May 17,

SOCIAL SERVICES COMMITTEE

The Committee met at 7:00 p.m. in the Assembly Chamber.

CHAIR (Mr. Wiseman) : I want to welcome all of you here. This is the

Social Services Estimates Committee and tonight we are doing the Budget

Estimates for the Department of Health and Community Services.

Before we get started, I am going to ask the Clerk if she would legitimize my

sitting in this chair by conducing the election and then we will proceed then.

CLERK (Ms Murphy): Is there a nomination for Chair?

MR. COLLINS: I nominate Mr. Wiseman.

CLERK: Seconded?

MR. PARSONS: Seconded.

CLERK: All those in favour, aye'.

SOME HON. MEMBERS: Aye.

On Motion of Mr. Collins, seconded by Mr. Parsons, Mr. Wiseman was elected

Chairman.

CHAIR: I thank the Opposition for nominating me and seconding my

nomination.

I ask now for the nomination for the position of Vice-Chair.

MS JONES: I nominate Mr. Butler.

CHAIR: Mr. Butler.

MR. PARSONS: I second the nomination.

CHAIR: Congratulations, Roland; unanimous support of the Committee.

CLERK: You did not put the motion.

CHAIR: I am sorry, I have to put the motion.

All those in favour of the nomination of Roland Butler, the Member for Port

de Grave, as Vice-Chair of the Committee, aye.

SOME HON. MEMBERS: Aye.

CHAIR: Contra minded?

On motion, of Ms. Jones, seconded by Mr. Parsons, Mr. Butler was elected Vice

Chairman.

Now the Clerk will call the first head.

CLERK: Subhead 1.1.01.

CHAIR: Shall 1.1.01 carry?

Minister, I welcome you and your staff this evening, and I open the floor to

yourself to make some opening comments and maybe introduce your staff. I leave

that to you.

MS E. MARSHALL: The first thing I will do is introduce my staff.

To my immediate left is Deborah Fry, Deborah is the Deputy Minister of the

department; to her left is Moira Hennessey, Assistant Deputy Minister of Board

Services with the department; to my immediate right is Jim Strong, Director of

Financial Services with the department; right here to my left, on the back, is

Lynn Vivian-Book, who is also an Assistant Deputy Minister with the Department,

Community Programs and Wellness; to her right is Carolyn Chaplin, Director of

Communications with the department; to her right is Gerry White, also an

Assistant Deputy Minister with the department, Intergovernmental and Strategic

issues; and to Gerry's right is Dr. Cathi Bradbury, Director of Physician

Services with the Department of Health and Community Services.

I do have a few brief opening comments, I will not take up too much time,

just a short introduction, and then, I guess, we can move on to the questioning.

It is my pleasure this afternoon to serve as Minister of Health and Community

Services and address your questions this evening with respect to Budget 2004.

Provinces across the country are grappling with the challenge of meeting the

increased demand on our Health and Community Services system with limited

resources. As our government wrestles with an inherited deficit, it is incumbent

upon us to invest wisely to best meet the needs of our population. With our

current fiscal realities we must ensure that more of our strategic investments

are directed to patient care, not just bricks and mortar. We will strategically

invest available resources in areas to address better mental health services,

new drug therapies, increased access to technology, long-term care needs of our

seniors, and a stronger focus on keeping well.

This year my department will be working with the Health and Community

Services system to develop a new mental health act and mental health strategy,

create a new division of seniors and aging to foster a more comprehensive

approach to planning for seniors, continue its initiatives to promote wellness

and healthy living, and reevaluate the way in which we deliver our long-term

care and supportive services. We will also embark on a journey of health reform

looking at our systems design at a fundamental level. We need to demonstrate

willingness for change to sustain our ability to provide public health care and

adapt to the realities of changing demographics, technologies and economics.

Our government remains committed to a publicly funded accessible health and

community services system. We continue to invest 45 cents of every program

dollar in health care. The gross current and capital expenditure is just over

$1.6 billion for 2004-2005. Our spending per person on health care in

Newfoundland and Labrador is among the highest in the country. According to the

Canadian Institute for Health Information, Newfoundland and Labrador is

projected to spend $3,018 per person on public sector health care, up from

$1,713 in 1995. This is $336 per person above the Canadian average forecast for

While specific details of the investments in health care are contained in the

Budget Speech and departmental news releases, I would like to highlight the

following:

There is $8.6 million additional investment in the Newfoundland and Labrador

Prescription Drug Program for increased utilization and the introduction of a

new chemotherapy drug, Gleevac, to help fight cancer. The additional funding

brings the total investment in the Prescription Drug Program to $107 million for

the current fiscal year.

There is also a $1 million investment in the Budget for provincial mental

health services in response to the recommendations outlined in Judge Luther's

report. This investment allows government to take immediate action on identified

long standing gaps within our mental health system.

Four hundred and seventy-five thousand dollars has been budgeted in

additional funding to increase the rates for personal care home operators. There

is also $500,000 annual commitment for new social work positions for Labrador to

enhance child protection services in Aboriginal communities. There is also

$300,000 to begin planning for a new long-term care facility in Corner Brook,

and there is a commitment to proceed with new satellite dialysis services in

Carbonear and Gander and the MRI in Corner Brook. Funding has also been provided

for a new Chief Nurse position.

Two hundred and fifty thousand dollars has also been provided for a

"Healthy Children- Healthy Schools" program to ensure the school

environment is conducive to healthy learning. The program will focus on physical

activity, healthy eating and mental health and the direct development of

guidelines and resources to promote healthy living and support curriculum and

services in our schools.

There is also $1.6 million in early learning and childcare funding to improve

access to regulated early learning and childcare programs and enhance childcare

services for low income families.

Thank you, Mr. Chairman.

CHAIR: Thank you, minister.

Just by way of a couple of housekeeping things: We will first have the

members of the Committee introduce themselves, and I think to facilitate the

process, what might be beneficial is if we alternated, so that we would allow

each person to maybe have the floor for about fifteen minutes, and then we can

alternate the individuals. I am just looking at the time. We have set aside

three hours for this evening's discussion, and we thought maybe that we would

take a break after an hour and a half just to relax a little bit. We will just

take maybe a five or ten minute stand-up break, and then we can come back and

wrap it up.

Mr. French, if you could introduce yourself, and then each of you would

introduce yourselves. I would ask that, when you are asking questions, for the

benefit of the people who operate the audio system, when you are about to speak,

if you could introduce yourself, so they can turn on your microphone. I would

ask, if you would, Terry, start the introductions.

MR. FRENCH: Terry French, the District of Conception Bay South and

Holyrood.

MR. JACKMAN: Clyde Jackman, the District of Burin-Placentia West.

MS GOUDIE: Kathy Goudie, Humber Valley District.

MR. PARSONS: Kelvin Parsons, Burgeo& LaPoile.

MS JONES: Yvonne Jones, Cartwright-L'Anse au Clair.

MR. BUTLER: Roland Butler, the District of Port de Grave.

MR. COLLINS: Randy Collins, Labrador West.

CHAIR: Roland is the vice-Chair. Did you want to start the questions?

MR. BUTLER: No, that is okay, I will turn it over to our critic, Sir, if

that is okay?

CHAIR: By all means, it is your call.

Ms Jones.

MS JONES: Thank you, very much, Mr. Chairman, and thank you, Minister. I

welcome you and your department officials this evening.

I am going to start by actually asking you a question that just arose out of

your opening comments. You talked about spending on health care in Newfoundland

and Labrador being the highest in Canada. I guess, I would like to ask you, what

your opinion is in terms of what contributes most to this health care cost in

Newfoundland and Labrador.

MS E. MARSHALL: It is a combination of items. I think change in

demographics is probably a contributing factor. I think that there is quite a

demand for services. I think that the geography of our Province also has an

impact and I think, too, probably some of the - I do not know if products is the

right term, but the fact that we live on an Island, that may attribute to some

of the costs also. I would also like to think that part of the reason for the

increased costs is that we do provide a better level of service, probably, than

some of the other provinces.

Having said that, I think it is very important for us, as a Province, to look

at what we are spending our money on, and how we are spending our money, and go

back and re-evaluate what we are doing on an ongoing basis to make sure that,

effectively, we are getting the best bang for the buck that we are putting into

the health care system.

MS JONES: Is there any statistical information in your department that

would also contribute to it? Are there any stats that outline that there is a

higher level - I know there is a higher level obesity rate in Newfoundland and

Labrador, but anything else, say, regarding heart disease, for example, and with

regard to other illness, the use of drugs, and things like that. Is there

information within your department to-

MS E. MARSHALL: I would say that there is a significant amount of

information on certain aspects. For example, there would be information on heart

disease in Newfoundland. Dialysis is something that is on the increase in

Newfoundland, so there would be information on that, and on obesity and

different things of that nature. I think the studies would show that compared to

other jurisdictions, for example - it rates where we are in line with other

jurisdictions. So, yes, in certain areas we are higher than the national

average, and then in other areas we are lower.

My Director of Financial Services has just provided me with some information

here. I have seen these numbers before, but I will just give you an example.

Smoking, for individuals over the age of fifteen, the national average is 21

per cent and ours is 24 per cent; drinking, 20.1 per cent for Canada and 29.1

per cent for Newfoundland; overweight, 47 per cent for Canada and 60 per cent

for Newfoundland; physical inactive, again we are the highest in the country, 56

per cent compared to 49 per cent.

MS JONES: Were those numbers in a Canadian wide study released by the

federal government, or what was the source of the information?

MS E. MARSHALL: I do not remember now where those - the Centre for Health

Information, the abbreviated name is CHI, generates statistics on health across

the country, so those statistics would have come out of that.

MS JONES: Was there any indication that statistics such as the ones you

outlined, obesity, alcoholism and smoking, are going down or up in the Province?

Was that indicated?

MS E. MARSHALL: I am speaking from memory, so I would ask my staff to

correct me if I am wrong, but my recollection is that the statistics on smoking

would be improving

whereas those on physical inactivity and obesity would be on

the rise. It would depend on what exactly you are looking at, what criteria you

are looking at.

MS JONES: Okay.

I am having trouble hearing you, I do not know if there is a way they could

turn up your microphone.

A few questions with regards to the request that has been made of health

boards in the Province to submit cost-cutting measures to the department. Have

all the boards in the Province now submitted their plans, I guess, for

cost-cutting measures to the department?

MS E. MARSHALL: Yes. I believe what you are referring to is a request

that I sent out to the individual health care boards in December whereby I was

asking them to come in and indicate to me how they could balance their budget in

the, well it would be the current fiscal year now, and how to recuperate their

accumulated operating deficits and how they could start to repay them over a

reasonable period of time. Actually, I did impose a time frame on that, and I

believe - again I am speaking from memory - it was February. That is what I

believe the time line was. All of the boards either met the time line or

submitted their plans probably within a week or so of the request deadline.

MS JONES: I am aware that you have one external study underway by the Hay

Group on the West Coast of Newfoundland and the Northern Peninsula boards.

MS E. MARSHALL: Yes, that is correct.

MS JONES: When is the deadline for submission of that study?

MS E. MARSHALL: The deadline for that study, again speaking from memory,

was to be sometime in May, but because of the public sector strike that has now

been revised to the month of July.

MS JONES: I can only assume, from the fact that there is an external

study underway with the Grenfell board and the Western board, that you have not

accepted their plan for cost cutting measures.

MS E. MARSHALL: Yes, that is correct. Also, with regard to the other

health care boards, I have made no decision with regard to the other health care

boards either.

MS JONES: No decisions have been made at all, yet?

MS E. MARSHALL: No, that is correct.

MS JONES: Are you intending to look at any other external studies of any

of the other health boards in the Province?

MS E. MARSHALL: At the present time, no, I am not. There is no funding

provided in the Budget for any other review, although I would not categorically

state here tonight that there will definitely be no reviews carried out in the

current fiscal year, because something may come up later on during the year. At

this point in time, there are no further reviews anticipated of any other health

care board.

MS JONES: It seems that you will have all of the information that you

have requested by July. When will you be making a decision on how some of this

stuff is going to roll out, with regard to how they deal with their accumulated

deficits and so on?

MS E. MARSHALL: I would think sometime after that, after July. I do have

the plans, as you indicated, and I have also visited all of the boards around

the Province, but having said that, I am planning to do some more visitations

once the House of Assembly closes for the summer, and go out in what I call the

field and speak to the health care boards and other stakeholders.

MS JONES: Have the board budgets for the current year been finalized?

MS E. MARSHALL: That is something that we are now working on. Officials

have been working, in consultation with the boards, which is probably the best

way to put it, but at this point in time, it has not been finalized. They have

been doing detailed work but I have not been privy to the work that they have

done at this point in time. They are doing the detailed work on analysis.

MS JONES: When do you expect to finalize the current year budgets?

MS E. MARSHALL: Do you have any idea as to when it would be finalized?

OFFICIAL: (Inaudible).

MS E. MARSHALL: We think that will be a couple of weeks. In the past, it

has taken varying lengths of time to finalize the budgets of the health care

boards. My officials have advised me that they think it will be within the next

couple of weeks.

MS JONES: Will there be a cut in the overall vote of allocated funds for

boards this year over last year?

MS E. MARSHALL: Pardon?

MS JONES: Will there be any difference in the amount of money voted for

board budgets this year over last year?

MS E. MARSHALL: The amount that is voted for the boards, I can get you

that number. If you want to look on page 200 of the Estimates book, for the

Health Care Facilities, this would be the hospital boards, primarily.

MS JONES: What is the section?

MS E. MARSHALL: It is 3.2.01, Health Facilities Operations. I think that

is what you are referring to, on page 200. The Community Boards would be on the

previous page, on page 199. They are budgeted separately.

The Community Services board, last year the projected expenditures was just

over $253 million and this year we budgeted $256.8 million. For the Health

Facilities, which would be the hospital boards effectively, last year we spent

$943 million and the budget is $950 million.

MS JONES: Because of the public sector strike, there has been a backlog

of, I guess, clinical appointments, diagnostic testing, heart surgeries and so

on. You indicated, in the House, that you were asking the boards to provide a

submission to you on what additional resources would be required. Have you

received those yet?

MS E. MARSHALL: No, I have not. There has been nothing received from the

boards. We do have ongoing discussions with the boards and we have been advised

that they are rescheduling the missed appointments, the clinics, the surgeries,

the tests, et cetera, but at this point in time there has been no request from

any board, that I am aware of. Moira, you might correct me- no requests from

either board.

MS JONES: Why would they be indicating, publicly, that there is a huge

backlog but not be requesting any additional resources?

MS E. MARSHALL: I am sort of now second guessing what the boards would

say, but the boards are, effectively, going through and doing their

rescheduling. I would think that, at this point in time, they are just working

with their numbers to see where they are with regard to rescheduling the

surgeries and that. At this point in time, I have not had no official request

for additional funding.

I think the other thing that might be a complicating factor is that we are

presently in the process of determining what their budgets will be for the

current year, so I would think that they are waiting also to see what their

current budgetary allocations are. Again, as I have indicated, we are in

constant contact with the boards, and within the past week I have had an

opportunity to speak directly with two CEOs of the boards. As I indicated, we do

have ongoing contact with them, but there has been no official request at this

point in time.

MS JONES: Have you been updated recently on the backlogs in the Province?

MS E. MARSHALL: Yes, we receive information from the boards. I do not

have specific numbers here with me now, but they are rescheduling things that

were missed during the strike.

MS JONES: Can you provide me with a list of the backlogs, the number of

appointments, that are currently on the list for clinical, surgeries, diagnostic

treatments and tests?

MS E. MARSHALL: We would not be able to provide that tonight, but I can

certainly get that information for you.

MS JONES: Okay.

I am going to move on to some items arising out of the Budget. Most notably

was the cancellation of health care facilities in Grand Bank, primarily the

cancellation of the hospital there. Would you like to tell me why government

decided to do that and if you feel that there isn't - I can only assume that

you feel there isn't - a need to have a facility in Grand Bank for the

efficient and effective delivery of health care in that region?

MS E. MARSHALL: The primary reason for the cancellation was financial,

that for the current fiscal year we decided to put the resources into programs

and services. The increase that was given was in current operating dollars as

opposed to capital dollars. The other reason for the cancellation is: I wanted

an opportunity to have an assessment done of the health care facilities around

the Province, to come up with a long-term plan as to exactly where our capital

dollars should be put. I would like to say that, personally, I did not think

that we needed a large facility down in Grand Bank as was envisioned. I did have

the opportunity to go to Grand Bank and visit the existing facility, and I do

agree that there are improvements needed in bricks and mortar in the Province,

but I did want to have the opportunity to decide where that money should be

spent.

MS JONES: You said you were having an assessment of facilities done. Has

that been completed?

MS E. MARSHALL: No. That is not a formal assessment. I wanted to have the

opportunity to go around the Province and visit the health care facilities

around the Province. If there is a need for a formal assessment, then I would

have that done, but I have not come to that conclusion at this point in time.

MS JONES: It is my understanding that you are proceeding with

disassembling the steel that has already been erected for the Grand Bank

hospital?

MS E. MARSHALL: Yes, that is correct.

MS JONES: Have you tendered that yet?

MS E. MARSHALL: No.

MS JONES: Can you tell me how much money was invested in the start of the

hospital in Grand Bank and how much it will now cost you to disassemble the

project, take down the steel work and remove it from the property?

MS E. MARSHALL: Yes. My recollection is that we spent approximately $3

million. I will ask my staff to confirm that.

OFFICIAL: That is right.

MS E. MARSHALL: Yes, that is correct, $3 million. We are having

discussions now with Works, Services and Transportation regarding the

dismantling of the steel and we are expecting that to cost about $300,000, but

that is the initial estimate.

MS JONES: About $300,000, you said?

MS E. MARSHALL: Yes, I believe it is $300,000.

MS JONES: So, there is definitely no chance of reconsidering, or just

placing this particular facility on hold, until you have had a chance to do more

of an assessment?

MS E. MARSHALL: No, that decision is final. However, in saying that, I

would like to indicate that I did visit the clinic in Grand Bank. That is quite

an old facility and what we will do, in that regard, I do not know at this point

in time, but just to inform the Committee that I visited that facility and I do

recognize that we may have to do something with that. Whether it will be

replacing or repairing, I do not know, because it is very early yet.

MS JONES: But it is your intention to keep that facility open in Grand

Bank?

MS E. MARSHALL: At this point in time, yes.

MS JONES: I would also like to ask you about the cancer clinic in Grand

Falls.

CHAIR: Excuse me. I remind the member that we talked about fifteen

minutes, but I will give you a bit of latitude to finish off the question around

the Grand Bank issue. We talked earlier about allocating fifteen minutes per

person and to do a rotation. With that mind, I would ask if there is anyone else

on the Committee who would like now to ask a series of questions?

MS JONES: Well, Mr. Chairman, I have no problem with rotating, and when

it is my turn I will continue.

Thank you.

CHAIR: I would appreciate that, thank you.

MR. PARSONS: I have some questions, if it is okay.

Minister, before I get into the details, and I will be referring to page 191

of the Estimates, my colleague from Cartwright-L'Anse au Clair asked a

question about the Hay report and you indicated that you expected to have the

report by July of this year. Is it your intention to release that report to the

public?

MS E. MARSHALL: I would anticipate, yes, that that report would be

released to the public. My preference is that all reports of that nature be

released publicly. That is the Hay report. The Labrador report was received

either just shortly after I was appointed minister or before, and that one also

was released publically.

MR. PARSONS: So, you are prepared to undertake to release that Hay report

for the West Coast when it is available?

MS E. MARSHALL: Yes.

MR. PARSONS: Thank you.

Looking at page 191, under the Minister's Office, 1.1.01, first of all, it

looks like the actuals for 2003-2004 for Salaries was $268,700, and this year

you budgeted $251,900, which I believe is a difference of $16,800. What is the

difference this year, what is causing this difference in salary?

MS E. MARSHALL: I will have to check now with my Director of Financial

Services.

MR. STRONG: The former minister had a bilingual specialist (inaudible).

MS E. MARSHALL: The former minister had a bilingual communications

specialist so that reduced the salary expenditures, but it was offset by the

salary for the Parliamentary Secretary. In the Salary Details - I will see if I

can find it here for you now to give you more information on it.

Mr. Strong, could you comment on that?

MR. STRONG: The revised is up because last year there was a bilingual

communications specialist, who is no longer there in 2004-2005, and there is a

Parliamentary Secretary now in 2004-2005, who was not there last fiscal year.

MR. PARSONS: You are suggesting the $241,900 of your 2003-2004 budget

became escalated to $268,700 because of the bilingual person who was involved in

the department.

MR. STRONG: They were in place originally, and then the Parliamentary

Secretary was there for part of the year. The Bilingual Communication Specialist

would have left before Christmas.

MR. PARSONS: Neither last year's salary details nor this year's

salary details show anything about a Parliamentary Secretary. You are referring

to the Departmental Secretary to the Minister, but under the details that I am

looking at for Minister's Office, in terms of who is in there, it shows, for

this year, a Minister, an Executive Assistant, a Secretary to the Minister and a

Departmental Secretary.

MR. STRONG: Yes.

MR. PARSONS: That was the same as last year. The only difference I see

from last year, in terms of staff, is that the Special Assistant Communications

that was there last year in the Minister's Office at $57,243 is not there this

year.

MR. STRONG: Yes, that is right.

MR. PARSONS: That is a $57,000 less expense in your salary component in

the Minister's Office, yet the figures here only reflect an $18,000 difference

between your actuals of last year and your budget for this year. Why would we

have moved a person out who was making $57,000, yet our figures only show that

we have an $18,000 reduction?

All other staff, according to what I am reading, from this year's

Departmental Salary Details for 2004, all personnel in that department are the

same as last year except for that Special Assistant Communications.

MR. STRONG: I will have to check my notes for that.

MR. PARSONS: Okay.

Minister, following up on that issue, I notice that the only person who was,

last year, employed in the Minister's Office who is not there this year in the

details is indeed the Special Assistant for Communications which added to the

Minister's Office Salary Details by $57,243. That person, now called the

Director of Communications, is listed this year under heading General

Administration, Executive Support, and the cost for this year is $62,059. What

is the rationale for moving the Director of Communications, last year called the

Special Assistant Communications, from the Minister's Salaries budget to the

Executive Salaries budget?

MS E. MARSHALL: The Director of Communications, my understanding was in

the previous government that it was a political position. It is now a regular

public service position. It was recruited through the Public Service Commission,

and that position now reports to the Deputy Minister of the department and does

only departmental as opposed to political work.

MR. PARSONS: Okay, that makes sense. I would still like to get the

answers from the gentleman, Mr. Strong, if you can, as to why the difference

there, because there is still a substantial difference there.

MS E. MARSHALL: Are you talking about the position that we spoke about a

few minutes ago?

MR. PARSONS: You have given your explanation as to why the person is now

under Executive Support versus Ministerial Office, i.e., one was political and

now it is departmental. I accept that, not a problem, but I still cannot work

the math on why a $57,000 position out of the Minister's Office only shows an

$18,000 reduction in your salary bill?

MS E. MARSHALL: Yes, we will check that.

MR. PARSONS: I have not seen the logic of that.

MS E. MARSHALL: I have the salary details for 2003-2004 and 2004-2005,

but I would need to get the revised numbers from Mr. Strong for the $268,000 in

order to provide you with the information.

MR. PARSONS: Okay.

Under 1.1.01, again the Transportation and Communications, we had $50,000

budgeted in 2004, $30,000 actually revised, and now we are back to $50,000. Why

the $20,000 increase being budgeted over what you spent last year?

MS E. MARSHALL: Part of the year was incurred by the previous government

and the other half of the year was my travel. I know that I did not do very much

travel in the six months of the last fiscal year. The $50,000 was put in

thinking that we will have a regular year, this year. So, the budgeted is just

the same as last year.

MR. PARSONS: On the Purchased Services issue, 06, from what you spent

again last year, $5,000 to $16,000 this year, what is the rationale for that?

MS E. MARSHALL: Again Purchased Services provides for entertainment of

dignitaries on behalf of the department. I can tell you, that I entertain very

little, or I did last year, and that the same amount that was budgeted last year

was put in for 2004-2005.

MR. PARSONS: Are you planning to do more entertaining?

MS E. MARSHALL: Not really, but the funding is there.

MR. PARSONS: The funding is there should you wish to entertain, is that

what you are saying?

MS E. MARSHALL: Yes.

MR. PARSONS: Given a fiscally responsible government then, Minister, why

would you budget it if you do not know you need it?

MS E. MARSHALL: As I say, I had six months in the department and the

first six months were a busy time. I do not know what historically is required

of the department on an annual basis. The funding is provided, but if it is not

needed it will not be spent.

MR. PARSONS: Under the heading, 1.2.01, Salaries again, according to my

figures from the actuals of last years to now we are looking at a $42,100

increase. I can appreciate, again, that those salary details would include that

Director of Communications that has been put back into the Executive Support

side, but I have difficulty with the figures if that person is being paid

$62,000 and the figures here only show a $42,000 increase.

MS E. MARSHALL: There is one less ADM there, which would account for

probably part of the difference. The salary costs for that ADM would have come

out and then the -

MR. PARSONS: Director in?

MS E. MARSHALL: Yes, and there could be a bit of annualization, but to do

a dollar for dollar comparison, I would have to - I think I will refer to Mr.

Strong. He has more details on the salary dollars.

MR. STRONG: There were some changes in the executive personnel from last

year, the new Deputy Minister, compared to last year's budget when it was

prepared. Our medical consultant is in this vote as well and there were some

increases that he got in line with the (inaudible).

MR. PARSONS: Under Professional Services, 05 of that heading, $50,000,

what type of Professional Services would your department use?

MS E. MARSHALL: It provides for the cost of services associated with the

department's communications plan. Again, I will have to refer to Mr. Strong

for more detailed information on that.

MR. STRONG: We engage consultants occasionally for our communications

plan. Likewise, the Purchased Services would be the purchasing of advertising.

MR. PARSONS: Under the revised last year, $167,000, up from the budgeted,

$96,500, that you put back in this year as a budget figure, any particular

reason it went to $167,000?

MS E. MARSHALL: Yes. There were some legislative changes made to our

post-adoption services that promoted more open adoption, so that adult adoptees,

as well as their birth parents, could apply for information. I guess, for the

adult adoptees it would be information relating to their birth parents and in

reverse for the birth parents to obtain information relating to the adult

adoptees.

There was a flyer that arrived in the newspaper, and you probably saw it. It

arrived with The Telegram . We did send out two flyers, which indicated

the changes that were being made to the legislation, indicating that if adult

adoptees or their birth parents did not want certain information provided they

would have to notify vital statistics or the Department of Health and Community

Services. It was either a disclosure or a veto with regard to the release of

information. That was put out in a flyer to make people in the Province aware of

it. As a result, again, of the public sector strike there was a delay. There was

a deadline of April 30, and the deadline was extended as a result of the public

sector strike, so I believe a second flyer was also inserted in The Telegram .

MR. PARSONS: On page 192 of the Estimates, Administrative Support,

1.2.02, $3,153,900 budgeted for Salaries, what is the explanation for this

$84,900 increase in Salaries in Administrative Support?

MS E. MARSHALL: I am going to defer again to Mr. Strong for the details

on that.

MR. STRONG: The budget is down from the original budget of $3.3 million.

The increase from $3,069,000 to $3,153,900 would be primarily the annualization

of salary increases, step progressions and things like that.

MR. PARSONS: Under the salary details for Administrative Support shown on

page 140 of the Departmental Salary Details book, there are about thirty-seven

or thirty-eight different positions noted there, starting off with the Director,

Financial Operations ending with the Data Entry Operator; probably more than

that, forty I guess. Are all of these positions currently filled?

MR. STRONG: No.

MR. PARSONS: Can you identify for us which of these positions are

currently vacant?

MR. STRONG: I do not have that detail here but I can get it for you.

MR. PARSONS: You can provide that to us I take it. Whenever we ask

questions and there is an undertaking to provide, I assume we will get this

before the Budget debates close off, because this will be relevant to the

Concurrence debates that we are going to be having in the House before we clue

up the Budget. We need to have it in a timely fashion to deal with that.

MS E. MARSHALL: Just to make sure now: For account 1.2.02, for the

sixty-eight positions that are listed as being permanent in the Salary Details

book, you would like to know how many are filled permanently and how many are

filled by other means?

MR. PARSONS: Yes, and to save time, not only do I wish to have that for

the Administrative Support, but in all of the references in the Health and

Community Service's Estimates that refer to employees. As listed in the detail's

booklet, because that is only one heading, Administrative Support, could you

provide me with a list for all of them and identify which of them are currently

vacant. Is it your intention to keep some of these vacant or are they being

advertised? I know in each department, for example, we may budget for all of

these positions and for whatever reasons, cost-savings measures, we try as a

department not to fill them if we do not have to so that we can indeed save some

money. I am sure there must be some of these here that are currently vacant, and

probably have been vacant for quite a while, and you have no desire or no

intention of filling them immediately.

MS E. MARSHALL: Yes. There would be some that are vacant that would

remain vacant, but there may also be some which are currently vacant which may

be filled if we do have the funding.

MR. PARSONS: If you could give us some indication of which are vacant-

MS E. MARSHALL: Yes.

MR. PARSONS: - all of which are vacant and an indication of whether they

are going to be advertising to be filled within this current year, or if you

have made no plans to fill them in this current year; some indication of that.

MS E. MARSHALL: At this point and time, because we may, for example,

think that we are not going to fill the position and then six months down the

road we may.

MR. PARSONS: Things may happen that you may have well have to change your

mind and then you have to hire. My purpose in asking, of course, is it gives a

more accurate reflection of what your are budgeted up for, what you are geared

up, for in terms of staff, what the cost of those staff would be if you had a

full complement. We would know from day one, at the time that you do the budget,

exactly how many vacancies there are, and we would have some indication of where

you intend to go for the next twelve months. At least then it makes it easier,

at the end of the year when we see the actuals for salary details, pretty easy

then to say, well, it is quite accurate, that what was vacant was not filled and

so on. I think it makes it easier and more accurate.

We will move on to Mr. Butler. I think my fifteen minutes are up.

CHAIR: Thank you for remembering and making my job easier. He keeps track

of his own time.

MR. BUTLER: Thank you very much, Mr. Chair.

One of the questions that my colleague asked, with regard to the Grand Bank

facility - and I think I understood you correctly when you said that the cost

that was gone into it, at that point and time, was $3 million.

MS E. MARSHALL: Yes.

MR. BUTLER: And you are anticipating there will $300,000 to take the

steel down. I guess that is to return the property to foundation there, and the

full thing. What I am wondering, from that, once the steel comes down is there

any value on how much money you might recoup from the sale of the steel, or will

you use it again somewhere else?

MS E. MARSHALL: I have no estimate on that, but I have raised it with the

Minister of Transportation and Works and we are waiting to hear back from them

as to what we can do with that steel.

MR. BUTLER: The other thing: I know you mentioned in your opening remarks

about the dialysis system for Carbonear and other areas, and I know your

intention was that the one in Carbonear would be up and running this summer. I

was just wondering if you could update me on that? Is that still the projected

time?

MS E. MARSHALL: I think it is a little bit later, again because of the

public service strike . I will just refer to Ms Hennessey - it is late summer?

MS HENNESSEY: Some time in the fall.

MS E. MARSHALL: It has been moved to this fall. We have hired the

coordinator. There is a coordinator now on staff in the department who is

coordinating dialysis services so that service will be available in the fall.

MR. BUTLER: So, it will be up and running this fall, and at least people

will not have to travel back and forth this year?

MS E. MARSHALL: Yes, that funding has been provided for that.

MR. BUTLER: The other thing, minister: I know over the last several years

long-term health care has been an issue, not only in our area of Conception Bay

North but all around the Province. I was just wondering what is the status of

the reviews that have been done in the past with regards to long-term health

care for Conception Bay North area?

MS E. MARSHALL: I am somewhat familiar with some of the reviews that have

been carried out in the past. We recently had a review completed of the personal

care homes in Newfoundland, and that review has just come in. We are going to

carry out a review now of long-term care in the Province. We are in the very,

very preliminary stages of that, so I am unable to make any further comment on

that except to say that we are anticipating carrying out a review.

MR. BUTLER: That would still include, I guess, the Conception Bay North

area?

MS E. MARSHALL: Yes, that would include all areas, both Newfoundland and

Labrador.

MR. BUTLER: With regard to the timeline of February that you gave to the

various health boards with regards to a request as to what they plan on doing in

balancing their budgets and so on, I was just wondering - I know you probably

cannot provide all of the details this evening, but as you know there are some

rumours circulating in our area and people are getting really concerned. One of

the options that we hear in the area is the possible closure of twenty-five beds

in that particular facility. I think it only has seventy-four beds, if I am not

mistaken, somewhere in that vicinity. I was wondering, is there anything to

that? Maybe you cannot diverge what -

MS E. MARSHALL: I heard that rumour also, but I can assure every member

on the Committee that there have been no decisions made with regard to services

provided by the health care boards. I did hear that the other day also, and I do

not know where the rumour came from.

MR. BUTLER: Okay. I guess each and every year we hear about beds closing

for the summer season. I am just wondering: Is there any anticipation of how

many beds might have to close, not only in that area but all over, this summer?

Will any hospital beds be closing? Usually, in the summer you hear of so many

beds closing down. Are there any figures that you could release on that?

MS E. MARSHALL: I have not been informed by the boards. I can check with

Ms Hennessey. Have you heard anything from the boards with regards -

MS HENNESSEY: (Inaudible).

MS E. MARSHALL: My officials have informed me that we usually hear from

the boards in June and they will provide us with the information at that point

in time.

MR. BUTLER: Okay. One of the problems that we have in our area, and I

guess it is not only common to that area, and I do not know if it was ever

looked at it, is with regard to general practitioners. I guess we are fortunate

in some instances, as compared to other areas of the Province, in that we have

quite a few general practitioners, but a lot of the residents in our area have

to travel to St. John's to see a general practitioner. The people who are

there are just booked up solid, and to make matters worse, a couple of doctors

did move into the city and they even have to travel back to the area to look

after the patients they had, because they could not get on with anybody else. I

am just wondering: Through your department has that ever been looked at? I am

sure it is not only a common thing in our area, some other areas are probably

worst than that.

MS E. MARSHALL: Actually, what we find, just going throughout the

Province, is that some boards seem to have more success than other boards in

attracting and retaining doctors. I can tell you, that the number of doctors in

the Province has increased over last year. While there may be a shortage of

physicians in certain areas, I know in the area that you are referring to,

sometimes people elect to travel to St. John's, they make the decision that

they want to come to St. John's for medical services. I do not know if that is

the situation you are talking about or if it is because physicians are not

available in the district?

MR. BUTLER: Minister, what it is now is, the physicians that are there

have such a big caseload that they cannot take any more patients. When a doctor

moves out, they probably might have 700 or 800 to 900 , and they cannot get in

with any of the other clinics, or some of the doctors in the same clinic where

that doctor moved from. I know one particular doctor moved here to Mount Pearl,

and those people are just left out. They have to travel to St. John's to see a

general practitioner, unless there is an emergency and they go to the Carbonear

Hospital, but they do not have a family doctor.

MS E. MARSHALL: I have not had any discussions with the seniors officials

on the board that you referred to. I have had some discussions with other boards

in the Province, and they have not been as successful as they would like in

attracting many physicians. I do not know if Ms. Fry or Ms. Hennessey can

comment on that further, with regard to the supply of physicians in the

Conception Bay North area. I do not know if that has come to your attention.

Doctor Bradbury is going to speak.

DR. BRADBURY: We have noted that there is a decrease in general

practitioners on the Avalon region. The number suggests that forty-four

physicians were there last year and there are forty-two there presently,

unfortunately, so that the location of general practitioners and the type and

the amount of services that we provide - our problem is not only in specific

areas within Newfoundland but across the country, and no doubt has resulted in

national attempts and plans to look at primary care reform. Certainly this area

has been prioritized by this government.

MR. BUTLER: I will move on to 2.1.01, Memorial University Faculty of

Medicine, and follow down through that area. Under 2.1.01, I take notice - and

there is probably a reason for - but there are no salaries allocated under that

heading. Is there a reason for that, that I am missing? Are there supposed to be

any there or not?

MS E. MARSHALL: You are talking about the Memorial University Faculty of

Medicine?

MR. BUTLER: Yes.

MS E. MARSHALL: No. We provide the grant to the Faculty of Medicine and

it is a flat amount. They have their own administration, they have their own

financial statements and their own budget. They are part of the University. The

Department of Education funds most of the University, but the Department of

Health is unlike other jurisdictions in that the Department of Health and

Community Services funds the Faculty of Medicine.

MR. BUTLER: Okay. Under Grants and Subsidies, I notice an increase of

$1,030,100. I was wondering if you could explain what the increase is there?

That is still under 2.1.01, Memorial University Faculty of Medicine.

MS E. MARSHALL: From the $21,753,200 there was an increase there

attributable to salary increases and employee benefits. There is $500,000 there

for pension reform. I was speaking to Mr. Strong about it earlier today, so I am

going to let him comment on it.

MR. STRONG: That was funding for changes to the Memorial University

Pension Act for indexing.

MR. BUTLER: Under 2.2.01, Drug Subsidization, I will ask the same

question again. There are no salaries listed there, so I am just wondering how

is that administered or who administers that.

MS E. MARSHALL: The costs that are reflected in that program are

primarily for the actual costs of the drugs. The $956,000 that is there, I

believe, is relating to the administration of the program at xwave.

OFFICIAL: That is right.

MS E. MARSHALL: That is correct, is it? Yes.

The processing is done through xwave. It is a longstanding agreement between

the government and xwave. They do the processing of the claims that are paid out

to the various pharmacists.

MR. BUTLER: Under Allowances and Assistance, 2.2.01, it went from

$56,581,000 to $61,142,600. That is over $5 million. I guess that is where you

referenced earlier, is it, about the new drug program?

MS E. MARSHALL: Yes. The only new drug that we approved this year was

Gleevec, the cancer drug, and it was $800,000, and $400,000 of the increase was

put under the Income Support drug program and the other $400,000 under the

Senior Citizens' program. The rest of the increase is directly attributable to

utilization, that there is increased utilization of the drugs and also a factor

for inflation. There has been an extra eight point something million dollars put

into the drug program, but only $800,000 million of that is for a new drug. The

rest of it is, as I say, for increased utilization and inflation, when the cost

of the drugs go up.

MR. BUTLER: Under subheads 2.2.02 and 2.2.03, Senior Citizens and the

Special Drug Programs, there are no salaries mentioned. I guess that is the same

as up under the -

MS E. MARSHALL: It is the same, yes. The staff who are involved in the

administration of the program would be budgeted for under Medical Services.

OFFICIAL: Pharmacists.

MS E. MARSHALL: Pharmacists, yes.

MR. BUTLER: Under subhead 2.3.01, Physicians' Services, I think there

is an increase there of $11 million. Am I correct on that? The budget was $169

million and it is up to $181 million.

MS E. MARSHALL: There was a new MOU entered into with the physicians. You

probably may recall that there was a physician strike. There was a new agreement

entered into with the physicians, and, of course, this led to increased costs.

If you notice, by looking at that account centre there, the budget for 2003-2004

was $169 million, then it went up to $184 million, and then it went down to $181

million. It was because some of the increases that were negotiated in the new

agreement were what we call front-end loaded. Of course, you get a blip in your

increase, up to the $184 million, and then it fell back a little bit, to the

$181 million.

Mr. Strong can correct me if I am wrong, because I am fairly new to the

department, but I believe that the Professional Services

section there, Mr.

Butler, is fee-for-service. Some of the physicians are on a fee-for-service

arrangement while others are on a salary arrangement. I believe 05 is the fee

for service. The category marked 10, Grants and Subsidies, would be salaried

physicians. I think the one in the middle there for $6 million has something to

do with out of Province.

MR. STRONG: That is right. That would be for services received by

Newfoundlanders in other provinces, insured services.

MR. BUTLER: Did you say, sir, services by Newfoundlanders in other

provinces or ones who travel to other provinces?

MR. STRONG: If you use your MCP card in Alberta or another province, we

bill.

MR. BUTLER: I guess under that same one would be, for instance, if there

is anyone away receiving transplants or whatever, they can put their costs in

and they will get so much reimbursed. Would that be under that same heading?

MR. STRONG: The cost of what we call out-of-Province payments for things

like transplants would be in the Health Facilities Budget. This would be just

for physician services.

MR. BUTLER: Grants and Subsidies: You have probably touched on that one

because there is an increase there of $12,433,000.

MS E. MARSHALL: Yes, those are doctors on salary.

MR. BUTLER: Revenue, the same subhead, 2.3.01, there is an increase for

$300,000. Is that money that is coming in from the federal people? The

provincial revenue increase there by $300,000?

MS E. MARSHALL: Those are the revenues that we receive as a result of our

audits.

MR. BUTLER: Could you explain that to me, when you say you received that

from your audits?

MS E. MARSHALL: Some of the revenue is from audit coverage. We do ongoing

audits of physicians and sometimes, as a result of those audits, we make

recovery. Part of it is attributed to audit recoveries and the rest would be

reciprocal billings, which is sort of the reverse of what we were talking about,

Newfoundlanders being away. It is people from outside the Province who come here

and receive services. We would bill their province and we would receive money

MR. BUTLER: So it is from billings, we will say, basically?

MS E. MARSHALL: Yes

MR. BUTLER: Subhead 2.3.02, Dental Services: I notice there is no - well

there is a change, I guess, because the budget last year was $4,775,000 and now

it is $300,000 less. Really, you have gone back to what the revised budget was.

MS E. MARSHALL: We put the budget at what the actual usage was last year.

One of the issues with regard to this program is that we have some concern as to

whether the program is reaching the children who it was intended to reach. We

will be doing a review of that program during the upcoming year.

MR. BUTLER: Okay. Under Emergency and Transportation Services, 2.4.01: I

will have to ask just for clarification. There are no salaries listed, but I

guess it is the same as all the other -

MS E. MARSHALL: Yes, that is correct.

MR. BUTLER: Under Allowances and Assistance, there is a decrease there

from $4,663,000 to $4,130,000. I am wondering why that cut is there.

MS E. MARSHALL: That is because we increased the cost of ambulance trips.

The extra revenue that is being charged will be netted in against the

expenditure and that is why the expenditure is being reduced.

MR. BUTLER: That is the increase that was announced in this year's

budget?

MS E. MARSHALL: Yes.

CHAIR: I remind the member for Port de Grave that his time has - if you

want a question to rap up before we move on.

MR. BUTLER: I only have another one there sir, and it is probably just as

well to finish them right now.

CHAIR: I will give you latitude. Go right ahead.

MR. BUTLER: Under the same heading, 2.4.01, Grants and Subsidies, an

increase of $4,162,700: I was wondering if you could explain that huge increase.

MS E. MARSHALL: That is similar to the physicians in that there was a new

one-year agreement reached with the ambulance operators last year. That

agreement resulted in an increased cost to the department. The contract expired

the end of March past and it has been extended to the end of May, the month that

we are in now, and we have commenced preliminary negotiations with the ambulance

operators.

MR. BUTLER: That was going to be the final part of my question, but I

think you probably touched on it just now. I was going to ask you how are the

negotiations going now, because we hear different reports.

MS E. MARSHALL: Yes, we have started negotiations.

MR. BUTLER: Very good.

Thank you, Mr. Chair.

CHAIR: Thank you.

The hon. the Member for Labrador West.

MR. COLLINS: Thank you, Mr. Chair.

I have a couple of questions for the minister. I would like to start of by

asking if, during the negotiations with the federal government or meetings with

the provinces and the federal government for funding for health care, have there

ever been any discussions held on funding the provinces differently than the way

that they are funded now, in terms of the per capita funding?

MS E. MARSHALL: Most of those discussions would have been held with the

Minister of Finance, but I can say that I have had one meeting with Mr.

Peddigrew in which I discussed increased funding. In addition, I did have a

telephone conversation with him a couple of weeks ago, again regarding increased

funding for health care. As well, I have had meetings and telephone

conversations with junior ministers also in his department, again aimed at

increased funding for health care, not just acute care but also for public

health and different other areas of health care.

MR. COLLINS: It seems to me, given our geography compared to P.E.I. or

Nova Scotia or New Brunswick, puts us at a very unfair disadvantage in trying to

deliver-

MS E. MARSHALL: You must be referring to the geography of the Province?

MR. COLLINS: Yes.

MS E. MARSHALL: That issue has been raised with Mr. Peddigrew during our

discussions. In addition, some of the Territories also have an issue with regard

to geography and we have been discussing that issue with them, as to some sort

of joint discussions. I do not think I should say joint proposals. We have

identified other areas or other jurisdictions that are concerned with that

issue. We have been having discussions with them also, but it has been raised,

yes, with the federal ministers.

MR. COLLINS: The Provincial Drug Program: I guess you have heard me

address many times in the House the question of drugs for MS and Alzheimer's.

Do you know if there has ever been any comparison done? I know the cost of

providing the drugs upfront - we are the only jurisdiction in this country that

does not provide any type of assistance to suffers of MS or Alzheimer's to

help them with their medications, which, as you know, are quite expensive. Has

there ever been, to your knowledge, any study done, sort of comparing the cost

of providing the drug upfront in relation to what happens to people who do not

take the drug, ending up in health care institutions at a greater burden to the

health care system?

MS E. MARSHALL: I have read some studies with regards to the Alzheimer's

drug. Again, I am sure that there are a variety of studies out there, but I have

read several that have indicated that it is not possible to identify whether

there would be savings as a result of using the drug. I would like to say that

there are a number of drugs which we have been requested to add to the

formulary; the MS drug, and there are also drugs for arthritis as well as the

Alzheimer's drug. The decision has been primarily financial at this point in

time.

Again, as I indicated, I have read some studies on the Alzheimer's drug

which indicate that it is not categorically proven that there would be savings

resulting from the use of that drug. We are doing a review of the drug program

right now to determine whether we could identify savings to cover some

additional drugs. In addition, the federal government has been, for some time

now, talking about a catastrophic drug program which I would surmise will give

us extra funding for drugs, but I do not know what the outcome of the

discussions on that program will be. It is something that we are keenly

interested in pursuing. At this point in time, the $106 million was what we

allocated for the drugs for this year.

MR. COLLINS: Are you aware of the study that was done - I think this was

just released recently - by Memorial University, the Division of Community

Health at MUN? It is quite alarming really. It talks about the issue of the

burden of expenses on cancer patients in Newfoundland and Labrador.

MS E. MARSHALL: That was released probably within the last month?

MR. COLLINS: Yes.

MS E. MARSHALL: Yes, I have read that. Actually, I had a meeting with

Peter Dawe who is the President of the Cancer Society, and I also followed it up

with a telephone conversation in which we did discuss the outcome of the study.

I think it is a short paper.

MR. COLLINS: Yes, I think it is only a four-page executive

summary and I

think there are eight more pages to come.

MS E. MARSHALL: It was only recently released, so we are only just now

looking at it. I think one of the biggest issues goes back to cost and whether

we would be able to afford an increase through the Budget, but having said that,

yes, we are looking at that study.

MR. COLLINS: As I say, it is quite alarming when you are looking at - and

it is a pretty in-depth survey of 484 patients and 21 doctors.

MS E. MARSHALL: I believe it covered a three-year period also?

MR. COLLINS: It did.

It talks about some people having to pay over $5,000. I guess, one of the

real alarming statistics that they have talked about is that, to reduce some of

the out-of-pocket patient costs some cancer patients ration their medication.

MS E. MARSHALL: Yes, I discussed that with Mr. Dawe. They identified

people who elected not to receive services in St. John's because of the

expense.

MR. COLLINS: Because of the cost?.

MS E. MARSHALL: Yes.

MR. COLLINS: Is there anything in the plans right now to address that,

even though, as I say, it has only been out for about a month?

MS E. MARSHALL: There was no additional funding provided in the Budget

for that, but having said that, I have had, again I would say preliminary

discussions with my officials on it. It is something that I will be following

up, because the commitment was made to Mr. Dawe that I would be getting back to

him.

MR. COLLINS: Sort of along that same line: there is a non-emergency

medical relief fund in the Province that people have utilized from time to time,

but again, according to the study, only 6 per cent of people have opted to use

that. I am inclined to believe that the reason that number is low - and I run

into it pretty regularly, on a weekly basis probably. In spite of all the people

who do use it in my district, I still run into people in my own district and

across the Province who are still not aware that there even is such a program.

Is there any way that your department has looked at identifying that by making

sure that information is available in doctor's clinics, at hospital rooms or

other things?

MS E. MARSHALL: Actually, I noticed that in the study, and I have had,

again because the report is new, preliminary discussions with Ms Hennessey. Ms

Fry has just returned from holidays today, so I have not had an opportunity to

discuss it with her, but I have raised that issue with Ms Hennessey, as to how

we could make that program better known.

MR. COLLINS: Okay.

MS E. MARSHALL: Ms Fry has just passed me a note. She said the program is

on the government website and the social workers at the cancer clinic are aware

of it. Again, as you indicated, and as noted in the study, there does not seem

to be a high profile with regards to that.

MR. COLLINS: It is not just for cancer patients, it is for anyone.

MS E. MARSHALL: I know that, but I believe the report was done for the

Cancer Society.

MR. COLLINS: Specifically, yes, 6 per cent of their (inaudible).

MS E. MARSHALL: Yes, I read that.

MR. COLLINS: I noticed there wasn't anything in the Budget, but is

there anything on the horizon from your department that would alleviate people

in the Western part of Labrador in terms of availing of CT scans, mainly in

Happy Valley-Goose Bay? As I have said many times here in the House of Assembly,

we are the only people in Labrador who are not entitled to any type of

assistance whatsoever, when we have to travel to the regional centre in Goose

Bay to avail of a service that is not available in our own area. Every other

person in Labrador has that, and Happy Valley-Goose Bay had the same subsidy

prior to receiving the CT capabilities when they traveled to St. Anthony for

that service.

MS E. MARSHALL: Are you referring now to the cost of transportation for

people in Lab West?

MR. COLLINS: I wonder if it would come under transportation, because the

health corporation - the reason I ask you that is, my first inclination was that

it was probably to do with the Department of Transportation where it involved

travel, but my understanding is that this cost is not directly through the

Department of Transportation, it is, in fact, a cost that is absorbed by the

Labrador Health Corporation. They, in turn, have informed me that they have no

problem covering residents of Labrador West if they receive funding from the

government to do so.

I could be wrong, I do not know this for a certainty, but I thought that it

came and was billed - I know that in the financial report, the financial audit

of the Labrador Health Corporation, air ambulance - and it is under air

ambulance - is covered off under that.

MS E. MARSHALL: Are you familiar with that, Ms Hennessey? Can you speak

to that?

MS HENNESSEY: (Inaudible).

MS E. MARSHALL: When you talk about their financial statements, you are

not talking about the study that was done on Health Labrador by Deloitte and

Touche, are you?

MR. COLLINS: No, the financial statement of the Labrador Health

Corporation, the audit.

MS E. MARSHALL: The audit. It must have been in the management letter. I

am not familiar with the document. I am just puzzled here now, because I read

their financial statements and their management letters, but I do not remember

seeing it referenced there.

MR. COLLINS: It is not referenced as such. That is why I had a bit of

difficulty finding the exact numbers in the beginning. When I questioned a huge

figure that was there, it was pointed out to me that it was the cost of bringing

patients into Happy Valley-Goose Bay.

MS E. MARSHALL: From the Coast?

MR. COLLINS: From the Coast.

MS E. MARSHALL: From the coast, okay.

I would have to take that under advisement because I am getting into an area

there now where I am not quite sure of the numbers that you are talking about.

MR. COLLINS: It is a subsidy by the Health Care Corporation.

MS E. MARSHALL: The concern that you have is that the subsidy should be

extended to Labrador West, is that correct?

MR. COLLINS: We are the only people in Labrador who are not entitled to

it.

MS E. MARSHALL: Did you say you had discussions with Health Labrador?

MR. COLLINS: I have had discussions with Health Labrador who told me that

if government provided the funding for it they would have no problem expanding

their program. The total cost to do that, based on the figures that we have,

that the Chair of the Committee is well aware of, is a cost of $40,000, which is

not a lot of money to government, but the $40,000 broken down to 100

individuals, many of whom do not have any insurance plans - if they are not

working in the higher paying jobs in my district, they do not have vehicles good

enough to drive to start with.

MS E. MARSHALL: Are your comments also in relation to the $40 fee that is

being charged on the coast?

MR. COLLINS: Yes.

That is absorbed, that is a subsidy by the Health Care Corporation.

MS E. MARSHALL: We have been looking at that because, as you say, the fee

for $40 is just on the Coast and it does not extend to Labrador West. The other

thing is, we could also increase the cost, I guess, over on the Coast, but that

is not the solution you are looking for.

AN HON. MEMBER: You got that right.

MS E. MARSHALL: You are looking for consistency, but consistency with the

Coast.

MR. COLLINS: I am looking for consistency throughout the region that is

serviced by the -

MS E. MARSHALL: Yes, you and I have talked about it.

MR. COLLINS: In other areas of Labrador, of course, it is in place to go

to St. Anthony.

MS E. MARSHALL: There is no funding provided in the Budget to provide any

type of subsidy to Labrador West, but I am well aware of the issue because you

have raised it with me a number of times. Some of the programs, the travel

programs, we will be reviewing during the program review and program renewal

process, so that will be looked at, at that point in time.

MR. COLLINS: When will that take place?

MS E. MARSHALL: That will be taking place over, I would say, probably the

next nine months or so. We will be looking at a significant number of programs

in the government departments. For programs that are in my own department there

will be certain select programs that will go into program review. That would be

one of the programs because the Health Labrador Corporation, I do not know if

you have read the report that was issued by Deloitte, but they also discussed

the $40 travel fee for residents of the Coast of Labrador. That was addressed in

that report and we are aware that is there and has to be addressed.

MR. COLLINS: Are there any other reviews going to be conducted, because I

notice there wasn't anything in the Budget, speaking of the report on the

Labrador Health Corporation, for a facility or a massive upgrade to the Captain

William Jackman hospital, because it is in deplorable condition.

MS E. MARSHALL: Yes, I visited the hospital.

MR. COLLINS: I know you did, yes, and you could see for yourself what is

going on there.

MS E. MARSHALL: Yes, I saw it for myself.

MR. COLLINS: Is there anything -

MS E. MARSHALL: There are no plans yet, but as I indicated to Ms Jones, I

believe we are going to be looking at all of our facilities and doing a

long-term plan as to what facilities need to be upgraded and where we need new

facilities. That will be conducted during the current fiscal year. Also, as I

indicated earlier, it was not my intention to hire any consultants or to incur

additional costs to do that review, but that is something that I am hoping we

will be able to do in-house, because there are a number of facilities around the

Province; the hospital that you referenced, and also I spoke earlier about the

Grand Bank clinic which is also in bad condition.

CHAIR: It sounds like a good question to end on. It sounds like a good

question to break on. We said, when we started, we would take a ten-minute break

halfway through. Let's come back together, then, at 8:45 p.m. We will take a

ten minute break and come back and pick it up from there. I cannot offer you any

refreshments, other than the water you have on your desk.

Recess

CHAIR: Thank you for your prompt response to the bells. I think when we

finished off, the Member for Labrador West had just wrapped up his questions.

MS E. MARSHALL: (Inaudible).

CHAIR: By all means.

MS E. MARSHALL: (Inaudible) now on some of our discussions, and I know

Mr. Collins was asking about the per capita funding and talking about funding

for health care, and I just want to mention that there are meetings scheduled

for the end of May with the Finance Ministers and the Health Ministers, jointly.

Just to let you know, there is dialogue between the Finance Ministers and Health

Ministers regarding the funding and whether it should be per capital funding or

some other formula. I just wanted to let you know that.

MR. COLLINS: Maybe we would be served by the other formula, whatever it

might be.

MS E. MARSHALL: Yes.

CHAIR: Thank you, Minister.

We ended with the Member for Labrador West. Who wants to go next? The Member

for Cartwright-L'Anse au Clair. I am going to give you a few minutes to wrap

up.

MS JONES: Thank you, Mr. Chairman.

It should not take me too long to do that, a few hours at the most.

I want to go back to page 197, 2.3.01, of the Estimates. My colleague asked

some questions earlier with regard to the medical care plan. I just wanted to

follow up with a few more questions, if I could? The fee-for-service for doctors

has increased according to the numbers here, it increased last year. This year

it is down a little bit but it is still an increase over the budgeted amount. Is

there more demand for fee-for-service doctors in the Province today than there

has been, and can you tell me how the percentage of expenditure for

fee-for-service doctors has grown over the past four to five years?

MS E. MARSHALL: I do not have the breakdown. I can tell you that as of

March 31, 2004, there were 948 physicians in the Province and fee-for-service

accounts for 609 of those. I do not have the number for a year ago.

OFFICIAL: (Inaudible).

MS E. MARSHALL: Yes, I do here now. I gave the number of 609, so add

those two together here now. It was 568 a year ago.

MS JONES: Is the fee-for-service retained doctors increasing because the

permanent physician numbers are decreasing? Is that the reason for it, or are we

adding more fee-for-service?

MS E. MARSHALL: The fee-for-service: anybody can come in and set up a

practice with fee-for-service. I do think now I can turn it over to the

officials, because they have a better history with the department. The most

recent MOU that was negotiated with the doctors seems to have had some positive

results in that it seems there are more doctors coming to the Province. The

fee-for-service doctors has gone up. I am just trying to take a look here now

for the salaried doctors. It was 346 a year ago for the salaried doctors and it

is now 339, so that is close.

MS JONES: The fee-for-service doctors, has there ever been a tracking

system on them? For example, are they all Province-based doctors or are they

coming in from other provinces? I am just wondering, are there doctors that set

up practice in the Province and do nothing else only fee-for-service in

Newfoundland and Labrador and in other provinces as well? I am trying to get an

understanding of how that works. I know they make a lot more money then salaried

physicians. I guess it is more appealing, but I guess there is a little more

travel.

MS E. MARSHALL: The fee-for-service would depend on your practice and how

big your practice is. Tracking over the years - I do not know if Doctor Bradbury

might be able to offer some information, but I do have some statistical

information that I will just take a browse through while Doctor Bradbury is

speaking to that.

DR. BRADBURY: Historically, about 30 per cent of the Province's

physicians have been salaried, and in the past two to three years that number

has gone up from 30 per cent to about 36 per cent to 38 per cent. We have seen

two phenomenons over the past two to three years. One, is a net increase in the

total number of physicians in the Province, as well as an increasing interest in

salaried arrangements rather than fee-for-service.

MS JONES: What was the total salary increase negotiated this year for

physicians, on a annual basis?

DR. BRADBURY: There was a three- year agreement that was signed, that was

retroactive to October 2002, for a three-year period, and during that three year

period salaried physicians were scheduled to receive an 18 per cent increase, 8

per cent in year one, 5 per cent in year two and a second 5 per cent as of

October of this year.

MS JONES: What was the total amount of money on an annual basis?

DR. BRADBURY: For salaried physicians?

MS JONES: Yes, in dollars. For example, the 8 per cent last year would

have been how much voted, and the 5 per cent this year would have been how much

voted?

DR. BRADBURY: Between $8 million and $8.5 million.

MS JONES: That is annually, right?

DR. BRADBURY: Yes, but it was added incrementally over the three years of

the agreement.

MS JONES: Under that same heading, you talked about the professional

services in the billings, the MCP billings from other provinces. Do you have a

breakdown of the billings from the Province of Quebec and do you have a

breakdown of what billings are directly associated with the Blanc-Sablon

Hospital System?

MS E. MARSHALL: They would have that information in the department, but I

do not have it here. The information is broken down by province. You are just

looking for the Province of Quebec?

MS JONES: No, I would like to have a breakdown of the billings from all

the provinces or territories, and if there were any billings outside of the

country.

MS E. MARSHALL: I would think there would be some from outside of the

country.

MS JONES: Also, if you have a specific breakdowns of billings from the

Long Point Hospital in Quebec, I would like to look at those because most of

those would be from my district. I am interested in seeing that.

MS E. MARSHALL: Yes, okay.

MS JONES: The other question - this issue, again, was raised by my

colleague, the Vice-Chair - with regard to the audit recovery, you guys said

that this was a result of audits by physicians. Are these false billings being

made by physicians themselves to the department? Is that what you are -

MS E. MARSHALL: No, not necessarily.

MS JONES: Can you explain that to me, please?

MS E. MARSHALL: I will have to turn it over, probably, to one of the

officials to further elaborate, but if there is insufficient documentation, for

example, to substantiate billings, we would make recoveries. I think the amount

that was budgeted, or the amount that is in the budget, would have been about

$150,000. Whether there have been any cases with regard to fraudulent activity,

I am not aware of any. I do not know if there had been any prior to my arrival

at the department or not. I could probably just turn it over to one of the

officials.

DR. BRADBURY: In the history of MCP, there has been one physician who has

been referred to the RCMP with regard to a fraud investigation.

MS JONES: Okay, thank you.

A question under 2.3.02, Dental Services. The government continues to

subsidize dental services in Northern Newfoundland and Southern Labrador. Will

that subsidization continue or is that part of the dental review that you are

referring to as well?

MS E. MARSHALL: Those services and that program will continue. The

primary concern that we had in the department was that the cost of the dental

services is not born 100 per cent by the program. As a result, we were concerned

that the program was not reaching, probably, the target we wanted to reach,

because families were required to pay a certain portion of the cost. We were

concerned that some children who should be receiving the services were not,

because of the cost to the families. Therefore, we decided that during the

current fiscal year we would be carrying out a review of that program.

MS JONES: I would also like to go back to the drug subsidization program

again for a minute. Again these questions were raised by some of my colleagues

this evening. In the budget you voted $8.6 million for an increase in the drug

program. That $8.6 million increase, was that increased costs that were occurred

last year with regard to drugs or is that what you are projecting to be a new

increase this year?

MS E. MARSHALL: That is what we are projecting to be a new increase. Just

to give you the numbers, in 2003-2004 the Budget approved $97.3 million. Our

expected expenditures for that same fiscal year were going to be $98.3 million,

so it exceeded its budget by about a million dollars. This year the budget is at

$106.9 million.

MS JONES: With regard to the Alzheimer's drugs, that has been a huge

issue in the Province, especially for the Alzheimer's Society and for families

who have loved ones who are, I guess, affected by the disease. They launched a

very aggressive campaign, in my opinion, towards the previous government of

which I was a part, and now towards the government of which you are a part. It

is my understanding that there was an Atlantic review done of two of the drugs

that were being looked at, I guess, to be prescribed to Alzheimer's patients,

and my understanding is that the Atlantic review policy, when it was completed,

recommended that these drugs be added to the formula in each of the provinces

and be provided to Alzheimer's patients. Is that not accurate?

MS E. MARSHALL: I am not familiar with that review. I am aware that all

provinces do cover that drug, but I will refer it to my officials to find out if

they are aware of the Atlantic review.

OFFICIAL: (Inaudible).

MS E. MARSHALL: My officials say, yes, that the Atlantic review did

recommend that drug be added to the formulary, but that it was left up to the

provinces as to when they would add that drug to their formulary.

MS JONES: Your department had someone sitting on that Atlantic review, is

my understanding?

MS E. MARSHALL: The officials have confirmed that one of our pharmacists

sat on that review.

MS JONES: It is my understanding, from the review and also from other

information that I have been provided, most of it through the Alzheimer's

Society I will admit, that although there is not, I guess, a 100 per cent

confirmation that this drug will work in all patients they do indicate it does

work in a percentage of Alzheimer's patients. They have also indicated to me

that, if government were to add the drug to the formula for Newfoundland and

Labrador, that pharmaceutical companies would provide the drug free to all

patients for up to four months.

MS E. MARSHALL: Yes.

MS JONES: Physicians that I have talked to have indicated to me that

within a four-month period they can determine if the patient will react to the

drug in a positive way or if they will not. I do not know if you have given any

consideration to the drug, based on the fact that that could be seen as a pilot

project, and that it could be seen to give government an opportunity to, I

guess, remove patients from the list that would not react in a positive way to

the medication? Did you consider that when you made your decision?

MS E. MARSHALL: That is something that did come up during our

discussions, but then, of course, we would be responsible for the cost of the

drugs after the four-month period, and the financial issue was really the major

impediment to putting that drug on the formulary. We are carrying out a review

of that drug program and we are hoping that there will be savings identified,

that we would be able to add some drugs to our formulary. I know we are

discussing the Alzheimer's drugs here now, but we have also had a significant

amount of representation from the MS society, and the Arthritis Society has also

made strong representation to have drugs added to the formulary.

MS JONES: I have also been told by physicians and by members of the

Alzheimer's Society that, for patients for whom the drug works, I guess, you

would see them being able to stay at home for maybe two years longer to be cared

for by their families, and that would certainly be a relief on government

financially, if you do not have to pay for the institutional care. Have you guys

looked at that option and that consideration when you made your decision?

MS E. MARSHALL: We have reviewed some studies which indicate that, that

conclusion is not definitively supported, but having said that, that was not a

deciding factor in deciding whether we would fund that drug. I realize we do

have to look at the financial issues and whether there are countervailing cost

savings, but I also think that a very important thing we have to look at is

quality of life for the patients. The fact that the drug would support a better

quality of life would be a very important factor.

MS JONES: Did you guys remove any drugs from the formula this year?

MS E. MARSHALL: Not that I can recall, no.

MS JONES: I am trying to recall now Bev Carter's new position. I cannot

remember -

MS E. MARSHALL: Bev Clark maybe?

MS JONES: Bev Clark, I am sorry. She used to work in the department in

John's.

MS E. MARSHALL: Yes, she is the CEO of Health and Community Services in

St. John's.

MS JONES: I heard her in the media, I think it was one evening last week.

It may have been at an OxyContin conference.

MS E. MARSHALL: Yes, that is correct.

MS JONES: She was talking about the fact that they had identified

physicians in the Province who were prescribing drugs, I do not know if

unnecessarily, but which could be deemed, I guess, unnecessarily, or prescribing

certain drugs for certain conditions that may not have needed to be prescribed.

She went on to say, in her talk, that a list had been compiled of these

physicians. I am just wondering, Minister, have you been provided with that

information as well?

MS E. MARSHALL: Not formally. Ms Clark did speak at the conference. I am

awaiting the final report of the task force. My understanding is, that

information will be included in the final report. She did take the opportunity

to speak at this conference regarding some of the findings of the task force,

but I have not received the task force report. We are doing some preliminary

work within the department in anticipation of receiving that report.

I believe one of the issues she raised was, and my understanding is, that

they will be proposing some amendments to some legislation that would facilitate

addressing those issues, and while we have not received the report yet, we have

done some preliminary work in anticipation of that recommendation.

MS JONES: When do you expect to receive the report?

MS E. MARSHALL: I was scheduled to meet with the task force, I believe,

May 26, and I would expect to be receiving the report probably some time in

June.

MS JONES: Will that report be public?

MS E. MARSHALL: Yes. The interim report was received, I believe, the end

of January and we did make the interim report public. It would be my intention

also to make that final report public.

MS JONES: Is there anything in the interim report that supports Ms Clark's

comments?

MS E. MARSHALL: I believe there is some reference to it. I am just trying

to think back to the report. My understanding is, what is going to be in the

final report will be in more detail than what was in the interim report, but I

believe the interim report did allude to this issue.

MS JONES: Minister, will you be looking at legislation that would

penalize physicians who abuse the practice of issuing prescriptions?

MS E. MARSHALL: We have not come to a definitive conclusion. Again, as I

said, I have not received the report so I do not know what exactly is going to

be recommended, but we have started to review some of the legislation to

determine what sorts of amendments we would look for.

CHAIR: I will just remind the member of her time.

MS JONES: My time is up. We will just move on.

CHAIR: If you are on a particular line of questioning that you wanted to

conclude, that would be great, rather than cut you off in mid topic.

MS JONES: No, I think I am finished with the drug piece.

CHAIR: Okay.

The Member for Burgeo & LaPoile.

MR. PARSONS: Thank you, Mr. Chairman.

Minister, a couple of questions. I will need to go back and ask some

specifics in terms of the actual dollar signs in the Estimates and whatever, but

I also have some questions of a generic or maybe even philosophical bent. I

would like to find out where you stand on some of those issues.

In your introduction you used the word efficiencies and you used the word

sustainability. We are all aware that health care is the most costly department

of government, and no doubt is the most costly service that we provide to the

residents of the Province. In that light and in that context, there is a

situation that I am aware of - and I made yourself aware of yesterday -

concerning how different boards in this Province act and administer what I

always thought was to be a policy made in the best interests of everybody

equally and fairly. I refer, of course, to the Botox issue where apparently this

is a neurological disease. I know nothing of the medical terminology, but it is

a neurological disease that a lady in my district, for example, of Burgeo&

LaPoile, had been diagnosed with and who required treatment. This particular

individual I would classify as being amongst the working poor. They are not

recipients of government assistance, but they have low income, and this is a

very expensive drug. She was treated in Western Newfoundland at Western Regional

a couple of times under her doctor's advice and then was subsequently told

that she could not get any further treatments. Now, you do not have to be a

rocket scientist to figure out that her and her husband, by looking at their

financial statements, cannot afford to pay for these treatments, yet she needs

these treatments. It has come down now, apparently, to the fact that she cannot

get those treatments in Western Newfoundland because, for whatever reason, the

Western board has decided that they do not have the money or will not fund this

Botox treatment. Yet, she has been advised that she can come in here to St. John's

and receive the Botox treatment. The end result is the same, i.e., this

particular lady gets the treatment that she needs and should have, but she has

to travel 2,000 kilometres return in order to get it. If we are operating under

a system in our Province that is supposedly equality, fairness for all, and the

issue of sustainability is not a factor here, because she can get it in the east

but she cannot get it in the west - I am wondering: What do you think about that

situation, number one, and what is wrong with our system as it currently exists

to allow that to happen?

MS E. MARSHALL: First of all, I agree that if we have policies they

should be consistent as we go from board to board. I was following up on that

specific case and referred it to Ms Hennessey. After I spoke to you, I thought

there was one case but apparently there is more than one case, so we are doing a

review across the Province to try to get a handle on exactly what is happening.

My position is that, as we go from board to board there has to be consistency

with regard to the programs that we offer.

We have not finished our review yet, so I am not quite sure what happened out

in Western. It appears that they may have been offering it and decided that they

were not going to offer it anymore, and it may be because of financial

pressures, but I have not had an opportunity to talk to the staff yet. Sometimes

the boards do take action on different programs and we are not aware of them,

but you are aware that they are having financial problems out at Western and it

could be in response to that, I do not know, but we are following up on it.

MR. PARSONS: I am pleased to hear you say that you agree that policies

such as that should be consistent from board to board. All boards are funded by

the taxpayers' dollars, therefore if we have policies, I would think the

rational and logical thing is that they would be -

MS E. MARSHALL: Consistent.

MR. PARSONS: - consistent.

This is another example where sometimes being economically and financially -

for example, Western being allowed to make a decision concerning whether they do

or do not cover Botox treatment has had an unnecessary, I would submit, negative

impact on this family, beyond the fact of whether she did or did not get the

Botox. By being told what she was told, she is going to get the treatments if we

get it ironed out and if she can afford to come here. A lot of people who live -

no offence to anyone who lives in St. John's - in St. John's, who work here

in the Confederation Building and work in the Department of Health and other

departments, do not truly appreciate that a lot of the decisions that get made,

albeit they are right from a financial point of view, impact the ordinary

citizen in the pocketbook. These people, as I say, who are the working poor, in

the particular instance that I am referring to, in the sense they are finding it

tough enough to get by as it is, have now got to travel to St. John's, and

they either borrow from relatives, $2,000 or $3,000, to get in and get out.

MS E. MARSHALL: When we become aware of those inconsistencies we would

followup and address them. I am aware of at least one other inconsistency

between boards. When we do become aware of the inconsistencies we go back to the

boards to try to correct the wrong.

Just on a more general note, and not in relation to the Botox issue, people

who are not in receipt of financial assistance but require drugs that are costly

to them, can also be financially assessed to determine whether they are eligible

for any financial assistance. I realize that would not be in this case because,

obviously, if Botox is offered in all the other boards then it should be offered

in that board.

MR. PARSONS: To follow that line of thought, i.e. board policies, what

boards should or should not be doing, I think it is public information, or

certainly thought to be in the future, that we are going to see an integration

of hospital boards the same as we have seen this year with our school boards

being reduced from eleven to six or five or whatever. There is some thought that

there may be a move afoot to reduce the number of hospital boards that we have.

Again, where, philosophically, do you stand on the issue of how many boards

we need, should board members be elected or appointed, and what do you see as

the efficiencies of boards? As I listen to the news media and look around this

Province, I even see boards competing with one another, and I think of the board

in Grand Falls - the official name of the board escapes me - versus Grand

Falls-Windsor and who should get certain services. Where do you stand in terms

of what is the best way to do this? Should it be all controlled by the

department and do not let individuals have a say in it, on a regional basis,

because they regional basis breeds competition as well? How do you see those

things working in the future?

MS E. MARSHALL: I do not think that it is practical or that it is in the

best interest of the Province to have all the health programs run from the

Confederation Building. I do support a board structure. I do think that fourteen

boards for half a million people is too many, so I do think we need to reduce

the number of boards. I do not see it, though, as a cost-cutting exercise. I do

not think that there is going to be a tremendous amount of savings or anything.

I look at it more as efficiencies and a better continuum of services. I am

especially interested in combining community boards with hospital boards.

Having said that, I have not made any firm decision as to where exactly we

are going to go with regard to the boards, except to say that fourteen boards

are, in my opinion, too many boards for 500,000 people. That is too fragmented.

MR. PARSONS: What is your view on elected versus appointed board members,

and just the efficiencies of boards? In my former life I was a board member and

a board chair and, in my experience, it is not the boards that, at the end of

day, make the decisions. The boards take their advice and are spoon-fed with

whatever the officials in the hospital you are working with tell you to do. I

had serious questions while I was there, and even after I left, about what my

role was, because you only knew what someone told you and you could only make

decisions based on what they told you. The effectiveness and efficiencies of a

board are, as you say, garbage in, garbage out, and whoever is putting the

garbage in, or the information in -

MS E. MARSHALL: The role of a board member is very important, and I feel

a bit sad when you say, what was the point of being a board member, that you

just accept whatever is coming from the CEO. The role of the board member is to

- I mean, it is the board that sets the strategic direction for the

organization. As you know I was Auditor General for ten years, and I saw a good

many instances where I felt the board was not sufficiently challenging the

organization that they were a board member on.

What the solution is: I think you need to train your board members, but I

think, too, board members have to realize exactly what their role and

responsibility is as a board member, and it is not just to accept whatever the

CEO offers up to you. As a board member you have a very big responsibility and

those in the private sector who are now being sued are starting to realize how

big that responsibility is.

The role of elected boards verses appointed boards, I have had some exposure

to the elected education boards and also some exposure to the boards that were

appointed, and, at this point in time, I think I would favour the appointed

boards, but I think my deliberations are still out on that. I think with elected

boards, it is a democratic process, so I can see the benefits of an elected

board, but I have also seen some appointed boards do really well also. I would

have to think a little bit more about whether an elected board or an appointed

board.

MR. PARSONS: Given your thoughts on the reduction in the number of

boards, if you have bigger boards - and just using Western again as an example,

that I am most familiar with - because the boards are structured in such a way,

at least at the present time, that they have representation from all over, that

I would suggest, in and of itself, breeds competition amongst the board members.

The whole concept of regionalization was not easily accepted, at least out West,

you know, what Stephenville gets Port aux Basques does not like, and what Corner

Brook gets Stephenville does not like. If you are going to make that region even

bigger by, for example, bringing in all of the Northern Peninsula or expanding

further west into Springdale, that even exacerbates the situation.

MS E. MARSHALL: I think, whatever structure you have in place, there are

advantages and disadvantages. Years ago there was a separate board for every

hospital or every facility, and I do not think that is practical especially in

this day and age, that there has to be some integration of the system or of a

region. While I realize there has to be regional representation on the boards,

each board member has a responsibility not only to the region that they are

representing but they have a responsibility to the whole board and to everybody

who lives in that region. I would like to think that, as a board member, people

would take their responsibilities seriously. It is to the common good of the

whole board and not just their particular region.

How you address the issue of competition between various regions is something

that will have to be resolved through the board members. If you look at Western

board now, that covers such a regional area and you have competition. What we

are saying now, if we move to a bigger area we are going to have competition. If

you make them smaller, you are still going to have competition. If you look down

on the Burin Peninsula you will see there is competition between Burin and Grand

Bank and St. Lawrence. I do not know if we will ever get away from that.

MR. PARSONS: That is why I raised the question, though. Is the design, in

and of itself, the proper one? If we stay with the model, board members, whether

it is small or big or whatever it is now, we are still going to have that

competing interest within the board. People do things, I would suggest,

sometimes for their own interest, and not necessarily in the best interest of

the whole region.

MS E. MARSHALL: But you get that whatever size your board is.

MR. PARSONS: Yes, that is what I am saying. Can you get rid of it by

having some other model?

MS E. MARSHALL: I guess the other model would be, we will go back to

having - how many boards did we have? - ninety-seven boards. Personally, I do

not think that is an efficient way to delivery medical services, that you have

just a little group here, a little group there, and you have your ninety-seven

groups.

MR. PARSONS: I am suggesting, Minister, that we do not go back to the

ninety-seven board concept and we do not keep what we have, but we look at a

still newer model whereby we do not have input, that you come up with a

structure that is bureaucratically run, period.

MS E. MARSHALL: What do you mean by bureaucratically run? From the

Confederation Building?

MR. PARSONS: In other words, people whose jobs it is to run the

institutions, and regardless of what area you are from and what your politics

are, if you are responsible for Western it does not matter who appointed you. It

is not a board that dictates what happens to that region, it is a bunch of

people who are employees. It is their job to do things efficiently, to make sure

we have a uniform provincial policy, to see that the money is properly spent,

and not to be subject to the dictates of various directors who may have vested

interests.

MS E. MARSHALL: But that too has bias. Just like there is board bias,

there is bureaucratic bias. I have seen it at both the board level and at the

bureaucratic level. I do not think there is one perfect solution. Having said

that, there has been no decision made with regard to how the health care

services are going to be -

MR. PARSONS: The reason I raise these questions is, I have been told that

health care is going to get even more and more costly, that it is not a case of

just throwing money at the problems, we have to find ways to fix the problems.

MS E. MARSHALL: Oh, yes.

MR. PARSONS: If that is one of the problems under the planning and policy

areas that you have, are there brainstorming sessions where people actually sit

down to try and see what is wrong with the system, how can we fix it, is the

board structure that we are using wrong, and is there something else we can look

at? Has that been done?

MS E. MARSHALL: Yes. Actually, it was done by the previous government of

which you were a member. All across the country, provinces and the federal

government are all grappling with health care, how health care should be

organized, what services should be provided, how it should be funded and how we

control costs. That debate goes on not only in this Province but it goes on in

all of the other provinces. All of the other provinces are doing things similar

to us, which are, looking at their board structures, looking at the types of

services, looking at location of services, the skill mix of the health care

providers, and what are the most efficient ways to deliver health care services.

We have not reached Utopia yet, but there are a number of reforms and a number

of initiatives that are going on throughout the country.

MR. PARSONS: I am not sure if Dr. Bradbury is the right person, I am not

sure if that is her area of responsibility, but I raised a question earlier in

the House this week in dealing with the Hay Commission studying the Western

region again, suggestions that there might be service cuts in certain areas,

vis- B -vis

clinics, and procedures being done in one area might be shifted off to another.

For example, surgical might be taken out of Stephenville and centralized in

Corner Brook. The issue I raised again, in knowing the individuals involved - we

have, for example, a young lady doctor in Port aux Basques who was trained here

at Memorial, went home, married, got her kids, settled in and wanted to stay

there, and was prepared to go to rural Newfoundland where we always had a

problem getting doctors recruited and retaining. I have a nephew, in fact, and

his fianc ,

both medical people, planning to go out west to the Corner Brook area, who are

uncertain now because of the uncertainty in the air and tied into their skill

levels.

I raised this question with you in the House the other day, because these

young people who have certain skills - Dr. Graham, for example, can no longer do

her obstetrics in Port aux Basques because the department's rule is that all

obstetrics have to be done in Corner Brook. She is very concerned with the

professional training that she has and she wants to keep her skills up. She

cannot keep her skills up if she stays in Port aux Basques because she will not

get the caseload in order for her to do it, similar to these other two medics I

just referred to. They wanted to go out West to rural Newfoundland as well, and

were prepared to do that, but they are very concerned about: Where is this

government going, vis- B -vis

the regional process, the restructuring process, where we might move certain

services, and how is it going to impact on where we live. How does that get

factored into your department's rationalization of this Hay group report and

so on?

MS E. MARSHALL: You may dispute it, but I would see that the goals of

that doctor would be the same goals that I would have. I would want to provide

the opportunity that a physician, who is skilled in a certain area, could go to

a certain area and retain their skills. You are saying that individual knows

that they cannot retain their skills if they stay in a certain community, but if

they move to another community, they can. That is one of the areas that we are

looking at, and the term that is used is location of services, where we will go

through a process of identifying, where should our services be provided, and

rationalize as to, should the pediatric services be in this community or should

gynecological services be provided somewhere else. Of course, one of the

criteria that you would look at is where would your caseload be and would there

be a sufficient caseload to sustain that doctor and enable that doctor to keep

up their skills by practicing in that certain area.

MR. BUTLER: I have about four questions here, Minister. One is with

regard to the personal home care facilities, the inspections. I guess it is

though your department that those inspections are carried out. I will put all

this into one question, with regards to the facility itself. I know a lot of the

residents in those homes have various diets that they have to have, and I am

wondering: Is there a follow-up or is that part of it inspected as well, to see

that they get the nutritious meals they should have?

MS E. MARSHALL: Those homes are regulated by Health and Community

Services. I am going to turn that over to Ms Vivian-Book because that is a

fairly detailed question. I understand that there are annual inspections and

probably Lynn could give a bit of an elaboration on that.

MS VIVIAN-BOOK: They are monitored through the Health and Community

Services Boards from the programming side, which would take you to your issue of

nutrition and special needs that particular residents have, but they are also

followed through Government Services and Lands from the area of fire and life

safety issues, and the licensing and monitoring is all done and coordinated

through the Health and Community Services Board.

MR. BUTLER: I listened very attentively when yourself and my colleague

here had the conversation with regards to the health care board structure, and I

guess I am surmising here now if something should happen, with reference to any

changes that may be forthcoming. I will just give you an example, and I am

stretching it here now. For instance, in the Avalon Health Care Board in

Carbonear, if there should be such a major change that it might be administered

through St. John's or something like that - I am just looking at this

hypothetically now - I am just wondering, do you think if something like that

should happen, and not only in our area, that the local people, whether they are

elected or appointed to the boards, in the stand that they take, I guess, for

their particular areas, and they know the responsibility, do you think their

impact would be lost, and the things that they fight for in the local area would

be lost if we go to small with the board structure? For instance, we have the

boards in our area and most of the people are from the immediate area, whether

it be Placentia, Trinity, or the Conception area and so on. If that should

disappear, and I am not saying it is going to disappear but if it should

disappear, and be operated, for instance, out of Clarenville, St. John's or

wherever, I know there would probably be one or two people from that area who

might be appointed to a board in St. John's but I do not think they would have

the impact in fighting for the needs of that area. Could that be considered when

you look into this structure, if it should come to that point?

MS E. MARSHALL: I guess it does go back to the earlier conversation that

I had, and that is, regardless of how the boards or how the structure is set up,

there should be regional representation, and not only regional representation

but also people with a diversity of backgrounds. Again it goes back to an

earlier conversation, and while I realize that it would be incumbent upon a

person from a certain region to represent their region, an effective board would

be looking at services and programs in the best interests of all the

constituents and not just in a select area.

MR. BUTLER: The other question I have is with regard to boards in various

areas experiencing major challenges in recruiting adequate numbers of RNs and

LPNs for casual employment. I am wondering what steps are taken. Are there any

steps taken - I am sure there are, but I am wondering what they are - to keep

our graduating nurses here in the Province? Only recently I know of a couple in

my area who are just waiting to graduate and they are gone out of the Province.

I am just wondering: Is there any plan in place whereby we can try to encourage

those people to stay? I know it is very difficult when they are offered $40 US

plus a signing bonus in the States. I am just wondering: Is there any plan in

place?

MS E. MARSHALL: I will ask my officials to speak to this, but generally

we leave it up to the individual boards to do their own recruitment. We will get

involved if they ask us to. For example, there was an issue in Happy

Valley-Goose Bay and Health Labrador did ask us to get involved, and we are

involved along with the Nurse's Union and some other representatives.

Generally speaking, in the area of nurses and the number of nurses we have here

in the Province working, actually I believe we have the second highest per

capita of nurses in the country. I think ours is the youngest workforce, too,

which I was quite surprised to learn.

I do not think that that really addresses your question with regard to

retaining and hiring our recent graduates, and I do not know if the boards -

Moira, if you could help me out here with regard to attracting and keeping

nurses. I am aware that we do not have significant problems right now except in

select areas like Happy Valley-Goose Bay. Are you aware of any special programs

that the boards follow with regard to hiring and retaining nurses?

MS HENNESSEY: (Inaudible).

MS E. MARSHALL: Ms Hennessey has confirmed that there are no special

programs, but that we have been quite successful in filling the positions we

have, and has indicated we are the second highest per capita.

MR. BUTLER: When you were responding there, Minister, you mentioned that

the boards look after that, but I know quite a few of the boards are challenged

now to bring their budgets under control and so on. I was wondering if there is

any new initiative that may help them when they do have this problem?

MS E. MARSHALL: Actually, yes, there is one new initiative and that is,

there was a new position created in the department, the position of chief nurse.

We have not recruited for that position, we are still in the process of

formulating the duties and responsibilities. All issues relating to nursing and

nurses in the Province, of course, would fall under the responsibility of that

position, and that position will be reporting - have we decided on the reporting

structure, Ms Hennessey?

MS HENNESSEY: We are not certain yet.

MS E. MARSHALL: Not certain yet, but to an ADM. That is a fairly senior

position in the department.

MR. BUTLER: Just to go back to one of the questions I asked earlier,

Minister, with regard to the long-term care institutional services: I am

wondering when a decision may be made, whether it is positive or negative, for

the Conception Bay North area. Is there anything to be announced, say, over the

next short period of time?

MS E. MARSHALL: I do not expect anything to be announced over the short

term. There are two issues there. One is that we are going to embark on a

long-term strategy for long-term care and supportive services. Of course, the

other thing is, there would be budgetary allocations for next year. I do not

know how that project would fair in relation to other projects in the Province.

For example, the Town of Wabush has approached the department with regard to a

long-term care facility, the one in Happy Valley-Goose Bay needs to be replaced

or upgraded, so there is quite a demand there. What I would like to see is a

provincial strategy with regard to setting some priorities in that area.

MR. BUTLER: This is my last question now. The

preamble is probably a bit

long, but I will try to get it all into one anyway. It is with regard to the

Pharmacy Association of Newfoundland and Labrador. I have had some

correspondence back and forth with the various pharmacists in my area, and to

begin with, I have to say that they are not against an audit but they have a

problem with the audit the way it was set up, I guess. They did go on and advise

me that the previous administration recognized the services that they provide

and various avenues whereby they save money for government. I know they received

some correspondence and they had to respond by, I think it was March 18, 2004,

and if they did not get those papers back they were not validated and were

cancelled. I think it was requested that a small working group, probably, be

together.

MS E. MARSHALL: Yes, there is a liaison committee established. There is

an issue with the pharmacists with regards to the audit process and the

provision of certain types of documents. That discussion is still ongoing. I am

sure, as you can appreciate, when we conduct an audit you cannot share your

audit procedures with the people who you are auditing. I have been saying to

them, that there is certain information that I could not provide to them. We

were going to go forward with some amendments to their legislation. That has not

happened because I am still having discussions with the association. I, too,

have received a massive amount of correspondence from pharmacists. I am working

with the association to try to resolve the issues. In addition, there is a

liaison committee that currently exists with representation from both the

Pharmacy Association and my department.

I think their major concern - and I am sort of second guessing it - is that

they were concerned that legislation would be brought forward that they did not

agree with, and, of course, that would not happen.

MR. BUTLER: A couple of the issues they brought up with me were, the

amounts that they were asked to prepare and send in at the one time, as high as

200 and 300 -

MS E. MARSHALL: Yes, the extent of photocopying was an issue.

MR. BUTLER: Yes, and the confidentiality of some of these.

MS E. MARSHALL: Confidentiality was an issue also, yes.

MR. BUTLER: Thank you.

That is it for me, Mr. Chair.

CHAIR: Thank you, I say to the member.

The Member for Labrador West, I understand you have one or two more

questions.

MR. COLLINS: Just a couple of short questions.

Minister, I know you do not have it tonight, but would you have any

statistics in your department as to the number of people in the Province who

suffer from MS, and of that total number, how many are actually being covered

under the provincial drug relief today?

MS E. MARSHALL: I would be able to get you some information on people who

have MS from the files of the department. Actually, I asked somebody for that

information myself. If people do not come forward and they are not members of

associations or societies, for example the MS Society, if people are not members

of a society, then, of course, they might not show up in the numbers, but I can

certainly get you the data that we have in our office with regard to the number

of individuals with MS.

MR. COLLINS: The second question is one that we have had some discussion

on and I know it is not directly related to your department, but I do know you

have some concern over this, the issue of the air ambulance when it comes to

palliative care patients.

MS E. MARSHALL: Yes.

MR. COLLINS: Like I said, I have had some discussions with you on a case

here and I know that you have expressed concern and compassion for people. I

wonder if you have had any conversations recently with the Minister of

Transportation.

MS E. MARSHALL: No, but I tried to catch you one day as you were leaving

the House. It is something that you and I should discuss. The concern that I

have, if we are doing that for your district and if that becomes a province-wide

program, depending on the extent of the usage, my concern is that the air

ambulance is going to be used exclusively for that purpose or almost exclusively

for that purpose. I wanted to meet with you to discuss exactly what are the

problems that you are having right now, because since I have been with the

department, every request that you have made to me, I think that we have been

able to assist. I wanted to speak to you about the process we have in place now

and exactly what is wrong with the process and how we can improve it. Whenever

you are ready to discuss it, I will be available.

MR. COLLINS: One final question: I know it is a problem in rural areas of

the Province, in particular, attracting doctors and nurses, mainly because, I

guess, if you are a doctor in a rural area you are sort of twenty-four-seven,

and even if you go somewhere socially you are still being a doctor when there

most times. I realize that you have only been in government since October, but I

am just wondering whether or not - maybe some of your officials know - there has

ever been a program in place, or if there has ever been consideration given to a

program, for doctors or nurses, where financing of their education could be

considered in turn for residency of a fixed term, to serve in remote or rural

areas of the Province.

MS E. MARSHALL: Yes, there are some items of that nature. I am going to

turn it over to Dr. Bradbury. Would you be able to answer that question? We do

offer some bursaries.

DR. BRADBURY: There is an incentive bursary program that is offered. It

is valued annually at approximately $1 million. About $600,000 of it is

earmarked towards physicians who undertake additional training in general

practice. That is perhaps the area that you would be referencing with regard to

the rural program. There are bursaries offered to students that have set returns

in service with them.

MR. COLLINS: Would that be offered through Memorial? I know there are

some programs offered through the UNB, students from this Province who are out

of Province studying to come back to the Province. Is that also applicable to

students at Memorial?

DR. BRADBURY: The program, historically, has been taken by students

studying here at Memorial. I am not aware that there are any sort of limitations

to just Memorial students, but historically that is the group that has applied

for them.

MR. COLLINS: Has that been successful?

DR. BRADBURY: The program has been in place, I should guess, probably

going back into the 1980s. The default rate sort of varies. There are four

different programs for general practice, psychiatry, medical specialities, and

then fellowships for programs that are not offered in Newfoundland, and the

default rate sort of varies between the various programs, anywhere between 5 per

cent to 15 per cent.

MR. COLLINS: Those are all the questions I have.

Thank you.

MS E. MARSHALL: The budget provides $1 million for physician bursaries

and incentives, so it is a fair dollar amount that is being provided.

MR. COLLINS: That would be subject - if they went under the bursary

program, then it would be up to the Department of Health and Community Services

to decide where they would serve in the Province.

MS E. MARSHALL: I think that is done through the health care boards.

Cathi, is that right?

DR. BRADBURY: There is a selection committee for each of the bursary

programs and when the students apply for the bursaries they indicate their areas

of interest, where they would like to work in the Province. That influences,

then, where and when the bursaries are awarded. The students then sign a return

in service contract with the Deputy Minister, but the return in service contract

is to the Province rather than to any one specific area.

MR. COLLINS: Of the people who have participated in that program, are

many of them sent to rural areas of the Province?

DR. BRADBURY: They are not sent per se. Several years ago the contracts

that these students would sign would be specific to an area, and th