Manitoba Hansard — 24 October 1989 (Sitting 56, 34th Legislature, 2nd Session)

34-2-56

Manitoba — Debates (Hansard)

LEGISLATIVE ASSEMBLY OF MANITOBA Tuesday, October 24, 1989. The House met at 1:30 p.m. PRAYERS ROUTINE PROCEEDINGS READING AND RECEIVING PETITIONS Mr. Speaker: I have examined the peti tion of the Honourable Member for The Pas (Mr. Harapiak) and note that it does not comply with the Rules of this House in that : (

a) it is not addressed to the Legislative Assembly as requ ired by the precedence of this House in Beauchesne 's Citation 1017; (

b) it is not in a format set out in Appendix " A" to the Rules of the House as referred to in Rule 81.(6); and (

c) the minimum of three ,;ignatures does not appear on the initial pages as required by Rule 81 .(7). I must therefore rule the petit ion out of order. Mr. Harry Harapiak (The Pas): Mr. Speaker , I would like to table that pet ition. Mr. Speaker: Order, please. On the tabling of the document by the Honourable Member for The Pas, the Chair will take this matte r under advisement and report back to the House. PRESENTING REPORTS BY STANDING AND SPECIAL COMMITTEES Mr. William Chornopyski (Chairman of Committees): Mr.

Speaker, the Committee of Supply has adopted certain resolutions, directs me to report the same and asks leave to sit again . I move, seconded by the Honourable Member for Seven Oaks (Mr. Minenko) , that the report of the committee be received. MOTION presented and carried. INTRODUCTION OF BILLS BILL NO. 77-THE CEMETERIES AMENDMENT ACT *

(1335) Hon. Edward Connery (Minister of Co-operative, Consumer and Corporate Affairs) introduced, by leave, Bill No. 77, The Cemeteries Amendment Act; Loi modifiant la

Loi sur les cimetieres. BILL NO. 78-THE PREARRANGED FUNER AL SERVICES AMENDMENT ACT Hon. Edward Connery (Minister of Co-operative, Consumer and Corpo rate Affairs) introduce d, by leave, Bill No. 78 , The Prearranged Fun eral Ser vices 2151 Amendme nt Act; Loi mod ifiant la

Loi sur les arrangements prealables de services de pompes funebres. INTRODUCTION OF GUESTS Mr. Speaker: Prior to Oral Questions , may I direct Honourable Members ' attention to the gallery , where we have 31 visitors from the Manitoba Rural Leadership Training Committee , Practical Politics Seminar, and they are under the direction of Ken Martens. On behalf of all Honourable Members, I welcome you here this afternoon. ORAL QUESTION PERIOD Canadian Airlines Pilot Relocations Mrs. Sharon Carstairs (Leader of the Opposition): Mr. Speaker, my question is to the Minister of Transportation (Mr. Albert Driedger) .

Winnipeg has a long history as the transportation hub for western Canada. We have watched that position deteriorate with layoffs at CN, at VIA , at Wardair, with reductions in serv ice, particularly in flights to Europe by Air Canada, and today we have had it confirmed that 22 Canadian Air pilots, presently stationed in Winnipeg, have been told they must relocate. Can the Minister of Transportation tell the House what contact he has had with Canadian Airlines, with respect to these transfers? Hon. Albert Driedger (Minister of Highways and Transportation): Mr.

Speaker, I would like to indicate that a few weeks ago , I had contact with Canadian Airlines when we discussed the proposed-not necessarily a move, because many of the pilots are stationed across the country . They have homes in various areas , but they keep getting shifted around from one city to the next. We are trying to establish exactly how many pilots would be actually moved out of the city. We do not think it is going to be a very major effect. Mrs. Carstairs: Mr. Speaker, Canadian Airlines confirmed to us this morning that it was 22 pilots that would be transferred outside of thi s city.

Manitoba Service Mrs. Sharon Carstairs (Leader of the Opposition): Can the Minister tell us what implications will this have on service in Manitoba , particularly to communities like Brandon and the North? Hon. Albert Driedger (Minister of Highways and Transportation): Mr. Speaker, it will have no effect on

Tuesday, October 24, 1989 the service that is prov ided. There are 22 pilots affected, but that does not mean that 22 pilots are moving out of this ~ity. It is just a matter of how they are stationing them. We have been on top of t his from the day that they contemplated this move, and we are trying to assure that it will not have an impact on Winnipeg and Manitoba . Maintenance Work *

(1340) Mrs. Sharon Carstairs (Leader of the Opposition): Can the Minister tell us if home base for these pilots is no longer going to be Winnipeg, and that is what was reP,9rted to us this morning, what effect will this have on maintenance work, long or short term, in the City of Winnipeg? Hon. Albert Driedger (Minister of Highways and Transportation): Mr. Speaker, the fact that pilots are being shuffled around has no impact on the maintenance aspect of it at all, and the service will still remain the way it is at the present time. Ground Crews Mrs.

Sharon Carstairs (Leader of the Opposition): Can the Minister inform the House if any ground workers will be affected by this transfer and how many may be involved? Hon. Albert Driedger (Minister of Highways and Transportation): Mr. Speaker , I am not aware that any ground crews are going to be affected by this move . Transportation Industry Manitoba Services Mrs. Sharon Carstairs (Leader of the Opposition): Mr.

Speaker, there has not been since this Government took office, despite the innumerable number of layoffs in a large range of transportation services, any long term strategy by this Government to stop the erosion of Winnipeg as a transportation hub. When will they enunciate such a policy for Manitoba? Hon. Albert Driedger (Minister of Highways and Transportation): Mr. Speaker, we are well aware that Winnipeg, and Manitoba, is the transportation hub of Canada so to speak. We are very proud of the fact that we are exporters of transportation services.

We also have the transport institute that is working on some of these things . We are also working with city organizations, we are looking at the aspect of enhancing our position as a transportation centre, and we are very concerned about the fact if there is any deletion of that. So, Mr. Speaker, we are working on all fronts in terms of trying to retain the reputation that we have of being an exporter of transportation services. Meeting Request Mrs. Sharon Carstai rs (Leader of the Opposition ): Mr.

Speaker , it is very difficu lt to maintain that repu tatio n when we watch CN layoff s, VIA layoffs , and Wardai r layoffs. We wat ch flights being cancelled , and we find service being disintegrated in areas like Brandon . The present erosion is killing our province as a transpo rtation centre . Will this Minister immediately call a meeting of representatives of all transportation sectors, trucking , bus , airlines , trains , to develop a strategy for the '90s so that we are prepared for the 21st Century? Hon. Albert Driedger (l\llinister of Highways and Transportation): Mr.

Speaker , I have just indicated that we have groups right now that are working on the aspect of the future of transportation in Manitoba and in Canada . We have TIDAC that is involved and we have the Institute of Transportat ion at the universit y that is involved in these things. We are looking at the possible shifts in trends that could happen in transportatio n over the next 10 to 20 years . Most certainly we want to make sure that we play a vital part , as we have in the past, as being a transportation hub for Canada , and we hope to enhance tha t position . Raggedy-Ann Day Care Centres Staffing Ms.

Judy Wasylycia-Leis (St. Johns): Mr. Speaker , as late as yesterday the Premier (Mr. Filmon) and this Government upheld the benefits of prof it-making day care , yet evidence continues to grow to show the problems in that policy . My question is for the Minister of Family Services (Mrs. Oleson).

Given that in the last week or so three of four trained staff at the Raggedy-Ann Day Nursery on McPhillips Street have quit, and the fourth has submitted her resignation effective the end of this month which will leave the centre without adequately trained staff to care for children on site, can the Minister tell this House whether or not she is prepared to deal with this situation and explain why she is allowing as many as 32 children to be cared for today in a facility that is ill equipped to provide services as set out in this province's Day Care Standards Act? Hon.

Charlotte Oleson (Minister of Family Services): Mr. Speaker, as the Member knows there is a licensing order on that centre with the proviso that they immediately provide adequate staffing ratios, and by November 1 provide qualified staff in that centre. We are certainly prepared to act if those regulations cannot be met . Ms. Wasylycia-Leis: If this Minister put children before profits, there would be a closed sign on the door of this day care, not a licence order . Mr. Speaker, my supplementary to the Minister is, given that the employees are leaving or have left this 2152

Tuesday, October 24, 1989 cent re on McPh illips Street because they have not been paid, they are recei ving bou nced cheque after bounced cheque, bad cheque after bad cheque, how can she in good con science allow th is pr ivate enterpris e day care operation to continue operating without prop er staffing, witho ut paying for staf f h ired as recentl y as the end of August and without - Mr. Speaker: Order. Order , please . * (1 345) Mrs. Oleson: Mr. Speaker , the same regulations are in place as were in place when that Member was a Mem ber of that Government and of the Cabine t of that Govern ment .

We are insisting tho se regulations have to be followed by all people who run child care centres. The protection of children, the care of children is uppermost in ou r minds as we work through this trying to get compliance to the regulations. Interim Director Ms. Judy Wasylycia-Leis (St. Johns): Mr. Speaker, by not acting promptly and by dragging her heels in terms of using the conditional licensed process, and now the licensing order process , innocent victims are falling by the wayside. My quest ion to the Minister of Family Services is: how many NSF cheques does it take?

How many inn ocent already low-paid staff must go as victims? How many children must be at risk? Will this Minister, given the seriousness of the situation, today announ ce that she is putting in place an interim director so staff can get paid so children are not at risk? Mr. Speaker: Order, order . The question has been put. Hon. Charlotte Oleson (Minister of Family Services): I do not hire the staff at the McPhillips Day Care Centre . They are hire d by the owner of that cent re and I am asking that owner to follow the regulations . If those regulations cannot be followe d, then steps will be taken. Ms.

Wasylycia-Leis: It is clear that thos e regulation s have not been followed, and now we have some serious problems on our hands . This Government is forcing day care workers to the Labour Board . Mr. Speaker: And the question is? Manitoba Child Care Association Meeting Request Ms. Judy Wasylycia-Leis (St. Johns): Mr.

Speaker, my question to the Premier is: given that today at two o'clock the Mani toba Child Care Association will be making a stat ement about their serious concerns in day care, notwit hstanding whatever is in that announcement, I am sure they would still like to meet with the Premier as soon as possible . Is the Premier prepared today to tell this House whether , after this press conference at two o'clock, he is prepared to commit himself to a meeting with the Man itoba Child Care Association as soon as possib le? Hon.

Gary Filmon (Premier) : I have said before that I will deal in good faith with the Manitoba Child Care Ass ocia t io n. I am not here in this House t o be negotiatin g with the Member for St. Johns on behalf of any group in M anitoba, whether it be the Man itoba Child Care Assoc iat ion or anyone else. I will await thei r new s con fer enc e, and I will aw ait any furth er com munica tion tha t I have wit h them . Provincial/Municipal Projects Scrap Yard Relocation Mr. James Carr (Fort Rouge): Mr. Speaker, there is an unsightly environmentally unsafe metal scrap yard in the Point Douglas area of Winnipeg .

When she was in Government , the Member for Logan (Ms. Hemphill) thought the province ought to cost-share the relocation of those yards with the City of Winnipeg , and we all know the Member for Logan is no fool. Some Honourable Members: Oh, oh! Mr. Speaker: Order . Order, please . *

(1350) Mr. Carr: My question is to the Minister of Urban Affairs (Mr. Ducharme) . Has his Government agreed to cost share the relocation of the scrap yards with the City of Winnipeg? Hon. Gerald Ducharme (Minister of Urban Affairs): Mr. Speaker, the amount that was decided at the time, we have not withdrawn that from our negotiations. Mr. Carr: What I gather from the Minister 's response is, yes, the province has agreed to cost-share the relocation of the metal scrap yards in the Point Douglas area with the City of Winnipeg .

May I ask the Minister of Urban Affairs why he is choosing to cost-share this project with the City of Winn ipeg but not the Works Yards by the Health Sciences Centre? Mr. Ducharme: That was a commitment put forward by the previous administration and my answer to him was we had still agreed to honour their obligation. Mr. Carr: Does the Minister of Urban Affairs believe it is appropriate for the Province of Manitoba to cost share and to honour the commitment made by the previous Government?

I recognize that the previous Government thought it was appropriate for the province to put some money into the relocation of those scrap yards. Does the Minister believe it is appropriate , in this case , to cost-share the movement of those yards with the City of Winnipeg ? Mr. Speaker: Order, please. The Honourable Member's question seeks an opinion , therefore out of order. City Works Yards Relocation Mr. Speaker: The Honourable Member for Fort Rouge, kindly rephrase the question. 2153

Tuesday, October 24, 1989 Mr. James Carr (Fort Rouge) : Mr. Speaker , why will the Minister of Urban Affairs (Mr. Ducharme) not commit his Government to cost-sharing the relocation of the City Works Yards with the City of Winnipeg? Hon. Gerald Ducharme (Minister of Urban Affairs): Very simple , there has been no proposal put forward by the City of Winnipeg . Some Honourable Members : Oh , oh! Mr. Speaker : Order, please . Order . P.C. Fundraising Dinner Drinking and Driving Jokes Mr. Paul Edwards (St. James): Mr. Speaker , I thought all three Parties were going to do some lobbying on this one .

My question is for the Minister of Justice (Mr. McCrae) . I have been advised that at the Tory fund-raising dinner held last Saturday, part of the entertainment included a comed ian who feigned he was drunk and told jokes about drinking and driving . Mr.

Speaker, the fund-raising dinner would normally not be the subject of discussion in this House except for the fact that at least some of the people who were at that dinner have contacted us and expressed their displeasure at these jokes, and have found them very offensive and in total contradiction to this Minister's and this Government 's stated position on drinking and driving . Quite simply my question is: how could this Minister sit at that dinner and tolerate a comedian paid for by the Tory Party to make light of drinking and driving? Mr.

Speaker: The Honourable Member 's question deals with a matter which is not within the responsibility of the Government, therefore it is out of order. The Honourable Member for St. James , kindly rephrase his question , please . Mr. Edwards: Mr. Speaker , given that this Minister has been at the vanguard of drinking and driving , at least he has said he has been in the last yea r, is the Minister offended by comments made at-would the Minister be offended by comments at a political fund -raising dinner which sought to make light of drinking and driving? Mr. Speaker: Order, please .

Again I would remind the Honourable Member that his question deals with a matter which is not within the responsibility of the Government . The Honourable Member for St. James, with a new question . Mr. Edwards: Mr. Speaker- Mr. Speaker: Order . The Honourable Member for St. James . Mr. Edwards: Will this Minister Some Honourable Members: Oh, oh! 2154 Mr. Speaker: The Honourable Member for St. James has the floor . Mr. Edwards: Mr.

Speaker, will this Minister reaffirm his commitment to taking drinking and driv ing seriously in this House particularly in light of comments which we have been advised were made at a Tory fund-raising dinner Saturday night? Hon. James McCrae (Minister of Justice and Attorney General): Mr. Speaker, the fund raiser was attended by a tremendous number of people - Some Honourable Members: Oh, oh! *

(1355) Mr. Mccrae: -and Tory fund raisers have been growing and growing ever since the advent of the liberal Party 's increase in vote in the last election . I can say to the Honourable Member that the organization of the dinner was not a Government -sponsored matter . I sat near the back of the room and had a little trouble , hearing what was going on, but what I did hear was clearly not funny . Some of that which I did hear, I do not condo ne. Ethnic/Racist Jokes Mr. Paul Edwards (St. James): I have a question for the Premier (Mr. Filmon) .

Will the Premier reaffirm his Government's commitment and his commitment to multiculturalism and to the preservation of ethnic minorities in our community , in our province , in light of comments which we have been advised were made by the same comedian , disparaging comments about the Polish people in this community? Hon. Gary Filmon (Premier): Mr. Speaker, as a Canadian of Polish descent , I would suggest to you that I in no way would ever allow myself to be involved in any situation in which I spoke ill of any person because of their race , religion or ethnic background .

Under no circumstances would I endorse or condone that being said by anyone in society. Premier's Action Mr. Paul Edwards (St. James): The Premier is the Premier of this province always, and when he speaks to Manitobans he is the Premier and he represents this Government and the province . Why did he not take the opportunity , when he spoke at that same event to Manitoba taxpayers and to Manitoba voters and citizens , to disassociate himself from those comments seeing as he spoke after they were made? Hon.

Gary Filmon (Premier): Events that are planned by those outside the Government are obviou sly not ones in which the Government can anticip ate any eventuality . I might say this , because of my concern about those comments that were made, I have spoken to various people who have been involved with the organization and am assured that such a situation will not occur again .

Tuesday, October 24, 1989 Child and Family Services Program Reductions Mr. Leonard Evans (Brandon East): Mr. Speaker , I have a question for the Min ister of Family Services (Mrs. Oleson) . It has been reported that the Child and Family Services Agency in Brandon, of the Westman area, is looking at cutting youth outreach programs, sex abuse prog rams, post-a doption ser vices, rural ,resource deve lopmen t and many other pro grams.

I I have also recei ved inf orma tion rece ntly that other Ch ild and Sa mi ly Service agenc ies are also very conc erned abo ut funding levels and the destr uctive effe ct on fam ilies and their children . Will the Ministe r make a com mitme nt today th at there will be no service cutbacks ? Hon. Charlotte Oleson (Minister of Family Services): ·when I met with the presidents of the Child and Family 'services agencies , within the last couple of weeks I ·believe it was , they indicated to me they were having 1financial problems. I indicated to them that they were 'to send me reports and budget information .

I also lindicated very clearly to them at that time that services should not be cut . Mr. Leonard Evans: I thank the Minister for that answer , but I understand from reports in the Brandon Sun that the Westman Agency has outlined the cuts that will be necessary because of lack of provincial funding. *

(1400) Can the Minister advise the House to what extent : the agency will have to cut the sex abuse programs, the post-adoption services, or the court and youth outreach program because of lack of provincia l funding? , Can she advise , what will the negative impact be on the children and the ir families in the Westman area? Mrs. Oleson: I will repeat what I said to the Member in answer to his prev ious question that services will not be cut. The indication in that

article was that

part icular agency's suggestions of what they might cut. They have sent the information to my office. My staff is analyz ing it, and I will be meeting with staff to discuss it in th e next few days. Mr. Leona rd Evans: As I understand it , to repeat what the Min ister has said, she has met with representat ives of all the agencies and she is looking at the possibility of maintain ing service s. Yet at the same time she argues that there will be no service cutback .

I would like the Minister to explain to the House how she expects the agencies to maintain services at the same time to refuse to fund them according to the level that they believe necessary to maint ain these services? How are you going to do it? Mrs. Oleson: Mr. Speaker, that is what I had indicated to the Member , that we are analyzing those figures of the needs of those particular agencies. We do not fund the projection that they come and tell me at a meeting.

I have to have the staff go through the numbers , analyze them, be sur e that th ey are accurate , and be sure that they reflect the true funding mechanism of the agency. We are doing that , and I will be meeting with staff shortly on that matter. Child and Family Services Deficit Analysis Ms. Avis Gray (Ellice): We know that the Child and Family Servi ces agency in Brandon is projec ting a deficit in this fisc al year, and this is not a new agency , Mr. Speaker . This is a long-est ablished agen cy that has always man aged to bring in a balanced budget to this point.

We know that ther e a re other agencies as well who are in similar circum stanc es. These deficits are caused by increases in cost which this Government has failed to recognize. Mr. Speaker: Does the Honourable Member have a question here? Ms. Gray: My question to the Minister of Family Services is: can the Minister tell us today, because she has been working with these agencies for over a year and a half, what does she attribute as the cause for the continual deficits with these Child and Family Services agencies? Hon.

Charlotte Oleson (Minister of Family Services): I would be better able to give a response to that question after I have seen the analysis of the budgets that have been sent to my department. Ms. Gray: Mr. Speaker, I have a supplementary question to the same Minister . In discussions with a number of the agencies over the past number of months , they indicated to us that very clearly they have laid out to the Minister and her staff a case as to why there are continued deficits.

Can the Minister indicate to us why she does not appear to have that information today , when in fact the agencies are saying they have been communicating continually with her and her Government? Mrs. Oleson: Perhaps I should lay out the process again . We informed the agencies what their funding level would be for this year. They asked for a meeting with me to discuss it. At that time, I suggested to them it would be wise for them to send me the details of their budget and what their projections were . We are working on them. I will be meeting with them shortly and we will analyze the situation .

Budget Request Ms. Avis Gray (Ellice): Mr. Spe aker, I have a final supplementary for the same Minister , a very simple question. Can the Minister indicate to us, has she asked the Child and Family Services agencies to bring in a balanced budget for this year? Hon. Charlotte Oleson (Minister of Family Services): I have asked them to send me their projections. I will repeat again, we expect all agenc ies to make every attempt to live within their budget , but as I say, I have not seen the results of the budgets that have been sent to my department recently. 2155

Tuesday, October 24, 1989 Arts Policy Review Committee Hearings

Schedule Hon. Bonnie Mitchelson (Minister of Culture, Heritage and Recreation): I had indicated yesterday in the House , of two questions asked by the Member for Selkirk (Mrs. Charles) , that I would bring information to the House today . I want to indicate to her when she says incorrectly that there are many arts groups and organizations throughout the province that know nothing about the Arts Policy Review , that I have with me some 400 pages of names and addresses of people and organizations that received copies of the Arts Policy Review Pamphlet.

Pamphlets were sent to 2,518 individuals and organizations throughout the province as well as a very comprehensive advertising campaign in all of the major papers , ihe weekly papers, and the ethnic papers . So many Manitobans have had the opportunity to hear about the Arts Policy Review. If she has the odd person that was inadvertently missed off that list, I would hope that she would bring that information forward, and we would ensure that those people would get copies of the hearing process. Rural Schools Library Services Mr. Jerry Storie (Flin Flon) : Mr.

Speaker , my question is to the Minister of Education (Mr. Derkach) . Most Manitobans would believe that access to quality education would mean access by most students, most teachers , to quality resources and quality facilities. In May of 1988 the Minister of Education was presented with a report from the Manitoba School Library Audio Visual Association, which indicated that only 4 percent of rural schools have a school librarian in charge of their library .

Can the Minister of Education indicate whether he has taken any action, which would give the people in rural Manitoba the hope that they too would have access to quality library services? Hon. Leonard Derkach (Minister of Education and Training): Again the Member for Flin Flon points out to a deficiency in our education system that in fact was created when he was Minister of Education. As a matter of fact , in late 1988 there was a report that was submitted to the department with regard to library and resource services throughout the province .

Indeed , there is a lack of the types of resources that we would like to have, as a province, in all our schools and that has to be addressed. The department and myself have been discussing that over a period of time . We were hopeful we could have some response to that report by June, but that has not been possible. Hopefully, by later this fall we will be in a position to respond in a positive way to that report . Mr. Storie: The Minister acknowledged that he got the report, not anybody else. Mr.

Speaker, yesterday I met with the president and the president-elect of the Manitoba School Library Audio -Visual Association, and I can tell you they are distressed because this Ministe r has not been responding to their needs. My question is: does the Minister have any intention of following up on his commitment to this association to have something in place , to do something concrete , both through the Ed Finance and through the departmental activities to ensure that library services are eq ually available throughout the Prov ince of Manitoba? Does he intend to act or not? Mr. Derkach: Well, Mr.

Speaker, I can tell you that we will not do like the former Government and not act at all. As a matter of fact, we will take the recommendations very seriously and we will be prepared in a short time. I indicated that later this fall we will be prepared to respond positively to some of the recommendations that are within the report. Mr. Storie: The Minist er should be telling this to Reesa Cohen, the president of this association . Educational Materials Selection Criteria *

(1410) Mr. Jerry Storie (Flin Flon): Mr. Speaker , the Minister of Education promised in June of 1988 that he would revise the policy relating to the selection of learni ng materials in our schools. He promised that in June; he promised again in May. Will the Minister promise again and act on behalf of the parents of Manitoba , the teachers and our schools , to implement guidelines for selecting learning materials in the schools? Will he promise that again? - (interjection)- Mr. Speaker: Order . The question has been put - (interject ion)- Order , order . The Honourable Minister of Education . Hon.

Leonard Derkach (Minister of Education and Training): It is unfortunate that the Member for Flin Flon cannot even read a letter correctly , because if he had a letter I had written to MSLAVA he wou ld have found that I had indicated in May we would not be able to respond by June . We would be responding positively in the fall of this year, and we still intend to do that. Rural Economic Development Strategy Mr. Mark Minenko (Seven Oaks): In response to questions yesterday , the Minister of Rural Development (Mr.

Penner) stated he was going to be Santa Claus with respect to rural economic development in this province . Although Christmas Eve is two months away, he told us he was going to have a rura l economic development stra tegy in place not until some time after that . We in the Liberal Party are not asking for the Minister to be Santa Claus but to provide this province with an 215.6

Tuesday, October 24, 1989 effective rural development strategy which rural Manitoba deserves. My question is: can the Minister resp onsib le for Rural Development advise this House why rural Manitobans are still waiting for a rural economic development strategy when this was a Tory election promise in the last election some 18 months ago? Hon. Jack Penner (Minister of Rural Development): Mr. Speaker , the Honourab le Member has a somewhat distorted memory of what was said yesterday during Estimates debate. I think he was so far into the season that I am wondering whether his hearing was impai red.

I want to remind the Honourable Member that if he had been following events in rural Manitoba , he would recognize that this Government has not sat idly by and watched rural Manitoba deter iorate . Just yesterday there was an announcement that there would be an oat processing plant built in Portage la Prairie. Not very many weeks ago, there was an announcement that there would be a combine plant built in Portag e la Prairie.

In the spring of the year, this Government anno unced the sale of a forestry industry that had been losing money for the province for years , and that initiative in itself will cause economic enhancement in Portage . Some Honourable Members: Oh, oh! Mr. Speaker: Order , order. The Honourable Member for Seven Oaks. Mr. Minenko: Mr. Speaker , the reply of this Minister is the kind of thing that Man itobans are outraged about. Some Honourable Members: Oh, oh! Mr. Speaker: Order . Order , please . The Honourable Government House Leader . Hon. James McCrae (Government House Leader): Mr. Speaker , the feigned- Mr.

Speaker: On a point of order . Mr. Mccrae : -anger of the Honourable Member does not really wear so well in the beginning of a

preamble , which is not allowed, to a supplementary quest ion. I know the Honourable Member is frustrat ed that his Party is doing so poorly in rural Manitoba , but this is not the place to have an outburst. Some Honourable Members: Oh, oh! Mr. Speaker: Order, order . The Honourable Member for Seven Oaks , ki ndly put his question now, please. Mr. Minenko: Mr. Speaker, my question is to the same Minister. In that from the responses we see in Hansard from yesterday , we see the Minister has no strategy .

My question to this Minister is: how many people have left rural Manitoba since his Government has been in power , and how many more shall leave if the present trend continues, which is instead of the ir policy? They said there is going to be a . . .. 2157 Some Honourable Members: Oh, oh! Mr. Speaker: The Honourable Member 's question has been put. The Honourable Minister of Rural Development Mr. Penner: Mr. Speaker , it is small wonder that the Honourabl e Member is frustrated . Some Honourable Members: Oh, oh! Mr. Speaker: Order. Mr.

Penner: The amount of support that has been indicated during recent polls to the Liberal Party in rural Manitoba indicates very clear ly that they should show some frustration. I wan t to say to you, Mr. Speaker , that there are a num ber of other initiatives that have been taken through the land and water strategy , and the Liberal Party knows full well that this Government took upon itself to develop wate r policies and land policies that rural people have been looking for a long , long time. Out of that initiative, Mr.

Speaker , I would lik e to indica te to this House that only yesterday we announced the raising of the level of the Jackson Dam , which will cause the Community of MacGregor to have a better water supply . We also announced the raising of the Stephenfield Dam , which will cause better water- Some Honourable Members: Oh, oh! Mr. Speaker : Order , please ; order, please . I would like to remind the Honourab le Minister that answers to questions should be as brief as possible . The Honourable Member for Seven Oaks , with his final supplementary question . Mr. Minenko: Mr.

Speaker, my final supplementary is: why does the Government have nothing in place with respect to a rural econom ic development strategy? Why is there no economic development strategy, and when the Minister suggests , and that is evidenced by the Minister's suggestion that we have to wait till the next budgetary year- Mr. Speaker: Order please ; order please . The question-order . The Honourable Minister of Rural Development. Mr. Penner: Mr.

Speaker , I would hope that the Honourable Member would concur that we do have regional development corporations , which I think in most part have been doing a pretty fair job in trying to identify the kind of things that need to be done . I would suggest to the Honourable Member and ask him if he would concur th at in order to develop a proper long-term strategy , you need to consult with the communities that are going to be involved . That is what we have been doing , and as I said the other day in Estimates, it is our intent to bring that plan forward once it is- Mr. Speaker: Order , please .

The Honourable Member for Thompson.

Tuesday, October 24, 1989 ***** Mr. Speaker: Order , order. The Honourable Member for Seven Oaks, on a point of order. Mr. Minenko: Well, the Minister of Rural Development (Mr. Penner) has asked me a question, and I was just wondering whether I could- •

(1420) Mr. Speaker: Order. The Honourable Member for Seven Oaks knows he does not have a point of order. The Honourable Member for Thompson has the floor. ***** Northern Development Agreement Negotiations Mr. Steve Ashton (Thompson): Mr. Speaker, I have a question to the Minister of Education (Mr. Derkach) that follows previous questions from myself and from the Member for Rupertsland (Mr. Harper) regarding the situation -(interjection)- Mr. Speaker: Order, please . Order. The Honourable Member for Seven Oaks (Mr. Minenko) has had an opportunity to pose his three questions . You have done so.

The Honourable Member for Thompson has the floor . Mr.

Ashton: The situation facing education programs in northern Manitoba following the elimination of the Northern Training Authority , following problems in a number of other programs including the Civil Technology Program , and the uncertainty facing many of the programs because of the uncertainty with the Northern Development Agreement, I would like to ask the Minister whether he will commit this Government now to maintaining the level of programming that exists , regardless of whether there is a new Northern Development Agreement, and whether he can further indicate the status of the latest negotiations on the NOA?

Hon. Leonard Derkach (Minister of Education and Training): Well, Mr. Speaker , I reject the premise of the Member for Thompson (Mr. Ashton) when he says that we are cutting programming in northern Manitoba or suggesting that. Certainly our intention is to increase programming, not just to maintain it, but to increase programming in northern Manitoba for northern Manitobans and for Native Manitobans. Mr. Speaker , there has never been any suggestion by this Government to reduce programming to northern commun ities in this province .

As a matter of fact that is exactly why we changed the NTEA, so that we would not have the administration in Winnipeg and programs delivered in northern Manitoba. Now the administration and the programs will be in northern Manitoba. Mr. Speaker: The time for Oral Questions has expired . SPEAKER'S RULINGS Mr. Speaker: I h ave two rulings for the House. On Friday October-order, please. I am sure all Honourable Mem bers would like to hear this . On Friday October 13, 1989, I took under advisement a point of orde r raised by the Honourable Member for Thompson (Mr.

Ashton) respecting the alleged reference by the Honourable Member for Wolseley (Mr. Taylor) from his seat to the Honourable Member for St. Johns (Ms . Wasylycia -Leis) as " the Member for hypocrisy. " As I said at that time, I was unable to hear the alleged remarks because of the disorder in the House . I have reviewed Hansard and have had the recording tape listened to. It was not possible to identify the words allegedly spoken nor the Northern Member speaking. I must therefore rule that there was no poin t of order .

Again , might I remind all Honourable Members to choose their words with care so as not to create disorder .- (interjection)- Another ruling for the House? On October 17, 1989, I took under advisement points of order raised by the Honourable Government House Leader (Mr. McCrae), the Honourable Member for Thompson (Ashton) and the Honourable Member for Churchill (Church ill) respecting the conten t of non political statements and th e m anne r in whic h t he opportunities to make such statements are currently being used . The statement made by the Honourable Minister of Education and Training (Mr.

Derkach) and by the Honourable Minister of Co-operative Consumer and Corporate Affairs (Mr. Connery) were not , in my opinion , truly non-political statements within the usages of this House . The practice of non -political statements being made by leave is not recognized in the Rules of this House ; however , our Rule 19( 4) does make prov ision fo r Ministe rial Statements respecting Government polic y. A specific item for these is included on the Order Paper. Research has indicated that the practice of non political statements apparently originated in 1973.

At that t ime, and for some years afterwards , such statements focused mainly on drawing to the attention of the House , athletic , educational or community achievements , significant anniversaries or for conveying congratulations respecting such occasion s. Such statements appear to have been made more frequently by private Members although a few at each Session were also made by Ministers of the Crown . Since 1988 , a trend seems to have deve loped whereby the subject matter and content of these statements have become somewhat more political tha n in the past and are moving away from the original practic e.

Additionally , I note that the number of Minister s rising to make non-political statem en ts incr eased significantly in 1988. In some other Legislatures , the potentia l fo r controversy such as was seen a few days ago is avoided by providing an opportunity for statements by Members other than Ministers of the Crown and by providing under a separate item for statements by Ministers 2158

Tuesday, October 24, 1989 relating to Government poli cy and program which may be responded to by Opposit ion Critics. Beauchesne 's Citation 348 indicates that under "Statements by Ministers," shor t factual announcem ents or statements of Government policy may be made and Opposition Members may comment. Manitoba Rule 19(4) contains very similar provisions. Beauchesne's Citation 37 4 adv ises that under " Members' Statements," Members other than Ministers may make one minute statements on topics of their choosing.

The non -political restrictions do not apply to such statements although certain other fairly generous criteria do. House Leaders may wish to discuss a possibility of adopting similar practices for th is House and I leave that to them .

In the meantime , I would strongly encourage Ministers of the Crown wishing to make statements on matters wh ich in any way relate to their ministerial re sponsibi lities, do so under the item "Ministerial Statements and Tabling of Reports ." Also , I would caution all Honourable Members rising to make non political statements to ensure that the subject matter and content of their contributions is truly non-political. NON-POLITICAL STATEMENT Mrs. Iva Yeo (Sturgeon Creek): May I have leave to make a non-political statement, Mr. Speaker? (Agreed) *

(1430) We on this side of the House would like to express our sincere sympathy to the members of the family of Dr. Paul Henrik Thorbjorn Thorlakson who died last week and whose memorial service will be held tomorrow . Dr. P.H. Thorliksen is an outstanding Manitoban of long standing service, an outstanding member of the Icelandic community. His accolades are long and many. One of the latest ones is that he served three terms as Chance llor at the University of Winnipeg.

I think it is very appropriate that tomorrow at the tim e of his service shortly thereafter , there will also be a service in a building that has been named after him in the Health Sciences Centre complex. I extend, on behalf of we on this side, sympathy to his family , his many friends and literally thousands and thousands of Mani toba patients . COMMITTEE CHANGES Mr. Edward Helwer (Gimli): I move, seconded by the Member for Minnedosa (Mr.

Gilleshammer) , that the composition of the Standing Committee on Public Utilitie s and Natural Resources be amended as follows: Cummings for Pankrat z; Enns for Gilleshammer; Praznik for Helw er; and Burrell for Connery. Mr. Speaker: Agreed? (Agreed) HOUSE BUSINESS Hon. James Mccrae (Government House Leader): Mr. Speaker, by agreement with the House Leaders , 2159 the order for dealing with Estimates will be altered somewhat for the next little while.

The Department of Urban Affairs when completed would be followed by the Estimates of the Seniors Directorate , and perhaps Co-operative Consumer and Corporate Affairs. Depending on further discuss ion s, we would return to Culture, Heritage and Recreation at an approp riate time, but after Urban Affairs would come the Seniors Dire ctor ate . I now move, seconded by the Honourable Minister of Environment (Mr. Cummings) that Mr. Spea ker- Mr. Speaker: Order, please. Is there leave to make such changes as is being recommended by the Honourable Government House Leader (Mr.Mccrae)? Mr.

Mccrae: By leave, I would ask Honourable Members to agree that we move from Urban Affairs to the Seniors Directorate Estimates at this point. Mr. Speaker: That is agreed? The Honourable Opposition House Leader (Mr. Alcock)? (Agreed) ORDERS OF THE DAY Hon. James Mccrae (Government House Leader): Would you call the Address for Papers standing in the name of the Honourable Member for Osborne (Mr. Alcock)? ADDRESS FOR PAPERS Mr. Reg Alcock (Opposition House Leader): Mr. Speaker, we of course are pleased to give leave on the changes requested by the Government House Leader (Mr. Mccrae) . Mr.

Speaker, I move, seconded by the Member for Fort Rouge (Mr. Carr), THAT an Address for Papers do issue praying for: (

a) a copy of the report on the impact of the Goods and Services Tax on the Provinces, recently prepared jointly by the Provincial Deputy Ministers of Finance; and (

b) a copy of the study commissioned by the Provincial Finance Ministers from the Conference Board of Canada on the regional impacts of the Goods and Services Tax. MOTION presented . Hon. James Mccrae (Government House Leader): Mr. Speaker, this Address for Pape rs is not acceptable to the Government . Mr. Alcock: Mr. Speaker, I would ask this be referred for debate on Tuesday. Mr. Speaker: In accordance with Rule 49(1), the item will appear on the Order Paper under the appropriate heading, Private Members' Business . (Agreed). Mr. Mccrae: So now, Mr. Speaker, if everything seems to be in order, I would move, seconded by the

Tuesday, October 24, 1989 Honourable Minister of Environment (Mr. Cummings) that Mr: Speaker do now leave the Chair and the House resolve itself into a committee to consider of the Supply to be granted to Her Majesty . MOTION presented and carried and the House resolved itself into a Committee to consider of the Supply to be granted to Her Majesty with the Honourable Member for Minnedosa (Mr. Gilleshammer ) in the Chair for the Department of Health ; and the Honourable Member for Burrows (Mr. Chornopyski) in the Chair for the Department of Urban Affairs. CONCURRENT COMMITTEES OF SUPPLY SUPPLY-HEALTH Mr.

Chairman (Harold Gilleshammer): I would like to call to O"rder this meeting to consider the Estimates of the Department of Health. When last we met we were on item 1.(

d) Research and Planning : subsection 1.(dX 1) Salaries, $416,000- the Member for Kildonan . Mr. Guizar Cheema (Kildonan): Mr. Chairperson, can the Minister of Health tell us how far this day hospital pilot project has gone, because during the last year 's Estimates this project was still under way. When can we expect this to be completed? Hon. Donald Orchard (Minister of Health): I missed the very first part of my honourable friend 's question. Mr.

Cheema: During the last year's Estimates there was talk about the day hospital pilot project, and I just wanted to know what is the status of this project and what are the conclusions made? Mr. Orchard: Well, have not received a recommendation from research and planning as to how we ought to proceed, but let not my honourable friend take that as no activity in the area, because I think it is fair to say that more and more the institutions and their senior management and boards are seeking out the day hospital concepts to see whether they can fit as part of their programming .

We certainly encourage that innovation, but I just simply say that as of today, we do not have the recommendation from research and planning. Mr. Cheema: Mr. Chairperson, the Minister is quite aware of the two day hospitals , one is at Seven Oaks, the other at Deer Lodge hospital. Since I have been involved at day hospitals myself personally and we have seen a number of patients being served by that project, it is the common knowledge in that area that it is a very effective way of dealing with patients .

Certainly it is keeping the patients away from the hospital and sort of promoting the idea of supported independent living. During last year's discussion the Minister clearly indicated that he was in favour of such a project, and they may look at various places such as some of the rural communities. I have given him a couple of examples and I will repeat those again , such as Dauphin and Swan River. Can the Minister indicate that he will consider such proposals in the near future? *

(1440) Mr. Orchard: Mr. Chairman, my honourable friend is right. It is not as if we are advanci ng a new concept. There are day hospital programs right now. I believe and I think I can speak for my honourable friend-I say this without having the resea rch data I quess , if you will , to back up what you would call a gut feeling I believe that they do provide to a group of patients in Manitoba a very effective and very economic treatment regime.

I do not think there is any question about that but again what we are wanting to attempt to demonstrate is the fit-in context of the home care program because some of the home care program provides alm ost equivalent, or even greater level of serv ice and more hours per day type of service . It is a proposition of clearly determining that that is an effective program initiative that we would make part of, if you will, the regular service availability throughout the system.

That decision has not been made from the standpoint of not having before me the analysis that I have asked for in terms of assisting decision-making. Mr. Cheema: Mr. Chairperson, I th ink yesterday we ma:de a lot of progress and I do not want to hinder that progress, but I am dissatisfied because we discussed this issue last year during the Estimates process. It is common knowledge that these are the good effective ways of providing patient care, especially the seniors , and keeping them out of the hospital system.

When we have two day hospital programs and why has it taken so long to reach a conclusion and expand this program? We are not saying that you have to just go in each and every hospital. That may not be financially possible, but at least look at certain areas according to the demographic variation in the City of Winnipeg and also the rural communities. I will certainly request the Minister to maybe ask whosoever is doing this study to come up with a conclusion so that it could be started at the earliest possible date .

This has already been since September, 1988, almost one year and this project was already in place when we discussed last year. So I would ask the Minister maybe he could check with his staff and see how far they have gone and when we could expect a report so that such a program could be expan ded and which will be, as the Minister is moving into one of the very right directions of keeping the cost inta ct and also cont inuing to provide a cost-efficient way of providing health care. This is one of them and this is one of the alternate ways of keeping the patient away from the so-called acute care beds. Mr.

Orchard: Mr. Chairman, I accept my honourable friend's exhortations and I know that he wants the answers as much as I do, but I can only indicate to him that in the past a number of initiatives, and we got into this discussion yesterday when we were talking about the analysis criter ion for the Health Services Development Fund. 2160

Tuesday, October 24, 1989 In the past, decisio n-mak ing on new program has been made on the basis of what people believed was an appropriate way to go. You know the effectiveness within the system was , quite frankly , not analyzed in the longer time frame . What happened is that we ended up with the programs being merely add-ons to the system .

What we are trying to assure , and I cannot speed up the process because really some of the analytical information is not as easi ly accessible as one would like, because our information systems, and I say this in a non-partisan way, our information systems were not structured particu larly to allow analysis of outcome. Very much, not only in Manitoba but across the health care system of Canada , more people are asking for outcome analysis.

That is what we are trying to achieve here so that we can make the appropriate policy decision armed with the information that it is a cost effective method of new programming, that it may well replace costs in term s of long-term beds that are set aside in hospitals for panelled patients , or possibly curtail the need as quickly for personal care home beds , or may result in reduced demand on the over-cost care patient in the Home Care Program.

I appreciate that we are pull ing information from three separate streams of funding and to make it, I suppose, appropriate information on which to base decisions is taking a little more time that what one would like to see. I share my honourable friend's sense of frustration. Mr. Cheema: As I have repeated a number of times in regard to the Dauphin Hospital, the personal care home wing of the Dauphin Hospital, it will be a right place to build an attached day hospital to deal with patients who are in that age group .

I think when we are in the process of developing a plan it will be advisable to have that plan now , so that we do not have to spend extra money maybe next year to change those plans. This is one of my concerns that money should be spent very wisely because I do not think there is enough money just available to keep on building some of these places , changing the plans . Mr. Orchard : I defer comment. Mr. Cheema : My next question is, what is the cost of this stud y for this day hospital pilot project out of this $416,000 .00? Mr. Orchard: I will have to seek ex pert advic e on that.

This is not going to be a dollar figure but it is rough ly at a half-year commi tment of one medical records staff position . So I guess, what , 20,000 , is that fair? Mr. Cheema: Is this correct then, the $20,000 this year and $20,0 00 last year, so rough ly we will be spending about $40 ,000 to study this project? Mr. Orchard: Just once . Mr. Cheema: I am sati sfied with the answer . My next question is with regard to Seven Oaks Hospital psychogeriatric review.

It is my understanding that there has been a review goin g on and it was supposed to have been complet ed by the mid-summer and can the Minister update what are the conclusions made from that review? Mr. Orchard: I am just reading over my-we have completed that study and the gathering of data has been completed and now they are into the analysis and compilation of a report and it is anticipated that we will have that by year end or early January. Mr. Cheema: Does the Minister think that it will advisable or it will be possible to share the general thrust of that study with us today?

Can he indicate to us what are the major problems with that program or whether the major advantage of that program to have at Seven Oaks Hospita l and what they have learned so that further planning can be done for the other places such as Deer Lodge Hospital? Mr. Orchard: I cannot share some of that information simply because I do not have it. I will tell you what the evaluation was designed to compile.

Investigation of program operating characteristics based upon semi structured in-depth interviews of the program staff at Seven Oaks, determination of the unit costs of the program in comparison to other programs at Seven Oaks General Hospital and elsewhere both in and outside of Winnipeg . At an investigation of patient process such as treatments, and outcomes such as length of stay, change in health status and drug utilization. *

(1450) As I indicated in my first answer, the gathering, the compilation of the data has been completed. Now it is the analysis and the completion of a report indicating findings that is in process, hopefully completed by the end of this year or early into January. Mr. Cheema: I would like to indicate to the Minister that there was a question about 10 days ago in the House asked by my Leader . The question came out of the surveys done by the Manitoba Health Organization . One of their findings was the lack of psychogeriatric beds .

After that I did have a discussion with the program director but it seems to be not a fair judgment according to him . He says that they have a number of beds available and probably most people are not aware of the psychogeriatric hospital beds at Seven Oaks Hospital. Maybe the Minister shou ld take a note of that and make sure that this kind of information is given to the individuals who are concerned with the lack of the availability of such beds in Winni peg City. Mr. Orchard: I really acc ept my honourable friend's advice and I am going to offer him some , well, really offer his Leader some advice.

The report that my honourable friend 's Leader presented to the House was presented and - I am trying not to be partisan , but I do not think your Leader understood the issue that was attempted to be addressed in the MHO study, No. I because the whole issue got convoluted between psychogeriatric care, personal care home beds and acute care hospitals . 2161

Tuesday, October 24, 1989 The survey which • my ·honourable friend's Leader referred to was not a survey that was ever shared with Government. I received a copy of that the day after the questions were raised from MHO. It was a survey done some time ago, designed as an internal sur vey so that it would assist MHO in policy development. It was not designed to be brought to Government per se and in fact the survey was taken , as I understand it, prior to the change of Government or at least right around the transition period .

It did not reflect some of the initiat ives that we had taken in terms of psychogeriatric care. What I am saying to my honourabl e friend is that one has to be careful in reaching conclusions from that report lest , as my honourable friend has indicated today, the conclusion reached by his Leader in the Question Period _was in fact, according to experts at Seven Oak s Hospital who are care deliverers, not a correct conclusion. That is the danger of having those kinds of reports used in what I am sure was a sincere but partisan attempt to show understanding of an issue . Mr.

Cheema: I just brought to the Minister 's attention one of the findings , and one of the findings where some of the professionals have a different view. I think we bring to the floor what is being said from both sides of the story. That does not mean that my Leader was not correct in a number of other areas . She presented an overall view of the mental health survey in Manitoba. I think the Minister should check the date on that survey. It was done during his term . I think he may be confusing this survey with something else.

I am pretty sure that survey was during the mandate of this administration but I am just bringing to his attention the point that there are beds at Seven Oaks psychogeriatric ward. It is the understanding from the staff that probably people do not know in the system that they have beds and probably they can use them. I think the Minister should accept a positive suggestion rather than twisting the story around. Let us keep it very straight. Mr. Orchard: would provide a comment to my honourable friend , but I would just provoke an argument with him at this stage of the game.

I certainly want to engage in meaningful debate with the full kindness of my office to date . Mr. Cheema: I just missed the last word of the Minister 's statement. Mr. Orchard: I do not want to debate technicalities with my honourable friend as to who was technically right and who was technically wrong. I simply say that my honourable friend's Leader did not present the issue with the clarity that my honourable friend has been accustomed to bringing issues to the House , and therefore the issue was somewh at confused and improperly communicated to the House, hence to the public.

I know that my honourable friend has to defend his Leader , and so I choose not to pursue it with him any further because it would be a meaningles s debate to debate how incorrect his Leader was on that issue. Mr. Steve Ashton (Thompson): Mr. Chairperson , we have touched on a number of the items that have been subject to studies and reviews under this particular

section in the Estimates. I would just ask if the Minister could perhaps give a brief update, because I know perhaps the Liberal Critic was really following up on a cou ple of concerns he had from last year, but could he give us an update on all the reviews?-I know last year he outlined the various reviews and studies before I get into the specific questions on each item. Mr. Orchard: I think we dealt with the National Physician Data Base . The first report from the data base will be made to the Conference of Deputy Ministers in the spring of 1990. I dealt with the walk-in clinic issue yesterday.

In terms of Indian health care issues , that is being discussed between several departments with the delivery involvement within Government. A number of health care demonstration projects are certainly under way and evaluation taki ng place. There are some research projects that have been under way. For instance, on the cost containment at adult medica l intensive care units at the Health Sciences Centre, we are expecting the final report in the near future. At the Discharge Planning Model at the St. Boniface Genera l Hospital , again we are expecting the final report and analysis by the end of this year. *

(1500) The review of rehabilitative services in Manitoba has been completed and I tabled the Dr. MacDiarmid Repor t at a press conference with my honourable colleague the Minister of Education (Mr. Derkach) at which we remedied the 1975 cutback of the spaces for training at the occupation al therapy and physiotherap~ rehabilitative faculties.

The recommendation in the MacDiarmid Report was to rein stat e those training positions to the pre-1975 cutback level of approximately eight per faculty and my colleagu e the Minister of Education, through the Universities Grants Commission , provided sufficient funding to not only reinstate to the 1975 cutback level , but to exceed that by four positions for a total of 20 additional slots, not 16 as was recommended in the MacDiarmid Repo rt. A number of other issues are currently unde r investigation. Evaluation of the geriatric day hospitals , I have indicated that to my honourable friend just now.

Hospital utilization by the elderly is a report that is due very shortly. It was due the end of September but it has been delayed slightly. National Health Research Development Program: the Federal-Provincial Territories Committee, because this is an issue at the federal-provincial territorial level, held a special meeting in August to identify the priorities for the Decemb er completion notice. Two priorities were identified , namely the health manpower studies, and cost effecti ve strategies , and those are to be presented by year-end. Again , that is the target date .

The Breast Cancer Screening : we are expecting a report I believe two months out. Would that be fair? Manitoba Health Research Council: there has been a number of ini tiatives with the Manitoba Health Research Council, namely-and I know my honourable friend for Thompson will applaud Government's action 2162

Tuesday, October 24, 1989 initiative in more than doubling the fund ing to the Manitoba Health Research Council so that they can undertake very valuable research projects in the Province of Manitoba. In addition to that, I know my honourable friend from the New Democratic Party will also applaud the establishment of a four-year $4 million fund under the auspices of Manitoba Health Research Council and IT& T in Government to further research in hea lth care in the Province of Manitoba.

That represents a more than tripling of the resourc es available over the next four years for research in Manitoba , a signif ic ant commitment by this Government to health research that demonstrates clearly our prio rity in that area. Mr. Ashton: I want to focus on a number of the items that the Minister made reference to , and items that were referenced to last year in terms of the studies being conducted by this

part icula r

section of the department. I want to begin in regard to the physician situation. I want to focus actually on the statistical side .

I realize that we have discussed it under the Health Advisory Network and we will be discussing it again in terms of the standing committee , but I just want to deal with the statistical side to get some idea of the situation we are faced with, and ask the Minister basically the · same question that was asked last year, that is, what the current doctor-to-patient ratio is in various areas · of the province, most particularly the rural and northern communities, and also what the current situation is in terms of particular communities. I know that this was · one that was asked last year.

The question was raised as to what number of communities were looking actively for general practitioners because of the shortage of rural northern communities. Mr. Orchard: Mr. Chairman, I do not think I have the , Standing Committee on Med ical Manpower 's report in my file here , but that I believe was tabled in the House · abo ut three or four weeks ago.

I am going from memory and I will confirm the number s but I think the ratio in urban Winnipeg is approximately 470-or-so patients per physician , and in rural Manitoba I believe it exceeds 1,000 , or just under 1,000, in the ballp ark of 1,000, but we can find that for my honourable friend . Mr. Ashton: I certa inly appreciate that information .

I am wondering too, if the Minister can ind icate what . communi ties-and I realize it is somewhat of a subjective ques tion in the sense that the real question has to be as ked , what is a sufficient number of physicians, but let us deal with communities that have no physicians . What number of communities are looking for doctors this year? I know the figur e last year was in excess of a dozen communities that had basically no medical service. Mr. Orchard: I will tell you what , Mr.

Chairman , I will give my honourable friend a copy of the latest informa ti on I have fro m the Standing Committee on Medical Manpower which indicates the physician recru itment by general practitioner and by spec ialist cate gory in the vario us communit ies thr oughout Manitoba that SCOMM is curre ntly assis ting in recruitment efforts. I will try to get that to my honourable friend tomorrow, so he has it for Thursday. Mr. Ashton: I would very much appreciate it.

I would also like to get an upd ate in terms of the current situatio n in t erms of med ical students and the postgraduates, both in terms of the numbers, and whether the Minis ter feels that the cu rre nt admission number is sufficient to meet the needs of Manitoba in terms of positions . Mr. Orchard: There are 80 undergraduate spots that are currently funded . My honourable frie nd , there are two pro blems . First of all, that is probably a quite adequate undergraduate number if there was an equitabl e distribution of the undergraduates in practice . It would more than adequately serve the needs of Manitoba .

As my honourable friend well knows and appreciates , the placement or where those physicians have gone to practise after passing their examinations varies very significantly with the majority not going to rural or northe rn Manitoba as Manitoba graduates. Mr. Chairman , that is a long-standing problem and a problem with which we are very pro-actively seeking solutions. As I indicated to my honourable friend earlier on and I am going to rethrash a little ground with him, but I know that he considers the issue important enough that he will allow me the liberty to do that.

I make the straight-out observation that the whole medical manpower issue was attempted to be resolved by Government alone in isolation of the Faculty of Medicine and the MMA and the college . That is why I refer with some optimism to the renewed and restored co-operative approach from those organizations in working with Government , because I have made and my Deputy had made and the commission has made very open overtures to the major players in physician training and recruitment and retention to seek out their co-operation in building solutions for Manitoba.

That resulted in the most recent conference in Portage la Prairie sponsored by the MMA. I referred to it in my opening remarks specifically because two years ago the environment may not have led to that kind of a meeting and conference being held. But the MMA sponsored it, it was attended by myself , by the Minister of Education , naturally the MMA, the College of Physicians and Surgeons , and the Faculty of Medicine . It focused clearly on what some of the problems were, what some of the difficulties were and, as proposed, post meeting some proposals which I think have arrived .

We have just recently received the report and some of the conclusi ons that were drawn, because the meeting had those professional groups there fro m the faculty to the MMA etc., but it also had substantial rep resentat ion from communities in rural and northern Manitoba . *

(1510) So, you know, I am saying to my honou rable friend that I would think , and the current indication is that we have more than enough graduate spots in medicine in Manitoba . The difficulty is in the distribution of where 2163

Tuesday, October 24, 1989 those graduates end up practising medicine, and very much I think it is fair to say that all players are pro actively seeking , in a collaborative and co-operative fashion, some remedies to that maldistribution. Mr. Ashton: One question I have once again focusing more on the statistical side, it is support information. I do want to get into a greater discussion on this at a later time in the Estimates, and I know the Member from Kildonan (Mr. Cheema) does as well because it is a very impo rtant issue.

It was raised last year, and that was the breakdown between rural and urban students , because clearly one of the factors-and the Minister, I think, implied that in his answer as well one of the major factors that determines where a graduate ends up practising is where they are originally from. I know in the time that I have been in Thompson, and I went to high school in Thompson , I know that there is a grand total I believe of two people who have graduated from R.D. Parker Collegiate in the last 25 years who have gone on to be practising physicians.

One of them happens to be my brother who is practising in the North , one of whom is not practising in the North. The experience, I know, in talking to people, graduates of the program here in Manitoba, is that many of the students are from Winnipeg and their goal when they enter the medical college is to graduate, become a practising physician here in Winnipeg, and never even consider the alternative , something that we need in rural and northern communities. I am sure the Minister can identify with that .

It is the same problem whether it be Morden or Winkler or Thompson or Lynn Lake, or any of the communities . I would like to ask the Minister, because I know this was raised in previous Estimates, what information there is in terms of the original, shall we say, address of the individual. Where is the breakdown between northern and rural students, and urban students in the Faculty of Medicine? Mr. Orchard: I cannot give my honourable friend those numbers . I had them last year. We can seek them out. It was not a population split , if you will.

It was not 55- 45 as the demographics of the province are ; it was weighted in favour of urban students. Mr. Ashton: I certainly appreciate the updated information . I know that was provided at the committee last year. I think it is important to have that type of information gathered because I know the Minister did indicate , and I know it has been discussed, the Faculty of Medicine , in the past , mechanisms to try and get a larger number of people in the program .

Apart from the medical access program which is aimed in an affirmative action way of getting Native people into pre-medicine actually , and has had some impact at least at th at level , my understand ing , essentially the way the Faculty of Medicine does operate is, while there has been a greater percentage of the attention given to the interview process and some of those factors, the policy in terms of promoting medicine as a career has been more limited in recent years to 2164 promoting the information and awareness of that as an available career.

I think one thing that also should be looked at is the general trend in terms of the students who are being admitted , and in particular I would suggest the grade point average of students , because I am sure a study and I know Dr. Carter did a study on the rural-urban breakdown-I really believe you would find that there would have been an increase in the grade point average over time to the point where you require a very high grade point average now to be admitted to medicine. I guess what I am suggesting is perhaps 20 to 25 years ago , you could have become a doctor .

You could have been admitted to the Faculty of Medicine with a far lower grade point average, and we end up in the difficult situation. I realize it is a philosophical debate in terms of how you select. Do you go with a person with the supposedly best academic credentials?

What I am suggesting is that there are many people with more than adequate academic credentials with quite high grade point averages who might not normally meet the requirements of admission in competition with others who might have a 3.9 grade point average, and they may have a 3.7, but what I am suggesting is that perhaps we need to be weighing the selection process more toward getting more input from rural and northern students.

I believe that for example if the ratio was to reflect the population in Manitoba more equally , we would not solve the problems that we have in terms of physicians overnight, but we would end up with far more people returning to their home communities because I think it is a natural process. When you graduate, particular ly when there are practices ready and available in rural and northern communities , for at least a significant percentage of people to return to those communities.

So I would ask the Minister if he could perhaps provide that information as well , and that is both the breakdown, the rural-urban breakdown , this year as opposed to other years, and also perhaps an analysis of the criteria, including the grade point average and other factors that we are taking into account, so that we can see the trend in whom we select as medical students . Mr. Orchard: Mr.

Chairman , I will provide as much of that information as I can get, but I think my honourable friend would understand that I am not the dean of the Faculty of Medicine, so I will provide the kind of information that is within his ability to share with me and provide it to the committee. I did that last year and have no hesitation in doing it. Mr. Ashton: I have further questions, but I can defer to the Member for Kildonan . Mr. Cheema: Mr. Chairperson , we have tried to avoid this issue for the last three days .

I thought we were going to discuss it under the Standing Committee on Medical Manpower , but it seems like the issue keeps on coming back. Certainly I would like thi s o ppo rtun ity to address this issue if the Minister is ready to do that. Mr. Chairperson , as the Minister of Health has indicated, he was at this meeting at Portage where it

Tuesday, October 24, 1989 was organized by the MMA and the Manitoba Medic al Steward Association. There were members from the local municipalities and other co ncerned groups. I had some knowledge of the mee ting and later on I was communicated through peop le just by personal conta ct. It was a very successf ul meet ing and there were a lot of suggestions made fr om the floor in terms of how to solve this ongoing problem which then came for the last six months, or one year, or two years . It has been there for a numbe r of years .

It is not only for Manitob a but this pro ble m i s probably worse in so me parts of Saskatchewan, Nort hwest Territories , northern Quebec , and proba bly worse in Newfou ndland where they are having a real difficulty in attracting doctors into the smaller communitie s. I think there are a number of major issues here. One, I think there has been no policy from the previous administrat ion .

I am sure the Member for Thompson will have some patience to listen to this because it is not personal , but I think this is a point I wanted to make , that under their administration there was a deterioration in terms of rural medical manpower , also the numbers for the areas, and particularly to the Faculty of Psychiatry. It was such a severe blow that so far we have not even recovered from that. The message was very dangerous when you are negotiating with any group. A confrontational attitude is not going to achieve anything and when you say, if you do not like Manitoba, leave, and many people left.

That is one problem and still it is going to take a long time for any Minister of Health to solve that situation and come to grips of how to avoid such situat ions in the future . But as regards to the rural manpower for primary health care, which has been a No. 1 issue, personally for me and for my caucus, and I am proud of that, we have worked very hard to develop a very practical, very possible solution, and the Minister knows that. There are at least now about anywhere between 20 to 2 4 communit ies who would like to have a permanent doctor .

They may have people doing locum or they are the re for a short time, but they always get into difficul ties. There are about six to eight communities even cannot secure physicians and people have to travel long distanc es. Even 40 to 50 miles is a long distance if you have t o go tor primary health car e. *

(1520) For the m it is not possibl e and some of the commu nities' viabilitiy is very much att ac hed to the fac ilit y t hey get in their own community . If they canno t have a doctor and a n urse or a pharmacist in their own commu nity, wha t g ood is the use of having all those hospitals when they cannot even use th em ? Som e o f the hospitals are empty and that is the - in some places , yes. The Minis ter of Health does not like that word , but that is the way it is.

As we have point ed out many tim es, one of the ways to attract students from the rural commun ities is to prov ide to th em all the incentive grants and some of the funds that they may return when they go back and practise, but this yea r t he budget has been doubled and that is very posi tive. It has not materiali zed in the past and we sincerely hope that may be one step in the righ t direction .

The other major pro blem whi ch we are facing-and we are not uniq ue, it is very commo n in Saskatchewan and some parts of North ern Ontar io-the doctors coming from certain pri vileged co unt ries tor a short term period get a licence and leave for a bett er practic e in better area s or for more mon ey, whatever reason one wants to put in. That is unfair because you have a system that is being used by peo ple wh o know how to go about the system , get immi gration , get financial backing for a while and then go and use Manitoba as a stepping stone. N othing has been done to stop that.

The Minister of Health (Mr. Orchard) could play a very wide role to decide that factor , even though he has said the college is right. No one is arguing saying that the college is strong here, but the college has policies, certain regulations , and if those regulations are met , if communities come in and say we need a doctor , and if that doctor fulfills all the requirements , they will give a licence and therefore somebody will practise medicine , but the statistics are very clear that 20 percent to 25 percent minimum would leave, leaving Manitoba after using all those grants.

All the incentive grants are used for six months and the local communities also spend some money because some of them the airfares are even paid, they are getting subsidized accommodation, so the communities are also putting their money in for the jobs. I think it is unfair that those individuals would leave and do not have a permanent commitment for Manitoba. There should be a policy clearly indicating that if you come to Manitoba, stay with us for five years .

The other part of the sad story is that there are a number of individuals who would love to practise in Manitoba or any northern communities or any remote community provided they have a place, have internship, because without internship they cannot get a licence , they cannot pass their exam . I went a number of times on this issue with the Minister of Health to debate , and according to him I do not understand the issue , but according to me he does not understand that specific issue . We are talking about a specific number of individuals who are on a Canadian Intern Matching Service.

That is not service made by me or any politica l Party, it is a uniform service which is serving a very valuable role to the whole of Canad a. You have 500 individuals on that list who are qu alified , who have passed all the exams , and the only hurdle for them is to have internship positions . Unless they get that position they cannot practise medicine . Most of them are Canadian citizens , they were not able to secure positions here, they went outside the country and got training . So when we have communities who need physicians, we have physicians who would lik e to practise , why not use them?

We are not asking to create a new position for anyone , we are asking to use tax dollars in the right manner , and that is not being done. 2165 Absolutely I think this is wrong and out of this $400 ,000, I would ask the Minister later on how much

Tuesday, October 24, 1989 money for the lpst few years has been was,ted in terms of how much money has been spent on all those doctors who have left Manitoba? How many commun ities have been spending money on them? I think our tax dollars are being wasted when the Minister of Health has not come up with a solid proposal , but we do have a proposal which is very valuable. The proposal was very, very widely accepted by the past president of MMA and all the professionals in the U of M, and also we got good response from the rural communities.

We are asking the Minister today to say whether he likes the policy or not , yes or no. The proposal is very simple , very practical. You pick up a certain number of individuals-who picks that number is by the University of Manitoba from the Canadian Intern Matching Service , and they should , prefer people who stay in Manitoba who are already residents of Manitoba and then have a clinical exam. After they have passed the clinical exam they should go and visit those communities.

We do not want somebody to come here and practise and after six months say that , well , I did not know where Thompson was, I did not know how Flin Flon looks, I did not want to practise medicine . That is the common thing, that has been happening , people would leave. The communities must play a direct role here, the local municipality . The individuals should meet with them, have a discussion and have approval from them, and then there should be a program established for six to eight internship positions . We wanted that program to be started this year. It is already five months late.

We could have got six to eight doctors for next year, for five years practice of medicine in a rural community. We are not even asking the provincial Government to put the whole money . We are asking that they should at least take care of part of those funds . It is probably $21,000 to $22,000.00 . It seems a lot , the Minister will say. We are asking to spend money but when you count how much each doctor is taking out of Manitoba when they com e and practise here , it is much less than that.

When you have an indiv idual who is going to practise medicine in a community for five years, he or she will establish the family contacts , they will estab lish practices and normally they do not leave. That is the common thing, they would just look at the statistics. Why is the Minister so hesitant? He should take the lead and accept this program, try it for two years , and after that we may not need this kind of program . It is just that you have people who are available and 500 people on the Canadian Intern Matching Service.

We can at least select five of the best possible and let the Universi ty of Manitoba , the municipality, make a decision . They are the ones who are going to be in trouble if they do not get doctors. People who will make decisions in the immigration department or the college, they are not responsible . Ultimately it is bad news when you do not have a doctor in a given communi ty. That is common knowledge, that is what happened last Wednesday . People from Thompson left .

A number of individuals in the small communities at times they leave after six months , and if you sum up how much money they are taking from the taxpayers of Man itoba, it is more than $21,000.00 . You are giving them incentive grants , you are giving them subsid ized accommodation, you are giving them tax incentives , and they have nc commitment.

It sounds very radical from a physician's point of view, but I think, as the taxpayers of Manitoba , we have the responsibility to utilize the tax dollars in the best possible way, and I will request the Minister to clarify his Government's position on such a proposal. *

(1530) Mr. Orchard: Mr. Chairman , there is a very good program in place which I support , which the individuals my honourable friend referred to can access and have indeed been willing to attempt to access, that does not require any new policy , it does not require any change in policy , it exists in the Province of Manitoba today. My honourable friend shakes his head . He shakes his head because my honourable friend has not offered to this committee full and complete information .

My honourable friend has said that there are doctors in Manitoba who have passed all the examinations and are not allowed to practise . I know of no such individual that is in that circumstance . My honourable friend might want to take the opportunity right now to indicate, and he does not have to put the individual 's name on the record. He can pass me a slip of paper with the individual's name and I will investigate that. So I will give my honourable friend that opportunity righ t now. Mr. Cheema: Mr. Chairperson, the Minister is well aware of that .

There was supposed to be one exam, the general exam which is called Medical Council of Evaluation exam for foreign graduates . A number of individuals who come to Manitoba from time to time , they passed that exam and some of them leave because they cannot find a position. We have a number of individuals and I will certainly pull my file and give him certain names. What I am asking him is simple, people are not going to wait for six months or one year. They have to look after their family. They are not a single indivi dual.

Some of them are running away from their countries but do not have funds to keep on writing all those exams . Some of them , the exam which has been started by the U of M, it costs $500.00. Some of them do not have even that kind of funds . What I am saying to him, there are 500 indiv idua ls, he does not need my help. He could simply make a phone call , maybe just to the Canadian Intern Medicine Service and get all those names . He does not need anyone's help . He has all this staff, just a phone call , they have an office in Ottawa. The names are all listed there.

They will give them the address , telephone number, hopefully, to all the individua ls in Canada and why not use them? I am asking him a simple question . If certain individuals have left Manitoba, are we going to then go after them and chase them? What I am 2166

- • Tuesday, Octobe r 24, 19 89 simply asking them does not matter where people live in Canada. We have available, tho se individuals, we should use them. This is a good program. The Minister is saying the y have the pr ogram right now. Accord ing to the information we have, it is different. They say you have only two positions and that comes under the Refuge Doctors Progr am, but we are asking, is the program established for a given period of time, either one year or two years service, six to eight positions each year, so that by the end of two years we would have about 12 doctors?

I do not think we will need more than that. You do not have to have more programs. The pr esent pr ogram does not specify that you have to pr actise in a rural communit y. It does not. Can the Minister sho w me where is tha t line that says tha t you have to pr actise in a given commu nity for five years? No, it does not say that.

Wha t we are asking is a commitment from th ose individuals who cannot find a place, who are ready to work, and the communities want them there, why we are being a hitch in tha t, why we are putting up all the obs tacles, why we have to put two or th ree or four exams, just a systematic way of discoura ging people. You can put all the exams and discourage people.- (inter ject ion) - What I am saying that the clinical exam, you can discourage people. It is one way of telling them we do not want you. It is the pol itical real ity. Mr.

Chai rperso n, it is really disappointing tha t we have to argue about this for the last year when many pr ovincial authorities are looking at such a prog ram. Can the Minister tell me which line says that the y have to pr actise for five years? Mr. Orchard: Mr. Chairman, I intend to deal with each of the issues raised by my honour able friend. First of all, in 1981 in Ottawa we patriated the Constitut ion complete with a Charter of Rights and Freed oms which makes it legally impossi ble to enfo rce a five-year return of service cont ract on any professional individual.

That has been tried in other jur isdictions and you cannot enforce it, so tha t even though my honourable friend's next statement is, well, but th ese people will want to do it, tha t may well be, but th ose people can sign the cont ract tomorr ow, pr actise medicine for one month and leave for Victoria the next month, and we have an absolutely unenforceable contract. I wish my honourable friend would acknowledge that. That is not me saying that, that is the reality of the legal system based on the Char ter of Righ ts since 1981 in this nation.

My hono urable frien d, and I asked him for th ose individuals who had passed all of the exams req uired, said he would pr ovide me with that information but then later said, why do we have to put th ese individuals thr ough all of this examination, because all we are doing is discoura ging them from practising medicine? Mr. Ch airman, I want to tell my honour able friend that ther e is a refu gee program which is a leader in the nation in terms of the training of refugee physicians.

What my honour able friend is referring to are for eign trained physicians who come to Canada, and when they immigr ate to Canada they have not stated to 216 7 immigration authorit ies that the y are a physician and the y wish to pr actise medicine. My honour able friend is acknowledg ing that fact because my honourable friend knows that Immigration Canada, should th ose foreign-trained physicians ident ify th ems elves as physicians, they will be told the difficult and maybe impossi ble circums tances for them to und ertake pr actice of medicine in Canada.

That is the reality of the Canadian Immigr ation policy. It is not meant to discri minate in any way, sh ape or form, as is the common fall back when this difficulty is faced by th ose foreign-trained physicians. It is a simple recog nition by the Immigration people of Canada that Manitoba, Saskatchew an, Canada, have a sufficient numb er of Canadian grad uate physicians, and my honou rable friend is even agreeing with that.

Despite th at, at the Faculty of Medicine at the University of Manitoba in addition to the refugee program - because refuge es are a differe nt status, th ey are forced out of their countr ies and they are coming here under different circumstan ces, they are not immigrants in the pur e sense of immigration policy-for landed immigrants th ere is a policy that has been in place at the Faculty of Medicine, and I will indicate it to my honour able frien d.

There are four qualifications which any individual who is a forei gn-trained gradua te must accede to prior to acceptance into an inter nship program , the Faculty of Medicine. First of all, th ey must have landed immigrant status or be a Canad ian citizen, and all of tho se citizens presumably qualify. They must have passed the Med ical Council of Canada Evaluation Exam ination. They must have succe ssfu lly passed the University of Manitoba Clin ical Compr ehens ive Examination, and they must have external funding for the inter nship year at arm's length to the individual.

I reitera te what I have stated, and my honour able friend knows that I am speaking accurately. Ther e are no foreign-trained immigrant doctors, to my knowledge, in Manitoba who have met tho se criteria. I know of two who have passed the Medical Council of Canada Evaluation Examination. Two of the 16 who petitioned Go vernment, which my hono ur able friend has been advoca ting their position to Go vern ment, have passed the MCGEE but as of the last time I che cked , which was rece ntly , neither of the two had passed the Un iversity of Manitoba Clin ical Compr ehen siv e Examination.

So my honourable frien d's statement tha t the y had passed all the examinations is simply not an accu rate one. That is the difficulty that th ose for eign trained physicians face. I want to sh are with my honour able friend some informa tion that was given to me by the Colle ge of Ph ysicians and Sur geons of Manitoba because, as I sa y, when th ese crit eri a ha ve no t been met by individuals, the next easiest thing to indicate is, well, this policy is discri minatory, th erefore Canada is not trea ting me fairly, ther efore we should change the rules.

I cannot say that is an accurate assessment of what is happen ing and I do not like the use of the old di scr imina tion ar gum ent being dr awn into this argument. We ha ve expecta tions of com petence amongst trained physicians because in Canada we fund

Tuesday, October 24, 1989 tt,e physician for his or her ent ire service provision. It is under the Canada Health Act, it is under Medicare , and as such we have responsibi lities for assuring the quality of care is assured. The professional disciplines themselves hav e substantial checks and balances on physicians that are registered to practise to assure that they practise competently. That is the whole nature of the two examinations that the individuals who immigrant to Canada , trained in foreign medical schools , must pass .

There are some exceptions to that and those are exceptions of graduate students in foreign countries whose medical training programs have been patterned off the " British training system." Those countries are Australia, New Zealand , Scotland, England and Wales, Ireland , and South Africa, by and large-and the United States is also in there-because their medical schools undert~ke a teaching and a training program wl;lich has been accepted in this country for years and years . *

(1540) The Medical Council of Canada Evaluation Examination is designed to indicate whether the individuals training in schools other than that is sufficient to meet Canadian standards, rigorous Canadian standards . The University of Manitoba has a clinical comprehensive examination , again to ensure that the individual has the necessary qualifications to enter an internship program . Not discriminatory , simply assurance of standards .

I want to share with my honourable friend information from the College of Physicians and Surgeons which shows the successful pass rate of physicians trained in medical schools of various countries. In Australia, there is a 100 percent pass rate . In New Zealand, there is a 100 percent pass rate. It drops down to Scotland at 83 percent , England and Wales at 82 percent , Ireland and South Africa at 59 percent , Sri Lanka is 52 percent , Germany 42 percent, Chile 21 percent , 21 percen t passed the clinical examinations .

That is why the college will not offer, except under knowledgeable circumstances, an exemption to the examination to practise immediate ly in Manitoba. The range of successful passage decreases. For instance, physicians trained in Czechoslovakia, if I have the line right , have a 5 percent passage rate; from the U.S.S.R., 4 percent passing rate ; from Nicaragua, 2 percent passing rate; China, 2 percent passage rate; El Salvador, O percent. I wish my honourable friend to have a copy of that because it is not discrimination .

It is an attempt to assure that the person you have given licence to practise medicine is competent and capable to do that , not standards that I have set because I am not a physician and I am not knowledgeable in what is needed to certify that the individual can practise medicine . That is why, Mr. Chairman , my honou rab le friend will find that the college and the Faculty of Medicine have some examinations to prove basic competence before foreign-trained physicians can enter the internship program. That is why those steps are in place .

I say to my honourable friend , when he says that there are physicians in Manitoba, foreign trained who have passed all of the examinations, he is not correct. They may have passed one exam, but they have not passed the exam at the Faculty of Medicine in Manitoba , so therefore they have not proven their ability to undertake the internship program. Let us make sure that we are talking objectively on this issue and we are putting accurate informat ion on the record, because the information that I have just shared with my honourable friend is accurate. Mr. Cheema: Mr.

Chairperson , I fully agree in terms of providing the best possible care. No one ever said tha t the quality of care or quality of the individual should be lowered and that is not only coming from this Ministry of Health. It is common knowledge for the whole of Canada , and that is why they have this uniform exam of which everyone has to pass . Now he has read this requirement. No. 4 requirement is you want them to qualify for all the exams, I have no objection to that.

Absolutely, any rational person on the street would say that give them the fair exams, but why do you ask them , people who are fleeing from their countries , who do not have even the money to put bread on the table , you are asking them to go to somebody to pay for their internship which is $25,000 .00 ? You are asking them to pay $500 to pass exams . Some of them cannot even speak the language . I am not saying that you have to teach them everything , but is this system fair bec ause you are providing $400,000.00? Out of that, at least some amount is going to these privileged five countries and that is unfair .

What I am saying is that there should be fair treatment to each and every individual if they are qualified . I am not asking to provide a special status for anyone . We are simply asking that this system, your line No. 4 is completely unfair . Nobody has to be a genius to look at that and say " unfair " and you have repeatedly denied that right for them to have a place to have internship . Even after they are qual ifie d, how are they going to get $21,000 to $25,000 .00?

When you are providing all those grants, you should also ask the college to provide a list of individuals who have left Manitoba and how much they have cost the taxpayers of Manitoba . Why can we not get that information? I cannot get it, I am simply an Opposition Critic. As the Minis ter of Health , you have all the rights to have access to all the information , but this is common knowledge and I would say you should have a look at this policy which is unfair . Mr. Orchard: Mr. Chairman, let me correct my honourable friend's statement .

This is not my policy , this is the criterion set by the Faculty of Medicine in the Province of Mani toba . Not my policy .- (interjection) Mr. Chairman , my honourable friend, if he would listen with patience, I will indicate to him how he has now argued on both sides of the issue . This issue started presumably in April of this year, with a petitio n from a number of foreign-trained physicians, 16 of them, who on April 27, sent me a petition . One of the lines , and I will read it back to my honourable friend because I think he has forgotten this .

The Faculty of Medicine 's criterion is the indiv idu al has 2168

Tuesday, October 24, 1989 outside funding, at arm 's length to the ind ividu al, in other words, comm unity support. My honourable friend might be interested in know ing that in the petition to me from those 16 physicians they have indicated-I will read the last , we feel confident that having an opportunity to be retra ined during the first part of the program (the internships ) we would be ab le to serve well and meet the expectations of the rural commun ities. In our opinions this program could solve many proble ms.

It cou ld bring various benefits not only to us doctors but also to the communities involved and to the Government budget as well (the costs of retraining us would be covered by those communities) . That is what the physicians , the 16 physicians indicated they were willing to do. Mr. Chairman, I have pointed out to my honourable friend that is fully and completely available to those individuals if (

a) they are landed immigrant or Canadians , (

b) they have passed the Medical Council of Canada Evaluation Examinations and passed the clinical comprehensive examination of the University of Manitoba , and the individual has outside funding which they have acceded to in their petition . Nothing is preventing them from achieving the ability to practise medicine in Manitoba . I cannot understand why my honourable friend is now saying that is unfair , because those 16 individuals agreed to that on April 27 when they petitioned Government. I replied to them that they have every opportunity to practise medicine by simply passing the exams .

My honourable friend just a few minutes ago agreed that people must pass the examinations, so that is no problem for criteria 2 and 3. He agreed with this petition back in April where the physicians themselves said it would be economic to Government because the cost of retraining us would be covered by those communities . Mr. Chairman , I have indicated that is f ully open to those individuals . There is nothing unfair, there is nothing discriminat ory, the opportunity is there in the province of Manitoba . Mr. Cheema: I will clarify that situation now.

You have that petition indicating that they are going to get funding from those communities. What they are understanding in their own mind, this money is going to come where they are going to practise medicine . There are the small communit ies or the northern communit ies, but is that a fair state ment? They are just picking any comm unit y from their own imagination, and they think that the proposal we put forward that the communities plus the Ministry of Health and the U of M would share the cost of $7 or $8 per person.

I think they are relating to that part of the community covera ge, but I do not think they are made assured that somebody is going to pay for the internship fully. That is not correct. I think they have not conveyed their message properly in the right way. I think they are not clear or the Mini ster has failed to get a clear message from them . What I am saying to him , you have annou nced $400,0 00 .00 . Part of that is for tax incentive grant s.

Part of them is for the stud ents from the rural comm uni ties and that is excellent, but once you are getting all these indi viduals from the outside country and they are getti ng all the advantages , they are tak ing more money away from Manitoba than these individuals wh o will be given a chance if they are given a one-y ear chance to have internsh ip position whenever they are ready after they pass all those criteria. •

(1550) I have no objection to that but I think it is unfair when you are getting indiv idu als from outside when you can have a plan advertised or get from the Canadian Intern Matching Service. There must be 5 to 10 individual who can pass all the exams. I mean, people are not stupid, excuse my language . I mean people who are practising medicine now , when they came 10 years ago , they came from the same medical schools . If they were good 10 years ago , why are they not good now? Because of demand and supply, that is a simple answer .

We should be fair to each and every individual who is already in Manitoba or in Canada . They should be given the first chance, and the Minister said that is according to the Canadian Char ter of Rights . Why are we not being fair? You should take a lead role in Canada and make sure that this thing happens. You could be a hero but if you take this policy and run it for two years. Their letter is not even clearly indicating the way they are going to secure money . When they come to us they are asking they do not have money, who is going to fund and guarantee positions.

Now you are saying, according to them , they have secured money from certain communities , where their understanding is the community they are going to practise in, for example The Pas or Flin Flon , they may cover their costs . That is not true , we do not have that policy. That is what we are asking you to do as a share program between the local hospital , the local municipalities and the Manitoba Health Services Commission , or the Ministry of Health, whatever suits you the best. Also , when they are doing a one-year internship, they will provide a very essential service in the hospital system .

It is not free , they will also be provided a very essential service . To answer your other question, well , they are going to leave in one month , I mean you have to believe people to a certain extent. When they are ready to have a commitment for five years , that will be immoral for somebody to use Manitoba and leave after one month . That is not true , I do not believe people are that low in their thinking . When they are desperate in situations like this, I think we should use them rather than ask them to cook hamburgers on some body's stove; they are doing it.

But we do not have a program to even encourage them, and last year there was an announcement to provide $2,000 to help them, some individuals to get the m i n tra ining . There are lots of problems and I am not saying the Minister has to deal with all of them . I am simply asking him to make available funds to each and every individual on the basis of merit, not the country of origin of the medicine . Mr. Orchard: Mr. Chairman, now we have another version of the Liberal policy which is different from the 2169

Tuesday, October 24, 1989 p_etition I received , which is different from my honourable friend's I believe sincere comments to committee, that there was good response from the rural communities , that the rural communities want them there. Mr. Chairman , I have checked that and we have not had an enquiry through the Standing Committee on Medical Manpower as to how communities might be able to assist these physicians as they indicated in their petition to me, i.e., support them in their internship year for return for service.

So my honourable friend has to be consistent in his development and his suggestions to Government. I have been consistent in what I have been saying to my honourable friend that the opportunity is certainly there for each of these individuals to practise medicine in Manitoba. It existed a year ago, it existed two years ago, because it has been a policy of the Faculty of Medicine that has been in place for - I cannot tell you how long . I also just simply want to reiterate to my honourable friend , and he agrees with this, that both levels of examination ought to be passe d.

None of those individuals have passed both levels of examination to the latest information I have . So they simply cannot access any program for internship until they pass those basic examinations . That is significantly different from the physician who is trained in Australia or England or Wales who comes to Canada and receives the opportunity to practise because their success rate on passing the MCGEE is excellent. This is the important point fo r my honourable friend to understand : they do not require any further training . They simply have to pass the Medical Council of Canada Evaluation Examination .

We got into that issue in one circumstance where the individual was granted a waiver to practise medicine because the College of Physicians and Surgeons, the certifying body, indicated they believed the individual had the ability and the knowledge and the training to pass the examination . The individual failed to pass the examination, and we removed the individual 's right to practise and that caused some problems.

That, unfortunately or fortunately , depending upon whether you look at it from the individual 's standpoint as a physician or the public 's standpoint , is a standard that we have used to help us to assure that quality level of practice is available . I know my honourable friend is not asking me to break the rules in that regard , and he shakes his head saying , no, and I am not. I am simply pointing out to my honourable friend that the opportunity is there for those individuals to practise medicine in Manitoba. It is not an unfair system , it is not a discriminatory system.

It is a system which is in place designed to prove competence of training, of past training, an ability to enter internship for some foreign-trained physicians . For others, the examination in designed to show that they have the competence to practise medicine without requiring further internship . Mr. Chairman , the opportunity is there to take up that career and that livelihood in medicine in Manitoba for foreign-trained immigrant physicians. Indeed, it is even there for refugee physicians who are accepted into this country because of troubles at home . Mr. Ashton: Mr.

Chairperson , I realize we are in a bit of a dilemma when we get into the issues of, for example, this issu e in terms of physician shortages th at we do tend to get into the broader discussions. I had originally intended, my line of questioning anyway , to be more in terms of the research aspect of the whole question, although it is an interesting debate back and forth in terms of the various views of how we deal with the situation with immigrant doctors and recognition of qualifications .

I know I raised my own concern about a case in my own constituency where a physician who was recruited with a great deal enthusiasm by the Thompson General Hospital did not receive his qualifications . I know there had been the question raised by the Thompson General Hospital as to whether the qualifications were really appropriate to the type .of work that the individual would be doing .

I do not want .to get into the details _of the case, but I just want to point to that as being some th ing that I think also should be considered and that is the legitimacy of the qualifications , particularly when you are dealing with rural and northern communit ies which are often faced with the choice of either a physician who may be able to perform some duties or no physician at all. I think that very real question has to be raised. *

(1600) It is not by the way that people are cognizant of the need to maintain standards . I know in the current situation, once again in terms of the Thompson General Hospital and it is a situation I know that it is discussed in other hospitals , one of the concerns related to the departure of two doctors this past week is the fact that while there are a number of physicians in the community who do have some experience obstetrically, they do not have even the Level 1 experience which is a requirement I believe of the college and is supported by the hospital.

It is a real dilemma you run into when hospit als are faced with the choice as they may be in communities , such as my own and other communities, whether you lower the standards to have staff in that area able to perform a certain service or whether you have to ship patients out. That is assuming, of course , that you cannot find a replacement physician . I raise that having had some direct knowledge . I do not know whether the Minister wishes to comment further because I know he had commented fairly extensively on the questions from the Member for Kildonan (Mr.

Cheema) but I will certainly defer if the Minister has any comments on that particular eleme nt of it. Mr. Orchard: Mr. Chairman , the circumstance that my honourable friend referred to is the circumstance I alluded to earlier on where the indi vidual practi sin g in his constituency began practice under a Waiver of Examinations with the full expectation that there would be successful completion of the Medical Council of Canada Evaluating Examinations . That was not done , so the individual did not successfully complete those examinations . That was a precondition to practise .

As a Minister, I tell you right off the top the easiest thing for me to do as Minister is not to sign any Waivers 2170

Tuesday, October 24, 1989 of Examination for any physicians train ed outside of Canada, and to leave the commun ities waiting for an extra three to nine months for that physician to practise . I have chosen since I came into this office, and I have signed I believe 40-some-odd Waivers of Examinations for locum tenens and others.

I have done it because in each circu mstance the College of Physicians and Surgeons has indi cated that they believe this ind ividu al can pass the examinations and there is a commitment they will write the examinations and if they fail to pass them their temporary certification to practise medicine will be revoked. The easiest thing for me to do to avoi d the circumstance that happened in Thompson is say I will not sign a Waiver of Examination, but I simply say that does not serve the medical needs in rural and remote Manitoba.

I have decided it is worth the risk, when I am taking professional advice from the Colle ge, that these individuals are appropriately tra ined to practise , that I should, with confidence , sign the Waiver of Examination, and I have done that. I know the dilemma that cause d in Thompson because I received personal corres pondence from the hospital asking a further waiver and exemption.

We attempted to investigate the appropr iateness of that and I am sorry to say that the professional advice I receive d was that would not be an appropriate measure, because without passage of that examination there was the natural question as to whether , in given circumstances , the medical competence was there to meet all emergent and crisis circumstances , a judgment not made by myself but made by peers in the medical profession. With regret I concurred , and I know that caused the community some difficulty .

I simply ask my honourable friend , what would have been lead question in Question Period had I signed a second Waiver of Examination and unfortunately, through a mistake or an inappropriate undertaking of a procedure , one of my honourable friends suffered grievous medical consequences as a result of the practice of that physician? Would my honourable friend have jumped up, lead question asked me what in the world I was doing allowing such a person to practise , because I suspect that may well have been the approach taken.

I have attempted to be balanced in my approach to this situation, erring wherever possible on the side of communities who are unde rserviced , and to date with one exception that action has been appropriate. Mr. Ashton: I believe in my question I recogni zed the dilemma that does exist and I did not want to get into the details of the case. I know the Minis ter was faced with a very difficult decision . It was difficult for the community, and the Minister I think recognized that.

What I am suggesting is that I think you need a constant process of looking at the criteria that are set in term s of practising physicians , and I believe tha t is something that perhaps hopefully will be the outcome of that . I do know the concern that was expressed by the hospital loca lly was, yes, the individual did not meet the criteria in one particular segment of the requirem ents. There was some ques tion as to whether that was appropriate 2171 but I realize they are in a difficult situation when the individual has not passed the exams.

What I am really suggesting is that I think it is important to look at the valid ity of the exams , particularly validity vis-a-vis the situation that individual is in. I am not questioning the Minister 's judgment in this particular case. He obvious ly had a difficult decision to make. He obviously received the recommendations from the people in Thompson. I know I raised this in the Question Period, not in a sense of pressuring the Minister but raising the question whether he would review it. I am pleased to see that at least that was done.

Like I said , it was a difficult decision and the Minister clearly had information which he based that individual's decision on, information that perhaps was not available to the hospita l. That may be the reas on for the decision but what I am suggesting is that may be something that can lead to the questions to be raised about the appropriateness of the standards we do set. I am not suggesting there be no standards , I am just suggesting there be-not even that the re be low standards. I am sugge sting there be appropriate standards. I thi nk incide ntally too that the Member for Kildonan (Mr.

Cheema) did have some good points in terms of the situation facing people in a very personal sense. It is very difficult for some of the physicians who have been caught in the situation of going through the qualification period , and I think the Member for Kildonan outlined that. (Mr. Edward Helwer, Acting Chairman, in the Chair) I have talked to some people I know who have faced great difficulty. I raised the issue just in the House yesterday, the doctor shortage in Thompson.

There are two physicians who are on a locum who are currently their status is threatened because they are employed by a clin ic that may no longer exist. I have already made a number of phone calls . I know the people in the community and we are trying to see if there is something we can do at a community level to keep that clinic going . I will get into that when we get further into the Estimates , but once again I th ink it may be the opportunity to review that process . It was a blow to the community of Thompson.

I am not in any way denigrating the Minister 's decision but I think that was the one question that people did have . When I say people , it was not just the hospital board but also other physicians who I have spoken to. The bottom-line question was whether the standards were really appropr iate in th is particular case, because while the physician in question was in the hospital he did work very well with the staff ther e. The general view of his own colleagues , his own peers was that he was a very competent doctor . I think that is something that is important.

I do not know if the Minister has any further comments but I did want to shift into another area under this particular area of discussion, and that is in terms of the Indian health care . The Ministe r ment ione d briefly when he was running through the update on the status of that , basically that there are a couple of

Tuesday, October 24, 1989 interdepartmental committees reporting to the Cabinet. I am just wondering what progress has been made in this area since last year , and in particular what discussions have taken place with the federal Government, because obviou

Document details

Collection	Manitoba — Debates (Hansard)
Citation	34-2-56
Type	hansard
Volume / chapter	34th 2nd hansardpdf 56.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	698076117a0156c4f537cb23a6edcb2beaa62586

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