1986 Legislative Session: 4th Session, 33rd 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, APRIL 10, 1986

Afternoon Sitting

[ Page

7667 ]

CONTENTS

Tabling Documents –– 7667

Ministry Of Post-Secondary Education Act (Bill 15). Hon. R. Fraser

Introduction and first reading –– 7667

Education (Interim) Finance Amendment Act, 1986 (Bill 12). Hon. Mr. Hewitt

Introduction and first reading –– 7667

Oral Questions

Premier's principal secretary. Mr. Stupich –– 7667

Northeast coal. Mr. Williams –– 7668

Government advertising. Mr. Macdonald –– 7668

Expo 86. Mr. MacWilliam 7669

Food bank operations. Mr. Williams –– 7670

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)

On vote 37: minister's office –– 7670

Mrs. Dailly

Mr. MacWilliam

Mr. Howard

Mr. Davis

Mr. Lockstead

Mr. Stupich

Mr. Cocke

THURSDAY, APRIL 10, 1986

The House met at 2:05 p.m.

HON. MR. GARDOM:

At considerable sacrifice in coming over the waters from that great

riding of Vancouver–Point Grey today, and missing a day in classroom,

are 22 grade 7 pupils from St. Augustine's School. They are in company

with their teacher, Mrs. Gladys Brown, and I would like to inform all

members that St. Augustine's and its church will be celebrating their

seventy-fifth anniversary this year on May 31 and June 1. Much welcome

to Victoria. Glad to have you here.

HON. MR. CURTIS:

Among those in the gallery at the start of our afternoon sitting are

Deanna Mulvihill, the Victoria

chapter president of the RNABC,

accompanied by Ruth Ditchburn, who is a constituent in Saanich and the

Islands and director of nursing at Sunset Lodge. Would the House make

them welcome.

HON. MR. RITCHIE: I would like the House to welcome very good friends of the Ritchie family, Mr. and Mrs. Gordon, visiting us today.

HON. MR. SMITH:

Also in the gallery as part of the delegation of registered nurses is

Mrs. Wendy Underhill, registered nurse from my constituency. Would the

House welcome her.

MR. PARKS: Very early yesterday

morning we had a serious apartment fire in Coquitlam. Luckily there

were two RCMP members on routine patrol and they spotted it. Not only

did they turn in the alarm, but at great risk to their own lives they

went into that building and ensured that every resident got out safely.

Both of them unfortunately were overcome by smoke, and I understand

that they are recovering. I would ask the House to join me and

acknowledge our RCMP throughout the province where they are continually

doing a very fine job and often not given recognition. I would ask the

House to join with me in acknowledging the efforts of Const. Randy

Marquardt and Const. Reg Steward.

HON. MR. WATERLAND: In the precincts today and meeting in Victoria are

members of a very important industry in British Columbia, managers of the various

mines in our province. I ask the House to join me and welcome these gentlemen

to Fantasy Island.

Hon.

Mr. Curtis tabled the report of the auditor-general for the year ending

March 31, 1985 and the 1985 annual report of the commissioner of

critical industries.

Introduction of Bills

MINISTRY OF POST-SECONDARY

EDUCATION ACT

Hon. R. Fraser presented a message from His Honour the Lieutenant-Governor:

a bill intituled Ministry of Post-Secondary Education Act.

HON. R. FRASER: Mr. Speaker, after much consultation with the education

industry, the government, as you know, has moved to combine post-secondary education

into one ministry. This has met with great approval around the province. I would

therefore move that the bill be placed on orders of the day for second reading

at the next sitting of the House after today.

Bill

15 introduced, read a first time and ordered to be placed on orders of

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

EDUCATION (INTERIM)

FINANCE AMENDMENT ACT, 1986

Hon. Mr. Hewitt presented a message from His Honour the Lieutenant-Governor:

a bill intituled Education (Interim) Finance Amendment Act, 1986.

HON. MR. HEWITT:

Mr. Speaker, I move that the bill be introduced and read a first time

now. In making that motion. I would like to take a few moments to

explain the principle of the bill.

These amendments

basically give school trustees the right to raise additional revenue

through residential taxation to provide programs identified as those

which meet local community preferences. With these amendments, there

will be a three-tiered system of educational funding in British

Columbia: first, a fair and equitable allocation of funds per student

throughout British Columbia, paid for by the provincial taxpayer via

the Ministry of Education fiscal framework formula; second, the local

school board's ability, because of these amendments, to tax residential

property owners to cover expenses in excess of the provincial funding

allocation, in order to provide services which may be unique to that

particular school district; finally, the opportunity for local school

boards to now apply to the Excellence in Education fund for funding of

innovative projects.

In introducing these changes, I can

say there is strong support for greater local autonomy in

decision-making, and this is a move towards that goal. Secondly, fiscal

controls introduced in the education system in recent years have been

in keeping with the economic conditions of the times. School boards

must continue to be cautious in increasing the tax load on homeowners

in a district. I would like to remind them that along with the ability

to tax goes the corresponding responsibility and accountability.

Therefore school boards should ensure that program enhancements have

the support of their local taxpayers.

Bill 12 introduced,

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

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

Oral Questions

PREMIER'S PRINCIPAL SECRETARY

MR. STUPICH:

Mr. Speaker, my question is for the Minister of Finance in his capacity

as chairman of Treasury Board. Will the minister advise whether the

government's contract with Jerry Lampert in the Premier's office

entitles him to use the private government aircraft fleet in connection

with his duties and responsibilities?

[ Page 7668 ]

HON. MR. CURTIS:

Mr. Speaker, did the member say the private government aircraft fleet?

What was his phrase? I didn't hear the last part of it, I'm sorry.

MR. STUPICH: ...fleet.

HON. MR. CURTIS:

Mr. Speaker, I don't know. I have indicated this is the third day of

questioning with respect to the person who is taking up the position as

principal secretary in the office of the Premier, replacing someone who

has served as principal secretary. I would refer the member to the

opportunity, which will be as long as members of the opposition wish,

to examine the Premier regarding the expenses of his office and

policies in his office at the time....

SOME HON. MEMBERS: He's not here.

HON. MR. CURTIS:

I understand, Mr. Speaker, the Premier will be here quite soon — if not

tomorrow, then the beginning of the week. I also wonder if the question

meets the test of urgency as in question period.

MR. STUPICH:

Mr. Speaker, I would just like to remind the Minister of Finance that

for the last two years the Premier has not been here for his estimates.

It used to be that we had someone who took his place as deputy Premier,

but that post has been done away with.

However, another

question to the chairman of Treasury Board. I'd expect the Treasury

Board to have some answers to some of these questions. Can the minister

advise us whether or not the hard-pressed taxpayers of B.C., in

addition to providing a $77,000-a-year salary for this person, will be

supplying him with a government automobile in connection with his

duties and responsibilities prior to and during the election campaign,

which we have been told will be sometime within the next two years?

HON. MR. CURTIS: Mr. Speaker, the question asks of future government policy.

MR. STUPICH:

Mr. Speaker, on the contrary; it asks whether or not the contract

provides him with an automobile. Is the minister saying that it's

future because it does not at this point?

[2:15]

HON. MR. CURTIS: I do not know of a "contract" — the NDP might like to put one out on him —

which has been signed by the future principal secretary to the Premier.

If such exists, then I will admit the same to the House, but I do not

know of the existence of contractual arrangements or a contract between

the office of the Premier and the soon-to-be incumbent of that position.

MR. STUPICH:

Mr. Speaker, again I'm a bit puzzled. Is there nothing more between Mr.

Lampert and the government other than a golden handshake? I do have

another question and it's along the same lines. Maybe I should let him

answer that one.

Apart from the automobile, on which we

will have to wait for an answer, I wonder if the Treasury Board

chairman knows whether or not the taxpayers will be reimbursing Mr.

Lampert for his travel expenses within B.C., again during the period

prior to the election — during the election campaign.

HON. MR. CURTIS:

Mr. Speaker, I clearly heard the phrase "will be," and if that does not

relate to future government action, then I don't know what does. The

member has tried valiantly. I am confident that the Premier of this

province will stand in this House before Committee of Supply to answer

questions. He enjoys debate on his estimates.

Interjections.

HON. MR. CURTIS:

You have difficulty thinking up some questions for him, but as it turns

out, Mr. Speaker, I'm sure that opportunity will present itself. As

soon as I see the Premier of this province — in a day or two or three —

I shall indicate to him the interest shown by the member for Nanaimo,

and urge the Premier to call his own estimates relatively soon. Then we

can have the full discussion which that member wishes. I hope he

doesn't, however, run out of questions, as often happens.

MR. STUPICH: Just one more question to the Minister of Finance.

AN HON. MEMBER: Don't stop!

MR. STUPICH: Just one more for today.

Does

the Minister of Finance recall the most recent occasion on which the

Premier stood in this House and answered questions in connection with

his estimates?

MR. SPEAKER: Out of order.

HON. MR. CURTIS: That's clearly out of order, and that would be a matter of record in this chamber.

NORTHEAST COAL

MR. WILLIAMS:

Mr. Speaker, a noted economist and Rhodes Scholar, the member for North

Vancouver–Seymour (Mr. Davis), stated on February 5 that there was to

be a discount in the first five years in terms of the surcharge on the

Tumbler Ridge line. Could the Minister of Finance advise me whether

that is the case or what the revenues have been from surcharge on that

line?

HON. MR. CURTIS: Mr. Speaker, a question very

similar to that has been taken as notice, and I will return to this

House very quickly with the full answer. The question today has

slightly different shading, but I shall examine that and take it as

notice as well.

MR. WILLIAMS: Could the minister advise the House how the $501 million extension to the northeast coal fields will be paid?

HON. MR. CURTIS:

Mr. Speaker, I think actually that that matter has been explained in

this chamber before, but I restate for the member's interest, in terms

of northeast coal and financial obligations associated with it, that I

will bring that information back to the House.

GOVERNMENT ADVERTISING

MR. MACDONALD: To the Minister of Finance. A citizen sitting and watching his television, not doing anybody

[ Page

7669 ]

any harm, saw the minister on an ad. It began with.... There was even a picture

of Bob Hope — you know, government with and without hope over there. It talked

about the film industry, and I think the minister knows the one I'm talking

about. Then it said how great that we were putting people to work, and then

the minister was behind his desk. The citizen wanted to know whether that was

paid for by him, in part. Is it being paid for by the taxpayers?

HON. MR. CURTIS:

Mr. Speaker, I think we have again encountered a circumstance where, if

you choose, almost any question can be directed to the Minister of

Finance of the day in terms....

MR. BLENCOE: You don't like the heat, eh?

HON. MR. CURTIS: Why don't you get a question of your own and then you can ask it, Mr. Member?

Mr. Speaker, I think that there is a more appropriate minister for that question to be directed to. It is certainly not....

Interjection.

HON. MR. CURTIS: I've never met Bob Hope.

MR. SPEAKER: Order, please.

HON. MR. CURTIS: I tried once, and he declined, and I don't blame him.

But, Mr. Speaker, the activity to which the member's question refers

— i.e. television announcements, if you wish to use that term — are not

under the jurisdiction of the Ministry of Finance.

MR. MACDONALD:

Mr. Speaker, I ask the Minister of Finance again: did the public pay

for that ad? Are you really going to fudge that question? Are you

really?

MR. SPEAKER: Order, please.

HON. MR. CURTIS: Will the member sit, Mr. Speaker?

MR. SPEAKER: Order, please. The Minister of Finance.

HON. MR. CURTIS:

Mr. Speaker, the member is occasionally here for question period, but

not always. I would suggest that he determine, with the assistance of

his research department, the minister who is responsible for a question

such as that and direct the question to that member of the executive

council.

MR. MACDONALD: Mr. Speaker, would I have

the approval of the Hon. Minister of Finance to reply to this citizen

that the Minister of Finance would not answer my question...

MR. SPEAKER: Order, please.

MR.MACDONALD: ...and that what to the citizen was obviously outrageous

political advertising at the expense of the taxpayer is something this government

is so guilty of that they won't answer the simplest questions about it'?

Interjections.

MR. SPEAKER: Order, please.

MR. MACDONALD: You know that that is larceny of public funds.

[Mr. Speaker rose.]

MR. SPEAKER:

Hon. members, it's question period; it's not expressions of debate or

interest. May we continue with question period, please. There was no

question there, hon. minister.

I Mr. Speaker resumed his seat.]

EXPO 86

MR. MacWILLIAM:

Mr. Speaker, in the absence of the Minister of Tourism (Hon. Mr.

Richmond), and the Provincial Secretary (Hon. Mrs. McCarthy), I'll

direct my question to the Minister of Education, who is the backup for

Tourism, I understand. Expo 86 Corporation requires approximately

15,000 temporary employees, I understand, to operate the world's fair.

I wonder if the minister would advise how many of these positions have

now been filled'?

HON. MR. HEWITT: Mr. Speaker, in

order to be accurate, I'll take that question as notice and have the

Minister of Tourism report back to the House.

MR. MacWILLIAM: Thank you. Mr. Speaker, I'll inform the minister that it's 9,000. which leaves about 6,000.

new question to the minister: Mr. Bob Griffiths, who is the director in

charge of hiring, is among the small contingent of Expo executives— I think somewhere in the number of 42 —

who have recently been dismissed by this government. According to the

Minister of Tourism's earlier statement, these people were dismissed

because their job has run out. Obviously with the 6,000 people

remaining, his job has not expired.

My question to tile

minister is: in view of the fact that Mr. Griffiths was dismissed

before his job was complete, is the minister prepared to reveal the

total value of the severance package?

HON. MR. HEWITT: Mr. Speaker, in the form of a correction to

the member, the employees — I think you mentioned some 42 or 43 of them

— were dismissed by government.... The member made an error. It is not

"dismissed by government," but released — or if their contract was up

or their job was finished, they would be released by, or in some cases

maybe fired, Mr. Member — by the Expo corporation, not by this

government.

Mr.

Speaker. I for one find it that good management would dictate that when

a job is complete, then there is no further need to pay or have an

employee on staff. If this gentleman that the member refers to is one

that has been released, and there is a severance package available to

him, I would advise the Minister of Tourism of the member's question,

and the Minister of Tourism will respond when he gets back as to

whether or not he is prepared to release that information.

[ Page 7670 ]

MR. MacWILLIAM:

Another question to the same minister. The government has failed to

comply with the provisions established in the Financial Information Act

with respect to Expo corporation. The financial disclosure report was,

I remind the member, due on October 1, 1985. Expo spokesman George

Madden says that the government has been given a specific list of the

fired executives and a complete list of their severance arrangements.

question to the minister is: why does the Minister of Tourism refuse to

make this information, which is available to him, available to this

House and available to the public?

HON. MR. HEWITT:

Mr. Speaker, I am not aware of any material that has been passed to the

Minister of Tourism. As a result, of course, I will again take that

question as notice so that the Minister of Tourism is aware of the

member's concern about Expo and its employees as opposed to being

concerned about some of the areas of the economy in this province.

FOOD BANK OPERATIONS

MR. WILLIAMS:

To the Minister of Human Resources. The executive director of the food

bank in Vancouver yesterday announced that one week a month she would

be discontinuing food bank operations for people in need. Is the new

minister willing to meet with the director of the food bank, and is he

prepared to go there and see the problems that they currently face in

these very difficult times?

HON. MR. NIELSEN: Mr.

Speaker, I don't know whether I've heard from the executive director of

that particular food bank, but I'm sure if she wanted to get in touch

with me she could contact me— unless that member is booking appointments for her.

MR. WILLIAMS: It's a simple question. Will he or won't he meet?

MR. SPEAKER: The bell terminates question period, hon. members.

Hon. A. Fraser tabled answers to questions from the member for Mackenzie (Mr. Lockstead) on Wednesday, March 26, 1986.

Orders of the Day

The House in Committee of Supply; Mr. Strachan in the chair.

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $207,950.

MR. HOWARD: I'll defer to the member for Burnaby North.

MRS. DAILLY: Thank you to my colleague from Terrace.

Would

the minister respond on the hospitals'? I gave you some statistics, and

I know you and your deputy were writing down the answers — if you would.

[2:30]

HON. MR. NIELSEN: I apologize for the break in continuity of the questions which the member was discussing prior to the adjournment.

were discussing hospitals, and the member was mentioning various

situations with respect to hospitals' budget and surplus situations,

and with respect to the comparison between the number of beds available

today and in 1982, and whether in 1982 the action was taken with

respect to closures because we were over-serviced, and perhaps what the

situation may be today.

I don't know whether the member

would want the precise financial position of all hospitals at this

time. We some time back developed a program where all hospital budgets

are subject to a quarterly review. In many instances we make

adjustments to budgets to reflect their actual caseload. Those changes

in budgets could be up or down. Then there is the year-end

reconciliation, once again, to determine precisely what the caseload of

the hospital was that year.

Some hospitals could be in

positions, at certain times of the year, which would indicate that they

could be headed for a deficit. The quarterly adjustment could recognize

their caseload increase, and their budget could be modified

accordingly, or vice versa. I'm not sure at this time.... In fact, the

fiscal year having just concluded, I would think that the ministry is

just now receiving actual figures from some hospitals to see what their

situation is.

We told the hospitals some years back that

we would no longer pick up deficits, that we felt it was their

responsibility to manage their facilities, and the deficits would have

to be worked out in future budgets. They would have to carry some over.

Most of them have been able to comply with that, but we do look at

increases in cost as they relate to the workload, and we make

corrections.

With respect to the number of beds, there's

been a change over the last number of years with respect to beds.

There's been a conversion of beds from acute to various forms of

long-term. There's been added interest in day-surgery beds, newborn

beds and other categories, and there has been some conversion. In fact,

we were rewarding some hospitals with grants when they converted from

acute to extended, because the patients in the acute beds were actually

extended-care patients.

Mr. Chairman, I got the figures

between the two sessions today with respect to the acute-care bed

vacancy situation in the province. At the present time we have 11,084

acute-care beds, what they refer to as "approved" beds. As of April 7,

1986, 9,505 were occupied. The beds which were reported available for

acute-care patients but not utilized as of that date: 1,451. The 1,451

beds which were available April 7 are, of course, staffed and available

for patients. It is spread all over the province, of course, and you're

going to get different situations at different hospitals, some of which

operate at very close to 100 percent occupancy almost always because of

the nature of their facility. Those were the numbers as of April 7. I

don't have the reports going back to the other weeks, but we do have

this done on a weekly basis. The number is usually in the 1,100 to

1,400 range.

We do have, if you like, provincewide a 10

percent factor or so of beds available for acute-care needs. Obviously

a person who requires a bed in one town is not going to be able to take

advantage of a bed available elsewhere unless it's a highly specialized

need. But on balance we're usually sitting in about a 10 percent factor

of available beds which, at the

[ Page 7671 ]

moment, are not being utilized. I think that was part of the question that the member had asked.

I'll wait and see if there are further questions, but I think basically that's what you were speaking of.

MRS. DAILLY: While we're on hospitals —

and there will be some other questions coming up from my colleagues

which will point out to the minister that there are still concerns in

some of the areas in the province about the shortage of beds, but I'm

going to let some of my colleagues report from their own areas later.

There's

one point I want to bring up before the member for Okanagan North (Mr.

MacWilliam) speaks: that is, that when I was discussing with you.... I

know we cannot come to any meeting of the minds on the matter of user

fees, but I do want to point this out for your consideration, to get

your reaction. Mr. Minister, 19 of the hospitals that we surveyed in

the province reported either an increase in the number of bad debts at

the hospital or an increase in the number of people entering the

hospital without MSP coverage. So apparently more people are letting

their coverage lapse, particularly young people; this has occurred more

often than not— being able to pay for the emergency fee, which some

people going to the emergency manage to scrape together, even if

they're in great difficulties, although I consider that can be a burden

for some also.

My question to the minister is this: many

people today, now that your government has seen fit to increase the

premiums to a point where a single person now has to come up with over

$200, are not paying for that coverage — young people particularly.

They're out of work; they can't come up with that amount of money.

You

may say yes, but if they go to the hospital we won't let them suffer.

The point is: this breaks the universality of medicare. I'm wondering

if the minister is not concerned that more and more people are turning

up at hospitals today without coverage because of this policy. We're

also having an increase in the number of bad debts at some hospitals.

Would you comment on those two problems?

HON. MR. NIELSEN:

The member is aware that if a person is on income assistance, then the

Ministry of Human Resources takes care of their premiums. If a person

is on low income but not in need of income assistance, there is a

subsidy program of up to 90 percent. I would suggest that very few

people, young or otherwise, could not pay a couple of dollars a month

for premiums. So there is no excuse for not being covered under MSP in

the province. There's no excuse, in my opinion.

Increase in

bad debts, I don't know. I'd have to verify that. We probably have

numbers somewhere in the system. One of the reasons could be because we

do not pursue relatively small amounts of debt owing with great vigour.

We certainly ask people to pay. But we do write off some, yes.

The

Medical Services Plan, of course, is not the hospital. The hospital is

available to the person. They don't have to have MSP; that's to do with

the medical service they may receive from the doctor, or otherwise.

There are really very few reasons for a person not to have coverage.

There are many occasions where a young person has been covered by a

family plan and is no longer and never applies for medical service. In

some instances, they believe they'll never be sick. But they should

apply for it. There is a subsidy program if they are in a position of

having a very low income. So I don't see that as a major factor. I

don't see why it should be.

Mr. Chairman. I might also

mention that there are people in the province who sometimes get into

some medical difficulty and then complain that they're not covered, or

that they're not eligible to be covered, even though they did have an

opportunity at some time to acquire forms of insurance to cover it: and

we get these from the different people. It's almost as though they want

to buy fire insurance after the fire. We do cover people in a

retroactive way: if a person's insurance has lapsed, and a couple of

months go by and they're in need of care, we will permit them to

retroactively pay the premium. I've never met a person who has been

involved in expensive medical coverage who was not delighted to be able

to get the coverage simply by paying the premiums. But in the instances

of some young people, medical premiums, probably, are not one of their

highest priorities until there's the need. But they should be aware

that they can have the coverage, and should have that coverage.

I don't think it's widespread as perhaps some of your surveys indicated —

I think you said 19 of the 97 hospitals. I would have to try to confirm

that with some. But bad debts have always been a fact of life; and

that's why they try to get people to pay up front for a portion of the

period of time they are expected to be in hospital.

According

to the Greater Victoria Hospital Society, bad debts have decreased from

$404,000 in 1982-83 to $234,000 for the current fiscal year; that

represents less than I percent of the non-grant revenue generated by

the hospital. The provincewide basis: the industry — we refer to it as the hospital industry —

in 1982-83 reported bad debts of $4,465,000. During the current fiscal

year it is projected the expenses will not exceed S4 million, so there

seems to be a downward trend on bad debts.

MR. MacWILLIAM: To the minister, last year when we were

discussing previous estimates — and I know it comes under previous

estimates, but it comes under these estimates too —

I had talked to the minister at great length in regard to the speech

therapy program, specifically as it relates to the North Okanagan area.

Perhaps I can just quote from a letter that I wrote subsequent to that

regarding that program, and the minister may recall the details. But I

will, if you permit me, refresh his memory.

"Pursuant to my recent statement in the Legislature regarding

speech and hearing therapy, I am writing to supply specific details....

"Discussions with Dr. Roland Katagi, ministry speech consultant,

verified that there are 170 people awaiting speech therapy in the North Okanagan

Health Unit. The average length of wait is approximately one year, depending

upon the severity of the cases."

Now that was written in July of 1985, and the minister may recall that he responded to that letter with the following:

"At present the Ministries of Health and Education are reviewing

the distribution of speech and language services in the province. If rationalization

of services is accomplished, there would be a significant increase in speech

pathology services to the preschool and adult populations of the North Okanagan

region."

Perhaps

I would ask the minister at this point whether such a rationalization

of services has now been completed and what the results of that study

have shown.

[ Page 7672 ]

HON. MR. NIELSEN:

I am advised that that study has not been completed. It is still being

worked on, apparently. Mr. Chairman, with respect to that subject the

member raised, the question of speech therapy is quite difficult

without knowing — as you mentioned, 170 — what type of therapy is

required. There are various types, as you know. One of the more common

is the effects of a stroke and various other difficulties for adults.

There are separate problems for children who have some form of a

handicap that frequently affects their capacity to speak. But just as

quick general information, there were 1,800 clients who received direct

intensive speech and language therapy in the '85-'86 year. There was a

success rate— although I wouldn't attempt to suggest how they determine the success rate —

in their program in excess of 50 percent. That's the speech and

language therapy. The companion to that of course is audiology, which

is often the problem. There are 47,000 children screened for possible

hearing impairment through the high hearing program and the school

hearing conservation program. So the combined speech, language and

audiology program is an extensive program. But specifically, no, we

have not yet concluded that rationale. I am advised that the report has

not been finalized.

[2:45]

MR. MacWILLIAM:

I certainly have no disagreement with the minister that the program is

very successful, if in fact a person can get onto the therapy program.

The cases I cited and supplied to the minister last year were largely

cases of children, preschool children specifically, that could not get

access to the program without undergoing lengthy waits, up to two

years. Sometimes by the time the person finally got a chance for the

therapy program for initial screening, they were already of school age

and a lot of the effectiveness of the program had been compromised by

the wait.

Anyway, to make my point, I have received further

correspondence in regard to this problem, and when I checked with the

North Okanagan health unit, I was advised — and this is just recently —

that the waiting list is still about 156 to 160 long and the length of

time for initial screening and assessment is still an excessively long

period of time. I guess what I am trying to say is that not much has

happened in the last year, and I would suggest to the minister that

there are a number of preschool children up in that area who are

anxious to get onto the program. It seems that after a year in process,

I would have hoped that this rationalization program could have been

finalized and some recommendations for rectification made at this point.

Moving on to another area with regard to a number of letters I have

had from chiropractors in the North Okanagan area — and I will submit

these letters directly to the minister at this time, if you would like

to take them over — the letters do outline a number of concerns, but I

will break them down into just a few.

Firstly,

fee schedules for chiropractors. Just a little background information.

In 1985 there were 355 chiropractors treating approximately 322,000

B.C. residents. The information that I received from them is that about

80 percent of the general populace experiences periodic back pain at

some point in their lives, but about 30 to 40 percent suffer from daily

spinal problems. They may be minimal or they may be very serious. About

six years ago the value of insured services with chiropractors was

fairly much on a par with that of physicians in the province, but the

difference has grown quite dramatically over the years. In 1977 the

average income of a chiropractor was $40,700 before expenses — about

$23,500 in expenses, leaving a net salary of approximately $17,300. The

1985 figures I have indicate that income is now at $69,000, expenses at

approximately $44,000, with a net income — I am told — of approximately

$20,000 to $25,000. It seems that for the years of training and the

responsibility that these professionals have, their remuneration has

fallen far behind remuneration in other areas of the health care

system. That information, by the way, has been supplied both by a

survey of the practitioners in British Columbia and from Ministry of

Health files.

Now apparently — and the minister might address this point —

the budget for chiropractic care under the Medical Services Plan has

increased fairly significantly since 1981; but the records indicate

that the increase is due to an increase in the number of practitioners,

a significant increase in the number of patients and a small increase

with regard to fees for service. Comparing it to the medical

profession, an increase of 74 percent in the MSP budget since 1981 has

been mainly and largely, I guess, due to an increase in fees for

service. B.C. chiropractors, according to information available to me,

are the lowest paid in Canada. After initial visits they receive $11

per visit. I just want to compare this with other provinces. Apparently

Alberta is $15 per visit; Manitoba, $16; Ontario, $19; Quebec and the

Maritimes, approximately $18. So it seems that B.C. chiropractors are

financially quite behind the rest of the country. I would suggest that

the minister consider the fact that these professionals, who have a

very important part to play in an integrated scheme of health care

delivery.... I don't think they're getting their fair share of

reasonable remuneration.

The second point I'd like to make

is in regard to visitation rights for chiropractors in hospitals. If

the minister cares to peruse the letters that I have received from

chiropractors in the greater Vernon area, he will find that a number of

them are proceeding to attempt to get visitation rights with patients

they have in Vernon Jubilee Hospital. I guess I and my colleagues come

from a philosophical point of view that these professionals are a part

of the total health care scheme, an important part of any integrated

scheme of health care delivery, and should have access to their

patients, after consultation with the physician and if it's in the

patient's obvious best interests. I wonder if the minister would care

to comment both on the present remuneration received by chiropractors

and on the area of chiropractors' hospital visitation rights, and shed

some light upon the direction he'd like to take in the ministry.

HON. MR. NIELSEN: The last question first —

the visitation rights in hospitals. The B.C. Chiropractic Association

and I are in complete accord with respect to what they're asking for

and what they should have. As a matter of fact, I was speaking — I believe it was yesterday —

with the president of the Chiropractic Association. I told him I was

quite prepared to encourage all hospitals in the province to permit the

chiropractor to attend a patient in hospital, provided the person

responsible for the admission of the patient concurred — that's the

medical practitioner who puts the patient in the hospital. Mr.

Chairman, I might mention that the medical practitioner who admits the

patient has the responsibility of that patient while the patient is in

hospital and must be responsible for all treatment of the patient. So I

said if the medical doctor who admits the patient agrees to

[ Page 7673 ]

permit

the chiropractor to work on that patient, I would encourage the

hospitals to agree. The chiropractors said that is precisely what

they're asking for. They don't wish to admit patients to the hospital;

they simply want to be permitted to work on a patient with the

concurrence of the medical practitioner. I have no objection at all to

that. It is the hospitals who must make the decision in that they are

running those facilities. Why they would object to it I do not know,

but I certainly intend once again to send a general statement to all

hospital administrations and boards to let them know what I think the

situation should be and recommend that they cooperate.

Just

staying with the chiropractors for a minute, Mr. Chairman, it was

recently that we advised the hospitals to make available to

chiropractors copies of x-rays of their patients, rather than

submitting the patient to a separate x-ray where one had already been

taken. I think now every hospital has agreed to do that. There was

reluctance on the part of some. There was some concern about releasing

documents or files that they deemed to be confidential, but we

eventually.... I think it was changing the regulations that permitted

this to occur. So they now have that, and it's working reasonably well.

There are still a few bugs in the system.

So the

chiropractors have been able to achieve that, and I know they

appreciate that, and it's probably to the benefit of the patient. The

availability to patients in hospital I agree with. I will encourage all

of the hospitals go along with that at least to see what the problems,

real or imagined, may be. I think we'll have a handle on that.

was just waiting to see if information came down with respect to the

fee schedule. Chiropractors have been excellent over the last number of

years in cooperating with the provincial government when it comes to

fee schedules and costs. They were the first of the health

professionals who agreed to a capping system — not necessarily

implemented but agreed to the concept. They were the first to roll back

the fees of a few years back. They've been very cooperative. We've

discussed many ways in which we could improve the situation. A few

years back the chiropractors were concerned because a global amount of

money was allocated per patient for that service, and as their fee

schedule 1ncreased the number of visits declined, so what we said was

no, we will keep it at a fixed number of visits, rather than a total

amount of money. That also assisted.

The chiropractors can

quote fee schedules from different provinces, but they haven't said

whether they're covered in those provinces. Chiropractors are not an

insured service in some of the provinces in Canada. They are in British

Columbia up to that limit, but in some provinces it is not an insured

service at all, so in effect they can charge whatever they want and get

paid that. We do cover it. They also have private patients who pay

their full fee schedule. They also do work for the Workers'

Compensation Board, ICBC and others, so they are not limited to what

would appear in our blue book, paid from the Medical Service Plan.

Chiropractors do have a lot of private patients, and they also have

services to people who are insured by other methods.

The

$11 is low by comparison to other fee schedules across the country. We

recognize that. Chiropractors have been very good about not making

excessive demands. The amount has increased substantially, because the

utilization has increased substantially. It is most interesting,

because there are those who have been critical of the Medical Services

Plan, which limits the number of chiropractic visits per patient per

year as an insured benefit — a dozen at the moment and 15 for seniors —

and many people have said that it's unfair, and it should be

open-ended. But just as an aside, the investigation into utilization

for chiropractic adjustments shows a remarkable number of people who

utilize 10 to 11 per year and stop there. Only about 9 percent of the

patients actually exceed the limit. It's argued that if there were 15 a

year, that would be the number; if there were 20, that would be the

number. But it has worked.

I can't give you the list of

provinces who cover chiropractors, but not all of them do. So some of

their figures may be interesting but really not part of what we would

offer in B.C.

Chiropractors do deserve some consideration

for modification in their rates. I think they provide an excellent

service to the people in British Columbia. They're an important adjunct

to the medical system, and I regret the traditional animosity that

seems to continue between chiropractors and medical doctors.

The

information, I'm told, is that Quebec and the maritime provinces do not

cover chiropractic as part of their services. But I've been in constant

contact with the chiropractors, and we've had good discussions. We are

in negotiations with them right now for fee modifications. I don't

negotiate with them directly, probably because I've been a patient of

chiropractors for many years and perhaps they might take advantage of

that. But your message is well received, and I have great respect for

that branch of the health sciences.

[3:00]

[Mr. Ree in the chair]

MR. HOWARD:

First I want, out of my ordinary, normal, compassionate nature and

friendliness, to express my understanding and concern about the mental

health condition of the cabinet when it was revealed that its national

leader is Jim Keegstra. I can see how much you....

Interjections.

MR. HOWARD: I have full concern about your feelings that this has suddenly been revealed to the general public.

Anyway,

I want to deal also.... This is under the estimates. So was the other.

Mental health is under this minister's jurisdiction, and I'm sure he's

concerned about the mental health of his colleagues, as well as he is

about the general citizenry. But there were two or three items, if I

might, one of which relates to user fees, which had been raised by my

colleague from Burnaby North (Mrs. Dailly) earlier, and to which the

minister replied that in his view the member's opinion about user fees

was in error.

Interjection.

MR. HOWARD:

That her view was in error. You said that it was a good view. Her

opinion about user fees was correct and supportable. I want to talk

about user fees and tell the minister that at the annual general

meeting of the Mills Memorial Hospital Society in Terrace, a motion was

passed stating that the society opposes user fees in general and in

particular in the emergency department. At Mills Memorial Hospital, no

one is refused service because of inability to pay, and I'm sure Mills

Memorial is not unique in that regard. That can be demonstrated by the

patients who never seem to be able to pay according to their account

card but who

[ Page 7674 ]

continue

to receive the necessary health services. That's a commendable approach

for all hospitals. As I said, I'm sure Mills Memorial is not unique in

that regard.

For the hospital's fiscal period ending March 31, 1985, the total

visits by insured residents to their emergency department was 13,959,

and that generated a total revenue of $83,369, which is 1.2 percent of

their total hospital budget.

"Our in-patient and out-patient user fee

(excluding MSP rejects) write-off accounts total $24,297,

whereas total

revenue for in-patient and out-patient user fees was $229,394. Terrace

and the area served by Mills Memorial Hospital has been no exception in

feeling the effects of the recession" — and of restraint.

I'm reading now from the letter from Mills Memorial Hospital.

"In

discussion of 'user fees,' we support the new Canada Health Act, Bill

C3, and its intent to ensure that the fundamental principles of

medicare are protected. If not the immediate abolition of user fees,

planning for a more cost-effective health care system should include

phasing out user fees.

"A comparison of

specific hospitals over a two-year period shows that while other income

increased by 23 percent in hospitals' revenue totals, the bad debt

expense for these same hospitals for the same period rose by 31

percent. The bad debt experience of hospitals is increasing, indicating

that the ability of hospitals to realize the income generated by

increased user fees is diminished.

"User fees

only deter the poor, the elderly or the chronically ill. User charges

are not deterred, but people on minimal or fixed incomes are deterred" —

or may feel deterred. "User fees may deter persons from seeking help in

what may or could be an emergency situation. Although mechanisms can be

created whereby Human Resources clients are exempt from user charges,

studies have shown that it is the 'working poor' who are the lowest

beneficiaries of health services...."

They refer there to a study by the Ontario Economic Council, identified as "Income Classes and Hospital Use in Ontario.

"The

parliamentary task force on federal-provincial fiscal arrangements

agreed that, for reasons of both principle and practicality, user

charges for hospital services should be discouraged.

"One

could understand and possibly support user fees as a means of

increasing revenues in times of budgetary constraints, if retention of

these revenues could be negotiated with the Ministry of Health. As it

now stands, any revenues raised by the hospital are deducted from the

portion payable by the B.C. hospital programs; in effect, the

responsibility for funding merely shifts from the society as a whole to

the sick, the elderly and the infirm. This is contrary to the spirit of

medicare and the national health program which was legislated into

being by the Medical Care Act of 1966.

"From

time to time there have been incentives, offered by the Ministry of

Health, to hospitals who were prepared to introduce programs that would

generate cost savings" — and they enumerate two or three of them there.

They

go on to say, in the final representation made by Mills Memorial

Hospital, that "from the patient's viewpoint, user charges amount to

extra charges that an individual must pay after he or she has already

paid for health care through federal and provincial taxes. The society

is requesting that legislation be drafted for the next sitting of the

Legislature abolishing all user fees and, in particular, emergency

outpatient fees." That letter was written at the end of January,

incidentally, and submitted and signed by Mrs. Linda Hamilton,

president of the board of trustees of Mills Memorial Hospital.

I understood the minister to say earlier, this is not a matter that

anybody seems to clamour about consistently and persistently enough to

get the ear of government with respect to it. But the fact of the

matter is that the highly respected board of trustees of one hospital

have made a deliberate and conscious effort to this effect — abolishing

user fees. They approved a motion at their annual meeting, prepared a

letter in support thereof and transmitted that for consideration. I

wrote to the minister's immediate past predecessor about this, and got

a terse reply back which said that user fees have been in existence as

long as the program has been in existence — period. That was the end of

the reply — no comment as to whether it was agreeable or disagreeable.

think we need to take into account, in dealing with user fees, the

facts of the matter that many of us know, as stated in this particular

letter from Mills Memorial Hospital. Let me just sort of reiterate

them. It is basically the elderly, the infirm and the working poor who

are taxed an excessive amount, through both user fees and general

taxation, and can least afford it; and those are the ones who receive

the least amount of health care services, when compared with other

groups in society or with those in a much higher income bracket.

also want to discuss a question of sexual abuse. Some psychological

opinion, in a very broad sense, says that sexually attacking women,

children or other relatively defenceless people is an exhibition of a

power trip on the part of the abuser, that there is an element of

insecurity involved in that person's makeup, so that ordinary, regular,

normal, healthy sexual relationships are not participated in, and they

have to have this aberrant view and approach to sex and exhibit that

power by attacking children and women. In this regard, I wonder whether

the minister can advise whether his ministry has any knowledge of or

information on, or has conducted any inquiry into, the subject matter

of sexual abuse of patients in mental hospitals and of elderly

residents in intermediate- or extended-care facilities — whether there

is any indication that the power trip that people with aberrant sexual

behaviour go on is visited upon people in those groups. I have heard

that it occurs. I don't know of specific instances and so on, but I

have heard from different sources that it does take place, and I think

it is worthwhile examining — or hearing from the minister as to what

knowledge may exist about that and how it's being approached.

want to deal with the question of alcohol abuse or booze or whatever

name is used to identify it. While it might be an exaggeration to say

that this is a government that is in partnership with alcoholism, I

think that it's necessary to declare that they are partners in

alcoholism for the purposes of making the point. Being partners in

alcoholism results in the budget that was presented to us, showing that

there's an expectation of an income from the liquor distribution branch

this year of $420 million, or $185 for every person in the province of

whatever age.

[ Page 7675 ]

AN HON. MEMBER: Is that profit?

MR. HOWARD:

That's the income to the provincial treasury. It's in the budget as an

income, and that would be from the liquor distribution branch into the

province's hands, down the gullet of the treasury branch — $420

million. In these estimates, for the community services side, the

alcohol and drug portion of it is some $22 million — $22.3 million, I

believe from memory —

or something in the neighbourhood of $9 to $10 per capita; $185 per

person income, a $9 to $10 expenditure, and that is an expenditure

after the fact. It's an expenditure supposedly treating alcoholism.

It's an expenditure after the damage is done. It's an expenditure for

detoxification centres and for treatment in facilities, both public and

private, of people who have problems with alcohol and need, therefore,

to be treated for it.

The income is about 19 times the

expenditure, and the expenditure is after the damage, not before. The

expenditure is not in the area of prevention, not in the area of

education. It's in the area of trying to clean up the mess for the

individual afterwards. It's after the misery, and it's after the family

breakup takes place, and it's after the child abuse takes place, and

it's after the wife-battering or woman-battering takes place. It's

after the accidents, it's after the physical damage. It's after

everything that takes place that's damaging with respect to the abuse

of alcohol that the government then steps in and says: "We're going to

put out some money here for treatment." It's a paltry, insignificant,

piddling amount of money compared to the income. I don't think anybody

who looks at it could justify raking in $420 million on the one hand

and paying out $22 million on the other to deal with the effects that

the $420 million created in the first place.

I've no idea what the costs to the health scheme are.

I see my time has expired. I'll leave it at that and maybe come back in a moment to the same theme.

[3:15]

HON. MR. NIELSEN:

I'd like to just respond to the member's questions with respect to the

abuse of those people who may be in mental institutions or intermediate

care, and frequently we're dealing with elderly people.

There

have been a fair amount of inquiries into what is known as elder abuse.

It is a problem. There was a provincial conference on abuse and neglect

of the elderly in November 1985. The report indicated that the

instances of abuse of the elderly are becoming more visible and are

more frequently reported. The growing number of the elderly receiving

care in the home and in institutions has heightened the instance of

abuse. Staff employed in the community and institutions report cases of

financial abuse, emotional or psychological abuse, and, less

frequently, physical abuse. There was no mention in that one report

with respect to sexual abuse. This is primarily the elderly; this is

not necessarily all mental institutions.

Mr. Chairman, if I

could just, in a very general way.... It is a very serious problem, the

matter of abuse and the matter of sexual abuse, particularly in

instances where the victim is, in effect, in the custody of the abuser,

or the person who is the abuser has some form of authority or

opportunity because of the nature of their employment. We've had some

specific instances which have led to reaction. I'm not going into

precise detail, but in one instance a person employed in an institution

was believed to have been abusing some patients sexually. It was

brought to the attention of the administration and the person was

suspended for, I believe. three or four days. Immediately there was an

appeal to the suspension, and the matter carried on for a period of

time. We found out about this and asked questions as to: is that all?

It then turned into something a bit more; the RCMP were brought in and

criminal charges were laid. I was astonished that an incident such as

that would be dealt with by way of a relatively light suspension from

duties. If the person were not responsible for the abuse, then why

suspend them at all? If they were, then what is a suspension?

Nonetheless,

it has become far more understood that it's not to be swept under the

carpet. We have had reports of some incidents where a person, again

engaged in an institution of some kind, has been the subject of

accusations of that type of thing and charges have been laid. I would

think the incidence of abuse is far less in our medical or our health

institutions than in others. In most of these areas there is generally

a reasonably large number of staff around at all times. There are times

when the staff is minimal — overnight and so on. We have had very few

reports of sexual abuse in these institutions. I am very concerned

about that possibility and we have instructed a number of the

institutions to provide us with information, including what procedures

they follow, but we have not had large numbers of cases reported to us.

Mr. Chairman, again in general, a national report — I forget the

name of it — which spoke about sexual abuse suggested that there should

be a specific criminal act, rather than a general act that applies to

all, for a person in a position of trust who abuses victims. It also

suggested — which I very much support — not permitting people found

guilty of that conduct to return to that line of endeavour. It

suggested they be disbarred from that particular vocation once found

guilty of breaking that trust. I truly believe we are going to have to

consider that form of legislation across the country and in provinces

because we seem to be in the centre of an epidemic because of the vast

number of reports which are beginning to show up. We could be in two

positions: more of this being reported now than previously, or more of

it occurring now than previously. But it's a very, very serious matter.

I agree completely.

Basically,

Mr. Chairman, a person in a position of trust with people in his or her

custody has an extreme responsibility, and when a patient is in a

hospital or a child is in a school, or a citizen is in any form of

institution where people are responsible for their care, they and their

relatives must be assured that they are not about to be abused. So

we're working toward that end. As you know, we have legislation

specifically with respect to the protection of children which requires

people to report suspected cases of abuse. It leads to all types of fun

and games, but nonetheless it's an attempt to try to bring that matter

to the attention of the proper authorities.

On the alcohol

and drug abuse, I don't think there's a direct relationship to how much

money people in B.C. spend on liquor. The amount the member quotes is

from the sales of our liquor in the liquor stores to citizens,

restaurants and licensed premises. The S420 million is the profit,

which is, I suppose, about half of what they actually receive, because

the markup is about half. But then, of course, much of that liquor is

purchased by licensed premises, who then dispense it to their customers

at a far greater cost. So I would think you might be looking at $1.5

billion — a huge amount of money spent on alcohol in the province.

[ Page 7676 ]

don't think it would be reasonable to suggest that that amount should

be used to rehabilitate people, because not all people who consume it

of course are going to be in need of rehabilitation. The member

mentioned, and he didn't complete his statement but I think I caught

part of what he was saying, that the prevention is far more practical.

Of course it is, just as it is in all matters of health care. We have

introduced various programs by way of education. We've tried to warn

young people, particularly. The Ministries of Attorney-General,

Education, Health, Human Resources and the Insurance Corporation of

B.C. have cooperated with respect to alcohol and driving. There have

been many programs. We do offer counselling. We do have, as the member

said, detox centres and others dealing with the results of the problem.

And we do fund a number of agencies which specialize in treatment of

those suffering from alcoholism.

[Mr. Strachan in the chair.]

There are also a tremendous

number of people who are being treated for the effects of alcoholism in

our hospital system by medical doctors, and so on — after the fact. How

you prevent abuse of alcohol is a problem facing all of society. We

have entered into agreements with various agencies to try to assist

those who are suffering from the difficulties. It is perhaps the

greatest contributing factor to our social services budgets, be it

health, human resources, corrections or whatever. If someone has an

answer as to how you avoid that, it would be most welcome. But I know

tremendous efforts have been made everywhere. The problem does not seem

to be abating. Perhaps the member might have more on that issue, Mr.

Chairman.

MR. HOWARD: I had just earlier reached that phase of the comments that we're dealing with.

think we need to look at who benefits from the consumption of alcohol,

in a very broad, general sense. The minister referred to the $420

million as being profit. He touched his pocket when he did that. That's

money in the pocket. That's profit. That's what it is in terms of

liquor sales. There's another profit as well. That's the profit that

accrues to the producers, to the beer, wine and hard liquor producers

in this land who sell the product, and who promote and advertise it in

the slickest way possible at all possible levels to entice people to

consume it.

I've looked at a number of ads in household magazines, newspapers

and the like, and in not one ad promoted by a liquor company — that I

have seen in any event, although there may be exceptions to this —

has any advertising by a liquor company tried to talk about the damage

that would accrue from alcohol. It's always beautiful, glorious and

sexually attractive, youthful, virile, gay and happiness that's exuded

in these advertisements. If you'll just drink the booze, you'll realize

all those attainments of contentment and happiness and lifestyle and

pretty women or pretty men — whatever you're looking for. The liquor

industry is selling anticipation of something better, and that's what

adds to a great deal of the misery. The profits go to the government —

$420 million of them —

and to the liquor industry and its distribution elements. The misery

and the suffering come to individuals in society, but to society

generally. The misery and the pain and the cost are borne by the

taxpayers. It's the taxpayers who put up the money to keep and treat in

hospitals those people who are impaired or injured by the ravages of

alcohol. The industry does not suffer. Hiram Walker doesn't suffer in

that way; Calona Wines, to name just one in the wine field, doesn't

suffer by that. They are the beneficiaries. They receive the benefits

in the form of profits from the sale of their product.

[3:30]

And the government receives the benefit in the form of profits, as the minister

said. He called them profits and touched his pocket — a $420 million profit.

I submit that this government is looking at liquor no differently than does

the liquor industry. They're both bottom-liners. "What profit can

we reap out of this in dollars and cents that we can stick into the budget and

show that it's there?" You can't stick in the budget family misery

and pain and battered children and broken homes and broken bones. You can't

stick in the budget the common plea of the person who gets drunk and appears

in court on some charge or another, or as a witness, and says: "Your Honour,

I don't remember. I was drunk." You can't put in the budget here

the pictures of people murdered by drunken drivers who end up in court and plead,

"Your Honour, I don't remember. I was drunk," and somebody's

life is snuffed out or they're injured for life as a result of that.

Yes,

many examinations have been made of this. I don't think the government

is trying hard enough. I don't think they're recognizing the

fundamental question of who benefits and who suffers in alcohol.

Industry and government benefit; people are the ones who suffer. I've

advanced the idea on a number of occasions and I put it forward again.

I put it forward in this House a few years ago and the response I got

from the Minister of Health was a simple one: "Oh, if I carried out

that idea, all it would do is to raise the price of liquor." I didn't

think that was of any consequence. The government doesn't look at that

when it comes to taxation. It says: "Let's raise the price. What's the

difference?" They exploit the frailties of human beings who have an

affinity for alcohol or who want to buy it regardless of the cost.

I suggested — and I suggest again —

that we deal with the liquor industry on the basis of its advertising

program, and that for every buck spent on advertising and promoting its

product, the liquor, wine and beer industry set aside another dollar in

a fund. It doesn't really matter to me whether it's a government fund

or an independent group fund. Dollar for dollar advertising — that extra

dollar can be used to advertise and educate and promote and give the

balance factor. The liquor industry's sole interest is in selling its

product; it doesn't give a damn about the results on society or people.

Individuals in the industry probably would. The individual president of

a corporation may have that feeling about the damage that accrues, but

the industry per se is an inanimate object and the corporation per se

doesn't have compassion or a soul. It only has a bottom-line approach:

how can we expand our profits today?

I'm saying that the

beneficiary, he who reaps the benefit in dollars and cents from the

sale of liquor, should also put up money to deal with the misery part

of it. It shouldn't be all one-sided. I urge the minister to look at

that as a possibility, and perhaps find a sufficient amount of money

that we can engage in an educational and promotional campaign to talk

about moderation in alcohol use. All the general public is getting now,

with the full endorsement of this government, is advertising that says

liquor is glorious and beautiful, it's the way to go, and no damage

will ever accrue to you if you drink this brand of gin or that brand of

scotch or this kind of wine, or

[ Page 7677 ]

whatever

it is that they're promoting. If we don't do something of that nature,

we'll be having this same debate next year and the year after and I

don't know how long into the future — if we don't take a dramatically

different view of it and ask the people who are reaping the profits to

also share in some of the misery on the dollar side.

MR. DAVIS:

Mr. Chairman, I want to make several points and ask one or two

questions. The first point I would like to make is that not only do we

appear to have kept our health care in this province under control, but

that our health care costs, relative to the total income of the

province, are quite low. I don't really understand what the reasons

are, but in the United States more than 10 percent of the gross

national product goes to pay health care costs. In this province the

figure is somewhere around 7.5 percent. It is around 7.5 percent across

Canada. While our health care costs have risen substantially over the

last decade, they have, by and large and especially in the last few

years, mounted more or less in line with the ability to pay of

Canadians and in our case British Columbians.

So I think

that the minister and certainly the government and indeed a succession

of ministers should be complimented for the containment of health care

costs relative to other countries. Even in the United Kingdom, where

per capita incomes are much lower than in the United States, the health

care cost proportion is more in the order of 8 or 9 percent. So we have

in this country and in British Columbia a remarkable record in this

regard. I would like to hear from the minister why he thinks we in

Canada and we in British Columbia in particular have been able to

contain costs to this extent, particularly because the quality of

health care service here is so good and because it compares favourably

with those services delivered in other countries.

I would

in this connection like to quote a recent report on health care funding

in B.C. The quote is from the B.C. Economic Policy Institute, which,

while critical of some aspects of health care administration in the

province, has this to say:

"Restraint is no

new phenomenon in the health care area. Despite periodic claims of cost

explosions by various political figures, the Canadian medicare program

has achieved a degree of stability. Health care costs in Canada have

run between 7 percent and 7.5 percent of GNP since the early 1970s.

B.C.'s health care costs have risen somewhat faster than the national

average, Between 1970 and 1981 they increased their share of provincial

output from 6.8 percent to 7.5 percent. But the key point of these

figures is that the Canadian form of funding universal, comprehensive

and public insurance has made cost control possible, at least thus far."

a pat on the back from a left-leaning institution which otherwise was

critical of health care. Certainly they were saying that performance in

terms of cost containment was reasonable and compared favourably with

other administrations.

I would like the minister to tell

us, if he can, the extent to which we have been able to contain our

costs by treating people at home, treating them outside of expensive

institutions like modern hospitals. That has to be a contributing

factor, and I know that the ministry has further plans in that

connection.

Doctors' fees, more particularly billing

numbers. I understand from several people in the medical profession

here in B.C. that no new billing numbers have been issued for some

time. We had legislation last year which empowered the government to

deal directly and forthrightly with the numbers of doctors in the

province. I gather that by 1983 some 400 new billing numbers were

issued; in 1984 some 260; in 1985, how many? In the last six or eight

months, how many? My impression is that zero or very few if any new

billing numbers have been issued. And in the face of the fact that

taxpayers are paying for and graduating a hundred or so new MDs a year

from our centres of higher learning, what are the longer-term

intentions or plans of the ministry? We've had a bulge in admissions.

We are overdoctored in this province. The doctors themselves agree

about that. There has to be some way, if not immediately, of

rationalizing our expenditure on the education of young doctors, and

the fact that for the time being at least, we are not admitting more of

them or any additional doctors to practice via billing numbers in the

province.

There is an attrition of a hundred or so doctors

a year. Could we have a policy where we were educating of that order of

young doctors and they have some priority in entering the medicare

system in this province — in other words, in obtaining billing numbers?

realize this is a problem. It is not a problem unique to British

Columbia, although we have a unique way of dealing with it. The

profession across Canada — certainly the health ministers — agree that

we have too many doctors. We also appear to have too many doctors in

our major metropolitan areas and, in some instances anyway, not enough

doctor care in the outlying areas of Canada and of the province.

Ontario has a financial incentive for doctors to serve in smaller

communities in northern and western Ontario. I gather that the

incentive for a family practitioner in northern Ontario is currently of

the order of $40,000 and is income-tax-free. It's certainly

income-tax-free from a provincial point of view, and it is paid

quarterly — $10,000 a quarter — to doctors practising for a period of time in those outlying areas.

What

do we have? What do we intend to have in order to give an incentive for

doctors, young and old, and particularly our new young doctors, to

serve in those under-doctored areas of the province? Have we a

longer-term objective? Have we a plan other than simply limiting

billing numbers in the greater Vancouver area drastically and perhaps,

over time, issuing billing numbers in some of the under-doctored

regions? Do we intend, in other words, to introduce an incentive plan,

as opposed to one which is directly administered by a committee largely

of doctors, who determine where the regional requirements are in the

province?

Last year — on August 1, I believe — the Health

ministry decided not to extend publicly financed health care coverage

to foreign students. I'm not talking about landed immigrants or

Canadians whose parents — or, indeed, they themselves — came to Canada

in the not-too-distant past; I'm talking about people who have visas,

who are foreigners. As of August I last year they ceased to receive

tax-supported health care coverage and had to go, if they wished

coverage at all, to the private market. I agree with that policy; I

think it makes good sense. But there are several cases I currently know

of in which people who have obtained Canadian citizenship have returned

to their country of origin because of financial and other problems

here, and are now sending their children back for various reasons: one

is the low cost of education here;

[ Page 7678 ]

another is to escape the draft in Iran —

or whatever. I would hope that the minister would continue that policy

of not giving them any more financial incentive to come here.

[3:45]

Finally, a serious problem area —

the rising cost of no-fault insurance carried by doctors. Plans of that

nature are being discussed in the United States, especially where the

annual cost to a doctor of covering the likelihood of lawsuits is now

running at $10,000 a year, and in some instances $50,000 and $100,000 a

year per doctor. There is some increase in settlements here, and there

certainly is concern about this. I've been told by doctors practising

in the province that not only are they concerned about exceptional

settlements which might go against them, but also, because of the fault

system that we have, the adversarial system in the courts, that they

can be sued for not having carried out all conceivable tests in a given

set of circumstances. In order to cover themselves, they are calling

for all kinds of tests at great expense to the taxpayer, when common

sense tells them that only a few tests would do, would focus in on the

problem as they see it developing with their patient, and that this

problem of insurance is therefore adding materially to the costs of

delivering health care here, because it's adding immensely to the

testing, to the laboratory expenses of our health care program. I

wonder if the minister might care to comment on any or all of those

points.

HON. MR. NIELSEN: ML Chairman, the health

care costs.... I'm not convinced that a percentage of the gross

national product is the only way to measure, although it's a consistent

factor you can reflect on.

One of the features, I guess, of

the system in Canada is that we do not have practitioners engaged in

the financial obligations of the facilities. There is no advantage to a

practitioner having a patient in hospital with respect to profit,

whereas if you are an owner of the facility you may be also interested

in maintaining maximum use of the facility by patients. That could be

one reason.

But it's interesting, the dilemma country to

country, by comparison, because in some countries the utilization of

hospital space is grossly inefficient compared to Canada, and yet our

utilization appears to be grossly inefficient compared to many

institutions in the United States. The average length of stay for an

acute-care patient in B.C. Is about 7.6 days, down from about eight a

few years back, when we asked them if they could speed up the admission

and release programs to get people in quicker or out quicker, and thus

reduce the average length of stay. So it's down to about 7.6. In

Washington state the average stay for acute-care patients is about 4.3

days. The obvious reasons for it: there's a tremendous financial

incentive to get out.

I was in Los Angeles last year at the

Cedars of Sinai Hospital, where I was advised that their per diem rate

is $1,600 a day. Patients who in our system would be admitted to

hospital the previous day for, let's say, bypass surgery arrive at that

hospital frequently the day of the surgery to avoid that extra charge

and are released much quicker than our patients might be. So there seem

to be inconsistencies, where their system seems to have certain

efficiencies from a turnaround point of view, but the costs are

extraordinarily high.

Our institutions are quite different

than many of theirs, where they have private facilities that really

look like headquarters of international banking corporations, with

tremendous duplication of equipment. The hospital I was speaking of was

designed in such a way that each floor is a self-contained hospital

with laboratories, radiology, operating theatres and so on. So the

patient never has to leave the floor. It's awfully expensive to operate

that way — and four and five nurses per patient in the intensive-care ward.

[Mr. Ree in the chair.]

we have developed tremendous efficiencies, I think, in the health care

system across Canada, probably in B.C. as well, because we have far

more direct control in the big spending areas, and we've had some

success. We've also put on the pressure. B.C. at one time was leading

the way across Canada in health care costs. We still have the highest

fee

schedule by about 30 percent, but in all aspects of our health care

system B.C. was leading the way, and we were subject to a tremendous

amount of criticism from the other provinces for excessive settlements

for health care workers and doctors.

That has been reversed considerably, and now we are the only province that I'm aware of — perhaps Quebec has a similar system —

where we have introduced a partial capping method for the medical

doctors. I'm advised that the CMA has expressed very strong opposition

to that concept with the BCMA people, but we've had some success.

The

savings for patients outside of hospitals is only measurable with

respect to what we pay per day compared to what we would pay in a

hospital. The saving to the system, however, is not the same, because

while the patient is relieved from the hospital care and sent home,

someone else takes their place in the hospital, so the cost is still

there, with an additional cost for the patient at home. The cost for

the individual patient, of course, is considerably lower. I think the

big saving we're seeing is coming about by substitution — by way of day surgery rather than in-patient surgery —

where patients are using minimum facilities in a hospital for the

surgical procedure and then being released and going home that day

rather than utilizing the full bed.

I mentioned earlier,

Mr. Chairman, the use of high technology such as the lithotripter.

That's an absolutely amazing comparison. The lithotripter for kidney

stone disintegration permits a patient to be released the same day

rather than stay in for eight days at a cost of several hundred dollars

a day, so that is a tremendous saving, and more will be coming.

The

question of billing numbers is before the courts, isn't it? It is

always before the courts. I think we've had four or five cases. Mr.

Chairman, you may recall that the government lost a case in court, and

our Medical Services Commission was ordered by the court to issue

numbers, in effect. We had been doing very well trying to contain the

numbers. In 1984 there were 258 numbers issued. We got into the glue in

1985, and by way of court instruction had to issue certain numbers. In

1985, 455 numbers were issued, 281 permanent, 174 locum; 258 the year

previous and 455 last year. We do have too many doctors in B.C.; the

doctors acknowledge that. We tried to do something about it, and we've

been challenged in court repeatedly. So we will continue to pursue that.

The

question of medical coverage for foreigners. Last August, as the member

mentioned, changes were made with respect to the definition and

eligibility of people in Canada for the Medical Services Plan. It

centres around the definition

[ Page 7679 ]

"residence" and also "visitor." The people the member spoke of would be

regarded by the definition as visitors to Canada. One of the reasons it

was changed was a matter of consistency and equality for all

non-residents in Canada. If a person visits us from Seattle as a

visitor, they are not eligible to be covered by our plan. If a person

visits us from another country by way of some other method of coming to

Canada, they are not eligible for the plan.

We have a large

number of problems and a continuing argument with the federal

government about ownership — we'll be here until Monday, anyway — of

these people. Our argument is that if the federal government permits a

person into Canada as a refugee, a visitor or whatever other status,

they should be responsible for that person's costs, rather than the

provinces.

We've had a poor fellow in the hospital now for

two or three years with a kidney disorder, and I think he owes the

hospital about $800,000 or somewhere near that. The costs are just

incredible. The man is not eligible for the coverage. Of course he

hasn't paid it, but we've asked the federal government to please send a

cheque forthwith for our costs in taking care of their patient, and

they have said no. We've tried to encourage these patients to return to

their homeland, and we would also assist them medically. But that's

been turned down as well.

But I think it is improper for

Canada to permit a person into the country who then requires extensive

medical care and then to say to the provinces: "Pick up the tab." We

did not permit the person in. They're here, and I think we have to say

that our program is paid for by the citizens of Canada for the citizens

of Canada and those who are eligible for that status, including landed

immigrants and others. We've had some flack about it, but we're not

doing too badly, I think.

The member asked about the

liability insurance. Mr. Member, I have some specific numbers which may

be of interest. The liability premiums have risen in Canada from $50

annually in 1973 to $500 by 1983. In 1984 a differential fee structure

set higher fees for hire of specialists up to $2,900 per annum. The

Chair may be interested that a second-year gynaecologist in New York

state is required to pay about $90,000 in premiums yearly. The doctors

are very concerned, as we are, because the money does come from the

taxpayer by way of a portion of the fees. The hospitals are also faced

with this liability insurance problem, as are municipalities and so

many others. I think there is going to be some resolution to it. We

have suggested that it is worth considering with the doctors that

rather than the coverage, the traditional method of insurance, perhaps

there could be a fund established, jointly funded in some way —

basically self-insurance. I think perhaps that is the only way to go.

MR. DAVIS:

I just have one specific question in one area, really, relating to

children born at Grace Hospital. I wrote to the minister last year and

asked how many children had been born in the Grace Hospital, and in the

calendar year it was about 7,600. Of that figure, some 5,700 were

covered by the B.C. hospital plan. Therefore some 1,900 were not; and

there were 70 out of province. So there was a substantial remainder in

the order of 1,600 to 1,700 babies born.

They are,

generally speaking, born to foreign people who either come here and by

accident had a baby here but more likely come here by design. They

first, I believe, pay average cost. They are not subsidized in any way.

I'd like the minister to confirm that. My comment really is that a

child born here, in the fullness of time and certainly at reaching

maturity, is a Canadian citizen. Not only can that Canadian citizen,

having been born here, come to Canada as a Canadian citizen at any

time, but that person can also bring younger brothers and sisters and

parents to Canada upon reaching majority.

[4:00]

Has

the provincial ministry expressed any concern whatever about this

particular category of coverage. Obviously facilities are being used in

the province by outsiders, and I think a good many of them for the

purposes of obtaining Canadian citizenship. Does the minister think

this presents a problem of priorities in getting into Grace Hospital

and other hospitals in the province when outsiders are tending to use

our system as a way of obtaining Canadian citizenship?

HON. MR. NIELSEN:

The utilization of Grace Hospital is of major concern. It is not the

foreign visitors who have arrived who are the major contributing

factor; it is the tremendous success of the Grace Hospital as a

tertiary centre for maternity cases, and the popularity of the facility

to the point where people who would otherwise go to their community

hospital are booking into Grace Hospital, and it is being overutilized.

There

is an element of births resulting from intentional visits to Vancouver

by people from other countries. I believe the member is probably quite

correct that it is primarily for the purposes of Canadian citizenship.

There are distinct advantages to having Canadian citizenship, and in

certain areas of the world where there is tremendous political unrest,

parents are considering having children born in Canada so that child

will have the right to Canadian citizenship in the future. Thus, having

that, they would be in the position to sponsor relatives as well to the

country. So there is no question that part of that is occurring.

don't think it's causing an overcrowding at Grace Hospital. Grace

Hospital has worked with all of the other hospitals in the metropolitan

area to try to get them to make better use of their own facilities

rather than automatically sending patients to Grace. It was designed

for 6,500 to 6,700 deliveries annually; in 1984, there were 7,474, so

it is being overutilized at the moment and we are trying to do

something about it.

The member is correct. The people who

are not covered by our plan do pay the actuarial price, which is still

pretty cheap for them compared to some international standards, and

they don't spend that much time in the hospital. I don't think it's the

major element, but it's part of it.

MR. LOCKSTEAD: I want to thank the member for deferring to me because I have to be somewhere in a short while.

Firstly,

I want to say that I don't want to break up the thread and trend of

this current debate, and I want to associate myself with the remarks

from our caucus spokesperson, the member for Burnaby North (Mrs.

Dailly), but I have two specific matters to bring to the minister's

attention involving my constituency and I welcome the opportunity to do

so now.

The first is the construction of a new hospital in

the Powell River regional area. For some years, as long as I have been

an elected member of this House, this matter has been under discussion

with various ministers of health, particularly over the last eight to

ten years. That hospital board and regional board has, over the years,

slowly been building a construction reserve fund for this purpose and

has acquired

[ Page 7680 ]

the

property near the populated area of the community. What I am asking the

minister in terms of that is if the ministry has any plans to work with

the hospital board in the Powell River regional area to start

construction of that Powell River regional hospital.

In all

fairness I should tell you that I did pose this question to a recently

former Minister of Health, and he was very obliging. I hope the

minister is listening, because this is quite important; it's the reason

I'm on my feet here today. The then Minister of Health of a few weeks

ago did respond to my correspondence, and did imply in that

correspondence that that this matter would be a priority item within

the five-year hospital plan of the ministry. But I'm suggesting to you

that a more specific date or answer would be appreciated.

rarely invite cabinet ministers to the riding. However, on this

occasion, if the Minister of Health would like to visit the Powell

River area, and perhaps do a little politicking for his party on the

side — yes, you're welcome — and visit the hospital and look at the

equipment, and meet with the administrator and members of the board,

that would be appreciated. So you've got an invitation — might even get you a salmon or something.

Interjection.

MR. LOCKSTEAD: Well, the local Socred will look after that.

We have, Mr. Chairman, a matter that is just as serious. This is St. Mary's Hospital in the Sechelt area —

the one hospital, aside from the clinic at Pender Harbour, that serves

that whole Sunshine Coast. They urgently require a new wing for

extended care. That area has a large proportion of senior citizens.

It's a great retirement area. People are moving in all the time for

retirement purposes. Once again, I'm requesting firmly in this House,

and for the record — because you have all of this in your correspondence, I know —

that that particular very much needed project be undertaken just as

soon as possible. It's my understanding that people who require

extended care in that area from time to time actually have to go to

Vancouver, Powell River, Courtenay or other hospitals, as I understand

it. That's secondhand information. Nonetheless, perhaps the minister

could give us some idea where this matter is on his priority list or on

the ministry's list. While you're in Powell River, you may as well take

the ferry and go down the Sun shine Coast and visit St. Mary's as well.

HON. MR. NIELSEN:

To the member for Mackenzie, Mr. Chairman, there were two projects

being considered for Powell River General Hospital. One is a 75-bed

extended-care unit. Then there's planning for a new acute-care

hospital. The planning for the extended-care unit is much further

advanced than for the acute-care one. Both are in the pre-planning

process — although I think the extended-care unit is in the planning

process now. I couldn't offer a date. It is, as you were advised,

within the five-year capital program. I wouldn't know precisely where.

We have never attempted to provide a date, other than when we are

assured it will be within the fiscal year. We've always tried to wait

until we know which fiscal year it will be in, and then made that known

during that fiscal year, or just prior to it, so that they can then

begin the process. You could tell them it might be in a couple of years

and then, for whatever other reasons, it can't happen. Sure, I'll go up

there.

Interjection.

HON. MR. NIELSEN:

Is there any doubt? I'd be pleased to go up to Powell River with you,

visit the hospital and look around a bit. Work out a time, and we'll go

up and see it. But I'll have to do some digging to see precisely where

they are at the moment. I'd be pleased to accompany you up the coast,

and we'll have a look at these facilities as soon as we can. How about

tomorrow?

[Mr. Rogers in the chair.]

St.

Mary's. The planning for a 50-bed extended-care unit, expansion of

associated support areas, planning for.... This is just on St. Mary's.

There's an extensive request from them — about $6 million. At the

present time the action is the planning for the 50-bed extended-care

unit. I believe I will be meeting with these people very soon. I think

they've made an appointment to come down and talk about it. They do

have a request before us, and it's still being considered. But I can't

give a specific date.

MR. STUPICH: I have a specific

complaint to raise on behalf of a constituent, and then a more general

concern in connection with the same thing. It's from a letter — a file of correspondence, actually —

from a constituent of mine, a Mr. Walter Ward. He wrote to the then and

current Minister of Health on November 19, 1985. I talked to him as

recently as today, and he was a bit upset that I couldn't raise this

matter with the Minister of Health, who was also then Minister of

Health. And I said: "Well, things have changed. By tomorrow maybe not,

but the Minister of Health today is the Minister of Health who was in

office on November 19."

"Dear Mr. Minister:

receive handicap assistance. My lower jawbone has shrunk to such an

extent that it will no longer hold a denture. My gums are constantly

irritated and my speech is affected. Since I am unable to properly chew

solid foods, I have constant indigestion and stomach pain."

sent a copy of that letter to the Minister of Health and to the

Minister of Human Resources. I was able to tell him that it is one and

the same person today, although he was Minister of Human Resources

yesterday for the purposes of estimates. He has received a reply from

the Minister of Human Resources telling him that there was nothing that

that ministry could do for him. What his specialist wanted was

financing for a special material — durapatite. The Minister of Human

Resources, in expressing concern for him and saying that her ministry

could do nothing, did say in her letter:

have taken the liberty of sharing your letter with my colleague the

Hon. James Nielsen, Minister of Health, as hospital programs fall under

his jurisdiction. The Minister of Health may be able to assist you.

His

concern was that he wrote the letter to both of them on November 19,

1985. He has yet to have any response from the Minister of Health,

which surprises me. I think it must be an oversight. Knowing this

minister's record in that regard, I think something has gone astray.

wrote again on January 23 to the Minister of Health, and mentioned the

letter that he had written to the Minister of Health on November 19,

saying that he had written to two ministers and had had a reply from

one, and had still not

[ Page 7681 ]

heard

from the Minister of Health. He had a date for surgery approved, and in

this letter says: "Since you did not answer my letter, my surgery,

after several months' wait, had to be cancelled. You know very well

hospital beds are very hard to come by."

[4:15]

Along

with the correspondence he includes a letter from the oral and

maxillofacial surgeon. The surgeon said that there are three possible

ways of dealing with this situation. The most inexpensive would be

through day-care surgery, which could be done locally, but which

involved the use of this durapatite. That was the most inexpensive from

the point of view of care or lost time: it would take just day care,

whereas the other two possibilities would both involve travelling to

some other community to see an orthopaedic surgeon as well as an oral

surgeon. Yet it would seem that the rules of the game would provide for

that kind of operation to be done in Vancouver for him, but would not

provide for it to be done locally since he's on handicapped assistance

and couldn't afford to provide the durapatite material himself.

But

really, he would like to have some response from the minister. I'll

make a copy of this file available just so that.... I can appreciate

that. But my more general concern is with respect to.... I talked to

the oral surgeon, and he said it's not really just a matter of this

durapatite, but a matter of prosthetic devices that are surgically

implanted. Generally they're just not provided for under the medical

health plan, I understand. I understand that that's the case, but I

don't understand why it works that way. I believe, from what he told

me, that even in the event that he has patients — which he has — who are

quite able to pay for this on their own, the hospital just can't have

that material on hand that the surgeon can then implant and have the

patient reimburse someone for. That surprises me. I just don't know

that the system works that way, but that's what the oral surgeon, as I

took the conversation on the telephone, told me. He believes, from his

letter, that this is much the best procedure. I'll make a copy of his

letter available to the minister as well, although he didn't want his

name used in this discussion. My constituent had no concern.

Apart

from that, I have had other correspondence. Every one of us on both

sides of the House, I suppose, could complain about this. There are

stories.... I had a letter from someone who was in the hospital who had

nothing but good things to say about the attention the staff gave, but

was concerned about the fact that the staff were just hard-pressed —

they weren't able to provide the level of service that this patient

felt would help her recover from the condition for which she was

hospitalized. There's a story here that was in one of the local papers,

the Nanaimo Times — "Heavy Hospital Workload." I have a photocopy here and the original elsewhere.

"My

wife spent ten days in Nanaimo Regional General Hospital recently with

a serious infection. We were both impressed by the care given by the

doctors and nurses, especially during the critical phase of her

illness. However, we could not fail to notice the extreme pressure the

nurses were under to maintain the required level of care, given their

heavy workload. This became even more evident as my wife's condition

improved and the nurses' attention shifted to newly admitted critical

patients."

I notice the minister, in responding to a

comment from the hon. member for North Vancouver–Seymour (Mr. Davis),

said that where people had to pay the whole shot themselves for a

hospital bed in the U.S. A., their time in hospital is much less. I

don't know of any patients in British Columbia, or anywhere in Canada,

for that matter, who decide themselves when they can get into a

hospital and how soon they should leave. It seems to me that that

decision is made by the doctors. If the system is being overutilized — if the hospitals are being overutilized —

then it's something that should be taken up with the doctors. It's not

the patients who should be suffering, and unfortunately that's what's

happening, because of the workload and because of the fact that there

are limited funds and because some people are taking advantage of the

situation — and not the patients; it's the doctors.

Now

I'd appreciate the minister's comment maybe on that. I don't know what

he can do about it, but it would seem to me that it's nothing to do

with the patients. They just don't make the decision.

HON. MR. NIELSEN:

Mr. Chairman, I usually can recall all the correspondence, and I do not

seem to be familiar with this. Now perhaps the gentleman.... If he's

tried twice, I'm not wishing to pass the buck to him — perhaps the

address has been wrong or something, because I just don't recall it.

The deputy does not recall having seen it either, so there's maybe

something wrong somewhere, but I would be pleased to get the

information.

The last comment with respect to length of

stay in hospital: the patient has a certain amount to do with it. They

could do a little lobbying with the doctor to stay in a day or two

longer. We get this frequently in maternity situations where the mother

may want to stay in for a day or two just to rest. It seems to be

inappropriate to have a hospital setting for that, but we do get that.

The doctors basically are responsible for the ins and outs.

One of the reasons why sometimes the staff appears to be overworked.... And they do work hard — I'm not suggesting they don't —

but the 12-hour shifts certainly take their toll. A 12-hour shift is a

very long time, particularly in nursing, if you are in an intensive

area. A 12-hour day is a long work day, and some of them get pretty

ragged before that day is over.

Nanaimo hospital is a

burgeoning hospital; it has been. Its location has just been that way,

and as the member would know we have approved, I think, a 150-bed

extended care which will offer some relief to the hospital.

Interjection.

HON. MR. NIELSEN: Yes. Well, Nanaimo is growing very rapidly too.

AN HON. MEMBER: Not right now, but....

HON. MR. NIELSEN: It has been.

But the figures indicate that by provincial standards they have more

nurses per patient on average than the others — not a huge amount more,

but an identifiable percentage more.

The rule of thumb for devices is — let's see now —

if you can take it out, it's not paid for, but if it stays in as part

of a procedure in a hospital, it is. I'm not that familiar with this

procedure, but if as an example the implantation for a lens is in the

eye, then it's covered, but contact lenses that would go on the outside

are not. But I will respond directly to that letter, and if you're

talking to the gentleman, I'd appreciate you

[ Page 7682 ]

saying that I just don't recall having seen it, but we'll certainly look into that.

MRS. DAILLY:

Mr. Chairman, I want to turn to the topic of abortion, birth control,

and I must say that I find it necessary to take to task you as one of

the former Ministers of Health, as acting minister — and also the... I

guess the former Minister of Health, the member for Vancouver South

(Mr. Rogers).

the present Minister of Health, I believe it was in 1983 that you were

responsible for cutting off the grant to the Planned Parenthood

Federation. I think that was a tremendously backward step which has had

some bad effects on a number of people in this province since that move

was taken. I consider it, to put it quite bluntly, a step based

obviously on ignorance, because I can't understand the Minister of

Health, who certainly is an intelligent person and who has shown so

throughout all our debates.... I just cannot understand with his

background how he could possibly cut back a grant in 1983 to Planned

Parenthood.

What is even more astounding is that the former

Minister of Health, the member for Vancouver South, actually made

statements on the matter of the government's decision to cut preventive

programs, such as the aid to Planned Parenthood — actually spoke in

terms, Mr. Chairman; I've been waiting for you to be in the chair; you

can't get back to me right now.... Anyway, Mr. Chairman, I found the

terms in which it was couched.... His reasons for supporting the '83

move to eliminate the Planned Parenthood grant were based on statements

that would have fit in more with 1846 than 1986 — again, I feel, based

on complete ignorance. I find it astounding that any ministers of the

Crown in 1986 could have made such statements as were made by that

minister re this matter.

To make my point, if I may just quote from the Province ,

March 30, 1986: "Rogers defended the government's decision to cut

preventive-program funds for groups such as Planned Parenthood in the

1983 restraint budget, saying that most people, including teenagers,

are aware of birth control methods. It is not the state's job to ensure

everybody take care of themselves, and the problem is one of attitude,

not ignorance, he added." As I have said before, I'm afraid that the

problem is the ignorance of the Social Credit ministers who actually

believe that nonsense.

Mr. Chairman, for the edification of

the Chair and the other members on the Social Credit side who obviously

support this, may I point out to you, first of all, that each day in

B.C. — and these are figures for a couple of years ago — 18 teenagers

become pregnant. On the average, ten of the girls, little more than

children themselves, decide to bear their babies and nine of them

choose to raise them for adoption. That's just some figures that we

have from a few years ago. The point I want to make is that it is known

all across Canada and the United States, through many studies, that the

rate of teenage pregnancy in Canada drops when sex education takes

place in the schools and public birth control clinics are funded. Those

are statistics, and this government.... We have cabinet ministers who

make statements that fly completely in the face of the facts. I find it

incredible. Let me say this again. The rate of pregnancy in teenagers

drops. After a study it was found that it drops because of sex

education in schools and public birth clinics.

So here we

have the Social Credit government, through the voices of Ministers of

Health, the ones who are in control of this, saying that it's all a

matter of attitude, that women.... Actually, and may I quote again from

the Province of March 30, Mr.

Rogers went on to say: "Women are either blase (about birth control) or

whatever. They don't think about it." Asked if women are using abortion

as a form of birth control Rogers said: "You know it's true. I know

it's true. Of course they are." Of course, a man has never had to have

an abortion and never will, but I can assure you that for any woman

I've talked to who's had an abortion or any woman who has to be faced

with it, it is a dreaded thing that women do not look forward to. To

suggest out of ignorance that women would want to use this as birth

control is, as they say, completely based on ignorance, shocking

ignorance.

To suggest that all women, teenagers included,

in this province of British Columbia know all about how to prevent

pregnancy is utter nonsense. Teenagers today may appear very

sophisticated and very blase, but let me assure you that if you talk to

many teenagers today and you start asking them specific questions about

birth control and about how the child is created, how you become

pregnant, I would suggest to the Ministers of Health that you would get

a shock. They're making statements — one, particularly — presuming, out

of ignorance, that all teenagers are right up to date on all this, that

are absolutely false, particularly in the province of British Columbia.

Ever

since the Social Credit government came into power back in 1975, it has

very carefully refused to move on this area of sex education in our

schools. I know the present Minister of Health will stand up and say:

"Yes, there are programs going on." But they've only been dragged in

without any leadership or help from Ministers of Education or of

Health. There has been no real cooperation or leadership given by the

Social Credit government to this matter.

At the same time

that we have these Ministers of Health not doing anything to encourage

and do away with ignorance, which is not their fault, in our teenagers

by encouraging good sex education in our schools — and, may I say, of course, funding birth control clinics —

they are decrying the fact of high abortions and the high number of

teenage pregnancies. That wasn't stated by either of the ministers, but

I have the figures here for that.

The member for Vancouver

South, the former Minister of Health, has certainly decried the fact of

abortions. I must simply get this on the record: I think that the

Ministers of Health of the Social Credit government are doing an

extreme disservice by turning their backs on real support for sex

education in our schools and turning their backs on helping Planned

Parenthood to do their job. I find it absolutely unbelievable.

[4:30]

All the costs that arise —

not only the social costs and the emotional anxieties from young girls

becoming pregnant, but the cost to society at large.... Let me give you

an example. Do you know, Mr. Chairman, that $1 spent on prevention of

teen-age pregnancies will save $10 in social services. Even though you

may be reluctant, on a matter of principle or philosophy, or whatever

it is, to endorse birth control clinics and sex education, you still

have a responsibility to look after the taxpayers' money, and you're

not doing that when I can give you these figures that $1 in prevention

saves $10 in social services.

Here is another example. In

the United States, do you know how much money is now spent on support

services because of teen-age pregnancies?

[ Page 7683 ]

I do hope the Chairman doesn't have to leave — not that I don't care

to see the new Chairman, but.... However, you can read it in Hansard .

(Mr. Strachan in the chair.]

Mr.

Chairman, do you know that in the United States, $17 billion has had to

be provided for support services in health care, etc., because of the

teen-age pregnancies that take place in the United States. Yet we have

the president and other groups who are doing nothing there — in fact,

they're doing the opposite — when it comes to preventing these

pregnancies.

really feel that any government in 1986 that comes out with these kinds

of statements.... I find it abhorrent and I find it tragic, because of

the tragic victims of those policies. I don't want to appear to be

lecturing to the ministers; I simply want to say to you that I believe

you have a responsibility in this area. I would like to hear from the

present Minister of Health and know his reasons for cutting back on the

grant to the Planned Parenthood Association. I would like to know if he

will reconsider reinstating that grant. I would like to know if he

endorses the statements on abortion made by the former Minister of

Health. I think we simply owe it to the many people who have been upset

by those statements, and by the government's policy, to have an answer.

I would like to hear from the minister on those.

HON. MR. NIELSEN:

Mr. Chairman, I'm trying to remember all the details associated with

the Planned Parenthood Association, which is a private organization. I

mean, they have an attitude and a product to sell, and we....

Interjection.

HON. MR. NIELSEN: Well, sure. We decide whether we're going to contract their services. We decided not to.

I said, for a number of reasons, one of which was that the services

they offer are available elsewhere. We're not obliged to continue

contracts with one organization when there may be a similar service

available from others or in some of our other clinics or through

different forms of counselling. The Planned Parenthood Association is

just one of many available and we're not obliged to continue grants to

these organizations indefinitely. We do make decisions and make

modifications as to whom we fund.

They had 17 birth

control/VD clinics across the province. The grant portion of the

funding was terminated. The Medical Services Plan continued to provide

payments to the association for their physicians. The member may be

interested that in 1982-83 they received $115,000. In 1983, as of

September, they received $50,550. In 1985-86 they received $115,000.

The payments made to them in 1985-86 were $115,000 from the Medical

Services Plan, so they are still receiving moneys, but not the grant

portion. We provide free space to the association in our health units

and, as I said, payments from the Medical Services Plan totalling

$114,500, so their physicians may continue their service. So we are

still supporting them.

I'm trying to get some vital

statistics for the last year, and I know the book is on its way,

because I don't know what the numbers were for the last year. The book

has just been produced, I believe. In fact, I don't think I've tabled

it in the House as yet.

Interjection.

HON. MR. NIELSEN:

Far too many, I believe. Sex education does take place in our schools.

There are programs available. I think we're looking at the age 11 and

Interjection.

HON. MR. NIELSEN: It

may be. But it does take place. It may not be the best program. I

recall the great furor over sex education in schools. I also recall

some of what I consider to be the errors made by some of the

proponents, and the extreme reaction by those who oppose it.

Mr.

Chairman, I think it's absolutely essential that young people have

access to information that would be useful to them to avoid unwanted

pregnancies. The alternative is unnecessary agony for our society. I'm

not speaking about the costs; I'm speaking about the individual

difficulties.

We receive a tremendous amount of

correspondence on abortions. We receive perhaps an equal amount from

the two sides of the question: those who are opposed to abortion, and

those who are in favour of wide-open laws permitting abortion; those

who identify themselves as the right to life, and those who identify

themselves as the right to choice. I'm not taking either side. The

government of British Columbia is obliged to follow the laws of Canada.

The laws of Canada permit therapeutic abortions. The Criminal Code of

Canada permits therapeutic abortions where a hospital board establishes

a therapeutic abortion committee and each application for an abortion

is reviewed.

MR. COCKE: They're supposed to be obliged to do that.

HON. MR. NIELSEN:

It's optional, Mr. Member. They must establish a committee before they

can consider abortion. When an application is made for an abortion, the

committee must approve the application before the abortion can take

place; that is the law of the country. There is an option by a hospital

board to determine if such a committee should be established. It's

certainly an issue that is not going to go away. It's revived rather

regularly, and the same opinions are offered each time.

One of the alarming figures — and I don't have the information immediately before me —

is not just in teen-age pregnancies; it's also quite alarming to see

the number of older women who are having abortions. You wonder if

indeed education is the only factor. You will see in the statistics the

various categories in age only. It's rather surprising to me that

abortions involving people of more mature years are still showing up.

So it's not a matter of just education; there's another element as well.

It's

a problem that I hope some day we can resolve. I agree with those

members who talk about the need for education. Unfortunately, parental

responsibility is part of that education program. I don't think parents

can simply say it's up to the schools to teach certain things; parents

have a very real obligation as well. Perhaps better information could

be made available to them.

I think that pretty much covers it. If I get those statistics later, I might make mention of them.

MRS. DAILLY:

Mr. Chairman, I find it most interesting when the rationale given by

the minister for not funding Planned Parenthood is: "Well, you know, we

contract it out.

[ Page 7684 ]

It's

a private institution." This is the very government, since they came

into office, that has talked about less government involvement and

assisting the private sector more and private groups. It shows that

this can be just used.... Mainly underneath it is what you really

believe in and what you don't believe in philosophically. As far as I'm

concerned, to continue the funding of Planned Parenthood, which is a

prestigious, well-recognized organization, is

an act of faith in the

work that those kinds of groups are doing.

Interjection.

MRS. DAILLY: Did they get that? But you did cut back on them.

So you have shown them that you do accept the fact they have some responsibility. But when you start....

HON. MR. NIELSEN: No more than any other.

MRS. DAILLY: Oh, no more than any other. The point is that leadership from the government is all-important in this area.

When

the minister mentioned the area of abortion, I did not get into that

discussion of abortion at this time from that point of view; I got into

it to bring up the point that we actually had a Minister of Health who

considers it used by women for birth control; that was my point, and

that was not addressed. But I don't mind saying it right here on the

floor — and I always have — that I'm pro-choice. I do not believe that

the state should be involved at all in that area. This again is the

government that is always saying: "Keep the state out of people." The

Minister of Highways (Hon. A. Fraser) is known for saying: "Keep the

government off the backs of the people." Yet when it comes to an area

like this, the other line is brought up. I say the state should not be

involved in this, and that's why I'm pro-choice. Many people, even

people who have strong religious convictions, feel this is a decision

for the woman and her doctor, and government should not be involved in

it. Of course, I realize that it's federal at this time, but it

certainly would be a great help if some provincial governments would

speak out on behalf of the majority of women. And they are the

majority; the majority of men and women, whenever a vote is taken, are

in favour — some of them of the present procedure, of course, others who are also pro-choice.

just want to say to the minister that yes, I realize there are sex

education programs in the schools. I realize parents have a certain

responsibility, but the facts are that many parents cannot or will not

talk to their children about sex education. That is why it's absolutely

essential that governments take leadership in this, and the Social

Credit government has not given encouragement. The programs we have

have mainly been done through the school boards and demands by parents

themselves. Times are changing. If the Social Credit government is

afraid they might be subjected to some of the scenes that I was

subjected to as minister when I endorsed sex education, I think you'd

find it somewhat different today. I used to be followed around to

meetings, as the Minister of Health knows, by a loud, vocal minority

screaming about what I was doing by trying to endorse sex education. I

won't go into all that again. You'll still have a vocal minority

shrieking against bringing sex education into our schools; you always

will have. But I do think you have to look at what is best for the

young people, the adults and society, and ignorance is never the best

way to go. It's always interesting that people are usually against this

based on no facts whatsoever; basic ignorance.

So I'm still

concerned, Mr. Speaker, that no great leadership is taken by this

government in supporting more birth control clinics and in the matter

of sex education in the schools.

[4:45]

make one final comment on this, the minister did state that it is not

just teenagers who get pregnant. He was concerned with the increase, I

think he said, in abortions in adults. Perhaps the minister should look

at what is going on in our society today — the economic problems. Often

women, because of economic necessity, have to face this problem. Social

stresses are much greater. All these things come in. If the minister

asked someone to give him some background on the reasons for an

increase in abortions in adults, I think he would find that much has to

do with the stresses and strains, the economic and social conditions

that women and families face today because of our economic situation.

There is nothing simplistic about the answer for it, I am quite aware.

I just hope this government will repudiate the kind of statements that

came from the former Minister of Health from Vancouver South. I would

like to see that repudiated openly for the whole province to hear. We

haven't really heard that.

Another area which I wish to

discuss with the minister, if I can find my file here, is AIDS. I know

that the minister has expressed concern over this. He and his ministry

have definitely taken some steps in this area and I commend you for

steps taken so far. I would like to ask you specifically if you are

giving any consideration to requests which I know you have received

from people with AIDS who feel there should be some form.... I may not

be expressing exactly what they want, but I know the provincial Health

ministry has said they would examine it, and that's a long-term care

area for the victims of AIDS. I don't think any of us felt at all happy

when we read about the AIDS victim who was turned away from the UBC

hospital. I know that was discussed. I'm not sure; I think the minister

did comment on it.

The very fact that a situation like that

could arise, the very fact that other hospitals are wondering if they

are going to be in a position to cope with it, the very fact of the

tragic scene for those victims of AIDS who should be given all the

encouragement they can and the best surroun