, BCPWA has not requested a meeting, but I would certainly be

prepared to meet with them. I have met with them in the past, as has my

colleague the former Minister of Health Planning. The short answer is yes, I

would be pleased to meet with them.

When we

start talking about resources, I think we also have to look at where the

opportunities may be. I think the fact that the Canadian strategy, the funding

that comes from the federal government, is up for renewal is one of those

opportunities. We've certainly been trying to work with Health Canada with

regard to the renewal of that HIV/AIDS strategy, and it's something that we will

continue to do to see if the federal government is able to put more resources

specifically into this area as well.

[1555]

J. Kwan:

They didn't ask for a meeting. However, they wrote to the former Minister of

Health Planning, as I did, and to be frank, the response I got back is certainly

less than satisfactory in terms of the concerns that were raised. As well, to

just conclude this discussion, here is what I want to put on record from BCPWA

[ Page 9343 ]

— hence, I think, the importance of actually doing something about this on

the resource side. It reads in the concluding paragraph:

In a

nutshell, the provincial Health ministries must act. It is not enough for them

to adopt priorities and pledge implementation. Those ministries must, as well,

produce the substantial additional funds essential to do that implementation. To

do otherwise would be to expose the pledge embodied in the document's adoption

as a contemptible deception. Indeed, in the absence of substantial new funding

from the provincial Health ministries directed to fight against HIV/AIDS, the

status quo itself may collapse.

I certainly

can appreciate their concern in this area as dedicated people trying to fight

against HIV/AIDS.

Let me

move, then, to another area with the minister relating to Bill 92. The minister

will recall that when the bill, Medicare Protection Amendment Act, 2003, was

tabled, the minister stated:

"The

changes will help protect patients' access to publicly funded health care by

providing greater clarity to patients, physicians and private clinic operators

about charges that are not permissible under the Medicare Protection Act, as

well as auditing procedures and penalties for violations. These changes will

clarify when it is inappropriate to bill patients or unauthorized third

parties, such as friends or relatives, for medically necessary medical

procedures, including diagnostic services."

These are the minister's own words during second reading debate.

As we know,

the Premier now says this bill will never be enacted, yet the bill was

introduced by the minister, and the minister was certain in his statements that

the bill would be enacted. Now we have a flip-flop from the government on this

issue, so I just want to canvass this a little bit with the minister. After the

bill was introduced, we read in the paper that the minister had played down the

significance of the bill and that the minister had stated the changes we're

making today are not a policy shift by the government but that the bill

contained only relatively minor changes aimed at protecting patients from

inadvertent billing errors.

The text of

the bill, of course, told a different story. The bill limited patients' choice

by banning the common practice whereby people obtain care at private clinics by

having friends, relatives or others pay. Plus, it threatened the clinics

themselves with fines of up to $20,000 and intrusive auditing procedures. The

government had formerly supported the private clinics, and I think that in this

situation, the minister really dug himself into a hole with the government's

direction. The Premier then came forward and effectively yanked the bill. I

would like the minister's comment on this flip-flop, please.

Hon. C.

Hansen: First of all, just to correct something the member said. What the

Premier said is that this bill would not be proclaimed until we were able to get

clarity around

interpretations of the Canada Health Act. Just to back up a

little bit on this, we brought in this legislation because the provinces have

the responsibility to essentially provide the policing function for the Canada

Health Act.

The Canada

Health Act is federal legislation, and it should be the responsibility of the

federal government to determine what is or is not a contravention of that act.

In reality, there has been very little direction from Ottawa around what is or

is not considered medically necessary, which is one of the terms used in the

Canada Health Act that is not defined. There are two terms that are key, which

are in the Canada Health Act and not defined. One is "medically

necessary," and the other is "medically required" — both of

which appear in the act.

[1600]

We brought

in Bill 92, and as the member indicated, I did not think it was a substantive

change in terms of what was being proposed. What came back after we had brought

the legislation in and put it through the House was feedback from some of the

doctors involved. They said that until governments, federal in particular, can

tell them what the definition is around what is medically necessary or medically

required, it makes them extremely vulnerable. With the changes proposed in Bill

92, what we were saying to them was that if they undertook a procedure that was

considered to be a violation of the Canada Health Act, then they would be almost

guilty until proven innocent in that they would be subject to very large fines

potentially.

Their

argument to us was that we needed to give them some certainty around what was

appropriate and what wasn't appropriate. We agreed that we would not proclaim

that until such time as the federal government was able to provide them with

those

definitions and that reassurance.

J. Kwan:

This is interesting, because what the minister just said is different from

what the Premier has said on record. Here's a direct quote from the Premier:

"It has not been proclaimed, and it is not our intention to proclaim

it." That's what the Premier has said. It was said on tape on BCTV news —

on Global.

There were

no caveats associated with what the Premier has said. Now the minister has just

added caveats to that. It's another flip in the flopping that is going on with

this issue of Bill 92, I might add.

The Premier

actually then went on to say, "I think it may well turn out that we don't

need it at all," which leads one to consider or think that, by implication,

what the Premier is saying is that the whole bill is going to be scrapped

altogether. What the Premier said is — a direct quote from the Premier:

"It has not been proclaimed, and it is not our intention to proclaim

it" — period. From the Premier.

What the

minister has said in this House is that they would not proclaim it until they

get clarification from the federal government on the Canada Health Act. That is

substantively different from what the Premier has said. I would want to note

that if it's the case.

Presumably,

aside from the changing stories here, when the minister tables the bill and

debates the matter in the House, the minister actually should know what

[ Page 9344 ]

the ramifications are and the issues related to the federal government and to

the Canada Health Act.

In fact, I

think the minister did know what those ramifications were, because according to

a news report dated January 15, 2004…. The

article was "Liberals Look Bad

as Premier Forced to Fix Clinic Foul-up." It was an

article by Vaughn

Palmer. The minister is cited. "The Health minister dug himself in deeper

in support of the bill. He pushed it through the House in early December and

told reporters enforcement would begin early in the new year."

When he

introduced the bill, the minister knew then what the ramifications are on the

federal side and what the issues are. One has to assume that he has to know,

given his responsibility as the minister. Even then, he introduced the bill, and

he said it would be enforced beginning early in the new year.

Is there

new information on the federal side that the minister was not aware of when he

introduced this bill and passed it in this House?

[H. Long in

the chair.]

Hon. C.

Hansen: As I mentioned earlier, I did see this particular piece of

legislation as a relatively minor change. As the member knows, there are

protocols involving legislation and who can see the legislation before it is

tabled in the House. In respecting the privileges of the House, no, I did not go

out with the legislation and show it to those that may be directly affected by

it.

[1605]

As a

result, when the legislation was finally brought in, it was the first time a lot

of the doctors affected had the opportunity to see it. It was only after that

that they were able to point out some of the ramifications of it that I was not

aware of at the time the legislation was introduced. We've been trying to work

with the physicians to make sure we can get clarity on the issues around the

Canada Health Act. In the meantime, as the Premier indicated, we are not

proclaiming this piece of legislation. We're not bringing it into force in the

meantime.

J. Kwan:

The minister had just said earlier that they would not bring the bill into

force until they have clarification from the government on the federal side. The

Premier has said they would not proclaim the bill and it is not the intention of

this government to proclaim the bill — period. That's what the Premier said

— nothing about clarification on the federal government side.

It's

interesting how strong this lobby is from the private clinics, because what Bill

92 does, effectively, is that…. It was an attempt to prevent queue-jumping, as

required by the Canada Health Act. The bill would actually empower patients to

request an audit of private clinics that they believe have inappropriately

billed them for needed medical services. That to me, especially with respect to

that aspect of the bill, has nothing to do with the Canada Health Act — in

terms of asking for an audit by members of the public. The government is backing

down because of the fierce campaign that was launched shortly after the bill was

introduced. I think the bill really, basically, lived for three weeks before the

Premier said publicly, on record, that the bill would not be proclaimed and that

it is not the intention of the government to proclaim the bill. So that's

another flip-flop.

Let me ask

the minister this question. He says that until the Canada Health Act is further

clarified…. When does the minister expect the Canada Health Act to be

clarified?

Hon. C.

Hansen: That time line is not up to me. As the member knows, the Premiers

and first ministers have had conversations about the future of health care with

the federal government, and it is my hope that that will lead to some feedback

on those subjects. But I'm not aware of a particular time line that I can expect

in terms of feedback from the federal government in this area.

J. Kwan:

Has the minister written to the federal government for their feedback on Bill 92

now that it is tabled — it's public information — and asked whether or not

it contravenes the Canada Health Act?

Hon. C.

Hansen: That's not the question that is before us. It's not a question as to

whether Bill 92 contravenes the Canada Health Act or not. The question is around

the

definitions that are associated with the Canada Health Act itself, which is

federal legislation. This is a matter that has been part of discussions

involving Premiers and first ministers.

J. Kwan:

Sorry, my apologies. I actually didn't mean whether or not Bill 92

contravenes the Canada Health Act. Bill 92 is trying to prevent situations that

are occurring in British Columbia that may contravene the Canada Health Act. My

apologies. I misstated that myself. I'm interested in whether or not…. The

minister says he is awaiting Ottawa to take action on this issue. Has the

minister written to the federal government asking them to take action on this

issue so that we can, in fact, enact Bill 92?

Hon. C.

Hansen: The short answer to the member's question is no, I have not. As I

mentioned earlier, this has been a topic of discussions between Premiers and

first ministers.

[1610]

J. Kwan:

Well, then the minister's statement about awaiting the federal government's

response on the issues around the Canada Health Act rings a bit hollow, I must

say. Maybe, after all is said and done, it is the intention of this minister to

hope that there will never be clarification from the federal government so that

the Premier's promise of never proclaiming this and the Premier's intention of

not proclaiming it would be upheld and so the minister can say: "Oh well,

we're waiting for a response from the federal government." The

[ Page 9345 ]

minister is not asking the federal government for a response with respect to

this issue, so effectively, I think it's fair enough to say Bill 92 is dead. It

may as well be dead, because I don't foresee it being enforced anytime soon, and

neither does the minister. From the way it sounds, neither does the minister

care. He's not really pursuing it with the federal government for that

clarification that he claims is needed.

Let me move

on to another area here with the minister: nurse shortages. I know the minister

has actually done some good work around this, but there are still some issues

associated. Let me just put some facts on the table to share with the minister.

The information I have indicates that there's a deficiency in nurses not just in

British Columbia but in the country.

There are

issues particularly with respect to British Columbia — that is, only about 40

percent of registered nurses have regular full-time jobs. In spite of that

shortage, I should note that only 40 percent of registered nurses have regular

full-time jobs. That figure is actually down from 52 percent in 1997. Almost

2,500 casual nurses are working at three or more different work sites in B.C.

today. I think this is an issue.

Actually,

when I was in the hospital delivering my daughter, I spoke with some of the

nurses there, and they actually told me…. I went through three shifts of

doctors and nurses when I was in labour, and two of the nurses told me, to my

recollection, that they're not full-time. In fact, they're working at multiple

sites in order to get a full income, basically. Yet we have a major shortage

situation in terms of nurses. I wonder, first of all, if I could ask the

minister to respond to that situation.

Hon. C.

Hansen: The member may have…. I'm not sure where she's getting her

statistics from on this, but in 2002, 51.8 percent of registered nurses worked

in full-time positions, 32.1 percent worked in part-time positions, and 16.1

percent were working in casual positions. This compares to 2001 data, where

there were 50.7 percent full-time, so we saw an increase of in excess of one

percentage point. The part-time was 31.2 percent, so we've seen a slight

increase in the number of part-timers. The number of casuals actually dropped

from 18.1 percent in 2001 to 16.1 percent in 2002.

[1615]

J. Kwan:

The minister compared 2001 and today. The data I put on record was compared to

1997. Maybe the minister could look back a few years. The data I have actually

shows that it's down from 1997. In 2001 there already was a shortage. Yes, as I

mentioned, the minister is trying to do some work around this. The comparison

I'm using was back in 1997.

Hon. C.

Hansen: I don't have data that would go back to 1997 on that specific

perspective that the member has, but I do have a comparison that came from the

Registered Nurses Association, where they did a survey of nurses graduating from

B.C. post-secondary institutions. It compared 1997 and then repeated this in

2001. In 1997 only 38 percent of the graduates were able to find permanent

positions. In other words, 62 percent were only able to find casual positions in

1997. By 2001, 78 percent of all the nursing graduates were able to find

permanent jobs, and only 22 percent were faced with casual employment at the end

of that.

J. Kwan:

The information that I have actually is from the Ontario nursing leader. A

release was sent out on February 3, 2004. The issue that was raised was that in

Ontario the deficiency…. This is across many jurisdictions, but certainly she

cites that in British Columbia our key deficiency facing patients today is the

deficiency about our nursing situation.

Let me just

put on record what the release says:

"Ontario

nursing leader to target key deficiency in B.C.'s health system. Veteran of

SARS crisis will criticize overreliance on casual nurses working multiple work

sites. She wants a dramatic increase in full-time RN employment to improve

patient care.

"One

of Canada's most outspoken nursing leaders will deliver a warning

Wednesday" — that was February 4 — "about one of the key

deficiencies facing patients in B.C. It's a deficiency that almost crippled

Ontario's ability to deal with last year's SARS crisis and posed serious

problems for any future infectious disease outbreak in this province. Doris

Grinspun, executive director of the Registered Nurses Association of Ontario,

will speak about the growing dependency of the health care system on nurses

who work on a casual basis without regular jobs. As a result, many nurses are

forced to work at three or four different work sites, a phenomenon that

facilitated the spread of SARS in Ontario."

Then it

skips on. It gives the address and location where she's speaking, and then it

goes on to say:

"She'll

be addressing the fact that in B.C. only about 40 percent of nurses have

regular full-time jobs. That's down from 52 percent in 1997. Almost 2,500

casual nurses are working at three or more different work sites in B.C. today.

Grinspun believes health care managers should work toward a goal of 70 percent

full-time employment for RNs."

Then she talks about how that is vital in our health care system.

With that,

let me just canvass with the minister some questions around displacements of

nurses in the British Columbia system and amongst the hospitals. In the

Children's Hospital, in the pediatric clinic, according to the information I

have, we have two nurses displaced there. That's a net of 0.6 FTEs. In the Trail

home support community their number of nurses….

[1620]

I can sort

of go through the list, but I won't. I'll just skip right through to the total

numbers. The number of nurses that are displaced totals 100, and the total

number of FTEs is 53.6, with all these different communities — Children's

Hospital, Delta Hospital, G.F. Strong, George Derby Centre, Howe Sound Home

Support, Langley, North Shore, Queen Alexandra, Royal Jubilee, Simon Fraser

community health, Vancouver Hospital, Women's Hospital, etc. Then there's a

cumulative total of displacements accounted for since the start of 2002 to date

— a total of 909 nurses displaced and 472.18

[ Page 9346 ]

FTEs. This is as of January 20, 2004, so it's rather recent information.

It seems to

me this level of displacement is concerning, and it is high, relatively

speaking, given that we already have a pre-existing challenge. I'd like the

minister to comment about the displacement issue.

Hon. C.

Hansen: I think it's important to note that we still have nurse vacancies in

British Columbia. When we formed government, there were about 1,000 nurse

vacancies, difficult-to-fill positions, and we've been able to get that down

significantly over this last two and a half years. There are still opportunities

for nurses in B.C.

It's

interesting to note that studies will show B.C. has been the largest net

recipient of nurses from other parts of Canada compared to any other province,

so B.C. is certainly an attractive place for nurses to come to practise nursing.

It is important to note that the number of full-time nurses in B.C. is up. The

total number of hours for nurses in British Columbia is up.

When the

member talks about displacement, what that is…. When we have the change in

terms of the use of facilities, which is an important part of our whole redesign

of health care, we have to abide by the terms of the collective agreement that

govern how a nurse can be relocated from one facility to another. Under the

terms of the collective agreement, in many cases that means we have to, first of

all, lay the nurse off or provide termination notice before we can then rehire

them at a new location.

Just

tallying up the number of displacements in the system is not an indication of

nurses that are not employed. It's simply an indication of the fact that we are

redesigning where services can be offered to British Columbians and making sure

we have the appropriate number of nurses working in the appropriate facilities.

We're doing that within the parameters of the collective agreement.

J. Kwan:

The BCNU made a submission to the Select Standing Committee on Health on

November 9, 2001, and their recommendations are as follows. I'll just read the

headings of each of the recommendations. There are six of them:

"(1) provide the resources required to ensure that

British Columbia has enough registered nurses to provide the health care

services British Columbians need and deserve;

"(2) provide patients with one-stop shopping for health

care through a network of community health centres. Group nurses, doctors,

social workers, physiotherapists, etc., under one roof as part of one salaried

team, and let the people served by these centres decide how they'll work;

"(3) use registered nurses and nurse practitioners more

effectively to advise patients on diet, exercise, health care prevention and

treatment of minor illnesses and injuries;

[1625]

"(4) increase the role of RN nursing supervisors in

deciding when patients are ready to be discharged from hospital and what

support they need when leaving so that they make a good recovery and do not

return to the emergency department;

"(5) appoint an RN to sit on every health authority;

and

"(6) ensure overall quality of care by preserving

medicare as a public system, rather than lowering standards through increased

privatization in long-term care or surgeries."

The

document was presented to the Health Committee. I don't believe the NU has

actually received any comments from government on their recommendations in this

regard. I would like to canvass the minister's comments on their six

recommendations.

Hon. C.

Hansen: First of all, with regard to training, we have increased the number

of training spaces for nurses in British Columbia. Every time I talk about nurse

training, I think of a conversation I had with the president of the B.C. Nurses

Union; she prefers to use "education." The education programs for

nurses in the province increased by in excess of 1,800 additional seats in our

universities and colleges.

In terms of

the one-stop shopping that she talked about in the second one, we are developing

new primary care models, and I think we went through some of those earlier in

the estimates process. We are making some progress in that regard.

Using

nurses and nurse practitioners more effectively. This is an area where there

have been changes that I know not all of the registered nurses in the province

like, but I can recall an ad campaign that the BCNU put out several years back

talking about nurses doing non-nursing duties. We have actually tried to put

more resources to freeing up nurses so that they could not only focus in on

nursing duties but that registered nurses could focus in on what was their

unique scope of practice. We have also brought in licensed practical nurses to

assist with nursing duties that are within the LPN's scope of practice, freeing

up the RNs to do activities that are purely in their unique scope.

We've also

expanded the nurse practitioner program. There is now a program that just

started at UBC and UVic to educate nurse practitioners in B.C. That is a program

that is being expanded. I know I've had great feedback from individual nurses

who are quite excited about that new program.

With regard

to discharge planning, today nurses are very much a part of discharge planning.

Certainly, they play a very important role and continue to do so. With regard to

a registered nurse on every health authority board, the boards are the

governance boards that are there to provide oversight for the activities of the

health authority. I think virtually every single health profession has commented

to me that they think their particular profession should be represented on those

boards. If we followed through on that, we would have unwieldy governance

boards.

[1630]

What is

more important, I believe, for nurses in the province is to have a nursing

officer in the health authority. Every one of the health authorities now has a

[ Page 9347 ]

chief nursing officer. I think that's an important innovation.

Then, with

regard to the protection of public medicare, that is a priority for us as a

government — to make sure we continue to have and protect a publicly funded

health care system. Part of what we are doing around a redesign of the health

care system is to make sure that proud public health care system we have is, in

fact, sustainable into the long term so that it's not only there for us next

year but there ten or 20 years down the road.

J. Kwan:

Just to counter the minister's comments on that last point particularly. The

government is actually privatizing health care in a big way, and the services

within health care are being privatized as we speak. Privatized hospitals are

being opened and are under construction, and we just dealt with Bill 92, which

would actually halt some of the issues around queue-jumping, that is now forever

sitting on a shelf, never to see daylight — certainly according to the

Premier's comments. The actions of the government, quite frankly, are contrary

to what the Premier is saying, in my view, on that basis.

The other

issue I would like to raise with the minister is this. The minister said that

the nurses had — I think he said — some sort of ad campaign to the effect

that they were saying nurses will not engage in non-nursing duties. There was

some sort of ad campaign, I think the minister said. In any event, there was a

dispute around that issue. Because the government is privatizing segments of our

hospitals, the services within it…. Those, I would say, are a continuum of

services within the hospital realm, whether you be a security person, a person

who serves and prepares the food or a person who cleans the hospital. There's a

continuum of health services. Those health services these other individuals

provide, in my view, very much need to remain as part of the public care realm,

because there's a continuum of services within the hospital, within an

institution.

When we

talk about doing nursing duties, what this document refers to is allowing for

nurses to take on more responsibilities that would actually alleviate the

pressures on doctors, which I think both serves (

a) to reduce costs for our

health care system and (

b) also to utilize the skill set more effectively and

efficiently with those who do have the skill set in the health care profession.

I think that's what these points, relating to taking on more responsibility in

the area of nursing, refer to.

I just want

to set that aside. I know there's been much debate on this issue, but I do want

to table this because, as far as I understand, the six points that have been

raised have not been responded to by anybody from government since the Health

Committee has sat.

[1635]

The last

issue I want to canvass with the minister around the nursing situation is around

foreign nurses in terms of foreign nurse recruitment. I know there are different

points of view out there around this issue, and this is my own personal point of

view. I do think that it is important to recruit Canadians to fill the positions

required in British Columbia, and I also think there's an opportunity with

respect to foreign nurses. It's a forever age-old difficulty, particularly

impacting the Filipino nurses and — I should say, actually — live-in care

workers, many of whom are nurses with the credential to do the work required of

them. But because of various regulations federally, in particular, they are not

able to do so. I just wonder: on that front, what work is the minister doing to

try to advance this issue actually for both doctors and nurses?

Hon. C.

Hansen: I just want to be clear that I'm answering the right question here

for the member. If what she's referring to is the requirement that an individual

who comes to Canada on a working visa and then wants to change the nature of

that working visa, then that's not an issue that affects the provincial

government, because it's the federal government that…. I know the Filipino

Nurses Support Group has been advocating in that regard, but that's not

something that we have authority over. It is, in fact, the federal government

that has to address that issue.

We have

been very supportive of foreign-trained nurses coming to British Columbia. You

know, our first priority is to make sure that we provide education opportunities

for our own young British Columbians to get into nursing, because they are truly

excellent careers. That's why I'm very proud of the fact that we've been able to

expand the number of seats at our post-secondary institutions.

We also

recognize that we do have an ongoing challenge in terms of the nursing shortage,

and we do look to internationally trained nurses to help fill that gap there.

Since March of 2001, there have been 158 internationally educated RNs and RPNs

that have been nominated under the provincial nominee program we have in place.

In 2001-02 there were 189 internationally educated nurses who received support

from the Return to Nursing fund. About half of those were educated in the

Philippines. In 2002-03 there were 92 internationally educated nurses who

received support from the Return to Nursing fund, and 24 of those had been

educated in the Philippines. In 2003-04 — this year that we're in now, which

obviously still hasn't ended — we are projecting that 70 internationally

educated nurses would be funded from that fund, 27 of which were educated in the

Philippines. That's as of January 2004.

J. Kwan:

I may add this. Yes, the live-in care workers' situation is very much a federal

government jurisdiction issue. However, I also think that the provincial

government can play a role to facilitate in assisting it by requesting and

advocating with the federal government for immigration policy changes. If we're

recruiting overseas for nurses from the Philippines or elsewhere — and we do

need to…. I absolutely agree that we need to make use and maximize the talents

from our own communities, from British Columbia and Canada. I agree with that,

but on the flip side of that, in

[ Page 9348 ]

light of the shortage and in trying to address the health care needs of our

communities, from time to time we do need to look elsewhere. So given that we

are recruiting from overseas, it would make a lot of sense that those who are

live-in care workers, who are already here, who have the skill set could

actually be facilitated to become nurses and provide those services.

understand that it's not a provincial government decision, but I do think that

the provincial government can have a role to play in advocating for change with

the federal government. That certainly was the role that we played when we were

in government, and I was a very strong advocate for change in that area. I know

that we couldn't change the immigration policy laws — it does rest with the

federal government — so I'm asking the minister to commit to be an advocate

with the federal government on that front with the live-in care workers.

[1640]

Hon. C.

Hansen: Certainly, we have advocated with the federal government with regard

to flexibility around the provincial nominee program, which we've had some

success at in recent years, using that vehicle to facilitate more

foreign-trained nurses. Also, when it comes to an individual who is a landed

immigrant in Canada, we can help them. We can provide them with support to get

education upgrades, to get their licensing, so they can become part of the

nursing workforce in B.C.

Where we do

have some difficulties is around recruiting health care professionals from

Second and Third World countries. There is a growing international concern about

the countries recruiting from those countries when those countries themselves

have a shortage of health care professionals, and that's a subject that has been

discussed by health ministers nationally at the FPT discussions. We do have some

tools that can help facilitate foreign-trained nurses, but we have to be careful

not to be recruiting nurses away from countries that are also experiencing

shortages themselves.

J. Kwan:

Agreed, and I'm not disputing that point with the minister. The point I want to

raise with the minister is this. With the domestic care workers, particularly

from the Philippines, which we are recruiting from, many of them are here on the

basis that they are to be care workers in the home of somebody — to be

nannies, to be frank. Many of them have qualifications to be nurses in their

hometowns, but they are not able to practise there for whatever reason, or

they're looking for other economic opportunities to improve their lives and the

lives of their families.

When they

are here on the live-in care worker visa approval from the federal government,

they're not able to do anything else. They can work only as nannies,

essentially. What I'm suggesting is for the minister to advocate with the

federal government to change that policy to allow access for live-in care

workers into the health care profession as nurses. They're here already.

If we're

recruiting from the Philippines or elsewhere, for that matter, we're recruiting

from outside and still looking; yet we have individuals from those countries who

are already here with those skill sets. We can actually truncate the process in

some ways by taking advantage of the individuals who are already here and who

actually desire to move into the health care profession with the skill sets they

have from their previous training. That's all I'm asking.

Hon. C.

Hansen: The thing that's important to note in this discussion is that these

workers are coming on temporary visas. They would be in Canada on a temporary

work visa so that they could provide a specific service, for which they have

been granted a visa by the federal government to work in Canada for a specific

period of time. Then they would return to their home country, where presumably

they would resume their professions perhaps as nurses or other caregivers in

their home countries.

[1645]

Again, it

sort of falls back into that issue: to what extent is it appropriate for a

country like Canada to be trying to recruit health care professionals from

countries that may need those health care professionals themselves?

I certainly

empathize with those individuals that would like to advance their economic

situation and would like to become landed immigrants in Canada, but I think the

federal government, first of all, has responsibility for that process. They do

have a process that would not preclude anyone who is a caregiver in Canada on a

temporary work visa from then applying to come to Canada at a later date to

become a nurse in Canada. I think there is a process they can follow. I think we

have to be sensitive to some of the international issues in this area as well.

J. Kwan:

The point I'd like to make with the minister is this. These individuals have

left their country already, and they are here. Because of a lack of

opportunities for them to improve their lives and those of their families, they

have left their home country to do work that does not meet their skill set.

Their skill set, in fact, is far superior to that of the work they are now

doing.

Under the

conditions they are required to accept for the working visa, as domestic live-in

workers they are not allowed to look for other opportunities in terms of

employment, which is hugely restrictive for them in trying to secure better

opportunities.

It's true

that it does not preclude them from applying at a later date for landed status.

However, the point I'm making is that they are here already, and they desire to

actually engage in their profession, but they are not able to do so because of

the parameters of the federal government.

Oftentimes

the other reality is this. Even if the government does allow them to look for

work elsewhere, the employer, of course, would not allow them. Therefore, in

fact, a lot of the domestic workers are living in

[ Page 9349 ]

a situation where they experience a lot of stress and in some instances

abuse. They have nowhere to turn.

My hope is

that the minister considers advocating for change from the federal government's

side with this group of people so that we can maximize the skill set that is

already here in British Columbia and also, in that process, assist those

individuals in creating better lives for themselves.

I recognize

that this debate here may not allow for the full level of information to be

exchanged around the live-in care worker program — the ramifications on the

federal government side — and around what role I think the provincial

government can play as an advocate on this front. I fully recognize this.

What I

think I'll offer is this. I actually have a whole stack of files of information

on this issue in my constituency office that I didn't bring with me for debate

today. I would like to send this information to the minister for him to peruse

at his leisure so that he can understand fully what I'm talking about and,

hopefully, respond at a later date to me with confirmation that he would be able

to play an advocacy role in this area.

On that

basis, Mr. Chair, I'll move on to another area with the Health minister. Let me

talk with the minister about water quality and health. The drinking water issues

fall, I believe, in the Health ministry because the health officers are very

involved in this.

There's a

particular case I want to bring to the minister's attention. I'd like to canvass

the minister about this. This is a letter from the Anglemont Ratepayers

Association. They wrote to the chief medical health officer on September 20,

2003. I won't read the entire document, because it's quite lengthy. I'll just

read some of highlighted parts of it.

[1650]

It reads:

"Our

community of Anglemont is situated on the north shore of