1979 Legislative Session: ist Session, 32nd Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

TUESDAY, JULY 17, 1979

Afternoon Sitting

[ Page

789 ]

CONTENTS

Routine Proceedings

Oral questions.

Cheekye-Dunsmuir transmission line. Mr. Lockstead 789

TV coverage of B.C. Games. Hon. Mr. Curtis replies –– 789

Government policy on Kitimat oil port. Mr. Howard –– 790

Price Waterhouse taxation report. Mr. Stupich –– 790

Port Simpson cooperative. Mr. Lea –– 790

Mental health survey. Ms. Brown –– 790

Refugee Settlement Program of British Columbia Act (Bill 32). Hon. Mr. Williams.

Introduction and first reading –– 791

Attorney-General Statutes Amendment Act, 1979 (Bill 29). Hon. Mr. Gardom.

Introduction and first reading –– 791

Committee of Supply: Ministry of Health estimates.

On vote 128.

Hon. Mr. McClelland –– 791

Mr. Cocke –– 796

Hon. Mr. McClelland –– 800

Mr. Cocke –– 801

Mr. Mussallem –– 802

Mr. Cocke –– 803

Ms. Brown –– 804

Mrs. Jordan –– 811

Hon. Mr. McClelland –– 813

Presenting Reports

Ministry of Forests annual report as at December 31, 1978.

Hon. Mr. Waterland –– 814

Select Standing Committee on Standing Orders and Private Bills third report.

Mr. Mussallem –– 814

TUESDAY, JULY 17, 1979

The House met at 2 p.m.

Prayers.

HON. MR. McCLELLAND: Mr. Speaker, I

would like the House to welcome three visitors in the gallery today who

are here to watch the proceedings with some degree of interest, I'm

sure. They are the president of the British Columbia Medical

Association, Dr. Mel Petreman; the executive director of the British

Columbia Medical Association, Dr. Norman Rigby; and the public affairs

chairman of the B.C. Medical Association, Dr. Gordon Ritchie. They are

here somewhere in the gallery, and I'd like us all to welcome them.

HON. MR. GARDOM:

I would like to ask the hon. members to bid special welcome to a good

and old friend of mine, Mr. Tom Ternoway, from the Fraser Valley.

HON. MR. CHABOT:

I'd like to ask the members to join me in welcoming to the House Mr.

Metro Tomyn, chairman of the Radium Waterworks District of Radium Hot

Springs, B.C.

MR. MUSSALLEM: Please welcome Mr. and Mrs., George Bandringa from Maple Ridge, and Mr. and Mrs. W.G. Veldman from Redlands, California.

MR. HYNDMAN:

We have with us today two executive members of the British Columbia

Social Credit Youth Auxiliary, both from Burnaby. Would you please

welcome Ardell Brophy and Colleen Chin.

Oral Questions

CHEEKYE-DUNSMUIR TRANSMISSION LINE

MR. LOCKSTEAD:

My question is to the Minister of Environment. Will the minister agree

to make public all reports made on the economic and environmental

feasibility of the proposed Cheekye-Dunsmuir 500-kilovolt transmission

line to Vancouver Island?

HON. MR. MAIR: No.

MR. LOCKSTEAD:

I have a supplementary question. Will the minister now agree to table

the so-called Dr. Schaeffer report, which was commissioned by the

Environment and Land Use secretariat for his perusal? Will he make that

report public?

HON. MR. MAIR: My first difficulty is

in identifying the report, since the only report I have which is dated

the date the member indicated yesterday has no signature on it. In any

event, the answer is no.

MR. LOCKSTEAD: My

supplementary question is to the Premier. Does the Minister of

Environment's decision to keep secret reports on the proposed

500-kilovolt Cheekye-Dunsmuir transmission line to Vancouver Island

reflect government policy on reports affecting the public of British

Columbia?

Interjections.

MR. LOCKSTEAD: I

have a supplementary question. First of all, I resent that the minister

is not answering questions. Secondly, I resent that the government is

keeping reports secret. The most secretive government we've ever had in

British Columbia sits right over there.

MR. SPEAKER:

Order, please. I would remind the hon. members that it is not proper in

question period to seek to expose government policy, according to

section 171 of Beauchesne.

TV COVERAGE OF B.C. GAMES

HON. MR. CURTIS:

Mr. Speaker, recently the hon. second member for Vancouver Centre asked

questions in connection with televised coverage of the British Columbia

Games. With your indulgence, sir, the answer is not very long.

agreement was made between British Columbia Games and B.C. Television

on November 18, 1977, giving the television organization exclusive

coverage rights of competitive sporting events for the 1978 Summer

Games in Penticton. On February 20, 1978 this agreement was extended to

include coverage rights of the competitive events at the 1979 Winter

Games in Kamloops. On September 21, 1978. the agreement between B.C.

Games and B.C. Television was extended to include the 1979 Summer Games

in Richmond, the 1980 Winter Games in Kimberley and the 1980 Summer

Games in Kelowna.

To provide for appropriate games coverage

by local cable-television stations, Mr. Speaker, I am pleased to inform

the member and the House that an agreement has been reached between

British Columbia Television, representatives of the cable television

industry in the province and representatives of British Columbia Games.

I am informed that the three parties to this agreement are pleased to

see that it conforms to the following guidelines: (1) cable television

is not restricted in any indepth coverage during the games — that is,

background, colour, human interest stories and so on, except by item 3

which I shall mention in just a moment: (2) cable television is

required to delay visual coverage of competitive sporting events

themselves for, I believe, one week;

(3) British Columbia Television

has first vantage position at any site during the games; and (4) in

future, cable television stations authorized to cover aspects of the

games under the terms of this agreement will be required to undertake

advance publicity for the games during the zone play-offs. I submit

that is most important, because it is the zonal play-offs that are so

vital to the success of the British Columbia Games.

Mr.

Speaker, I conclude by noting that there is no financial exchange

between British Columbia Television and British Columbia Games and

that, by contrast, in the province of Alberta the provincial government

supplied production costs for television coverage. The agreement

between British Columbia Television and British Columbia Games ensures

the widest possible television coverage of the games on a continuing

basis at no cost to the taxpayer of this province.

MR. BARNES: Mr. Speaker, I would like to thank the minister for that comprehensive reply. It's quite lengthy,

[ Page 790 ]

and

I don't feel ready right now to ask all of the questions that I intend

to ask. I'd like to have an opportunity to study his answers.

However,

I would like to just ask the minister one very basic question and that

is: on whose authority did B.C. Television negotiate in reaching an

agreement with the B.C. Programmers' Association? You suggested there

was an agreement between the programmers and BCTV. Why would they be

negotiating in a free-enterprise system?

HON. MR. CURTIS:

Mr. Speaker, I know of no prohibition against negotiation in the

free-enterprise system. I'm aware of negotiations which took place. I

was not party to them at that particular time, bearing in mind that I

did not occupy this portfolio at that particular time. There is more

than one television network operating in British Columbia, and it

appears that British Columbia Television was willing to undertake the

most important part, which is not just the coverage of the games

themselves — the Summer and the Winter Games — but also local coverage

of the zonal play-offs which lead to competition in the games. I'm at

loss to further answer the member's question.

MR. BARNES:

I have one final question. I accept the minister's explanation; I

realize he was not responsible at the time these arrangements were

made. However, my question is simply — and he doesn't really have to

answer it; I guess he may want to think about it — why, in a

free-enterprise system, any cable company or private television company

would find itself in a situation where it has to negotiate with one of

its competitors in order that it should be free to just cover the

games. What restriction should have occurred? How did that happen? Was

there an arbitrary agreement that gave an exclusive to BCTV to cover

the games, when this was not its right?

HON. MR. CURTIS: Mr. Speaker, I'd like to assist the member, but I'm afraid his reasoning in that question is lost on me.

GOVERNMENT POLICY ON KITIMAT OILPORT

MR. HOWARD:

Mr. Speaker, I'd like to direct a question to the Minister of

Environment. Has a government policy been determined yet with respect

to the proposal for an oil port at Kitimat?

HON. MR. MAIR: No.

PRICE WATERHOUSE TAXATION REPORT

MR. STUPICH:

Yesterday I asked the Minister of Finance about a Price Waterhouse

report on the effect of taxation on commerce and industry. It could be

a very interesting report, and I'm wondering if the minister has any

idea at all as to how long it might take to have that report delivered

to him. While I'm at it, could he give us some idea of the scope of the

inquiry and the target as to the estimated cost of the study?

HON. MR. WOLFE: I don't have that information so I will take the question as notice.

PORT SIMPSON COOPERATIVE

MR. LEA:

I have a question for the Minister of Labour. A couple of weeks ago I

asked the minister if he knew of any new relationship between the

Central Cooperative and the Port Simpson cooperative. At that time he

said he didn't know but he would check into it. I wonder if the

minister has checked into it and could tell me if there is any special

arrangement that he knows of now between the Central Cooperative and

the Port Simpson cooperative that didn't exist, say, a month or two ago.

HON. MR. WILLIAMS:

There is no new special arrangement involving Central Cooperative with

the Port Simpson cannery operation. During the herring season this

spring there was, as I told the member earlier, an arrangement whereby

certain management services were being provided by the Central Native

Cooperative, and they were also using the facilities on a shared basis,

in the same way as their cannery was available to Port Simpson

fishermen. That arrangement is continuing during this salmon season.

MR. LEA:

On a supplementary, has there been a policy adopted by the government

that would put the operation of Port Simpson cooperative under the sole

management of the Central Coast Cooperative?

HON. MR. WILLIAMS:

No, there has been no such policy decision, Mr. Speaker. The

arrangement that existed during the herring season and exists today is

one worked out between the directors of the Pacific North Coast Native

cooperative and the Central Cooperative.

MENTAL HEALTH PROGRAMS SURVEY

MS. BROWN:

My question is directed to the Minister of Health. Will the minister

tell me whether he has commissioned a survey of mental health programs

and services in the province?

HON. MR. McCLELLAND: Mr. Speaker, yes, there has been an ongoing survey of mental health programs in the ministry.

MS. BROWN: Would the minister say who is conducting this survey?

HON. MR. McCLELLAND: The survey is being conducted by Dr. Cumming.

MS. BROWN: I am wondering whether the minister is going to release the survey for public scrutiny or table it in the House at any time.

HON. MR. McCLELLAND:

Mr. Speaker, I wouldn't suppose so, although parts of it will become

policy. It's an ongoing ministry survey of the services that we

provide. That's being done in most parts of the ministry and, I would

expect, will always be done.

MS. BROWN: Mr. Speaker, the only reason I asked the question was because

I had hoped that the annual report would have had some information in it from

the survey so

[ Page

791 ]

that we could discuss it under the minister's estimates. But am I to understand

that information is going to be kept within the department, and that no

one is going to have any access to it?

HON. MR. McCLELLAND:

Mr. Speaker, what we're doing is an ongoing survey of ministry

programs. I would believe that every ministry should be doing the same

thing, and probably is. It's an ongoing service of government.

MS. BROWN: So share it with us.

HON. MR. McCLELLAND: Well, we will, in terms of the great new programs we'll be providing for the people of British Columbia.

MR. BARRETT:

Will the minister file with this House the reports if they have been

completed? Have any reports been completed on the mental health section?

HON. MR. McCLELLAND: What reports?

MR. BARRETT: The surveys. Have any of the surveys been completed?

HON. MR. McCLELLAND:

Mr. Speaker, this is an ongoing survey which is being done as a part of

the government services. It will continue to be done. I would hope that

we'll continue to do it forever, so that our programs continue to

evolve in a way in which they will become most useful to the people of

this province. That will be a continuing part of all of the Ministry of

Health services.

MR. BARRETT: I ask the minister

specifically if Dr. Cumming has completed any specific area of survey

and filed a report on those specific areas to the minister.

HON. MR. McCLELLAND: Yes, Mr. Speaker.

MR. BARRETT: Will the minister make public the completed survey reports that the minister now acknowledges exist, and are in his hands?

HON. MR. McCLELLAND:

Mr. Speaker, as I've mentioned before, there's no secret about anything

that's happening here. The programs will be made public. The programs

will be part of the public service of this province, and that will

continue to happen.

MR. BARRETT: Mr. Speaker, the

minister is probably not hearing correctly. I'm not asking about future

programs, which would be out of order. I'm asking the minister if he's

prepared to file the reports that have now been completed, and

submitted to him, by Dr. Cumming. Yes or no.

HON. MR. McCLELLAND:

Mr. Speaker, it's not a matter of me not hearing the question

correctly. It's a matter of the member for Vancouver East not hearing

the answer correctly. I've answered it as correctly as I can and as

much as I'm going to.

MR. BARRETT: On a further supplementary, is the minister saying that

he is not going to file...?

SOME HON. MEMBERS: We want Rosemary! [Laughter.]

MR. SPEAKER: Order, please, hon. members. Let's hear the question.

MR. BARRETT:

I asked the minister whether he is prepared to file with this House Dr.

Cumming's surveys that have been completed, as confirmed by the

minister. Do you intend to file with this House the information that

Dr. Cumming has submitted to you in terms of the survey that he has

conducted, and you've acknowledged he's conducted? Yes or no.

MR. SPEAKER: The bell terminates question period.

Introduction of Bills

REFUGEE SETTLEMENT PROGRAM

OF BRITISH COLUMBIA ACT

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

a bill intituled Refugee Settlement Program of British Columbia Act.

Bill

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

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

ATTORNEY-GENERAL STATUTES

AMENDMENT ACT, 1979

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

a bill intituled Attorney General Statutes Amendment Act, 1979.

Bill

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

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

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

On vote 128: minister's office, $144,082.

HON. MR. McCLELLAND:

Mr. Chairman, members of the committee will now have before them

estimates that detail a very large program of expenditures for the

Ministry of Health. For that reason, I might ask the indulgence of the

committee to make what might be considered a little longer statement

than is usually made at the opening of this kind of a committee hearing.

The

sum that we're considering here today, Mr. Chairman, is just over $1.2

billion, a very large commitment and a strong statement of this

government's view of the place of health programs in contemporary

society.

In terms of dollar values, in terms of services and

activities, the Ministry of Health's endeavours are the largest of any

jurisdiction in government. The largest portion of the spending we

propose will be directed at

[ Page

792 ]

treatment, at relieving people of painful, debilitating conditions and in many cases saving them in life threatening situations.

suppose that most of us, if we look at society in purely Utopian terms,

would desperately hope for the day when the Ministry of Health wasn't

needed. We all know that's the kind of ideal we will not achieve. The

fact is that for the present and for as long as we can probably see in

the future, health ministries are a fact of life, and so they must make

fiscally realistic commitments to the maintenance of health and the

prevention of disease.

Mr. Chairman, the estimates of this

ministry illustrate our government's sincere commitment to preserve and

to enhance what is one of the best health systems in the western world.

Before I describe in greater detail the direction the ministry proposes

to take and some of the policy terms that will be enunciated by the

spending estimates which are before us, I would like to mention some of

the internal realignments that have taken place in the ministry.

Last

fall we undertook a very major reorganization, grouping similar

activities in an organization structure that we know in the future will

enhance our effectiveness and our accountability for the large

expenditures made by the Ministry of Health. In an organization of the

size of this ministry, such a restructuring doesn't happen easily.

However, I am pleased to be able to report to the members that

reorganization is progressing very successfully and some of its effects

are already very noticeable.

The person who is responsible

for carrying out this reorganization, Dr. Chapin Key, is with me on the

floor of the chamber today. I would like the House to recognize Dr.

Key. He was appointed Deputy Minister of Health last autumn and I think

it's the first chance the House has had to officially meet him. Dr.

Key, of course, is known to many members on both sides of the House, as

he came to this ministry from Vancouver General Hospital, at least

immediately, where he was executive director of that hospital.

I'm

sure you will be interested in another senior appointment. All of our

community health services, the traditional public and mental health

programs plus our new long-term care program are now in a single

grouping under Dr. Gerald Bonham, a senior assistant deputy minister.

Dr. Bonham came to us last spring from the Vancouver city health

department and, of course, previously served with our public health

programs. He too is known by many of the members in this House today.

His responsibilities fall into two general areas: preventive activities

and direct services provided outside of hospitals and other health

institutions.

In our reorganization, Isabel Kelly was

appointed an assistant Deputy Minister in charge of our direct-care

programs. Mrs. Kelly was the first executive director of our new

long-term care program which is now just one of her responsibilities.

Mrs. Kelly is also sitting in the gallery along with Dr. Bonham and

others.

The ministry is now recruiting a senior assistant

deputy who will be responsible for the operation of our medical and

hospital programs. Another appointment which we hope to make soon will

strengthen our planning and development activities, making them an

essential part of the working of the ministry's executive.

Also,

I thought that members of the House would be interested to know as well

that just a few days ago I attended a retirement function for Mr.

Harold Price, who left the public service after 43 most distinguished

and dedicated years. Again, Mr. Price was a public servant in the

truest sense of the word, and I'm sure everyone here wishes him a very

pleasant retirement. He would have been with us except he's on that

retirement. He's away on holidays right now and I don't blame him.

During

the past year, Mr. Chairman, the ministry has taken very tangible

measures to heighten citizen awareness of sound health practices. We

need to reinforce public awareness that most of our major diseases,

certainly those responsible for the greatest death and disability in

our society, are preventable. We've combined several sections of the

ministry in a new grouping known as health promotion, of which Maurice

Chazottes, also known to many in this chamber, is executive director.

This is a first step in clearly identifying that part of the ministry's

operations which concerns itself with awareness of health, personal

behaviour and lifestyle. We believe that these activities should have a

readily identifiable presence which is separate from the traditional

areas of preventive medicine and public health, and which should

certainly be easily distinguished from the cure of disease and the

treatment of the sick. Because I believe — and I'm sure it's shared by

most here — that we can reduce the demand on expensive medical

treatment and hospital care by making people aware of the benefits of a

good lifestyle and the consequences of a poor one.

Before I

deal with the estimates in more detail, there are two or three general

matters I want to raise with the committee. The first has to do with

philosophical persuasion more than anything else. Political parties to

the left of the political spectrum historically have put forward the

argument — and it's accepted by many, I'm sure — that they have a

strong tradition of being analytical and aligned with many of society's

intellectual movements. This base of intellectualism, history tells us,

had no small role in some of the progressive events of the past 100

years. The fact that many of those events didn't do what they set out

to do is really neither here nor there.

By contrast with the

extreme left, Canadian socialists, according to the history we have

before us, have a tradition of being studious and of displaying a

certain amount of care and thoughtfulness. It remains a matter of deep

concern to me that tradition was abandoned in advertisements sponsored

by the New Democratic Party during the last election campaign. I refer

specifically to the ads that dealt with the health-care systems; these

advertisements were dishonest and lacked intellectual integrity. That's

a point that should concern all of us: the absence of intellectual

integrity. In its advertising, the NDP portrayed one segment of society

as conspiring against the health-care interests of another.

one wishes to debate the allocation of resources, then the discussion

should be on those terms; I'm sure they will be during these estimates.

But I will not debate, nor should we be asked to debate,

health-resource allocation, as the opposition proposed in those kinds

of ads it used during the election campaign, as if a conspiracy were

involved. That approach is based on deception; fortunately the public

saw through it. But before the public realized they were being duped,

that approach, which was deliberately designed to spread fear among the

sick and disadvantaged, dirtied the political process in this province

at a time when we should

[ Page 793 ]

all be strengthening the credibility of politics and politicians.

There

is another issue I hope all of us might reflect on in the future — and

particularly the providers of health care. I refer not only to the

doctors, nurses and paraprofessionals, but also to the health

scientists who are the innovators responsible for much of the

life-giving technology we have today. I have a very strong feeling that

perhaps the time has passed when we should be telling the people not

only what the health system can do but what it cannot do. More and more

frequently we come to the conclusion that some of the public's

expectations are not realistic; it's not their fault. For too long the

public has been led to believe that the health system can cure

virtually any condition, no matter how it was caused and regardless of

how far it may have progressed. The belief that the health system can

do everything for everyone is a hypothesis that unquestionably requires

review now. For too long the public has been led to believe that the

health system can deliver almost any cure. The facts are that the best

we can do in most circumstances is to control disease. There are few

conditions today that we can actually cure. Perhaps when the public's

expectations come a little closer to reality, the pressures that are

forcing our health system into a very scary cost performance will start

to ease.

In any event, I hope all members from all sides of

the House might have some advice about how we might encourage

expectations to become a little more realistic. It's something we won't

accomplish overnight. It's something that may require generations of

human experience. Obviously there are no easy answers; if there were,

we would have had them by now and they would be in place. All of us, I

believe, will have to look at bold, and certainly new, initiatives.

Our

long-term care program, Mr. Chairman, is an outstanding example of the

government's intention to develop alternative methods of providing our

citizens with necessary care, especially care that can be provided in

their own homes and in their own communities. Another somewhat similar

initiative that has been taken by the government is embodied in a new

regulation under the Medical Services Act that permits payments to

nurse practitioners. We hope that nurse practitioners in some of our

isolated areas may eventually provide first-stop health care of a

sophistication that exceeds basic nursing care, but that does not

require a physician.

But we cannot hope to have everything

needed by every single individual at the right place, at the right

time, all the time. Obviously, then, Mr. Chairman, we need to make

certain that the services and equipment we have are used for the

greatest good and for the greatest number. Instead of taking expensive

equipment, for instance, and highly skilled personnel to each patient

who might need such resources, we are increasingly doing things the

other way around. We are trying to take the patient to the most

appropriate treatment.

The air ambulance service provided by

our Emergency Health Services Commission has been well received by the

people of B.C., and increasing use is being made of this service by

sick and injured persons. I am happy to be able to report, Mr.

Chairman, that during the first eight months of this service patients

were carried at the rate of 1,440 a year. That is about four a day. You

will also be happy, I am sure, to know this volume has almost doubled

in two years.

Between April 1 and June 30 of this year the

rate at which we were carrying patients on the air ambulance service

was about eight every day — double in two years of service to the

community.

As you know, it is one thing to provide a vehicle

and the necessary equipment; it is quite something else to have

well-qualified persons respond to emergency calls. We have one of the

outstanding programs on the North American continent for the training

of our paramedical personnel. Our interest in providing early

life-support doesn't end there. We have made a number of program

commitments, one of which is an arrangement with Douglas College to

coordinate the instruction of interested people in the public in basic

life support — cardiopulmonary resuscitation. All persons, including

members of the general public who take training from qualified

instructors in this program, will receive certificates from the

Ministry of Health.

The costs of operating the general

hospitals of British Columbia have occupied some considerable time in

the press and in this House in the past. I am sure they will again

during the estimates now before us. Approximately $650 million is

provided in these estimates for the operation of our general hospitals

in B.C. — a program of expenditures that has increased explosively in

recent years. We all know that even though those cost increases could

be described as almost stunning, the fact remains that hospitals are an

essential service. In fact, going beyond the traditional view of an

essential service, they are a service in which more can always be done.

The

fact is that hospitals are doing more. They are caring for more people,

and ameliorating more disease than at any other time in the past. The

best examples can perhaps be found in the dramatic advances in surgery

and the huge gains in pharmacological treatments. The use of such drugs

as steroids has not only added their prime costs to the cost of health

care, but has also made new forms of maintenance therapy available. In

other words, we are keeping more people alive than at any time in the

past, with modern treatment. That modern treatment quite often adds

larger costs in proportion to the number of patients served.

Recent

and current examples of high-cost treatment would include things like

hyperalimentation, the technique that some of our larger hospitals are

using now to totally feed patients intravenously, and computerized

tomography, which is revolutionizing, in many ways, radiological

diagnosis. We now have both full-body and head scanners in operation at

Vancouver General Hospital. I have approved two additional full-body

scanners, worth about $1 million each, for Royal Jubilee in Victoria

and the cancer clinic in Vancouver. We have allocated another $600,000

to these hospitals for the treatment planning systems that go with the

scanners. Computerized head scanners have been approved for Kamloops,

Prince George, Kelowna, Royal Columbian in New Westminster and St.

Paul's in Vancouver.

Hyperalimentation is a vast improvement

over previous methods used. Twelve hospitals, Mr. Chairman, have now

been designated to provide this service. Other hospitals will be

considered as the program needs are demonstrated. I don't suppose there

is a member in this House who hasn't at least one friend or constituent

whose life has not been prolonged, or whose disability has not been

greatly eased, by such costly medical or surgical techniques provided

through a hospital. Indeed, one only needs to read the daily

[ Page 794 ]

papers to know that a contemporary hospital has a very visible impact on modern society.

want the House, Mr. Chairman, to look, as well, to what is happening on

the cost side. I fully expect the House to be as astonished as I was

when I first observed that most hospital operating budgets have tripled

— many have quadrupled — in ten years. The expansionist nature of

hospitals is something we must all come to grips with. Even allowing

for general inflation, and the general growth of all labour-intensive

programs, I don't think anyone could claim that our hospital outputs,

the volume and effectiveness of the services provided, have increased

at the same rate as the costs. I am certain, Mr. Chairman, that if we

look closely at our hospitals we must come to the view that something

needs to be done on a rather urgent basis.

Every dollar

invested in curative medicine today is yielding fewer returns than at

any other time in the past. So — as Minister of Health, and as elected

officials — all of us are faced with a couple of very large dilemmas.

One is the one posed by the increasing medical-care needs of our

citizens on the one hand, and the dilemma of the diminishing returns on

dollars spent on the other hand. It should again be obvious that there

are simply no easy answers to either of those dilemmas — nor does the

government expect that those answers will come easily.

don't think, Mr. Chairman, that anybody in the heath-care sector can be

running away from those dilemmas or otherwise copping out. We've got to

face up to them — and that includes all of us. The mentality of a

hospital — or a person in the health-care system, or a politician —

that says we can carry on in the same way as we have in the past is of

the same mentality, Mr. Chairman, that brought the western world to the

brink of an energy crisis. The unquestioned assumptions of the past,

whether in energy, health care or virtually any other public sector

endeavour, need painful reassessment.

In any event, we in

British Columbia are in a bit of an enviable position. Some other

jurisdictions in this country have placed far greater restrictions on

the operation of their hospitals than British Columbia — 4 percent

ceilings are in place in some provinces in this country. We fully

expect that we will meet 7.5 percent growth this year, and

simultaneously eliminate the debts that hospitals have incurred in

recent years.

Some cost savings will be made available

through updated management systems. We are encouraging hospitals to

look at their administrative procedures and, in a few cases, we are

trying to give them actual examples of how they might reduce their

paperwork costs. Some of those are in place within the hospitals now.

The

point, though, Mr. Chairman, that we need to make is that we will not

run away from the problems which face us. We will face them, instead,

in a realistic and forthright manner. And we expect the managers of the

system as well — the boards of directors and the administrators of

individual hospitals or institutions — to take a similarly realistic

and sincere view of the situation. I'm not saying we have anywhere near

a perfect or ideal system of hospital funding. In fact, I don't think

there is any doubt that the system of funding at the present time is

out of date. But we are facing up to that.

Quite frankly,

our ability to analyse hospitals and their costs carefully, and so

distribute more fairly and more equitably the funds which are

available, isn't as sophisticated as it should be.

We're seriously concerned over the general issue, then, of equity in hospital

financing. We hope that by the end of this year — in fact, we know that by the

end of this year — we will have a much more vivid view of hospital funding

requirements when the joint funding study which has been underway for about

eight months by our ministry and by the B.C. Health Association is complete.

This study, I think, is the most extensive analysis ever done in the province

of the funding framework. It is being coordinated by Ernst and Ernst, a firm

of management consultants with an international reputation in the health-care

field. It's a major task that the party opposite did run away from when

it was in power.

Another

step we're taking toward developing a balanced hospital system involves

the role study which is now underway, which has had some publicity in

the press already. It's a detailed analysis to determine what services

or programs are most appropriate to which hospital in the province.

Again, it simply isn't possible for everyone to have everything, to do

all the things that they might like to do. When the role study is

complete — and that will take a few months, Mr. Chairman — we will have

an outline of hospital services that are interactive, a situation in

which duplication, hopefully, would be minimized and in which we should

be able to feel much more confident than we do now that every dollar

spent on hospital care is spent wisely and to the best advantage of

everyone.

We don't intend to impose this study on hospitals

from the top. We are at present in the midst of another joint study,

with the hospitals themselves involved through the British Columbia

Health Association in the formulation of the various roles. I'm sure

members on the opposite side will realize the complexity of that

operation, particularly the member for New Westminster (Mr. Cocke), who

may recall the difficulties involved in getting our four or five

teaching hospitals to come to some sort of agreement on relative roles.

Many others in this House will realize that one of the reasons that it

took 10 or 15 years to get a replacement for Victoria General Hospital

underway here in the capital city was a continuing argument about what

hospital did what in the capital region. The current role study will

involve some 100 hospitals, so the problem will perhaps be magnified

that many times.

In addition to dealing with those funding

problems, the ministry is moving ahead with the largest hospital

construction program in the history of British Columbia, investing at

the rate of approximately $100 million per year. Many members are

familiar with the progress we are making, especially in our

metropolitan areas which have been sadly neglected over the years. We

have firm construction programs underway in Prince George, Victoria and

Vancouver, which will shortly eliminate many of the chronic problems

those areas have had to deal with concerning outdated and overcrowded

acute facilities.

Starting in Victoria, there will be a flow

of about $90 million into hospital construction during the next few

years. Victoria General is being replaced, and a very large

modernization program has been committed for Royal Jubilee. Greater

Vancouver is receiving a very large infusion: the new Children's and

Grace facilities on the Shaughnessy site are well under way, and will

be opened sometime next year. The virtual rebuilding of Vancouver

[ Page 795 ]

General

and St. Paul's is underway; construction is about to start on Eagle

Ridge Hospital in Coquitlam; and there is the Delta Hospital — just to

name a few, Mr. Chairman. The new hospital at the university will open

next year.

We don't expect our hospital utilization problems

to be solved by new facilities alone. New programs will be having an

impact as well, and undoubtedly will make our acute-care hospital

system much more efficient.

Mr. Chairman, just as it took

three or four years after their initiation for the day-care surgery and

extended-care programs to have an impact on general hospitals, so there

will be a lag before the full effects are felt following the

introduction of our long-term care program. We know that there are

complaints, particularly in the metropolitan areas, that long-term care

patients are occupying costly beds in the general hospitals — and

that's true. We will probably have to live with this for a while yet,

perhaps as long as two years. Between 1,600 and 1,800 new long-term

care beds will come on line during this period. We expect that those

beds will more than take care of the present deficiencies.

Every

member of this House has reason to be proud of our long-term care

program. In the last month for which figures are available — February

of this year — we had 27,242 people benefiting from this progressive

health program. The population of our long-term care program is

considerably larger than that of some of our cities in this province.

Last month there were just over 12,000 people receiving homemaker

services, 1,200 in mental-health boarding homes, and some 14,000 in

non-profit and profit-making care facilities. In addition, we had about

5,800 patients at the extended-care level. The program, Mr. Chairman —

just as an aside — has had a significant effect on employment as well.

During the latter part of 1977, before the program went into effect, we

believe there were about 2,000 to 2,300 homemakers employed at various

agencies in British Columbia. In contrast, by May 1979 we had over

5,000 homemakers. Our homemaker work force had more than doubled in 17

months.

Mr. Chairman, is my time up?

MR. CHAIRMAN: Yes, it is.

HON. MR. McCLELLAND: Mr. Chairman, I had a couple more statements I'd like to make. I wonder if I could ask for leave.

Leave granted.

HON. MR. McCLELLAND:

Mr. Chairman, I know we'll have a fair amount of discussion on the

long-term care program. Another matter I think we should mention too is

that during the past two months my ministry and the B.C. Medical

Association received the terms of a new agreement that will preserve

our medical plan in its present state over the two-year term of the

agreement. During those negotiations we were determined that there

would be no deterioration of our present medicare program. I'm certain

that all sides of the House will join me in acknowledging the good will

expressed by members of the British Columbia Medical Association when

they accepted the terms of that new agreement.

In

summary,

Mr. Speaker, I suppose that I could say that I believe that we have

reached a stage in the evolution of our health programs where the

public at large is expecting from us much more than the traditional

medical and surgical programs. We're expected to be much more

innovative, responsive and realistic. We intend to be realistic, not

only in terms of the content of our programs, but also in the terms of

society's ability to pay for them. The estimates before the House at

this time illustrate that our government is committed to a realistic

and rational health system that gives access to British Columbians to

as, wide a range of modern health services as possible.

Mr.

Chairman, just in closing I want to make reference to a very special

problem that we've had in the last while. It has to do with the

problems that have been raised in this House on occasion, and certainly

in the press, and which have been under scrutiny by the ministry for

the last several weeks as a result of the events in the Alert Bay area.

Following the tragic death of a child in the Alert Bay Hospital some

weeks ago, and the subsequent inquest and then a separate inquiry by

the joint hospital committee of the ministry and the BCMA, some

recommendations have come forward to the ministry. As a result of those

recommendations, I am announcing today that I am appointing a personal

representative as a coordinator or administrator, under the terms of

the Hospital Act, to work in the community of Alert Bay to help the

hospital trustees, the residents and the hospitals in the area resolve

the difficulties which have led up to some of these situations.

might say, Mr. Chairman, that finding such a person has not been an

easy task. But I am pleased to announce to the House now that I have

secured the willing cooperation of a man who exhibits the degree of

leadership and human understanding that the situation and the Alert Bay

community deserve. I am therefore appointing today Mr. Eric Powell as

my representative in Alert Bay, to act as coordinator for the hospital

and the community and the Ministry of Health. He will assist in the

implementation of the recommendations made by the committee. I won't go

into the recommendations except to say that I will table those

recommendations when I have the opportunity when the committee rises.

The

first recommendation made by the committee was that the Minister of

Health appoint an adviser-coordinator with authority to assist in the

implementation of the recommendations. The chairman of the hospital

board has wired me asking me to accede to that recommendation. I had

said that I would and this now is the appointment of the person who has

been chosen to do that.

The recommendations deal with much

more than just hospital service, as might be expected. They deal with

the widest range possible of the delivery of health services in that

area. You'll understand, I'm sure, the delight that I have in telling

you of Mr. Powell's acceptance of the invitation to undertake this

task, when I tell you that Mr. Powell has a very deep personal feeling

and understanding of Alert Bay as a community. Eric Powell was born in

Edmonton, was educated at South Burnaby High School, UBC, the Anglican

Theological College in Vancouver, and St. Augustine's College in

Canterbury, England. He completed his education at the Ecumenical

Centre at Basel, Switzerland, and at the Ruel Howe Institute at

Berkeley, California.

The coast of British Columbia has been

very much a part of Eric Powell's life. He worked as a deck hand on the

Columbia Coast Missions hospital ship Columbia in 1951, before

accepting a post as a teacher in the remote and

[ Page 796 ]

isolated

inlet of Seymour. This position included teaching on a floating logging

camp, working in the bunk houses as well as assisting the camp cook.

The following year he returned to UBC to complete a BA an a theology

degree. During the summer months he was posted in Kingcome until 1958

when he was appointed priest in charge of the area. The district

included the Indian villages of Turner Island, Gilford Island, Village

Island, New Vancouver and all the logging camps in the area.

1960 he was transferred to Powell River with the responsibility of

supervising Kingcome Inlet. The following years were years of continued

study, with appointments to St. John's and Shaughnessy, Vancouver, St.

Michael's and All Angels, Prince George, and as director of programs

for the diocese of New Westminster. For many years, Eric Powell has

been concerned about interpreting the story of the work of the church

with our native Indians on the coast of British Columbia.

1961 he invited Margaret Craven, an author from Sacramento, California,

to visit Kingcome and work with him on a story to preserve some of the

local history as well as write the human story of life in an Indian

village. The book I Heard the Owl Call My Name

was completed in 1967, and in 1973 a TV film was produced based on this

novel. The book and the film reflect part of Eric Powell's

understanding of the coast, our last frontier, and challenged us to

work together as people, sensitive to each other's cultures.

It's

generally accepted, incidentally, that Eric Powell was the model for

the priest in Margaret Craven's sensitive work. Mr. Powell has

discussed the problems at Alert Bay with me and I have been impressed

by his frankness. I earnestly hope that the people of Alert Bay will

give him their trust and confidence and will work with him to overcome

what is a very difficult situation.

While the Ministry of

Health cannot be drawn into local political issues, I am determined

that we should meet our obligations in terms of health and hospital

care for the people of Alert Bay. Mr. Powell's appointment is one step

in a rational approach to the problems of such isolated communities.

While

I am basically responding to the request of the chairman of the local

hospital board to implement these recommendations, I am going further

in my determination to do more than come up with just a band-aid

solution. I want to stress that Alert Bay is not the only community in

which we are taking planned and positive action. For example, in Port

McNeill we will shortly be opening a new ten-bed acute-care hospital

within the next month, which cost some $ 1.1 million. In Port Hardy,

the overcrowded and outdated hospital there is being replaced by a new

25-bed acute-care unit at a cost of about $4 million. Construction is

expected to be completed in about mid-1981.

In Zeballos,

which has also experienced problems in clinic accommodation, we are

arranging for a mobile unit to be moved from Campbell River. Mrs. Kirk,

the village clerk at Zeballos, is now making arrangements to find — a

suitable site. We have also asked if the local people would take on the

administration of that facility.

Mr. Chairman, I just wish

to say in closing that Mr. Powell will also be asked to cooperate with

the regional district in that area to ensure that future health care

delivery services can be rationally planned. The terms of reference for

his task are quite simple. They are simply to provide leadership and

assistance to the board of trustees of St. George's Hospital and to the

community in the implementation of the recommendations, to consider, in

cooperation with the Mt. Waddington Regional Hospital District and the

Ministry of Health, the present and future role of the hospital in that

area, and to make any other recommendations in regard to health care

that would aid the community in resolving its problems.

Mr.

Chairman, perhaps the most important part of Mr. Powell's task will be

to ensure more opportunity for the native Indians in Alert Bay to have

a voice in the organization of health care services in their own

community.

Mr. Chairman, with that, I am looking forward to

the debate and the questions which will be posed to me in the

deliberation on my estimates.

MR. COCKE: Mr.

Chairman, obviously whoever wrote the speech for the minister didn't

know about our time limitations, but we were only too happy to let him

set a new record for the House for a minister's opening remarks.

any event, Mr. Chairman, I just would like to allude to those opening

remarks very briefly. I know that had he probably thought it through a

little more carefully, he would have used the insulting material close

to the end of his remarks and, in that way, taken my eye off the ball,

so to speak, and got me away from criticism and after the minister.

would like to say, however, that it was very interesting indeed to hear

the minister charge the NDP with dishonest advertising — that and

dishonest statements. That comes from that member, that minister, whom

I recall sitting across the floor in this House when he charged the NDP

with caring for indigent children in the Empress Hotel — just for want

of something to say in this House. That minister works for a leader,

his boss, who went around this province charging the NDP with being

National Socialists. My heavenly days, I can't believe it. And the ads

that they ran during the campaign! If he had anything to do with it — I

know they wouldn't have consulted him, but in any event, he ran with

that party — to say the least, they were nothing but the greatest

assortment of lies that I've ever seen in my life. But anyway, having

said all that, I would just like the minister to remember that we know

that he represents a group so filled with mendacity that they have real

trouble among themselves, and certainly in the appeal that they have to

the people of British Columbia.

Let me get on with some of

the things I'd like to say about the minister's estimates, the

minister's performance and, hopefully, our need in the future for some

real thought in terms of looking for something that could possibly

assist us in turning things around in health pre in this province.

guess, Mr. Chairman, what started the November fiasco — and I refer to

the November fiasco of the memorandum on November 15 that came out of

the minister's office calling for a 5 percent maximum increase on

budgets for all hospitals in British Columbia — what precipitated that

more than anything was a twitchy government reacting to Proposition 13

in the United States — a very twitchy, confused, concerned, scared

government who were really reacting to that, plus reacting to a little

chap by the name of Stephens, who was going around the province

extolling the virtues of Proposition 13. Where is he now? However, at

that time he brought quite a response from this

[ Page 797 ]

government.

One of the first responses, of course, was from the Minister of Health.

He's the easiest of the group to carry the message and to do the First

Minister's bidding. He's the one who wrote to the hospital boards and

said as follows:

"I would like to take this

opportunity to thank the hospital boards of trustees and their

administrators for their efforts in providing efficient management over

the past three years, while attempting to keep hospital operations in

line with the growth in the provincial economy."

It's quite a statement. He tells them they're doing well; he's thanking them for what they're doing. Then he goes on to say:

"For many years hospitals have been telling the ministry

that one of their major difficulties in achieving good fiscal management has

been caused by the delay in establishing approved budgets.

"As

you are aware, arrangements were completed last year to change the

fiscal year of hospitals to coincide with that of the government. In

addition, Hospital Programs has been instructed to process hospital

budgets promptly so that you can be notified early in the new fiscal

year of your approved budget."

What date is it today? When

is our fiscal year? April 1. This is July 17, isn't it? The hospitals

still haven't got a clue. Ask them one at a time. Phone the

administrators and they're all negotiating with this government. For

one reason or another, there has been no satisfactory end of those

negotiations. They're all being kept on the back griddle or on the

front burner or wherever the minister likes to have them, but nobody is

satisfied. I'll tell you, Mr. Chairman, we're in greater chaos now

after that particular remark than we've ever been.

Then he goes on, Mr. Chairman, in this famous memorandum:

"In

keeping with this new policy, I have to tell you that your estimates

for 1979-80 should be predicated on an increase of up to 5 percent over

the 1978-79 approved budget expenditures."

[Mr. Strachan in the chair.]

Well,

we'll deal with that in a moment or two. But I'll just say, Mr.

Chairman, that he knew — and if he didn't, then he should resign —

there was no possible way they could live within that limitation.

The

minister's been talking about the terrible increase in the cost of

health care. I'd like to draw his attention to an

article in the

February bulletin of the Economic Council of Canada, captioned

"Contrary to Current Belief":

"Health care

expenditures in Canada have not increased at an excessive rate

recently, according to two council economists. In fact, their

discussion paper analysing recent trends in the health field finds that

health-care costs in Canada compare favourably with those in the U.S.

and OECD countries."

chapter 2 the author demonstrates

that a real GNP growth rate of only 2 percent will be able to absorb

future demographic pressures on government-insured health expenditures.

"Between 1960 and 1970 the total health-care costs, as a

percentage of GNP, rose from 5.6 percent to 7.1 percent, in part an extension

of health-care services to those who could not previously afford them. However,

between 1970 and 1976, health-care costs, as a proportion of the GNP, levelled

off. In 1975 this proportion was 7.1 percent of the GNP: in 1976 it was about

6.8 percent. This means that health-care costs in this period did not increase

at a greater pace than the economy's capacity to pay for them. Compare that

to the United States, however."

They go on to say that the situation of health-care costs is not as bad as

is often thought, and this is particularly obvious when compared with the situation

in the U.S.

For

those of you who are not aware, the U.S. does not have the kind of

medicare and hospital-insured programs we have here, yet their share of

the GNP has risen constantly, reaching 8.6 percent in 1976, while in

Canada it levelled off at 6.8 in 1972.

It's too bad that not

long before the election the Premier didn't make a twelfth change in

his cabinet. On second thought, I wonder where in that group we could

find a competent person. But I'm sure we could find a stronger and a

more competent person than the present Minister of Health — for doing

the kinds of things he is doing.

AN HON. MEMBER: The member for North Okanagan (Mrs. Jordan).

MR. COCKE:

The member for North Okanagan is jockeying for the Agriculture

ministry. But, you know, that's a thought. We might just be able to

convince the Premier that would be an optimum change at this time.

I'd

like to deal with the hospital situation for a few moments. The

hospital situation in this province went from bad to worse; I'm

thinking in terms of the VGH problem that surfaced last year. This was

the situation that led to the appointment of Peter Bazowski. The

minister received the report, and he commented on that report. On page

6 of that report we find some criticism. But in the minister's press

release we don't find criticism; we find the minister's answers to the

criticism. He said: "I have given the interim board some firm

guidelines." I'll come back to that. I want to go to the criticism:

"In closing, let me comment on the criticism that much of

the responsibility for problems faced by VGH rests with the provincial government,

primarily because of outdated facilities, shortage of day-to-day funding and

lack of recognition that this hospital has special status as a provincial teaching

referral facility. Much of that criticism may be valid, but we have taken firm

and positive corrective measures."

you know what those corrective measures are? Those corrective measures

are that the minister is now the administrator of that hospital, so

anything coming out of there has to come through him. When he made that

decision. he said: "I have given the interim board some firm

guidelines" — incidentally, this is not an interim board of trustees

but is an advisory board — "and they will assist the board in an

orderly takeover of responsibility and in laying the groundwork for the

permanent board to take over when the method of structuring the new

board is changed by amending the Vancouver General Hospital Act at the

next session of the Legislature." We're still waiting for that session

of the Legislature. Meanwhile, the minister is in charge.

[ Page 798 ]

The

minister has an advisory board which is not free to act other than at

his bidding. That is an indication of what we have in this minister. We

have a minister who is keeping things quiet at the VGH. Why is he

keeping things quiet? I say he's keeping them quiet, Mr. Chairman,

because things are very bad at the Vancouver General Hospital. Things

are very bad across this province in terms of the whole hospital

system, and this is one way he can certainly keep that large hospital

out of the limelight for the time being. We expected to see some

legislation this sitting. We expected to see it last sitting. But, so

far, despite his own words saying that it would come forward at the

next sitting of the Legislature, nothing has happened. There is a deep

quiet. But there isn't so deep a quiet in the other hospitals in the

province. I believe in the last session of the Legislature, and, as a

matter of fact, the last speech during the last parliament, if anyone

cares to refer to Hansard , they will find a speech that I made

outlining the problems at the Lions Gate Hospital. I'm not going to

regurgitate that situation, only to say that we haven't seen much

relief at this point.

What is happening at St. Pauls,

another large hospital in the lower mainland, is that they can't pay

their bills, and that is as of July 12. Unless things have changed

dramatically on the 17th they cannot pay their bills. The hospital is

tied by budgetary restraints, said Dr. Hugh McDonald, the executive

director, while fighting a losing battle with inflation and the

devaluated dollar. McDonald said 17 percent of the hospital's $40

million budget, or $600,000 per month, goes toward supplies. The

remaining 83 percent is for salaries. He said many of the suppliers

haven't been paid for the past two months." Their willingness at this

point to carry the hospital is the only thing that's going for the

minister in terms of St. Paul's. The minister is going to jump up say:

"But I've alleviated their problem. We're going to wipe out their

overruns and their overdrafts at the bank and their deficits. " This

was, incidentally, his third try at trying to get things on the track,

but we'll go over that in a moment or two.

The Royal

Columbian — the last headline I saw was on July 6: "Royal Columbian

Slashes 90 Jobs." Financial problems caused by the health budget

restrictions would force 90 layoffs on July 15th at the Royal

Columbian. That is in addition to 50 jobs through attrition. Here is a

press release that I did during the last election, and I said at that

time the Royal Columbian hospital in New Westminster might have to lay

off as many as 160 employees because it didn't have enough money to pay

their salaries. At that time that minister squawked "Foul!" He went

around the province screaming "foul," and yet today here it is — 140 so

far. What will it be tomorrow? We are within 20 of my prognostication

during the election campaign: Oh, that minister whined. He whined

within his constituency. I can remember him calling one of our

candidates, the worthy candidate who ran against him, a prevaricator,

of all things — a mendacious person.

HON. MR, McCLELLAND: I never said that.

MR. COCKE: You didn't?

AN HON. MEMBER: He used the word "liar."

MR. COCKE:

He used the word "liar." He just doesn't understand that it's all the

same thing. Yes, that is what he called him. I don't know how can he

say that, because that is what that candidate was talking about at the

time he was quoting me and my prognostication. It was right on, and it

is going on across this province, Mr. Chairman.

The minister

cried foul. He did it again today in his opening remarks. Let me tell

you that any person who wrote a letter like this infamous thing — this

letter that was sent out to all hospitals a few days before the

election, at public expense over the minister's signature and on his

stationery, an electioneering piece of material — should resign his

seat never to set foot in this House again.

He has

absolutely no inhibitions whatsoever. He is purely political in the

worst possible sense, and this is the worst political act that I've

seen for an awfully long time. He has the audacity to stand up in this

House and suggest that there was something wrong with our

advertisements during that election campaign. Shame on that minister,

Mr. Chairman. Shame on him for publishing a letter like this and

sending it out. Thanks and congratulations to those hospitals that

refused — not all of them sent it out to their staff. What a

hypocritical standard to take; what a hypocritical action.

Listen

to how he leads off. I have been deeply disturbed over the amount of

misinformation and, in fact, deliberate falsehoods which have received

public attention in recent weeks. "These misleading statements reflect

on the hospitals and the health workers of the province, and are a

cause for concern among the general public." What rot! What nonsense!

On the hospitals? No, they're inadequately budgeted. On the workers?

No, they were being laid off and put in a position where they were

working double trying to keep up with the demands under those

circumstances. The public had and has every right to be concerned, Mr.

Chairman, as long as we have a minister who will resort to the tactics

that minister will resort to in order to try to get re-elected.

Intimidation

of staff, misinformation, Mr. Chairman yes. We know where

misinformation comes from. It comes directly from that minister, and

it's a shame that the minister should pull off a trick like that. He

should immediately stand up.... As a matter of fact, I'll let him stand

up right now if he'll say: "I'll get up and pay back the $1,100 that we

filched from the taxpayers to put this letter out."

You

know, the taxpayers of this province were beset by that government the

day before the election. During the election call, they were putting

out a publication to every person in this province, the B.C. Government News .

It was just the first leaflet of the Social Credit campaign, and

everybody paid for it. We also paid for this. We're getting tired of

being taken to the cleaners by that group over there. I suggest that

minister should have some thought when he cries foul.

Let's

review some of the hospitals that saw fit to let the world know what's

going on. In the first place, I'd like to talk just for a moment about

the Jubilee, which was famous recently because Dr. Scott Wallace got

back into the picture. We were glad to hear that he's alive and well.

He was calling for the resignation of the chairman of the board of the

Jubilee. I won't comment on that, but he was talking about the

outrageous situation at the Jubilee. He was particularly outraged by

the fact that surgeons and doctors were asked to cut down on their

surgery at the Jubilee so that they could stay within budget. Really,

what Dr.

[ Page 799 ]

Wallace

is saying is: "Is that any way to run a ship?" And he's quite right. So

the Jubilee obviously is in a dangerous situation.

We noted

a headline in the early paper today — they're closing another ward,

blaming it on the nurses, saying there are no nurses available. I've

been interested in this, and as a matter of fact I've got some people

in the RNABC who have been feeding me some information as to their

applications for jobs in the hospital. If the minister stands up in

this House and tells us that there's a major shortage of nurses that is

causing all these ward closures, I'd sure like to have him prove it,

because I don't believe it. I do not believe it.

I'd just

like to say that the Victoria General Hospital has also said that

there's no possible way that they could live within the 7.5 percent.

You know, I'm not going to go into great detail, but there it is.

We have a letter from the minister. He was replying to a "Dangerous Penny-Pinching" editorial in the Victoria Times .

In his letter — a long, long letter saying very little.... Let me read

you a couple of comments the minister makes in that letter:

"I dispute your statement that Victoria General has been

forced to go over budget in 1978. The hospital was informed of this budget allocation

for 1978-79 on April 28, 1978, and shortly after the start of the fiscal year.

Surely it's the responsibility of the hospital's board of trustees to

operate within that budget."

Can

you operate within a budget that tells you don't have enough money? I

suppose you can if you get increasingly dangerous in your service. But

those people felt that they could not operate within that budget and

that's exactly what happened. The Victoria Times editorial was quite right. It's dangerous penny-pinching.

MR. BARBER: Even the government appointees on the board agreed.

MR. COCKE:

Even the government appointees agreed, my colleague tells me. Mr.

Chairman, I suggest that Victoria General is not alone. I say that the

little hospital at Powell River is another example. "Powell River

Hospital Service Cut Severely by Forced Deficit."

Salmon Arm

— it's like a poker game and the government has all the cards. There

never is a surplus for a rainy day. "Following government austerity

guidelines for hospitals, Shuswap Lake has gone the whole bit on

cutbacks," Benham says — and he's the administrator — "from restricted

lighting and heating to cutbacks in air conditioning, and motor

shutdowns in certain times in non-essential areas." Mr. Chairman, the

hospitals are suffering.

In Prince George "Budget

Restraints" was the headline; Merritt.... It's all over the province,

Mr. Chairman. How can the minister stand up in this House and suggest

to us that he's right and everyone else is wrong? How can he have that

kind of confidence? What do they say in Merritt? "Financial restraints

placed upon the hospitals must necessarily result in a reduced staff,

together with possible reduced patient care " How can it be possible?

Of course there's going to be reduced patient care.

Burns

Lake: "The hospital could face a cutback in staff resulting in a loss

of some services," said the hospital administrator on July 4. This is

not back in April. This isn't at the turn of the fiscal year. This is

now. These are articles that are right up to date, Mr. Chairman.

Comox

— the member for Comox (Ms. Sanford) drew this to my attention. Now if

there was ever a hospital that was run carefully by the sisters, this

is one. It's the same thing, incidentally, with St. Mary's. It wasn't

long ago that I saw a comparative

article saying that St. Mary's in New

Westminster is in great shape. That is not the case, however, when you

go and talk to them quietly and personally.

At any event, what does the sister say? The sister says:

"Comox Strathcona Regional Hospital District, regarding the urgent need for extra extended-care beds...."

She goes on to say:

"You are aware of the 5 percent ceiling. Our

submission went to approximately 10 percent and the reasons for that

figure are stated in the letter and are also a fact of our constant

awareness of costs and our continual striving to provide the best

patient care at the lowest possible costs."

She says she can't do it. Yet, Mr. Chairman, the minister says they must. Ten percent is her absolute minimum.

I've cited a few and I could go on to cite practically every

hospital in this province. But do you know what I'm going to do? I'm

going to leave a lot of this to the back-bench Socreds who can get up

and tell us how their hospitals are doing in their particular areas.

I'm sure they will have some comments.

I was pleased to see Dr. Pacey's comments. He's a responsible person in the medical community. What did he say in the May Medical Journal ? He said:

"A crisis now exists in hospital financing. Severe restraint

on budget increases has resulted in cost control efforts in all B.C. hospitals.

Many dollars have now been saved, but all this restraint has also resulted in

severe functional problems which have reduced confidence in patient safety.

Administrators have reduced nursing budgets to dangerous levels."

That,

Mr. Chairman, is the kind of statement that we've been making, and

we've been called irresponsible for having made it. Yet this is a very

thoughtful statement by a person who knows. You talk to the doctors in

this province, and that's precisely what they're going to tell you.

That's what they've been telling the minister, and I'm sure when he

gets up he's going to tell us that's quite right.

Those are

just a few examples of what's going on, and where it's going on. Mr.

Chairman, I'm sure that somewhere along the line I will have somebody

give me an opportunity to say a few more words, just like the minister.

I would like to refer the minister to a Vancouver Sun

editorial where he talks about the good life. Maybe the minister read

it, because it's only a few days ago. I would like to also suggest that

in a few minutes I'm going to review just a little bit of the Burnaby

General situation. This is the tip of the iceberg.

I would

like to say in review, however, that last November he said 5 percent.

During the election he said that there could be 7.5 percent, and now he

says: "We'll pick up your deficits." Let me tell you what happens

through all of this. Nothing. The hospitals are still in an impossible

situation; 7.5 percent is actually 5 percent, and

[ Page 800 ]

let

me tell you why it's only 5 percent. The other 2.5 percent is going to

be required to pick up the increased negotiated raise in the first

three months of 1980. Now the Premier doesn't understand that. We know

that he has difficulty with most things, but let me repeat it for him.

The 7.5 percent is only 5 percent for the following reasons. All of the

2.5 percent increase that the minister so generously gave is going to

be required to pick up the increase that has been negotiated for the

hospital staffs for January until April of next year. So therefore

they're still at a 5 percent situation which is utterly impossible. The

minister has created chaos. I see the red light, so I'll give somebody

else an opportunity.

HON. MR. McCLELLAND: Could I

just quickly answer a couple of those questions, Mr. Chairman? I'm glad

for the last couple of remarks, because it cleared up something for me.

I understand now the kind of mathematics that member used in running

ICBC into a $200 million deficit before they got out of office. I'll be

very brief. I just want to refer to a couple of things the member for

New Westminster said.

The 5 percent limit was not a limit,

but rather an estimate of how much money would be available to the

hospitals in British Columbia. It was the first time in the history of

hospital funding that they were given some indication in advance of how

much money they might have. In the previous administrations, including

the one which was headed by the member who previously spoke, hospitals

never did know how much money they would have until they were six,

seven, eight months into their own budgets. With two or three or four

months left, they had to scurry around to find ways in which they might

cut back services to meet the government money that was made available

for them. That was a stupid way to do things, and we changed it. We've

changed those things. The minister then was the member for New

Westminster (Mr. Cocke). But those things, hopefully, will continue to

improve as we make improvements in the methods by which we fund

hospitals.

The member for New Westminster amazes me when he

talks about the need for restraint in health-care costs. If it had come

from anyone else I would have accepted it. But for that member to say

that there's no need for some concern about the way hospital costs and

health-care costs are rising is strictly incredible to me, when the

whole world is concerned about increasing health-care costs. There have

been front-page stories in recent weeks and months in Maclean's magazine, on the television, in Time magazine. I have an

article here from U.S. News and World Reports

of March of this year. They paint a dramatic, frightening picture of

what's happening to the hospital system in the United States because of

governments not taking notice of the way those costs are rising. In New

York City 25 hospitals have closed, bankrupt; 54 of the 57 voluntary

hospitals in New York City lose an average of $2 million a year. One

hospital in Atlanta has gone bankrupt and closed its doors. Hospitals

in Los Angeles are going bankrupt and closing their doors. The whole

world is concerned about health-care costs, and for that member to

stand and say that we should not be concerned here in British Columbia

is really putting the blinders on in a way which could find us bankrupt

ourselves in this province, and unable to maintain the kinds of

services which our people both demand and deserve in the future.

we must reject that there isn't some concern about the rising costs of

delivering health-care services. In fact, Mr. Chairman, if that member

was not concerned about the rising health-care costs, I wonder why he

wrote a letter in 1975 which said: "Dear Hospitals" — or dear somebody

— "I am writing at this time to ask for your assistance in restraining

the rate of increase and expenditure on health services." It was

signed: "Dennis Cocke, Minister." Why did he write that letter if he

wasn't concerned about the increasing costs of hospitals?

Listen to the kinds of things we read every day in our newspapers. This one is headlined "Victorious" in the Vancouver Sun :

"Hospitals throughout B.C. have been urged to hold the line on

spending." That wasn't by me; that was by the former Minister of

Health, dated February 14, 1975. "Cocke urges hospitals to hold the

line on spending." You know, let's be at least honest about the way

things are going.

MR. LEA: What's wrong with that?

HON. MR. McCLELLAND: There is nothing wrong with that, and that's what I am saying, that....

MR. LEA: Ah, but there's a difference between doing that and starving them.

HON. MR. McCLELLAND: Mr. Chairman, there must be....

MR. CHAIRMAN: Order, please. All members will address the Chair, please.

HON. MR. McCLELLAND:

Mr. Chairman, for that member to even indicate to this House that there

isn't a serious concern about the growth of health-care costs is not

serving the needs of the people of this province in any kind of honest

way.

The member talks about Vancouver General Hospital,

about the minister keeping quiet. There was a problem at Vancouver

General Hospital and we attempted to deal with it in the most

expeditious manner possible. The member says that we expected to see

legislation this session dealing with the permanence of the interim

board which was put in place at Vancouver General Hospital. If I'm not

mistaken, there was a message bill today before this House which has

that provision in it — to make sure that the board that is now in place

is legitimized and made the permanent board of Vancouver General

Hospital. The member might have expected that sometime this session

before he commented that it wasn't coming. It's here in the House, and

you'll have the opportunity to debate it before this session is over.

The

member talks about other hospitals, St. Paul's included, having

problems. Yes, hospitals have difficulty managing; so does everyone

have difficulty managing. It's not always easy to stay within budgets.

It isn't easy for us personally to stay within certain kinds of

budgets, but I'm struck again by the similarity of the things that we

see over the years. This is not a new problem. Hospitals have always

had difficulty managing.

Here is a headline that all of you

can read, I'm sure. It says: "St Paul's is running into debt." You'd

think that was yesterday, but it wasn't yesterday. It was in the Vancouver Sun , December 1, 1975. Mr. Ron Longstaff, chairman of

[ Page 801 ]

the

board of St. Paul's, said St. Paul's had to use its credit while

waiting for late payments from the provincial government. "They" — the

government — "always run you at a deficit," said Longstaff about the

Minister of Health in 1975.

The other headline is this one,

and it will be interesting to all of you: — VGH Broke, Seeks

Transfusion." When was that? Yesterday? Last week? No, it wasn't. It

was the headline in the Province ,

November 29, 1975, when the member opposite was the Minister of Health.

It says: "Vancouver General Hospital has run out of money. Its

executives say it hasn't received considerable sums owed it by the

provincial government."

There is another headline: "Government owes VGH $200,000 from two years ago and hasn't paid its bills."

MR. LEA: Oh, $200,000. Isn't that something, Bob?

HON. MR. McCLELLAND: Well, that's just the past bill.

Mr.

Chairman, I'm not saying that I'm right and everybody else is wrong. I

accept that it's a serious problem that we face, but we must face it. I

said in my opening remarks that we won't run away from it. We will

attempt to deliver the services in the best way possible, and we will

also accept that living within our budgets is not easy at the best of

times, but that it must be done if we aren't to bankrupt the taxpayer.

MR. COCKE:

Mr. Chairman, I note that the member for Dewdney (Mr. Mussallem) wants

to speak, and I'm going to give you a good reason. One, I'm going to

have that member charged for practising medicine without being

licensed. He's been feeding me vitamin C for a sore eye for days and

days, and I can prove it.

By the way, I'd just like to give

the minister, while he's been sitting in here, a message from Ottawa.

The message is that the federal government has decided that it will not

help fund the B.C. Heroin Treatment Program. That's very thoughtful. I

would have predicted that.

MR. BRUMMET: Are you happy about it?

MR. COCKE: What do you mean, am I happy about it? What a phony, pouring-water-down-the-gopher-hole program.

MR. CHAIRMAN: Order, please.

MR. COCKE: It goes on to tell you why, Mr. Chairman. The reason is that

there is a controversy over the c program. The decision is because of the controversy,

and also because it is being challenged in the courts. I just suggested that

maybe the minister wanted to think about that for the next little while.

want to say one word about the Burnaby General Hospital. Here is a

hospital that is such pressure that the administrator sends out a

letter to all his employees. He tells them, among other things, that

the board chairman has clearly reaffirmed the policy that no member of

the board, the medical staff or the hospital staff is to provide

information to the news media except the administrator. This is the

kind of a situation that is dangerous. The minister has people coerced

to the extent that they'll send out this kind of memorandum. I think it

is just too bad.

I suggest, Mr. Chairman, that this is a

situation where we do have a great deal of chaos, and I suggest that

the ministry's reorganization isn't helping anything. So maybe the

minister had better get on top of his job and see what he can do about

ameliorating the problems. If he doesn't, he's likely to get fired. Let

me tell you why. The papers in Kelowna say: "KGH Board Plagued by

Growing Deficit" — "Kelowna General Continues to Fight for a Just

Budget" — "KGH Board Chairman Not Ready to Panic But Almost." That's

the Kelowna General Hospital, and the Premier comes from Kelowna. I

suggest that minister had better watch himself, otherwise the Premier

maybe sometime will get around to reading his home papers.

thought maybe I would just bring a little levity into the House and

talk about the government Whip (Mr. Mussallem). During the election

campaign, the Whip, my good friend, got up and did his dance. His dance

was as follows: he said that when they closed the 14 beds at the

hospital in Maple Ridge it wasn't the fault of the Health ministry — it

was the fault of the hospital board there. It was not the fault of the

Minister of Health and his budget. It was the fault of the hospital

board. I suggest, Mr. Chairman, that if the people in Maple Ridge had

sufficient money they wouldn't have closed down that 14-bed ward. But I

bet you that member is going to get up and give us a full

explanation....

MR. BARRETT: Blame the people for getting sick.

MR. COCKE: Right. He'll give us a full explanation of why that occurred. He is very lucid, and I'm sure that he can inform us.

think probably the best symptom of this sickness that seems to prevail

at the moment in our whole hospital situation is best said by the

medical staff of the Royal Jubilee Hospital some months ago, on

December 2. What did they say? They put an advertisement in the paper —

that's a very unusual thing for a medical staff to do. But they said

they had resolved that the public should be made aware of the

deteriorating level in patient care which has resulted from government

measures of cost control.

The minister said I should have

some concern about the increasing health costs. Of course I have, and I

had then. But using an atomic bomb to knock out a very small rock isn't

my idea of good sense. I think the minister has over-reacted to the

extent that I brought out in the first place; and that over-reaction

has brought us into a situation where I get these kinds of phone calls.

A chap phoned me the other day and he said: ''ll can't get my brother

into Shaughnessy. He is dying of cancer and is going, to the cancer

clinic every day. He doesn't live here, he lives up-country..." — I'm

not going to identify the town for fear of identifying the person —

"and he's staying at a relative's house. He is being taken in all the

way from New Westminster to the cancer clinic each day, and it almost

kills him. The fight we had to put up to get him into Shaughnessy and

then finally get him recognized for treatment elsewhere is just

ridiculous in this day and age." The one thing the people will tell you

out there is that they re prepared to pay for health care. They don't

need this kind of squeezing that's going on.

[Mr. Davidson in the chair.]

[ Page 802 ]

Mr.Chairman,

I would like to deal with another area for a few minutes. Just to give

you a bit of a comparison, let's talk about the cerebral palsy grant

that the minister so very helpfully sent a note to his caucus about.

The reason he did that was that the cerebral palsy people had put out a

press release saying that they're squeezing us and squeezing us to the

extent that we just cannot give the service. So the minister does his

usual thing. He's very verbose, and he also pins a good deal on this

particular letter. He tells us how much the budgets have been from

1973-74 up to 1978-79, and how much the Cerebral Palsy Association has

increased its service.

"The Cerebral Palsy

Association has of its own volition expanded its mandate to include

many types of neurologically handicapped children and has likewise

expanded its range of services. As you can see our grant for this

organization is now over $1 million and I feel we cannot continue to

turn over such large and ever-increasing amounts of public funds to

voluntary health agencies without being convinced that this is the most

equitable and efficient way to spend funds."

And he goes on to worry about overlapping and so

on. Well, Mr. Chairman, he gives round figures: it was $250,000 in

1973, and in 1979-80 it's $1 million. That's the way he treats it. So

naturally he can convince the caucus that he's on the right track,

squeezing the cerebral palsy people.

Let's look at another way to compare, however. In 1979 there

are 1,934 people in the caseload. As recently as 1976-77 there were 902

people in the caseload — over double in three years. And the minister

says: "But we can't do that. We can't expand." What happens is that

when you provide physiotherapy for people with cerebral palsy in

Kelowna and Penticton, others will hear about it and surely will want

that for their children afflicted with cerebral palsy. Is it any wonder

that there's an increase in demand? There isn't an increase in need;

the need is already there. But once you provide the service.... And the

minister says: "Shame on us for providing the service."

But

you know what he's talking about, in terms of this huge budget of his?

He's talking about a few thousand dollars. There have been a number of

letters written back and forth, from the association to the minister

and from the minister to the association. But, Mr. Chairman, the one

thing that I would like to bring to your attention is that the

association has proven its need. It has shown everything that's

happening and everything that will not happen if the minister doesn't

increase his grant from $1,000,034 to $1,234,000 — $200,000 for the

needs of some of the most unfortunate disabled people in this province.

This,

I think, is the way he's been treating the hospitals. It's the way he

treats everything that he touches. But the saddest part of it all is

that I really don't think he wants to do this. I don't think he's

sufficiently able or strong enough to put a case up to Treasury Board

that's going to get the kind of accommodation that is required. He

can't do it, so he should quit.

Mr. Chairman, the cerebral palsy people are not alone. As I said, they're just part of the picture.

would like to just briefly deal with the emergency health services in

this province. How many do we need? How many ambulance attendants do we

need? We said back in 1974, or 1975, that there was a need.

Interjection.

MR. COCKE:

That member's talking about a diagnostic and treatment centre. He

doesn't even know what I'm talking about. I'm talking about ambulance

service.

Mr. Chairman, there was a need then for 750 people,

full-time, and how many have we got now? There are 550 people. He's

still 200 short.

The present budget, Mr. Chairman, if it

prevails, will mean that there will be further cutbacks. I want to tell

you this — and this, as far as I'm concerned, I find to be the most

shocking thing. Do you think that cash is the only lack of priority, or

that cash is the only situation that is bothering us in the emergency

health services situation?

Mr. Chairman, I'm going to need somebody to fill in for a second.

MR. MUSSALLEM:

I am amazed when I hear the hon. member for New Westminster decrying

our hospital system. It's simply unbelievable. I do not know how anyone

can stand in his place in this House and decry the finest hospital

system in Canada. It was this government that brought in the first

comprehensive health-care system. It was this government that

maintained the system.

MS. BROWN: What are you talking about?

MR. MUSSALLEM:

Yes, it was this government. It was brought in by another government

before our government's day. I won't go into details, but I said "the

first comprehensive health-care system" in British Columbia, and that's

true.

MS. BROWN: What nonsense!

MR. MUSSALLEM:

I want to tell you this in addition: today we have a system that looks

after everyone everywhere under any circumstances, with the best and

finest facilities that I know of perhaps in the world, and certainly in

Canada. I know that in other countries they may have specialized things

to do certain jobs, but in British Columbia we have the best care that

is known in this country.

To have the hon. member for New

Westminster rise in his place and say that care is inferior.... I just

have to sit here and cringe and wonder how a man who lives in this

beautiful province would stand up and knock his own system. He should

stand up and say it is the finest system, it is the best system and

everyone is cared for. No one who needs an operation, no one who needs

surgery, no one who needs help is denied. Can anyone stand in this

House and say this government is not doing it? I say to him that it's

not the government, it's the principle that we work on. I regret very

much to hear my honourable friend decry a system that is so excellent,

so foolproof. There's only one problem with it. We have to hold the

line.

I'll tell you, the people of British Columbia will not

stand for wasteful expenditure of their money. If this government lets

loose and opens the floodgates to hospital care, I can tell you that

within one year we would be beyond the scope of our budget.... I

compliment the Minister of Health for showing courage in doing what

he's done.

I doubly compliment him for his courage in doing what he did when he did it. At the hour the election was called, a

[ Page 803 ]

letter

came out to tell the hospitals to hold the line. It was the most

unpolitical thing you could do, but it was the honourable thing to do.

I wonder if the people of British Columbia recognize that. I wonder if

they recognize the fact that he could well have held back those letters

for two months and slopped it in afterwards and said: "Now hold the

line." But no way, he came forward with a letter when the time was

right, and said: "The situation is this way now. You must hold the

line."

The letters came out to hospitals to hold the line on the

eve of an election. None of us are here because we need the pay. We're

here because we want to save this country from the dire results of

socialism. By doing what he did, he practically opened the floodgates

and turned us out. Yes, he did. But it was the honourable thing; it was

the courageous thing, I didn't like it at the time. The Hospital

Employees Union sent out word on the radio and letters in the press,

saying: "This government is going to close your hospitals. This

government is unfair to labour." Just the reverse is the fact. We are a

responsible government. We do the thing correctly. We do not wait until

we get into trouble before we move.

Ontario is closing

hospitals; the hon. minister told you that. Doctors are opting out of

the scheme. And the hon. member for New Westminster said: "Ask the

doctors." Well, I just did exactly that; I met with 35 of our doctors

in Maple Ridge Hospital in one day, and they were totally and

completely satisfied with the course the government was taking. They

told me that. They said there were problems; but they are not problems

that cannot be met. Today, with proper care and with some adjustments,

the doctors will remain happy. We need them. They need to be well paid.

Let me tell everybody in this House that people who have gone through

the course of training they have gone through, and with the

responsibilities that they have, must be treated as special citizens.

Not that they're the only ones to be treated thus, but they have a big

responsibility. I'm telling you, when your child is sick you don't

argue about the price, you don't say to the doctor.... You might say a

doctor is careless, that he does this or he does that, but when your

child is sick you want that doctor right now. In this province it's

that way, and I want to say here that I admire the minister for

maintaining a ministry that's as reliable and as intensely effective as

it is in this province.

All we need here today in this

debate is a recording machine which recorded the debates of the

opposition parties during all the years since 1967, one year after the

other. I could almost tell you verbatim what was going to be said — the

same story, the same problems. But we go onward and upward, improving a

solid, excellent system of hospital care. I regret that anybody would

condemn it.

You mentioned the hospital in Maple Ridge

closing beds. I know they closed beds. I was talking to the chairman of

the hospital board on the telephone before the meeting, and I said to

him: "My friend, there's no need to close beds; don't close the beds;

it's not going to do you any good, because the government always comes

through. They'll pay you; they've always done it; they'll do it again."

He said: "Can you guarantee it?" I said: "No, I can't guarantee it." So

what happened? They came through; they paid the bills. But that does

not say that the hospital board does not have fiscal responsibility —

that is the issue. I don't say there's anything wrong with it, but you

can't spend money carelessly, and our hospital is no different than the

others.

But I'll tell you we have a bad problem in this bed

business. One lady phoned me and said to me: "I can't get an operation

because there are no beds." I phoned the doctor, and he said:

"Certainly there are beds, but I'm not ready to do the operation yet."

So I find out what the doctor says and, according to the proper medical

lingo, when they get a bed they'll get her in for elective surgery.

It's not the shortage of beds.

No one is without health care

in British Columbia. I say to you, my hon. friend, there isn't a better

system, there isn't a more competent system, and we're just plain lucky

to be living in British Columbia.

HON. MR. HEWITT: With leave, I'd like to make an introduction,

Leave granted.

HON. MR. HEWITT:

I'd just like the House to welcome Mr. Bob Kadlec, the president and

chief executive officer of Inland Natural Gas, who I have just noticed

up in the gallery.

MR. COCKE: I'm delighted that the

member for Dewdney (Mr. Mussallem) gave us his opinion of what's going

on in the hospital field. I find it difficult to understand, but I'm

going to have a talk with him afterwards, and then he's going to be

able to explain how it is that the minister is doing all the right

things.

I was dealing for a moment with the emergency health

services. I said that there was a need for many more ambulance people —

we're 200 short right now in this province. Now this is the situation,

and I think it's shocking, in view of the fact that, if any area is a

preventive area, if any area can save the whole health system a great

deal of money and an awful lot of trauma in the long run, it's the

emergency services. When you have 200 too few people to man those

ambulances, then they have to be late, don't they? The whole idea of an

ambulance service is to get them there quickly so that they can provide

immediate care which will reduce the complications that occur before

they get the person to the hospital. That's the whole idea behind an

ambulance service. But it's certainly not a priority with this minister.

a matter of fact, it was very interesting to see how the government

responded to the paramedical training course. When the Minister of

Labour (Hon. Mr. Williams) had a slight affliction, which could have

cost him his life, all of a sudden the paramedical course and the

paramedics became a very high priority in this province; the training

plan was restored by the minister. The paramedical training plan still

continues, but other courses are not taking place the way they should

be in order to create the 200 trained persons we need.

There's

something that kind of gives me an idea of just how we feel about the

emergency health services. Do you know that in this province a cabinet

minister has priority over an ambulance case on government aircraft?

You shake your head, Mr. Chairman, but it's true. I have this

information from many sources indeed. They are sources sufficiently

close enough.... Let the minister stand up and deny it, if he dares.

The fact is that the priority for government air flights goes to

cabinet ministers, not ambulance cases.

[ Page 804 ]

HON. MR. McCLELLAND: Nonsense!

MR. COCKE: If you think it's nonsense, then you don't know what's going on around you. You're even weaker than I thought you were.

Just

to give you an idea how much priority ambulance service gets.... The

members for the north just sit there and smile, particularly the member

for Peace River. He should know that over two months ago there was

Treasury Board approval to secure garages for ambulances in the north;

there has been nothing done by BCBC since. Ambulances continue to sit

outside in the north, whatever the weather might be.

The

communications system is a shambles in the emergency health service.

The transmitter sites are absolutely ridiculous. In a very small area

by comparison, the Vancouver police have seven transmitter sites. Don't

forget — when you are dealing with this kind of transmission you are

dealing with line-of-sight transmission. They have seven sites. The

ambulance service has two sites in the whole metropolitan area of

Vancouver — that's from Vancouver all the way out to the Fraser Valley.

So the ambulance people often find themselves in blind spots, where

they can't call in. As a matter of fact, there has been no improvement.

Some say to me that it has reversed since 1974, and that communications

are worse now than in 1974 when the service was set up.

Today,

in my town of New Westminster, the fire department is actually so

concerned with the service they are transporting people to hospital. I

can't believe it — and the minister sits back, so unconcerned. These

are the kinds of situations we face here. It's just not good enough.

We're

almost back to the old grab-and-scoop days. I'll never forget the way

it was when I took over as Minister of Health: there wasn't even an

ambulance Act in this province. You could have used an old

light-delivery truck; you required no training; it didn't matter. You

could be, running a mortuary business and ambulance business together,

or you could be running a day service, or whatever. That was all that

was required; put it together, grab and scoop.

There is a

higher priority paid by this government to property than to people. All

you have to do is look at the fire brigades around this province and

see how rich they are by comparison to the emergency health services.

Not long ago in this House I used the example of Vancouver where there

are 800 firefighters and about 200 ambulance people, and far more

ambulance calls than fire calls. Naturally, you don't require as many,

but you sure require the kind of priority that doesn't leave it for a

fire department to transport people to the hospital, particularly in a

geographically small town like New Westminster — six square miles. It

is not good enough, Mr. Chairman, and yet this is what we get from this

minister. This is what we get from the Emergency Health Services

Program.

I believe that if we're not careful we're going to

go the way of Ontario. Remember Ontario, at one time, was a leader. As

a matter of fact we looked to Ontario when we were setting up the

Emergency Health Services Program. They had an ambulance service there,

but you know what they're doing now? They're farming it all back to the

private areas, except in Metro Toronto. I suggest that this is what is

going to happen here, unless that minister has a care.

would like to give an example. I was talking a moment ago about the

communication system in the mountains. The Ministry of Transportation,

Communications and Highways and the police have a tremendous system.

They are in constant contact, and yet, when an ambulance is two miles

out of Hope, forget it. If you want to stop that ambulance, you know

what you do? Let's say that the reason for calling the ambulance has

changed, or there is no need for the ambulance. You know what they have

to do at Manning Park? They phone to Manning Park, send somebody up on

the highway and flag him down. That is the kind of communications we

have in the ambulance service. Yet the police are in constant touch,

and even the Ministry of Transportation, Communications and Highways

trucks are in constant touch with one another and their base.

suggest that it is crazy to live with an inadequate system. Let me give

you an example from Surrey. There was a medical call in Surrey that

involved an emotionally upset person. The phone was ripped off the wall

and the windows were broken. The ambulance driver had to drive up a

hill a mile away to call the police for help. Why did he do that?

Because he was in a dead spot. He could neither hear nor could he be

heard by the headquarters.

There was another situation. At

168th and Fraser Highway is a dead spot, and yet that spot was used for

three years as an area where an ambulance could park and could respond,

and now it's dead. I have another example. For some months Gray

Beverage Co., which has a two-way radio system, cut out the paramedics

whenever they were on. I suggest, Mr. Chairman, we're in tough shape.

MS. BROWN:

I am just going to be speaking, I guess, for a few minutes until our

critic regains his voice, and then I will give up my position to him.

would like to first of all say that the three members for Burnaby —

Burnaby North (Mrs. Dailly), Burnaby Willingdon (Mr. Lorimer) and

myself — have been sufficiently concerned about the situation at the

Burnaby General Hospital that we have been meeting with various

representatives of that institution. We have met with some of the

medical staff, representatives of the registered nurses, some of the

hospital employees, union people as well as HLRA and, of course, with

the administrator. We wanted to be absolutely sure about what was

happening to Burnaby General Hospital.

One of the reasons,

of course, that we were interested was because of that letter quoted by

our critic, in which the minister wrote to everyone and said: "...while

others are being forced to retreat and cut back, this is not happening

to us here in British Columbia. Instead there is careful and steady

growth and management of the province's economic health, and this

allows us to continue with our commitment to social health."

decided to investigate and find out to what extent it was accurate,

certainly as it applied to Burnaby General Hospital. One of the first

things that we came across was an

article by Dr. Pacey which was

published in the B.C. Medical Journal

of May 1979. He talked about the crisis which now exists in hospital

financing, severe restraint in budget increases which has resulted in

cost control efforts in all of British Columbia. He goes on to say it's

not just a matter of saving dollars; if it were just an economic

situation, one would not have cause for much concern — but indeed, and

I quote: "This restraint has resulted in

[ Page 805 ]

severe

functional problems which have reduced confidence in patients' safety.

Administrators have reduced nursing budgets to the danger level." I

find that particular sentence interesting in view of the fact that the

member for Dewdney (Mr. Mussallem) stood on the floor of this House and

said we have the best delivery of health service anywhere in the world.

I think if that is correct, then the world is in serious trouble

indeed. Here we are having a doctor who, presumably, knows a little bit

more about what goes on inside the hospitals than the member for

Dewdney, telling us that in fact the budgets have been reduced to the

danger level. And this is someone who is practising in the hospital.

And,

of course, it's clear, Mr. Chairman, that all of the newspaper

reporting, on TV and on radio, talking about the situation in the

hospitals where people could not have open-heart surgery when they

needed it.... This kind of information has somehow not seeped through

to the member for Dewdney. The statements he made, one has to take into

account, were based on a total lack of information on his part.

However,

Dr. Pacey goes on to tell us that in many hospitals nurses are so

thinly sprinkled they find it impossible to keep track of patients

under their care. I think that certainly is a dangerous situation. And

he goes on to say this also reduces the information flow to the

physicians.

Mr. Chairman, I recognize that, although Dr.

Pacey is from Burnaby and is attached to the Burnaby General Hospital,

he was in fact discussing other hospitals in the province as well. But

if one just concentrates on what's happening to Burnaby General, I

think these statements of his certainly make very good sense in terms

of what we know about that hospital. He goes on, and I quote.... And

for the benefit of the member for North Peace River (Mr. Brummet) I'm

going to use the comments of other doctors as well on the staff of

Burnaby General Hospital that support these statements of Dr. Pacey.

This is not an isolation, and one has no reason to believe the doctor

would be dishonest or display a lack of integrity in stating these

facts.

Dr. Pacey tells us that more common now are incidents

of undetected oliguria, known as unrecognized death, and other

problems. Night shifts are extremely poorly staffed, and reliable

patients complain of long delays for simple nursing services. He ends

his column in this journal by saying that the B.C. Medical Association

and the Registered Nurses Association should pressure government to

improve the standard of safety for hospital patients by insisting on

safe nursing levels.

I contacted Dr. Pacey and asked him

whether, in fact, Burnaby General was one of the hospitals where he

felt the patient care was in jeopardy as a result of the shortage of

nursing staff and other staff. He said he definitely thought so. He

pointed out the fact that Burnaby General Hospital served an older

population; that there are a lot of senior citizens living in the

catchment area who use Burnaby General Hospital; and that the quality

of nursing has to be of a very high calibre to deal with them, because

this is a community with a lot of medical problems. He points out that,

in addition to that, it's a very fast-growing community. The population

of Burnaby is on the increase, and indeed the hospital has been

expanding to try to keep up with this. But the fiscal restraints, the

budgetary restraints, have certainly been a hardship; the operating

budget, he said, is just not able to provide even the basic kinds of

services to ensure there is a safe nursing level and safe patient-care

level — certainly not in his opinion, anyway.

He said that

the doctors in the hospital were asked by the administrative staff if

they could assist by recommending areas which could be cut out, what

things could be dropped, so that they could live within the budget. The

administration is trying to live within the budget. It's a very

responsible administration, and they are trying to live within the

budget. So they approached the medical staff and asked that they make

recommendations and offer suggestions as to what areas could be cut

out. What frills were there? What things were the doctors doing which

they considered to be unnecessary? What kind of luxury items were

involved in terms of the delivery of health care? The doctors found

that there was absolutely nothing that they were doing. They felt that

they were delivering — or trying to deliver — good basic health care,

that they were not indulging in any frivolous or non-essential medical

practices. He decided — and he said this quite openly — that he thought

the government was playing a shell game with the hospitals and that the

medical profession should refuse to go along with this. He said that

there was just not enough money to do the job. The member for Dewdney

(Mr. Mussallem) would have us believe that the fault, of course, lies

with the hospital boards, that it's their fault beds are closed down

and hospitals are not doing the job. But, of course, that is not true.

It's the government that does not give the hospital boards sufficient

funding for their administrations to be able to carry out the job

effectively. The administration is hamstrung as a result of the

budgetary decisions made by this government.

Later on, I

think, we should make some comparisons between how this government

chooses to spend its money and the kind of funding it puts into areas

that are involved in services to people.

Mr. Speaker, he

mentioned three areas in particular that he thought were suffering as a

result of the budgetary restraint. He mentioned the coronary care unit,

the intensive care unit and enterostoma therapy. He talked about the

fact that they were not permitted to open their nuclear medicine and

EEG sections — and I'm going to be speaking in more detail on that

later.

He said the administration asked them to work out

some kind of concept of the number of patient-days that they would be

using in 1980. He said: "How do you decide? How do you know how many

patient-days the hospital is going to need from one year to the next?"

They know how many patient-days they used last year. But when they are

dealing, as I said before, with this double factor of a large

senior-citizen population — there are a large number of senior

citizens' houses in the Burnaby area that fit into this hospital's

catchment area — and a population that's growing by leaps and bounds,

how do they sit down and make any kind of reliable plan as to exactly

how many patient-days they're going to be needing?

Then, Mr.

Chairman, I contacted someone else who is also on the medical staff at

Burnaby General. He wrote a letter which I would like to read into the

record, because it covers a number of very specific areas in the

delivery of health care. I particularly hope that not just the

minister, but also the member for Dewdney (Mr. Mussallem), is

listening. This letter is dated July 15, incidentally, so we're not

talking about January or December of last year, or last

[ Page 806 ]

spring; we're talking about the present time at Burnaby General Hospital:

"Dear Mrs. Brown:

"The

desire of the provincial government to apply stringent economic

measures to the financing of hospitals in British Columbia should be

tempered in special situations, and I believe Burnaby General Hospital

to be one of them. As you know, Burnaby General Hospital has recently

completed expansion of its physical facilities and is now in the

process of following through with extending health services to the

people of Burnaby and east Vancouver..."

it's not just the Burnaby area which is served by this hospital, which

was designed to be a community hospital for the Burnaby area as well as

east Vancouver.

"...many of which are long

overdue. It seems strange to me, therefore, that the provincial

Ministry of Health has not honoured these commitments, but has

indicated withdrawal of major health services which are now being

provided for, as they have been in the past, to a population of about

130,000 people."

And here he's specifically talking about the obstetrical services and the pediatric services.

"You will see from the communications which I have provided" — and he sent me a number of letters which I'd also like to refer to — "that there has been an increase in obstetrical cases at

the hospital to over 1,200 a year. With the anticipated closure of maternity

services at Grace and Vancouver General Hospital in the not too distant future,

such services at Burnaby General are bound to expand."

And the enclosure he sent, Mr. Chairman, was a letter from a Mr. Glenwright,

Assistant Deputy Minister of Hospital Programs, which went out — and I guess

it went to all hospitals — in November 1978. It clearly designed which of the

hospitals were going to be included in regional neonatal intensive-care referral

units and expanded obstetrical services. He talked about Prince George, the

Royal Inland Hospital at Kamloops, the Royal Columbian in New Westminster, Victoria

General, the Jubilee, the Vancouver General and the Grace Hospital, but Burnaby

General was not included in this list at all. The decision was made that the

Burnaby General should refer these particular patients to the Royal Columbian

Hospital.

One

of the doctors on staff wrote a letter to Dr. Gottschling, the head of

the department of obstetrics at Burnaby General, on April of this year,

in which he says:

"I am writing in response to

a letter that has been received by Burnaby General Hospital over the

signature of Mr. Glenwright, Assistant Deputy Minister of Health in the

hospital program of the Ministry of Health. You are well aware that the

letter suggests that this hospital be designated as a primary-care

hospital and complicated problems in obstetrics be transferred to the

Royal Columbian Hospital.

"My present

management of high-risk cases which I feel would be better attended

elsewhere is to transfer them to the Vancouver General under the

specific care of Dr. Bryans. I have at times also referred to Grace

Hospital under the care of Dr. MacEwan. It is my understanding that

should our hospital be compelled to transfer patients to the Royal

Columbian Hospital, that I shall no longer be able to choose my

consultant, which I may believe is the most capable in the field, and

consequently I must allow my patients to be managed at the Royal

Columbian Hospital by whoever happens to be on call for that week. You

will understand that it is not the machinery, house staff or nurses who

have the alternate responsibility and care of high-risk obstetrical

patients, but the obstetrician himself. And therefore, as I have faith

in these two previously mentioned physicians, I feel it is my right and

obligation to the patients to transfer them specifically to their care."

[Mr. Strachan in the chair.]

what we have here, Mr. Chairman, is a doctor who is saying that in his

opinion, to designate the Burnaby General Hospital — which again, I

repeat, was built to be a community hospital to meet the needs of the

Burnaby community, but as a result of the fiscal policies of this

government has now been designated as simply a primary care hospital

which has to refer its complications to the Royal Columbian — is to

take away from the patient's doctor the right to decide who is going to

take care of her patient or his patient if a complication arises.

The

Minister of Health has probably never had a complicated obstetrical

problem to deal with. If I can say something on behalf of people who

use obstetricians and gynecologists, the last thing that you want when

there is a complication involved in an obstetrical situation is to be

referred to the care of a doctor who is unknown to your own

obstetrician, who does not have the respect of your own obstetrician

and who is unknown to you.

This is not just with obstetrical

services. I'm sure that this is true of any instance in which there is

a complication in an illness. But specifically, Mr. Chairman, if I can

speak out on behalf of those people who use obstetricians, when there

is a complication, to deprive from the doctor the right to decide whom

to refer her patient or his patient to is intervening and interfering

in a very serious relationship, at a time when the patient is in the

most vulnerable situation emotionally as well as physically. This

cannot be justified on the basis of saving dollars and cents. It's the

kind of thing that Dr. Pacey referred to when he said that this

government, in terms of balancing its budget and fiddling around with

its financial dealings, is placing the quality and the delivery of

health services in this province in jeopardy. This particular

obstetrician goes on to say:

"I'm also

concerned about the fact that as the Burnaby hospital is located

directly between the two major centres of medical care, that we will be

forced to transfer patients actually from Vancouver and the East End,

on which our practices are founded, far out of their own district to

the Royal Columbian Hospital."

Now here is a doctor, a

number of whose obstetrical patients are from east Vancouver. He sees

them because he has visiting privileges at the Burnaby General. They go

into Burnaby General to have a baby. There is a complication. Instead

of being able to refer them back to Vancouver where they are from, to

the Vancouver General under the care of Dr. Bryans or Dr. MacEwan, the

two referring specialists in whom he has particular faith, he is going

to be told that he has to transfer them to the Royal Columbian

Hospital, and

[ Page 807 ]

any

obstetrician who happens to be on call that week suddenly has the job

of caring for this doctor's patients. That is a direct interference in

the patient-doctor relationship, and I am not convinced that the

government has the right to do that. But the government does it because

the government is responsible for the funding, and if they decide that

the money is not going to go to the Burnaby General Hospital to allow

the hospital to give the kind of obstetrical care that should be given,

then the patients who go into Burnaby General are at the mercy of the

fiscal decisions and the financial decisions of this particular

government.

That is just not good enough, and I think more

and more people should be told that when they go into Burnaby General

Hospital, they'd better beware, because if there are any complications

when you go into Burnaby General Hospital, if you have any obstetrical

complications, your doctor loses control over you. It's taken out of

your doctor's hands. The patient is going to be transferred to the

Royal Columbian, and the duty doctor — who may be the best doctor in

the world, I don't know.... But this doctor is concerned, anyway, that

the care of the patient is goi