2000 Legislative Session: 4th Session, 36th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, MAY 18, 2000

Afternoon Sitting

Volume 19, Number 21

[ Page 15825 ]

The House met at 2:07 p.m.

Hon. J. Kwan: There are a number of visitors and guests today in the gallery. First I'd like to introduce a group called the Circle of Hope. They are folks who are here trying to raise awareness and who I met with earlier today to talk about the substance misuse issue. With the Circle of Hope is also a group called From Grief to Action. They are part of the coalition, but of course, they're also a separate entity on their own as well.

These individuals are Jim Leyden, the co-chair of the Circle of Hope; Rob Ruttan from From Grief to Action; Keith Guertin of the Quality Recovery Society; Bill Blair, a Circle of Hope supporter; Garvey Soosay, a Circle of Hope supporter; and Pauline Johnson, who's also a supporter of the Circle of Hope, along with Conor Mervyn, Cathy Golding and Rhonda Roben. There are others as well; some of them came in at a later time and I did not get a chance to catch their names. If I've missed any of them, my greatest apologies. Would the House please make this delegation of people welcome.

I. Chong: Today at the noonhour, all members of the Legislature were hosted at a luncheon by the Certified General Accountants Association. They've done this for a number of years, and we're very grateful for them doing that. They provided us with an interesting presentation.

From the association, we have some representatives that are here. I would like the House to welcome the following people: Mr. Ted Friesen, FCGA, president of CGA-BC; Bill Caulfield, executive director of CGA-BC; and Edward Downing, director of communications and public relations, CGA-BC. I would ask the whole House to make them very welcome.

Hon. P. Ramsey: Joining members of the press gallery in the Legislature today is Mr. David Twiston Davies. He's with The Daily Telegraph, London. He's in our province for a few days, giving him a chance to compare how parliamentarians act in this House compared to Westminster and, I suspect, how the media report on their activities. Would the House please make him welcome.

C. Clark: I'm delighted to be able to introduce today representatives from the district 43 school board in the Tri-Cities area. They have finally got a long-sought-after meeting with the Minister of Education, so congratulations to them on that.

I'd also like to introduce Mr. and Mrs. Ulrich, who are the owners of Cherry Point Vineyards in Cobble Hill on the Island. I hope the House will make them welcome as well.

[1410]

Hon. I. Waddell: We have in the gallery today my uncle and aunt, Robert Gardiner Dickie and Evelyn Dickie from Toronto. Robert is very active with the machinist retirees in Ontario and the Ontario Federation of Union Retirees. Both Bob and Evelyn are great dancers, which unfortunately their nephew has not quite mastered. I ask the House to make them very welcome here today.

G. Farrell-Collins: There are two people visiting us in the House today. One has also come all the way from the United Kingdom. His name is Alex Folkes, and we met this morning. He's an activist with the Liberal Democrat Party in the United Kingdom, and he's here talking about electoral reform. With him is Julian West, who is a member of the Green Party. I'd ask the House to make them welcome.

J. Cashore: In addition to the member for Port Moody-Burnaby Mountain, the member for Port Coquitlam -- the Minister of Health -- and I would like to introduce the members of the delegation from district 43 who met with the Minister of Education today. They are Barb Hobson, chairperson; Keith Watkins, vice-chair; additional trustees John Keryluk and Judy Shirra; as well, representatives of partner groups, Teresa Grandinetti, John Simpson, Brenda Dane, Diana Dilworth and Colleen Dane. Would the House please make them feel very welcome.

L. Stephens: Also in the House today, visiting from the Campbell Valley Women's Centre in Langley, are Dr. Carl Stroh, Terri-Lee Seeley and a graduate from that program, Erin. Would the House please make them very welcome.

Hon. G. Mann Brewin: I have a couple of introductions and welcomes. I would first like to add my words of welcome to guests from the Circle of Hope Coalition and the From Grief to Action group, as well as the group from Campbell Valley. I was very pleased to meet with the Campbell Valley group this morning. It was a good meeting, and I think we heard each other very well -- more anon on that one.

In the gallery today, as well, is a chap named John LeRoy, father of Sean LeRoy, who is one of our legislative interns. Sean has been working in my constituency office as well as doing great work for the caucus in the Legislature. Would the House please make Sean's father John LeRoy welcome.

F. Randall: In the visitors gallery this afternoon is Margaret Koster. She's a constituent of Burnaby-Edmonds and is on the Seniors Advisory Council of the Simon Fraser health region. Margaret is also on the accreditation team for continuing care, and she is certainly very active in the constituency of Burnaby-Edmonds. With Margaret today are daughters Judy Ostling and Margaret Hangartner. She also has her brother Eric Pettman with her, who she has not seen for about 40 years. Eric is from Lindisfarne, Tasmania, and he is a civil engineer and an expert on tunnels. Would the House please make them all very welcome.

Oral Questions

CONDITION OF PROPERTY

OWNED BY PREMIER

M. de Jong: Just when I thought things couldn't get any more bizarre, I wake up, I read the morning paper, and I read Surrey councillor Dianne Watts's comments describing how the Premier of B.C. is a slumlord.

The Speaker: Will the member take his seat, please.

The member may wish to rephrase his question.

M. de Jong: If I rephrase the question, if that's appropriate, Mr. Speaker . . . . The

article I'm referring to describes the Premier as the owner of a house that neighbours have

[ Page 15826 ]

described as a rundown disaster -- numerous complaints to the city. There was a marijuana grow operation bust. Last year the bylaw inspectors had to move in, apparently to stop the illegal sale of rats. If that's not the description of a slumlord situation, maybe I could ask the Premier what his description of that is.

[1415]

Interjections.

The Speaker: Members, order, please.

The question is out of order. It does not relate to the ministerial responsibilities of the Premier.

The member for Matsqui has a new question?

M. de Jong: I do have a new question. Imagine the howls of outrage that we would be hearing from those pious, sanctimonious, self-righteous members of the NDP if a member of this opposition were conducting themselves in this way. Imagine that. Imagine the Premier . . . .

Interjections.

The Speaker: Will the member take his seat, please.

I recognize the Government House Leader on a point of order.

Point of Order

Hon. D. Lovick: The previous question was ruled out of order. Demonstrably, the member is coming at precisely the same issue to ask the same question, which will also be out of order. I suggest he be stopped from that rather disgusting and very questionable behaviour.

Interjections.

The Speaker: Order, members. The members will pay attention to the rules in regard to parliamentary language in this chamber.

M. de Jong: Here are the facts. The Premier is sitting on land worth, apparently, $750,000, and while he waits to develop it, he is behaving no better than the slum landlords his colleagues and he take great delight in criticizing day in, day out, Mr. Speaker. His excuse is: "Oh, it's my property manager's fault. Talk to my property manager." My question for the Premier is: when is he going to begin to accept responsibility for his own actions instead of assigning blame to everyone else?

The Speaker: Members, the question does not relate to the minister's responsibilities. If the member for Matsqui has a new question on a different topic, I will recognize him.

M. de Jong: Absolutely, Mr. Speaker -- a new question.

Will the Premier confirm this? Amar Bains, the individual identified by him as his property manager, is in fact not some individual he hired at arm's length; it's his business partner.

The Speaker: Excuse me, member. Would the member take his seat, please.

M. de Jong: Mr. Bains is his business . . . .

Interjections.

The Speaker: Order! Order!

Members, the Chair would suggest that if this is going to be a productive question period, we will have a question on a different topic from another member.

G. Plant: I have a question with respect to the administration of the Residential Tenancy Act. I have heard from ministers responsible for the administration of that act -- including the current minister responsible and the former minister, now the Premier -- that there are concerns that the government takes into account from time to time with respect to the conduct of landlords in the province of British Columbia. That is the basis, apparently, upon which they occasionally consider whether or not government policy in that area is adequate.

I have a question for the Premier. If he can't conduct himself like a proper landlord, how can he expect to be in a position to make public policy for the rest of the landlords in British Columbia?

The Speaker: If members continue to show disrespect for rulings from the Chair, we will not continue this question period.

Interjections.

The Speaker: I caution the member. I have made a decision in this matter. I would ask for a question on a different topic.

G. Plant: I am interested in the government's position with respect to the adequacy of the protection available in the Residential Tenancy Act of British Columbia for the conduct of landlords in this province. I know the issue is under review by the government. The government has been presented very recently with evidence that suggests to me that there are reasons they should look in-house with respect to the conduct of landlords in British Columbia. What is the government's position on this issue?

[1420]

Hon. A. Petter: I don't think the member is fooling anyone. We had an extensive debate in estimates on residential tenancies and other matters, as the member well knows. To try to use this as a cute way of trying to raise inappropriate questions and trying to breach the rules of this House is something that I think the public can well see through, hon. Speaker.

Interjections.

The Speaker: Order, members.

DIESEL FUEL SPILL IN BURNABY

J. Weisgerber: My question is for the Minister of Environment. Several weeks ago I advised the minister of actions taken by the state of California and by U.S. President

[ Page 15827 ]

Bill Clinton with respect to a ban on the gasoline additive MTBE, a known human carcinogen. There are reports today of a massive MTBE diesel fuel spill at the Chevron refinery in the minister's back yard, in Burnaby. What steps has the ministry taken to protect groundwater and surface water from serious and lasting contamination as a result of this particular MTBE spill?

Hon. J. Sawicki: I certainly, as I've said previously, share the member's concern about MTBE. My ministerial staff were out at the site immediately, along with the Burnaby fire department, to contain that spill.

I would add, as I have said before in this House, that there is only about 10 percent of the gasoline in British Columbia that contains MTBE. It is being phased out, and it will be gone. I certainly agree with the member that the sooner it is out of our gasoline, the healthier our groundwater will be. I would just add that I am pleased to hear the member reiterate that he is concerned about groundwater protection.

The Speaker: The member for Peace River South has a supplemental question.

J. Weisgerber: For the first time that I'm aware, MTBE is being added to diesel fuel. I don't know if the minister has been aware of that. We do know that a cupful of MTBE will pollute 13 million gallons of water. A major spill could do irreversible damage both to groundwater and to fish habitat.

Can the minister advise how many cups -- or how many litres -- of MTBE were involved in the spill in Burnaby? And will the minister commit today to some definitive action to protect B.C. water, both groundwater and surface water, against further contamination by MTBE?

Hon. J. Sawicki: Hon. Speaker, it was this member and his party who campaigned against groundwater protection.

Interjection.

Hon. J. Sawicki: It certainly was the hon. member's former party. The hon. member, in the past, did not understand the need to have groundwater protection when we this in House had been working very hard to do that.

I can only repeat what I have answered for the hon. member on this issue before: I agree with him. MTBE is not something we want in our gasoline. Our ministry is working hard on this issue. This government is taking initiatives to promote ethanol production as an alternative to MTBE in our gasoline. All across North America, it is already on its way out, and I would welcome the day, along with the member, when it is gone.

ADDICTION PREVENTION

AND TREATMENT SERVICES FOR CHILDREN

L. Stephens: Today in the gallery are Rob and Susie Ruttan, members of the organization From Grief to Action. Their son was put on a five-month waiting list for drug addiction services. When he finally got to the top of the list, he was told that his problem was too severe to be handled in British Columbia and that he would have to go to Ontario for treatment. Why is there no help for youth in British Columbia, and why must they go to another province for long-term residential drug treatment? And minister, don't tell me about the $9 million being spent on therapeutic foster care homes, because that is a different issue.

[1425]

Hon. G. Mann Brewin: I thank the member for the question, and I appreciated this morning's meeting. We in British Columbia provide a range of services, including at-home detox, residential care, out-patient services, day programs and supported recovery options for more than 40,000 British Columbians. And I will say: this government has invested $9.25 million just for youth and child addiction services, including the opening of 75 more beds from Victoria to Fort St. John.

That $9.25 million investment includes 17 youth detox beds, for $4 million; 16 youth residential services beds; 42 youth residential detox-treatment services beds; intensive day-treatment programming; and family and youth counsellors. There is, further, $2.18 million for youth justice addiction services and $3 million in capital funding. That will provide for youth in British Columbia 117 beds -- a 79 percent increase from one year ago.

The Speaker: The hon. member for Langley has a supplemental question.

L. Stephens: Many parents in this province know that those services aren't there. Regardless of what the minister is saying, the services are simply not there.

After seven months of treatment in Ontario, the Ruttans' son is back in British Columbia, and he needs more treatment; he's had a relapse. But the ministry is still not funding long-term intensive residential treatment programs. There are programs like Campbell Valley Women's Centre . . . . Those are not there; regardless of what the minister says, those kinds of programs are not there. Kids still have to go to Ontario or Alberta or the United States. What is the minister going to do, and what is she going to do for the Ruttan family and all of the other families in British Columbia who believe that your government has let them down?

Hon. G. Mann Brewin: I will pass out to anyone who wants a copy the information that I just provided. The commitment is there for the drug and alcohol addictions services that are there in this community. I want to know, Mr. Speaker, just how the opposition would have dealt with this, when they said to the business community: "We are going to cut 5 percent out of these budgets."

USER FEE INCREASE

FOR KAYAK BUSINESSES

G. Robertson: I have a growing number of sea kayaking tour operators within my constituency. They are concerned that BCAL staff are talking about raising the annual rental fees on camping sites from $500 to $2,000 a year, and possibly even making that retroactive. Does the minister for BCAL want this industry to grow? And what is he going to do about my constituents' concerns?

Hon. C. Evans: Congratulations to the member for asking a real question in defence of his constituents. Now, it is true that BCAL was going to raise the fees of the sea kayaking industry. But the Premier said to me: "I want you to use BCAL for community economic development. Rather than getting in

[ Page 15828 ]

the people's way, make it work." And the hon. member said to me: "These people are making jobs in my constituency, so see if you can fix it."

So I met with the hon. member's constituents last week. I said that there will be no increase in fees or regulations this year. And more than that, because the Premier said, "Make community economic development work," and the member wants to make it work in his constituency, I told the sea kayak industry that I'd meet them this fall in Alert Bay, and the member and I will solve the problems.

[1430]

The Speaker: The bell ends question period.

Interjections.

The Speaker: Order, members.

GOVERNMENT HANDLING OF

WHISTLE-BLOWER ISSUES

Hon. A. Petter: I rise to respond to a question I took on notice a few days ago from the member for Matsqui.

The member alleged that staff at the Fraser Regional Correctional Centre have been disciplined for revealing wrongdoing. This is categorically not the case. The issue to which the member refers had nothing to do with whistle-blowing; it had to do with allegations of inappropriate behaviour on the part of those disciplined.

I'm constrained from commenting in further detail because the matter is still subject to an ongoing grievance and arbitration process, but let me say this. There were two independent investigations in 1997 at the FRCC prior to the airing of the "Fifth Estate" report regarding illegal drug activity by staff, abuse of inmates and harassment -- one by retired Vancouver police chief Bob Stewart; another by the investigation, inspection and standards office.

These investigation reports were publicly released on December 15, 1997, and neither report substantiated any allegations of wrongdoing. In fact, they concluded that the majority of staff were managing a difficult and complex inmate population in a professional and appropriate manner.

I may say also that the ministry strongly encourages staff with knowledge of any illegal activities to come forward. If the member would like a further briefing so he can avoid using these kinds of issues to grandstand in the House, I'd be happy to provide those to him.

Petitions

Hon. J. Kwan: I have the honour to table two petitions. The first petition is from the Circle of Hope Coalition Society. It has over 900 signatures calling attention to the need for additional detox centres and supportive recovery service programs that are essential to people who are seeking treatment for addiction.

The Circle of Hope petitioners call upon all levels of government to work cooperatively to provide treatment on demand and further call upon the government to facilitate decentralized delivery of ethical services within British Columbia communities.

I know that the members across the way will be happy to work on this issue in a non-partisan way, as the people from the Circle of Hope and the From Grief to Action folks have said to me as well. We on this side of the House would like to do that.

The second petition that I'm tabling has been signed by almost 200 people who are also Circle of Hope members, but they are residents of the Fraser Valley specifically. They're calling for detox services in that region more specifically.

Tabling Documents

Hon. G. Wilson: I have the pleasure to table the annual reports of the Ministry of Employment and Investment for the years 1998-99.

Orders of the Day

Hon. D. Lovick: I call Committee of Supply. In Committee A we shall continue to debate the estimates of the Ministry of Advanced Education, Training and Technology and Ministry Responsible for Youth. In Committee B, in this chamber, we shall continue to debate the estimates of the Ministry of Health.

[1435]

The House in Committee of Supply B; T. Stevenson in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 36: ministry operations $8,125,203,000 (continued).

C. Hansen: Before we adjourned for lunch break, we were discussing issues surrounding nursing education and nursing supply. I want to move on to some of the more general areas of labour force issues other than nurses, which I think have the potential in many cases to be at least as serious and critical for health care in British Columbia as the nursing situation has become. In September of last year the former Minister of Health announced that there was a federal-provincial initiative for a chair that was to be an advisory committee on health human resources that British Columbia was going to chair.

In fact, I believe it's being chaired by the B.C. deputy minister. I am wondering if the minister could advise us what progress has been made in the work of this committee to date.

Hon. M. Farnworth: The committee is indeed up and running. It is working on two strategies. One is a national nursing strategy; the other is a primary care reform strategy. The work is proceeding. In fact, it's proceeding quite rapidly.

C. Hansen: In terms of the professions, what differing professions are being considered by that committee? What's the scope of its work?

[1440]

Hon. M. Farnworth: Well, clearly the nursing strategy is dealing with nurses in terms of the primary care reform

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strategy. It's dealing with a full spectrum of occupations involved in there -- physicians, nurses, psychiatrists, psychologists and the whole range of people involved in the delivery of primary care.

C. Hansen: We have started to hear increasing alarm bells going off with regard to doctors in British Columbia, particularly in some specialty areas. I'm wondering if the minister could tell us, in view of the action that has been taken with regard to increasing training spaces for nurses in British Columbia, whether or not this government is going to deal with the physician supply issue and the physician training issue in a timely fashion, rather than waiting until the crisis gets even worse than it is today.

Hon. M. Farnworth: That is a very good point, and it's one that we have mentioned a number of times over the past few days. In fact, I've been talking about it publicly since assuming this post. I am concerned about the issues around physician supply. We have to start working on those now. We have to start interministerially, with this ministry and Advanced Education, in terms of addressing those issues. That's one of the priorities I'm attaching . . . with the ministry -- that we have to start to address not just physicians but a whole range of specialties and technicians as well.

We also need to do that in concert with other provinces. This is one of those areas, in terms of human resources, that we want to address in our discussions with the federal government -- how we train more people here in Canada. That, to me, is the ultimate solution to the challenges that we face in the coming decades. We have to train more people here. As far as I'm concerned, that's one of the key areas that I intend to be working on.

C. Hansen: Certainly I'm glad to hear the minister say those words, but what we're interested in is what to expect in terms of when we will see some action taken on that front. Currently UBC medical school has 120 spaces. In British Columbia we don't even train 50 percent of the doctors that we need in this province. We rely on our ability to import doctors who have been trained in other jurisdictions.

There are two things wrong with that. One is that doctors trained in other jurisdictions are going to be increasingly difficult for us to attract to British Columbia. The second issue, which is equally as important, is that these health care professions are good jobs, good-paying jobs. I think we owe it to our own youth in British Columbia that those opportunities for training are there, so that they can meet the health care needs of British Columbia in the future.

I would like to know from the minister if we can expect an increase in the number of training spaces at the UBC med school within the next year.

[J. Cashore in the chair.]

Hon. M. Farnworth: Certainly in terms of, "Is work being done within the government," yes, it is. We're starting to do the work that's required. Will it be in time to make some decisions by September of this year? I don't think so. I mean, September is just a few months away.

But certainly I want to have the work done, start to have some consensus and involve the people who are required to be involved, which is this ministry, the universities and Advanced Education, so that we can . . . . We're starting to lay the groundwork so that we're in a position that we can make decisions early next year, which can start to come to fruition very quickly.

[1445]

I attach a great deal of importance to this particular problem; I think it needs to be applied to a range of specialties as well. This fits in with one of the areas I've been talking about, in terms of the longer-term vision of what we need to do to address physician supply in this province, which comes back to . . . .

Part of the training program that takes place for health care professionals in this province is to have a focus on rural and northern areas, so that we are training, for example, physicians who are going into a program with the idea that when they are entering the program, they are going to practise in northern British Columbia or in rural communities. That's very much part of the long-term strategy that I see.

We are doing the work required. My goal is to have us in a position, sometime next year, where we can actually make some decisions that can be implemented fairly quickly.

C. Hansen: There's one very important player that I think the minister left out in describing the various bodies that would have to be consulted in the development of this program, and that's the teaching hospitals.

There is certainly a concern that the number of residency positions at the teaching hospitals has been scaled back considerably in the last couple of years and that the teaching hospitals simply aren't given the resources, or don't have the resources when they're under other cost pressures, to set up those residency programs to complete the training cycle for a physician. I'm wondering if the minister can give us any assurance that the funding will in fact be there to provide for the residency positions as this program expands.

Hon. M. Farnworth: Just in terms of the explanation, I certainly don't mean to omit the teaching hospitals. But I will also raise this for the member. I have met with the dean of medicine at the medical school at UBC, and we discussed these very issues. I've raised this with him, and I'm very encouraged by the response I got from him.

Second, in terms around funding, that's the type of work that needs to be done -- identify what costs would be, how we would go about doing it, what type of services or what type of requirements, for example, the teaching hospitals need, what is the work that has to be done within the ministries. That has to be done first so that then we can make decisions around what costs are, for example. But certainly it's my intention that we start to move so that we can do something like that and ideally make some decisions at some point next year.

C. Hansen: One last point on this subject before we move back to regional operations -- it's actually regarding nursing; this document had slipped out in my sequence of issues to deal with -- and that's the training for foreign-trained nurses who need skills upgrading in order to be registered to practise in British Columbia.

Just to read a sentence from a letter that was sent to me . . . . This individual would like to see a course for foreign nurses who are here in Canada presently, as landed immigrants or Canadian citizens, to be given at Vancouver and

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other provincial sites -- perhaps as an evening or weekend course to accommodate those who must also make a living, as well as day programs. I'm wondering if the minister has given consideration to the expansion of courses to allow trained nurses from other jurisdictions to come up to the standards that we expect for registration in British Columbia.

Hon. M. Farnworth: There are, in this year's allocation, about 28 refresher seats for ESL nurses. So that will go some way to meeting the demand for nurses who were trained outside the country. I also recognize that there needs to be work done in terms of identifying the pool of nurses here from outside of the country that may not have qualifications and finding ways of getting them qualified and into the system.

[1450]

C. Hansen: I think the point the individual was making in his letter to me is that there's a need for a variety of training. I think this applies not just to foreign-trained nurses who want to upgrade their skills but also to those nurses who are in service today in British Columbia, who are having difficulty accessing training programs to upgrade their skills. This is particularly a problem when you get outside of the lower mainland and greater Victoria area, as courses are less flexible to accommodate particularly shift work and other schedules.

If we're going to be able to meet the need that's there, there's going to be a need for far more innovation in the way that nursing training is offered for upgrade skills and in-service training. I'm wondering if the minister can give us any sense of new programs that might be coming on stream to provide that kind of opportunity for training.

Hon. M. Farnworth: This is one of those areas where we're working with Advanced Education to find ways of bringing more flexibility into the system. We're also working with HLAA to try and deal with issues around tuition, for example. There are some ways in which they can help in that regard. In terms of nurses coming into the system who have credentials in specific areas and where they may need upgrading, for example, what we try and do is see if there's a particular area where they need specific upgrading in order to try and work with a hospital to provide that particular training.

But in terms of flexibility, I think that's one of the key areas. That applies not just to nursing but to a host of training that is required by workers in all kinds of fields, not just health care. There needs to be flexibility to recognize the different shifts and the different work styles that people in fact actually have.

C. Hansen: There are many, many more issues in the whole area of human resource training. We could go through virtually a roster list of health professions and identify that each one of them is facing some challenges when it comes to having an adequate number of trained professionals available in the future. I'm certainly aware of the fact that the average age of anaesthesiologists in British Columbia is, I believe, 57 years. That's a rather scary thought, when you think of the importance of anaesthesiologists in making sure that our acute care system can function.

We start looking at the shortage of physiotherapists -- the growing shortage, when you start looking at the numbers that we're training -- and then you start realizing how important physiotherapists are to ensuring that regional hospitals can provide a very meaningful service for individuals who live close to home, instead of having to not only go through surgery, say, in the lower mainland but then also have to go through the rehab work in the lower mainland because of the shortage of physiotherapists in some of these smaller regional hospitals.

While it is an area that we could spend a lot of time on, I just urge the minister to keep that issue very high on his priority list. It's an issue that potentially has some very serious consequences for us down the road a couple of years, if we don't start taking the actions to ensure that we don't face a similar crisis to what we are facing today in terms of a nursing shortage.

With that, I want to move back to the area of regional operations. As I indicated to the minister before, I want to work through their performance plan as a convenient way of sequencing some of these issues that come up. On page 6 of the document are regional operations. We have already dealt with the issue of accountability to my satisfaction.

If we can then move on to the issue of cancer care, the key program objective, as outlined, is to address the availability and timeliness of cancer care. The performance measure is wait-time standards established and actual wait times reported for surgical oncology cancer treatment. This is an issue that I think there's been a growing concern with in the last few weeks. The minister made a comment in response to one of my colleagues, when asked a question about wait-lists for cancer treatment. He indicated in his reply that wait-lists are down to what they were two months ago.

I would say in response that that's not good enough. Two months ago those wait-lists were unacceptably long, especially for certain types of cancer treatment.

I understand that there is a shortage of oncology technicians in British Columbia. I also understand that we have been able to recruit a couple of new oncology technicians from Alberta, much to the dismay of the Alberta Ministry of Health, which the minister may hear about at his next Health ministers' meeting. But there has been some action taken to try to deal with the problem.

[1455]

My concern is not the mean wait time for cancer treatment. My concern is for those individuals who wind up on the long end of the wait time. I get letters from people virtually every day, who are facing wait times of four and eight months for cancer treatment. I think the minister would agree that is much too long and is not acceptable, even if that is the level that we were at two months ago as opposed to a month ago. I'm wondering if the minister can tell us what action is being taken to deal with those wait-lists and what options have been considered by the ministry to get those wait times down.

Hon. M. Farnworth: At the current time, while the new facilities are coming on stream, there is a system of triage which physicians administer in terms of assessing what type of treatment the patient requires. Of course the answer to deal with the issue of wait times is also dependent on the facilities that are available. Currently there are two facilities which are under construction. One is the bunker in Surrey; that's the radiation machine in Surrey. The other is the facility here in Victoria. One opens up at the end of this year; the other will open up early in the following year. That will have a dramatic impact on wait times.

B. Penner: Just two days ago, on Tuesday, I raised a matter with the Minister of Health regarding a constituent of

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mine, Mr. Joe den Bok, who had been told by his physicians that he'd have to wait up to four months before he could begin radiation therapy at the Surrey cancer clinic. Some cynical people would say . . . . Not surprisingly, exactly 24 hours after I actually raised the matter, he received a phone call from the Surrey cancer clinic asking him to come in, in early June, to receive an appointment for blood testing. Presumably the purpose of the blood testing is to see if he's ready to begin radiation therapy.

While I'm pleased for Mr. den Bok that he at least has some light at the end of the tunnel, I am concerned about the process followed by the Ministry of Health. I know that my colleague the opposition Health critic, the member for Vancouver-Quilchena, will follow up on this. I wonder if the minister could explain how that happens. Or is it just a coincidence that he got action once the matter was finally brought here to the Legislature?

Hon. M. Farnworth: It is a coincidence. In fact, when staff were looking into the background of the letter, they found out that he had already been scheduled for June 7. There is no way that we would interfere in terms of a clinical decision.

B. Penner: One question which was left unanswered from our discussion on Tuesday was: what policy or procedures does the ministry follow when people are seeking out-of-province care due to unacceptably long wait-lists in British Columbia? I know that in years gone by, quite a number of people from the Fraser Valley have received treatment in Bellingham, Washington, at the expense of the B.C. Ministry of Health. In fact, I know personally of some people in the Harrison area who had to make use of that service, because the waiting list was simply too long here in British Columbia.

Does the ministry still follow that procedure? And what are the criteria that are applied in deciding whether or not to pay private authorities in Washington State to treat patients from British Columbia for cancer?

[1500]

Hon. M. Farnworth: There was the contract a number of years ago. However, with the construction of the new facilities in British Columbia, that was discontinued. Since then, the policy is to treat people here within B.C., because we have the capacity to do that. We work with the B.C. Cancer Agency, and they have indicated to us that if it comes to the point, in their opinion -- and they are the experts on cancer -- that we don't have the capacity to treat in a timely fashion, they would notify us.

The fact, as I'd mentioned earlier on, is that we have two new facilities coming on stream this fall and early next spring, which will have a dramatic impact on wait times. So I don't see any change in that policy taking place. We don't send people out of province at this time.

B. Penner: So just to confirm, then, in the past fiscal year the province of B.C. did not pay for anyone to go to Washington State to receive cancer treatment.

Hon. M. Farnworth: That is correct. We have not. We don't send anybody out.

C. Hansen: I want to just pursue that issue of out-of-province care, because the minister said that in 1995 the decision was made to fund treatments in Washington State. I think the words that the minister just used were: "We didn't have the capacity at that time." Yet if you look at the last five months in British Columbia . . . . The minister talked about the new facilities that are coming on stream. But what has been clear in the last five months is that we have not, at this time, had the capacity. We might have it in the near future, but that hasn't helped the people on the wait-list now.

I am told that in January of this year, there were more than 700 people waiting for radiation treatment, and that that was up by more than 100 over the previous month alone. Although I haven't been able to confirm this, I'm also told that is a number considerably higher than what the wait-list was in 1995, when we did go out of province in order to allow these individuals to get the treatment that they urgently needed. I'm wondering if the minister can explain why it is that in 1995 it was felt important that these people get timely treatment out of province.

Yet here we are in the year 2000, and suddenly there seems to be a much higher threshold of tolerance before the government considers it to be important to look at out-of-province treatment.

Hon. M. Farnworth: There are a number of things that we need to realize. First off, the B.C. Cancer Agency has told us that it can cope with the current situation, that they would advise us if they can't and that we need to rethink our current policy. There's a number of changes that have taken place, which have allowed us to increase our capacity until those new facilities come on stream. We've increased the number of hours at the facility here in Victoria, for example, to 13 hours from ten hours a day. We have been able to recruit a number of technicians, which has also allowed for an increase in the number of procedures that can be performed. Those things have been put in place.

Couple that with the fact that our new facilities are coming on this fall and next spring. B.C. Cancer feels that the situation is sufficient, that the resources are sufficient and that we can cope. If they advise us otherwise, at that point we would then reconsider something else.

C. Hansen: I know the subject of prostate cancer has been raised by a couple of my colleagues. I just want to pursue a couple of issues in that regard. Tonight at 7:30 I'm going to be in Courtenay at the offices of the Comox Valley health council, at the invitation of the Comox Valley prostate cancer support group. They are organizing a public health forum. I would like to be able to take some positive messages from the minister to them, in terms of treatment for prostate cancer in British Columbia.

I would also like to take them some positive messages in terms of increased funding for PSA testing in British Columbia. I'm wondering if the minister can give me some indication that there is, in fact, some positive initiatives that will be taken by the ministry in the very near future.

[1505]

Hon. M. Farnworth: There's a number of points that I'd like to make. First, the B.C. Cancer Agency is currently reviewing its policies around PSA testing and prostate cancer, and they will be in contact with the ministry shortly, once that review has been taken. Second, as I said, there are the new cancer treatment machines coming on line this fall and next spring, which will significantly reduce wait times. Perhaps the most important issue is that British Columbia has the best

[ Page 15832 ]

prostate cancer outcomes of any province in the country. I think that speaks considerably to the work that's done in terms of cancer treatment in the province. Thirdly, around PSA testing, if a physician recommends that you need a PSA test, it's covered, and it will be done and paid for by MSP.

C. Hansen: In discussions I've had with people who are living with prostate cancer or perhaps a family member or those that are involved in some of the support groups around the province, the one subject that often comes up is the parallels between prostate cancer and breast cancer. In British Columbia there has been a lot of attention paid -- and appropriately -- to the issues around breast cancer screening mammography. There has been considerable government effort put into those programs, which are to be supported.

I note that individuals who raise concerns about prostate cancer in no way want to diminish the effort put by government into issues around breast cancer, but the parallels are drawn. In the same way that the PSA testing has all kinds of uncertainty around it -- that it does produce false positives and does produce negative results -- we have the same kind of results coming out of screening mammography programs.

I'm wondering whether or not, in developing the public policy around prostate cancer issues, whether or not the ministry consciously looks at the parallel between breast cancer and prostate cancer in terms of the consistency of government policy in these areas.

Hon. M. Farnworth: Absolutely. Of course there are parallels in a number of ways, but I think there are some key issues that need to be recognized. First, the specificity of the test as it relates to mammography and breast screening is different than the PSA test for prostate cancer. The rate of false positives is much higher in the PSA test. Also, the treatment that derives from the results of those tests is significantly different. So it's very difficult to compare the two on a straight medical basis.

Having said that, I also understand the parallels between the two forms of cancer and how they . . . . If you're a woman, you fear that cancer most, and if you're a man, it's the same thing: you fear prostate cancer the most. I think what's happened is that for a long time there has been considerable awareness in the public around the issue of breast cancer that has highlighted that in terms of research and the focus on it and has engendered considerable discussion amongst the public around breast cancer and breast cancer awareness -- the importance of examinations and those sorts of things.

Historically we haven't seen that around prostate cancer in this province or this country. It's only in the last few years that you've really seen attention and focus and awareness around public debate on prostate cancer. I expect that the focus and research -- and we're already starting to see that -- are also now coming in terms of prostate cancer. We've seen the $20 million donation from Jimmy Pattison, which received a great deal of public . . . . And I think it has done a lot to raise awareness around the issue.

I also think it's safe to say that when there is a screening test that is reliable and that people know is accurate, so that you're not unduly alarming people who may receive a false-positive test and are putting them on a treatment program that can have serious consequences, it will be adopted as quickly as we can.

[1510]

C. Hansen: I guess the concern is what appears to be an inconsistency in approach. If you look at screening mammography and if you look at cervical cancer screening, those also produce false positives. Yet that does not seem to be an impediment for those programs to move forward. There seems to be an inconsistency when it comes to the approach to prostate cancer. There are false positives that come out of PSA testing, and that comes up as a reason why we don't move forward in this particular area. I'm just wondering if the minister can square the seeming inconsistency in that?

Hon. M. Farnworth: I understand the concern, and I understand the frustration that people may have. I certainly understand the perception, but there is a considerable clinical difference in terms of the outcomes between the two tests -- between mammography screening or screening for cervical cancer. The procedures that are used are much more accurate at this point in time than they are for PSA testing for prostrate cancer.

We really have to take that into account. Across the country and indeed around the world there is considerable debate and focus going on -- and in fact a lot of effort -- to find a reliable test for prostate cancer. The sooner we can find a test that is accurate 99 percent of the time, that will be a big breakthrough. That's the difference between the two screening tests. One is much more accurate than the other. The consequences of a false positive test have serious implications for the person who has had that test, in terms of treatment and what may happen.

C. Hansen: I think in terms of the medical practice, a false-positive will result in additional testing as opposed to surgical intervention or radical treatment at that point. In the area of cervical cancer screening, there was a court case last year that attracted a fair amount of media attention. A woman in Vancouver had received a false negative three times -- three consecutive tests over a period of time. Only after it was too late for her not to suffer some long-term effects, it was finally positively diagnosed. The woman is Stephanie Nicolls.

I've had the opportunity to talk to Stephanie Nicolls on a couple of occasions. She won that court case, in essence. I don't think it was the judgment that was important to her. What was important to her was that this issue be addressed and there be some things learned from the experience that she went through, so that other women in British Columbia aren't faced with the same results she faced.

My understanding is that there was a review of that done within the ministry and in the B.C. Cancer Agency. I was told that that particular paper was going to be completed on or near January 17, 2000. I'm wondering if the minister has that paper and whether or not there have been any changes that have resulted from the review that was done.

Hon. M. Farnworth: Yes, we have in fact got the review. We are looking at the proposals in it. We are looking at the requests that flow out of it. They are currently under consideration.

C. Hansen: I had previously written to the minister asking if a copy of that report could be made available to me. More importantly, I would like to ask the minister if he will undertake to share a copy of that report with Stephanie Nicolls. I think that she very passionately wants to ensure that every action is taken that can be taken to make sure that other women don't go through the same experience.

[ Page 15833 ]

[1515]

Hon. M. Farnworth: I would be quite happy to do that.

C. Hansen: I want to move on to screening mammography. In the budget of a year ago, there was a commitment made that 38,000 more women would receive screening mammograms in British Columbia. I'm wondering if the minister can tell us how close they came to achieving that goal.

Hon. M. Farnworth: We managed 225,000 screens on a target of 240,000.

C. Hansen: So in terms of the increase, basically that's falling short by almost 50 percent of what had been targeted in the increased number. I wonder if the minister can explain to us why the promise was made in the budget last year for 38,000 additional women to receive screening mammograms, and yet by the numbers that he's just given me, in fact we've seen that it falls short of that considerably.

Hon. M. Farnworth: There was some delay in getting the program up and running, particularly in the new centres. However, those targets are still ongoing in terms of us trying to achieve the screenings in those new areas. We are still going ahead to make sure that they happen.

C. Hansen: My information was there were some problems that developed in terms of affiliation agreements between the ministry and some of the host hospitals that would be offering this program. I wonder if the minister can explain how affiliation agreements of this nature would be delayed. My question is relating, first of all, to ensuring that we're going to have these services available when they're promised. Second, there's a concern in terms of the relationship between the ministry and the host hospitals that result in these kinds of problems arising and whether or not it could even spill over into other programs.

Hon. M. Farnworth: I have some differing information, so you have my undertaking that I will check out the concerns that you have raised, and I will get back to you on them. The issue, from what I gather, is not between the ministry and the hospital, but it may in fact be between the program and the hospital -- if indeed that is what happened. But I'm not sure that that is entirely accurate. I will find out for you and get back to you.

C. Hansen: In terms of the expansion of the screening mammography program, are all regions of the province now on line in terms of the centres which are expected to deliver some of these increased services? And are we now at a level of screening programs that will be stable for the foreseeable future?

Hon. M. Farnworth: There are currently three areas which have to get up and running, and it's our expectation that they will be, and then all the ones that were anticipated will be functioning. At the current time, though, all areas of the province do have access in one form or another to the screening program.

[1520]

C. Hansen: Can the minister tell us what three areas are yet to come on stream?

Hon. M. Farnworth: I know that Penticton is one of them; the two others, we'll get for you, hon. member.

C. Hansen: Thank you. I want to move on to a slightly different subject, still under the realm of the B.C. Cancer Agency. One of the things that has bothered me considerably in terms of letters that I've received from individuals around British Columbia . . . . It bothers me a lot, and I hope we can find ways of dealing with these issues. That's programs for the working poor. Whether it's Pharmacare issues or other things, we have programs set up for seniors, programs set up for those who are on B.C. Benefits. And once they get off B.C.

Benefits, they lose a whole range of programs and yet really can't afford some of the deductibles that the general public is facing under some of these other programs.

The one that I particularly want to ask the minister about is drugs that are required in cancer treatment. Individuals who are treated in hospitals have those medications covered. Of course, as soon as they go home, they're not -- which is an issue that we covered off the other night, to a certain extent, under Pharmacare. But I was also concerned that there was a program being run by the Canadian Cancer Society for drug coverage as part of what they call their emergency aid program. It had provided financial assistance for needy families, which they defined as having an average income under $17,000 a year.

Apparently we were the only province in Canada relying on a not-for-profit agency to meet this need in the community.

Just to read this note here: "It became increasingly evident to us that this was properly a responsibility of the Ministry of Health, as is the accepted practice in most other provinces. A couple of months after, we withdrew the service entirely, and soon after media exposure, the government indicated a willingness to take responsibility for these drugs through the B.C. Cancer Agency."

My question to the minister is: has that in fact taken place? Is that now fully operational? If the minister could give us some indication as to how that commitment is coming to fruition.

Hon. M. Farnworth: All direct cancer drugs are covered under our system. In terms of issues for low-income people on the side-effect drugs that were not covered, the program that was in place was taken over by the B.C. Cancer Agency, and they now provide that service. So those drugs are covered as well.

C. Hansen: I want to move on to northern issues. I've deliberately skipped over the capital planning process in the performance plan, for the reason that it comes up again when we follow continuing care in the list that has been provided for me by the deputy minister. So I will defer capital. There's also a report which I'm hoping to have the opportunity to read before we get into that section. So I look forward to receiving that.

On the issue of northern health care issues, I was interested in a comment that was made in the environmental scan that the ministry sent to me. I'll just read this quote under rural health. It says: "Analysis of utilization patterns show that per-capita expenditure on medical services, including physician services, is less in remote and rural communities. Consumption of acute rehabilitation hospital days in rural communities is actually higher than the provincial average.

[ Page 15834 ]

Rural residents receive a higher portion of their care in specialty and teaching hospitals."

[1525]

I read that to say that what is happening is that those who live in rural and remote communities are travelling in order to access medical care, much more so than the average British Columbian, in that the specialty and teaching hospitals are typically in the lower mainland. In order to access care, far more British Columbians from smaller communities and rural communities have to travel. I'm just wondering if in fact that's an accurate

interpretation of the comments in this document and whether or not the provincial government is looking at programs that would assist people in travel to access necessary medical treatment.

Hon. M. Farnworth: If I've got the second part of the member's question wrong, I'd ask him to correct me, but the way I understand the member's question, I would say that he is right. That is an accurate assessment, on the first part of his question. Northern and rural British Columbians, in fact, do travel farther than their lower mainland counterparts. That's a reflection of a number of factors. One is the geography; another is the sparsity of population. The fact is that for a lot of services, you require a critical mass of population to deliver or to supply those services. Those are fewer and farther between, especially in northern British Columbia, than they are in the lower mainland.

If I understand the member correctly around his second question, there is the travel assistance program that is a part of MSP. In that sense I would say, yes, there is a program to assist people with their travel costs -- if I understood the member correctly.

C. Hansen: The travel assistance program -- if we're referring to the same thing -- is a program that basically provides for reduced airfares. It is a program that was put together by what used to be the two major airlines. I can tell by the minister's reaction that we may be talking about two different things here. I want to make the point about the air travel assistance, and then perhaps he can elaborate for me on the travel assistance program.

The reduction in airfares for individuals from rural parts of British Columbia who have to travel by air to access necessary medical treatment, and for their accompanying family members, is a program that . . . . While it certainly isn't encouraged by the provincial government, it is an initiative totally funded by the airlines. At least it's funded to the extent that they're accepting a lower fare, which is still considerably above what would be charter-class fares in this province, for people who have to travel for medical reasons.

I have two concerns. One is the issue the minister raised about the travel assistance program and also the other program which is provided by the airlines. And there's whether or not the reduction in service by Canadian Airlines and Air Canada in this province is going to have a detrimental effect on British Columbians' ability to access, and to afford to access, necessary medical treatment.

Hon. M. Farnworth: The issue around the merger is a good one. That is one of the areas which we are monitoring. In fact, we're working quite closely in terms of trying to determine the effect that the merger is having on communities throughout British Columbia, in terms of levels of service and the potential impact that that may have.

[1530]

However, the travel assistance program is based on a number of criteria. One, it's available for medically approved travel. In terms of the airlines, whether it's Air B.C., Canadian or Central Mountain Air, the discount is about 30 percent. In terms of rail travel, which is also covered -- B.C. Rail, Via Rail -- it's 50 percent. In terms of B.C. Ferries, it is in fact free. In terms of approvals or the numbers: 46,417 people were assisted in terms of ferry travel, 62 by rail and 4,492 individuals by air.

C. Hansen: The minister made reference to a travel assistance plan under MSP. Is this what he's talking about?

Hon. M. Farnworth: This is in fact what we are talking about, yes.

C. Hansen: I thought it was me that was getting confused earlier, when the minister seemed to indicate there were two different programs.

The travel assistance program obviously helps some families in British Columbia, but I guess you could argue that there is a component of B.C. Rail in there that is provincial government dollars and a component of B.C. Ferries dollars that is in there that is obviously provincial government dollars. Aside from that, it's outside of government that this is being run. I would like to ask the minister . . . .

In terms of air travel in particular, the minister listed the range of airlines that are involved in the program, and given the Air Canada-Canadian Airlines merger, what we see is that there are going to be fewer options for patients in British Columbia. I would like to ask the minister if any action has been taken by government to talk to other airlines in British Columbia in terms of joining the program.

Certainly as Air Canada and Canadian Airlines are obviously giving a slap in the face to British Columbia, in terms of the reduction of service to this province, there is an opportunity for other airlines, such as WestJet, Pacific Coastal Airlines and others, to start filling that void that is being created by Air Canada and Canadian Airlines. I'm wondering if the minister has had any discussions with those other regional carriers to urge them to become part of the travel assistance program.

Hon. M. Farnworth: Central Mountain Air is one of the participants in the program, as is Harbour Air. Those are regional airlines, and we are more than happy to talk to, and will talk to other airlines as well. Around the issue of the merger, as I said, we're monitoring that, and that's one of the areas where I think there is a wide government look in terms of what's happening. I think there's a lot of government concern around there.

It also, I think, highlights one of the issues that we having been raising and that I have raised in discussion with the federal government. That is the issue around transportation for northern and rural residents. One of the things that I think we need to do is look at if there's a better way of addressing the issue than we have right now by perhaps recognizing that it's not just B.C., but it's all the provinces, especially the western ones -- all the provinces that have those large rural areas, along with the Territories.

Maybe there's a critical mass if we are cooperating together to provide a better range of services than we cur-

[ Page 15835 ]

rently have. That's something that I've been pushing for us to be looking at. So I recognize the issues around there, and I think there are ways of dealing with it. But certainly in the practical short term right now, there is the existing plan. We are happy to talk to other regional airlines. Of course, we are watching and trying to assess the impact of the merger on communities in British Columbia.

C. Hansen: I want to deal with the travel assistance program first, because it is a program that is in place that provides some small benefit to families living in northern and remote parts of British Columbia. But, to put it in perspective, even the 30 percent reduction in airfare is 30 percent off of their full fare rates. It's not 30 percent off of even charter-class fares that we see around the province, and charter class is usually considerably cheaper.

[1535]

Where this program does help families is when they have to travel on very short notice and don't qualify for charter-class rates that are there. So they can see a 30 percent reduction. But if you're talking about a $1,000 plane fare out of a community in northern British Columbia, obviously 30 percent helps, but you're still facing $700-plus per seat per family member that has to travel. I would like to ask the minister to give the House his definition of what universally accessible health care means to him in this context.

Hon. M. Farnworth: That's a good question and an interesting one, because there are a number of ways to answer it, and I think that needs to take into account some of the realities upon which we operate. My definition of universality would be that the services are available to everyone in the province who needs them when they need them, in a timely fashion. However, if you look at what services are available and you look at what universality was set up to be, it was services covered under the Canada Health Act.

Since that time there has been considerable growth in the services that are available under our medicare plan that are outside of that. In that sense, universality is not there; but, in fact, it should be. Ambulance services, for example, are one of those services outside of that.

This is where I think it's important that we have that debate around what the core services of medicare are in this country. What should the Canada Health Act be covering? That means that we need to recognize that we have changed. The country has changed, the health care system has changed and technology has changed since it was first brought in. And it is going to change dramatically more over the coming decades. We need to anticipate what those changes are, how they are going to impact on Canadians and British Columbians and what the pressure points are. How do we cover them to ensure that there is universality of access and service for the people of this province?

C. Hansen: Yesterday I read excerpts from a letter that I received from Mr. Earl Houlden of Terrace. I'm sure the minister would agree that when it comes to our universal health care system -- the core of medicare -- there's probably nothing that would rank higher in most people's minds than the premature birth of a child. This family -- just to quickly remind the minister of the circumstances that we went over yesterday -- was medevacked from Terrace to Vancouver. The baby was born, I believe, at 26 weeks. They were in Vancouver for a few days and then were told . . . .

In the system that we have today, that family incurred thousands of dollars of cost in order to enable a premature baby to survive and grow and have the prospect of a healthy life. I would like to ask the minister: if that's not two-tiered medicine, what is it?

Hon. M. Farnworth: I think that example illustrates the point I made. Twenty-five years ago those children didn't survive. Now they do. We have centres and can provide specialists and specialties that can deliver the medicine and can deliver the ability to save lives, in a way that was never imagined when our system was developed -- was never even dreamt of.

That, to me, illustrates why we have to re-examine the act, and look at what it is we can now do and what it is we should be covering -- recognizing that with the advances of technology, and the ability of new medicines and new surgical procedures to do so many more things than we've been able to do in the past, there also come other issues.

[1540]

For example, issues around transportation of family members to be with their loved ones when they're receiving the care and transportation . . . . Those things were never envisaged when this system was set up. That, to me, is an illustration of how much our system's changed and why we have to address these issues in a comprehensive review of what medicare does now and what medicare can be expected to do over the coming decades. How are we going to deal with those changes?

[T. Stevenson in the chair.]

C. Hansen: I want to raise an issue which flows from that, although this takes us right back to the discussion we had on acute care and takes us out of the northern issues.

It's actually a case that was brought to my attention by the member for Langley. She outlined for me a discussion that she'd had with a constituent who had to take their child from Langley to Children's Hospital for daily treatments. In the course of the treatments that had to be undertaken, they have now accumulated parking costs of $1,600 at Children's Hospital in Vancouver. I appreciate the fact that I'm taking us on a bit of a tangent from our discussion on northern health care. But I wonder . . . . Given that under the TAP program we've got some of the airlines forgoing some of their revenue, B.C.

Ferries forgoing 100 percent of its revenue and B.C. Rail forgoing 50 percent of its revenue, is it appropriate, in the minister's mind, that here we have an acute care hospital -- a tertiary care hospital in Vancouver -- that can't make the same kind of concessions for family members who have to make frequent and regular visits in order to obtain necessary medical treatment?

[ Page 15836 ]

Hon. M. Farnworth: I don't think it would be too difficult to look at ways of relieving some of those costs that people would face. I don't think it would be inappropriate, because most people don't go to a hospital month after month. That clearly speaks to unusual and not typical circumstances in terms of accumulating that level of parking. It speaks to the intensity of the care that an individual requires.

I think you could structure something with the hospital or with the foundation that would recognize the impact on a family in terms of the costs of parking alone and find some way for there to be either a nominal pass or a pass in recognition of the visits that are required. I think that is something which is not beyond the bounds of what would be reasonable to expect.

C. Hansen: Would the minister undertake to give consideration or at least to initiate a process of reviewing these types of issues within the next month?

Hon. M. Farnworth: I would certainly be willing to raise that with the health authorities. I don't want to be accused of micromanaging, but certainly that's an issue that I'd be happy to raise. My sense of fairness . . . . It would seem to me that if I were a health authority or hospital, that would be something I would be willing to look at. I'm certainly happy to do that.

C. Hansen: I want to move on to the area of provincial wait-lists. I would like to address some issues around the wait-list web site. If the minister would prefer that I save those questions for our discussion on information technology, I'd be prepared to do that. But if now is the appropriate time, under wait-lists, I would certainly do it now.

Now? Okay.

[1545]

In the wait-list web site, what it shows today on the home page is that there are 61,000 waiting for surgery. Yet if you take all of the various areas and the categories of surgery that are listed, the numbers don't add up. This is a wait-list web site that was launched a year ago last week. It was brought into being in a rushed fashion. It was obviously done for political reasons to allow the minister to say that something was being done in the area of wait-lists. In the rush to get it on line, there were a considerable number of errors that became evident as soon as it was unveiled.

Now we see what appears to me to still be some pretty blatant errors in terms of the numbers of individuals in British Columbia who are waiting for surgery. I wonder if the minister could comment.

Hon. M. Farnworth: The reason that the two numbers don't reconcile is in part because there are a number of surgeons who have fewer -- let's say two or three -- patients on there, who are not included in that number. That's part of the reason why the number doesn't reconcile with all the different types of surgeries on there. Second, not every single surgery for which people may in fact be waiting is included on the list.

Before I yield the floor, I just want to ask leave to make an introduction.

Leave granted.

Hon. M. Farnworth: In the gallery today we have one of British Columbia's longest-serving mayors, someone I know very well and have had the opportunity to work with when I was a city councillor in Port Coquitlam and later as Minister of Municipal Affairs. That is George Ferguson of Abbotsford. Would the House please make him welcome.

C. Hansen: I don't think the minister's explanation was satisfactory. The home page says 61,000. Then he indicated that there are several areas that would not be included. The problem is not that the number, when you total up the list, is less than 61,000; the number is considerably greater than 61,000. In fact, the number on the home page says 61,000 people waiting. If you add up the list, you come up with 77,354. Clearly there is a discrepancy here of 16,000 patients. I'm wondering if the minister could explain where those 16,000 patients are.

Hon. M. Farnworth: I've been informed by the architect of the system that that couldn't possibly be. So we are going to check it out for the hon. member and get back to him.

C. Hansen: I would like to visit some of these numbers in terms of what we saw a year ago compared to where we are at today. The problem that we see when we actually look down this whole list of surgical procedures reported in that web site is a significant increase in virtually every single area except for cardiac surgery.

[1550]

Cardiac surgery, to the credit of all of those involved in British Columbia, is down. The wait-list is down by 26.5 percent. I know that the ministry put some targeted dollars into trying to deal with the cardiac surgery wait-list. I am also aware that cardiac care is one of the areas -- I believe it is the only area in British Columbia -- where there is in fact a managed wait-list system in place. I think we start to see the benefits of that attention that has been paid.

Radial therapy is up 37 percent. I'm not going to be able to pronounce all these surgical terms, so I'm not going to try. But basically the only areas that are down are cardiac surgery . . . . That's the only one of any significant degree. Neurosurgery is down by only 3 percent; urological surgery is down by 0.8 percent.

In all the other categories we see increases, and in most cases significant increases. Vascular surgery: the wait-list is up 29 percent. Plastic surgery: the wait-list is up 11 percent. Orthopedic surgery: it's up 15.4 percent. Knee replacement wait-list, up 15.2 percent; hip replacement, up 7.8 percent; gynecological surgery, up 18.4 percent. Some of these are in the 5 and 6 percent range, so I will skip those. Opthalmological surgery is up 41 percent; cardiac surgery is up 40 percent.

I wonder if the minister can explain to us why they are claiming to be having success on the wait-list front, when in fact we see significant increases in wait-lists in all of these areas except for cardiac surgery.

Hon. M. Farnworth: I think a number of points need to be made. First off, it's not the waiting lists themselves, but rather it's the median waiting times that are in place that are important. Second, since those figures are based on an annual basis, there are a number of things that have happened -- there have been a significant number of new facilities and institutions that have come on line -- in the past year.

There are also a number of areas where some additional program or additional funding has been targeted that will now start to show up. Orthopedics, for example -- there were

[ Page 15837 ]

a thousand new procedures built into last year's base. In turn, they will be allocated throughout parts of the province this year. We will direct them to those areas which show greater than median wait times. So there is the ability to target those.

Second, in areas around cancer treatment, for example, there are new facilities which are coming on stream later this year and early next year which will also have a significant impact on the wait times in terms of procedures and treatments that people are going to need to receive. That will have a significant impact as well.

C. Hansen: I want to come back to this issue of the management of wait-lists in British Columbia. I made the comment earlier that my understanding is that the only managed wait-list that we have in British Columbia is in the area of coronary care. Can the minister explain to us what initiatives are underway in terms of managing wait-lists and when we might see that approach expanded beyond coronary care?

[1555]

Hon. M. Farnworth: There is a provincial advisory committee that is looking at access in a number of different areas. There is work being done in several other areas as well. Perhaps one of the most important, on a strictly provincial basis, done here in British Columbia is to mirror what has been done in terms of cardiac surgery with regards to orthopedics. There's work being done to try and manage the wait-lists for orthopedics in much the same way as has been done around cardiac care.

Second, there's a program underway involving the four western provinces, which is looking at how we can do similar things in terms of managing the demand for services in five key areas. They include MRI, hip and knee replacements, cataract surgery, general surgery and mental health. We do recognize that there have been some significant advantages in terms of how we deal with cardiac surgery. We're looking to expand that to orthopedics and other areas as well.

C. Hansen: If the minister could anticipate all of my next questions, we would actually be able to move through this even faster. This project that he just referred to . . . . My understanding is that that report is entitled "From Chaos to Order: Making Sense of Waiting Lists in Canada." I was told that it was actually due in March of this year. Can the minister give us an update as to where the report is and, if it's not already finished, when we might expect it.

Hon. M. Farnworth: That is actually a literature

article and not the name of this particular project at all. That's something completely different.

C. Hansen: Then maybe the minister can advise us in terms of the other work that is being done by the western provinces. When will we see some tangible outputs from that?

Hon. M. Farnworth: It should be by September that we should be able to have some tangible information for the hon. member.

C. Hansen: One last point on the issue of wait-lists, and that's a quote in the environmental scan on page 30. It says: "Simply increasing funding often paradoxically results in increased demand and longer wait-lists." I'm wondering if the minister can elaborate a bit on that thought.

Hon. M. Farnworth: It's a worldwide phenomenon. Perhaps I can put it this way: before I had a dental plan, I'd go to my dentist and all I ever needed was a filling; since I got a dental plan, all I ever need is a crown. Sometimes it seems to be that because we can do it, you need it, and that is a problem. Because we're able to provide a service, and sometimes it's deemed to be the best and most encompassing procedure . . . . Even sometimes when other procedures may in fact work, we get the one that's deemed the latest and the fanciest.

C. Hansen: I challenge the minister to make that thought and that sentiment a part of his opening speech to the health innovation forum, which I think would probably stimulate some very interesting debate from some of the various stakeholder groups that the minister has invited to that forum.

I have one last issue to deal with before I turn this over to my colleagues. It's actually the last issue under the area of regional programs -- when we take this up again, we'll be able to move into public and preventative health -- and that's the issue of the trauma strategy.

[1600]

The performance plan talks about enhancing tertiary services and indicates that the performance measure is: "Provincial trauma strategy is developed and implemented, and a cardiac costing model is developed and implemented." Particularly in the area of the trauma strategy, I'm wondering if this is part of a process that in fact started in 1990 with the trauma report, which I think largely got stalled. There didn't seem to be much progress being made on the implementation of some of the recommendations in that trauma report.

Is this process that the minister is talking about in this document picking up on that 1990 report and fleshing out the parameters of a provincial strategy? My question is: when are we going to see that, and how expansive is that strategy going to be?

Hon. M. Farnworth: All the recommendations are in fact being acted upon. For example, the one at Vancouver Hospital was designated and opened on May 3.

C. Hansen: At this time I'm going to turn this discussion over to the member for Peace River South, who I believe has some issues that he wants to raise.

J. Weisgerber: I have a couple of issues that I'd like to raise with the minister. The first probably will come as no great surprise to him. Last week in question period I raised the issue of Eric Read and the ambulance charges incurred when he had a heart attack up in Whitehorse and wound up being flown to Vancouver. At that point he was facing a $12,640 bill as a result of that trip.

I was aware at the time that I raised the issue that Alkan Air, a private air ambulance firm, had taken a patient from Vancouver back to Whitehorse. We were arguing with Whitehorse -- with Yukon Health -- about taking a share of that responsibility. My understanding is that they have now offered $4,800, which they say would have been the cost of an alternate arrangement had they not used the return flight. I wonder whether or not the minister has been able to examine this issue with the point of looking at that bill.

[ Page 15838 ]

In examining the issue in a broader context, it seemed to me that the one thing that most British Columbians don't consider is that travel within the country, within Canada, might expose them to a significant health care cost. I think that most people -- most people that I've spoken with -- believe that there is a broadly universal health care system in this country, regardless of where you are in Canada. It seems to me that this issue simply highlights the risk that many British Columbians are at when they travel outside of the province. From my perspective, I would like to see three things.

First of all, I would like to see a commitment to Mr. Read to look after that uncovered portion of the air ambulance -- some $8,000. Secondly, I'd like to see B.C. move forward -- kind of go out on a limb, if you will -- and commit to British Columbians to cover ambulance charges, when ordered by a physician and not covered by some other jurisdiction, regardless of where you are in Canada.

If I understand the situation correctly, if you happen to be in Alberta and require an ambulance -- either ground or air ambulance -- to another location in Alberta, chances are that that will be covered by some reciprocal arrangement. It is only in the transport of patients between provinces where this lack of coverage comes into play. I'd like to see us take the lead in British Columbia by assuring British Columbians that regardless of where they are in the province or this country, they wouldn't look at an air ambulance bill or an unreasonable ambulance charge.

Thirdly, I would urge the minister to work with other health care ministers across this country to include ambulances under the Canada Health Act. I wonder if the minister could comment on that.

[1605]

Hon. M. Farnworth: I can tell the hon. member that we have had some discussions, and I have looked at the situation regarding the Reads. I'm able to tell the member that we in fact can resolve it to their satisfaction. They have no need to worry about any unnecessary burdens, and that will be taken care of.

On the other points the member raises, I think they're excellent points, and they're ones that I would like to address for a moment, because I think they're important. Certainly in terms of the policy as it relates to British Columbia, I am more than happy to look at the policy as it relates to transfers and to out-of-province transfers. I think British Columbians do expect that when they leave the province, that is in fact covered. Unfortunately, the Canada Health Act doesn't cover that. So I'm happy to look at that, to look at what the policy is, to see what the costs are, what's involved and to do a thorough analysis. I think that's an important first step.

Finally, I'd also like to comment for a moment on the issue around other provinces and the Canada Health Act. This comes back to my comments a little while ago in terms of how our system has changed in this country over the last 25 years. We are now able to do so much more than was initially anticipated with our health care system. You know, 25 years ago there were injuries or situations, and basically there was the inability to transport people to major trauma centres, for example, in time -- or to communities where necessary services were provided -- and those people died.

Now with changes in technology, better ways of delivering service, better ways of ensuring that important decisions are made in the first stages of an accident or trauma or illness, patients can be transported to centres where technology can literally work modern miracles. We can do far more than we could 25 years ago. We look at that in the coming decade, and the advances will be even more remarkable.

I think it's prudent and important at this time that we recognize that these changes have taken place and that we engage in that discussion with the federal government around the Canada Health Act and what it covers, recognizing that the ability now to move people to different places has a tremendous impact on their ability to receive treatment and to survive, in many cases, illnesses that they would have died from 25 years ago. I think it's appropriate that the member raises that, and I think it's appropriate that it is part of the discussion. It is something that I have been raising and will continue to raise.

The final point that I think we need to add in the meantime, while we're working on that, is to recognize that in terms of rural and northern communities in this province, we face the same issues around transportation and being able to move people around as we do in northern Alberta, northern Saskatchewan, Manitoba, Ontario, Quebec, the Territories and the Yukon.

Maybe what's also required is for the provinces to recognize that we can achieve more if there is more interprovincial cooperation -- whether it's through reciprocal agreements or what have you -- recognizing that if we're working together, we can probably supply or develop a service that services the residents and communities of the northern and rural regions of this country far more effectively than if we're operating independently. So I'm quite happy to work on this issue, and I'm more than happy to work on it with the member, who I know has considerable interest in this regard.

[1610]

J. Weisgerber: Well, first, let me say on behalf of the Reads, thank you for dealing with this issue. I know that it has been something that's been burdensome to Mr. Read, and to his wife as well. I know they're going to be very, very relieved to understand that that's an issue they don't have to worry about any longer.

I also welcome the commitment of the minister to look at the issue in a broader policy sense, because it is an important issue. I don't think there are many cases where a British Columbian is outside of the province, gets ill and then is flown from one jurisdiction back to British Columbia or to a third jurisdiction. But when it does . . . it obviously can generate some huge air ambulance costs. My constituents, particularly, travel into the Yukon regularly. The Alaska Highway runs right through the constituency.

The business relationship between Whitehorse and Watson Lake and Fort Nelson, Dawson Creek and Fort St. John is a very real one. People, not only on vacation but as part of their business activities, are routinely in the Yukon Territory. So this issue is relevant not only for the Reads but for many of my constituents.

The same applies to people working or visiting in the Yukon Territory. I expect that in most other jurisdictions, emergency-type air evacs would take place within the jurisdiction. If my understanding is correct, that doesn't normally put the patient or their family at risk with respect to the costs involved with ambulances. I may be wrong there; it may be that I've just never run across one before. But I think that to examine that in the broader policy sense is extremely worthwhile. Good luck, in terms of what you can do with the federal government and the other Health ministers. Perhaps I could let the minister respond at this point.

[ Page 15839 ]

Hon. M. Farnworth: I thank the member for his comments. It's worth noting as well, while we are undertaking these investigations and analyses around the problem . . . . In terms of our discussions with the federal government, I would be remiss in not saying that it is also a good idea to ensure that you do have some travel insurance if you are going out of province to avoid potential situations like this, because we don't want to see them happen.

J. Weisgerber: I appreciate the caution that the minister is extending, although I will just say that I don't think British Columbians should have to worry about insurance as long as they're staying within Canada.

I would like to move on, if I could. I'm certain that my colleague from Peace River North has touched on a somewhat related issue, and that is the whole issue of travel for health care services by other than ambulance. It has seemed to me for as long as I've represented this constituency that one of the great imbalances or injustices in our health care system is that if you live in the lower mainland or greater Victoria and you require treatment for something like cancer and are obliged to go perhaps once a month, those costs, if you have to bear them, are minimal.

But I have constituents who have been travelling for years to Victoria or Vancouver once a month for treatment. They wind up paying thousands, if not tens of thousands, of dollars in airline fares.

[1615]

What is particularly heart-rending is families where one of the children is ill, and the patient being treated is too young to fly by themselves. Every time that they go to Vancouver from Dawson Creek, even on a special fare, they're looking at about $1,000, or $500 each, per ticket. I'm thinking of one family in particular who built into the family budget $1,000 a month for travel to Vancouver for treatment. I have believed for a long time that we need to address that.

I've thought that we could address it by way of frequent-flyer points, and I've raised that issue over a number of years, so far without success. Certainly that wouldn't necessarily be the only way to deal with that issue. If we're going to have truly single-tiered health care in the province -- and I know the minister believes in that concept -- then the cost of travel for northern residents should be factored into that health care delivery system. The people shouldn't be obliged to pay $1,000 a month for one or two or three years as part of their obligation to get treatment for serious illnesses.

I wonder if the minister has any thoughts beyond those raised by my colleague a couple of days ago.

Hon. M. Farnworth: The member's right; it is a problem. I think it's a problem right across this country, and probably acutely so in British Columbia because of our terrain and topography. There are no easy answers to it. I think there are a number of ways we can try to look at addressing it, but I don't have any quick answers, and I don't think anyone has any quick solutions. Certainly there is the issue around airline points, and that has been looked into and is being looked into again. There are some issues around the airlines in terms of making something like that successful.

Even then, that's not, I think, how a good program would provide the entire answer. I think part of it needs to be addressed in terms of the discussions that are currently underway, in terms of health care around health care reform and change in this country, in terms of the discussions with the federal government, in terms of let's say . . . . Well, one perhaps is if the province were together in looking at things on a rural and northern basis, and working cooperatively . . . . I don't know.

Maybe if you have the air ambulance that can transport people as part of a routine service with maybe an opportunity for individuals to fly down with them, and that cost is part of the service provided. That may be an option, an opportunity. Second, there may be ways within the provincial or federal tax system that you could address some of the costs. These are possibilities.

I don't know how you deal with that specifically. All I know is that it does place a burden on families. We need to recognize that given the advances that have taken place in technology and our ability to do far more than was ever anticipated . . . . It's these types of issues that have to be part of the reform to health care and the reform in the services that are provided or covered by the Canada Health Act or by the provinces. There has to be some way of addressing it.

I'm more than happy to try and look at solutions that may solve the problem, but it is a complex one, and there isn't an easy answer to it.

[1620]

J. Weisgerber: I appreciate that there isn't. But I think of the families in my own constituency who are faced with the problem that I've described -- perhaps $1,000 a month; that's probably the most expensive. It's probably the case that is the best example, if you like, because it's the most dramatic example. That family is probably also looking at pharmaceutical costs. The entire family budget in that case is all focused around the cost of getting proper care for this child, which must be a tremendous burden on the child itself. The child must realize that this whole family is focused around his treatment.

I don't think we should pay for everybody to drive across town or to take a taxi across town. But I wonder if the minister has examined or thought about putting health care travel on a footing very much like Pharmacare, where a family would look at the first $800 or $1,000 being the deductible. Dealing, then, with travel that was authorized by a physician, there would be some kind of either coverage or coinsurance for the next X number of dollars. Then beyond something in the neighbourhood of $2,000 a year, the health care system, rather than the family, would accept those obligations.

That would seem to me to be something that would serve as somewhat of a deterrent, so that there wasn't unnecessary travel, so that people weren't immediately wanting to jump on and accompany their spouse or whoever it is if that wasn't absolutely necessary, so that there's enough of a financial obligation on the family to treat this cautiously and prudently. On the other hand, surely our whole health care system and what makes our health care system unique is that families aren't at financial risk as a result of illness. I look at what happens with some of my constituents, and I say that the health care system, because of those costs, appears to be failing them in a very fundamental way.

I would appreciate -- not a commitment, because it would be unreasonable . . . . I ask whether or not the minister might ask his staff to consider dealing with this issue of air travel using the Pharmacare model, which I think has been a good one, as a model for focusing on or covering health care travel in this province.

[ Page 15840 ]

Hon. M. Farnworth: I want to thank the member for that very constructive suggestion. Those are the types of ideas that we need to examine. We may find that it's not workable or we may find that it is a very workable idea and certainly worth a look. Those are the types of ideas that I'm certainly interested in, and I'm more than happy to try and work on them to see what would be involved and to see how something may work -- see if we can bring a resolution to this particular issue. It is a challenge, and it is an issue that I recognize is a concern.

The member is quite right: you're quite often dealing with a small number of cases where the travel bills are of this magnitude. Certainly I think it's something worth exploring and trying to do further work on.

J. Weisgerber: It is, perhaps, an example that is at the extreme. But I believe also that the minister might be surprised at how many people travel out of Dawson Creek, Fort St. John, Terrace or Fort Nelson on a regular basis for health care treatment, where those bills really have an enormous impact on the family budget. It's certainly not isolated.

Because of where I represent, I spend a lot of time on airplanes and in airports. I meet a lot of people that are travelling for health care treatment. It can have a huge impact on someone who's on a fixed income or on people who are living on $700 or $800 a month to all of sudden have to pay -- even at a reduced rate -- for a trip to Vancouver. If a spouse has to travel with them, it can be a matter of going to the extended family to raise the money, and not on a one-time basis.

I want to move also, while I have the opportunity, to an entirely different area -- one that involves B.C. Housing as well as the Ministry of Health. I may in fact be asking some questions that might better be addressed under Housing.

This has to do with a facility being created or built in Dawson Creek to replace an existing extended multicare facility. Approval has been given through the South Peace health council for a 44-bed multicare unit that is to be located on 17 acres of land in Dawson Creek that was donated by the city. What has been proposed by the council, the Ministry of Health, the city of Dawson Creek and the Rotary Club is to construct, in conjunction with that, a 36-unit complex -- one- and two-bedroom units where people can move in and have a shared recreation-dining area. People could choose to take their meals with that group in the multicare facility or in fact look after their own food services.

[1625]

Just incidentally, my mother is in a very similar facility in Alberta. It's a small community; it's kind of unique. My mother is 88 or 89 years old; she has an older sister who is in the facility, as well as a younger sister and her husband who have a two-bedroom unit. It really has been a marvellous transition from her home in quite a close-knit community into a facility that really has been an extension of that community.

I'm wondering if the minister is familiar with the proposal for Dawson Creek. To what extent can his ministry support this 36-bed add-on to the multiplex unit?

[E. Gillespie in the chair.]

Hon. M. Farnworth: I can tell the hon. member that the ministry does indeed support this project. It is the type of project that we want to see go ahead. I'm particularly pleased about the fact that it is a partnership between Health and Housing.

One of the things I want to see is projects of this nature going forward. It allows for the flexibility for people to be in a residence and then, at the appropriate time, to be able to move into the care facility either on a full-time or on a gradual basis -- to be able to take meals . . . . In a sense it benefits everybody. People become accustomed to the extended care facility where they know they may one day end up, and at the same time, they're still able to be in surroundings that are familiar that and offer them a great deal of independence.

The ministry is supporting this project. There are some steps yet that still have to be gone through, but it is one that we want to see go ahead.

J. Weisgerber: I want to close by thanking the minister for the positive response on all of these issues. Again, on behalf of Mr. and Mrs. Read, I want to thank him for what I'm sure will be very nice news for them today.

Hon. M. Farnworth: As the member knows, I am generally receptive to sensible solutions.

L. Stephens: I have some questions for the minister around women's health issues. I see a staffer here, so we can proceed -- or would the minister like a little bit of a recess for a few moments?

Interjection.

The Chair: We'll have a five-minute recess while staff change.

The committee recessed from 4:30 p.m. to 4:35 p.m.

[E. Gillespie in the chair.]

L. Stephens: I have some questions that I'd like to ask the minister around women's health issues, to recognize that the issues in health care for women are very significant. Over the years those needs have increased, and they've certainly changed somewhat. I think the minister's aware that the determinants of health for women are poverty and housing and safe environments -- and, frankly, sometimes whether or not she's a mother.

There is "Women-Centred Care: Working Collaboratively to Develop Gender Inclusive Health Policy," a final report of August '98 that I'm sure the ministry has. It talks about women-centred care. It gives the definition:

"Women-centred care recognizes that women's health involves emotional, social, intellectual, spiritual and physical well-being, and that women's health is determined by the social, environmental, political and economic context of women's lives, as well as by physiology. This includes a recognition of the validity of women's life experiences and women's beliefs about and experiences of health."

It also goes on to say:

"Furthermore, women-centred care recognizes the importance of gender differences in health experiences; seeks to reduce inequalities; values women's experience in defining their problems and health goals; recognizes women's diversity -- in race, ethnicity, culture, sexual preference, education and access to health care; supports empowerment of women in their own recovery and as valued members of the community; supports women's values of caring and providing social support; and works to change the context of women's health problems."

[ Page 15841 ]

I would like to ask the minister whether or not the ministry has been making plans to include, within the policies and practices of the ministry, women-centred health when it comes to the delivery services of health care for women.

Hon. M. Farnworth: The ministry takes this quite seriously and has initiated a gender mainstreaming health planning project with health authorities, for example, and has also attempted to incorporate what you've outlined, with a gender lens, into the different components of the ministry, such as aboriginal health. HIV/AIDS care is another example. We are trying to bring this approach to all aspects of the Ministry of Health and with health authorities around the province.

L. Stephens: One of the issues that always comes up when you're talking with women who are involved in the delivery of health care services and are recipients of health care services is that what we have in British Columbia is a biomedical model of health care. Most women would like to see a more holistic way to deliver that health care, which would include socioeconomic considerations.

Have discussions been going on within the ministry -- on how we can move away from a patriarchal, hierarchical, biomedical model and move to one that is more holistic and takes into consideration all of those aspects that I talked about earlier?

[1640]

Hon. M. Farnworth: There have been a number of activities take place -- initiatives around regional workshops, for example -- to promote the inclusion of women's health issues. A women's provincial health statistical profile has been done. Gender-inclusive planning tools for health authorities . . . . Also a project, for example, around menopausal health to recognize that there are health issues that are natural and should not be medicalized, for want of a better term . . . . There is work that has taken place and is in fact ongoing.

L. Stephens: In the regionalization process . . . . I know that our region, South Fraser, is now incorporating women and children's concerns and considerations into the health planning process and has actually separated that out as a separate concern that needs to be addressed and that some planning needs to be done around. We are well on our way to developing those kinds of models. Is the minister aware that that is in fact happening in every region around the province? Have all of the health regions a plan to specifically focus on the needs of women in those particular regions?

Hon. M. Farnworth: There are about four or five health authorities that have specifically included women's health issues in terms of their health planning, and they are incorporating them, in the way that is taking place in your particular area around the province. There are others who have, to somewhat lesser degrees, incorporated them into their plans and into their practices. We expect, though, that all authorities need to do that -- incorporate them into their practices, plans and health procedures.

L. Stephens: Could the minister make available which regions those are, if there's a time line in which all regions must bring forward their system changes and what those system changes may involve? If the minister could be a little bit more specific about some of those regions and what specifically the Health ministry is looking for in outcomes for the planning process for the regional boards . . . .

Hon. M. Farnworth: In terms of the specific health authorities, I can tell the member that they are Vancouver-Richmond, Coast-Garibaldi, Fraser Valley, South Fraser, capital health region and the North Shore. Clearly as plans are being developed and communicated to the ministry, this is one of those areas in which we can, in turn, say: "Look, we need to have these issues addressed. You need to be looking at addressing gender, women's and children's issues in your health plans.

There are health authorities that are currently doing that -- some in a very broad range; some on a more specific issue." We can assist, if they're having difficulty in doing that, in terms of saying: "Look, here's what's happening here, and here's how you go about doing it."

[1645]

L. Stephens: In terms of some of those issues that the local health authorities -- and the ministry as well -- are going to be grappling with, one of them is biotechnology. The federal government introduced a bill a year or two ago now to do with the new biotechnologies in health care and reproductive technologies. Can the minister comment on what is happening with that particular initiative? Are there still ongoing talks between the federal government and the provinces to address the issues of these new technologies? They're having some significant impact on, for instance, the ethical questions of reproductive technologies in particular.

Hon. M. Farnworth: Yes, in fact we are working with the federal government, and the member is absolutely right. This is an issue of enormous importance in the coming years. One only has to see the research and the data that are coming out of such things as the Human Genome Project to recognize the implications that that has, not only in terms of being able to cure disease and illness but especially in areas such as reproductive technology. I think it's critical that we address the ethical and moral questions.

This information, as much as it is beneficial, is also a double-edged sword, and we have to start recognizing that. We are more than happy to work with the federal government in terms of addressing those issues.

L. Stephens: Cloning and all of those kinds of issues have been in agriculture for quite some time, as I know the minister knows. Also, transgenic food is now the top of mind of a lot of people as well. So it is getting closer. The issue is becoming much more urgent.

I will ask the minister whether or not there is a committee of the Health ministry in British Columbia. Is there a formal group of some kind that is meeting regularly, talking with scientists, all of those people in the medical profession and others, to put together a response to that particular piece of legislation? What might the time line be? What time line is the minister working towards?

Hon. M. Farnworth: In terms of regulatory decisions and the framework, they are in the federal government's purview. As far as the provinces are concerned, though, there is an advisory committee on health services, which is comprised of representatives of the provinces and the federal government and is working on the particular issue. The federal govern-

[ Page 15842 ]

ment is expected to deal with this legislation in the fall, if I'm not mistaken.

L. Stephens: Is there any appetite for the ministry to include some women's organizations, perhaps some forums, to gather broader public input into what might guide the ministry's position? Has any of that happened?

[1650]

Hon. M. Farnworth: We would certainly be interested in consulting and working with women's groups around these particular issues. We have to recognize that the federal government does have the responsibility in this area, but certainly in terms of . . . . If there are issues around a forum, the provinces can encourage the federal government to recognize this and to deal with it, perhaps in the way of forums or those sorts of things. We would certainly be interested in helping to move something like that along.

L. Stephens: The minister talked a little bit earlier about medicalization of women. It's a fact, and it's been going on for quite some time. It's largely a case of overprescription of benzodiazepines -- tranquilizers and sleeping pills. This isn't the first time that we've raised this issue with the Health minister. Previous Health ministers have acknowledged that it is a significant concern and that there have been some processes undertaken to try to deal with it.

The facts are that it is a chronic use with women; it is primarily women. The average number of prescriptions is five for women and four for men. I think that if you talk to the medical people, they'll tell you that these medications should be used on a short-term basis and certainly not for a long term. There is a significant number of women around the province who have been on benzodiazepines for up to ten or 15 years. A lot of people think that they are not addictive; they are. They're highly addictive. They have many side effects, and they're very difficult to withdraw from.

I'd just like to know whether or not the minister has addressed this issue of overprescription -- for people generally, but women in particular.

Hon. M. Farnworth: There have been a number of initiatives to deal with this particular problem. There has been a health transition fund project to address the problem around sleeping pills in particular. There is the 30-day supply rule so that when you go to your pharmacist, they will give you a 30-day supply; that is it. After that, you have to get another prescription from your physician. Thirdly, there has been a change in the dispensing policy with the pharmacists so that we pay double in terms of the dispensing fee, as opposed to the number of times that your prescription is actually filled.

L. Stephens: Yes, those are some initiatives, but the problem is that the doctor keeps prescribing them. It doesn't matter what the pharmacist says, in effect. The doctor will keep prescribing, and that's the problem. Somehow we have to get to the doctors that are prescribing benzodiazepines day after day, week after week, month after month and year after year.

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This is a very large issue. About 20 percent of the senior men on the North Shore and 30 percent of the senior women on the North Shore were prescribed a benzodiazepine. These individuals continue to be medicated in this way. There are all kinds of other health problems that flow from that, particularly for senior people, who can fall and have trouble driving. There are all kinds of safety issues around it as well.

I wonder if the minister could perhaps look at this particular issue and give it a little bit more care and concern. It is serious; it is systemic, it appears. There does have to be a concerted effort made to address it and to change the way the doctors are prescribing these particular drugs.

Hon. M. Farnworth: Absolutely. I don't disagree with the member one bit in terms of trying to address the issue. I outlined some of the initiatives that are currently taking place. There are some others. The therapeutics initiative, for example, in terms of people who approve new drugs and the conditions that they can be used for, has recently tried to educate physicians on alternatives to treating some of the conditions you outlined -- anxiety, those sorts of things -- without using these particular drugs and has sent a newsletter out on that. Certainly if we need to do more, I'm prepared to look at ways of how we might accomplish that.

L. Stephens: In the whole area of addictions and dependencies, many of the groups and organizations that are women-serving organizations believe that there needs to be more of a fused approach to treatment as opposed to the sort of stovepipes that are now employed -- more of a unified approach for women. This is particularly true in the area of substance abuse, where women must be either/or. They must be either completely detoxed and stay that way or completely free of drugs and stay that way before they can get services for the issues that developed in the first place.

It just seems that what they're doing is dropping out of treatment, because they can't stay clean. So there needs to be more flexibility. There needs to be more of a continuum for women to come into programs and remain there, to get the kind of counselling and support and medications that they need in order to build better lives.

I'd like to know whether or not there is a pilot project that is happening along that line -- whether or not the ministry is trying to deal with a more flexible arrangement for treatment, particularly for women who have perhaps dual addictions, perhaps mental health issues, drug and alcohol issues and children.

There's a lot of issues around women who have these kinds of concerns and have children. And what do they do with the children? They can't get treatment with their children. There is only one facility in the lower mainland where they can take their children, and that's up in the valley at Peardonville House. So we need to have some more resources around those issues, and we need to have some more attention paid to how we're going to deliver those services in Vancouver.

Hon. M. Farnworth: It's a complex issue that the member raises, and a significant part of the answers can come from the Ministry for Children and Families. But what I can tell the member in terms of our approach at Health is that we do support a harm reduction strategy in terms of dealing with treating addictions. We have a methadone advisory committee that advises Pharmacare on the services that are required. That committee consists of physicians and people who are using it, and it includes women on it as well, so that their input is part of the advice that's given.

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In terms of mental health . . . . Again, part of that comes in with Children and Families, but I think that we recognize a need for a good, close working relationship with that ministry in attempting to ensure that those services are there and that we're recognizing some of the issues facing them. Certainly we have the ability to raise the issues of concern to women in that process.

L. Stephens: I wonder if the minister could talk about the mental health plan and what components of the mental health plan are geared specifically to women. I think the minister knows that many women who access the mental health services do have dual addictions. They self-medicate, or they don't take their medications. But there are other issues around . . . other than just mental health. What are the specific programs or policies in place for women in the mental health system?

Hon. M. Farnworth: I'd like to make a couple of points. First, B.C.'s mental health plan is the first mental health plan of any province in Canada to recognize the need to move away from gender-neutral services and recognize that there are differences between men and women in mental health service utilization and also in key aspects of life experience. That can have a significant impact on mental illness.

There have been a number of projects that have been undertaken within the mental health umbrella to deal with some of the issues that women face in particular. We have done provincewide research projects on women-centred mental health care, development of treatment guidelines for women with mental illness during pregnancy and postpartum, and symposiums on the needs of parents with mental illness and children whose parents have mental illness, for example.

So there are a number of initiatives that have taken place and will continue to take place. As I said, the mental health plan is the first in the country to recognize the differences in terms of needs for women and men.

L. Stephens: The drug and alcohol services for adults are still with the Ministry of Health. I'd like to ask the minister: what amount of money has been set aside in this year's budget for drug and alcohol treatment services for women in the province?

Hon. M. Farnworth: It's all with Ministry for Children and Families -- both adult services and youth services.

L. Stephens: Perhaps the minister could comment on the sobering centre that the city of Vancouver has been looking for, for quite some time. Is the minister aware of that? What is the state of negotiations? Has it been complete? When will that sobering centre be up and running?

Hon. M. Farnworth: I am aware of the particular facility and part of the harm reduction strategy. As for the specifics around it, I will get the information and get back to the hon. member.

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L. Stephens: I just have a few more questions. One of them is around nurse practitioners. I know the critic for Health has talked at length about the needs of the people in the rural parts of British Columbia -- that certainly extends to women -- and the difficulty of keeping doctors and other medical personnel in some of the more rural and remote areas of the province. Could the minister tell me what the policy of the ministry is on nurse practitioners?

[T. Stevenson in the chair.]

Hon. M. Farnworth: The Health Professions Council is currently dealing with the issue and looking at all the different aspects around nurses and scope of practice. I myself have made some public statements which say that I think we need to see expanded scope of practice as opposed to restricted scope of practice. People should have the ability to work to the fullest opportunity that they are trained for. I think that speaks volumes about where I'm coming from on it.

L. Stephens: I will have to agree with the minister. I think that nurse practitioners have a major role to play in the rural and remote areas of the province. They've been used to great effect in other parts of the country; I'm sure that they would be here as well. Expanding their role is critical. There are many women in some of these areas who would prefer a nurse practitioner to travelling great distances, for instance, to get to see a doctor. Depending on what the nature of the illness was, a nurse practitioner, in my view, would be able to serve the patients quite well. That's an area that I would like to encourage the minister to work on with some vigour.

Part of the reason for that is the FAS problem that we have, particularly in the northern and the central parts of the province, and again, trying to find services for these kinds of issues, trying to provide counselling programs, educational programs on what happens if you drink during pregnancy . . . . I think we have to do more along that line as well. I'd like to ask the minister what the Ministry of Health is doing presently on the education side of FAS.

Hon. M. Farnw