LEGISLATIVE ASSEMBLY OF MANITOBA Monday, 3 May, 1982 Time - 8:00 p.m. COMMITTEE OF SUPPLY - HEAL TH MR. CHAIRMAN, Jerry T. Storie (Flin Flon): This Commit tee will come to order. We are continuing with the consideration of the Health Estimates, Manitoba Health Services Comm ission, the Hospital Program. The Honour able Memb er for Emer son. MR. ALBERT DRIEDGER (Emerson): Thank you, Mr . Chairman, I just have a few comments and questions that I'd like to direct under this heading here regard­ ing hospital facilities in southeast Man itoba.

I want to express my appreciation to the Min ister for exten din g some of the information for me regarding the arrangements with our neighb ours to the south, south of the border that is. I think we have a very compatible type of arrangement right now in terms of the health facilities and I want to compliment both sides in terms of the arrangement that is in place at the present time.

My understanding is, from the information that I have received, that the services that are provided by our Am erican friends in Roseau and in Warroad, that Man itoba Hospital Services Comm ission pays for these services and it's accepted that way across the line as total payment for the services rendered. I think it's a very unique and commen dable type of situation that we have especially when you consider that there's li mited services in the southeast for these kind of services and they can be provided within a short distance across the border.

I'd like to refer specifically to the Vita and District Hospital Board who over the past short period of time or over the past years have had some difficulties in resolv ing some of their problems there. I think, pretty well most of them have been resolved and they've been internal problems. They haven't necessarily affected the Man itoba Health Services Comm ission except maybe in an advisory capacity, most of the problems were of an internal nature.

However, I'd like to draw to the attention of the Mini ster the fact that the facilities that we have in Vita right now, when you consider that this hospital in Vita has been built many many years ago, the buil din g is a very old buildi ng; there's been some renovations done on it -(I nterjection)- Oh my gosh. I'll try and get back on this subject, Mr. Min ister, because you pointed out what just happened. Any way I think the Mini ster realizes the facilities that are available there. We have problems with the facilities when you con­ sider the amount of people that they really should service.

At the present time many of our people in the southeast go across the line and get very capable services there. The concern I'd like to express is twofold. What happens if the relationsh ip breaks down with our neighb ours in the other country which, hopefully it never will, but if this should happen to be the case or if they change their rules, their arrangements, and it's a wide open thing, it's not pinned down or written down and I don't criticize that, but what happens if, all of a sudden, these thin gs get a little strained?

Hopefully, it will never happen but with the kind of facility we have serving the southeast out of Vita, with a doctor there who's doing his best, but we have one doctor and it's very difficult for him to be on service or on call all the time. I think an effort has been made to try and get an additional doctor established in the area and I under­ stand that a proposal has been presented to the Mani ­ toba Health Services Comm ission, in terms of improved situation there and maybe additional doctor services.

I think that the Vita and District Hospital Board, the mem bers that are on it, fully appreciate the lim itations that are there for that kind of service. Their expecta­ tions . I think, are reasonable, they don' t expect the kind of facilities that we have in Stei nbach, St. Pierre or Winnip eg. I think they're prepared to accept a rea­ sonable proposition, as I forwarded to the Mini ster, in terms of providing some reasonable health services in the area.

I'd also like to suggest to the Min ister, and I realize this is all part of plannin g and wha t have you over a long period of time , but when you consider the dis­ tance involved, from example, Middlebro and Sprague, whether there could be some interim units set up there, and improving the facilities at the Vita Hospital. The request has been made and I have to express a little bit of disappointment when I looked at your pro­ ject that nothing was in there for the souteast area, in view of the fact that I think the hospital Board pres­ ented a reasonable proposal to the Man itoba Health Services Com mission.

I would hope that within a rea­ sonable period of time that this could be looked at because two things that could enter into the picture, as I mentioned, is the fact that if the relationsips with our Am erican neighb ours to the south break down. The other thing, and I think this is of major impor­ tance, there is a possibility of border closi ngs on a few of these ports of entr y. If this should happen that they close some of these ports of entry as, some of the motivations on the Am erican side happen to be there, it would create a real problem.

I would urge the Min is­ ter that he priorize the situation in the southeast Mani ­ toba because if all of a sudden the Federal Govern­ ment or the Amer icans who are proposing right now in some of their cutbacks, to close some of the ports of entry then it gets extremely difficult for some of our people to get across to the Amer ican side. If there's only going to be one port of entry left at Middlebro or wherever it is, then it creates a long drive for them to get around all the way to get health services. Then, Mr .

Min ister, I would suggest to you the pressure is goi ng to come on doubly hard and I would hope that there was planning in the back wings right now so that we could look objectively at improving some of these services. 2120 I, at this time, would hope that maybe the Min ister can give me some indic ation as to where we're at with the proposal that was presented by the Vita Hospital Board, and whether there could be some priorization of this, in view of the fact, that we can see some of the problems coming up, as I ind icated, the distance involved, the people in the area. They're living in a

Monday, 3 1982 low-assessed area; it's hard to provide services in terms of ambulance service; it's difficult to provide the kind of service. Here in the city it's pretty easy. It's not that bad, we have facilities available, the best of care available to these people, but it makes it extreme ly difficult when you consider the fact that some of these people have to travel maybe 12 0 mil es or more to get to proper services.

In view of the fact that there is a strong possibility that some of these ports of entry will be closed that the Min ister could maybe move up the priority of the health services in southeast Manitoba. MR. CHAIRMAN: The Honou rable Mini ster of Health. HON. LARRY DESJARDINS (SI. Boniface): I thank the member for his comments. There is no doubt that in areas I recognize that we'll have to look at, first of all - although we've passed this- the personal care home, although it was probably the first one, we had per­ sonal care home jux taposed to the hospital - now its gone the circuit.

Soon it'll be Vita's turn, but I must admit that Vita, as such, is a community that's under­ bedded like many other areas, but the region is over­ bedded. So, that is one of the problems that we have. As far as the hospital, well, I'm not going to try to guess; there's enough problems without one worry­ ing about the problems that might happen if we declare a war with the Un ited States or things get a little more difficul t.

So, the point that I'm trying to make is we're satisfied now with the arrangements that we have with the people; the doctors at Roseau, the information that I gave the Mini ster, we know that there is no doubt that if we didn't have that facility we would have problems. The Comm ission has to look at the situation. The Commit tee of Medi cal Manp ower is also look ing at it. Soon the Commis sion will be dis­ cussing with Vita. We feel that probably the best thing would be the unit such as they have at MacGr egor. In other words the hospital is not being used the way it should.

It's a building that eventually might have to be replaced. But, I think that before we decide to do that ­ that mig ht be one of the reasons it's not on the imme ­ diate list - we'll have to look at the situation. It might be that we would want a cli nic kind of jux taposed at the personal care home, some holding beds and so on. I think this would be needed because of the distance also as long as people can have the arrangements where it doesn't cost us anymore; in fact, it would probably cost us less because they have the facilities out there and the States will keep using that.

I think the people would prefer that because it is closer to many of them anyway. So, I recognize that there certainly would be more problems if we didn't have the kind of a working arrangemen ts that we have with the doctors and I think chir opractor and optometrist and so on in Roseau. So, we're look ing at it. I think one of the proble ms being drawn to my attention is that, at that border that there's only certain hours that are in oper­ ation and that at times make it difficult, I guess, for patients to go to the hospital.

Of course, that works both ways also for the people that would come from the Un ited States. It's the same proble m. But, anyway to recap: we're going to look at the situation if we ever enr ich the Personal Care Home Program. As I stated Vita itself is underbedded but the 2121 region is overbedded. The hospital - we're not too sure - I'm not going to say today that we're going to replace that hospital. That hospital is not being used that much.

So, it might be that the Commis sion will want to look at func tional program; will want to dis­ cuss with Vita and maybe get something like they have in MacGregor that seems to be working well; that you'll have the personal care beds; that you'll have a few holdin g beds and have some type of cl inic juxta­ posed to the personal care home. As far as the manpower, the doctor, the Manp ower Comm ittee is look ing at that and the Com mission is look ing at the old program and we're keeping our fin gers crossed and I see no reason why the relation­ ship with the States will not continue. MR.

CHAIRMAN: The Honou rable Mem ber for Emerson. MR. DRIEDGER: Thank you, Mr. Chairman, I would just like to take this opportuni ty to maybe encou rage the Min ister if he has an opportunity to visit the health facilities in Vita. I don't know whether he has had that opportunity in the past at all. I know that the previous Min ister of Health has been out there and expressed his concern and felt that something had to start mov­ ing in that direction. There's a few things that enter into this thing, for example, the babies that are born on the Am erican side, in Ame rican hospitals, end up with dual citizens hip.

These are things that might appear not that serious at this stage of the game but they have that option up to the age of 21 which citi­ zen ship they want to take out. At the same time, until they've done that they can't vote. You have three years, if they want to, they can make the decision, but many of them take that option that they don't neces­ sarily make a decision until later on. These are all things that, I think, somewhere along the li ne we have to pay attention to and try and zero in on some of the problems.

This surfaced just in the last election again, many of our people in that area, youngsters that were born 18 -21 years ago, are faced with this kind of thing and they have a bit of a problem making up their minds which way they want to go. I think that should � be spelled out specifically and some attention should be paid to that. The Mini ster indic ated that the border hours were lim ited and the possibility of closing hours, but that it applied to the Americans as well.

I can guarantee the Min ister there's nobody coming across from the American side in my area that has need for the health facilities that we are providing because they are way too lim ited. There are much better facilities there. -(Int erjection )- The Mini ster says they come to Winnip eg but I'll tell you something, in my area they certainly don't cross the border at any given time.

If they need health facilities in Win nipeg they come across at Emerson but they certainly don't cross in the southeast area at any one of the Ports of Entry to go and visit the Vita Hospital because the trade is all one way so I just want to make that point. The expectations, when we consider the kind of doctor ratio-per-patient in the city, as compared to the thousands of people who rely on one doctor, the Min ister ind icated that hospital was not utilized fully. I would encour age the Mini ster to maybe have his peo-

Monday, 3 May, 1982 pie check out why it is not necessarily utilized to the maximum. Certainly there are enough people, thou­ sands of people out there that need medical attention and when he uses the statement that it is being unde­ rutilized, maybe one of the reasons is the facilities, the other reason possibly is that there is lim ited doctor service available because we only have one doctor for maybe 5,000 or 6,000 people out there.

If the Min ister is not goi ng to start getting thi s into the program and realizing some of problems that are pending, then it will come down very hard later on somewhere along the line. The sooner the Manitoba Health Services Comm ission and the Mini ster accept the fact that there is a problem there, we don't have the kind of services, for exam ple, like the people from Northern Man itoba who have an emergency situation can be in a Winnip eg hospital long before the people from my area can.

By the time you phone, an ambulance from certain areas has to go out 30 or 40 or 50 miles on some of these coun try roads,

whereas when you take from some of these northern points where they can land with a plane, they rush them into Winnipeg, they have better service than we have in the southeast corner. I think that is one of the most - how should I put it? - not derelict, but the least facilities and servi­ ces available aside from the American side now. Those problems are also coming up and the Min ister says, well, he doesn't have to worry about things that will happen in the future.

These things are going to be happen ing and the Mini ster better have some plan­ ning in place before it happens because otherwise there will be a lot of criticism and that's why I raised the issue here today. MR. CHAIRMAN: The Honou rable Mem ber for Gladstone. MRS. CHARLOTTE OLESON (Gladstone): Thank you, Mr . Chairman, through you to the Min ister. I wanted to ask about the major hospital upgrading project at Gladstone; it's listed on page four of this material that you put out the other day. I wanted to ask what the upgrading project is at Gladstone Hospital? MR.

DESJARDINS: It will be about 4,000 square feet of new space for the hospital and the cl inic. MRS. OLESON: Mr . Chairman, what type of space? How is this to be used? Is it hospital ward space, office space? MR. DESJARDINS: It's the gen eral improvement of the patient service area, diagnostic, lab and X-rays and so on. It's for the service area not more beds; also doctor's offices. MRS. OLESON: How much money is looked at for this project? When is the work supposed to be done? I see that this is architectural planning for this year.

Is this a project that is going to be started this year, or is it just in the planning stage and will start next year ? MR. DESJARDINS: I gave quite a full explanation of that the other nig ht. We don't intend to give you any amount on this at this time because it is only for the plan nin g. What is approved this year is money for the planning. Next year, if there is still some plan ning to be done that will have to be approved, probably it'll be fin ished and it'll be placed in front of Cabine t and if there's a recommenda tion to be made that we go to tender, then they would start buil ding imme diately.

So, this building will probably be done sometime next year. MR. CHAIRMAN: The Honou rable Member for Niakwa. MR. ABE KOVNATS (Niakwa): Thank you , Mr . Chairman, I just have a few comments that I would like to make, nothing of great seriousness and nothing really to pick fault with the Honour able Mini ster or his department. But, there are a few comme nts. First of all, this new CAT Scanne r for the St. Boni­ face Hospital; I understand that there's only one other CAT Scan ner in the province and that's at the Health Sciences Hospital and that there has been a building to house this CAT Scanner at the St.

Bonif ace Hospi­ tal. Can the Honour able Min ister give me some infor­ mation on the CAT Scanner, its usefulness and why we have only had one in the province for the last few years, and why would we even be consi dering - it says a new CAT Scanner - would we be considering a second-hand one perchance? MR. DESJARDINS: Mr. Chairman , a few years ago I guess we'd look at that the same as we probably looked at the cardiac unit at St. Bon iface Hospital. It was felt that there was only one. There was a comm it­ tee of both hospitals that recomme nde d only one at the time.

But, as it's being used more it has been made obvious that there were good points and it was recom men ded by all that there should be a second CAT Scan ner at the St. Bon iface Hospital. It takes time to plan these things. There is a period that you're not too sure if you should go to a second one; these thin gs are very costly; you have to get the experts, the personnel. The situation is now that we feel that there should be another, in fact, the former government thought the same thing.

We agree and this is why we went ahead. 2122 Prior to November 1, 19 79 the Scanne r operated eight hours a day, five days per week plus callback for emergenc ies; in November, 19 79 the hours were extended to 12 hours per day, five days a week plus callback; in November, 19 80 approval was granted to operate 4.5 hours each Saturday; in June, 19 81 the hours were extended to 8 hours each Saturday and Sunday. So, you see that it's being used more and more until you couldn't use it anymore, so you have to go to a second one.

In February, 19 82 the hours were extended from 12 hours a day to 15 hours a day, 5 days a week plus callback. Therefore, the current hours of operation are 15 hours a day, 5 days a week, 8 to 11 ; 8 hours a day Saturday and Sunday, 8 to 4 o'clock plus emer gency callb ack; I think it's quite obvious that we need a second one. We have excel lent personnel at St. Bon iface Hospital with Dr. Hill and others and this is why it was decided to go ahead and it's been approved this year. MR. KOVNATS: Thank you, Mr. Chairman, I was just going to complimen t the Min ister for bringing it in and

Monday, 3 May, 1982 he gave credit to the former govern ment. I'll give credit to the Min ister for following the efforts of the former government. I don't think we're look ing to see who gets the credit for it. It's just a heck of a good thing and the amount of hours it's being used is the important aspect. I came into contact because my wife's cousin was involved at the Health Sciences and he required some time at the CAT Scanner and I have some information on it about how it takes 18 frames a second or a minute and it's a mil lion-dol lar machine.

But I am told that this machine does break down on occasions and it is on such a full schedule, like 7 days a week and from 7:30 in the morn ing till 9:00 o'clock at nigh t and that there are parts that are not easily accessible for these machines, and when it does break down it does put these people at a credit inconvenience.

I would hope that with the coming of this second machine at a different hospital that the Health Scienc es or the Man itoba Medical Association would make some sort of arrangements to see that spare parts are available; at least, if you've got two machines that you'd have spare parts available at all times so that the important machine is never out of service. The question that I was going to ask is: is this CAT Scann er in a special building at the St.

Bonif ace Hos­ pital, and is the whole project developi ng or is it just a CAT Scanner, or is it a whole new concept in this type of therapy or checking out whether there's this type of cancer? Are the proper precautions being taken? Is there any sort of a side effect that the patients might have to go through with the rays that come from these machines? I'm not look ing to be critical; I'm just wondering whether in fact there can be anything of a hindrance rather than a good point to the machine? MR. DESJARDINS: Yes, Mr .

Chairman, it's a very expensive machine and we are probably getting bet­ ter use of it - the one at the Health Scienc es Centre, the present one - than any other provinces in Canada. I think it's obvious with the hours that I mention. Now, as I say it's an expensive machine that has to be kept in working order. We've had good success. The main­ tenanc e is done whenever hours that it is shut down. So far, it's been working well. As the statement that I made, it is a buildin g at St.

Bon iface Hospital which will provide space and equipment for a new cobalt radiotherapy unit; a new CAT Scanner; a new space for diagno stic ultrasound and for a wide range of oncology services. As far as the safety of the building, the walls are all lead-lin ed and we've looked carefully at every need and every­ thing has to be approved by the Cancer Society and Dr. Israels has mon itored everything to give his okay on the buildin g on the project. So, we're quite pleased with the way it's going. MR. KOVNATS: To the Min ister, thank you very much for that information.

The re seems to be some difficulty between the dif­ ferent hospitals. There's quite a competitive arran­ gement between hospitals, between the St. Bon iface and the Health Scienc es particularly with open-heart surger y, and I wouldn' t want to cause any more prob­ lems than the Honour able Minister has at this point with the developing of open-heart surgery at the Health Scienc es. I would lik e to refer to the pediatric department where I know that at the Health Scien ces, it's second to none.

It's well known throughout the whole of North America and possibly the world in the manner in which they handle their pediatrics. But, we do have a pediatric division at the St. Bon iface Hospital and they seem to bethe poor country cousins in compari­ son. I don't think that they're being funded in the proper manner , or is there some arrangements being made that one hospital is being funde d because that's the main hospital for pediatrics? And is St. Bon iface just going through the motions to handle the cases that sort of drop in? Or can the people at the St.

Bon iface Hospital develop their pediatric department with the help and financing of the Min ister of Health so that it can be of an important nature to whole of the St. Bon iface area? As the Min ister obviously kno ws, I support that area moreso than I do others but I have to consider the other areas. I'm not turning my back on the other areas. I'm look ing to see that the pediatric department at the St.

Bon iface Hospital be expanded to the point and if it's not going to be expanded I would think that the Honourable Min ister must advise the people con­ cerned that they're not going to have an expansion, that they're on sort of a hold system at one of the hospitals. I mentioned pediatrics but it could be any other division, but it's pediatrics that I'm interested in at this point because I was tal king to a particular doctor about it and they brought me up-to-date. Can the Honourable Min ister advise me whether the St.

Bon iface Hospital Pediatrics Department will be expanded and, if not, will be people who are at the St. Bon iface Pediatrics Department be advised that they will not have an expanded operation? MR. DESJARDINS: Mr . Chairman, I think I under­ stand the concern of the honourable member but he's been on both sides of the issue.

I think he started by saying there's competition between these two teach­ ing hospitals, we have to be careful not to have dupli­ cation; he's gave an example of the cardiac unit and the problems that we had and then he introduced where the No. 1 the priority has been at the Health Sciences Centre, that's true, and we certainly don't want to dupl icate everything, we look at the needs of Man itobans. There is no doubt that there is this kind of competition between the two hospitals who would like to have their own everything.

We're not about to do that, it would be too costly. 2123 We've never refused anything at the St. Bon iface Hospital because there hasn't been a request. I cer­ tainly don't intend to go wherever we're not expand­ ing and say "hey this year we're not expan ding any­ thing in your department." I don't think that the memb er is suggesting that. The thing is that they have to priorize, now maybe people are taking short-cuts and talking to their MLAs about something they would li ke to see and I'm sure that that is probably true of every discipline of every hospital, especially the two teaching hospitals.

But we don't operate like that, we'd have nothing but trouble if we encou raged them direct negotiation with the Mi nister or the department. This is done through the Board of the hospital, that's why there's a board and they also have their

Monday, 3 May, 1982 medical comm ittee, their medical director. This is something that they have to priorize themselves and they kn ow that there is li mited amount of money for new projects and they make a proposal. Now, we have no such proposal in front of us so we haven't refused anything. If this is presented, if he is faced with the same situation again, I think that the member should sugge st the first step is that they should go to is their board and I think they kn ow that already. MR. KOVNATS: I think the Honou rable Mi nister is not really accepting my words in the manner in which they were meant.

I wasn't saying that we should be expanding the pediatrics division at the St. Boni face Hospital, although I guess I wouldn't be against it, because we do have a good pediatrics division at the He alth Scien ces. I'm just saying that the people at the St. Bon iface Hospital, or any other hospital that has a pediatrics division, should know that they're on a hold rather on an expansion basis, that's all I'm suggesting.

I'm not saying that the Honou rable Mi nister start throwing money into these different projects because I kn ow that you could probably spend a heck of a lot more mone y than what you are and you're going to be criticized for spending what you are spending and I'm not loo king to see that you get criticized any more, not for another three-and-a-ha lf years, and then we will see if we can criticize you.

At this point I think that we're all working together for the good of the people in the Province of Manit oba I have a couple of other things that I wanted to bring up and I kn ow that time is of the essence tonight and I'm not going to keep talking too long, just a couple of particular projects that I was involved in or that I was interested in. I' ve seen the out-patients working at the St. Bon iface Hos pital and at the He alth Scienc es and all of the others and I kn ow that they do a good job.

Some of these out-patients, rather than being out­ patients, have to go in and become hospital patients and I'm not sure what the cost of a hospital room is, $10 0 a day, some thing like that? Would the Min ister just nod his head, is that about what the cost of a hospital room is today? $200 a day, $15 0, $300? What my idea was is not really so out of the way.

Has the Honour able Mini ster or anybody ever considered that these people who have to take up a hospital bed at $300 a day, is there any way that we could put these people into a, not a nursing home but something similar to a hotel, at maybe $50 a day which is 1/6 of the cost of putting them into the hospital. Could the hospitals develop their own, for lack of another word, hotel, that is associated with that hospital so those people who are coming in from out-of-town would have a place to stay rather than just putting them right into the hospital at $300 a day.

Could we not put them into an area, into a hotel-li ke structure close to the hospital so that they could take their treatmen t at the hospital, go back to the hotel, for lack of another word, and the savings I think would be tremendous; or is it just pie in the sky, is it a stupid idea on my part, has it ever been thought about before, because I can see the savings could be fantastic and it would free up some of the hospital beds in the city. Has it ever been thought of before? MR. DESJARDINS: Mr.

Chairman , that would have been probably - I'm not certainly criticizing the member there is a lot of good points - that would have been more valid a few years back. There has been a fantastic amoun t of progress done in this field. One time a woman giving birth was kept a week, ten days, now they're even talk ing about discharging a woman 24 hours after giving birth. There is all kin ds of that, that's why you need the facilities to receive the day patient or the people that are not registered as in­ patients and there is all kinds of progress being made on that.

Home care also will do a bit of that and we're looking to see if more could be done in doctor's offi­ ces. At one time it wouldn't be covered if people were not admitted to hospital. There's been a tremendous improvement on this. The member has a good point when he talks about hostel and there is one being developed, dialysis also is a big improvement. It's costly but it's a lot cheaper than if they had to come to the hospital. So home care is doing some of this and extended treatment hospi­ tals, to a point, are getting people out of these expen­ sive beds. There was one point that was quite interest­ ing.

The hostel-type facility to people that come from out-of-town that have to come to the city, because the facilities are not in the remote areas and rural areas, there is a pilot project now, there is one setting up this year at the Health Sciences Centre and that is going to be a pilot project to see how it works and we'll have to assess it and maybe it'll part of our programs for other hospitals in the future. MR. KOVNATS: It's getting close to the last of the questions. I do recall a few years back when I was inv olved with the City of St.

Bon iface under the advi­ sory capacity, not as an elected member, we went through a routine of somebody had donated a rescue wagon to the City of St. Bon iface Fire Department, a rescue wagon that was well-eq uipped which was something that the City of St. Bonif ace couldn't have afforded. It was really well-eq uipped and it was a beautiful rescue wagon except that we couldn't afford to maintain it by putting qualified people on it. The rescue wagon really wasn't required.

It wasn't an emer gency that we have it but some well meaning person said, all right, you're going to have this rescue wagon because I think that you should have it, and we said, thank you very much. I think it was used, it wasn't just taken and accepted and not used, but it was used at a cost and really we didn't get the full value of it. The only reason I tell you that story is now I'm going to get back to the Deer Lodge Hospital. Can we afford the Deer Lodge Hospital or are we going to be compen­ sated by the Fede ral Government to take over the Deer Lodge Hospital? MR.

DESJARDINS: All people treated at the Deer Lodge Hospital are Manit obans. If we have an insur ed program they all qualify. We're fortunate now that the Fede ral Government is paying for it because we would have to deliver that service any way. The inten­ tion, if we go ahead with this program, they will pay all construction, the way it looks now, for what we need, they'll pay the whole cost of construction which will be $30 million in round figu res. So we won't pay any­ thing in construction; we won't have to borrow any money at all. It gives us flexibility because we'll build 2124

Monday, 3 May, 1982 what is needed. We won't be stuck with something and have to deliver the same thing. We would proba­ bly, in return, have to guarantee, everything being equal, that we have some many beds that a veteran would have the first chance of, would be admitted first. Everything being equal I think there's, I don' t know exactly how many beds, but anyway, there are not that many, that won't cause a problem and they don't have to be just in one space, one area.

It was very costly, it's all taxpayers' money, to run Deer Lodge; the way it was bei ng run; there weren't enough facilities and they had a lot of expensive pro­ grams. So all in all the taxpayers of Canada and Mani ­ toba will save money, plus the operating costs of 15 0 beds will be paid by, if this agreement goes through that we're negotiating, the Federal Government for at least the next 1 O years, the 1 O years after construction is fin ished. So I think it's a darn good deal for us. We're not paying anything for the property and we're getting valuable property.

Also it is going to belo ng to the province and we'll develop that kind of a gerontology centre out there for these people with the help of the Federal Government who will pay the cost of con­ struction and the operating costs for 1 O years at least, of 15 0 beds, and for what? To deliver service that, because of our programs in Man itoba, we would be required to deliver anyway. MR. KOVNATS: I guess we can't look a gift horse in the mo uth and I think it could develop into something real good and I'm not agai nst it.

I just say be a little bit wary and let it not cost us more than what we can get out of it and I think we've got to be a little mercenary and remember what we can get out of it, taking into account that the veterans who have first choice, God bless 'em, you know they were the ones who defended our country and I think are entitled to that sort of a first choice in loo king after their health at this point. Just a couple of other small little items now. I received a letter from a Nun in St. Bon iface advising me that there is an abortion cli nic being sponsored or being supported by the Provincial Government.

I' ve not gone to the Mi nister on this, I was just a li ttle rel uctant to do so at this point but I just got the letter a couple of days ago and advised that there was an abortion cli nic that was bei ng spon sored by the Pro­ vincial Government. I' ll go on record as saying: "I hope not." I'm going to ask the Honour able Min ister, is there such an item in the Estimates of the Depart­ ment of Healt h? MR. DESJARDINS: First of all, before we leave Deer Lodge. When I was talk ing about certain beds, that's not all the beds, that's only one category of beds.

There would be so many beds that will go to the veterans first. Besides that, beds that we need, nothing to do with veterans, there'll be another 250 beds billed at $50,000 so the province is saving $12 .5 million on those beds. Now on the cli nic, I'm not aware of the cl inic. There was a clinic , I think, that received some help, some funding from the Federal Govern ment. I think Axworthy had a program. The Women's Cli nic is sponsored by fee-for-service doctors lik e everything else and, as far as I'm concerned, we're obeying all the federal laws on that.

There has to be a comm ittee and now if those comm ittees are stretched, you kno w, you can't dictate to every doctor but we're doing every­ thing we can, as the former govern ment, to stay within the law that governs such thin gs here, in other words, therapeutic abortions only. MR. KOVNATS: I would hope that, not only are we staying within the laws of the country, we're staying within the laws of our morality.

I had quite a discus­ sion with my wife and we don' t quite agree on this and it's something that really caused me to be a little bit upset because, as I just fin ished stating, I think we've got to be very strict on the idea of having these abor­ tion clinics and I can accept some abortion, not on demand, but some abortion with the type of groups that will have a say as to whether these abortions can take place. I was discussing it with my wife and she says, you know, you can just go across the border into the Un ited States.

Like we're sending our people from the southeast corner, as the honourable member was saying, we're sending our people from the southeast corner into the Un ited States for their hospitalization and for their medical needs. Are they going to be able to go down there also for their abortion needs if it comes to that and wou Id the people of the Province of Man itoba be paying for them to take that type of a service in the Uni ted States? MR. DESJARDINS: Mr . Chairman, I want to make a point quite clear. The cl inic that my honourable friend was talking about there's no abortions being per­ formed there at all.

There's counselling, they might refer them for abortion, then they have to go through the therapeutic comm ittee of different hospitals. Now if they're referred to the States the government is not paying any operation for any abortion in the Un ited States at all. There was talk at one time, the Federal Government talked about setting up some abortion cl in ics and it's been suggested in Man itoba. Not too long ago there was a recommendation from some doctors at the Health Sciences Centre but that has never been acted upon. MR.

KOVNATS: The Honou rable Min ister's given me the answers I like to hear but I would just lik e to go a little bit further. To get back to the Honou rable Member for Emerson, when he was making remarks about how the people in the southeast corner, Sprague and Pi ney and Menisino, and I was just thinking about a particular case in Menisino where the young lady went across and had her baby at the hospital in Roseau, and I would think that Man itoba Medical would cover the expenses of her having her baby across the border.

Can the Honour able Min ister tell me, right at this point, rather than have her baby, if she went across and had an abortion, would the Manit oba Medical cover that cost? 2125 MR. DESJARDINS: No. MR. KOVNATS: One more question. I would like to refer to the Misericordia Hospital where they have been trying to get an overpass or an underpass from their parking lot to the hospital over the last so many years and I have been directly involved in that; it's not a conflict of interest any more and it might have been

Monday, 3 May, 1982 a few years ago. But what is to stop the Manitoba Health Services from supply ing them with a safety factor? Because somebody's going to be kil led over there as they come from that parking lot to the hospi­ tal. There's no protection at all because they come off that Ma ryland Bridge; they're just whipping around there and somebody is going to get killed because the type of people who do visit at hospitals are older people and they can't move quite as fast as some of us young ones.

They're going to get hit by a car and they're going to have to, rather than just visit, they're going to have to stay in the hospital if they're not lucky. But what is to stop the Department of Health or the Manitoba Health Services from supplying them with some sort of a facility to get across from the parking lot to the hospital and back again after they finish visiting? I don' t think I can accept the answer of, let them walk down a block to the lights and carry on from that area there. I'm looking for something that is easily accessible.

Can the Honou rable Mi nister advise me as to a crosswalk or an underwalk or some sort of facility? You can't put a light on that corner, there's just no chance for the driver. So it has to be either over or under. Can the Honour able Mini ster advise? MR. DESJARDINS: That's exactly what's going to happen. It'll either be under or over. The planning has been approved. They're in the process of plan ning. I think that parking lot will and their steam building also, there'll be either an underpass or an overpass, but the plannin g is being done now. They've been authorized to go ahead with the plannin g.

That'll be the first part of the buil ding I think what­ ever has to be done, from what I unde rstand. MR. KOVNATS: Well. I would hope that the previous Min ister had some involvement in it because, you know, everything is just coming up roses. Everything that I' ve asked about, the Honour able Min ister has been able to give me the right answers and I'm quite satisfied. I hope that in another year or two when I ask him somewhat the same type of questions that they have expanded on the operations that he suggested that were going to take place today.

One last item and that is the service provided to the Northern reserves. I kn ow that a gener al practitioner doctor - and let me just go back a little ways - I'm told that in the Province of Manit oba that there is one doctor for ever y 550 people, appr oxi mately, -(I nterjection)- or 600 people something like that? Let's say one doctor for every 600 people. Why can we not - and I' ve got to wait because I want the Mini ster to be able to answer this leave him alone for a min ute and I' ll ask him a question and I'll be fini shed. Thank you. Okay.

Now I kn ow that we have trouble getting doctors to go into Northern Manitoba. We ship them up from Winn ipeg or from some of the larger centres; we fly them up for two or three or four days to the reserves, some of the gener al practioners, they go into the reserve and they do their job and after four days they come out and the nurses are up there and they have to handle the situation themselves, but the doctors, we have trouble getting them up there.

Is there any discussion with the Manitoba doctors right now, during their discussion as to increases in fees, as to whether they will co-operate with the Prov­ ince of Man itoba and allow some of their new doctors or even some of the doctors with experience, to set up a residence in Northern Man itoba at least for a short time? Is the Honour able Mi nister negotia ting in that way, or has he just set up his mind that he's going to negotiate on increased fees and thin gs of that nature? But are we going to be getting any additiona l services from the Manit oba doctors in return for giving some of the concessions?

I would think that there's going to be some concess ions made both ways and I'm just guessing at this point because I really don't kn ow. Would one of the concessions be that the doctors would supply us with better service for Northern Man itoba? MR. CHAIRMAN: The Honou rable Mem ber for Wolseley. MS. MYRNA A. PHILLIPS (Wolseley): Yes, Mr . Chairperson, in response to the question raised by the member opposite, I can't leave the issue of the building program at the Misericordia Hospital in the state it will be now on the record.

I want to make it very clear to the Member for Niakwa that the building program was scheduled by the previous NOP government. The plans were put on hold by the previous Tory Government and just recently since we became elected in November, my collea gue the Mi nister of Health announced the resumption of that program. So if anybody was injured or was in danger of being injured or maimed or kil led crossing Sherbrook Street to get from the park­ ing lot to the hospital and if the member is le gitimately concerned, my question is, why was he not con­ cerned over the last four years and all of a sudden is concerned?

I want to commend my Mini ster for going ahead with the buil ding program at the Misericordia Hospi­ tal which, as people in the room know, that it is in my constituenc y. I' ve met with the board of that hospital and they're quite delighted that the plans are going ahead for not only the building and expansion of the hospital, but also the parking lot across the street with under or over access through that busy thoroughfare. MR. KOVNATS: Mr. Chairman, to the Honou rable Mi nister, I don't think that any of the comm ents that I made this even ing have been political in nature.

I have complime nted the Honou rable Min ister and I've been questioned by the Honour able Member for Wolseley and I think that it's very very unfair. If that's the type of operation - I really didn't ask the Honour able Me mber for Wolseley the questions. I got an answer from her and she asked me, why wasn't I concerned in the previous four years? Well, just for the record, I was concerned in the previous four years and it was discussed. I have spoken with the people at the hospital. There weren't the mon ies avail able at that time and I accepted that.

I just fin ished tel ling the Honour able Min ister not too lo ng ago that he's got a problem because he just can't go throwing mone y around, he's got to have some­ thing leg itimate. To get me set up with the Honour - 2126

Monday, 3 May, 1982 able Member for Wolseley in her remark that, where was I four years ago? I was here representing the Province of Man itoba. I was the Deputy Speaker of this Legislatur e and I was doing a damn good job. I wasn't standing up in my place as Deputy Speaker and making some detri­ mental remarks about the Speaker of the Legislature. Maybe it was because I had a good Speaker at that time, but I think that we do have a good Speaker at this time and, you know, I'm just getting all these things off my chest at this time, Mr.

Min ister, because the Hon­ ourable Deputy Speaker who is the Chairman of this Com mittee stood up there and criticized the Speaker of this Legisla ture. I listened to some of the remarks and I didn't appre­ ciate it. I' ve got it off my chest now too because I don't think that the remarks that you made or, the honour­ able Mr. Chairman, that were made by the Deputy Speaker were called for. I don't think the remarks made by the Honourable Mem ber for Wolseley were called for either. Where was I four years ago?

Repres­ enti ng the people of the Province of Manitoba and I'll be here a lot longer than that government on that side after the next election. MR. CHAIRMAN: The Honourable Min ister. MR. DESJARDINS: Well, Mr . Chairman, I'm gla d that he fin ished in that joking mood, his remarks. I might say that I don't think anybody was criticizing the memb er. We've had a good exchange in this department. I think that last Friday, certain mem bers felt that they wanted to be on the record. They chas­ tised the present government which was fair enough on the construction of personal care homes.

I cer­ tainly must defend the right of the Member for Wolse­ ley. After all, this hospital is in her own constituency and she wanted to make some remarks so I don't think that anybody should take it as a personal affront. I think this is something the mem bers can speak and we have no control over what will be said. It's not necessarily a criticism but the member had stated that things were so easy - I think this is what calle d it on that everything had been done or planne d by the former government.

There's a lot of things that had been done but I think the Memb er for Wolseley wanted to say wel l, this is an area and I'm not that concerned about the credit - but, this is an area that we had approved, that wasn't approved before lik e many of the things. If you remem ber the mem bers of the Com mittee that I' ve tried to give credit to the former government and said this is something that was approved. So, I don't think we should start a quarrel on that. I don't think the memb er should be too touchy.

Every member of this House can put somet hing on the record and, as I say, last Friday many of them wanted to say that we were not reaso­ nable; we weren't right in not giving them personal care homes and so on. This was something the memb er obviously is quite interested in because it's her own constituency. Now, to go back to the question. I think there was a question about the service up north, especially to the Natives. This is something that actually is the respon­ sibility of the Federal Government, but we're not wait­ ing; we can't wait forever. We're trying to participate.

Of course, anybody in the north will get a 10 -percent increase in fees: that's one thin g. Then there's some people that we've made arrangements with - the Four Nations, I guess, and then whenever possible also with the MMA, and they've sent people either on fees if they wanted or I think there's been on sessional pay­ ments. I think they've had the choice; it was left to them and at times they can benefit by sessional and this was done. There's always a lot of improvement we could do.

I certainly feel that the memb er is right, that the medical profession should be given this challenge of providing services, seeing if they can improve the services all across Manit oba. Of course, our Comm it­ tee on Medical Man power is studying the situation also. So, it isn't perfect but it's not that bad at this time. MR. KOVNATS: I'm not too thin- skinn ed, to the Hon­ ourable Mini ster. I sometimes let things bother me more than I should.

It seems to me that I was compli­ menting the Min ister for what he had done at the Misericordia Hospital and then you know the remark just didn't seem to be consistent for the remarks that I had made. I again complim ent the Honour able Mi nis­ ter for planning this crosswalk. I compliment the Honourable Mem ber for Wolseley for assisting the Mini ster in putting in the crosswalk, if she had any­ thing to do with it; I imagine, that as a representative in that area that she has had something to do with it.

But, for the last well half-an-hour or so since I've been talking, I' ve been tal king about the hospitals in the Provinc e of Man itoba. I don't have a hospital in my constituency, but the people in my constituency go to hospital. So, therefore, I think that all of the hospitals in the Province of Man itoba are min e, so I can talk on them in the same manner as somebody who lives right next door to them. So, I don't think that what the Honourable Mini ster said concern ing the Honourable Member for Wolseley and her constituency real ly bears any importance.

I think that we all represent Manit oba and we represent hospital locations. 2127 One point - you kn ow, I had almo st forgotten and I kn ow that the Honourable Member for Portage wants to ask just a few more questions - it was concerning pediatrics in the North where we have to send up somebody qualified in pediatrics to bring back the patient via aircraft.

I kn ow that there has been some aircraft set up and I hope the Honour able Mini ster is listening because it's just going to be one more ques­ tion that we do send up very qualified pediatricians to bring these people in because these young children have to come int o Winn ipeg where we have the facili­ ties. They might be in the guardiansh ip of a qualified nurse, but what happens is that this pediatrician goes up and brings the child back and it's all done by aircraft because time is of the essence .

What facilities, or in what manner does a pediatrician or anybody from the City of Winnip eg going up to bring one of these chil dren back, what comm and do they have of an aircraft to bring back the patient? Who pays for it? In fact, are there government aircraft available to bring these patients back into Win nipeg, and if they're not, do they just go and do they hire somebody else by luck? Is there any sort of a routine to look after these things? MR. DESJARDINS: Mr. Chairman, we've covered

Monday, 3 May, 1982 that when we covered the Northern Patient Transpor­ tation Prog ram. Anyth ing up north, there's a fund there. The people that have the control would be the local doctor who would issue the warrant that the plane will be used and this is what happens. Now, if you're tal king about the real young babies, if they have to be brought in the City they will be brought in an incubator. Anytime that a patient needs transpor­ tation and the doctor feels it's an emergency and it warrants this service he gives the order and there's no problem. These people would be brought in. MR.

KOVNATS: Just in conclusion, I want to thank the Honourable Mi nister for answering some of the questions because I was here last Friday and I just restrained from asking any questions. I was here last Thursday and I restrained from asking any questions. I thought I would have the opportunity of asking the Honourable Mi nister questions on all of this under Salary or under this particular department and the Honour able Min ister has complied. He's answered the questions as honestly as he could.

I'm al most in com plete agreement and I give him credit and the previous Mini ster of Health credit and any body else who's had anything to do with the upgrading of hospi­ tal services or medical services in the Province of Manit oba. I don't think we can be critical of that. Thank you very much. MR. CHAIRMAN: The Honourable Member for Por­ tage la Prairie. MR. LLOYD HYDE (Portage la Prairie): Thank you, Mr . Chairman. To the Mini ster, if I may just to refer back to the Deer Lodge Hospital. I am certainly in full agreement with the move that the government has taken in respect to the Deer Lodge Hospital.

Of course, as we all kn ow, this has been in the talk in the books for a numb er of years but I'm pleased that it has finally has been decided to move on it. Also, Mr . Minis­ ter, the fact that you are going to be looking to the concerns of the veterans in the allocation of bed space to them. I'm sure that you're quite aware, as I am, tha t the veterans look to that hospital as their home; that is their home. I expect that I may have to return there some day.

I spent nine months in that place foll owing my return from overseas and I expect lik ely someday I'll have to return there and I hope there's a bed vacant for a veteran. That is what I wanted to mention to you, Mr . Minis ter, just to make sure that I expressed my thoughts in regards to the hospital. It has been a kind of a sore spot, you might say, in my min d for some time to see the large portion of that hospital being vacant the way it was; left vacant for so many years. It's a good building and no doubt will need some changes and renovations but how­ ever, that can be looked after.

I wanted to make it be on record that I certainly am in favour of the move that's taken place. MR. DESJARDINS: I'd lik e to make a correction. If this goes through I'm sure that the mem ber will not return to Deer Lodge. He migh t return to another facil ity but the other arrange ments will be made. That's what we're talking about guaranteeing beds for return people. I think that it looks lik e a very good deal; everything will be torn down except the building on Lodge Street which was built in 1959 so it's in fairly good shape. There'll be some renovation and the rest will be torn down and rebuilt.

As far as the veterans, we have informed the Federal Government that we want to make sure that problem is taken care of and that's their responsibility. I met with all the different groups, representing different groups of veterans. I met with them together, we had a good meeti ng, they expressed some con­ cern and this is a commit ment that I made to them. I sugge sted that they should meet with the Federal Government, we're being assured that the Federal Government, before we do anythi ng, will meet with them again.

Then I intend, to make doubly sure after we sign the agreement, there are not all kin ds of ques­ tions, to invite them to a meeting, in fact, they've asked for this meeting and I agreed. Once they've had their federal meeting and if need be we'll have another meeting or that would be the first meeting with representation from the Federal and Provincial Governments to make sure that there is no misun der­ stand ing. We want to know now any services they want us to give these people, fine, but they will have to pay for that.

We're ready to deliver anyth ing but if they want to keep something for the veteran they will have to pay for it but we want to know now we don't want to be stuck later on saying there's been an understand­ ing with the veterans. Before any agreement I intend to show them the agree ment, let them look at it and to get their recommen dation and try to straighten that out before we finally sign any agreement. So we're quite satisfied, the mem ber is absol utely right, this has been going on since 19 65 or so when this first was brought up so it's quite a while ago. MR. HYDE: Mr .

Chairman, I'm sure that no matter what you do you'll not have the full agreement by all veterans, that's to be sure, no matter what you do you'll not be able to satisfy them all but it's nice to kn ow that the consideration is being given, you've given the veterans group the opportunity to express their concern about the future of the veterans. MR. CHAIRMAN: The Honourable Memb er for Fort Garry. MR. L.R. (Bud) SHERMAN (Fort Garry): Thank you, Mr .

Chairman, there are a few questions I wanted to conclude with the Minis ter on the subject of hospitals program as we move to the end of the exam ination of his Estimates. My coll eague, the Honour able Memb er for Niakwa, brought up the subject of Mis ericordia in a limi ted way and I wanted to ask the Min ister some questions about his statement a few weeks ago with respect to regeneration of the Misericordia Hospital. I want to say, at this juncture, Mr . Chairman, that I was interested in the gratuitous comments of the Memb er for Wolseley where the Misericordia Hospital was concerned.

I would remind her that the Capital build­ ing program of the previous govern ment, in the health facility field, approved, into construction and under way totaled $234 milli on. I would remin d her that our government sorted out a problem that had plagued two previous governments to get the Health Scienc es Centre regeneration under way and comm itted $75.6 2128

Monday, 3 May, 1982 mill ion to that. I would remind her that althougl1 she may represent Wolseley today, Wolseley was represented by a Pro­ gressive Conse rvative mem ber at that time.

Wolseley, althou gh it draws for its patient load from patients all over the city, is essentially consi dered a South Win­ nipeg hospital and if one, I suppose, were to look at the political demarcation lines in Winnip eg, as in Man itoba, I think it's no secret that essentially the northern part of Winnip eg is regarded as oriented towards the New Democratic Party, the south end of Winnip eg is regarded as oriented towards the Pro­ gressive Conservative Party.

I could have approved redevelopment of Misericordia the day I was made Minis ter of Health, instead of that we moved on Seven Oaks, we moved on the Health Sciences Centre, we moved on a $234 mil lion Capital construction pro­ gram, in general, and we priorized Misericordia, to move on it as soon as we could. I did not elect to go with Misericordia first, or even close to first, in our list for a numb er of reasons, not the least of which was dol lars. The most important thing was to get the major tertiary care centre and major referral centre in the provinc e back into shape.

When we could move on Misericordia we intend ed to move on Misericordia. If she has succeeded in obtaining a crosswalk for Mis­ ericordia Hospital, good for her I congratulate her. Whe she stacks that up against a $234 mill ion Capital construction program I'll be prepared to trade notes with her, until then I regard her comme nts as highly cynical, highly political and highly gratuitous. Now, insofar as the announc emen t of the Min ister with respect to regeneration of Misericordia's con­ cern, Mr.

Chairman, I wonder if he could elab orate on the plans for Misericordia, whether he is tal king simply about another rehash of the functional pro­ gram which we went through and which I believe the previous govern ment may have gone through, or whether he is talking about a $40 mil lion to $50 mill ion regeneration of Misericordia Hospital, when it will get under way, and what it will entail over and above a safety crosswalk. MR. DESJARDINS: Mr. Chairman, that vastly func­ tional program is going to architectural planning and drawing s and the intent would be a hospital around the figure of maybe $40 mill ion.

Mind you it's not going to give you any more beds but it's something that ought to be done, if anything be very close, in fact we might lose one or two beds or something, roughly 400 beds but something would have to be done or we could lose the hospital. MR. SHERMAN: How many beds.Mr. Chairman, 409 beds right now and it'll still be approximately 400 beds and what will the regeneration consist of, largely the replacement of the centre core? MR. DESJARDINS: Mr. Chairman, on the planning I think we'll have a better idea when they show us their drawing s, that is, I could n't give you the details at this time.

I kn ow that on one side they'll start with the parking and the boiler and the steam room, that'll be in the present parking and then it'll be either under­ ground or overground access to the main hospital. A lot of it will be replacement, I think the central part will be replacement and there'll be renovation in the north and south buildings. MR. SHERMAN: What chang es in categories of beds and bed config urations are being contemp lated? Are there going to be beds designa ted there as extended care beds that, up to this point in time, have been active treatment or obstetrical beds? MR.

DESJARDINS: No, this is going to remain the acute bed hospital. As I say we can't afford to lose any beds there. It will be practically the same numb er of beds, the same kind of beds, but there'll be replace­ ment of some of the buildings and certainl y improve­ ment in others but most of it will be replacement. Wel l, figure it out for yourself, it will be for 400 beds, it will be about $40 mil lion or so, but when it's fini shed the same hospital will be new with newer, more modern facilities. MR. SHERMAN: Mr.

Chairman, I want to ask the Min ­ ister about a couple of other hospitals but because this is related I want to ask a question on obstetrical un its at this moment and where the present govern­ ment stands with respect to consolidation and ration­ alization of obstetrical units. Is the government con­ templating any rationalization program and would Misericordia be contained and retained as an obstet­ rical ce nt re, as a mate rn ity hospital in tha t rational ization? MR. DESJARDINS: If you're tal king about Misericor­ dia, that is being reviewed at this time.

Now there's no plan to deal with the whole matter here in Winn ipeg but I've asked the Comm ission to review that and bring some recommen dation in view of the problems that we've had and we seem to have, every time we build a hospital in the city. There's no doubt that we'll ask for an opinion. I think we've already received some opinions from the medical profession and this will be vetted or discussed with either the college or the MMA once we get a recommen dation from the Com mission. 2129 MR. SHERMAN: How many live births are there at Misericordia a year at the present time?

Can the Comm ission advise the Minis ter and advise the Commit tee? Is it anywhere near a thousand? MR. DESJARDINS: It's approximately 800 at this time. MR. SHERMAN: Mr. Chairman, I want to ask the Min­ ister about Concordia.

He had said in his statement that among projects that will be pursued in addition to the program that he announc ed dealing with con­ struction this year, he had instructed the Com mission to conti nue to work in the "refineme nt of functional programs for the foll owing hospitals and personal care home projects," and in that list and in that cate­ gory he includ ed Concord ia Hospital, the addition of 13 6 acute-care beds plus expansion of emergency and out-patient departments.

It was the intention of the provinc e, under the pre­ vious adminis tration, to encourage Concordia Hospi­ tal to go to construction of the two desired and

Monday, 3 May, 1982 required additional lifts on their hospital in 19 82-83. Does the Min ister's statement mean that the new gov­ ernment is intend ing to pursue that initiative or does this really put the Concordia Hospital situation back in a tem porary holding pattern? MR. DESJARDINS: Mr .

Chairman, I think that the answer would be that the department, and I as the Mini ster and the Com mission, feel that should keep on receiving our attention but it is not obviously on the same priority list as those that I announ ced so far but we felt it important enough that in a couple of years it might not be the bigge st priority at this time, but in a few years from the time that the func tional program is looked at, I would think that there should be some recommen dation in front of Cabine t next year.

If this is done, if it advances all these steps, next year there would be the planning and it could go to tender the followi ng year so it could be three or four years from now. It could still be in the 5-year plan. MR. SHERMAN: Does the Min ister have any plans, Mr. Chairman, with respect to the Municipal Hospi­ tals, the City of Winnip eg Municipal Hospitals, the King George and the King Edward essentially - not so much the Princ ess El izabeth - but the George and the Edward? MR. DESJARDINS: That's what I thought.

There was something announced that it is ready to go now but as far as the functional thing, yes, that is pretty well the same as Concordia Hospital. We will look at the situa­ tion. One of the reasons that one was delayed was because of Deer Lodge. We'll see what happens in Deer Lodge. MR. SHERMAN: Is the government consideri ng tak­ ing over the Municipal Hospitals from the City of Winnipeg? I might say, Mr . Chairman, I'm not trying to start an argument with the Mini ster. I would not be opposed to that; I want to know whether he's thinking about it. MR.

DESJARDINS: All I know is that they've asked to discuss it with us. We will later on when the Estimates are finished but we haven't made any comm itment or we have no indic ation what we'll do at this time except that we'll talk to them because they've requested it. MR. SHERMAN: Do the long-range plans for the Mu nicipals still include a personal care home on the campus? MR. DESJARDINS: Wel l, Mr . Chairman, as I said pre­ viously, a lot depends on what happens at Deer Lodge. That might change our thinkin g.

If we don't have Deer Lodge I think that some of the action will have to take place at the Health Sciences Centr e. Now if we develop Deer Lodge as we propose to do it, then we'll have to review the situation at the Municipal Hospitals. MR. SHERMAN: Mr. Chairman, the weather of course is in the Min ister's favour at the present time, or any Min ister's favour at the present time, but going back approxi mately to the month of February, in the latter months of the winter, can the Minister report to the Comm ittee that he is satisfied with the volum e of patient-load in the general comm unity hospitals in Winnip eg?

There certainly were concerns expressed during the winter by Misericordia, at least, and I belie ve one other major hospital in the city about overcrowding and emergency departments being unable to accom­ modate people other than in stretchers in corridors at the hospitals, blocked beds - which is a term that I don't particula rly like but it's a term that's generally understood I guess - and overcrowding in gener al.

Obviously that condition is more likely to occur in Janu ary than it is in July and we're moving into a season now when perhaps the pressure is a little eas­ ier but I'd lik e to kn ow where the Minister stands as of January, February and March of this year with respect to patient-load and patient-demands at Winnip eg hospitals, basical ly Winnip eg hospitals. I don't think the problem is anywhere near as great in rural communities. MR. DESJARDINS: There's no problem in the rural area. There's still problems in pretty well the same period of the year as was mentioned.

I belie ve it was a little easier this year although the problems existed but we look when Seven Oaks is fully opened as, hopefull y, relieving some of the pressure. We'll be able to tell next year. MR. SHERMAN: Mr. Chairman, in reviewing the budget for the hospital system, I don't believe the Min ister mentioned and I didn't ask him that I recall, for the situation with respect to commu nity health centres and community clin ics. Is the 14 . 7 percent a general rule-of-thumb budgetary increase that's being applied in the hospital and personal care home field; also being applied in the community clinic field. MR.

DESJARDINS: Yes, the same increase applies to them. I might say that this was something that when we were in gove rnme nt previously we had quite an interest in that. I should say that I haven't had time to do too much yet but, I've been instructed by the col­ leagues in Cabine t to look to see if there's anyth ing to salvage or if we could go in that direction also. So, the value of that system is going to be looked at. MR. SHERMAN: But at the present time the spectrum of community clin ics or community health centres in Manit oba is as it was a year ago. Is that correct?

So that means that Norwest Co-op is out of business except for the day care centre and that means that the Citizens Health Action has been integ rated into the Health Sciences Centre Outpatients Department for geriatrics. Is that correct? MR. DESJARDINS: Yes, there's been no change on that at all at this time. The increase will cover this also as I stated, but there's no change at this time. 2130 MR. SHERMAN: Mr.

Chairman, an area that I'm very keenly interested in is blood fractionation and the Rh In stitute and appreciate frankly that fate and fortune were such that they gave me the opportunity to partic­ ipate in some considerable progress in that area

Monday, 3 May, 1982 where the Rh Ins titute is concerned and where Man it­ oba's status with respect to the blood fractionation industry in Canada is concerned. I'm pleased that the capital project which will find a new plant for Dr. Bowman and the Rh In stitute on the campus of the Un iversity of Manitoba is going ahead at a multimil ­ lion dollar figure, a multimillion dollar level.

But, I'd like to ask the Minis ter where we stand on agreements with the other provinces in Canada and with the Canadian Red Cross and I suppose, neces­ sarily, with the Mi nister of National Health and Wel­ fare on the division of blood fractionation responsibil­ ities. At the time we that we left office we bel ieved that we had an agreement which would find Manitoba through the Rh Ins titute being em powered or entitle d to produce 50,000 litres of plasma fractions per year out of a total market requirement, I believe, of between 200,000 and 250,000.

The other 200,000 that wasn't going to be fractionated here in Man itoba was going to be handled by Ontario and Quebec. We hoped, in fact, that our quota might go as high as 75,000. Cer­ tainly, we wanted to be sure that we could supply the plasma fraction requirements of Western Canada from here if necessary. What's the status of those discussions and that quasi-official agreement at the present time, Mr . Chairman? MR. DESJARDINS: Mr.

Chairman, there was a com­ mittee, as my honourable friend kn ows quite well because he was one of the mem bers as Mi nister of Health, and his col leag ues at the time set up this comm ittee with Mr. Frank Anderson representing Manitoba. A lot of the details are not set up as far as the blood. I think that it will be 200,000 litres in all, and will provide 10 0,000 and the other 10 0,000 will be split between Quebec and Man itoba. Now, the concern, there was a tentative - we hope it's just tentative - arrang ement made that we could recapture by the sale of blood half of the cost of the construction.

We feel that could be improved and brought it to the attention of the western Mi nister and there's been an informal promise or com mitment that they would support me to try to improve the situation. It has been placed on the agenda of the meeting that we'll have with all the Provincial Min isters and the Federal Mini s­ ters later on this month - I think it's the 26th and 27th; somewhere around there. As far as the National Min­ ister, I don't think she's involved in that at all. I think that it is set with this committee pretty well. In fact it's past the stage.

I would imagine that she's given her approval already. We're not concerned with her on this at all. MR. SHERMAN: Is everything settled and acceptable insofar as the Canadian Red Cross is concerned? There was some difficulty in the initial phase of the undertaking with respect to the Canadian Red Cross. I think they had some concerns and some legiti mate ambitions of their own.

There was considerable dis­ cussion required in order that everybody understood each other and that all parties understood that the objective really was the security of plasma fraction supply in Canada in the most modern and the most eco nomical and effi cient format. Ha s that been resolved satisfactorily with the Canadian Red Cross? 2131 MR. DESJARDINS: Mr . Chairman, I'd be exagger at­ ing if I said that they were jumping for joy but they are not fighting anymor e. They've accepted the decision of the comm ittee; they would sooner control the whole thing but, they've accepted. MR.

SHERMAN: Are we marketing expertise in frac­ tionation to Quebec which was als o part of the origi­ nal discussions? MR. DESJARDINS: There hasn't been any discus­ sion between our people and Quebec lately but now that the an nouncement has been made we expect to hear from Quebec fairly soon. I think that was their intention before and I would imagine that they will try to explore that again. MR. SHERMAN: Would the Mini ster have a boxcar date that he could put on completion of the new Rh In stitute Laboratory? MR. DESJARDINS: Mr.

Chairman, I'm told that until the full program is fin ished it could be as long as two-and-a-half years. There'll be a year for construc­ tion, another year-and-a-half for full licensing by the Federal Government. This is what we expect. MR. SHERMAN: Mr . Chairman, can the Min ister advise the Comm ittee what the average length of hospitalization is in Man itoba at the present time? What is the average length of stay of a patient in a hospital in Man itoba, or more specifically in Winnip eg? MR. DESJARDINS: I believe we covered the whole program. It's approximately 9.8.

Winnipeg would be less, it would be around 9. But, of course, I' m not including the beds that are being used as a personal care bed. MR. SHERMAN: Is the long-range planning group that the Mi nister is putting into place going to be looking at that subject and looking at that question with an attempt to get it down?

Can the Mini ster con­ firm that the average length of stay in hospital in the State of California, which I'm not recommending necessarily as a panacea or a guideline, but just for comparison sake, the average length of stay is approximately 5.5 days and I kn ow the Mini ster is going to tell me that the patients have to pay their own bills and I understand all that but the fact of the matter is that there is a substantial difference in terms of bed turnover in many other jurisdictions com pared to Man itoba?

Will his medical advisers and hospital advisers and long-range plann ers be looking at this among other subjects? MR. DESJARDINS: Mr . Chairman, I think the memb er covered the problem. If you have to pay for it yourself sometime s you're not going to stay the required time, that could be dangerous. If everything is free well then you're not going to be in any hurry and you can stay a lot longer and it's going to be costly.

I think that's so important to have the proper guideline also and keep pressure on beds because if we have too many beds they would all be, no matter how many beds we have, they'll all be occupied, and that's the problem. I think

Monday, 3 May, 1982 that we have to make sure that we have enough hospi­ tals to serve people. It puts the pressure on the medi­ cal profession also, we need the beds and I think that we have to have their co-operation to assist us because we can't discharge patients, it has to be done by the doctors and I understand that this is improving all the time. Of course the different programs that we have should be quite hel pful once we have all these pro­ grams in place. We have home care, we can have respite care. Many people associate home care with older people but tha t's not necessarily the point.

Before home care the people would have to stay in the hospital, or before extended treatment care, after an operation for instance, now they can go home and get certain help where they don' t need the same type of care or so many hours of care and the expertise care, that could be done in the home with home care, so there is an improvement but we have to keep on the pressure and we have to be careful with the beds we build. At one time there was no doubt that we had probably too many acute beds and not enough per­ sonal care beds.

That might be one of the reasons why there is, although you'd think that the opposite would be true, that the stay in the hospital in the city would be lon ger. It isn't the case and one of the reasons I would guess would be that all the rural area is over­ bedded but tha t's not as costly as these teaching hospitals and these gener al hospitals here, for instance, it's not as much a problem. MR. SHERMAN: Mr. Chairman, the latest testament I have for the average per diem cost of an acute care bed in Manitoba in 19 81 -82 was $1 94.30, that's the daily cost, on average, of operating an acute care bed.

The average for extended care beds was $1 19 .10 . Can the Min ister advise the Comm ittee what those projec­ tions are today and I think it's more compl icated than simply mul tiplying them by 10 percent or simply adding 1 O percent? Does he have a projection for the average cost of an acute care bed and an extended care bed in a Man itoba hospital today? MR. DESJARDINS: Mr .

Chairman, before I do that, just to make sure that I don't forget, I want to make a correction here, the member had said that Northwest Co-op would continue just as day care, continuing to provide medical, day care and outreach services, the three not only day care.

The average per diem cost, let's say that I can start from 19 69, that was terrific it was $37.80 all hospitals, the acute care was $40.10 , extended care was $24.85; let me start in 19 79-80, the acute care was $15 0, extended care $93.80, all hospital $1 44.35; 19 80-81 was $1 88.80 acute, $1 08.55 extended, $1 77.20 all hospital; 19 81 -82 estimate $224.29, extended $1 28.96, $2 10 .51 ; and 19 82-83 estimates $257.27 for acute, extended care $1 47.91 and all hospital $241. 46. MR. SHERMAN: Mr.

Chairman, the net result on the positive side of the Diag nostic Ul trasound Program and the High Risk Maternity Program that's in place has been a very gratifying improvement in child and maternal health statistics, certainly in infant mortality and perenatalogy statistics. If there is a downside to it, and I don't sugge st that the downside outweights the upside, it doesn't but nonetheless it has to be recog­ niz ed.

If there's a downside to it it is to be found in the pressure that the use of these techn iques and this programmin g and, the wide-spread application of these referrals has had, in their impact on pediatric ICU beds, newborn ICU beds and nurses in the ter­ tiary care hospitals in Winnip eg. Some months ago, in fact, there was noticeable and vivid pressure on the ICU nursery at St. Bon iface and I think that the pressures were being felt in ICU nurser­ ies in other tertiary care hospitals.

The programs annou nced by the Mi nister for 19 82-83, although ref­ erring to additional hospital beds and hospital upgradin g and hospital improvements and expan­ sions, do not speak specifically to this question of intensive care nursery beds and ICU pediatric nurses. Can the Mi nister advise the Commit tee as to whether the Diagno stic Ul trasound and High Risk Maternity Program are, indeed, having this kind of a permanent impact and affect on the ICU nursery and the ICU nurse and, if so, what does the comm ission plan to do about it in its 19 82-83 program? MR. DESJARDINS: Mr.

Speaker, I don't know if you could win on a situation like this. There's no doubt that the cost is increasing, but there is no doubt also that you're providing better care. So what value do you put on that care? What kind of judgment can you make on that? I kn ow that we are expanding the ICU nursery at St. Bon iface and we're looking at the situa­ tion and spending more money in that direction. I think there's no doubt that it probably would save quite a few lives, but it's also a very costly program. I don't know what else I can say on this at this time. MR.

SHERMAN: Wel l, I'm not challenging the ethiqs or the morality of the program, Mr . Chairman. I'm asking the Mini ster how the hospitals are coping with it. Are there enough ICU nursery beds and are there enough ICU nurses? There certainly were indications a year ago when these two programs really got on stream and really began to establish themselves, that this was one downstream effect that probably hadn't been properly antici pated. What is the Comm ission's response on May 3rd, 19 82, to that problem and that pressure? 2132 MR.

DESJARDI NS: The response is as I indicated that we're satisfied with the programs at the Health Scienc es Centr e. Grace is maybe not the same high risk as these two hospitals, that's progressing fairly well. But we're expanding the ICU at the nursery at St. Bon iface Hospital because of need. There's more problems there so I guess we're saying that we have to beef up the program if we're looking at the total program. MR. SHERMAN: But at the moment then the ICU nurseries are not facing pressures that can't be met. Is that what the Min ister is saying? MR.

DESJARDINS: They're feel ing pressure that can't be met if we don't expand St. Bon iface. That's our answer to it. There is pressure. We feel, though, that we will meet that pressure by the expansion that we're sugges ting.

Monday, 3 May, 1982 MR. SHERMAN: Could the Mini ster advise the Com­ mittee, Mr . Chairman, where we're headed with the day hospital concept using the day hospital at St. Bon iface Hospital as a, not a pilot project, but let us say a pilot exa mple ? Do his and the government's plans and contempla ted intentions for the future include a wider application of the day hospital concept? MR. DESJARDINS: Is the member tal king about what we at times refer to as Day Care for the Eld erly? MR. SHERMAN: Yes, but not attached to a personal care home. MR. DESJARDINS: No, no, that's being discussed I think with the St.

Bon iface, with the Youville Founda­ tion, the Brandon group and we're very impressed on that, but there's no decision made. Of course, this is an area where we would - I think it would be danger­ ous to try to impose it on anybody - I think that after discussion we would hope that some of these hospi­ tals will come on their own and really want the pro­ gram, I think that's the only way it's going to work, but there's no decision made as yet. In discussing that, we had sugge sted to Dr. Hamp­ ton that he should meet with the Youville Foundation. He did that.

He thought that was a good idea and we're going to try to establish some kind of an advisory comm ittee through the Mini ster and I'm looking cer­ tainly at these two as the leaders right now. Anyway, it may be expanded to the rest of the province later on and we will discuss this with the hospitals also, as well. MR. SHERMAN: Wel l, there's a new, young geriatri­ cian in place, in office, at St. Bonif ace Hospital. Is that not correct, from Liverpool? MR. DESJARDINS: Yes. MR.

SHERMAN: Well, is that facil ity operating as a day hospital or is it opera ting as a chronic care or extended care, long-stay institution? MR. DESJARDINS: It's oper ated as extended care, but from what we kn ow of Dr. Paul, I think they will be requesting that one of their programs will be a day hospital. We certainly intend to look favourably on that request at this ti me. MR. SHERMAN: Mr. Chairman, I just have one remaining question on this aspect of the Min ister's Estimates. It may be a long one though. I hope it isn't too long.

That is, the state, fate and futur e of Child­ ren's Hospital, the former Childr en's Centre at the Health Scienc es Centre, now renamed the Childr en's Hospital again and the new plant, the new physical plant that is going up there. I understand fully that the five-storey bed tower that's being constru cted on the site of the old or exist­ ing Children's Hospital is going ahead without change.

I kn ow that there was some confusion gener ated by media reports a few weeks ago on this subject and, subsequent to that, officials of the Health Scienc es Centre held a press conference and issued a media statement and assurances to the Mini ster and the public that that buildin g is not going to be chan ged. It will conti nue to be a bed tower for childr en - I don't know that I've got the figures right in front of me - but I think perhaps do have, Mr . Chairman.

In any event, there were at least 10 0-plus beds scheduled for that building and it apparently is going ahead without any changes or modifications or altera­ tions. But that assurance really was of little comfort to many, including myself, who were interested in the future of Childr en's Hospital as a separate, identifia­ ble and autonomous unit on the Health Sciences Cen­ tre Campus because I believe other mee tings have been held with respect to a building to be constructed during Phase Two of the development of this Centre which is going to integrate a great many services for children with services for adults.

I believe that those services include the Emergency and day surgery, operating rooms, even a burn unit and that that new building is going to be an int egrated centre which serves both chil dren and adults. So the reassurances about the Childr en's Hospital as such are not satisfac­ tory to a great many people and they're not satisfac­ tory at this point to the Opposition.

We would like to kn ow, what is the status of the apparent intention on the part of some to integ rate chil dren's and adults' services downstream in a build­ ing that is not under way on the Health Scienc es Centre Campus yet, but is scheduled to be built after Child ren's Hospital is completed? Retention of identity simply for medical and surgi­ cal beds where chil dren are concerned is not by any means the total object of the exercise in the view of many, Mr . Chairman.

The conventional wisdom is North America today is that the best care for child ren is provided in an envir onment which is designe d and geared specif ically and exclusively to serve children and not to co-mingle them with an adult commun ity. I don't want to get into all the sociological and philoso­ phical arguments that have been advanced in sup­ porting that position in the debates.

Suffice it to say that all across this continent the recognition has been dawning that children's hospitals should be children's hospitals and childr en should live in a hospital envi­ ronm ent that is as comfortable and as happy and as conducive to their tender years as possible. That envi­ ronment is impossible when they're in a facil ity that is also serving adult s. 2133 So I just want to assure the Mini ster that there is still deep concern about the future of children's hospital as such.

A bed tower is fine , that's one thing but those who are interested in the future of the children's hos­ pital want the whole chil dren's medical-surgical hos­ pital environment to be self-co ntained and separate. MR. DESJARDINS: Mr . Chairman, I'm pleased to receive the impression and the advice of the Memb er for Fort Garry. As far as I am concerned it's a little premature to talk about these things.

Yes, the member is right, we've asked for a review, the Man itoba Health Services Comm ission look at the capital spending and that resulted in continuin g support for construc­ tion at the chil dren's hospital tower the new six­ level main entry - and the support service, the labor­ atory service building at the centre. Now, we have nothing in front of us at this time. I

think there is a possibil ity that there be a recommen­ dation for joint space for the areas and the services that were mentioned. I can assure the memb er we have the same concern that he has but we will have to look if there's a presentation made to us. I've requested that they give us whatever they have to give us; any recomm end ation or any proposal that they place in front of us as soon as possible because of the concern but no doubt we will look at it. We'll look at the positive and the negative points and then we'll have to make a decision.

I think it's normal that people who want to go a certain way will be concerned. We'll have some concern until a deci­ sion is made but it would be premature for me to even discuss it at this time because we have nothing in front of us. If they have certain recommend ations to make and we'll have to look at the financial implica­ tions for one thing and then all the bad points as was stated by the Mem ber for Fort Garry. Right now. we have nothing in front of us so I have very little idea what they're going to suggest or recommend, if they do recommend that there be joint space share for the two.

I have no assurance that they will do that either. MR. SHERMAN: Mr . Chairman, on a related ques­ tion. There had been a very high priority given to the establish ment of a peri-natal unit at the Health Scien­ ces Centre at Childr en's and at the Women's Centre. Plans had called for the integration of the intensive care nursery with the rest of obstetrics and the rest of the whole neo-natal program.

My understand ing is that as a result of different thoughts and objectives and ambitions that are being brought to bear now in the discussions with respect to the redevelopment plan in general at the Health Sciences Centre that that whole thrust and initiative to establish an intensive care nursery related to. phys­ ically tied to neo-natology and obstetrics. has now been pushed back almost a full decade on the sche­ dule and we're going to have to continue to operate, mothers and their newborns are going to continue to have to operate in separated envir on ments at the Health Sciences Centre where the intensive care nursery is separated physically some distance from obstetrics and neo-natology and that we're not lik ely now to get that integr ated un it with an intens ive care nursery and obstetrics tied together for something lik e 8, 9, or 10 more years.

I would find that a very serious error and a very serious setback to child and maternal health and to peri-natology in Manitoba. I think if that is the present thinking of those who are looking at the. redevelop­ ment plan that the Min ister and the Com mission had better intervene directly to assure that no such unac­ ceptable postponement or delay of that kind is permit­ ted and that the thrust and initiative for the immm e­ diate future re main an in itiative that's aimed at integra ting the intensive care nursery with the rest of the obstetrical program. Can the Min ister comment on that?

This information emanates from ongoing meetings and discussions that are taki ng place among various comm ittees and clini cal com ponents of the Health Sciences Centre and the hospital's adminis tration with respect to the total redevelo pment program. I think it flies in the face of the objectives that many of 1982 us, includin g the Department of Child Health had agreed upon at the time that the redevelopme mt plan was fina lized and ann ounced , Mr . Chairman. MR. DESJARDINS: Mr . Chairman.

I think that unfor­ tunately there's too many rumours that come in from different clini cal chiefs and different people that are so worried that they're not going to get what they feel is coming to them. Noth ing has been changed what has been approved by the former gove rnment . We intend to do exactly what the memb er stated. The situation is that we will renovate the high-risk un it for the time being on Willi am at the Women's Pavillion. I think the concern is they figure well if that mone y will be spent they'll probably want to leave it there. that's not the intention at all.

Later on, as soon as that'll be built there will be the different un it as was stated. There's nothing changed at all. MR. SHERMAN: Wel l, I'm gla d to have the Min ister's reassurance on that. Mr . Chairman. No doubt, com­ ments and perspectives will occur with respect to the think ing and the participation of individuals . groups and compone nts in the refinement or re-development plan from time to time but I would hope that the Minis ter and the Comm ission hue to a pretty sensitive and understand ing line where Childr en's Hospital and neonatology is concerned.

I'll certainly be look­ ing to them with interest as the re-development pro­ gram at the Health Sciences Centre contin ues and I hope that they will guarantee the integrity of Child­ ren's Hospital and of individual, excl usively presented care for childr en and the necessary advancements in neonatology that will complement all that we're trying to do in child and maternal health. I recognize the ambitions of different interests and interest groups and clinic al compone nts at the Health Sciences Centre and I kno w that it's a difficult thin g to accomm odate them all and try to be fair and equitable about it.

Oftentimes the voices that attempt to speak up for certain elements and certain units.

Childr en's Ho spital among them. are lost in the welter of other ambitions that are being pursued and I would just ask the Min ister's reassurance that will not be the case and there will not be disappointment s and frustra­ tions and setbacks put in the way of those people in the Department of Child Health who have worked so hard to achieve this objective. 2134 The Min ister has sugge sted to me that so far these are all speculative and he hasn't had any firm changes or plans or refinements of this kind put in front of him, when that occurs he'll be looking at them very inten­ sively and conscientiously.

So. at this juncture, I can't ask for any more assurance than that, Mr .

Chairman. but I hope that those who have worked long and hard in this province for Childr en's and for maternal and chil d-health care will be re-assured, and can be re­ assured, by the Min ister's office that there are no arbitrary disruptions in planning that are being con­ templa ted or that are going to be permitted; that if there are any changes. they will be chan ges that can be justified as chan ges that will be made in the inter­ est of all and for the best of all concerned; that they won't be arbitrary, unilateral changes made as a result of competing in terests and competing interest groups where one side loses out unfairly.

Monday, 3 May, 1982 MR. DESJARDINS: Mr. Chairman, I think I could give this assurance as far as I can possibly commi t myself or del iver. There might be something that I can't fore­ see at this time but this is the road we intend to go. MR. CHAIRMAN: Hospital Program -pass. Should we return to include the items to be considered under Resolution 79. THEREFORE BE IT RE SOLVED that there be gran ted to Her Majesty a sum not exceed ing $828,8 06,500 for Health, Man itoba Health Services Comm ission for the fiscal year ending the 31 st day of March, 19 83-pass. Returning to Item No. 1, Executive Function, 1. (a)

(1) Mini ster's Salary. 1.( a)(1)- pass. The Hon ourable Mem ber for Turtle Moun tain. MR. A. BRIAN RANSOM (Turtle Mountain): Yes, Mr. Chairman, thank you.

When I was still the Mini ster of Finance and meeting with some of my col leagues from across the country at the time and we were tal king about the Federal Government's moves to cut back funding in some areas and to gain, visibil ity I believe was the term the Federal Government wanted for their input dol lars, one of the Min ister's of Finance at the time suggested that perhaps the way for the Federal Government to gain visibil ity for their dolla rs spent would be to take over the responsibi lity for the Health Care system in Canada and for the provinces to assume complete control over the Educational sys­ tem.

The sugge stion being that the Federal Govern­ ment would have total control over Health, the prov­ inces wou ld have total control over Education. I'm wondering if the Mi nister has had that suggestion made to him, Mr. Chairman, at all in any of the discus­ sions he's had with his colleagues in the Health field? MR. DESJARDINS: No, Mr. Chairman, this is the first time I' ve heard that.

I must say that I' ve only had one meeting so far, a very shor t meeting to be specific, that was with the Mi nister of Health of the three west­ ern provinces, in fact, one of them was replacing the Mini ster of Health, he was Acting Min ister of Health, so there was no discussion. My first exposure to the Min isters of Health of all Canada and the Federal Mini ster will be later on this month when we have our ann ual meeting in Ottawa. I think we'd have to think on that for awhile.

If they want visibil ity, if they want to financ e it, we could give them all the credit but I think that, off the top of my head, as I say, this is something new that we'd want to look at. I think that we have to not really surrender these responsibilities, certainly not at this time. I think that the province has the responsibi lity to del iver the service. One thing that I would suggest to the Minis­ ter, though, if they want to do something with Medi­ care, in some of these areas I think they have to do a little bit more of the fundi ng.

I don' t think the arran­ gements that we have now, block funding, they can say: "Here, there's no strings attached," and then come and want to start bringing in all kinds of legis la­ tion to prevent opting out and those kind s of things . I think that is the responsibi lity of the provinces. I per­ sonally would li ke to see us go back on cost-sharing on this, at least we would kn ow that they would pay for this. I think that over the years we will have to pay more than 50 percent of the cost even if we allocate a certain amoun t of money that comes from the feds, what is considered our fair part.

Another think that I'm very, very concerned about is that they're going to stay with Med icare. There is no way that Man itoba can compete with other provinces, that we could talk about parity with other provinces, that is not a responsible statement to make. I think that we would be fooling the medical profession and anybody else if we felt that, yes, we can talk about parity with other jurisdictions, other provinces, that just can't be done.

I personally have no objection if the medical profession would be the best paid profession in Man itoba, providing they realize they're Man ito­ bans, providing the state of the economy reflects on any settlement that we make with them also and pro­ viding that we don't give it all to one group. They could be right at the top and I think that probably they should but that is another problem.

Now, if this allowed to go on, they're all owed the settlement I am told they're going to have in Ont ario, the settlement that they had in B.C., for instance, if that's going to go on and if they're going to go ahead and leapfrog one province and then the other, if they're going to keep on like that, I don't think it's humanly possible for Man itoba to compete and I think then, if there's going to be any danger to Medicare, for instan ce - and I guess we could say to a degree all the health field - but I think we'll have to go along and the Federal Government will have to look at some of the recommendations of the Hall Commis sion.

It might be that they might to pay the balance for some of the provinces that are have-not provinces. I expect to bring this up when we meet with the Federal Mi nister because there is no way that we can compete forever and ever with other provinces and have parity with other provinces. I can't see Man itoba doing that at all. So if that is the only way to go un less there's some kind of a guideline or some formula, I think that the Federal Government will have to assist the have-not provinces or we're going to lose Medic are in our provinces. 2135 MR. CHAIRMAN: The Memb er for Turtle Mount ain. MR. RANSOM: Mr.

Chairman, this arose in an infor­ mal discussion. I guess it would n't be proper for me to suggest the names of those Min isters that had put this idea forward and discussed it. But it did arise out of the charges that had been made about the diversion of health care funds and diversion of education fund s and possible cutbacks, at the same time the controls that the Federal Government was going to put in place and there was talk of lack of visibil ity at the time.

I think it was put forward in quite a serious way intend ing that perhaps this might bethe way to get the national standards and give the Federal Government the visibil ity and the provinces, of course, see the advantage of retaining control over education. It was felt if they retained control over education that they didn't care. These are Min isters of Fina nce speaking, I must reiterate again, that they didn't care too much who had responsibi lity for del ivering the health care system. Just something the Mi nister may encou nter in meetings with his colle agues. Just one thing, I wonder perhaps, Mr.

Chairman, if

the Minis ter happens to kn ow offhand approximately what percentage of the overall funding for health care would be provinc ial and what percentage would be federal in the province now? MR. DESJARDINS: Mr . Chairman, with this new fed­ eral budget and the negotiati ng that's been going on between the different provinces and between our Min­ ister of Finance I must admit that I don' t know where we're at. I kn ow what I'm asking for. I can inform the mem bers that the Minis ter of Fina nce should be fol­ lowing me - not tonigh t - but he's the next one if I finish tonigh t.

I think those questions -(I nter­ jection)- I don't know but he should kno w more than I do because I haven't the faintest idea to be honest with you. Now this other concern to get back on that. I see the responsibility of the Federal Government, I lik e to see a strong central government.

I think certain programs lik e Medic are and health care and education, I think the Federal Government has to be involved in the financing, not necessarily that they have to have this high visibil ity that they have to run it, I think that we'd have to be very careful because I think the Constitu­ tion will have to be chan ged again because we're going to lose certain rights that we have now. But I think the responsibil ity when they have pro­ grams like that is to have a minimum of what they want every Canadian to have.

I don't think we have to go to the maximum with the Federal Government and all our neighbour s in other provinces that might be more well off than we are have to pay for all that. But, I think there has to be a kind of a concensus of at least a minimum that will be sponsored and that should be by the taxpayers of Canada, I would think because that's the name of the game. That's why you have a countr y. Now, if any provinces want to have an enr ichment or other programs well, that would be up to these provinces and I think that's the best way to go.

But if there's a un iversal program I think that it is the responsibility of the Canadian Government to make sure that the minimum can be supported financially by the provinces. If that is not the case they have to make a contribution to the have-not provinces so that at least all Canadians will be assured of at least a certain standard of care. If the richer provinces want to enrich it, that's their business. MR. CHAIRMAN: The Hono urable Mem ber for Por­ tage la Prairie. MR. HYDE: Thank you, Mr. Chairman, I'd like to ask a question to the Min ister in regard to the Dental Health Plan for the students.

I'm sorry that I wasn't able to be in attendance when you discussed your Estimates on that particular program. However, I believe, Mr. Min ister, you are in receipt of a letter from the Portage Divisional Board request­ ing from you that consider ation be given to them and including them in the dental plan for that school divi­ sion as soon as possible. It had been brought to my attention by the school board where they feel that we do in the Portage area have ample dentists to handle that demand on that program.

They have asked me to speak to you and see whether you would give it your consideration as soon as possible. 1982 MR. DESJARDINS: Wel l, Mr . Chairman, I think the member knows that the aim that we have is as soon as possible all the province will be covered. Now, of course, the same representations are made pretty well by all areas where the dental program is not in force. I think the first priority, I had announced when we discussed the dental program in the department, that the first priority will be not to go back.

In other words, certain school divisions are covered and the intention is to go from kinde rgarten to about 18 at the end of the school age. We don' t intend to stop at 14 to start somebody else. Now those that we started at six are approximately 14 now and we intend to carry on until they're 18 ; not necessarily go lower; not necessarily to go to kin dergarten at this time, but at least we start at six and the following year we take six and seven - these people are seven now - as they go along we want to cover them until they're finis hed.

Now, I had announ ced, in fact, I'm meeting with the Dental Association tomorrow, we're discussing a plan. I gave some in dication of what we wanted to do; that I would hope that it would be a mixed plan. This is quite a lengthy explanation. I sugge st that the hon­ ourable friend should look at Hans ard because that was covered. I didn't announc e all the details of the program because I want the fle xibil ity and I'm devel­ oping that and the staff are dev eloping that with the Dental Association. We hope to develop with them. So far the relationship and the co-operation has been very good. MR.

HYDE: I wonder, could you ind icate to the Ho use, Mr . Min ister, your long-range plan? Are you going to be dealing with the divisions in the South as wel l as the ones to the North? I'm of the opin ion that so far you are mainly serving the areas to the Northern part of our province. I'm wondering if you're going to expand that and give consideration to the Southern portion of the province as well. 2136 MR. DESJARDINS: There's two programs we've had to beef up the service in the North where there was nothing at all.

But if you're tal king about the Dental Program for the childr en, there's no coverage in the North as such. I don't think there's much point in tal king about where we're at; what we're covering. The intention is that we cover the whole of Manit oba. Everybody from kind ergarten to high school, to 18 or so. Then, we're discussing with the dental profession also the assistance under a form of pharmacare to dentur es and necessarily dental work for the senior citizens in this province.

Now, this is not all going to be done in one year, this is done graduall y as we could afford it as the planning and depending on the pro­ gram that we develop with the dental association. MR. HYDE: Mr. Mi nister, I notice in the list that I have got here where Pine Creek School Division, well that's our adjoining school division to the Portage division and it would be very nice if you could see fit to take and broaden that program to include the Portage School Division. MR. SHERMAN: Mr. Chairman, I don't intend to be

Monday, 3 May, 1982 very long on the Min ister's Salary, I think that most things that should be and would have been discussed under the Min ister's Salary have been covered under the process of examination that we have given to his Estimates in general, I think that has been good.

I appreciate the Min ister's responses and co-operation, I certainly wish the Mi nister and the Department of Health and the Man itoba Health Services Comm is­ sion well as they embark on their role for the next few years of meeting the responsibilities of the province and of their offices where the emerging and evolving Health needs and changing Health realities and requirements of Man itobans are concerned. I just wanted to take a very few min utes, Mr.

Chair­ man, to conclude by suggesting to the Min ister, once again, that probably the most important challeng e that we all face in the Health field is reform of the system. I've talked in the past about requirements that I think are needed with respect to Medicare and I have said in the course of those comm ents that in order to reinforce Medicare we've got to reform the hospital system. If one examines the situation, Mr .

Chairman, I think one fairly has to observe that since the Hospital In surance and Diagno stic Services Act became a part of our Canadian way of life and our Canadian Statutes in 19 58, in other words, since universal hospitaliza­ tion came into existence in 19 58, there have been no signi ficant changes to the hospital system in this country. The same dynamic s that were in place in 19 60, two years after un iversal hospitalization, are in place today and they are, in their own way, grinding every government down and grinding every Health Mini ster down and they're also grinding Medicare down.

I believe that to get at the improvement and streng­ thening of Medicare and the system in general the Min ister and his colleagues across the country, and all connected with and interested in the system, have to undertake reform of the hospital system. I pointed out the other day that approximately 30 cents of every dollar that government spends is spent on health care and of that 30 cents 18 of it goes on the hospital system. I think, Mr. Chairman, that we have to intro­ duce measures that are going to bring productivity into the hospital system.

I kno w that that's very diffi­ cult to do under a universally insured system where government really is the piper; where government really is the person paying the bil ls; where there really is only one paymaster and that is the taxpayer by way of his or her government. I'm not convinced that peo­ ple of imagina tion and effort cannot achieve produc­ tivity if they try, even under a system like that, even under a state-supported universall y-insured system.

I think if the right kin d of commitment is brought to the table , and I mean the table in the larger sense, that we can discover and uncover among our respective thoughts as we trade them with each other some methods for bringing productivity to the system. At the present time the hospital system is run by what I would call defensive management, it's certainly reactive management. I'm not blaming hospital admin istrators for that, that's the way the system is.

What we need in the hospital system is creative man­ agement, we need incentives for administrators, health care managers, to improve their product performance and their productivity. I think that there are possibly a dozen or more initiatives that could be taken to inject that kind of clima te, that kind of envir onm ent into the hospital system, but if we start looking at a dozen or 15 we will be discou raged from even embarking on the job. I think that we should begin by looking just at one or two and getting the process under way.

I think one of the things that could be done and should be done is that governments should very seriously look at three-year planning horizons. I know the Min ister is talking about long-r ange planning and certainly in his Capital program he refers to a five­ year plan and that's all well and good but I think in the hospital system we have to start look ing at three and four-year planning horizons. You can't look at ten­ year horizons obviously, ten years is too long. Further to that no government could make a commi tment for ten years.

Even five years is difficult but there is no reason why hospital budgets should forevermore be locked into the one-year planning horizons. I did it and my predecessors have done it and my colle agues of the day did it, that doesn't make it right; that's because that's the way it's always been. The Treasury Board calle d for it to be longer and I think that the reality today is that Health Min isters all across the country should be looking at a much longer hospital budgeting horizon than one year.

I kn ow that that's difficult but I think we have to strive for that because that's the only way we're going to inject imagina tion and in itiative and ideas and enthus iasm into the man­ agement component of the hospital system. If the hospital adminis trator or health care manager simply has to work on that one-year budget and if he knows that if he comes in under budget his base is lik ely to be reduced the next year then there simply is no incentive for developing new methods, for improv­ ing productivity.

I think we have to reach a point -a nd if the Mini ster does it he won't get any argument from me - where we say to hospital adminis trators that if you come in under budget you can retain your surplus and apply it to initiatives that you would like to pursue and you won't be penalized next year, your base won't be reduced, that as a very minimum over a three-year period planning horizon will guarantee you that your base each year will increase by the inflation factor whatever it might be. That is a very minimum.

It might even be possible to increase it beyond that but as a very minimum you will get your existing base plus the inflation factor, you won't be cut back. Now let's see what you can do over the next three years in improv­ ing productivity.

I think we have to come to that and notwithstanding the difficult ies that an elected Mi nis­ ter of the day faces in terms of the revenues for that year, in terms of what his Mi nister of Finance says to him that year, in terms of what his Treasury Board says to him that year, his col leagues have got to rec­ ogn ize that this is the only way that he can inject productivity and realism and efficiency into the hospi­ tal managemen t system.

I think that's one thing we should be looking at. 2137 The second thing that I would like to recommend is a system of what is known as util ization review and I think I referred to this in other comm ents to the Mi nis­ ter or other material that I have passed on to him. Un der that technique physicians, doctors, the medi­ cal staff of hospitals, doctors who practice and have admitting privile ges at a particular hospital review the

Monday, 3 May, 1982 work of themselves and their peers insofar as the use of health care resources is concerned. You kn ow. the Ame rican Surgeons Association did a survey a couple of years ago on hospital costs in the Un ited States and they candidly expressed in the results of that survey that the doctor gener ates 70 percent of medical costs and hospital costs and health care costs in the country -t he doctor generates 70 percent of the health bill.

Now. that is so. because the doctor makes the three key decisions in health care: admission. the resources and techniq ues and technologi cal services that are going to be used by and for that patient, and discharge. Sinc e he or she. the doctor. makes those three key decisions, he obviously plays the most fundamen tal role in deter­ mining what hospital costs and health care costs are going to be. The technique of utilization review calls for a review among one's own peers of the decisions made in terms of admission, use of resources and discharge, where patients in the hospital are concerned.

It mi ght not provide any miracle solutions. but it certainly would bring the medical profession and the medical staff into direct in volvement with the decision-making processes of health care admin istra­ tion and I think that would have two beneficial results: 1. It would. I think, provide the opportunity for this productivity improvement and creative man­ agement that I'm tal king about; 2. It would involve the doctors in health decision-making in a way that would be very beneficial to their morale, and might offset some of the unhappiness and disenchantment they feel about the Medicare system in general.

I must suggest to the Mi nister that. I think, all of us have to be looking at these things and many more. There are many other things that have to be done to reform the hospital system. The point is we've got to get started. and the point is no thing really has been done that I kn ow of. of a sign ificant nature in this direction sinc e un iversal hospitalization came into the country. We've had it for 24 years now and it's still going down the same track, in the same direction, and it's just genera ting more vol ume. more pressure and entren ching itself deeper and deeper in its conven­ tional format.

We've got to break it out of that format and ach ieve moderni zation of it. If we do that we will then be able to reinforce the whole system including Medicare. This Mini ster isn't going to be able to do that overnight; no Min ister is going to be able to do it overnight. We could do it by 19 95 if we all worked at it. So, my concluding remarks, Mr.

Chairman, would be in that vein; that I wish the Mini ster well and I congratulate him on the position that he occupies and on the staff that he has around him and I urge him to look at undertaking some bold initiatives that may cause him some problems for a year; that may cause him to be the target of some criticism for a year or two, but in the end if he achieves them he will be proven right because the system is in a condition and the economy of the country is in a condition today where, if we don' t undertake that sort of thing the whole health care system. hospitalization system and Medi­ care system is under siege.

Mr. Chairman. I would ask the Mini ster to ponder on those things and if he concl udes that there are some initiatives of that kind that he can undertake I can guarantee him that they will be addressed in a non­ partisan way by me. MR. DESJARDINS: Mr. Chairman. I accept the advice and the statement of the mem ber, the way they were given I'm sure. I might be a little less of a pessimist than he is. I seemed to detect in his address in the Hous e last Friday and today. that there is quite a bit of pent-up frustration.

I agree with him that there is diffi­ culty; I agree that we have to look at the situation; I agree that we should not be afraid to make chang e, that we should n't feel that we're locked in but it's going to be. as he knows, I think that he stated that it would n't be easy and I think that's an understatement. But I don't think things are really that bad. 2138 I think, f