November 12, 1981 ALBERTA HANSARD 1583 LEGISLATIVE ASSEMBLY OF ALBERTA Title: Thursday, November 12, 1981 2:30 p.m. [The House met at 2:30 p.m.] PRAYERS [Mr. Speaker in the Chair] head: INTRODUCTION OF VISITORS MR. KOZIAK: Mr. Speaker, it's my distinct honor this afternoon to introduce to you, and through you to the members of this Assembly, visitors in your gallery: a very distinguished musicologist, composer, and conductor, Professor Andrij Hnatyschyn from Vienna, Austria.

Pro­ fessor Hnatyschyn, who will be celebrating his 75th birthday while in Canada, has written over 1,000 reli­ gious, folk, and classical works since his first divine litur­ gy in 1938. In 1977, the Austrian government conferred upon him the degree and title professor, and presented him with the golden service cross for his musical accom­ plishments. Mr. Hnatyschyn was also honored with the silver cross by Pope John XXIII, and was awarded the Benemerenti Medal by Pope Paul VI. Mr. Speaker, Professor Andrij Hnatyschyn is without doubt the greatest living Ukrainian composer.

He is here in connection with a production, Steppes in Chorus, which will take place on November 20 in the Jubilee Auditorium, at which time he will be honored and a number of his works will be performed. On behalf of my colleagues, Mr. Speaker, I would like to address a few words to Professor Hnatyschyn in his native tongue. — jak ljubytel' Ukrajins'koji Muzyky, — jak chlen narodnix itserkovnyx xoriv, — jak shanuval'nyk vashyx muzychnyx tvoriv, ja maju pryjemnist' v imeny vsix meshkantsiv provintsiji Al'berty previtaty vas v Edmontoni. i prydstavyty vas mojim kolegam v Legislaturi.

Proshu vstatyi pryjnjaty nash shchyryj pryvit i nashe pryznannja. [As submitted] Accompanying Professor Hnatyschyn are Mr. Peter Prokopiw and Eugene Zwozdesky, a musicologist in his own right in the Edmonton field. I would ask that they all rise and receive your welcome. head: PRESENTING REPORTS BY STANDING AND SELECT COMMITTEES DR. REID: Mr. Speaker, I wish to present the report of the Standing Committee on The Alberta Heritage Sav­ ings Trust Fund Act relating to the 1980-81 annual report of the Alberta Heritage Savings Trust Fund. head: INTRODUCTION OF BILLS Bill 251 The Denticare Act MR. NOTLEY: Mr.

Speaker, I request leave to introduce Bill No. 251, The Denticare Act. The Bill would set out the legislative framework for the introduction of a com­ prehensive denticare program in Alberta. [Leave granted; Bill 251 read a first time] head: TABLING RETURNS AND REPORTS MR. LEITCH: Mr. Speaker, I wish to table a reply to Motion for a Return 134. head: INTRODUCTION OF SPECIAL GUESTS MR. SCHMIDT: Mr. Speaker, I have the privilege this afternoon to introduce to you, and through you to the members of this Assembly, the 1st Devon Scout Troop and their leaders.

The troop is to receive the Governor General's medal and a certificate for meritorious conduct. The awards will be presented to the troop in a ceremony at Government House in Ottawa on November 20 by Governor General Schreyer, who is the Chief Scout for Canada. The medal for meritorious conduct will be awarded for an incident in July 1980, in which members from the scout troop rescued three men from a mountain stream.

The certificate for meritorious conduct will be awarded for a rescue one month later, in August 1980, of three girls who were canoeing in the North Saskatchewan River and became separated from their party. The scouts trav­ elled three long hours by canoe to deliver the three girls to the Devon hospital. Mr. Speaker, I wish to add that a double group award has never been given in Canada before. The Devon Scout Troop, their leaders, and some very proud parents are seated in the public gallery. I would ask that they rise to receive the welcome and congratulations of this Assembly. MR. BATIUK: Mr.

Speaker, it's a real pleasure for me this afternoon to introduce to you, and through you to the Members of the Legislative Assembly, 12 social stud­ ies 30 students from the Holden school in my constitu­ ency. The number is quite small, but this cannot be said of quality. In reviewing the list of recipients of the Alexander Rutherford scholarships, I noted that one of the grade 12 students who attended the Legislature last summer is a recipient. The students are seated in the members gallery. They are accompanied by their teacher Mr. Burden and their bus driver.

I would ask them all to rise and receive the welcome of the Assembly. MR. KNAAK: Mr. Speaker, it gives me great pleasure today to introduce to you and to my colleagues in the House 30 grade 6 students from Duggan Elementary school and their teacher Mr. Rodger Langevin. I would ask them to rise and receive the warm welcome of this House. MR. BOGLE: Mr. Speaker, I'd like to introduce to you today, and through you to members of the Assembly.

1584 ALBERTA HANSARD November 12, 1981 representatives from two organizations in Alberta. People First of Alberta are, by their own definition, a consumer advocacy group of individuals who are endeavoring to find ways to help handicapped people in areas such as legal and moral rights, as well as community living accommodations. Three members of that organization are in the members gallery today. As well, Mr. Speaker, I would like to introduce members of the executive of the Alberta Association for the Mentally Retarded. The delegation is headed by the president, Pam Friesen, from Fort McMurray.

As all hon. members are aware, this evening in the Legislature cafeteria we will be having our annual dinner meeting between members of the Alberta Association for the Mentally Retarded and members of this Assembly. Would they please rise and receive the warm welcome of the Assembly. MRS. CHICHAK: Mr. Speaker, it gives me pleasure today on behalf of my honorable colleague for Edmonton Kingsway to introduce a group of 11 students from the Coralwood Academy in the Edmonton Kingsway constit­ uency. They are here with their group leader Mr. Gary Townsends. They're all very welcome here.

I'm pleased to have this opportunity to present them to you and to members of the Assembly. I believe they are in the members' gallery. I would ask them to rise and receive the welcome of the Assembly. MR. ZAOZIRNY: Mr. Speaker, I have saved the very best for the last. I am delighted to be able to introduce to you and to Members of the Legislative Assembly this afternoon some 45 grade 8 students from the Ian Bazal¬ gette school in the constituency of Calgary Forest Lawn. They are here to see the Legislature in action. They are accompanied by teachers Mr. Kerr, Mrs. Will, and Mr. McCauley; their bus driver Mr.

Sunderland; and by one of the parents as well. Mrs. Bonnie Ladner, who in addition to being a parent is also the president of the Dover community association and the constituency office co-ordinator for the constituency of Calgary Forest Lawn. I would invite all of our guests in the public gallery to rise now and receive the cordial welcome of the Assembly. head: ORAL QUESTION PERIOD Health Care Insurance MR. R. SPEAKER: Mr. Speaker, my question is to the Minister of Hospitals and Medical Care.

It is with regard to the negotiations going on between the Alberta Medical Association and the Alberta health care insurance plan. Could the minister indicate what involvement he has had to this date — I understand the minister has had a meeting — and the present stage of negotiations? MR. RUSSELL: Mr. Speaker, the negotiations are ongo­ ing at the present time. In fact, according to the last advice I received, I believe there's another meeting sched­ uled for today. They have traditionally taken place at this time of the year. I don't get involved directly.

This year I did meet with the president of the AMA, at his request, on the understanding that we would not get into negotiat­ ing details but rather would have a general discussion. MR. R. SPEAKER: Mr. Speaker, a supplementary ques­ tion to the minister. It is with regard to

Section 40 of The Health Care Insurance Act. Under that

section of the Act, it is permissive that the government establish a benefit review committee or not. Has the minister re­ viewed that

section of the Act, and would the government change their policy in that area and establish a formal bargaining procedure with the Alberta Medical Association? MR. RUSSELL: Mr. Speaker, shortly after I assumed this office I gave careful review to that, and proposed that Alberta use the method used by the government of On­ tario, which seems to be working well: a permanent seven-member committee that would sit throughout the year to review matters of that kind. The AMA turned that proposal down and wish to continue under the exist­ ing system. MR. R. SPEAKER: Mr.

Speaker, a supplementary ques­ tion to the minister. Could the minister indicate whether extra billing is part of this negotiation, or is that one of the matters discussed between the president of the asso­ ciation and the minister? MR. RUSSELL: No. At no time did the matter of extra billing enter the discussions, Mr. Speaker. Heritage Savings Trust Fund Auditing MR. R. SPEAKER: Mr. Speaker, my other question today is to the Provincial Treasurer.

Could the Provincial Treasurer, after reconsideration the last few days, table the management letters in his possession to clarify for Albertans, once and for all, the reasons for the $60 million realized loss in the Heritage Savings Trust Fund and, as well, document the management procedures put in place to prevent further losses or possible fraud? MR. SPEAKER: Quite candidly to the hon. Leader of the Opposition, I have some difficulty with the propriety of a question which is repeated daily or every 48 hours.

It seems to me that before that should happen — and there are strictures about that kind of thing in the rules relating to question periods — there should be some indicated change in circumstances. Otherwise we might have mem­ bers, for whatever reason, just deciding on certain ques­ tions and asking the same . . . I mean, if it can be done with one, it can be done with two or three dozen ques­ tions. They could ask the same two or three dozen questions every day. MR. R. SPEAKER: Mr.

Speaker, on the point of order raised in regard to the question, whether there are chang­ ing circumstances and whether this question should be raised again in a form similar to the way it's been raised before: one, a minister can review the matter and change his opinion and present documents. I feel the documents are important enough; that's why the question is re­ peated. Secondly, your point with regard to changing circumstances.

As I am able to travel home — and the opportunity prevailed yesterday — I was in a large group of people, and the question was raised repeatedly: what has happened to the $60 million lost by the government? I said, well, I'm going to ask the question again in the Legislature. Circumstances change continually. The pres­ sure is on for the answer to that question. That's why I

November 12, 1981 ALBERTA HANSARD 1585 give the government a chance to answer the question. [interjections] MR. SPEAKER: Without wishing to engage in a debate with the hon. leader, the first of his two points would imply a daily review of the situation by a minister. In fairness, I don't think that can be assumed. With regard to the second point, that would imply a change in circum­ stances with regard to something that has happened in the past. It would be difficult to conceive of a daily change in circumstances which would justify a daily repe­ tition of that question. MR. R. SPEAKER: Mr.

Speaker, on the point of order. I'd like to bring to your attention a document from the Canadian manual of chartered accountants for Canada that I tabled after my questioning the last time. In that document there was a definition of auditors' working papers as well as management documents. That was new information I made available to the the Legislature for the Provincial Treasurer to review, and I have omitted that information. Possibly I could have

preambled my question to that effect. Has the minister had a chance to look at that document and reconsider whether the infor­ mation could be tabled? Mr. Speaker, maybe that would have met your requirement. MR. SPEAKER: Well, with regard to whether the minis­ ter has looked at the document, perhaps that could be asked — not daily I would assume. But as far as indicat­ ing a change in circumstances is concerned, it would seem to me that it rather indicates a new discovery of some information by the hon. leader. MR. R. SPEAKER: Mr.

Speaker, on the basis of the document I presented to the Legislature, I would like to direct my question to the Provincial Treasurer, indicating whether he has had the opportunity of reviewing that new information and whether the management letters can be presented here to this Legislature. MR. HYNDMAN: Mr. Speaker, on a fair, balanced, and objective review of the language in that document, which may or may not be persuasive, it is very clear that the government's position is supported.

As The Auditor Gen­ eral Act states, working audit papers cannot and should not be presented to the Assembly or to the committee. MR. R. SPEAKER: Mr. Speaker, a supplementary ques­ tion to the minister. In this case, I agree with the defini­ tion of the Provincial Treasurer that audit working pa­ pers should not be presented in this Legislature. I support that position. But could the Provincial Treasurer table the management letter in his possession which is not an audit working paper? Could that document be presented in this Legislature, and if not why? MR. HYNDMAN: Mr.

Speaker, again, and for about the fifth time, the hon. gentleman's

interpretation is completely different from that given by the law of the province and the law of this Assembly. MR. R. SPEAKER: Mr. Speaker, a supplementary ques­ tion to the Provincial Treasurer. Could the minister indi­ cate what law he is referring to, because the law about audit working papers does not apply to the question at hand, Mr. Speaker. MR. SPEAKER: There may well be a difference concern­ ing the

interpretation of the law. It would seem to me that the hon. leader's question is directly aimed or in­ tended to get a legal

interpretation when he's asking what the law says. Native Secretariat Employee MR. NOTLEY: Mr. Speaker, I'd like to direct this ques­ tion to the hon. Minister responsible for Native Affairs. Is the minister in a position to confirm that Mr. Bernie Makokis, a treaty Indian employed as a liaison person with the Native. Secretariat, has been asked to resign? Could the minister inform the House as to the reasons? DR. McCRIMMON: Mr. Speaker, no, it is not a fact that Mr. Bernie Makokis has been asked to resign. As far as I know, there is no intention of asking him to resign. MR. NOTLEY: Mr.

Speaker, a supplementary question to either the hon. minister or the hon. Premier with respect to the aboriginal rights amendment discussion paper. What review of this discussion paper has been made by the government? MR. SPEAKER: With great respect to the hon. member, that is really not a supplementary question. If that was the hon. member's main question, my suggestion respect­ fully would be that he might have come to that in the first place. However, since there's a reasonably short list in the question period, I'm sure there'll be an opportunity to come back to that topic. Liquor Licences MR. D.

ANDERSON: Mr. Speaker, my question to the hon. Solicitor General is further to a question I asked last week. Since that time, has the minister had an opportuni­ ty to review to what extent new liquor licensing categories have been utilized by applicants or prospective applicants? MR. HARLE: Mr. Speaker, I have some figures. There have been seven new nightclub licences issued, 34 recrea­ tion facility licences, nine commercial passenger airplane licences, and five travellers' lounge licences at airports.

One commercial passenger bus, one passenger train, three racetracks, six sports stadiums, nine theatres, 10 postsec¬ ondary educational institutions, and one residential facili­ ty for senior citizens have received licensing. MR. SPEAKER: Without expressing at the moment the extent to which I marvel at the minister's knowledge, may I respectfully suggest that that kind of question and answer might be handled quite effectively by means of the Order Paper. MR. D. ANDERSON: Mr. Speaker, I'd like to thank the minister for not making the Order Paper necessary in this regard.

If I could ask a supplementary question, could the minister indicate if any significant public concerns have been raised about the significant number of licences granted? MR. HARLE: Not that I'm aware of, Mr. Speaker. MR. D. ANDERSON: Mr. Speaker, one final supple­ mentary question. In light of the positive response to

1586 ALBERTA HANSARD November 12, 1981 these extensive applications under the new liquor licens­ ing category, is the minister considering recommending to this Assembly any further categories, specifically a com­ munity pub licence which might allow community asso­ ciations and volunteer organizations to establish small neighborhood establishments? MR. HARLE: No, Mr. Speaker. Extended Health Care Benefits MR. MANDEVILLE: Mr. Speaker, my question to the hon. Minister of Hospitals and Medical Care is with regard to widows between the ages of 60 and 64 and their provider, over the age of 65, has passed away.

All our departments, except medicare, have taken care of these people between 60 and 64. At the present time, if a spouse loses her provider, within 60 days she is cut off from her extended health benefits and the medicare premiums. Could the minister indicate the reason for not bringing these spouses under this, so they get continued extended health programs and their premiums paid? MR. RUSSELL: Mr. Speaker, as the hon. member is aware, extensions have been made to some government programs, on a survivor basis, to the kinds of people the member referred to.

We have reviewed the matter with respect to the medicare program and, at the present time, don't feel the need is there to do it. There are other ways of providing for the needs of those people. I assume the member is referring to the extended health benefits pro­ gram, because all other aspects of medicare are paid, no matter what age. MR. MANDEVILLE: A supplementary question, Mr. Speaker. Could the minister indicate why the time period was extended from 30 to 60 days? They can get their benefits for 60 days now, instead of 30 days. MR. RUSSELL: Mr.

Speaker, I had had a couple of letters from people who found that that 30-day time period was providing a hardship, depending on how it was counted. It was done as a general benefit to ease the transition period for those people. MR. MANDEVILLE: One final supplementary question, Mr. Speaker. The minister did indicate that there are programs in place to help widows between 60 and 64 who have this hardship. Could the minister indicate what program there would be for a widow between 60 and 64 as far as extended health care and her premiums are concerned?

After the 60 days after she loses her senior citizen, she has to go on paying her premiums and she's disqualified for extended health benefits. Could the min­ ister indicate what programs are in place to cover this? MR. RUSSELL: Mr. Speaker, both those programs have provisions for premiums, directly geared to income. Those are the programs I was referring to. In both instances they'd be eligible for reduced premiums or no premiums at all, depending on income levels. MR. R. SPEAKER: Mr. Speaker, a supplementary ques­ tion for clarification.

Is the minister saying that after the 60-day period a widow between 60 and 64 has to apply for social assistance in order to get benefits and extended care? MR. RUSSELL: Mr. Speaker, it would depend on the individual family circumstance. They may or may not apply for social assistance, depending on what other sources of income they have. All they would be required to do, with respect to health care premiums and Blue Cross, is to declare their income. In other words, it's a sort of means test. The premiums are related to the level of income. MR. BOGLE: Mr.

Speaker, I may supplement the an­ swer given by my hon. colleague, as we have drifted into the area of other assistance for senior citizens. I'm sure my hon. colleagues will recall that we passed

an Act this spring, The Senior Citizens Benefits Amendments Act, which allows that if the senior citizen passes away and that senior was receiving benefits under the Alberta as­ sured income plan — the maximum benefits in that plan at the present time are $85 per month per individual — the surviving spouse would continue to receive the same level of support, as if the partner were still alive. In that sense, we have certainly moved in a very significant way to support surviving spouses. Interest Rates MR. KNAAK: Mr.

Speaker, my question to the Provin­ cial Treasurer deals with the value of the marketable securities in the Alberta Heritage Savings Trust Fund. It's been communicated to me that today the bank rate dropped by 1.5 percentage points. I had asked an invest­ ment analyst to determine what impact this would have on the marketable securities of the Heritage Savings Trust Fund. I've been advised that just today. Mr. Speak­ er, the value would increase by $100 million alone. Can the minister confirm this figure, and can the minister advise whether he has . . . [interjections] MR.

SPEAKER: With great respect to the hon. member, the device he is now using is rather transparent. MR. KNAAK: To change the question, Mr. Speaker, can the minister advise whether he is aware of the relationship between the value of the trust fund and the interest rate and, in particular, the reduction in interest rates? MR. HYNDMAN: Mr. Speaker, I'm not sure of the tens of millions of dollars of added value to the heritage fund that's accrued by reason of the interest rates dropping, but there's no question that the heritage fund, in terms of its value, is gaining very significantly as interest rates come down.

I'd be happy to provide further information to the Assembly and the member in future weeks. Constitution — Aboriginal Rights MR. NOTLEY: Mr. Speaker, I'd like to address this question to the hon. Premier. It flows from a proposal by the Native Council of Canada, as well as the ITC, with respect to

Section 34 of the Charter of Rights concerning aboriginal rights. The aspect of it that applies to federal jurisdiction would be proclaimed immediately, but there would be a three-year moratorium with respect to appli­ cation of that provision to provincial jurisdiction. Mr. Speaker, my question with respect to

Section 34 is: is the government of Alberta prepared to consider the proposal that is now being presented, or I believe was presented a few moments ago, to the Prime Minister of Canada?

November 12, 1981 ALBERTA HANSARD 1587 MR. LOUGHEED: Mr. Speaker, obviously we would have no objection to a decision taken by the federal government with regard to provisions that are exclusively within federal jurisdiction, but we would not be prepared to include provisions that are indeterminate and unde­ fined, as far as we're concerned, in a new constitution of Canada, as I mentioned both in the question period on November 10 and during the course of debate. MR. NOTLEY: Mr. Speaker, a supplementary question.

Is the Premier in a position to advise the Assembly what impact the position paper "Aboriginal Rights Amend­ ment Discussion Paper" had particularly with respect to concerns expressed in this paper dealing with

Section 34 that in fact there might be some impact on provincial rights, as well as another

section dealing with, and I quote: "However explicit constitutional recognition of their rights may provide a psychological boost to Metis groups and encourage them to litigate their land claims". What assessment of this paper was made either by the hon. Premier or by the minister in charge of the Native Secretariat? MR. LOUGHEED: Mr. Speaker, the hon. member will have to help me with what he's waving and identify the document, because I have a fairly full file. From his description, it's not a document with which I'm familiar. MR. NOTLEY: Mr. Speaker, I'd certainly be glad to do that.

It's the Aboriginal Rights Amendment Discussion Paper prepared by the Native Secretariat. MR. LOUGHEED: Mr. Speaker, that's still an inade­ quate description of the document, at least in terms of anything that I perused. Could he give me the date, who is alleged to have received it, who it's to, and who received copies of it, because it's not a document I'm familiar with. MR. NOTLEY: Mr. Speaker, I believe the information was given to the Indian Association of Alberta.

However, getting back to the details within it, I ask the Premier . . . [interjections] I think I've given you the information that is relevant to it. Whatever additional information, we can go into it later on. MR. SPEAKER: With great respect to the hon. member, possibly the document might be produced and then ques­ tions could fairly be based on it in a future question period. MR. NOTLEY: Mr. Speaker, I was just going to say I'd be quite prepared to table the document, but the point I want to raise is a matter of policy. One doesn't need the document to raise it. It is the question . . . [interjections] MR.

SPEAKER: Of course, this is a significant change in the hon. member's position, since he was using the document as part of his question in the first place. MR. NOTLEY: Mr. Speaker, on a point of order, I thought the Premier would have had this document. If he claims he has not had an opportunity to [review] it, that's fine. I'll table the document. However, the question I want to put to the Premier is with respect to one of the major concerns — it's a public concern in any event — and that is whether or not the government's position on

Section 34 is related to the possibility that were

Section 34 incorporated into the Charter of Rights it would prejudice the government's position in this province vis-a-vis Metis claims, both in terms of financial remuneration for royalties which the federation of settlements believe are due them and whether or not that is any factor at all in the govern­ ment's position on the exclusion of

Section 34 from the Charter of Rights. MR. LOUGHEED: Mr. Speaker, on the point of order first, I'm quite prepared to answer the direct policy ques­ tion the hon. member directed to me. I do really think it's somewhat both inappropriate and unfair for the member to wave a document at me and then, when I'm asking him to describe it, to change the question around. I welcome the tabling of the document. I will then ascertain whether or not I've had any opportunity to peruse it. I doubt it. Leaving that aside, perhaps I'd answer the question.

I thought I answered it as clearly as I could with regard to questions raised by the Leader of the Opposition on November 10. Perhaps the hon. member wasn't here. The reason for the position of the government of Alberta last week in not agreeing to the inclusion of

Section 34 had nothing to do with anything involving psychological ad­ vantages or disadvantages, or with the question of what claims might or might not be put forward. It entirely had to do with the fact that a

section in the proposed consti­ tution referred to rights and, as we were not party to the inclusion of that section, we could not define what it was we were being asked to agree to. There was a

section in the former Canada Act which suggested that there be a constitutional conference. I think the only fair way for any provincial government is to have an opportunity to understand what it's being asked to agree to, and to have the native groups, or aboriginal groups as they're defined, identify with some degree of clarity what rights are being claimed. I want to make it clear, abundantly clear again, that sections 25 and 26 of the constitution preserve existing rights.

What the hon. member says both inside and outside the House is up to him, but I don't think it's fair to the native people of this province to communicate to them that their exist­ ing rights are being taken away from them. They are not. The question, and it's a fair question, of whether or not there should be a provision within the constitution, such as

Section 34, in my judgment is something that's going to require identification by the native groups both to the provinces and to the federal government within the short period of a year. By that answer I don't imply one way or another whether we would find at the conclusion of the year that we would be satisfied that such a

section should or should not be included. MR. NOTLEY: Mr. Speaker, a supplementary question to the hon. Premier. On page 1579 of Hansard, the Premier is quoted on Tuesday as saying: "Section 34 purports to add additional aboriginal and treaty rights, undefined and undetermined." So there is no misunder­ standing, I will read

Section 34:

(1) The aboriginal and treaty rights of the abori­ ginal peoples of Canada are hereby recognized and affirmed

(2) In this Act, "aboriginal peoples of Canada" includes the Indian, Inuit and Metis peoples of Canada. My question very directly to the Premier is: in what way does

Section 34 "add additional aboriginal and trea­ ty rights"?

1588 ALBERTA HANSARD November 12, 1981 MR. LOUGHEED: Mr. Speaker, very clearly, if

Section 25 protects existing rights, if

Section 26 does not deny any rights that may be existing, the only purpose for having

Section 34 would be to add rights. MR. NOTLEY: Mr. Speaker,

Section 34 does not say that. In fact, it says "The aboriginal and treaty rights of the aboriginal peoples of Canada are hereby recognized and affirmed". Mr. Speaker, my question to the hon. Premier deals with

Section 25. The Premier is quoted again as saying:

Section 25 therefore maintains all existing rights of the aboriginal people of Canada, who are defined in the Act as including the Indian, Inuit, and Metis people of Canada. My question to the Premier, Mr. Speaker: in fact is it not

Section 34 which defines "the aboriginal people of Cana­ da" as including Indian, lnuit, and Metis? MR. SPEAKER: With great respect to the hon. member, I question the competence of the question period to deal with matters of disputed

interpretation of documents which are public knowledge. The hon. member may have his own

interpretation; he may not agree with somebody else's

interpretation. But I just can't see how we are following the purpose for which the question period was established, which is, namely, to elicit information un­ iquely in the possession of government. Here we are dealing with a very public document, which has had widespread attention, and we're simply arguing

interpretations. MR. NOTLEY: Mr. Speaker, on a point of order. Might I suggest that the issue is sufficiently important that the question is to ask for clarification. Now on Tuesday, sir, you allowed a question to be put and an answer to be made in the House which gave an

interpretation. I want clarification of that

interpretation. It seems to me that that is totally within the purview of the question period. Otherwise, sir, you should in fact have ruled the Premier out of order on November 10. MR. SPEAKER: Or have ruled the question out of order. MR. NOTLEY: That's right. I didn't ask the question. MR. SPEAKER: We've gone around and around once a year concerning the degree of latitude in the question period. It has been stated and implied very plainly that there is insufficient latitude.

Now, if on occasion there is additional latitude, and that is going to be used as a weapon against the Chair on a future occasion, that is a considerable discouragement to further latitude. I say again, notwithstanding any past irregularities, that the question period is not intended to deal with the interpre­ tation of documents. I agree with the hon. member that the matter is of very considerable importance. I'm sure all hon. members of whatsoever persuasion in the House will agree with that as well.

But there are ways of dealing with it outside the question period, ways which may be much more suited to the topic than this irregular use of the question period. MR. R. SPEAKER: Mr. Speaker, on the point of order. There was an indication about the quality of the question I asked on November 10. I want to point out to you, Mr. Speaker, that my question was not in the form of an

interpretation. I asked whether the government supports — my one word — reinstatement of the matter, whether there was consensus. It wasn't a question of interpreta­ tion. Mr. Speaker, with due respect, I think my question was in order. MR. SPEAKER: Well, I must concede. I have no clear recollection of the text of the question. I had assumed that a question which elicited an

interpretation was a question that was directed to get an

interpretation. I certainly imply no fault on the part of the hon. Leader of the Opposition with regard to that question. But we are now aware that we are clearly in the area of discussing and debating

interpretations of documents. Therefore, I must continue to say that that kind of exer­ cise is out of order in the question period, and even beyond the reach of considerable latitude. MR. NOTLEY: Mr. Speaker, I wonder if I could put a supplementary question to the Premier. It flows from the first response the Premier gave with respect to

Section 34 and the question related to provincial jurisdiction. The proposal is a three-year moratorium. In view of the ques­ tion of

interpretation of

Section 34 and the publicly announced hopes of all included in this discussion that over a period of months a conference would be success­ ful, what obstacle does the Premier see in the proposal of the NCC and the ITC that there be a three-year mora­ torium? Is it not the view of the government that the

interpretation of

Section 34 and the definition of the rights thereunder could in fact be achieved within three years? MR. LOUGHEED: Mr. Speaker, there are two weak­ nesses to that position, obviously. The first one is that over the course of discussion and consideration it may be simply impossible to appropriately define what is in­ tended by the rights provision stated in the earlier Canada Act, and there's the other one that the provinces upon reflection are not prepared to consider that rights may be added within provincial jurisdiction. Whenever rights are added, rights are often taken away.

An assess­ ment has to be made by the government as to whether something is being added and given to one group of people within the province or taken away from the others. And what are the equities involved? We're not prejudging the situation. We're merely saying, let's have discussions over the course of the next year; let's see what is proposed. Also, let's reach a conclusion that some of the aspirations that may be held by the Metis people of this province might be realized in a different way. ORDERS OF THE DAY head: WRITTEN QUESTIONS MR. HORSMAN: Mr.

Speaker, I move that Question 141, in the absence of the questioner, and Question 144 stand and retain their place on the Order Paper. [Motion carried] 143. Mr. R. Speaker asked the government the following question: Is it the intention of the provincial government to place the new orange and blue heritage fund logo on school

November 12, 1981 ALBERTA HANSARD 1589 resource material, university library books, student loan awards and applications, and other materials paid for by the Alberta Heritage Savings Trust Fund? MR. HYNDMAN: Mr. Speaker, I am prepared to accept the question with an amendment. The amendment is twofold: first, to delete "orange and blue", because that's not the color, and it does appear in black, white, grey, and other ways as well; secondly, to change "loan" to "scholarship". That's because student loans are paid for from the General Revenue Fund.

It's the heritage scholar­ ship moneys which come from the heritage fund. MR. SPEAKER: I'm not aware of amending a question in the same way as you amend a motion, but I suppose if the House agrees, that can be done, especially if it can be done without too much resistance from the person put­ ting the question. MR. R. SPEAKER: Mr. Speaker, there are always days when you should compromise and concede, and I guess this would be one of them. [interjections] Well, that's the Canadian spirit. I felt so good when I left on Tuesday that I didn't want to move away from that. Certainly, I'll accept that.

I know the orange and blue that is used on the colored ones has no relationship to any political party. I think that would be acceptable. MR. HYNDMAN: Mr. Speaker, then I can give the answer orally, for the record. Yes, in future months the logo will be seen on and/or in connection with many other heritage fund projects, including appropriate educa­ tional resource materials. head: MOTIONS FOR RETURNS 146. Mr. R.

Speaker moved that an order of the Assembly do issue for a return showing: (1) both the original estimated total cost and the cur­ rent estimated total cost to completion of every capital project presently receiving funding from the capital projects division of the Alberta Heritage Savings Trust Fund; (2) the annual operating cost to date of every capital project funded by the capital projects division of the Alberta Heritage Savings Trust Fund; (3) the estimated annual operating costs for 1981-82, 1982-83, and 1983-84 of every capital project funded by the capital projects division of the Alberta Herit­ age Savings Trust Fund.

MR. HYNDMAN: Mr. Speaker, this motion is accepta­ ble with one small amendment, with respect to paragraph two. We note that the information in paragraph three is requested and will be provided from the date of April 1, 1981. In order to assist in and facilitate the answer in paragraph two, I move to amend that by deleting "date" and replacing it with "March 31, 1981". That will simply have the effect of providing information up to the begin­ ning of this fiscal year. The subsequent paragraph three will provide it thereafter. [Motion as amended carried] head: MOTIONS OTHER THAN GOVERNMENT MOTIONS 215. Moved by Dr.

C. Anderson:

Be it resolved that the Legislative Assembly urge the government to encourage the availability of adequate training programs and to initiate incentives to encourage health care professionals to establish in rural Alberta in order to better serve the health needs of the smaller population centres. DR. C. ANDERSON: Mr. Speaker, it's indeed with a great deal of pleasure that I present Motion 215 to the Assembly today. Motion 215 is a follow-up to the motion presented last year by the Member for Grande Prairie. I feel it's still a major concern to us in rural Alberta.

Needless to say, it's a concern that's dear to my heart. I have practised in rural Alberta and feel I know a few things about the problems there. What is the importance of this motion to my constitu­ ency? I feel there is a general lack of health care profes­ sionals throughout the whole constituency. This lack of professionals involves doctors, nurses, dentists, physio­ therapists, speech therapists, optometrists, dietitians, ra­ diologists, and laboratory technicians. I'm sure most of us in rural Alberta can say we have similar problems. I know the Member for Grande Prairie would agree with me.

In my constituency alone, we have a real need for doctors. At the present time we have doctor requirements for our three hospitals in Vilna, Elk Point, and St. Paul. The hospital situation is such that Vilna has approximate­ ly 44 per cent of the senior citizen population. There is a lodge there and, at the present time, a very poorly con­ structed hospital. Our government has taken the initiative to create a 15-bed core hospital, which will be in opera­ tion within the next year to provide necessary health care facilities for those senior citizens. However, there is only one doctor there.

That doctor is presently at retirement age, and at the age when he would like to have assistance. Somehow we need to encourage new practitioners to locate in these smaller areas. In St. Paul, we have approximately five doctors: two are at retirement age, and one is the only surgeon. So in the immediate future, we are faced with the prospect of having no surgeon to carry out any surgery in our area. We are 120 miles from Edmonton. Therefore, to expect our constituents to travel to Edmonton for their surgery, to be away and displaced from their families, is not in the best interests of providing care.

Elk Point has an active- treatment hospital and now has two doctors. Of those two, one is near retirement age. In the past two years, surgery has fallen off to almost nil. And we're now at the point where very little obstetrics take place. The nurse situation has been critical in all three areas as well. I believe St. Paul is the only hospital in the constituency that has had the loss of beds or closure of the entire pediatric wing because of the lack of nursing staff. We're in real need of more dentists. We have no den­ tists at all in Vilna. We have five in St.

Paul — maybe most people would say that's excessive — and one in Elk Point. But there is need for more. Physiotherapists are really difficult to find. We need them in all three hospi­ tals. Speech therapy is another area we have incorporated into our health units. At the present time, we have one speech therapist for the entire northeast region. I under­ stand that therapist will be retiring at Christmas and,

1590 ALBERTA HANSARD November 12, 1981 therefore, we'll have no speech therapist for that area. That will necessitate parents taking their children all the way to the Glenrose hospital to get speech therapy — really a step backwards from what we've had. We have one optometrist in our area, who is also at the stage of retirement and is now semi-retired. As soon as he closes his door, it will mean all our people with just simple refraction will need to go to Edmonton for their refraction to be carried out. And we have need for radiologists and dieticians. Mr.

Speaker, as a member of the health and social services committee of caucus, we've met with numerous health care professionals who provide care throughout the province. Several have stated that they are in need of practitioners in the rural areas. We recently met with the optometrists' association of Alberta. They stated that over 50 per cent of their rural practitioners were nearing retirement age and, therefore, were looking at a need to replace them. What has the lack of health care professionals meant to our people?

I believe the lack of professionals has led to a lack of opportunity for our constituents to acquire the best health care within close proximity to their residence. In the past, we've had numerous participants working on the problem of lack of health care professionals. We've had the Northern Alberta Development Council, the Al­ berta Medical Association, the College of Physicians and Surgeons, the College of Family Practice, the Alberta association of optometrists, and many others looking at the problem. Mr.

Speaker, this resolution is asking the government to establish training programs to encourage health care professionals to locate in the more isolated and smaller population centres of rural Alberta. Alberta is not alone in this problem of attracting and retaining health care professionals for rural Alberta. We're competing with other centres for health care professionals: other prov­ inces in Canada and most states in the United States. This is also complicated by the fact that there's a general lack of health care professionals in the urban centres throughout the province as well, and we're competing with them.

The problem is further complicated by the economic stability and rapid growth of our province. At the present time, we're experiencing a growth rate of approximately 4,000 people per month. This is adding a requirement of approximately 48 new practitioners per year, which makes up a full 25 per cent of the graduates of our two medical training centres, in Calgary and Edmonton. At the present time, we have half as many doctors in rural Alberta and the isolated centres as we have in our cities, yet we have about an equal population. Mr.

Speaker, I would say that the problem has compounded since 1971 when this government establishment this decentralization policy and the stable economic growth ideal we have. I have been talking mainly about the doctor situation, but all the areas pertain to all the fields of health care. I'm sure that the other members speaking after me this afternoon will include them in their talks, so I would like to concentrate more or less on what's happening in the medical field. What has caused the problem of lack of physicians in our isolated and rural areas?

The Alberta Medical Association presented a paper entitled Physi­ cians in Isolated Areas. They outlined the deterrents for health care professionals entering rural areas, and listed them as follows: one. high cost in establishing a practice, the high cost in living, lower income due to the lower volume of patients, and the higher expenses; two, the lack of professional support and lack of peer group — in other words, really professional isolationism; three, the prob­ lem with inadequate facilities.

At present, we're working on a major hospital expan­ sion program throughout the province, and this will do a lot to alleviate the problem of lack of facilities. However, we still lack modern equipment in those facilities. This mainly comes in the diagnostic areas. At present, in a lot of our centres in rural Alberta, doctors have to practise on a different level from their counterparts in the city.

We often have patients come in with severe dehydration, diarrhea, and other things requiring instant treatment, yet we have to take medical diagnostic tests that have to be sent to Edmonton and, therefore, are flying by the seat of our pants in the initial treatment. Often when the lab work comes back, it's either too late or has already been accomplished. This is complicated mainly by the fact that since we've gone to the total program of the hospitals and the lack of local autonomy for purchasing equipment, we have to go through a complicated procedure of applying for neces­ sary instruments.

That's also complicated by the fact that the College of Physicians and Surgeons has a committee that evaluates these requests. The specialists in the city are usually on those committees, and it doesn't always meet their purposes if we put more of this equipment into our rural areas. So the fact that we don't have an equal distribution of types of physicians on those committees is also delaying approval for purchase of equipment. This past summer, when I went back to practise as a locum for the group in St. Paul, I had a patient come in with a severe case of diabetes. The diabetes had been treated with insulin.

The insulin had been given in the morning, but the patient hadn't taken the necessary re­ quirement of food. The patient came in unconscious, without a history that I could get from him or his rela­ tives. Normally, if you're in the city you can take blood at that time, have an answer within a matter of a minute or two, and know what the blood tests are. I had to act spontaneously and treat with sugar, in what I felt was an emergency situation. Luckily, the treatment was right, but it wasn't until two hours later that I got my blood tests back and found that we had overtreated.

So I would say that the lack of facilities is being looked after, but we still have equipment deficiencies. There are also problems that have caused the lack of physicians. That's basically a lack of social factors: recre­ ational facilities in a lot of these centres, educational opportunities for the professionals' children, and ade­ quate training opportunities, both in postgraduate train­ ing and upgrading. There's often a difficulty of attending courses.

Even if you have a group of five doctors, the courses are usually so arranged that often more than one of that group have similar interests and would like to attend the same course. Often you have to delay for two or three years before you have an opportunity to get the upgrading. Difficulty in obtaining upgrading of skills is also found by the lack of support in our city hospitals where surgeons do not want to help out in the upgrading of our rural practitioners. The sixth thing in discouraging practitioners is the poorly developed family practice residency programs.

At present there are, more or less, two different types of physicians, what I would call urban and rural, and their skills are different. At present, the family practitioners residency programs are presenting a course in psychiatry, internal medicine, and pediatrics, but don't do much to help out in the area of emergency care required if you go

November 12, 1981 ALBERTA HANSARD 1591 into rural Alberta. What studies have been done in the past? Mr. Speaker, a northern Alberta health needs conference was held in St. Paul in 1979. That was sponsored by the Northern Alberta Development Council. That study found that health needs in northern Alberta were based on the general drainage of the population, health personnel, and resources towards the secondary centres. It was found that there was a health manpower to population ratio too low for all areas.

It was found that the elderly were being underserviced, and there was a need for integrated pri­ mary care in many of the mid-sized communities. It also pointed out that an inadequate infrastructure was pro­ vided to the people in these areas. It pointed out that children and women were two of the important target groups who needed to have support services and that Indians and Metis have special needs. Dental services was one area where it was definitely pointed out that inade­ quate facilities were present. Mr. Speaker, another study was carried out by Dr.

Backus, who was the Member for Grande Prairie before our present member. His report, generally known as the Backus report but officially known as The Rural Health Care Facilities Policy Development, outlined the objec­ tive to develop a new policy to provide health care facili­ ties in rural Alberta to provide first-level primary care. That policy for facilities is being implemented. The report had five recommendations. The first rec­ ommendation dealt with the underserviced areas and stated that these areas should be treated individually in an effort to try to bring them adequate service.

This was to involve better communication, establishing health clinics, and providing incentives to doctors to locate in the area. In its first recommendation, it also pointed out that education and training of general practitioners needed to be improved so that the concerns of the family practitioners delivering service there were met. These fa­ mily physicians they were in contact with pointed out that training today did not train new graduates for practising in remote or isolated areas.

The second recommendation stated that government should provide additional funds to small rural hospitals approved by the college as having suitable educational potential, so that the members could receive training that would make them aware of the rural situation. The third recommendation was for a course for nurse practitioners and a course for remote area office nurses. The fifth recommendation was to provide incentives to doctors to locate in rural Alberta. Mr. Speaker, other studies have been carried out by our neighbor to the south.

I have here a study called Strategies for a Statewide Approach to Improving Geo­ graphic Distribution of Health Professionals, carried out by Syiek and Mayes for the South Carolina area. This study was proposed as a co-ordinated, state-level ap­ proach designed to achieve equitable access to health care in rural areas. It was pointed out that eight basic manpower strategies had been devised to influence the distribution of physicians in rural areas at the federal, state, and community levels.

One was to provide more equitable opportunities for residency training in the state as a whole and in rural areas; two was to increase scholarship and loan forgiveness programs with corre­ sponding increases in dollar amounts and penalties in­ volved; three was to establish a reimbursement system for rural practice that at least equals the urban practice; four was to give preferential admissions to residents of rural areas. It was found that if you train physicians in a rural setting, they're more likely to return to that setting.

The fifth was to alter the undergraduate medical education process to include rural preceptorships, and to provide greater emphasis on human and behavioral factors in the prevention of illness. The sixth was to establish or expand health educational centres and primary care residences associated with them. Another study, carried out by Cooper, Heald and Samuels, is called The Decision for Rural Practice. Its first statement is that "The country doctor of the past is vanishing." I think we have to realize that, and we have to look at that.

It's no longer the case where the doctor hooks up his team, or horse and buggy, makes a tour around the community, does everything, and is willing to put in seven days a week, 24 hours a day. The study pointed out that the location of the physician's medical school, internship, and residency training were influential in his location of practice. It states that this is one reason for encouraging the development of more training facili­ ties in rural areas. Another study carried out in the U.S. deals with optometrists.

It states that the attitude toward urban environment and the place of origin were found to be the best predicator of an optometrist's location. They point out that if practitioners happen to come from a rural setting, and are rural native sons or daughters, they would have a tendency to locate in the rural setting. Mr. Speaker, I'd like to go on to what has been done. Many programs are set up in Alberta. The Department of Social Services and Community Health has set up a visit­ ing dentist program, mobile training units, and profes­ sional training bursary programs.

Advanced Education and Manpower has set up with NAIT rural practicums of six months' duration for laboratory and X-ray techni­ cians in rural hospitals. We've been privileged to have some of those students in St. Paul on a regular basis, and they tend to go back into a rural setting. British Columbia has recently done a study that has shown that a quarter of those interns who have had the opportunity for rural training will return to a rural area. They've gone through many programs, and I understand that they're looking at setting up a new one in February. Saskatchewan has gone through some incentives.

They've had tax-free grants as well as establishment grants, but have found that these have been basically unsatisfactory and the uptake of them has been very poor. In fact, only five people have taken advantage of the tax-free grant since its establishment in April 1979. At the present time, Ontario seems still to have one of the better programs. They have what is called the under- serviced medical program, under which they've put 310 doctors into 161 communities. There's a 50 per cent attri­ tion rate.

But we have to realize that with the modern trend of staying for a short time in a community and then moving to another area, we have to be ready for attrition in the doctor population and, as well, in all health care professionals. However, the program co-ordinator feels that the cost benefit to the province was very worth while. They've also gone into an undergraduate bursary program. I just got a note that I'm about time and a half over already, so I'll try to wrap up in a hurry. As you can see, it's dear to my heart and I like to go over as much as I can. MR.

SPEAKER: With great respect to the hon. member, the note only predicts. The hon. member still has three minutes to go.

1592 ALBERTA HANSARD November 12, 1981 DR. C. ANDERSON: Thank you, Mr. Speaker. I guess you knew what I had in mind. What else has been done on this problem? In 1978, the Alberta Medical Association provided the government with a discussion paper called Physicians in Isolated Areas, on the provisions of health services. In 1981, an

article on rural health was provided to Dr. Grisdale. In 1980, following the discussions involving the

schedule of benefits, the department presented a discussion paper back to the AMA board of directors. In turn, this discus­ sion paper was turned over to Dr. Lewis by the AMA board, and further commented on. After going over and reviewing it, the board stated that it recognized that several factors were involved which affected the locating and retraining of physicians in rural and remote areas, and really went on to indicate its preference for the system being used at that time in B.C.

This is a system of a premium being paid on medicare benefits to physicians in remote areas, but was really based on a relatively complex formula. Mr. Speaker, what are the solutions to the problem we have before us? As the motion states, we need training programs first of all. We need to provide proper training programs that will deal with the situation in rural Alber­ ta. At the present time, the provincial College of Family Practitioners has its training programs located in Edmon­ ton and Calgary. In Calgary, they send their graduates out for some opportunity to practise in rural Alberta.

In Edmonton, it's not quite the same. Basically, the program gives psychiatry, internal medicine, and pediatrics. This isn't enough for our present situation. So, first of all, we have to establish proper training facilities. I think we made the proper step recently in regard to our nursing situation by establishing colleges in Grande Prairie and Lethbridge. I would like to suggest that we should look at the same type of thing for our doctors, and get them out of the city and let them see what rural Alberta is about.

I'd also like to suggest, and I could be accused of conflict of interest, that we need to have substantially larger fees paid in the medical field. We need to establish grants and minimum income guarantees. Maybe we can look at the Ontario underserviced area program. We need to establish physician relief back-up services for those communities with only one doctor, so he would have an opportunity to get out, upgrade, and have a chance to relax. We need to establish consultant services so these people may have an opportunity to meet with their peers and to upgrade.

We need to increase the opportunities for specialty training. We need to look at selecting students who might return to rural areas. Maybe we have to have preferential treatment for some of our possible health professionals. And I would like to say that we need to have an aggressive recruiting program. Mr. Speaker, the last thing I would like to do is have government more involved in the health care field. I think there are ways of encouraging and providing incentives to encourage the private sector to do a lot of these things for us.

At the present time, I think we lack private entrepre­ neurs in the health care field who will go out and actively recruit and match prospective applicants with the proper setting in rural Alberta. A matching process could be of benefit. The government needs to encourage someone in the medical field to do it. The other thing we need to do is take an active

part in the Alberta

chapter of the College of Family Physicians. On November 23, 24, and 25, they are having a confer­ ence on rural health care. I suggest that we go, take part, look at their recommendations and try to implement them. Thank you, Mr. Speaker. MRS. FYFE: As the member did perhaps go a little beyond his 30 minutes. I'll try to balance that out and go a little under 30 minutes. First, I would like to compli­ ment the Member for St.

Paul for bringing forward this motion; as he said, a follow-up to a motion discussed last year in the House, and one that I think is very worthy of debate and support of the members of this Assembly. I heard the hon. member say that rural doctors who work 24 hours a day and travel anywhere are a thing of the past. I would say that city doctors of that type are also a thing of the past. I guess there are a number of reasons for it.

Modern modes of transportation have made it far easier for patients to get to a place of treatment rather than having the physician travel, spending many hours which could be better spent seeing the various patients within his practice. [Mr. Purdy in the Chair] The motion itself deals with two specific areas. First, it deals with the area of adequate training programs, and secondly, incentives to encourage health care profes­ sionals to establish in rural Alberta. In reading through the debate last year, I believe that motion primarily centred on the lack of health professionals in northern Alberta.

This motion broadens it to include rural Alberta, which would extend to all four corners of this vast province. I would like to break my comments into two areas. First, dealing with a few comments related to training aspects, I think it's difficult perhaps to make any more meaningful comments than the member has already made. He has covered a vast variety of issues related to this broad topic. He has mentioned a number of initia­ tives that have taken place within this province in the training area, and there are some very significant happen­ ings that we've accomplished.

I like the idea of medical schools, training schools, or facilities outside the two large urban jurisdictions. I compliment the Minister of Advanced Education and Manpower for his announce­ ment last week of a new diploma training program in nursing in Grande Prairie. I think this is exactly the type of initiative we need and must continue to have. You can visualize a younger person choosing the health field, and I think it's a very exciting field for young people. Exciting opportunities and a wide array of pro­ fessions and choices can be made within this field.

Medical schools within the northern environment geared to issues, concerns, and training with northern residents, I think are very significant. On the other hand, we have to look at schools that will deal with other types of rural residents where often the concerns are different from those of the northern resident. In the north, we often have to deal with problems such as transportation and poor communication systems. There are different factors in other parts of the province. While there are similarities, we certainly cannot overlook one for the other. I like the idea of bursary programs.

An example is the psychiatric nursing training program at Alberta Hospital Edmonton within the St. Albert constituency. When there is difficulty attracting people to a particular field, I think having an incentive for people who become involved and committed to that particular field is a way to interest them. While money isn't always important, isn't the only factor in career choice or continuing a career, it certainly

November 12, 1981 ALBERTA HANSARD 1593 has to play a rather significant role. If there can be assistance to students acquiring their education without large loans or large commitments on the part of the family, I think that has to be an important factor that young people will consider. I'd now like to look at some of the initiatives and some areas we have been involved in, and probably follow that through with a few areas I think are important to consid­ er. One of the things I would like to see us as a government consider is dividing our province into respec­ tive health zones.

I know this type of approach has been discussed over the years, related to integrated services for medical care, but I'd like to do it on the basis of establish­ ing zones, trying to look at ways we can apply medical services in the best way possible to all people within that zone. I know it's not possible to have exactly the same type of treatment in all sectors of the province. We're not all a few blocks from the new Walter C. MacKenzie Health Sciences Centre. We're not all right across the street from the health unit, for example.

But I believe we need to look at zones where we can treat the people within that area in a smaller unit. I would like to see us try a pilot project in a number of different areas. Let's look at the types of incentives we could apply. Let's take the St. Paul area, represented by the member who brought this motion forward, and the whole area surrounding that community — a number of constituencies could be included within that zone — and let's look at incentives.

Let's apply that against some factors for another region, such as the Peace River re­ gion, where we look at whether the initiatives we tried over a period of time are effective, whether bursaries within that system have worked, whether we can look at systems of assisting in certain types of housing. We do this in Northland School Division. We provide housing units for new teachers going in. There are often subsidies related to utility costs for those houses. Would we be effective in attracting various health care personnel if we established these types of incentives?

As I said, I would like to see us try different types of projects so that we have some criteria for evaluation. The fees we have paid to our respective practitioners and to various health workers have, for the most part, been standardized. As I said before, money is one factor in attracting people to a certain field. But if they are within the field, we certainly have to take into considera­ tion that there may be higher costs in locating in certain parts of the province.

If you happen to be locating in a sector of the Peace River country, or further north in some of the isolated communities within our province, or even within some of the southern rural communities, there are certain considerations that a family has take to mind when they're making the choice to move to those locations. If you have a family and your children are reaching the ages of postsecondary schools, there's the consideration of the family having to pay added costs to assist their children to seek higher education.

There is a higher cost to receive exactly the area we're talking about: specialized medical care. There are many factors. I think that is a very legitimate area where we could consider ways of grading our salary scales to provide an incentive to go into rural areas. I realize this becomes more difficult when we're talking about the southern rural part of our province, but certainly one that can be considered in the northern jurisdictions within Alberta. I have covered the bursary program in my previous comments.

I think it would be most appropriate to co­ ordinate the bursary program with the training program and apply these within our incentives, within our zones, to find out whether one aspect of our incentives works compared to others. We have already made initiatives in some of the areas within the total health care spectrum that relate to the very basis of prevention. I think this government has indicated a very strong support for preventive programs. The budgets within the health units have expanded dra­ matically over the last number of years.

A whole variety of preventive programs has mushroomed, but still the need is there and the need continues to grow. Hopefully, if we could convince our population to curtail the intake of drugs and alcohol, and provide our society with an incentive for exercise — all these areas that are covered in prevention. Surely at the other end of the scale, we would have less expensive costs related to treatment programs. But until we get to that point, I think we have to continue working in the preventive areas. We need incentives throughout our province.

We need health care workers who are aware of the available treatment programs, ways to motivate our society, ways to get our population concerned about the total cost to family and society as a whole. Active treatment facilities throughout the province have obviously had tremendous support over the last two years. The Minister of Hospitals and Medical Care has announced a series of projects across this province that, as has been said many times in this Legislature, are second to none anywhere in the western world or the world, period.

Nevertheless, along with the development of these facilities, the other side of the coin is ensuring that we have adequate health care personnel to man the facilities that are so needed and will provide such a tremendous facility in a lot of small communities. I've heard criticism from persons within the health care field: why waste money building these small hospitals throughout Alberta, that's not important; what we need are the new large buildings within the larger urban areas.

But I dare say if you're the person living in the commu­ nity of Vilna or whatever small community that has had the benefit of the announcement of a new facility, that treatment centre is extremely important. It's also extreme­ ly important to the attraction of health care personnel throughout the province.

Ten years down the road, when these facilities are on stream and we have been successful in our incentives to attract health care personnel throughout this province, I think we will see just how important an integral part those smaller hospitals and treatment areas have played in our total health delivery system in Alberta. I think we have to look at a broader integration of active treatment with auxiliary, geriatic, home care; for example, treatment of the terminally ill.

The home care program is undergoing an extensive review at present to determine whether medical entry is the only way we should go in the future, whether we should consider social entry or whether there are other aspects of home care that should be expanded. In the meantime, home care is providing a very important role throughout Alber­ ta. Home care is a significant support service system to families suffering with having a member of their family terminally ill. Last year, I was able to attend a conference in Montre­ al related to care of the terminally ill.

One of the papers presented described a program in the state of Minnesota in the United States about care for terminally ill children. This program provided support services through trained

1594 ALBERTA HANSARD November 12, 1981 nursing personnel, through a central agency, over a 200-mile space. I think this program, and ones such as that, have a lot of application for a province such as Alberta that has a relatively small population over a large geographic area. By looking at zones and an integration of the services we have, and by developing a better ambulance service, more specialized communication that will tie our volunteers in with all the services we have in place, I think we can learn a lot from other jurisdictions.

We've come a long way within Alberta, and I think we still have a fair way to go in order that we reach the level where we have provided an adequate level in terms of just basic care to all citizens. Mr. Speaker, I'm going to conclude my remarks by once again thanking the member for bringing forward this motion, that is a very complicated area. The remarks I have made probably just scratch the surface in a few ways. As a lay person interested in health care, I appreci­ ate being able to make even a few comments related to this extremely important subject. I think we as a province have a challenge.

All of us have to be concerned one way or another about levels of service across Alberta. I think there's a challenge for all members of this Legislature. I would like to see a commitment and the support of every member in this Legislature for the motion. Thank you, Mr. Speaker. MR. WEISS: Mr. Speaker, it is indeed a pleasure for me as a rural member to participate in this motion today. I would certainly like to congratulate the hon. Member for St. Paul for bringing this to the Assembly and the partic­ ipation as shown by my colleague to the right, the rural Member for St. Albert.

I'm pleased to note that with her remarks so eloquently presented, perhaps it would be best if I were to sit down and just say, copy those as well. But I feel too that without the members agreeing to it, I would like to participate and perhaps be able to contrib­ ute as well. Mr. Speaker, I would like to try to cover three basic areas and what we are doing specifically in the areas of rural health, what the needs are, some recommendations for implementation, and hopefully put forth some issues for debate.

In particular, health care affects all of us, not just in rural Alberta, I might emphasize, but wherever we may live. Mr. Speaker, it involves not just one department but various departments, as has been illustrated. There is Social Services and Community Health, Hospitals and Medical Care, Advanced Education and Manpower and, strange as it may seem, it also involves the Department of Small Business and Tourism. How does it affect them, sir? Through the Northern Alberta Development Council, which plays a large role in the lives of northern and rural Albertans.

Alberta presently is facing a general shortage of health care professionals: nurses, psychiatrists, specialists. The problem is much worse in rural Alberta, although I have emphasized that it is a problem in all parts of Canada and in Alberta. We feel it's a very significant problem in isolated communities, more specifically. This resolution asks the government to consider taking action to combat the manpower shortage through incen­ tives and training programs. As has been pointed out, there are very many studies, four in particular that I'm aware of, that have reviewed the health care system.

Health Care Needs of Northern Alberta, prepared in 1980 for the Northern Alberta Development Council, was pre­ sented in the riding of the Member for St. Paul, the community of St. Paul. It was well attended, had a good response, and I'd like to come back to it later and point out some of the recommendations submitted during that time. The second is Physicians in Isolated Areas, pre­ pared by the Alberta Medical Association in 1979. The third is Nursing Manpower: a Study of Factors in Nurs­ ing Supply and Demand. The fourth is Strategy for Attracting and Retaining Physicians in Northern and Rural Communities. Mr.

Speaker, that was done in 1980, a non-public study for the Department of Hospitals and Medical Care. In northern Alberta in particular, the problems in these studies have been identified as the need for more counsel­ lors to aid in the treatment of alcoholism. I'm sure the hon. Member for Lethbridge West would support that, that alcoholism plays a significant part of the problems in rural areas. Secondly, the need for psychiatric staff: mental health services were considered very, very patchy and sparse.

Dental services were also considered very sparse and have presented a problem; the lack of speech therapists and audiologists, particularly in native com­ munities; the scarcity of physiotherapists and aids for the handicapped; the lack of general physicians and, more critically, in the specialist field; and the need for more community medicine specialists, especially in light of the need for co-ordination in the delivery of health care in the north and expected growth in many areas. Rapid growth communities, as well as isolated areas, face a serious problem. And, Mr.

Speaker, a very, very severe, direct shortage of nurses, not just in the north but in all areas. The Alberta Medical Association study identified the problems in attracting physicians to rural and isolated areas, such as higher costs — the cost of living, of estab­ lishing a practice, and of travel to rural and isolated areas. In addition, the volume of patients is lower, which of course decreases earning potential. If there's to be subsidization, I think it should be considered in those areas.

One has a difficult time competing in business today as it is, but having to provide a service to outlying, remote areas where the patient populace is very, very low certainly is very difficult. The professional is in isolation socially and in regard to working conditions, where there is no relief from duties. A doctor or medical person has to go into communities and is expected to work 14, 16, 18 hours, whatever it might entail. Not so in urbanized centres, where they can rely on change of manpower, shifts, shift differentials, back-up physicians, and help throughout the services.

In the larger institutions, of course, they have complete rotation of shift persons. That's not so in an isolated area. There's a less attractive social and cultural atmosphere both in the facilities and in some of the amenities offered to the people who would be servicing these health care needs. There is inadequate training in the profession for the type of care and service required outside urban areas. Strange as it seems, there is a lack of prestige and glamor compared to urban prac­ tices. I think that's a fear that faces a lot of young people in looking to relocate into urban areas. What is there for them?

What is to be offered? Do they have the amenities? Do they have the cultural aspects? I would hope we as government can help attain some of these amenities for people and make it more attractive for them. The nursing manpower study has pointed out that the number of graduates from training programs in Alberta has declined by 23 per cent in the last five years, particu­ larly due to quotas. Mr. Speaker, there is a need for a greater practical component in training programs, for more specialized training in some areas of care, the

November 12, 1981 ALBERTA HANSARD 1595 educational training aspect and upgrading, the high work and patient loads placed on nurses creating dissatisfac­ tion. These are just some of the problems that face rural areas in relation to urban centres. Physician recruitment and retention programs are es­ sential for improving the medical services in medical underserviced and isolated areas, and for maintaining availability and quality of medical services in those areas presently served by a sole practitioner.

There have to be professional considerations, such as availability of spe­ cialists and opportunities for continuing education. It cer­ tainly is a deterrent to a physician, or anyone in that field who locates to a rural area, when they're not able to upgrade and continue with that upgrading program. They then feel inadequate and wish to come back to the urban centre where this specialized training is available for them. The programs for training incentives in Alberta, while they are varied are, I think, somewhat restrictive.

Through Social Services and Community Health, they have mobile training units which provide mobile dental care by some students of dentistry to some of the various rural communities. I would say this is certainly very well accepted and very well utilized. But there is a shortfall, and they're not able to service all communities. Of course, it does help introduce a practitioner dentist into the rural area and hopefully will show them some of the other fine aspects of communities and rural life we have.

The pro­ fessional training bursary program through Social Serv­ ices and Community Health provides bursaries to stu­ dents of health care, in eight fields in particular. It's not specifically addressed to the rural needs, and I think this is an area we should be considering. The northern devel­ opment bursary, conducted through Tourism and Small Business, provides bursaries to students from the north. This year, the emphasis was placed on health care, with 13 per cent of the funds going to students of those professions.

Conditional upon return to the northern ru­ ral areas, the bursary is directly related to this. Unfortu­ nately, Mr. Speaker, the success rate has been only 50 per cent. I believe there could be some improvement in this area. Hospitals and Medical Care, through its implemen­ tation committee, has suggested conducting a study of nursing manpower in Alberta. We believe this can be expanded. We certainly all know there is a shortage. Of course, at present we're all aware that there is a review of the salary negotiations as well. Looking at some of the other provinces, British Col­ umbia has some varied programs.

The Deayse Lake pro­ gram, which is a native community primarily, involved the construction of a clinic in the isolated Deayse Lake community to be staffed by doctors on a rotating basis. This is on a two- to four-week basis. Doctors are paid salaries commensurate with their urban salaries, and there is no limit on the number which may participate. Mr. Speaker, response to this program has been very good. Perhaps this is an area we could explore as well. The extern program for dental students is also working in isolated areas. As well, it provides mobile training units.

Saskatchewan is another province that's faced with rural problems. There's a physician establishment pro­ gram, as mentioned by the Member for St. Paul, which provides grants to physicians: $15,000 to a generalist and up to $25,000 to specialists. This allows them to establish first-time practices in grant-eligible communities as speci­ fied by the departments. There's a great deal of commu­ nity involvement in these areas, Mr. Speaker, in recruit­ ment and provision of facilities. The main problem, though, is that it still has attracted only five physicians since 1979.

But five is a long way and would provide a long way to help in what we do have at the present time in our areas. The dental establishment program is similar, only the amounts vary approximately from $10,000 to $20,000. Although the program has been successful. I understand the province of Saskatchewan is going to be reviewing it, possibly because the communities are now able to attract dentists on their own as a result of the program. In Ontario in particular, programs are available for physicians, dentists, speech pathologist, and audiologists. They provide bursaries for part of the training.

Doctors receive $5,000 a year for the last two years of medical school. Postgraduate grants and income support incen­ tives are available to them as well. Support services are available, and the success rate there is approximately similar to our areas, at 50 per cent. There are special programs. There is tele-health, which is in a developmen­ tal stage at this time. It introduces technology into the co-ordination and provision of health services. There are isolated nursing stations. Many programs are taking place in all these areas.

I think it gives us examples that we can look upon, draw upon, and perhaps take the best of all these programs and implement them as required for our needs. Mr. Speaker, rapid development is taking place in many rural areas, particularly the north. I believe the government has a responsibility to provide adequate health care and to encourage such growth by providing the suitable atmosphere, which involves provision of health care. I believe we owe that not just to rural Albertans but to all Albertans.

The problems of man­ power shortages in Alberta are accelerated in rural areas by lack of professional development opportunities, lack of support resources and, in some cases, lack of commu­ nity services. There is a need to provide an attraction to these areas. There is also a lack of funding and facilities for training professionals in rural health care in Alberta. The problem is very complex.

The solution requires greater community involvement, improvement in the co­ ordination of health care delivery, improvement in the educational and social services facilities in rural areas, as well as additional training and incentive programs to become part of the overall solution. Mr. Speaker, I'm not saying the government has not recognized some of these concerns. I certainly am very supportive of some of the programs, in particular those mentioned earlier by the Member for St. Albert, in rela­ tion to the nursing program that's been implemented in Lethbridge and Grande Prairie.

We look forward to this same program to be announced from the minister and implemented in Keyano College in the Fort McMurray region. The government has partially recognized some of these difficulties, as I have mentioned. It has expanded its hospital construction significantly in the last year. In particular, in the constituency I represent we're very pleased with what is happening. It has approved several new training programs, such as I have already mentioned. These programs will certainly take away some of the problems we have spoken about today.

As well, it is committed to providing some rural practicum to students. However, the situation remains grave. Therefore, an examination of further action is warranted. It is for these reasons and these issues that I speak in criticism of our government, because I believe that we don't wish to be complacent. We must recognize these needs and strive to make this province of ours a better

1596 ALBERTA HANSARD November 12, 1981 place to live. Incentive programs have not been conclu­ sively proven successful, as is shown by the Saskatchewan experience. But I believe that we too can improve on these. Consideration should be given to providing some form of extension program or lecture series in rural Alberta, with the goal of making the opportunity for professional upgrading available. The lack of this has been cited as one contributing factor to drainage of professionals from rural to urban areas. Mr. Speaker, I mentioned earlier the involvement of Tourism and Small Business.

In particular, one of the departments that comes under that ministry is the Alberta Opportunity Company. I think the parameters of that particular department could be expanded. We talk about small loans to businesses, to beginning farmers through the Department of Agriculture. Perhaps we should be considering business loans to finance the beginning doc­ tors or essential services in communities. Get them in there. Get them involved. Help the communities. Get the practice going. I believe once we've got them, they'll never want to leave.

I'm one of those converts, having been an urbanite in the cities of Vancouver and Edmonton. I thought they were great places to live, and I'm sure they still are, with a lot of good benefits. But I don't think there's anything wrong in living out there in rural Alber­ ta. I'm pleased with a lot of the things our government has helped to make worth while: the amenities, the pro­ grams, and the education. Mr. Speaker, the Northern Alberta Development Council is just one of those committees and groups working to help improve it for Alberta. They encourage the support of this Motion 215.

Once again, I would like to thank the member for bringing forth the motion. I as a rural member certainly support it. I urge all members of this Assembly to do so as well. MR. HYLAND: Mr. Speaker, as I rise to participate in debate of Motion 215, I guess I've probably got three to four minutes of speaking time. Is that about right? Thank you, Mr. Speaker. Various members have co­ vered a lot of the areas I have in my notes. As I'm out of time, I'll skip over some of the areas. First, I would like to congratulate the Member for St. Paul for bringing forward this motion.

I note that last year I participated in a motion somewhat the same, dealing with the supplying of health services to rural Alberta. Mr. Speaker, in Alberta we have probably one of the best set-ups of postsecondary institutions anywhere in Canada. In the discussion of this motion, various mem­ bers have referred to these institutions and what they could do to provide the health care professionals we need to provide care in rural Alberta. I look at the maps out of a publication called Access to Opportunity 1905-1980, the development of postsecondary education in Alberta.

They have various postsecondary institutions dotted on them. In 1921, there were 19 such institutions, everything from Edmonton and south. In 1951, there were 15; it had dropped some. There was one at Fairview, and the rest were Edmonton and south. In 1966, there were 25 such institutions; three were north of Edmonton, the remaind­ er south. In 1980, there were 60. I haven't counted the ones that were Edmonton and north, because on the map it looks like a 50:50 percentage balance of these institu­ tions in the northern and southern parts of the province.

When you see a map with dots where these institutions are, I think it really impresses upon one that we have the facilities to train the people we would need in the rural areas to provide the service. And indeed we do, in various institutions. But I think we can do more besides the various programs we have in the junior colleges and other institutions throughout Alberta. Mr. Chairman, when I spoke last year, I noted what happens to a community when it loses its doctor. This can be very devastating. So we need some sort of way of attracting these health professionals to the rural areas.

Once many of them come to rural Alberta, they stay. They like it. But it's getting them out of the city to practise in a rural area. The constituency I represent, I believe I have . . . MR. DEPUTY SPEAKER: Order please. The time for this debate has now concluded. DR. C. ANDERSON: Mr. Speaker, on a point of order. Seeing as the Member for Clover Bar, whose Bill comes up for the second hour, is not here, I wonder if we could beg the Assembly to have unanimous consent to extend the debate for the second hour. MR.

DEPUTY SPEAKER: Is there unanimous consent of the Assembly that we continue the debate on the motion of the hon. Member for St. Paul? HON. MEMBERS: Agreed. MR. HYLAND: Mr. Speaker, I'm not sure where to start now. I left a good deal of it out to try to squeeze it into the four-minute time limit I had. AN HON. MEMBER: Great speech. MR. HYLAND: Mr. Speaker, I was dealing with doctors in rural areas, what happens to the community when there is a loss of a doctor, and the number of doctors who practise in the constituency of Cypress.

Indeed, two of them practise in Bow Island, and the remainder — three, four, or more — practise in an office in Redcliff. So a good part of the constituency doesn't have resident doc­ tors. There isn't an optometrist, and there aren't many other health professionals in the area. It is unique in that all these specialties are in Medicine Hat, being the larger central area. It's just a distance for people to travel. Mr. Speaker, we have one problem where you get health professionals — doctors, nurses, lab technicians — coming to rural areas. I guess it's the fault of people such as me.

On maybe their first night out after their first shift, these gals go to wherever the local high spot is. Some local, young fellow sees them and thinks, gee, she looks pretty good. So that's what happens to a goodly number of our health professionals in rural areas. Most of these people are out of the health care field for a number of years raising their families. Some return afterwards, and some return on a part-time basis. So it becomes an integral part of a small rural hospital to have people available on a part-time basis. But as I've said, I still think it was a good idea.

It provides stability in the community, because these people are here for a long period of time even if they just work on a part-time basis. Mr. Speaker, we've dealt with a great many possible remedies that could be used to draw health professionals to rural areas. The Member for St. Paul gave his feelings on what the education extras should be like so that we get an all-round general practitioner. Being a layman, I wouldn't be so brave as to suggest what courses they should take. I remember a friend who said that a general practitioner knows a little about a whole lot, and a

November 12, 1981 ALBERTA HANSARD 1597 specialist knows a whole lot about very little. I think that kind of sums up what the doctor in a rural area has to work with. When he is confronted with a problem, he has to make an immediate decision, in some cases with very little back-up of availability of very modern equipment. A lot is done on knowledge and gut feeling. That is the way it is, because it's a long way from modern hospitals that would have all the new equipment. In rural Alberta, we have some very fine facilities in our hospitals, and we're building more.

We have the best building program of any province in Canada. But to provide the equipment that would be in regional hospitals in each small hospital would be one thing, and then to have people there to run that equipment would be some­ thing else. Thus our idea of smaller hospitals with a good medical staff and a good amount of equipment, and the placement of regional hospitals within the shortest possi­ ble distance from these other hospitals for the transporta­ tion of patients and further service to them. We have talked this afternoon of many incentives to coax health professionals to rural areas.

We've heard about possible additions to their fees of 10 per cent, or whatever the figure may be. We have heard of a guaran­ tee of a certain wage or income. Some of the ideas are establishment of clinics, where a doctor would go into an area and the clinic would be supplied by the government or the community, as we do in social services with the mobile dental units. There could be such things as income tax credits or whatever, as suggested in this Assembly last week on the debate of a motion. Probably there could be many others too numerous to mention.

But these are all things we can think about and things we may try, to get health professionals into the rural area. Mr. Speaker, one area we may try to improve to help the situation would be the ambulance system. We have many different types of ambulance systems available and active in the province at present, all the way from those manned from hospitals with paramedics to those, in the case of two in my constituency, manned by the local fire department, with their St. John Ambulance training, with two relatively new units.

Maybe we could tie these kinds of systems together, partly with education and partly with better communication systems between the vehicles. Mr. Speaker, these are all things I feel could possibly be done, and I'm sure other members have many more suggestions we could think about that could accomplish the end of having more professional health practitioners in the rural part of Alberta. I guess the one important thing is that we have to put enticements there.

They have to be coaxed — if that's a good word — to rural Alberta because the practice of medicine and the practice of almost all the health professionals is that of free enter­ prise. They, like many of us here, want to be free to do their thing. So it is our job to place conditions or enticements out there so that they can make up their own minds if they want to go out to the rural area. I don't think there's any way we can force them, but we can do many things to get them into the rural area.

I'm sure that if we get them there, knowing the experience, many of them will stay and become an integral part of the community. MR. HORSMAN: Mr. Speaker, I'd like to participate for a few moments in this debate this afternoon. At the outset, I must say that I am indeed appreciative of the fact that the hon. Member for St. Paul has introduced this motion to the Assembly.

Part of the motion relates to the responsibilities of my department, Advanced Educa­ tion and Manpower, and others relate, more directly perhaps, to other departments of government, with re­ spect to either Hospitals and Medical Care or Social Services and Community Health. I appreciate very much the participation in the debate by several members today. I must say that after hearing some of the speakers, I began to wonder why anybody would want to live in the areas mentioned by the speakers in view of their lack of social amenities, lack of incentives on the part of professionals to practise within the regions.

But I can only assume they were putting the blackest possible picture on the delightful parts of Alberta from which they come and the people they represent in the Assembly, in order to emphasize the importance of hav­ ing more people in the health professional fields locate in their own areas. I'm sure that chambers of commerce from those areas might wonder at hearing members of the Assembly paint such a bleak picture. I was glad indeed to hear the hon.

Member for Lac La Biche-McMurray, at the conclusion of his remarks, qualify his comments to the point that rural Alberta, smaller centres in Alberta, are indeed very pleasant places in which to live. I was gratified to have that qualification added during the course of his remarks. I'm also grateful to the hon. Member for Cypress for having made reference to a recent publication sponsored in part by my department, entitled Access to Opportunity 1905-1980.

That was perhaps a 75th Anniversary contrib­ ution to an explanation of what is taking place with regard to postsecondary education in Alberta and the type of services available now as opposed to those serv­ ices that were available as recently as 15 years ago. In looking at the maps referred to by the hon. Member for Cypress, one only has to glance at them to realize that in the past 15 years there has been a dramatic increase in postsecondary credit programming available to the peo­ ple of Alberta.

In fact, I think it is true to say that access to some kind of credit programming at the postsecondary level is now available, within commuting distance, to 90 per cent of the population of Alberta. Now that doesn't mean of course that every centre which has a postsecond­ ary credit programming availability has a medical school, a dental school, or indeed a school of nursing. But it does mean that there has been a dramatic change in this province with respect to postsecondary opportunities for Albertans.

Many of those credit programs have come about in areas touched upon today, and I refer to health professionals or health technicians. I want to touch on a few points there, in particular, with reference to the very important decision to expand our postsecondary opportunities by way of consortia, or singularly, consortium. These new types of institutions are now operating in several locations in the province.

Recently, I had the pleasure of attending in Drumheller to officially open the Big Country consortium, having previously opened the one in Yellowhead region, an area now experiencing a rather dramatic increase in enrol­ ments in credit programming at the postsecondary level. I think these partnerships of institutions are a great step forward, and I expect there will indeed be greater empha­ sis placed in these areas upon the type of programming at the technician's level in particular with regard to the health services field, and the nursing level in the years ahead.

I really want to emphasize to all members of the Assembly today how important it is that we continue this regional expansion of our postsecondary educational opportunities. I know that several members have made reference to

1598 ALBERTA HANSARD November 12, 1981 the establishment of new nursing schools. It is of course well known that a baccalaureate program was approved for the University of Lethbridge shortly after I assumed the ministry, and that program was mounted in record time when one considers how difficult it is to acquire a new program, the instructors, the space, and the relation­ ships with the various other institutions which have to be part of the program. That program is now under way at the University of Lethbridge.

Likewise, I announced earlier that two new nursing schools would be established in northern Alberta, one at Grande Prairie Regional College and one at Keyano College at Fort McMurray. As I announced last week with the assistance of my colleague the hon. Member for Grande Prairie, the program at the Grande Prairie college is being mounted in such a way that it can go on stream a year earlier than originally anticipated. Once again, Mr. Speaker, that is remarkable.

I make no apologies whatso­ ever to anyone in Alberta or in this Assembly in saying that I applied for and obtained a special warrant of $452,000 in order to obtain the necessary funding for that program. I'm sure no one would argue with the impor­ tance of increasing the capability of our postsecondary institutions in Alberta, particularly in the north, to pro­ vide nursing educational opportunities for the people of this province. As well, I look forward to the same type of progress from the board of governors at Keyano College as they prepare their nursing education program.

So I want to say how pleased I am to see this expansion taking place. Before I leave the subject of nursing, it is important to realize that in the first budget for the Department of Advanced Education and Manpower I had the opportu­ nity to prepare and place before this Assembly, a new component called the professional faculties enhancement grants was added to the universities sector. The grant is over and above the standard block grant, plus infla­ tionary factors, made available to all institutions, and was made available for the first time to the University of Alberta in the budget of 1979-80.

It was in the neighbor­ hood of $870,000. That was made available to the univer­ sity board of governors with no strings attached except that it should go towards enhancing enrolment capabili­ ties in professional faculties of the choice of the university in question. I'm very pleased indeed, Mr. Speaker, that the University of Alberta chose to use part of that addi­ tional funding to double the enrolment, from 72 to 144 students, in the baccalaureate program in nursing. That is a very significant step forward.

Likewise, with respect to the budget year we are now in, additional professional faculty enhancement grants were made available, this time to all three conventional universities, so that in each case they could enhance the professional faculties that the board of governors and administration felt were important to the development of more spaces and improvement of spaces within each insti­ tution.

While I don't have all the details at this time, the important thing to note there is that several hundred thousand dollars has gone forward from this government to the universities and has resulted in additional funding for the medically associated professional faculties at those institutions.

As we look forward in the near future to the establish­ ment of the new technical institution to be located at Stony Plain, I want to emphasize the fact that, along with the new interim governing authority which has just re­ cently been appointed, we are planning there for a major expansion of health-related occupations, many of which will be in the two-year program area and will include quite a variety of health-related occupations.

That will give us more capability in this province to provide that type of training which will give young people in this province — and some who are perhaps not so young, and who want to go into a new career — the opportunity to find places within our technical institutions which now provide technicians' courses in the health-related occupa­ tions. That will free more spaces and, I hope, will be of great benefit to the people of Alberta.

I should point out that the location of the institution at Stony Plain is another step in our decentralization program of postsec­ ondary educational opportunities in this province. Mr. Speaker, I know that others are waiting to join in this debate, and therefore I will conclude by saying that I feel that all of us should look with a good deal of pride at our past accomplishments with respect to providing op­ portunities for Albertans to improve their skills in the field of health-related occupations and professions.

I am particularly proud of the emergency medical technicians' program, which originated in the Southern Alberta Insti­ tute of Technology and has spread throughout scores of smaller municipalities in this province, providing a much higher level of training for medical technicians or people associated with ambulance services and that type of serv­ ice. That program has succeeded very well indeed. While I say we should congratulate ourselves for what has happened in the past, let me assure all members of the Assembly that we do not consider the job completed.

As a government, we see the opportunity to expand health-related training opportunities throughout the col­ leges system, throughout the consortium method, as well as encouraging the universities to expand their credit programming throughout the province — and I must say the universities are being very co-operative — without the necessity always of the students attending on campus. Athabasca University is another exciting possibility for the expansion of further programming in this field, and I know we have much to be done.

But not only do we have much to be done; we have recognized that much must be, and will be, done. We have the will to do it, and I hope that my colleagues in government, in this Assembly, are prepared to vote the necessary funds associated with this expansion in the years ahead. Mr. Speaker, I conclude now so that others may join the debate and offer their comments on this very impor­ tant and very worth-while motion. Thank you. DR. CARTER: Mr. Speaker, I'm glad the previous speakers have not used all their material so that others might get into the debate.

I know that Motion 215 relates to a very important area, and I commend my bench mate and colleague from St. Paul for the introduction of the motion. [Mr. Speaker in the Chair] For a moment or two, I would like to reflect on some earlier times in the Northwest Territories and the prov­ ince of Alberta with respect to the whole matter of health care needs. I reach back into some of the dim nooks, or the further distances of my mind, into the archival cor­ ners, and I recall that most missionaries, no matter whether they were Anglican, Methodist, or Roman Ca­ tholic, had to suddenly become jacks of all trades.

They came not only to preach the gospel, but found themselves to be agriculturalists and sociologists. One of the more interesting facets of their lives was the whole matter of

November 12, 1981 ALBERTA HANSARD 1599 supplying health care. Many of them had their own ver­ sions of little black bags of minimal medical supplies to carry around with them. I also know that a tremendous number of them engaged in cultural conflict with some of the native peoples because many of our native tribes, if not all of them, had their own medicine men, who really were the doctors with respect to their own band and tribal associations.

So it is to some of those early mis­ sionaries in the Northwest Territories, what was eventual­ ly to become the provinces of Saskatchewan and Alberta, that we owe the foundations of our hospital and medical professional background. In particular, one would have to give all credit due to some of the nursing orders of the Roman Catholic church, the foundation of hospitals which became in time the necessary places of operation and, to use a play on words, the theatre of operations for some of the medical personnel in this province.

For a moment, I would like to give an example of what early doctors have meant in the development of western Canada. I reach back into our own family association and reflect upon my father, who came from England in 1928. As a clergyman, he was deposited in a very lush, lavish arrangement. He had an eight by six lean-to at­ tached to the drafty side of a church in west-central Saskatchewan. One day, he had a very severe pain in his side. He let it go on, being a stubborn Englishman; he could deal with anything. By the the next day, he decided the pain was getting to be just a bit too much to bear.

Now, the Anglican church, in its wisdom, had placed him miles away from anywhere, and his only method of transportation was his own feet. The pain was so severe, though, that he crawled and hobbled his way about a mile to the next farmhouse and spoke to the people there about his problem. They commiserated with him. They gave him a small shot of something to get this poor clergyman in some kind of condition so they could get him down to the nearest medic.

The only trouble was that they had to put him in the back of a buckboard and bounce him along some of Saskatchewan's finer back roads, down the 20 miles or so to the main line of the CPR. The pain in his side wasn't getting any better, because of Saskatchewan's highways in those days. They had to hang around and flag down a freight train. When the freight train eventually came, they loaded my father onto the floor of the caboose and bounced him another 35 miles along the main line right of way of the CPR into Swift Current. In Swift Current, they got him to the hospital. He was operated on immediately.

A day or two later, when he was starting to come out of the fuzzies that all doctors seem to get you into — sometimes that's before the operation, let alone after — the doctor looked at him and said, John, you're lucky to be alive. If you hadn't gotten here when you did, you were probably going to die of a ruptured appendix. But what did they give you? They must have given you something. My father looked at him and he said, well, they took a few drops of some stuff, put it on a sugar cube, and popped it in my mouth. I guess that's what it was. The doctor pressed him and said, well, what was it?

My father said, Doctor Bell's wonder horse medicine. MRS. CRIPPS: That's a horse of a different color. DR. CARTER: Well, it may have been a horse of a different color. Forty years later, my father went to a testimonial dinner for a certain doctor who had been well known in south-central Saskatchewan for his dedication, his willingness to make house calls, and to go about the countryside in all sorts of circumstances. It just happened that the doctor was sitting across the table from my father. Both of them had gotten somewhat more elderly in the course of those 40 years.

My father leaned across the table to the doctor and said, I don't suppose you remember me. The doctor leaned across and said, I sure as hell do, and I still say you should have been dead. So some of those doctors noted for making house calls and having sensitivity are also known for having very long memories and being able to keep you in your place. Well, I for one am appreciative of Dr. Bell's wonder horse medicine, because at the time all that occurred I had not yet even been born. So it's kind of nice from my own personal, private point of view, to be here.

One of the difficulties all areas of Canada described as remote have is simply that it is very difficult to attract professionals and trained personnel of all professions into those remote areas. Within my own background with the Anglican Church of Canada, we have great difficulty even today trying to persuade clergy and their families to go into remote areas of the provinces, let alone to go into the Northwest Territories or the Yukon.

Obviously, some of the difficulties are that oftentimes in the more remote areas, there is the whole problem of the higher cost of living, unavailability of a great variety of balanced food­ stuffs, and of course there's what's known as being cul­ turally deprived in more sophisticated circles, whether that's true or not. Nevertheless, the problem is there for professionals and service areas in all the remoter parts of the provinces. Motion 215 touches upon the medical profession, but it has ramifications for all professional areas.

In terms of incentives in the health care field, the province of Alberta with its rapidly accelerated program of new hospitals should be enough encouragement to lure, entice, and attract more professionals in the medical field to some of the smaller community areas within the province of Al­ berta. After all, we do want to have, especially if we are patients, not only adequate health care facilities but the best, particularly when our own families go into those facilities. We want to have the best facility and the best medical care available.

I for one am quite hopeful that the encouraging spate of new hospitals within the prov­ ince will be a great incentive to health care professionals to remain or to go to some of the smaller communities where they will be able to have first-class hospital facilities. In another area of incentives, I think one of the incen­ tives that is being put in place in the province is the whole matter of infrastructures, especially with respect to high­ way upgrading. This in itself should allow some of our doctors and their families to feel much closer to the larger metropolitan centres.

If they wish to come to Edmonton, Calgary, Red Deer, or Lethbridge, they would find easier access to those places, to partake not only of the goods and services of the community, but also to participate in some of the other cultural activities. We have to bear in mind that all our health care professionals have been through university training and probably have obtained a minimum of two degrees. In the course of that education­ al experience, they have also grown considerably in terms of cultural awareness.

So, it's not just a point to be pooh-poohed that many of the doctors' families do have very rich cultural interests in the broader aspects of the community, whether it be choral, symphonic, the painted arts, or the spoken arts. In that regard, the province has been doing a tremendous amount with respect to the

1600 ALBERTA HANSARD November 12, 1981 enlargement of the road system within this province, and also with respect to airports. This greater ability to move throughout the province has to be of great benefit to the patient as well as to the doctor and the doctors' families. Obviously, better roads, a better highway network, and better airport facilities are of great benefit to patients who, after they have received the initial care required in an emergency treatment centre in a local hospital, have to be moved to the larger centres for more sophisticated treatment, which requires the work of specialists.

It is obviously of great use to be able to be picked up either by helicopter or by light aircraft and flown into Calgary or Edmonton, or even trans­ ported to other centres. One of the other features which has taken place, and has been commented upon within the House, has been the mobile dental clinic program. As that system is eva­ luated within the province, it may well be that a variation on it could be used for some of the more remote areas of the province, where we might have some of the medical doctors move about the province in a similar style in terms of a mobile clinic.

Motion 215 mentions adequate training programs. Perhaps what is needed is a variation of an intern program.

That might be taken into consideration at the university levels or perhaps even through the medical association itself, whereby for a number of weeks or months some of the doctors who themselves are interning might come out of their program and be placed in some of the smaller communities throughout the province so that they might have that live-in work experience, the experience of functioning in a smaller size facility where they're going to know all the patients and all the staff, and they're going to be in an intimate relationship with a smaller community: a very unique situation which is not going to take place in any of our larger metropolitan centres.

Another area where we might think of aiming incen­ tives is to talk to some of the professionals who are in their so-called mature, middle years. It may well be that there are a number of medical doctors or other health care professionals whose own families have grown up, had the advantage of elementary school, a high school education and are into their university years, or perhaps they've even graduated through that spectrum. At any rate, they've left home.

Those medical doctors who find themselves in that position may well decide, as a number of us in this House may decide, that the rat race really isn't worth it anymore. There comes a point when we decide, yes, we've given enough in this particular role. It may well be that this is a whole target group of health care professionals, not just medical doctors, who might be reattracted and rechallenged to go to some of the smaller communities and be of service to people there, but also in the sense that they themselves might find a new pace of life.

They might find themselves again having more time for their spouse, for some of the other things in life, rather than just becoming medical workaholics. Mr. Speaker, once again, I commend my colleague and seat mate from St. Paul on bringing forward Motion 215. I hope all members of the Assembly will give support to the motion. DR. REID: Mr. Speaker, I had considerable doubts about entering this debate until the Member for Calgary Millican spoke about those professionals in their mature, middle years. I thought perhaps he was addressing me.

I thought I was a little post-mature, like some babies who arrive in the world. The subject of health care professionals in rural and northern Alberta is extremely complex. Many factors in­ terplay with each other. For all the studies that have been done — this was one done for me; this is another one; this is the one done for the Northern Alberta Develop­ ment Council — none has really come up with a definite and firm answer as to what the problem is. The problem does not just apply to the medical profes­ sion, about which I will make some remarks in a short time.

I would like to refer to some other significant professionals. The numbers in the cities of Edmonton and Calgary are between 1,000 and 2,000 per dentist. Outside of Edmonton and Calgary, it ranges up to as high as almost 6,000 per dentist. I'll leave the chiropractors alone for obvious professional reasons. In the cities of Edmon­ ton and Calgary, there is approximately one dental hy¬ gienist for every 5,000 to 8,000 people. Outside the cities it's as high as one for every 64,000 people. Dieticians: 5,000 to 6,000 per dietician in the city of Edmonton, and as high as 20,000 outside. It goes on and on.

In particular areas that affect the medical profession — it's about one laboratory technician for every 1,500 people in the two larger metropolitan areas. Outside those areas, it is somewhere in the vicinity of one for every 3,000 to 5,000 people. Physiotherapists likewise: in the cities of Edmon­ ton and Calgary about 3,000 people per physiotherapist: outside those two cities, anywhere from 6,000 to 35,000 people per physiotherapist. Psychologists: the same type of thing. As I said, the interplay between the various factors is considerable.

But being a physician, I would like to address my remarks to the problem of physician services. I still feel that in many ways the physician is the leader of the team