1974 Legislative Session: 4th Session, 30th 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, MARCH 26, 1974

Afternoon Sitting

[ Page

1655 ]

CONTENTS

Afternoon sitting

Routine proceedings

Committee of Supply: Department of Health estimates

On vote 75.

Mr. Chabot — 1655

Hon. Mr. Cocke — 1655

Mr. Fraser — 1656

Mr. McClelland — 1657

Hon. Mr. Cocke — 1658

Mr. Fraser — 1659

Mrs. Jordan — 1659

Mr. Gibson — 1660

Hon. Mr. Cocke — 1661

Mr. Morrison — 1663

Hon. Mr. Cocke — 1663

Mr. Phillips — 1663

Hon. Mr. Cocke — 1664

Mr. Phillips — 1664

Hon. Mr. Cocke — 1667

Mr. Phillips — 1667

Mr. Wallace — 1668

Hon. Mr. Cocke — 1669

Mr. L.A. Williams — 1670

Hon. Mr. Cocke — 1671

Mr. Gardom — 1672

Hon. Mr. Cocke — 1673

Mr. Gardom — 1673

Mr. Fraser — 1673

Hon. Mr. Cocke — 1673

Mr. Wallace — 1674

Hon. Mr. Cocke — 1678

Mr. D.A. Anderson — 1680

Hon. Mr. Cocke — 1681

Mrs. Jordan — 1682

Hon. Mr. Cocke — 1682

Mr. McGeer — 1682

Hon. Mr. Cocke — 1682

Mr. McGeer — 1683

Hon. Mr. Cocke — 1684

Mr. McGeer — 1684

Mr. Bennett — 1684

Hon. Mr. Cocke — 1684

Mrs. Jordan — 1685

Hon. Mr. Cocke — 1685

On vote 77.

Mr. McClelland — 1685

Hon. Mr. Cocke — 1685

Mr. McGeer — 1685

Hon, Mr. Cocke — 1685

Mr. Morrison — 1685

Hon. Mr. Cocke — 1686

Mr. Fraser — 1686

Hon. Mr. Cocke — 1686

Mrs. Jordan — 1686

Hon. Mr. Cocke — 1687

Mr. McClelland — 1687

Hon. Mr. Cocke — 1687

Mrs. Jordan — 1688

TUESDAY, MARCH 26, 1974

The House met at 2 p.m.

MR. G.S. WALLACE (Oak Bay): Mr. Speaker, we have in the

gallery today a group of senior citizens from that illustrious

riding of Oak Bay where we're not all millionaires. I'd like

the House to welcome them.

HON. N. LEVI (Minister of Human Resources): Mr. Speaker, in

the gallery today are a large group of senior citizens from

Vancouver — the Golden Age Club of the Jewish Community Centre.

Among them is Mrs. Rose Gordon, the Premier's mother.

For Mrs. Gordon's information, your son isn't playing hooky;

he's on his way to Ottawa on public business. I would ask the

House to make them welcome.

MR. D.M. PHILLIPS (South Peace River): Mr. Speaker, I'd like

the House to join in welcoming today a newly appointed judge in

the Peace River area, Judge Lundeen, his lovely wife Frances

and their daughter Trudy.

Introduction of bills.

Orders of the day.

The House in committee of Supply; Mr. Dent in the chair.

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

On vote 75: Minister's office, $82,898.

MR. J.R. CHABOT (Columbia River): Mr. Chairman, I've

listened this morning with great attention to the plea made by

the Member for Cariboo (Mr. Fraser), a very reasonable and

responsible plea. He asks very civilly that the Minister clear

the name of a public health nurse in this province who has been

arbitrarily dismissed.

The Member requested that the Minister show some compassion

for the fact that this woman's reputation has been damaged by

the action of his department.

I'm not going to suggest that the Minister of the government

is callous or indifferent to this plea, because I'm sure that

the Minister has always attempted to act in a responsible

fashion. I'm asking him to show that he's not callous or

indifferent to the plea put forward by the Member for Cariboo

on behalf of Mrs. Vaness.

I think also that this government has the responsibility to

let the people know that they're genuine when they say they care about people.

I want to assure you that Mrs. Vaness is one of those people

you talk about. She's not only a number in the civil service as

you might assume. All we're asking is that the Minister clear

her name. There's been a black mark against her record which

will damage her for the rest of her life in seeking gainful

employment either in British Columbia or anywhere else in this

country. The Member very ably appealed to the Minister to show

some compassion in this respect.

The Minister stood in his place here this morning and

suggested that he did not have the authority as a Minister of

the Crown to reopen this case. Now what a bunch of nonsense

from a Minister of the Crown! Certainly that Minister or his

cabinet has that authority to reopen this case to make sure

that Mrs. Vaness does get justice.

Also, the Minister has suggested that the Member for Cariboo

come and see the Minister quietly into his office so that he

can soft-soap him and bury the case — bury the case! That's not

the way this matter should be handled. This is a public

interest matter, and it should see the light of day.

MR. CHAIRMAN: Order, please! I would ask the Hon. Member,

since the subject has been quite thoroughly canvassed already

this morning, to confine his remarks to any new point he might

be wishing to make.

MR. CHABOT: Well, the new point, Mr. Chairman, is that that

Minister over there is trying to bury and trying to sweep a

public interest situation under the rug; that's exactly what

he's trying to do. I don't think that's good enough for a

Minister of the Crown.

We're asking for justice on behalf of a wronged former

public health nurse in this province. She has a right to have

her day in court. She has a right to have a fair hearing.

That's all we ask from that Minister: to stand in his place and

tell us that there will be justice and that her case will be

heard again, because she's been wronged.

The majority of the people in that community who know her

best, 1,500 people, know that she's been done wrong by that

government. They're asking for justice, and I think that that

Minister has the responsibility to stand in his place and say

that there will be justice — that that government cares about

people.

MR. CHAIRMAN: Order, please! I would caution all Members,

including the Minister, that this subject has been quite

thoroughly canvassed. I would ask them to keep their remarks

brief.

HON. D.G. COCKE (Minister of Health): Mr.

[ Page 1656 ]

Chairman, as a Minister I feel that it's up to me to answer

the questions that were raised by that Member for Columbia

River (Mr. Chabot), up there near the Alberta border where he

is away from things from time to time.

Mr. Chairman, in the first place, what did that Member say?

He said that she's been done wrong, referring to nurse Vaness,

by this government. The issue has never been before this

government. It's never been before this government.

MR. CHABOT: You're part of this government.

HON. MR. COCKE: Just a minute. It's been before this

Minister, but never before this government. There are two steps

that are to be taken, and those steps are as follows — if you

wish.... Now I suggested, and I think rightly so, that if we

want to deal with every personnel issue that comes up when

there are 40,000 people out there employed by the government

.... If we want to deal with those individually we might be

here beyond July.

I suggested to that Member that we discuss the whole

question, because there are two normal courses to go. You as a

former government Member and as a former cabinet Minister know

what those two are. We know what they are and there are two

appeals available — one that nurse Vaness has already taken

advantage of in 1971 over a different issue; that's an appeal

to the Public Service Commission. That's available to her

now.

There's a second appeal if, in fact, that first appeal is of

no avail. The second appeal is an appeal to the cabinet in

council. And that's where it's at. I really don't see why we're

making a public issue over a situation that can be....

Interjection.

HON. MR. COCKE: That's not putting it under the rug, Mr.

Chairman, with deference to that Member. That's giving the

opportunity to follow the normal procedure that's available to

every single solitary public servant in this province.

Mr. Chairman, they voted for that procedure, that group. So

it has nothing to do with a case that can't see the light of

day. My goodness gracious, this case has seen the light of day.

It's seen the light of day for the last number of months — publicity. I think now it's time, Mr. Chairman, to put due

process to work as opposed to this method.

What you're asking me to do here is to judge the case. What

you're asking me to do is judge the case from this vantage

point, and that would be frivolous. And the Member for Langley

(Mr. McClelland) that says, "Do your job:" Mr. Member for

Langley, I've been trying to do my job despite you. Thank you,

Mr. Chairman.

MR. CHAIRMAN: On a point of order. In response to comments

that were made I would just point out that this subject has

been discussed for something like two hours in committee this

morning and the subject has been, as far as the Chair is

concerned, fully covered. Therefore, I would request that the

Member, unless he has some new point to raise, move to another

subject.

MR. CHABOT: On a point of order, Mr. Chairman, I think it's

most unfair for you to anticipate what a Member will raise when

he stands in his place. I wish you'd refrain from that type of

anticipation when a Member stands in his place when another

issue has been raised.

One other point I want to make is the fact that you stated

this matter had been canvassed for two hours this morning. It's

quite obvious to me that you were not in this chamber this

morning because your figure of two hours is absolutely wrong.

You're not aware of when the debate took place and when this

issue was actually brought on to the floor of the House. I want

to suggest to you that it was nothing in the neighbourhood of

two hours that this matter was discussed. You are in error when

you state two hours, Mr. Chairman.

MR. CHAIRMAN: On the point of order I would just state again

that the subject has been canvassed at length, and unless

there's a new point introduced I would ask the Hon. Member to

move to another subject. This is simply a word of caution, but

if he has a new point to raise, the Chair will entertain

it.

MR. A.V. FRASER (Cariboo): Yes, Mr. Chairman, thank you very

much for your warning. I certainly have a new point to raise

and it probably leads to another one that concerns you, Sir,

regarding this case. Maybe you want to leave the Chair while I

discuss what you have had to say about this case.

MR. CHAIRMAN: On your request, the Chairman will remain in

his chair. You can discuss the Member for Skeena as if he were

a third person. (Laughter.)

MR. FRASER: I'm glad you chose to stay in the Chair in your

capacity as Chairman. But your other hat is that you are the

MLA for Skeena riding, and I would like to tell this House that

you are a long-time resident of 100 Mile House and you are

aware of the problems in this case. I will certainly give you

credit in having something to say about this case in this

Legislature.

I'd just like to inform the House what you did have to

say:

"Skeena NDP MLA Hartley Dent, a former 100 Mile House

resident, added his voice to those who wished the Vaness matter

reopened

[ Page 1657 ]

in a speech to the House earlier in the month."

I might say this is from a local paper of 100 Mile House,

the 100 Mile House Free Press . You went on further to

say:

" 'This is the very kind of situation which points up to the

need for an ombudsman for the province,' Dent said.

"Dent told the House he had many friends in 100 Mile House

and had received letters from people concerned about the forced

resignation of former 100 Mile House public health nurse, Freda

Vaness. 'I'm not going to say who is right and who is wrong in

this situation,' Dent said, but he read excerpts from letters

he had received."

I'm glad you have had some concern about this also, Mr.

Chairman, and I know why, because you know a lot of the people

in this area who are concerned about the treatment Mrs. Vaness

has had. I would like to take issue with the Minister on the

stand he appears to be now taking. He will not announce to the

House, apparently, that he'll reopen this case: he has just

stood in his place and related the two courses of action

available to Mrs. Vaness. He said one of them was an appeal to

the public service the other, I believe, was to the cabinet. I

imagine that either one will cost her a lot of money to

prepare.

I would like to bring another point on the scene on this.

When I wrote you, Mr. Chairman, through you to the Minister, in

February about this case, and brought it up on the floor of the

House, you wrote back and you never mentioned any of these

courses in that letter. I think, Mr. Minister, through you, Mr.

Chairman, that you were very remiss in not outlining it at that

time if you had concern. It seems to me now, you're just

grasping for answers to get rid of the case — grasping at

straws — and I can't understand your position.

If you were so sure, Mr. Chairman, that Mrs. Vaness had

these courses open to her, why didn't you put it in that letter

you wrote in reply to me on February 20? — in reply to the

letter where I asked you to reopen the case. You didn't say

that at that time; you just dwelt on the position that she had

up and left.

HON. MR. COCKE: You knew it.

MR. FRASER: I did not know it. I certainly did not.

Furthermore on that question, I'll read to you: "...that

maybe under the Public Service Act or something she has

recourse," but I'd like to put a new dimension on

this.

I am again reading from the local newspaper in 100 Mile

House, from another

article on this case:

"After four years of service at the 100 Mile House health

unit, Mrs. Vaness was asked to resign following complaints that she had misused

a government vehicle. The passage of Bill 75 prevented the B.C. Government Employees'

Union from representing public health nurses, and the RNABC is evidently unable

to act for her either, leaving her out in the cold."

Now, what kind of stuff, double-talk, are we getting here?

I'm not saying this is authentic and I don't know whether you

know what you're talking about. But as a lay person.... Maybe

you bright guys here...the Provincial Secretary (Hon. Mr.

Hall) can inform me. They are saying in this

article here that

because she's a professional person, as I understand it, the

passage of Bill 75 prevents them from acting on her behalf.

Interjection.

MR. FRASER: Well, this is where all the confusion is created

in this case, because this is what the lady thinks.

Interjection.

MR. FRASER: No, Minister of marbles, I don't need you to get

into this. (Laughter.) We'll have plenty to say to you

shortly.

All in all, I am still of the opinion that we can't resolve

this case until the Minister announces in this House that he's

going to reopen the case. Whatever course he takes that's his

business.

I'm sorry, Mr. Chairman, for repeating, but I feel very

strongly about this. There is a wrong being done here, and the

Minister can correct it without losing any face at all. What is

it to reopen a case — maybe they'll come back with the same

findings as before. I doubt it very much, but at least the air

will be cleared and this, as I fell, innocent person will get

the justice that has been lacking up until now.

I don't suppose the Minister wants to comment any further,

but perhaps somebody else will.

MR. G.F. GIBSON (North Vancouver–Capilano): Mr. Chairman, I

hesitate to jump into the middle of this particular case if

anyone has any more to say on it.

MR. CHAIRMAN: Order! I would suggest to the committee that

the subject has now been pretty thoroughly canvassed for two

hours. If there is a new point, the Chair will entertain a new

point, but I would request that you riot repeat old arguments

again.

MR. R.H. McCLELLAND (Langley): Mr. Chairman, I have not been

on my feet in this particular debate with regard to this matter

so far. I'd like just to remind the Chairman, that during

estimates it seems to me that is a time for Members to

[ Page 1658 ]

be allowed to get up and give their opinions about either

the philosophy or the handling of the administration of the

Minister's office. I would expect the Chairman would be fair

enough to allow us to do that.

What we are asking for here is simple justice and nothing

more. I don't understand why the Minister of Health wishes so

badly to sweep this case under the rug, to refuse to study the

case again, to determine once and for all whether or not an

injustice has been done.

I don't understand why that Minister who on so many

occasions in the past when he was a Member for the opposition,

stood in his place and fought and argued and pleaded for

individuals. He named individuals on the floor of the House,

brought individual cases to the floor of this House, as did so

many other Members of that group when they were in

opposition.

The Minister of Transport and Communications (Hon. Mr.

Strachan), the Premier, the Minister of Mines and Petroleum

Resources (Hon. Mr. Nimsick), the Minister of Public Works

(Hon. Mr. Harley) — we can name them. Time after time those

people who stood in opposition in this House brought forward

the names of individual public servants who they thought had

been unjustly fired. As long as it was on that side of the

House that it was being done, it was a perfectly acceptable

procedure.

I still feel that kind of action on behalf of an individual

MLA for the people of his constituency is the kind of action

that an MLA must carry out or he isn't doing his duty.

This is the highest court of the land. It is the court of

last resort as it were. I think that Minister has been derelict

in his duty simply by the nature of his reply to the Member for

Cariboo (Mr. Fraser) when he refused, or at least for one

reason or another, didn't outline the course of action that

this public servant had at the time he wrote back to the

initial inquiry from the Member for Cariboo. That's dereliction

of duty.

I say, Mr. Chairman, that what we want here is some justice.

We want that Minister to stand in this House and say that he

will reopen this case. The reason we demand that from the

Minister is that we can't trust you. We can't trust this

government to take action out in the open. We can't trust this

government to take action out in the open. You say, "Trust us."

Well, we say, "In God we trust, not in socialism."

HON. MR. COCKE: Mr. Chairman, if the Member for Langley (Mr.

McClelland) felt a tremendous empathy for me, I would have to

re-examine my whole being.

AN HON. MEMBER: Hear, hear!

HON. MR. COCKE: Simple justice that Member calls for. Simple

justice is available, Mr. Member. Simple justice is more

available outside the court of last resort that you are talking

about — far more available than splashing things across the

headlines.

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: There are two areas that have not been

canvassed yet, and those are the appeal procedures that I was

talking about.

AN HON. MEMBER: That you voted for.

HON. MR. COCKE: That you voted for. That Member for Langley

also went on to say, "The Minister refuses to study the case

again." He wasn't in the House this morning. He was out

drinking coffee, or whatever he was doing, when I said that I'd

be pleased to look over the transcript and discuss the matter

with the Member for Cariboo (Mr. Fraser) who, incidentally, I

think, at the time — I must give you my impression — was quite

happy with that, until the backbenchers over there started to

whisper to him: "Oh, no, don't. No, no, no."

The Member for Columbia River (Mr. Chabot) had to move over

and sit beside him, passing him little tidbits, sweet little

tidbits. You're a bunch of sweethearts. Take off that mantle

that you've got on of this great protector. The fact of the

matter is that this woman, if she wishes, can write to the

civil service commission, the public service commission, and

have an inquiry.

She can have the union, at least the RNABC, to represent her — which is part of the process — and failing any satisfaction

at that level, she can go on to a committee. I'm sure that when

that Member was a member of cabinet he sat in on cabinet

appeals. He knows that they're there, and they're available. If

he didn't, well, it is possible that they didn't let him on a

cabinet appeal.

But anyway, Mr. Chairman, I think that it's there. Don't ask

me to open the case. The case is not closed. How can I open

something that isn't closed?

MR. D.M. PHILLIPS (South Peace River): You said in your

letter the case was closed.

HON. MR. COCKE: As far as I was concerned.

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: Wait a minute....

SOME HON. MEMBERS: Oh, oh!

HON. MR. COCKE: What you ask of me.... Oh, jump around,

Peace River. The daffodils are

[ Page 1659 ]

beginning to bloom up there, so I'm sure that we'll be off

that.

But, Mr. Chairman, I was asked to make a decision as to

whether I should personally interfere....

AN HON. MEMBER: Not at all.

HON. MR. COCKE: That's a fact — whether I should personally

interfere with a decision made by public servants in charge of

other public servants...

AN HON. MEMBER: Tell them you had a reason.

HON. MR. COCKE: ...by district deputies and people of that

ilk. I don't think that I can go rushing around, as Minister,

making intervention after intervention in my department, nor

should I expect it from the other cabinet Ministers. The

recourse is to the commission. And that's the way to go.

AN HON. MEMBER: And he voted for it.

HON. MR. COCKE: That was what you voted for.

MR. McCLELLAND: If the Minister doesn't mind interfering in

labour agreements, why won't he interfere in a case of

justice?

MR. FRASER: Mr. Chairman, the Minister here says that about

opening and reopening the case. I think he's forgotten what he

said in his letter to me of February 20. I'm going to read an

excerpt out of it that is relative to what the Minister said.

It is dated February 20, addressed to myself:

"With reference to your letter of February 11, 1974, it is

not my intention to reopen the case of Mrs. Freda Vaness, since

Mrs. Vaness, of her own volition, terminated her employment with the Health Branch on January 18, 1974."

You stated there most emphatically that you wouldn't, and

that's what it's all about. Why can't you reopen it? You raised

another....

Interjection.

MR. FRASER: I beg your pardon?

AN HON. MEMBER: She resigned.

SOME HON. MEMBERS: No, no!

AN HON. MEMBER: With a little help from her friends, she

resigned.

MR. FRASER: You raised the other point, Mr. Minister, in your last answer

that a decision had been made by somebody down the ladder. Don't you understand

that you're in the position, an elected position, that you can do something

to overrule a decision — not of a junior clerk in your department, but an Assistant

Deputy Minister and his assistant and the head of the Public Nursing Service

of the Province of British Columbia? They weren't two-bit-level civil servants;

they were senior people.

But are you saying that that's it? That's final? And you, as

the elected person, the Minister, won't interfere? That

surprises me, that you won't overrule. Are you going to go

along and administer this department that way? I don't think

you are, even if you are nodding your head. I don't think you

are. You're going to find lots of times in your tenure of

office that you're going to have to overrule these people, and

rule probably against them.

Again, I think it is a very simple request: you just direct

that this case be reopened. I again ask that that happen, and I

sincerely mean that should happen in view of the fact that you

can do it. You are the elected person. If you want to direct

the public service to do it, fine; go ahead. But certainly Mrs.

Vaness says that as far as she knows she can't do it, and I

quote from that article.

MRS. P.J. JORDAN (North Okanagan): I listened with great

care to the Hon. Minister just now and frankly I think that he

just wove another thin edge of the wedge that is building the

laminated beam that he's trying to use against the professional

nurses in this province.

The Minister, through you, Mr. Chairman, is subtly building

layer upon layer upon layer of interference, discrimination and

public weaving which is working against the professional nurses

of this province.

You stood up here and you said that the nurse in question,

Mrs. Vaness, resigned. She resigned under the pressure of the

subtle schemes that this Minister and his government are

weaving for some of the people of this province.

We ask you, Mr. Minister, to stop skating around with sweet

talk and sweet smiles in this whole issue of health. It's this

Minister's trademark, and I refer back to his own words when he

talks about sweethearts. He's trying to be the sweetheart of

the health area, doing this through selective moves in his

responsibilities and through actually sitting in an area of

doing nothing except in the areas of motherhood.

Mr. Minister, you're the Minister of Health. The people who

work for you are responsible to you and to the public of

British Columbia, and that includes fair treatment for those

who work for the government. Surely it is time you came to

grips, through you, Mr. Chairman, with your

responsibilities.

We've seen one incident where this Minister went in on a

political basis to cure what he called a discriminatory

situation, and brought about a settlement that cost him $35

million. When the bill

[ Page 1660 ]

came home to roost, the Minister of Finance looked at him

and said, "Cockey, baby, your wife was too strong. Back off.

You're costing the people of British Columbia too much." That

Minister just turned around and closed his eyes to the second

discriminatory ripple that was caused by his actions.

Mr. Minister, if you can't come to grips with your own sense

of responsibility in so simple an issue as this, where a nurse

who has served remote people in this province well and long,

who is willing to work nights, weekends, and travel through

vast areas of this province alone, or in company with someone,

in order to meet the needs of the people who are her

responsibility...if you're not willing to stand by this

person, what hope do the rest of the people in this province

have?

Mr. Minister, there is an acute nursing shortage in this

province right now — a matter which I will deal with later in

the Minister's estimates. But there is, without a doubt, an

acute shortage of professional nurses in this province. There

is an acute shortage of public health nurses, and there is a

tremendous need for increased health care in remote areas such

as 100 Mile House and the district that this nurse serves.

Mr. Minister, in fearing to get your feet wet, you are

letting the people of this area suffer. I would urge you to

assume your responsibilities — as you felt that you had to in

the intervention you made on behalf of the licensed practical

nurses in this problem — and open this case, and bring it to

light.

If this nurse has been wronged and her professional status

and her ability to meet her responsibilities and carry out her

job has been impaired, then her name should be cleared.

In light of the long delays that have taken place — the

Minister's refusal, which has been quoted by letter in this

House, to intervene into the situation and have a hearing...

MR. CHAIRMAN: Order!

MRS. JORDAN: ...into a review of the case has left a

professional person whose name is in question....

MR. CHAIRMAN: Order, please! I would ask the Hon. Member to

raise a new point. Otherwise, as I said before, the subject has

been discussed at length.

MRS. JORDAN: Well, thank you, Mr. Chairman. It's hard to

raise a new point when the matter involves one human being, one

human being's professional status, and one human being's

willingness to serve the people. The Minister who has a closed

mind, closed eyes, in fact is trying to build a laminated beam

against the registered nurses in this province and he'll use

every avenue through which to do it.

MR. GIBSON: Mr. Chairman, I will be brief and mostly ask the

Minister general questions because I enter any debate on health

with some humility.

There's one topic on which I will pretend to speak as a bit

of an expert; that is on the question of the danger of

motorcycles. I want to congratulate the Minister on what he

said yesterday about that, and endorse his point very

strongly.

He brought out the point that people who ride motorcycles

are about four times more likely than automobile drivers to be

involved in accidents, and that those accidents are likely on

the average to keep them in hospital longer.

Mr. Chairman, the accidents on motorcycles, generally, are

particularly gruesome things, and particularly unfortunate

because they generally happen to people who are younger and who

have to go through the rest of their lives maimed in some way

or another by the damage done by these particular machines.

MR. CHAIRMAN: Order! I would caution the Hon. Member, and

just ask him when he's discussing a subject to relate it to the

administrative responsibility of the Minister.

MR. GIBSON: Mr. Chairman, I am relating it precisely to

remarks made by the Minister in opening this debate. In any

event it's not a subject on which I propose to linger at great

length, but I think it's important.

This is one of the jobs of a Minister of Health, to warn

people of health dangers. This very clearly is that.

There's this great feeling of freedom, of being out in the

open on these marvelous machines. It's fine in good weather;

then you get into the bad weather — the heavy traffic, the rain,

the poor visibility — and all of a sudden you're smack in some

kind of an accident with no protection around you. It's that

first six months. I don't know if your figures show this, Mr.

Minister, through you, Mr. Chairman, it's that first six months....

Interjection.

MR. GIBSON: It's in the lower age grouping and particularly

in that first six months that the riders get into trouble.

In any way I can, I beg every motorcyclist to take a course;

to have good crash equipment on their bikes which will give you

some protection, not much; to wear the helmet like you're

supposed to, and so on. I just want to make a very heartfelt

plea in that regard, as one who had an awfully close call. I

was in hospital a number of weeks myself.

Now, I'd like to ask the Minister some questions — that's all

they are; they're not suggestions at this stage

[ Page 1661 ]

— about people who are healthy, more than people who are

sick. I'd very much like to hear his remarks about the concept,

which has been kicked around in the medical world for many

years, of check-up clinics, diagnostic clinics, doing the same

for ordinary people on a routine yearly basis, or even a

six-month basis as people get older, that without thinking we

do for our automobiles if we care about them, which is: take

them in and get them checked over.

Many people follow this valuable practice with their own

private physicians, but most people don't. It's not a habit

that most people have gotten into. This is the comment I would

like from the Minister: would it be a good use of medical

manpower? Do we, indeed, have the kind of medical manpower to

set up this kind of preventive and checkup centres to become a

part of the ordinary life of British Columbia? That's the first

question I have.

The second question to the Minister is: what is happening

with respect to health in our schools? This, it seems to me, is

where good health habits are formed. The background that a

person needs for their health all of their lives, and, indeed,

for bringing up their children and seeing that they're healthy

too: this is where the knowledge and the habits are

provided.

I remember my own — I think it was called health and

personal development — classes in the school system many years

ago. I remember none of us paid very much attention to any of

it, but particularly the health part we paid almost no

attention to.

I ask the Minister: what is happening in the schools in this

regard now? Are there better ways being developed of seizing

the attention of students and teaching them about the

fundamentals of health?, I appreciate that is in part the

responsibility of the Minister of Education, but I expect this

is something that the two would liaise about. It's certainly

the responsibility of the public health nurses in the

schools.

The third question I would ask the Minister, speaking, as I

say, still about people who are healthy: What guidance is

available to the ordinary person in the choice of a doctor?

Many of us have been fortunate enough to find a good doctor

because he's been the family doctor, or because you knew a

friend — this sort of relationship. But many young families

start out without having a doctor. Many new residents come to

British Columbia. This is one, or should be one, of the closest

and most important relationships at any citizen has with a

professional person. Yet the ordinary way of finding a doctor

for people who are new to the situation tends to be to look in

the Yellow Pages. Now, I have to confess that I don't know of

any better way, but I'm asking the Minister if there is a

better way — if he'd comment on that.

I'd ask him a fourth question, which as a layman I'm much interested in. Would

he give us a brief report on the legal and medical status of acupuncture in

British Columbia?

I would make a final representation to him in the matter of

the field of research, specifically brain research. We had an

excellent talk yesterday from the Hon. First Member for

Vancouver–Point Grey (Mr. McGeer) who spoke about medical

research in general. He was, I assume, too modest to speak of

his own specialty, which is brain research, and the team that

is working in this field out at the University of British

Columbia.

There's widespread belief, whether it's true or not, that

most of us use only 10 per cent of our brains — some perhaps a

little less, some a little more. Given that fact, there's a

great chance here. In particular, there's a great chance in

British Columbia to approach the world frontiers of knowledge

in the brain research field, because it's a very low-cost field

as medical research, or any kind of research, goes. It doesn't

require a lot of equipment, it doesn't require expensive

cyclotrons or all of the hardware that's required. All it

requires is the first-class minds in the field in the world to

be brought together. There's a building block out at the

University of British Columbia for that purpose, and $1 million

or $2 million a year could get us close to the frontiers of

knowledge of brain research in the world.

The importance of this to me is that the next quantum jump

in human affairs will probably come about through mankind

learning better how to use this basic working instrument he

has. The brain researchers are a part of that. Researchers in

other fields, parapsychology and so on, are working on other

aspects of it.

I think it's a public investment that's a worthwhile one. I

would be grateful if the Minister would consider that and use

his influence, particularly with his federal counterpart and

the activities of the Medical Research Council, to try and have

this supported more extensively with the group working at the

University of British Columbia — also if the Minister would

work in that direction through any financial and other means he

has at his disposal.

HON. MR. COCKE: Mr. Chairman, thank you to the Member for

North Vancouver–Capilano. I'm glad that you were supportive on

that motorcycle situation. No question that the younger people

are the ones who are having the problem and that's why I

suggest that they be very careful with this whole area.

Just to give you an idea, out of the 1,000 that were

admitted to hospital in 1952, there were 404 males and 48

females who were between the ages of 15 and 19. That's

virtually half of them. Between the ages of 20 and 29, there

were 348 male and 25 female.

That really means the remainder were in the other

[ Page 1662 ]

age groups and, of course, were really not significant in

any other age groups. You are quite right; it is the same thing

applied to the hospital days — exactly the same situation. It's

a very dangerous plaything. I would hope that people would stop

regarding it as a plaything and think in terms of the serious

consequence of motorcycle accidents.

The Member also brought up the whole question of check-up

clinics and diagnostic clinics. I agree that this is a very

desirable kind of thing but one that is going to require a

great deal of public education. I know people who are fairly

close to me who don't go to a doctor for fear of what they

might find out. I have a little bit of that in me in a way; I

think we all have. You overcome it and you go. I think there

has to be some public education on the whole question of

preventive medicine in this area.

We had an all-day meeting at UBC on this question that I

attended just recently. I also have two consultants who are

working in this area, both preventive-medicine doctors, who

took their specialty in space centres, as a matter of fact. I

am told by both of these groups that we do not have sufficient

manpower at the present time to do a thorough job. There would

be a requirement for a great deal of paramedical manpower.

All I can say is that we are certainly looking at this. We

feel it is much better to stop an illness than to treat an

illness if it is at all possible. Our thoughts are in that

direction. We have had a tremendous number of discussions as to

just exactly which way to go. Plans are being sought and are

being made to carry us in the right direction in an area of

preventive health care. It's the old "ounce of prevention"

idea; it is still as true as it was when that philosophy was

first introduced.

We are helping out some cardiac preventive centres. Suffice

it to say that we are quite aware of this, Mr. Member, and I

appreciate your thoughts on it. We are certainly going to move

in that direction.

Health in schools. Naturally, the Minister of Education

(Hon. Mrs. Dailly) and I have discussed these questions. We

have people in our department who we call health educators. The

health educator's job is to move around to help and assist the

school teachers and people working in the school system to get

more attention paid to public health, prevention and nutrition.

We have teams available to schools who deal in all areas of

health.

It's very difficult. Some of us would like to say to the

schools, for instance, "No more of those hamburgers and chips.

How about some good nutritious meals in the schools as a good

preventive measure and also a little bit of education along the

way?" Unfortunately, where this has been tried, the kids go

romping off to McDonald's. It's very difficult.

Interjection.

HON. MR. COCKE: That's right. It is very difficult to make a

move in that direction. As a matter of fact, I thought of free

apples for school children. I haven't got too many statistics

on this, but my understanding is that where this has been tried

they have used them for helping one another.

Interjection.

HON. MR. COCKE: We have professionals available in our

public health department who make themselves available to the

schools to assist in public health education in that area. We

also have teams of nurses to work with school children. As you

know, they inoculate them, have immunization programmes and so

on. They are there and available and those teams are being

built up.

The choice of a doctor. I can't give you too much advice

other than ask a friend who you trust if he has a physician he

trusts.

Interjection.

HON. MR. COCKE: I understand that. Also access to the

College of Physicians and Surgeons. If one wants a lawyer and

doesn't know a lawyer in town, he can request the name of a

lawyer from the bar, I presume. I know the college would

certainly afford a list of Doctors available in a particular

area. The local health officer would be another choice. You

could go to whoever is in charge of the public health unit in

your area, wherever that area might be around the province, and

he would know doctors in the area. I realize it is a problem

for people.

The fourth point you brought up is the legal and medical

status of acupuncture. Acupuncture as a technique is not

recognized as a medical procedure as far as I know. Our college

and our department are working together to try to develop

standards for acupuncture treatment in this province mainly

where it involves the relief of pain.

We have had a clinic going; Dr. Saita from West Vancouver is

working with it. He is a qualified acupuncturist in his own

right and he is also licensed under the Medical Act in

B.C. He has a pilot project going in Vancouver where we are

using medical people as observers and arthritic people and

others as people who are taking treatments to find out just

exactly what standards we can set and how we can best get

acupuncture working in this province.

MR. GIBSON: Is it working well now?

HON. MR. COCKE: As far as I know there will be some results

very shortly. From what I see, it's working very well in that

they are doing all of the things they set out to do. I can't

give you the exact results of the procedure to take but I have

an idea we

[ Page 1663 ]

will be seeing moves in the area of acupuncture in the not

too distant future.

As far as brain research is concerned, we have discussed

this question with Dr. Gibson and his colleague, Dr. McGeer,

the Member for Vancouver–Point Grey. Certainly, we're most

interested. I think we will be developing even more

cooperation in the future than we have given in the past.

We still contend, however, that research with the federal

government should be more and more their responsibility. We

feel that at the provincial level there is a real chance of

duplication of research being done elsewhere. We've called upon

the Minister federally to get more involved and we have

participated in discussions that have included your Member.

I just hope that we do continue on as a country thinking in

terms of the necessity to go after those conditions, those

diseases, those illnesses that to date have not been

successfully dealt with. That's our position at the present

time. We can improve our participation and we hope that our

partners down east will improve their participation.

MR. N.R. MORRISON (Victoria): Just before we get off the

complete subject of motorcycles, I wonder if the Minister could

tell us if these statistics hold pretty well true for Europe

also where there are many, many more motorcycles. Perhaps their

younger children and young people are better trained in the use

of them and the drivers are a little more familiar with what to

anticipate. I'm a father who has gone through the motorcycle

stage with his boys — I hope; there's only one left in the

driveway now. At one time there used to be four. Fortunately,

we have had no serious accidents in our family. I do think many

of our drivers here are unfamiliar with how to treat a

motorcycle on the road and I am sure most of the younger people

are not adequately taught or trained how to drive motorcycles

and really how dangerous they are.

I would like to ask the Minister if he could tell us what

the present status of the Victoria area private hospitals is.

How many of them are currently being taken over by the

government or are being negotiated with the government? What do

you plan in the future, which ones do you plan to acquire and

what exactly is that programme here in the Victoria area?

HON. MR. COCKE: I don't have the European figures and I

wouldn't even try to second-guess those figures. I know that a

lot of the accidents that occur are not necessarily the fault

of those driving. They just have to be that much more of a

defensive driver than the person who is driving with a piece of

steel all around him to protect himself. They have to be much

more of a defensive driver.

As the Member for North Vancouver–Capilano (Mr. Gibson)

said, they should be very careful about the times that they

drive these vehicles. In the rain and when it's hard to see

they become even more lethal. But I do know that they have been

a problem as far as our health facilities are concerned. I just

want people to realize that the consequences might be

serious.

Now as far as the private hospital status is concerned, we

have bought — negotiated for and bought — two of Victoria's

private hospitals. At the present time, naturally, our thrust

has been to try to cover the need for extended care. Now

according to the projections that we have, we should now have

extended care taken care of in the Capital Regional District.

The numbers are now equal. In other words, the number of beds

we have available is now equal to the need, according to our

projections. Now we'll see just how accurate those projections

are in the next few weeks and months, I presume.

Of course, the next phase for us is intermediate care,

Whether or not the private hospitals will work out for

intermediate care and whether or not we will negotiate for a

number of them for that purpose, I'm not quite sure. It might

be that we're going to have to build a variety of.... We

already, as you know, have three or four that are pilot

projects to find out what best serves the intermediate-care

field. We'll be building smaller ones and larger ones, and so

on. But we might very well, and certainly if a private hospital

owner wants to sell, then come and see us. We're open to

negotiations as long as the hospital can serve a purpose.

MR. MORRISON: Are we going into an expanded outpatient-care

programme now in the major areas rather than trying to treat

them in the hospitals, where we can just bring them in very

briefly and out again? Is that programme being expanded

considerably?

HON. MR. COCKE: Yes. In most hospitals, Mr. Chairman,

day-care surgery and day-care treatment is on the upswing. I

can't give you the exact figures at the moment. I could under

the vote, but it's up a good deal. It's up here, it's up at

most of the hospitals in the province. Most doctors have been

most cooperative in this area, and I think it's going to

increase. It's a great saving; and that, combined with a little

bit of home care, can sure save you a lot of money.

MR. PHILLIPS: I'd like to ask the Minister of Health what

assistance the government is giving to people who are wholly

disabled by multiple sclerosis. Is there a hospital where

therapy can be administered, where these people can be occupied

with crafts, et cetera? Or is it still necessary to keep these

people

[ Page 1664 ]

who are chronically ill in the home? What action does the

government plan on taking? What facilities are available?

HON. MR. COCKE: Well, we have rehabilitation hospitals, as

you know, and rehabilitation wards in hospitals. We have a

number of multiple sclerosis patients in Pearson, for an

example, in extended care. There are a number of other patients

with this illness in a lot of our extended-care hospitals

throughout the province.

As far as what we are doing, my colleagues in the Department

of Human Resources provide Mincome for those who are

handicapped in that regard. Naturally we hope — and that's part

of what the Member for North Vancouver–Capilano (Mr. Gibson)

was talking about — we hope for a breakthrough in research in

this area as well. It is a dread illness and the quicker it can

be contended with, the better.

MR. PHILLIPS: There's one other subject I want to discuss. I

want to discuss it under the Minister's vote because it doesn't

only involve venereal disease control but it involves general

education in the public health service. I'd just like to spend

a few moments discussing this subject under this vote rather

than under vote 86 because it is rather far-reaching. I'd like

to dispose of it now, with your indulgence.

In listening to television last night, I must say I was

appalled to learn that there are 30,000 cases of venereal

disease in British Columbia at the present time. I guess maybe

I was under the impression, like a lot of people are, that

venereal disease has practically been eradicated and was no

longer a problem. But I would say, and as the television

programme last night stated, 30,000 cases is of almost epidemic

proportion.

So I started doing a little research into the matter between

then and now, Mr. Chairman, through you to the Minister. In the

1973 annual report of the Department of Health there is a

section on venereal disease control. It states that:

"Venereal diseases are diseases usually contracted through sexual intercourse. Of the five diseases

classified as venereal only gonorrhea and syphilis occur to any

extent in the province. Gonorrhea is very prevalent with 8,970

cases reported in 1973; syphilis is much less common with 100

cases of infectious syphilis being reported in 1973."

Either this report is wrong or the television broadcast is

wrong. I would like to know what the situation is. This is a

report of 1973. This is just a year later, and this report

stated that there were 30,000 cases in British Columbia.

In doing some research I find that venereal disease in Canada still exacts

an appalling toll in human suffering. As. of January 31, 1974, there are 425,000

Canadians a year infected or suffering from this disease. That's nearly a half

a million Canadians. That's certainly more than we have troubled with tuberculosis.

I'm not going to go into the origins or the symptoms or the

treatment of this disease, but I'd like to discuss with the

Minister some of the causes of this crisis and what government

action is needed to eradicate this menace.

MR. CHAIRMAN: Order, please! I would point out to the Hon.

Member that there is a complete vote, vote No. 86, and I would

ask him to keep his remarks relevant to the administrative

responsibilities of the Minister.

MR. PHILLIPS: Well, Mr. Chairman, I am. In discussing this,

I'm going to be discussing other votes such as the public

health service and the nursing and also education. So, please,

I am talking. I feel that the treatment and education of this

disease certainly comes under the administrative

responsibilities of this Minister. Certainly it is known that

both of these venereal diseases are curable and preventable.

What I want to know from the Minister is what is happening in

the Department of Health in British Columbia that would allow

this disease to reach such epidemic proportions, Maybe, Mr. Chairman, it's complacency on behalf of the

medical staff and on behalf of the Department of Health — and

maybe in the public health service, because they are like I am

and thought it was licked. Penicillin was discovered for the

treatment of venereal disease in 1943. Venereal disease in

Canada rapidly fell — the amount of cases rapidly fell. There

were 16,475 cases of syphilis in 1944 and this dropped to only

2,038 in 1958. So I guess I'm not the only one that thought

that this disease had been eradicated.

MR. CHAIRMAN: Order, please! I would remind the Hon. Member,

if the main point of this discussion is venereal disease, that

it would seem more appropriate to discuss it under vote 86,

entitled "Division of Venereal Disease Control." That is

clearly the area where this whole matter should be

discussed.

MR. PHILLIPS: Mr. Chairman, as I just pointed out to you,

I'm going to be discussing a vote for education and I'm going

to be discussing the public health service; and let's get the

subject out of the way now. If you'd just allow me to continue,

this does come under the administrative responsibilities of the

Minister. If you'd quit interrupting me, I'll carry on with my

talk. I haven't got much more to say, but if you keep

interrupting me....

One of the reasons, it is thought — and this is in the

research I have done, Mr. Chairman — one of the

[ Page 1665 ]

reasons it is thought that this disease has reached such

proportions is. because of the lack of government funds to

control, the lack of government funds to educate; and public

interest in this subject has seemed to have dropped.

Even in the medical schools, from the research I have done I

understand that emphasis on training general practitioners to

detect and to treat venereal diseases has not been dropped but

there is not as much emphasis on it today as there has been in

the past.

Dr. James Morrison, the director of VD control for the

Ontario Ministry of Health, said many family doctors today and

in recent years in Ontario are not really doing their job in

home treatment or in detecting it as a family physician. Maybe

this is why this disease has reached epidemic proportions. He

also feels there has been some lax use of chemicals.

Particularly the wrong type of penicillin is being used today

where it is not eradicating the disease as it has in the past

because certain types of venereal disease have developed

resistance to penicillin being used.

I suppose the development of oral contraceptives has had an

affect on VD's resurgence. Today, with the amount of

contraceptives on the market, there is not as much fear of

pregnancy. Therefore, probably sexual intercourse is on the

increase and this is probably one of the reasons why this

disease has reached epidemic proportions. Dr. Ralph Persad,

successor to Dr. Morrison at the Ontario Ministry of Health,

says many women in Ontario who were taking the pill feel that

the pill will protect them from venereal disease. There is a

great need for education, both in the schools and through the

public health nurses and through all types of medical

practitioners. As a matter of fact, he said taking the pill

probably makes many women more susceptible to gonorrhea than if

they were not taking the pill.

Another reason they in Ontario feel these diseases have

reached these proportions is because private physicians who

treat these cases in families do not report to the public

health service so that the giver of the disease can be traced.

One of the reasons I suppose is that the public health service

sometimes doesn't treat this disease with the privacy they

should.

It seems to be the appalling ignorance and the stigma still

attached to venereal disease that keeps it swept under the rug.

"It is not a sin or a crime," writes Dr. Ann Keyl,

director of the VD clinic at Toronto Women's College Hospital

in her book on VD. "They are diseases, and the sooner we

recognize them the sooner all infected persons will get proper

treatment.

MR. CHAIRMAN: Order, please! Hon. Member, I don't choose to interrupt

your speech, however, I'm just afraid that we're going to get into a general

discussion of this subject in the wrong vote. Therefore, I just point out to

you standing order 61,

part 2: "Speeches in Committee of the Whole House must

be strictly relevant to the item or clause under consideration." Clearly, all

of your remarks are entirely relevant to vote 86 and should be dealt with at

that time. It's coming up, I think, fairly soon.

MR. PHILLIPS: In due respect to your ruling, Mr. Chairman, I

would find it very difficult to discuss public health education

under vote 86, and that's what I'm leading up to. As I've asked

you before, if you will just let me continue, how can I discuss

education under vote 86?

MR. CHAIRMAN: Order! If the main point of the whole

discussion is venereal disease, then clearly it should be

brought up under vote 86. The Hon. Member may continue if he is

relevant to vote 75.

MR. PHILLIPS: This is, I would say, a very grave problem in

the Province of British Columbia. I would like to hear the

Minister's remarks as to what he's going to do if this TV

programme is true and if this disease has reached epidemic

proportions.

Our own Miss Trudy Rudermann, who was a senior nurse with

the B.C. Venereal Disease Control Division, says, "Too often VD

is covered along with abortion, drugs and all the other no-nos

in life." So she has some fairly strong feelings on this.

MR. CHAIRMAN: Order, please. If the Hon. Member is moving on

to another point, I would allow him to continue. But I would

rule any further discussion on venereal disease at this time

out of order. It should be brought up under vote 86.

MR. PHILLIPS: Mr. Chairman, this is the responsibility under

the Minister's salary. Under the Minister's salary you can

discuss any full responsibility under his jurisdiction. In all

due respect, as I told you, I'm going to be talking about

education. I wish you would quit interrupting me. You'd think I

was committing a sin of the House or something here.

MR. CHAIRMAN: I think the Hon. Member would appreciate that

the Chair is concerned we will get into a full discussion with

all Hon. Members participating on venereal disease at the wrong

time. I would ask the Hon. Member if he wouldn't mind waiting

until the vote comes so that we can have the general discussion

at that time. It would seem much more appropriate.

MR. PHILLIPS: I want to ask for money, Mr. Chairman. As I

pointed out before, I want to ask if the Minister will allot

money for education in the

[ Page 1666 ]

public health service. I'm going to talk about money for

pills; I'm going to talk about money for television; I'm going

to talk about money for billboards; I'm going to talk about

going into the schools. That comes under education; it's a

separate vote, and it's under the Minister's salary. It's under

his jurisdiction.

MR. CHAIRMAN: Order, please. Are all of these things that

you are to discuss related to venereal disease?

MR. PHILLIPS: They're related to education in the public

health field, yes, but education is a separate vote. Now, are

you being stubborn or am I being stubborn? If you would just

let me finish I'll be through in about three seconds and the

subject will be disposed of, I hope, to my satisfaction.

MR. CHAIRMAN: The Hon. Member may proceed if he's right.

MR. PHILLIPS: Just recently an Ontario task force

recommended that information on VD be included in health

curriculum by grade 7, through the Department of Education. The

Ontario task force proposed a campaign which would include

radio and television broadcasts through the Department of

Education in conjunction with the Department of Health. This

will take money; it may even take money from the Department of

Education. Maybe the Minister might have to use his influence

with the Department of Education to see that this is brought

about.

They recommended advertisements in newspapers; they

recommended pamphlets. Maybe I'm not going in the right places,

but it's been a long time since I've seen a pamphlet on

venereal disease. I remember they used to be lying around in

various areas. It has been a long time since I've seen a poster

warning against the disaster of contacting venereal

disease.

Films in the schools. Here again this may take the

expenditure of a fair amount of money. Lectures in the

schools.

MR. CHAIRMAN: Order, please! It appears the Hon. Member is

continuing on the same discussion on venereal disease. Perhaps

it would be helpful to the Hon. Member if we would ask the Hon.

Minister if he chooses to discuss the subject at this point or

whether he would prefer to wait until vote 86.

MR. PHILLIPS: I have about two minutes more....

MR. CHAIRMAN: Order! The Hon. Minister had indicated he

prefers to discuss the subject under this vote. Would the Hon.

Member continue, please?

MR. PHILLIPS: Does that have anything to do with your

ruling? Either you rule I'm out of order or I'm not in order.

But thank you very much, I'll continue.

MR. CHAIRMAN: You're now in order.

MR. PHILLIPS: They even went so far as to recommend that

audio-visual kits be distributed in the schools so that each

teacher can use them at his own discretion. They could be slide

films, pamphlets and all of the other paraphernalia that would

go to make up a good presentation in the school. This could be

used in all grades from grade 7 up.

What I'd like to know is what we are actually doing in the

Province of British Columbia. Under vote 86 we have a sum of

$303,913 for the total Division of Venereal Disease Control.

This is compared with the Division of Tuberculosis Control, for

instance, of $1,025,449.

I would say, listening to this TV broadcast, from the

statistics that I have, this epidemic of venereal disease that

is in the Province of British Columbia, and not only British

Columbia but in all of Canada, would be far more serious at the

present time, and a far greater threat, and a far greater

epidemic than tuberculosis. Yet on tuberculosis we are spending

three times as much money.

When you think, Mr. Chairman, that we spent approximately

$200,000 more on the Foulkes report than we are going to spend

on venereal disease control, I have to think. The Minister just

a few moments ago, when he was responding to the Member for

North Vancouver–Capilano (Mr. Gibson) said that it would be

better to stop an illness than to treat an illness. So this

education, I feel, should receive a great deal of attention

from the Department of Health.

Ontario, in the month of December had an hour-long film on

venereal disease. It was called "Careless Love" and it ran in

December in the Province of Ontario through their educational

TV network. After this film ran, Mr. Chairman, the phone lines

were busy to have a rerun of it because of the amount of

interest from interested students and interested parents.

Maybe we should get that film and run it in British

Columbia. Maybe we could get the cooperation of one of the TV

networks here to run it here.

In February, 1973, the Canadian Broadcasting Corporation ran

a similar film 4.4 million viewers, and it was called "The VD

Blues." This is a U.S.-produced film documentary and it

received a great deal of attention and a good response from the

viewing public.

"Information and education, it would appear, are the best

way of eradicating this disease, and today We have diagnostic

and therapeutic tools available which

[ Page 1667 ]

are effective in detecting and treating venereal disease."

So said Dr. J. Donald Miller of the U.S. Centre for Disease

Control at the 1972 International Venereal Disease Symposium in

Venice, Italy. "The question is whether or not we can supply

these tools sufficiently intensively to interrupt transmission

of these diseases."

So I hope, Mr. Chairman, that the Minister will bring his

statistics up to date and advise the House that some immediate

action is going to be taken. I suppose, with it being a coast

port, where there are a lot of visitors coming in, mariners,

seamen, I suppose that the disease is brought here from other

countries. Maybe we should have some type of a vaccination. I

don't know what the answer is, Mr. Chairman, but certainly some

drastic action is needed, and I would be very interested in

having the Minister's comments.

HON. MR. COCKE: Now, Mr. Chairman, let me first say that

there is no such thing as a vaccination or inoculation for

venereal disease, so we can dispense with any discussion of

that.

The Member talked about seeing a TV programme last night and

the TV programme informed him that there were an estimated

30,000 people in this province suffering from gonorrhea.

MR. PHILLIPS: No, I didn't say gonorrhea; I said VD.

HON. MR. COCKE: Well, Mr. Chairman, then he read the annual

report of the Health department and found that there were only

9,000, roughly, reported. It's not terribly inconsistent

because there are about one-third only that are actually

reported, or there have been in the past.

But in B.C. I believe we are making real progress right now.

We have met, over the last couple of months, with the B.C.

Medical Association, and indicated to them that lab findings

have shown us that there are a number of unreported cases in

the province. They've agreed, and very happily agreed, to

really put this whole thing together. There's real cooperation

between the Health department and the medical association, the

medical doctors of the province. Ways will be sought to do a

better job of the reporting, because reporting is very

important.

You talked about Health education, and we'll go into that in

a minute. But the reporting is important because you must find

out where the carriers are in order to stop the incidence, or

reduce the incidence.

Last year's summer programmes: in a number of the areas

which you talk about in the province, that we haven't built our

VD control bureaucracy any longer, that's quite right. You're

talking about a headquarters department, really. However, all

local health units are involved, should be involved, will be

involved to a greater extent.

Last year's summer programme was, to some extent, involved

in VD, our programme. We are now having discussions with the

Department of Education as to how we can best go about

assisting with health education in this respect.

We have put some material forward for education, because we

know, as everybody else knows, that it has now become a real

outbreak in the younger age groups. At one time it was,

generally speaking, an over-age-21 disease.

AN HON. MEMBER: What's the cost?

HON. MR. COCKE : Now it is an under-age-21 disease. It's in the

teens — at least a large

section of it is — and so therefore we have given to

PTAs and other people educational material to examine, to read. We have access

to the films which you are talking about, and we want to make this kind of educational

material available. It's a large programme. But certainly we are not lacking

any information and nor are we lacking in motivation to try to clear it up.

We certainly want to do that, and I think that we will move in the direction

of making our service available, so that we can correct some of the flaws that

have been in the system. One of the big flaws has been the reporting aspect.

So, in any event, let's hope that we can start to change the

trend and go in the direction that the trend went in the

50s.

MR. PHILLIPS: Mr. Chairman, just one other thought here. In

the report it says that diagnostic and treatment units are

maintained in New Westminster, Victoria, Prince Rupert, Dawson

Creek, Prince George and Kamloops only, with others in the

lower mainland and the City of Victoria. Now the Minister just

said that all public health units were involved. There are

public health units in more areas than mentioned in this

report. What about in Terrace, or Vanderhoof, or Williams Lake?

None of these centres are mentioned in here.

HON. MR. COCKE: They all have public health units, Mr.

Chairman.

MR. PHILLIPS: Well, it, doesn't say so in the report. In

other words, there are diagnostic and treatment clinics in all

public health...?

HON. MR. COCKE: We have special nurses seconded where the

incidence is high. But certainly they can get direction in any

of those public health units, even where there is just one

nurse working, for instance in Enderby, in an afternoon. You

can go and find out just exactly how to go about getting

correct information or diagnosis or whatever. So that's what

public health nurses are all about.

[ Page 1668 ]

MR. PHILLIPS: Are you telling me that there's a higher

incidence of venereal disease in Dawson Creek than there is in

Fort St. John?

HON. MR. COCKE: Mr. Chairman, that was the Member's

suggestion.

MR. PHILLIPS: Well, no. You said these treatment centres are

maintained where there's higher incidence than others, and I

see Dawson Creek but not Fort St. John.

HON. MR. COCKE: No, that's not necessarily the case. I said

there are people seconded in some areas where there's a higher

incidence; that would normally be in the lower mainland.

Naturally there would be a greater number of....

MR. PHILLIPS: Mr. Chairman, I want to thank the Minister for

his rational discussion on this. I'm certainly pleased to hear

that something is being done and I hope that next year when we

discuss his estimates there won't be 30,000 cases in the

Province of British Columbia.

MR. G.S. WALLACE (Oak Bay): I've been sitting back waiting

to discuss certain issues under certain votes, and I've just

become a little frustrated because everybody's all over the

ballpark on this side of the House, and I just find that on

some of these subjects I'll lose the thread if I don't take

them up at the moment. But I really feel that they should come

under specific votes — such as the hospital vote, which I would

like to talk about at some length, and some of these other

areas.

But I've noticed, Mr. Chairman, in previous estimates that

we've debated this session, that if you wait and try and

discuss it under the separate vote, we find that the person

speaking is somewhat harassed because it seems that the general

impression in this House is that once we get to specific votes,

you can hurry them along.

I think the consequence is that the Members of this House

are trying to cover every part of the waterfront under the

Minister's votes so that they won't be restricted when they

talk under the specific vote. I wish we could get our

guidelines clear because it's thoroughly confusing.

MR. CHAIRMAN: Order! The Chair was endeavouring to do just that, Hon.

Member. However, the Chair was a little more tolerant than it should have been,

and the point the Member's made is quite correct. The discussion should be brought

up at the appropriate place and it should be strictly relevant to the vote.

Therefore, we will make the attempt to keep the discussion strictly relevant

to the vote under consideration.

There has been a discussion of venereal disease tolerated to

this point. The Minister indicated he was prepared to discuss

it, but strictly speaking, it's out of order. However, if the

Hon. Member feels that the thread would be lost, or that he

needs to pursue the matter at this time, the Chair will allow

this, but would prefer the Hon. Member wait until the vote

comes up.

MR. WALLACE: I certainly will respect your ruling, Mr.

Chairman, as long as I can be reasonably certain that the same

ruling will be applied to all Members. You had about a

five-minute debate with the Member for South Peace River (Mr.

Phillips); then finally you let him carry on. Now, if that's

the way it's going to be, I've just got a whole sheaf of notes

here that I can start on right now and you would have great

difficulty ruling me out of order. So just as long as the same

ground rules apply for everybody, that's just fine.

MR. CHAIRMAN: The point is well made.

MR. WALLACE: Mr. Chairman, there are one or two points that

must come under the Minister's vote. One I have raised already,

and I respect the Minister's decision. But I would like him to

consider this question of coverage for individuals outside the

province which at the present time is extended for the period

of one year.

I raised a case with the Minister, and I won't mention

names; I'm sure he remembers the gentleman from the University

of Victoria. And I respect the answer because you can't stretch

the rules for one person and not for another.

I wonder if the Minister would comment on whether he would

consider some changes in the present legislation, or look at

the somewhat inconsistent situation which exists as a result of

order-in-council 492. The Minister answered in the question

period one day that he considered this a fringe benefit for

government employees. That's a fair enough statement also.

I should say, Mr. Chairman, that I'm talking about

order-in-council 492, which applies to employees of the

provincial government performing duties in the State of

California, who are presently not eligible for hospital

insurance and medical benefits after they have been absent from

British Columbia for six months.

The order-in-council is rather wordy; I'm not sure I

understand exactly what it says. The Minister can correct me if

I'm wrong, but my understanding is that for government

employees in California, there really is no time limit on which

the B.C. Hospital Insurance will cease to pay for that

employee's hospital and medical care costs. At least there

seems to me to be no time value; it's not just a matter of

extending it

[ Page 1669 ]

for six months to a year or 18 months. As I read the

order-in-council, it is a perpetual commitment by the

government to at least assist in paying the costs of medical

care and hospital service for B.C. government employees in

California.

The point I'm raising, Mr. Chairman, is, for example, the

situation of a member of the teaching staff of the University

of Victoria who went on a year's sabbatical to England. When he

finished the year's sabbatical, he was offered and accepted a

fellowship at the University of Liverpool. In his case it was

quite clear, both by his stated intent and by documentation,

that he was still a staff member of the University of Victoria.

In fact, this extra experience that he had greatly enhanced his

value as a teacher at the University of Victoria when he

returned. So he was out of the country almost two years. It's

interesting that when he re-entered Canada, his passport Was

stamped "returning resident."

Anyway, the very sad situation was that his wife became ill

soon after their return, and the bill for the hospital care was

$1,900. Now here is a resident of British Columbia, under these

circumstances, who finds himself committed to pay the bill

privately.

I won't belabour the point and I respect the Minister's

statement that there has to be some kind of guidelines and some

kind of period of time beyond which they cease to be regarded

as Canadian residents. But in light of the fact that the

Minister has given certain, it seems to me, unlimited coverage

to government employees in California, this in itself creates a

measure of inconsistency.

It's quite true, as the Minister stated, that his department

has chosen to give this as a fringe benefit, for lack of a

better phrase. But the fact is that the University of Victoria

has no option to provide that kind of fringe benefit for their

employees nor, for that matter, has any other business in this

province which has employees who are involved in considerable

periods of time outside of British Columbia. As far as I'm

aware, there is no mechanism under the legislation whereby they

could do that even if they wanted.

I suppose one might say they could take out private

insurance through a private insurer, but this is still not easy

to obtain compared to the ease with which government employees

in California are obviously covered under this order-in-council

492. I think it is certainly an area that I'd like the Minister.... I know there's no easy answer.

I'm not suggesting we just make it 5 years or 10 years or

some fixed period of time. But I wonder whether we could

consider legislation which allows the Minister himself some

flexibility which he doesn't have right now.

This was a case of a faculty member who came to Canada in 1961 and he's taught

here since 1961. He was granted tenure in 1968. As I say, all the way through

here was a man who is a resident of Canada beyond question, and who, for the

reasons I've stated, encountered a very substantial financial debt for hospital

care when his wife became ill.

I wouldn't even, have raised it were it not that the

Minister is obviously aware of problems for government

employees who may be out of B.C. for a while. I just wonder

whether maybe we shouldn't try and extend something of the same

benefit to other people.

HON. MR. COCKE: That's a good, valid question. I think we

should just take a look at it. In the first place, if we were

to increase the one-year coverage offered by BCHIS or Medicare

to, say, five years even, then somebody would be away for six

years and it would work a hardship on that person as compared

to the person who was only away four-and-a-half years, or

something.

I'm not saying that we're set, that one year will always be

the case. I'm saying, however, that at this point it's not a

high priority to change that situation. Therefore, until we can

think of some good basic reason for prolonging the coverage

time allowed outside the country, then we'll stay at the one

year.

Mr. Chairman, through you to the Member for Oak Bay, I think

you misunderstand the order-in-council. What the

order-in-council said is that the government will pay — not

Hospital Insurance, not Medicare — but the government will pay

the medical expenses of its own employees outside the country

where they are working for the government. And many of them are

outside the country for years and years and years working for

this government. Where they're outside the country working for

the government, if they're over the year, the government pays.

Prior to that, their medical expenses are paid by Medicare and

Hospital Insurance.

The reason for that is because we feel that we're asking

people to do something. to expose themselves to a situation

that their colleagues in other departments or in other

positions in government don't have to expose themselves to.

Therefore, we decided, as a cabinet, that we would provide them

with that fringe benefit. But it is not an insured benefit;

it's a fringe benefit. If MacMillan Bloedel or B.C. Telephone,

or any other company employing numbers of employees — and I'm

sure that some of the lumber companies employ Canadians and

send them out of the country for some years — if they wish to

do the same kind of thing for their employees, they may do so.

But they don't do it through Medicare, nor do they do it

through BCHIS, nor do we. So we're really not being

inconsistent. We're just saying that if a person is working

outside the country and gets to a point in time where he's not

covered by our normal Medicare or hospital insurance benefits,

then we pick up the slack.

[ Page 1670 ]

MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Just dealing

with the subject that the Minister mentioned as he took his

place, I don't know why government regulations have to be so

difficult.

If a person is employed in the Province of British Columbia

and their work is going to take them outside the province for a

year or 18 months, I don't see why some application can't be

made to the medical services commission for them to suspend

their coverage for that period of time and at the same time be

able to send back to British Columbia, within a fixed period,

to resume normal coverage without the waiting period. I just

can't believe that it's that difficult.

However, I don't want to discuss that, Mr. Chairman. I would

like to pursue with the Minister one step further a matter

which we discussed yesterday — the matter of health delivery

care in outlying areas. I want to carry it a step further in

another direction.

The Member heard from the Member for Cariboo (Mr. Fraser)

this morning on the situation that arose in the Chilcotin. I am

not concerned about the specific circumstances of that case.

Obviously we had the government satisfied that a team of a

doctor and a public health nurse was suitable for that area,

and the doctor was paid a salary by the government to carry on

his practice because a fee-for-service basis couldn't possibly

work.

I would like to know from the Minister whether or not his

department has made any assessment of other areas in the

province which could benefit from the location of a similar

doctor-nurse or doctor-paramedic team with appropriate

facilities, and if so, how many of such teams are required in

the Province of British Columbia, and to what extent the

department, in cooperation with the medical fraternity, is

being able to fill the need for such teams. This is one way in

which we can approach the problem that we discussed yesterday — the absence of health delivery systems in remote areas.

This is something which I would hope the department has

under consideration — in fact, is operating on now. As I read

the report of Dr. Foulkes, as a result of his lengthy

examination, it would seem that if the government is to accept

his proposals entirely or in part, the time to be involved in

bringing this new health delivery system into British Columbia

will be such that outlying areas are going to continue without

proper medical facilities for a considerable time yet.

I notice that in the report of Dr. Foulkes he talks about a time frame for

implementation of his ideas which, in order to meet it, would oblige us to be

considering legislation at this session — and I doubt that we will — plus availability

of staff for key positions and so on early this year. So obviously that's delayed.

If the government is considering anything like the scheme that Dr. Foulkes is

putting forward, I know that it is going to take a long time, and the people

of British Columbia should recognize that it will take some years before we

will realize the goal. Yet the department and the Minister must recognize that

in that interim period we still have got to make some progress.

Now in another

section of the Foulkes report he talks about

the manpower that will be needed if we are to make these

advances that he recommends. He suggests that we will need a

number — he doesn't say how many — of highly skilled people,

people with broadly based experience in the health care system

who can also manage and administer effectively.

He goes on to point out, as a result of his examination of

the province and its facilities, that these people are

currently in short supply throughout this entire continent.

Therefore he recommends that an immediate, full-scale,

professional effort be made to locate and hire key people for

the task.

I would like to know from the Minister to what extent he and

his department might be engaged in that search for personnel

who can be used to implement the Foulkes report as well as the

extent to which they are searching for personnel to meet the

current needs.

That brings me to another aspect of personnel, and that's

the training of our young men and women — maybe those not so

young — to do the jobs that need to be done in this province.

Certainly with the Foulkes concept of health care delivery, we

are going to be embracing an expanded medical team. Some are

going to be the doctor and the nurse, primarily, or the doctor

and the nurse with some other paramedic assistance. It's going

to be a much broader team that will be brought to bear upon the

health problems in all of our communities.

These people, I suggest, are not available to us today. I

would like the Minister to indicate what steps the department

is taking, or the government — his department in conjunction

with other departments — to expand the training facilities that

we must have to provide the required personnel.

Foulkes also deals with this in his report and it is

illuminating with regard to medical education: Dr. Foulkes

finds it essential to remark that "Medical education has

lagged, producing only 60 to 65 physicians a year." This was at

the time he was writing the report. It's now being increased to

80 doctors a year. But the number, he says, is still low.

"Training to the Canada average would indicate 152 doctors a

year with about 200 a year by 1981." That's for this province

to come up the Canadian average. He goes on to say:

"We believe that the province should be prepared to train

its own medical manpower skilled in the special problems of

this province. This should not be done, however, without

[ Page 1671 ]

assurance that the supply of physicians so produced will be

absorbed by the demand. In the past the graduates produced in

British Columbia have tended to stay in the province, finding

their way mainly into family practice while specialists have

been recruited from the outside."

That's why I was interested in hearing from the Minister the

extent to which his department now may be assessing the demands

for medical personnel and the paramedical support group, and to

what extent we may see this government moving towards meeting

our own medical manpower and womanpower needs. The problem is a

difficult one. It's expensive, but it's not going to become

less difficult nor will it become less expensive by waiting,

because it's not going to go away. If anything, it's going to

get worse.

I know the Minister has no doubt had the opportunity to

consider the admissions problem with regard to our own medical

school at the University of British Columbia. The statistics

with regard to admissions are really quite revealing.

In 1973 there were 625 applicants for admission to the 1973

entering class. That's down just a little bit from 1972 when

there were 698.

Of those 625 applicants, 302 were Canadians residing in

British Columbia or landed immigrants residing in this

province; 193 were Canadians residing outside British Columbia

or landed immigrants residing outside British Columbia; and 130

fell within the classification of non-Canadians, where their

citizenship or their residency wasn't clearly defined.

That's 625. But, as the Minister knows, in 1973 there were

only 80 of those who could possibly get into the medical school

because there were only 80 places.

This creates a very serious problem, not only for our

ability to fill our medical manpower needs, but also for the

entitlement of young British Columbians who want to go into the

field of medicine — and this applies as well to the ancillary

fields — to be able to take their place in this province to be

trained and to go out and serve the province which has been

their home and which they hope will continue to be their

home.

We've had a declining number of applications to our medical school over the

last three years. The decline is certainly not significant in number and can

be traced only to the number of non-Canadians, and non-British Columbians who

are applying for medical school. I can only assume that they recognize that

their chances of entering a class at UBC if they're non-resident is a little

less than appropriate, We also find, however, that another consequence flows

from the low intake into our medical school and that is the tendency on the

part of the admissions group to draw from the large number of applicants those

who stand in the highest categories, so far as academic qualifications are concerned.

They do range down as low as 70 per cent figures, so far as that is a measure

of academic qualifications, but generally they are drawn from the higher levels

of academic skills.

Also they are drawn from people who have spent many, many

years at school and university training before even making an

application for medical school. Of the 1973 entering class

there were 38 students of the 80 who had three undergraduate

years and no degrees. There were four who had four

undergraduate years with no degrees. But from then on you find

Bachelor degrees, Bachelor plus one, two and three additional

years, Masters' degrees plus additional years, and four

PhDs.

What concerns me, Mr. Chairman, in light of the discussion

that the Minister and I had last evening is that when you draw

people with these very high academic skills to our medical

school there is, I suggest, little likelihood that when people

of that caliber have passed through the medical school they

will be the ones who will willingly offer themselves to go into

our remoter areas and take up positions that the government and

the people of this province recognize must be filled.

Indeed, when you have people of very high academic skills — double doctorates, Masters degrees in other disciplines coupled

with medical degrees — those people are more likely to pursue

the route towards a medical specialty or perhaps go into

medical research, if that field is available to them. So then

having taken the positions in our medical school — I'm not

denying them their rights in that regard — and having graduated

there from, they do not necessarily flow with such ease back

into the areas where there is the greatest need.

I'm asking the Minister if he could indicate to the

committee what he sees for the immediate and long-range future

in British Columbia so far as medical education opportunity is

concerned. If you want a young man or young woman with a

first-class average, or high second class, who may be just the

right person to be a doctor, what chance will such a person

have to get into a medical school and complete his or her

training. This applies to nurses, to people in rehab medicine,

to all of the other paramedic ancillary groups who under a more

modern health delivery system will join with the doctor to

provide what we require for our community.

It's going to cost a lot of money, as I said. I know the

Minister recognizes it. I'd just like to know when we're going

to begin. What word do we give to the young men and women of

British Columbia today who are looking to medicine for a

career? What are their chances? Should they stay in British

Columbia or go elsewhere?

HON. MR. COCKE: Mr. Chairman, the Member is

[ Page 1672 ]

quite right. The Member for West Vancouver–Howe Sound (Mr.

L.A. Williams) indicated that there has to be some way to

develop health care personnel. It's all very well and good to

have ideas about the needs; it's okay to write a report

indicating that there are those needs; it's okay to have

manpower committees, suggesting that you need a much heavier

concentration in isolated areas or in rural areas. That's very

much a part of the reason that last fall we made the decision

to develop the whole British Columbia Medical Centre

concept.

This will be the training centre. The focus will be in the

Vancouver area but it will have its out groups, as far as

paramedical and nursing training is concerned, in the regional

colleges and so on. It will be the focus on the clinical aspect

of health education in this province, and it will certainly be

the clinical aspect of the medical training of this

province.

The University of B.C. Is very much a part of the

organization and the planning of this B.C. Medical Centre. We

feel that within two or three years we can increase our output

of doctors — start increasing it in a year or two — to the

level of 160, once we're well on the way to getting the B.C.

Medical Centre into first-class operation.

Interjections.

HON. MR. COCKE: What I'm talking about is the intake. The

intake has to grow from the 80, where it now applies, but it's

not only there, Mr. Member. You know, for instance, of the

school of rehabilitation medicine, where we're producing 40,

and we need so many more, and of the schools of nursing,

particularly the school of nursing at the University of B.C.

where we're hoping we can develop the Masters and PhD levels so

that they can be then free to go out and teach nursing in the

regional colleges, et cetera.

So a tremendous job has to be done. We have not carried our

load in this province as far as development of our own health

personnel goes. I hope that the B.C. Medical Centre will be a

great part of the solution to this whole question. It will be

the catalyst; it will help put things together. We will

probably be putting the council of the B.C. Medical Centre into

operation within the next few months. I think probably within

two or three months we should have all the appointments on the

council. Then, of course, we will have that liaison with the

regional aspect of this need. We will have members on the B.C.

Medical Centre council from the north, from the eastern end of

the province, from education and from some of the hospitals and

health districts outside of the lower mainland.

It is a real problem and we know that it's going to take a

great deal of work to achieve the kinds of objectives that

you're talking about.

As far as qualifications are concerned for entry into

medical school, I tend to agree with you. As a matter of fact,

I have talked it over with the Dean of Medicine and I've talked

it over with others involved. But it is a university decision

as to how the standards are set. I think, however, that having

a larger programme and the access to the wider setting will

give the university an opportunity to really do a job around

family practice. I think that's where we need the greatest

input now.

We have all sorts of super specialists, but what's getting

scarce, Mr. Member, through you, Mr. Chairman, are general

practitioners or family practitioners in this province.

Therefore we're hoping that that is going to be much more a

part of the programme in the future than it has been

heretofore. But you raised some excellent ideas.

MR. G.B. GARDOM (Vancouver–Point Grey): A few moments ago I

received a telephone request from a public-spirited citizen who

has presented a problem very deserving of the Hon. Minister's

attention. Would it be possible to incorporate any programmes

or make assistance available in the Province of B.C. for

mother's milk banks?

Apparently this came to light as a result of a youngster in

Arizona who suffers from a very rare genetic disease known as

acrodermatitus enderocatheca. I gather he's about the first of

eight people to have this in medical history and only one of

two do survive. As a result of the disease to the digestive

process, the body breaks into the equivalent of second degree

burns both internally and externally; the individual can die a

very slow and painful death of malnutrition if a supply of

mother's milk is not available. I believe this individual has

raised through donors up to 500 ounces last week in Vancouver

and hopes to have another 1,000 available by this Friday for

delivery to the United States.

He drew to my attention that there were apparently six such

banks in the United States and some of them have apparently

closed. I gather most of them if not all of them were

commercial. He very strongly recommends that there be a

mother's milk bank in Canada and that it be established free of

charge. There's not one in our country as far as he knows. In

order to initiate it, he mentioned that for pasteurization

processes and freezing procedures there would be an outlay of

perhaps $10,000 of capital. He would guesstimate at this

juncture an annual operating cost of something in the

neighbourhood of $20,000.

He very much impressed me with his talk over the telephone

of the great need for such a situation which should be brought

very much to light and to a head as the result of the very

unfortunate disease that is now being suffered by this

youngster in Arizona. I think it's a very worthwhile

suggestion; I wonder if the

[ Page 1673 ]

Hon. Minister would like to comment upon it.

HON. MR. COCKE: I only know of this case by way of the news,

and all I can say is that we would look into it. I can't say

anything further; I don't know what the incidence of the

disease is and what the priority would be. But certainly we can

look into it.

MR. GARDOM: I'm not relating the request for such a bank to

this specific disease, which apparently is a rarity unto

itself. But he indicated that there is a need for a milk bank

in our country because we don't have one in Canada. Babies do

require mother's milk on a temporary basis in all sorts of

situations, and this would be a means to establish that very

kind of a bank much in the same way as we have blood banks.

MR. McCLELLAND: I just want to take a second to pass on a

message to the Health Minister from one of the pages. I won't

name names, but one of the pages came to me and just asked if I

would ask the Health Minister to bite his lip on the McDonald's

hamburger thing. (Laughter.)

MR. FRASER: I want to take as much time as possible here,

Mr. Chairman, because I've done quite a bit of talking today

and haven't had any answers at all. I've had time to think

about the answers I've had and I haven't had any answers. I

intend to get some answers. I'm going to have to talk about the

weather for awhile.

The Minister is leaving now, but in the absence of the

Minister there's something else I would like to know. Maybe

it's in this report; I think we just got it. I'd like to know

the average daily rate we paid in the Province of British

Columbia for an acute-care hospital bed. I would also like to

know the highest daily rate we paid in the province in 1973 and

also the lowest. I would particularly like the average rate. I

am only referring to acute care on that question.

The other question is: what is the average daily rate of the

extended care paid in 1973? I think there's a big difference

there. Maybe his department people there can get the

information.

This morning we reviewed public health problems,

specifically in the Cariboo. I'm not satisfied that I got the

right answer about the Chilcotin, the Tatla Lake Health Unit — certainly not for the people out there. I gather the Minister

is satisfied to leave things the way they are; in other words,

locked up. I just wonder if he's had any opportunity to

reconsider. As I said before, I think the route is with the

doctor: why can't the department get him to cooperate so that

the citizens of the Chilcotin can have the use of this public

facility which is there but locked up?

The other thing I would like to come back to is the Vaness affair. This is

in reply to the answer he gave that he wasn't about to open the case. If he

is concerned about not opening the case, why, as a member of the executive council

the cabinet, wouldn't he discuss it with them and apparently they could take

that action. Quite frankly, it's completely unsatisfactory the way it is. I

don't want to have to go back to the Cariboo and tell them what the Minister,

where it stands now, just refuses to do anything about it. I've been trying

to get these answers but they're hard to come by from this Minister. I can't

understand why; they shouldn't be that embarrassing to answer. Everybody's entitled

to an error and to a second look.

HON. MR. COCKE: Okay, Alex.

MR. FRASER: Thank you very much for returning. I was just

saying that I didn't get the answers. I've asked first for

daily rates on acute care and extended care; I'm interested in

the differences. Probably your staff might have that now. I'm

not after any specific hospital, just the general provincial

scene.

I wish you would come up, Mr. Minister, with an answer to

the Tatla Lake Health Unit and our friend the doctor. I don't

think we should leave it the way it is. The way I see it now,

the House prorogues sometime this summer, the, staff will

probably leave it the way it is and we'll lose the rest of the

year. I don't think that's good enough when the facility is

there and everything. I think it's a question, in other words,

of negotiating with the doctor.

The last but certainly not the least is the Vaness case. I

suggested while you were out that if you won't reopen it, you

would consider taking this up with the cabinet. Then you could

have the cabinet take the responsibility and order the

reopening and review of the case. Thank you.

[Mr. Liden in the chair.]

HON. MR. COCKE: I can't give the Member the specific daily

rates at this point in time. I don't think they've been

finalized for one thing; they're working on provisional

budgets.

MR. FRASER: I meant for last year.

HON. MR. COCKE: Well, in that case I'll get them for you. I

can give you an idea what hospitals they are. The more

sophisticated the hospital, the higher the rate. In a way it's

kind of unfair. Where the sophisticated work is going on, the

rate is charged across the board. It could be that a person

goes in with a very minor complaint but the rate is charged

across the board and not to any individual. In any event,

that's the rate the hospital charges BCHIS. I'll certainly have

those figures for you.

[ Page 1674 ]

As far as Tatla Lake is concerned, we've tried everything in

Tatla Lake. I think you, the Member for that area, know as well

as I do that we financed the doctor in the region. Then we sent

in a nurse subsequently, hoping that the teamwork would be the

natural flow from that situation. But it didn't work. I'm told

fairly clearly that it's not likely to work in the future under

the present circumstances.

MR. FRASER: But it's worked in other parts of the

province.

HON. MR. COCKE: Oh, absolutely. There's no question about

that; it works in many instances. It's just a rugged

individualist in my view — that's the doctor up there.

I think it would be precipitous of me to suggest that the

community should go without a doctor, and have a public health

nurse look after the situation. So we are not unmindful of it.

As a matter of fact, I might go in there this year if I have

time, Mr. Member. I'd like to have a look at....

Interjection.

HON. MR. COCKE: Well, that makes it even more attractive.

And the Member for Victoria says only one of us will come

out.

As far as the necessity is concerned, I suggest to you she

should write a letter to the public service commission; that's

the first step. And it will certainly get every attention.

MR. WALLACE: Mr. Chairman, issues keep being raised that I

thought were going to be raised under other votes. So once

again I will just go on record that I will respond at this

time.

I wanted to make some comment on the question the Member for

West Vancouver–Howe Sound (Mr. L.A. Williams) raised about

medical personnel, and particularly the training of doctors.

I'd like the Minister to comment on the recent

federal-provincial conference where Marc Lalonde commented on

the fact that perhaps one should look at the restriction of

inflow of non-Canadian doctors to Canada, and accentuation of

more training facilities for native Canadians, or Canadian

citizens.

I may have missed part of the debate, and he may have

covered that, but I think it's a very important issue because

for the first time it may introduce an element of government

restriction of professional people coming into this province,

or coming into Canada.

I know that in the past the medical profession itself has often been criticized

as though it was the medical profession — the College of Physicians and Surgeons

— which was restricting access to medical school. I hope, once and for all,

that this debate and other debates have made it very clear that there is a very

limited number of places for medical students in British Columbia. To provide

a much increased number, as the Minister I'm sure knows, involves not only physical

plant and facilities but a great increase in the number of teachers. It's exactly

the same problem we have in the nursing profession.

It's all very well to say we need more nurses, but you just

don't produce them out of a hat or manufacture them like

cookies. You have to find not only physical facilities, but

well-trained teachers to teach the greater number of nurses. In

medical personnel, to take the very quickest, simplest example,

to teach anatomy you need cadavers. You need larger rooms to

house the cadavers, and you need more people to service the

facilities, and you need more teachers in anatomy and

physiology and pathology and bacteriology — and so it goes.

I think it would be tragic if this Legislature gave the

impression to the public of British Columbia that you just turn

out more doctors like you turn out more sausages out of a

factory. I know that's a ridiculous analogy. But the concept

must be clearly understood that you're spending many years

training people in a very highly complicated field. Therefore

you need teachers who themselves are well trained. And they are

not just that readily available.

In passing, I would say that it is my understanding, too,

that some of the problems in setting up the medical centre — and the Minister might wish to comment on this — involve the

pension plan. I wonder if it is accurate to say that part of

the resistance of the staff is based on their wish to continue

in the federal pension plan rather than enter the provincial

government plan which would apply when the Veterans Hospital

becomes operated by the provincial government. I'm not certain

what the strength of that argument is, but I'm sure the

Minister will be able to comment.

On that point of integration of service, I would just refer

back for a moment to the Foulkes report. I said yesterday that

there are many good recommendations in it. I stand by that;

there are very many that I can support completely. But my

general apprehension is in this word "system." I just get the

horrible feeling that the whole report endeavours to set up the

most complicated kind of administrative system rather than, as

it claims to do, guarantee adequate high-quality service at the

periphery, which is where the patient is.

It's perhaps too sweeping a criticism, but it seems to me

that if this report were to be adopted by the government — never mind in total, even in part---I think so much time and

energy and money would be spent setting up the various

administrative layers and structures and community health

clinics and advisory councils and disciplinary bodies, and Lord

knows what else, that the tendency of the report would be

[ Page

1675 ]

to glorify the system rather than result in very worthwhile

improvements in the delivery of service. Now that is too

general a statement, but I think it is a feeling that you get

from reading this report.

The final pinnacle of my concern is in two lines — recommendation 248 — that the government integrate the

Departments of Human Resources and Health and form a new

Department of Social Affairs. Now I just boggle when I read a

recommendation like that.

Earlier in the report...and again I can't find the page 1n

this publication, it's very frustrating. I can't get back to

the page, but there's a page earlier in the report where it

states that these two departments are already — I think the

phrase is — having acute administrative difficulties, or some

such phrase meaning the same thing. Similar words to the same

effect. (Laughter.)

I really don't think it's much to joke about, but the fact

is that somewhere earlier in the report it does admit that

already the administration in these two departments presents

some very realistic difficulties. Then you get to

recommendation 248 and it wants to put the whole works under

one Minister. Now this is just ridiculous, Mr. Chairman.

Furthermore, in the same theme, they want to increase the

size of regions, or rather diminish the number of actual

regions with a larger area covered in each region. All I can

say, Mr. Chairman, in this particular capital region is God

help us if they're going to enlarge the region looking for more

efficiency.

I'm quite willing right now for all the criticism that I'm

about to receive. I think the performance of the Capital

Regional Hospital Board and in the capital city of this

province at the very least, I could say, leaves a very great

deal to be desired. And that involves the specifics such as the

issue that was dragged out last night about the peninsula

hospital and whether it will expand to acute care, et

cetera.

The fact is, Mr. Chairman, to quote specifics rather than

give blanket condemnation, we had a referendum.... I'm just

trying to make the point that this government cannot be held

responsible for much of the dilly-dallying which to my mind

goes on at the regional level. There are reasons for that and

it's not all the fault of the regional municipal politicians

either. I'm not saying that. I'm just trying to point out that

regionalization in this city is not working well for whatever

reason.

In 1968, the people of this area passed a referendum for $12 million-plus for

extended care. The Minister mentioned earlier on today that, by and large, the

numbers have been met. But let me make it very plain that that was in 1968 and

this is 1974; and the only reason we've got the extended-care beds was that

just months ago the Minister took over two private hospitals to the tune of

150 beds. So for six years, out of the 600 beds that were financed in this referendum,

we sat around in this region of the capital district for at least five years

before we got half of the 600 beds.

Now I don't know how anybody trying to study the delivery of

health service can look for an even greater extension of

regionalization where you have bigger regions and fewer — of

them when we've got this dismal record in the capital

region.

In 1972 the people in this district of this region voted a

referendum for $22.5 million and there hasn't been a penny of

that spent. There's nothing to show for a referendum of the

people who passed $22.5 million for various facilities,

including some acute care.

I know the argument is, "Well, we're waiting to see what

happens to the Veterans Hospital." That's the kind of factor

which I agree has to be taken into account. But it really

bothers me, Mr. Chairman, when I read this Foulkes report and

all this emphasis is laid on systems, administrative

structures, regionalization, councils, advisory bodies, et

cetera, et cetera, et cetera.

All I can say, Mr. Chairman, is that we've had a bellyful — pardon the language. We've had a large amount of that already,

and as far as the capital city with 300,000 or 400,000 people

in the region is concerned, it's not working.

Their performance is very poor and I gather from reading the

Foulkes report that our present Capital Region would be

expanded halfway up the Island, and we'd have an upper Island

and a lower Island regional district.

It just seems to me that before we start getting into a

larger bureaucracy and more emphasis on systems and committees,

and departments, and so on and so forth, I think we should take

a pretty hard look at what's been achieved up to this

point.

I am told by others that fortunately the Capital Region's

performance has been bettered by other regions and I'm happy to

hear that. But I'm certainly very impatient with the situation

in the Capital Region, and when I complain about it publicly,

the chairman has the audacity to say that I'm playing politics,

and we've taken five years to get half the beds that were voted

for in 1968.

Who does he think he's kidding? I know who's playing

politics, and it certainly isn't me. If this is the kind of

carry on that goes on in the Capital Regional Board for five

years, let's not get misled by saying, "If we just enlarge the

region, have fewer numbers of regions," that's going to

solve anything.

The fact is that regionalization is a very sound and

necessary structure in the context of delivery of modern health

services, no question about that. But I'm sure that in setting

up regions, you have to look at two things. You have to look at

the size of the region and you have to look at the political

and

[ Page 1676 ]

administrative structure which is going to provide these

services through the vehicle of regionalization. That applies

whether it's sewers or hospitals or anything else.

I, for the life of me, cannot understand where some of the

problems lie. Now I understand in one respect, and I'm told

this as a physician, that a great deal of the problem lies with

interprofessional rivalries between two hospitals in this

community, and that may be.

I know I'm probably not making any more friends by saying

that today, but the fact is that what we need is leadership to

make decisions. Surely you're not telling me that all this

delay in the creation of the necessary facilities is being

purely stymied by interprofessional rivalries? If that is the

case then again I lay the decision clearly at the door of the

Regional Hospital Board who have avoided making decisions which

are urgently needed for the development of a general range of

hospital facilities in the Capital Region.

I had intended to talk about this under the hospital vote,

but since we're on the subject and since there are so many

points that must be made, I think I should just finish the

remarks I had prepared.

I'm not sure that the province and the people in the

hospital field have completely accepted the basic theme of

progressive patient care — that you treat a patient in the

appropriate kind of facility. You don't give more treatment or

more expensive surroundings than are needed, and you don't give

them less than they need.

We've got the paradox that we have people in acute hospitals

who no more need it than I do, at the moment, and we have other

facilities where they are receiving inadequate treatment in.

intermediate-care nursing homes.

Until we realize, the Minister better than anyone, and

certainly the federal Minister of Health (Mr. Marc Lalonde)

knows, that costs are just going up and up by something around

12 to 14 per cent per year, it's all very well to have all this

theory in this great pink volume, and I've talked about

theorizing about systems and structures and committees and

goodness knows what else. But the other point that's wrong with

the Foulkes report is its complete failure to deal with the

financial problems of providing health services. It skirts

around it.

It uses phrases like, "Adequate sums will have to be allocated," and all kinds

of very general statements. The Minister knows what kind of sums of money,

we're talking about and they are fantastic sums of money. When we're talking

about nursing care — and I won't get into this question of the negotiations

that are going on — but let's get one figure on record. The base monthly rate

for the RN which is being sought is $915 a month. So just dropping that little

pearl in there gives some idea. I quoted other figures for nurses aides, and

LPNs and orderlies, and so on.

Now I'm not for one moment denying the right of any employee

to bargain for the best wages that he or she can achieve. That

isn't the point. The point is that the total cost of all health

services is just going up on a steady line at a rate which

cannot continue. There is just no question that we cannot

continue to spend an increasing 14 per cent or thereabouts,

annually on these services. So the next most important

challenge which we have to face is to utilize what services we

do have in the most economic ways.

With respect, Mr. Minister, through you, Mr. Chairman, we

still don't have the extended-care beds, for example, that we

need. In answer to the Member for Cariboo (Mr. Fraser) the cost

of an acute bed in Victoria is around $70 and the cost of an

extended-care bed is around $25. So it's $45 a day difference

in ballpark figures.

We still have in the Jubilee Hospital and in the Victoria

General Hospital somewhere around 20 or 30 extended-care

patients. As I say, you cannot look upon any one category of

patient in isolation, and when the Minister took over the

extended-care hospitals that I mentioned — and I want to touch

on that briefly — I think it was a good move.

But the problem is that the Minister has to find

accommodation for — I don't know the numbers — 30 or 40 patients

who don't qualify for extended care. They've got to go

somewhere and there's just nowhere for them to go, and wherever

they go they are going to receive a lesser quality of care.

There's no question in my mind about that.

We have to look at this business of levels of care and try

not to define or to develop one level at the expense of other

levels. Simple economics for one thing, is most important. But

beyond that, to take the example of the extended-care hospitals

which the Minister has acquired, I talked to them just in

recent days, and I think it should be on record that the number

of staff has been increased. The wages have been increased and

we are now operating that kind of facility, in my view, under

much better circumstances, which will result in better care for

the patient. I credit the Minister with that move.

Now as I say, it bothers me that we talk of isolation about

different types of patient. When you're a patient, you're a

patient. You're sick. You need health care. you need nursing

care, and all these artificial divisions really bug me.

I think it's just incredible that in a supposedly

enlightened age with all the medical know-how and technology

that we've got patients compartmentalized and in one

compartment they get pretty good care and in another, well,

they're on their own. I know the Minister is aware of this, but

I wonder if he would try and do something at the same time as

he's dealing with extended-care facilities and

[ Page 1677 ]

expanding them, to deal also with these other people, and

try and find even some interim measure which really right now

is unsatisfactory.

Now, to look for a moment at acute care. I was staggered to

discover the other day that some of the patients admitted to

extended care have bedsores, Wherever they had been, they had

been receiving less than adequate care, and I was further

staggered to learn that some of them came from acute

hospitals.

So I enquired about this situation, as I thought this

certainly raised my eyebrows. The answer I get is that it is

now so difficult for nurses in acute hospitals to cope with the

total volume of work that somebody gets the short end of the

stick, to speak in metaphor. Now if somebody gets less than the

treatment they require, then Mr. Minister, through you, Mr.

Chairman, the person who gets less than fair treatment is the

little old lady, or the little old man lying in a bed not very

able to vocalize his complaints. Perhaps their needs are less

obvious and less acute compared to the surgical cases and the

people with strokes, and the more obvious serious pressing

needs. As a result some of these elderly patients who are

waiting for an extended-care bed are actually receiving less

than adequate care prior to their transfer to an extended-care

bed.

Now I've just read the Annual Report of the Royal Jubilee

Hospital which is a very proficient hospital and I read with

particular interest the director of nurses' report because she

puts in very clear language some of the problems that will have

to be faced and should be faced right now. With this tremendous

attempt to use acute beds intelligently, you discharge the

patient as soon as possible. The figure that's quoted, I think,

in the annual report of the length of stay is somewhere around

8.9, which has been steadily decreasing over the last few

years.

In passing, you quoted, Mr. Minister, the day-care

facilities. Something of the order of 25 per cent of all

surgery is now done on a day-care basis. That's certainly a big

improvement over the past and it should continue to

improve.

But there is a cut-off point; there is a point at which you

just cannot diminish the length of