May 30, 1996

SOCIAL SERVICES ESTIMATES COMMITTEE

The Committee met at 7:00 p.m.

CHAIR (Mercer): Order, please!

Ladies and gentlemen, we are ready to restart.

Welcome to this meeting of the Social Services Estimates Committee of the House.

We are going to examine the estimates from the Department of Health this

evening. Before we get into that I will ask the members to identify themselves,

starting at my far right.

MR. OTTENHEIMER: John Ottenheimer, St. John's

East.

MR. H. HODDER: Harvey Hodder, Waterford Valley.

CHAIR: Bob Mercer, Humber East.

MR. OLDFORD: Doug Oldford, Trinity North.

MR. WHELAN: Don Whelan, Harbour Main -

Whitbourne.

CHAIR: Thank you kindly.

We have the Minutes of the last meeting. Could we

have a motion to accept?

On motion, Minutes adopted as circulated.

CHAIR: The Clerk will call the first subhead.

CLERK: Subhead 1.1.01.

CHAIR: Thank you. The procedure we have been

following, Mr. Minister, is that we will give you up to fifteen minutes to make

some introductory remarks, followed by the Vice-Chair who will have an equal

amount of time to make some introductory remarks, or start his questioning.

Then, from there on in, each member will basically ask questions until they have

exhausted themselves or the questions.

AN HON. MEMBER: Or the clock.

CHAIR: Or the clock, of course. If you could,

please, introduce your officials. I would ask your officials if they are to

speak during the discussions to identify themselves for the purposes of Hansard.

MR. MATTHEWS: Thank you very much, Chair. It is

a pleasure to come this evening and to be party to examining the estimates for

the Department of Health. I hope that as a result of the exercise members of the

Committee will be reasonably satisfied with the answers they get to the

questions, and that they will have a good understanding of the department and

the composition of the budget in all its component parts.

Before I get into making some opening comments, I

think I would like to take a minute and introduce the officials who have joined

us this evening for more than adequate support, for my purposes. If there aren't

answers to all of your questions here in the room, then the department should be

in for an overall review. But I don't think that will be the circumstance.

On my immediate right is Dr. Bob Williams, Deputy

Minister of Health. To his right is Assistant Deputy Minister, Chris Hart. Chris

is ADM of Support Services. On my immediate left is Gerry White, the ADM for

Community Health and Drug Programs. At the end of the table is Roy Manuel, the

ADM in charge of Institutions.

The officials at the back are all an intricate part

of the executive team of the department. I am going to ask them to stand as I

identify them so that you will know who they are. I will start way over here, I

guess, on my right, your left, with my Executive Assistant, Joe Ashley. Next to

Joe is John Downton. John is in charge of generally our provincial drug programs

which are essentially for the seniors and indigents. Next to John Downton is Max

Osmond, and Max is the Director of Financial and Operational Services. Next to

Max is Debbie Sue Martin. Debbie Sue is Director of Mental Health Services.

The lady in the red, wearing my colours, is Eleanor

Gardner, and Eleanor is in charge of Continuing Care, which is our home supports

and programs related to that area. Last but not least is Kent Decker. Kent is in

Institutional and Financial Services. Kent and Max work essentially under the

auspices of Chris Hart. Chris is essentially in the financial part of the

department. In other words, they are CA types, you know what I mean? These are

the officials, and I appreciate their attendance this evening.

Just a quick overview of the department. The

Department of Health, in terms of budget, is obviously the largest department of

government. We spend about 35 per cent of all of the discretionary spending that

the government does. After we pay our pension obligations and debt charges, we

spend $903 million this year on the operational side of about a $2.7 billion

provincial expenditure for government services.

The Department of Health is also, of course,

through the health care system, the largest employer in the Province employing

somewhere in the area of 12,000 people if you include all of the system. As you

would understand and be aware of, the department has been undergoing significant

restructuring at the institutional level over the past four or five years,

starting back in 1991-1992, when we began to move significantly in the area of -

I won't say downsizing, but probably rightsizing and making adjustments at the

hospital and institutional side of the health care delivery services aspect of

what we do.

We are now operating with about 1,900 beds, give or

take, in our hospitals, our acute care side, as opposed to what was, I think,

2,600 back then. In addition to that, we, on the institutional side, run the

long-term care of the nursing homes; we have responsibility for the total

institutional sector and a small part of that would be the personal care homes

which is totally a private sector driven aspect of the health care system.

The department's budget breaks down into only five

or six major component areas, believe it or not, and they are represented in a

very general sense as compared to the figures I will give you, something like

this: The institutional sector of the hospitals and nursing homes would account

for about two-thirds or $600 million in our budgetary expenditures. In addition

to that, we have the community side of health care, the community-based

programs, the public health programs, as they would have been known in the past,

more identifiably by that title, and which accounts for about $70 million of the

health care budget.

We spend in physician and doctor services through

the MCP budget in the area of $140 million. These are very, very, rough figures.

I think MCP, for instance, is about $146 million. The drug programs account for

about $54 million of our expenditure; the medical school costs us about $17

million to run, to fund. We have a children's dental or children and indigents

dental program which accounts for about $5 million of our expenditures and these

are basically the main parts of the budget. I think if you total these up, you

would come to about $885 million of a $903 million budget. The balance of the

budget would be on grants to community organizations, a host of sundry other

services that we deliver, bursary programs, seat purchase programs, and included

in that, of course, we have to run the department, which accounts for several

million dollars, somewhere around $5 million or $6 million, I believe. The

Cancer Foundation is another significant part of the health care system which is

over at the Health Sciences, the H. Bliss Murphy Cancer Clinic as well.

As a result of restructuring in the health care

system, we have, by I guess, policy direction and government decision, been

moving more and more toward a health care system that is being organized,

managed and delivered as close to the community and as close to the people in

the Province as we can possibly achieve. We have put in place eight

institutional boards over the last couple of years to replace the twenty-five

hospital boards that were previously in existence, hospital and nursing home

boards. We have created four, new community health boards consistent with the

direction in which the health care is moving, which is toward community-based

services including the conscious decision of putting more emphasis on education

and prevention as opposed to the curative side of health care.

We are devolving I guess, more and more, the

micromanaging of the health care system to the boards, and to the community

level and at the departmental or the government level, we are, more and more the

macro-managers of the system. I guess that is reflected in terms of how we have

reorganized our department within the government structure. Back five years ago

in 1990-1991 - and I got these figures tonight from the deputy, although I had

them before - in 1990, we had 258 people working, if you like, in the

department, as you would say, at the Confederation Building type level. We have

reduced that staff level to a point where today we have only 128 people in our

department, and over the past six months alone, we have eliminated forty-three

positions mostly due to budgetary constraints and to a careful reorganization of

what we do in the department. I would have to tell you quite frankly that at the

departmental level we are probably as thin on the ground as any department in

government in terms of the human resources we have to get the job done. And we

run a very good operation, as best as I can judge, with committed people who

give good service as public servants to the people of the Province. We have

downsized by one assistant deputy minister as a result of the new government

that has just taken over two months ago. We now have just three ADMs as opposed

to four in the past.

So, in terms of trying to be as efficient as we

can, and in trying to maximize every dollar in terms of wanting to direct our

resources toward the front line services to the greatest extent possible, the

department, in my view, has reorganized itself most efficiently, notwithstanding

that I believe still we are effectively getting the job done. I think that is

largely a reflection of the commitment of the senior officials in the department

starting with the deputy and the assistant deputy and those whom you see here

this evening.

There are a number of issues that I am sure you

will want to raise and get into as we go through the budget. So I don't want to

take too much time. I guess the highlight for government this year in terms of

putting together our budget was the fact that we made decisions vis--vis

departmental expenditures based largely on what we perceived and understood the

public wanted us to do, that was, to follow a course of substantially no

borrowings or very little as a government, no new taxes, and preservation of

health care as the number one priority. And, in that context, we not only

preserved our operational budget of $901 million from last year, we actually

increased to $903.3 million.

Beyond that, probably what is even more significant

is that for the first time any department has ever achieved this, and any

government has been willing to make a commitment of this nature, is that

government made a commitment to a three-year budget for the Department of Health

at the same level of expenditure that we have this year. That was a very

conscious and deliberate decision to allow the health care system to continue to

reorganize and right size and reallocate resources consistent with where they

can best be spent, to get the best health care dollar service from our budget.

It was also in response to what the system was

telling us as well. The system said to us last year, when first I met going into

the department that one of the things health care would be best served by in a

budgetary sense would be some stable and predictable funding for at least a

three-year period, and they felt with a commitment of that sort, if it were ever

achievable, it would enable the system to do a better job in terms of planning

and restructuring. And we believe that the effect of what we have committed to

the system for the next three years will result in that happening.

I don't want to take up too much more time in going

on because I am sure the people will bring forward a lot of things in questions,

but I certainly wouldn't mind speaking to the issue of the substantial

restructuring that we have under way in St. John's in terms of the system, and

also to the issues of rural physician recruiting, ongoing efforts, and things of

that nature. So, in the anticipation that these questions may come forward, I

will simply say that we have come this evening prepared to answer any questions

that you have, we think, and certainly, if there is a question you have tonight

to which we do not have the answer, in that unlikely event, we will be glad to

undertake to get the information for the members of the Committee in a very

timely fashion.

Thank you.

CHAIR: Thank you, Mr. Minister.

Mr. Ottenheimer.

MR. OTTENHEIMER: Thank you, Mr. Chairman.

Mr. Chairman, I am assuming that we can carry on

the way we had during other committee meetings, and that was largely a process

of just asking a few specific questions based on what we find in the estimates,

and both Mr. Hodder and I have asked some general questions as well, rather than

any sort of presentation as such, because I find that is more effective in terms

of dealing with an issue, getting a response and then going on to the next.

Mr. Minister, I have reviewed the estimates and

there are indeed just a few questions I have with respect to the estimates, when

one compares this year's figures and last year's figures. However, I would like

to begin with a more general area and it has to do in some respects with what we

heard in the Budget in terms of long-term care rates for nursing homes and those

individuals who find themselves, obviously, because of their personal

circumstances and age, at a time in their lives when they must resort to

long-term nursing home care.

I know in my own district there are a lot of senior

citizens and I have personally - as I am sure all members have - received a

number of calls from individuals who have expressed some concern about some

changes with respect to government policy in terms of what an individual is

expected to contribute for his or her long-term care; and as our population

ages, it is a concern that is only going to increase and it will affect many

more people. The reason I ask is because it is an issue that I sometimes as a

lawyer have to deal with where, in the past perhaps, persons have come to me who

may have a matrimonial home for example, and find themselves in a situation in

life where they would like to no longer have the responsibility of a home, and

would like to take advantage of, and rely upon, you know, a nursing home as

opposed to living in their own private home, and therein lies the issue which

ties in, of course, with government policy and the increase in costs.

What is the department's position with respect to

individuals who find themselves in a situation where they are no longer capable

of looking after a home and in due course would want to move to a nursing home

type of institution but in fact, have a home? My question, I guess, specifically

is, from a policy point of view and from a departmental point of view: What is

acceptable in terms of what that family may do, in terms of transferring the

matrimonial home to family members, you know, preparing a Deed of Conveyance

over to their son or their daughter? We all know it happens, we all know it is

the kind of concerns that citizens often ask of their respective family members

or lawyers or personnel within the department, but it is a concern, it is an

issue. And I am wondering what direction the department is going in, if even

from a policy point of view, in dealing with that particular matter.

MR. MATTHEWS: Thank you, John, for the

question.

I won't get into the details of what the rates were

and what they are and that sort of thing because I don't think you want that;

you have that information already.

MR. OTTENHEIMER: No, it is more of a general

policy direction.

MR. MATTHEWS: Yes. To be specific with respect

to your question, government's policy has not changed as a result of this budget

as with respect to either the disposition of assets either liquid or in kind if

you like, that is real estate holdings and that sort of thing.

The people who go into nursing homes or people who

are otherwise seeking government's support in social services and those types of

things, going into personal care homes, whatever, are permitted to retain in

terms of liquid assets in the case of an individual, $5,500; in the case of a

married couple, $10,000 for their future expenses, let's call it. People who

have property, at the moment, have no restriction on them either in the past or

today. Nothing has changed as to what they can do with that property in terms of

retention, disposition or otherwise transferring or conveying it to another

individual, be it a family member or if they want to give it away to a charity,

or if they just want to leave it and bar it up and not use it. People today can

still retain their home and nothing has changed in terms of policy with respect

to that issue.

Interestingly enough, New Brunswick as one province

- recently, at their last budget this spring - have started to reflect on

whether or not governments should be looking at ways of accessing, leveraging or

getting use of the value of that asset, being a family home. I believe they have

contemplated it. In fact, they have not fully moved into the area of renting

homes of people who have gone into a seniors home, or at least they are

contemplating or reflecting on the possibility of taking those homes, renting

them and using the rental revenue to help pay part of the cost of the care. We

have not done that. We have not decided to do that.

The whole issue of asset disposition or asset usage

after you go into a home or before you go into a home is interesting and is

becoming a more important question that I believe we will have to address to

some extent in the near future. There is a lot of feeling amongst the population

out there, the taxpayers, that simply because a person changes their address

from somewhere in the community to a government run or funded facility such as a

long-term care home should not automatically translate into that person, whoever

it might be - it might be me or you or anybody - having the right for the rest

of their lives to be funded by the taxpayers of the Province while they are

either sitting on or have access to significant personal worth. In other words,

if you live in the community and you pay your own living expenses, as everybody

does, nobody bothers, that is your own business. If you go into a long-term care

home and you have a pension income of say, $3,000 a month, it begs a question of

should the taxpayers of the Province have to pick up the difference between what

was a universal rate of $1,510 and the real cost of your care.

It was interesting that after we announced we

would, in future, be expecting people to pay the real cost of their care - up to

that actual cost of $4,000 - that the first two calls I got in my office were

from people who lived in nursing homes, applauding the decision on the basis

that they felt - at least those two people - there were people in the nursing

homes where they resided, who could buy and sell the homes that they were living

in. And notwithstanding their significant income, they were not paying anything

near the cost of their care. They had disposable income that they were either

giving away or continuing to hold in reserve for whatever purpose or for who's

ever purpose, while the taxpayers of the Province were being asked to pay for

their care beyond a universal rate of $1,510. That rate was set, by the way, in

1986. One of the nursing home board Chairs this week told me that that rate, had

government adjusted it on an annual basis, which it should have been doing, by

their judgement, over the past ten years, would have been about $3,000 now

anyhow. So the rate of $1,510 was not only obsolete but totally unrealistic.

But to your specific question, the issue of

disposition of a home, a matrimonial home or of land that they own, a boat, a

cabin or anything, they still have it and they can still use it or do what they

like with it.

MR. OTTENHEIMER: Now, I asked the question

because I see it as an issue that is going to only develop. These circumstances

are going to increase as a result of our circumstances generally, but it raises

an ethical issue as I see it. It seems to me to be an area that has to be

addressed one way or the other and it raises the whole area of what is known as

fraudulent conveyance to some extent. I will just give you this simple example:

if an elderly couple, who were fortunate enough to have been accepted into one

of our nursing homes have, for example, a $100,000 home, they can simply, for

$1, transfer that home to their son or daughter and that son, a week later, can

sell that property, and the son retains the proceeds;

whereas if the husband or

wife who are, in the near future, going into this nursing home, a week prior to

going into the nursing home, sell the property, obviously their own assets are

depleted because of the existing policy down to the figure that you just

mentioned, the $5,500, or in the case of a couple, $10,000. It is an area of

concern that I know has been expressed to me often and, as I say, it seems to me

an issue that is only going to increase.

MR. MATTHEWS: Yes, I think that is our

judgement, too, and it is an issue that I think, as government, we will have to

reflect on. It is not a new issue, but it has been highlighted in all of our

minds as a result of our increase in the nursing homes rates, because I have had

calls from both the general manager for Newfoundland of one of the major banks

yesterday, and from a lawyer the day before, seeing people now coming to them

and trying to move their assets off so that they don't have to spend it on their

care. They can give it away or get rid of it so that government will continue to

have the obligation to continue to pay for the full cost of their care as

opposed to spending their assets down and spending their own money.

The point you raise is really an issue of morality,

and I guess if government could legislate morality we would have a lot of the

problems of the world solved. It isn't morally right to slough off your

considerable worth in terms of property.

MR. OTTENHEIMER: I guess, the real issue then,

from a more practical point of view, is that if that policy exists, people have

to feel free that they can do it freely.

MR. MATTHEWS: Oh, yes.

MR. OTTENHEIMER: And under the present policy

they can.

MR. MATTHEWS: And we are not the only Province

where that policy exists. I think we are pretty similar, Deputy, to most of the

Atlantic Provinces in that regard. As I mentioned, Nova Scotia, or New

Brunswick, is obviously starting to look carefully at that whole issue and

raised some eyebrows in their Province, I think, and elsewhere, in February when

they brought down their Budget, suggesting that they might even take seniors'

homes and rent them and use that to pay for part of the nursing home costs.

My own view, colleague, is that I am not sure that

is the direction I would recommend to government in terms of our own situation.

I think probably what we should have is a circumstance where if somebody seeks

admission to a nursing home that government would have not only the right but

the obligation to probably have a look back over a period of time prior to that

application for admission to see how people had dealt with their assets. Of

course, the question of what would be appropriate to try to achieve in a policy,

vis--vis trying to be fair all the way around in having that type of look back

and examining what people did with their assets would be a question that is not

only a health issue but is a legal issue as well.

There is something else I was just going to say to

that. The question of `what is a person's income', in some jurisdictions I

believe they use the previous year's income tax return to be the bench mark for

determining what a person's ability is to pay, that type of thing. It ties into

the increase in the rate.

I agree with you, it is an issue that we are going

to have to look at very closely as we (inaudible).

MR. OTTENHEIMER: (Inaudible) clarification, I

think, as well.

MR. MATTHEWS: Yes.

MR. OTTENHEIMER: A lot of people are unsure and

uncertain, and are simply somewhat afraid to even act on the issue, not knowing

what the potential consequences might be.

MR. MATTHEWS: Absolutely nothing has changed in

terms of government policy in that regard over the past number of years. The

adjustment to long-term care rates has not affected specifically how people can

deal with their own homes or property outside of liquid assets.

MR. OTTENHEIMER: Just a few specific questions,

beginning with heading 1.2.01 under Executive Support. I notice throughout the

Estimates there are some variations with respect to salaries, and maybe I will

just start with this one. Under Salaries, under Executive Support, we see a

decrease of some $100,000. I am assuming that has in part been answered by your

reference to the fact there has been an overall reduction within the staff and

personnel in the Department of Health.

MR. MATTHEWS: Yes, and more specifically within

that area, one assistant deputy minister, from four to three, is it?

WITNESS: From four to three.

MR. OTTENHEIMER: On the next page under

Administrative Support, again we see that difference as well, so I am just going

to pass that. Under Information Technology, we see an increase of - under the

same

section - 1.2.02 - Information Technology, $1.4 million as compared with

the revised figure in 1995-1996 of $1.2 million. I am just wondering if there is

some explanation for that?

MR. MATTHEWS: There has been a decrease, is

what you are saying, of $200,000?

MR. OTTENHEIMER: Yes.

MR. MATTHEWS: That, basically, is a decrease

over the original budgeted. It relates primarily to the upgrading of the

departmental restraint measures in the last four months of the fiscal year.

CHAIR: Are we referring to 1.2.02.12?

MR. OTTENHEIMER: No, 1.2.02, page 234.

CHAIR: Information Technology.

MR. OTTENHEIMER: The difference approximately

$200,000, under Information Technology.

CHAIR: Of an increase?

MR. OTTENHEIMER: Of an increase - a decrease, I

think, from this year to last year, but an increase to this year.

MR. MATTHEWS: Yes, during the last four months

of last year we had to find and effect some restraint measures to meet the $60

million deficit problem we had in the last fiscal year. We found part of that

money in this budget. This year the new expenditure reflects basically what we

will be spending on technology development in the institutions, and the

community health branches. There has been some increase demand and need there,

because what we have found, is that, on the information side of the health care

system in the past where we have had all of these different health care boards,

everybody has been out there doing their own thing and down on I-95 in the

Boston area buying their technology and their information package systems. What

we anticipate being able to do in the near future is put in place an information

technology, I don't know if you would call it a secretariat, or a group or

organization within the health care sector that will strive to develop in

concert with hopefully the local information technology capacity in the Province

in the private sector, an information system that will be user-friendly and be

able to talk to and work with each other right across all aspects and all

spectrums of health care. Right now, we don't have that capacity in terms of

being able to share between institutions, information on patients, drug

utilization. What we want to be able to do is have an information system that

ties MCP, all the hospitals, the long-term care homes and even the personal care

homes into a situation where the information that is in one system will be

easily retrievable and available to any other part of the health care system.

That is essentially where we are going in information technology in health care.

MR. OTTENHEIMER: Okay. On the next page, Mr.

Minister, page 235, under Health Human Resources Planning, 1.3.02, there is an

absence of any reference under Allowances and Assistance - you see that under

1996-'97 estimates?

MR. MATTHEWS: Yes, okay.

MR. OTTENHEIMER: My question is simply, what is

different, I guess, in this coming year as opposed to the previous year?

MR. MATTHEWS: Yes, the reduction basically of

the revised figures reflects payments of lower levels of bursary assistance.

MR. OTTENHEIMER: I see. So this is for

bursaries for what program?

MR. MATTHEWS: Well, we announced in the budget

or it was a part of our budget this year, basically a decision to phase out of

the seat purchase program we had for certain non-medical seats at mainly

Dalhousie and bursaries attached to those seats. We have had over the years a

seat purchase program outside of the Province for disciplines that are not

offered within the Province, occupational therapy and physiotherapy and those

sorts of things. We do two things, we have been traditionally purchasing seats

to assure that there is space available for at least a limited number of

Newfoundland students who want to go into those areas.

MR. OTTENHEIMER: Would this be in dental,

maybe, or...?

MR. MATTHEWS: It isn't dental, no. It is OTs,

PTs, speech pathologists, sociologists, those types of things - what we call the

non-medical areas.

MR. OTTENHEIMER: Do we have the reverse

situation now where we give assistance to any students from outside the Province

coming to our own med school? Does that plan exist at the present time?

MR. MATTHEWS: We had an arrangement which was

almost reciprocal to what I'm talking about with New Brunswick for ten seats at

the medical school. New Brunswick last year withdrew from that program. They are

still funding the students from New Brunswick who are going through and haven't

completed yet, but they no longer purchase the seats. I think they were

purchasing ten seats at $12,000 a year, was it?

WITNESS: Ten seats at around $12,500.

MR. MATTHEWS: Yes, they were spending. It was

the exact opposite. They were buying seats in our medical school for their

students; we were buying seats in Dalhousie for some of our students who wanted

to go over for some of these disciplines.

MR. OTTENHEIMER: But that has ended.

MR. MATTHEWS: It is being phased out. The

bursary program is being wound up this year. We are going to have to meet our

contractual obligations to the students who are in the program - some are in

their first, second and third year - to completion. These seats are funded

through an Atlantic Province organization that is - what is it called?

WITNESS: Maritime Provinces Higher Education

Commission.

MR. MATTHEWS: The Maritime Provinces Higher

Education Commission. That is how the provinces work together in terms of - I

won't say trading spaces in universities, but accessing where one doesn't have

the capability or the capacity and the other province does. We are phasing out

the seat purchase programs as soon as we can wind up the ones that we are

committed to, consistent with our commitment to that organization within the

Atlantic region. The bursaries themselves are gone this year.

Unfortunately, it is one of the adjustments we have

had to make. The program has largely served its purpose. We have now a fairly

good supply of OTs and PTs, which are the big ones, working in the health care

system and/or available to go to work there, subject to our requirements and

ability to fund them, of course.

MR. OTTENHEIMER: Do you want to ask whether I

should continue?

AN HON. MEMBER: The Chair decides when you

(inaudible).

MR. OTTENHEIMER: Okay. Well, I have a number of

other points but, Mr. Chairman, if you - I can defer to my colleagues.

CHAIR: Perhaps you would like to give an aside

for a moment.

Mr. Whelan.

MR. WHELAN: I was just doing some preliminary

searching through the estimates and I was trying to get a handle on the amount

of money that is being spent this year on home care services - specifically,

whereby a person is still going into a personal care home or a nursing home, and

they are being looked after by some people who have been paid, in their own

home. I haven't been able to find an exact figure.

I am looking here under 2.2.01, Community Health

Services, and I noticed that the revised figure for last year was $26,391,700.

This year it is up to $29,003,400.

MR. MATTHEWS: I'm sorry, Don, I -

MR. WHELAN: Is that -

AN HON. MEMBER: (Inaudible) page, Mr. Whelan.

AN HON. MEMBER: Page 12.

MR. MATTHEWS: Page 12. Page 237 in your book.

MR. WHELAN: Page 237.

WITNESS: Page 236 - but it's the one that is

under page 237.

MR. WHELAN: So it is 2.2.02, is it?

WITNESSES: Yes.

MR. WHELAN: Okay. So it is up this year from

$15,700,000 to $16,157,800.

MR. MATTHEWS: Yes. What is included in that is

$13,296,000 for the home support program for seniors that was transferred from

the Department of Social Services in 1995-1996 - in other words, the Enriched

Needs Program. That is the program that was rather open-ended and on which we

were expending up to $5,000 or $6,000, in some cases, to permit people to stay

in their homes. That program, as you know, was capped last year at a maximum

expenditure of $2,100. It was a budgetary decision but we felt it was the right

one in terms of health care.

Also included in that is an amount of basically

$2,800,000 for community based non-nursing services such as adult day care,

homemaker services, and Meals on Wheels, those types of things. They are

delivered by various boards and associations throughout the Province. The

V.O.N., as a case in point, is involved in that program, but there are a number

of other agencies that do that.

So, that is a combination of those two elements,

one is a home supports program and the other is the $2.8 million non-nursing

services, such as day care and Meals on Wheels and programs of that nature.

MR. WHELAN: I am trying to draw a conclusion,

and the only conclusion I can draw from that is, since the budget for community

based services has increased over the last year I would assume that you are

planning on continuing that particular service, and from what I can see,

probably extending on it and increasing the expenditure in that particular area?

In the past couple of years there has been a tendency to come down, you

mentioned before, it used to be $30 million, was it?

MR. MATTHEWS: Well, it went to $29 million the

year before last. Then last year - not this year, but last year, the Department

of Social Services when they had control of that program for seniors, the

mentally challenged and the physically challenged, that program was going to $37

million. It is really an open-ended program going this way. Government decided

that the seniors element of the program should go to Health, because we are

responsible for seniors and we have a responsibility for that part of the

program with these dollars. There is still a substantial amount of money being

spent on home supports through the Department of Social Services. I don't know

what their budgeted figure is this year for those home supports. I believe it is

in the area of $16 million, if I recall.

MR. WHELAN: $16.157 million.

MR. MATTHEWS: What is that?

MR. WHELAN: $16 -

MR. MATTHEWS: No, not my figure - I think,

Social Services figure for Home Supports.

MR. WHELAN: Alright.

MR. MATTHEWS: But they have a lot of other

programs, so that figure is probably not a meaningful figure in terms of all

they spend on all their programs in Social Services. This is what we will spend

on Health this year, we project.

We have a cap of $2,100 for new entrants into the

program. As people come off the program by virtue of going into a home or

deceasing or something like that, that budget will gradually come down, but one

of the other things we found when we got into the program is that it was a very,

very different level of service being offered across the Province. This program

grew tremendously in areas like the Southern Shore and the Twillingate, New

World Island area and the Gander area. It is a program that has a very, very

small uptake, and has had historically on the West Coast, the Corner Brook area.

We have had to put some extra money into the West Coast to bring them up to some

reasonable level of service. We are trying to do that in two ways - putting a

few extra dollars in, but more than that, shifting resources from other regions

as people come off the program to sort of balance the program across the

Province. It is a program that was totally out of whack in terms of its uptake

on a region-by-region basis.

MR. WHELAN: You say you capped the total

allowable figure down to $2,100 from $2,700 a month, is that it?

MR. MATTHEWS: Well, it was open-ended

previously, and we were spending as much as $5,000 and $6,000.

MR. WHELAN: But I notice that the total figure

this year is increased. So does that mean that the criteria for people receiving

the money has changed or eased or...?

MR. MATTHEWS: No, the criteria hasn't changed,

I don't think, but I'll tell you what is happening -

MR. WHELAN: I am just trying to find out the

reason why the figure has gone up from $15 million to $16 million, if you capped

it at $2,100 per month?

MR. MATTHEWS: Yes, one of the things we have in

the Province in terms of health care - health care, I guess, is a growth

industry in the Province moreso than any other industry with the -

MR. WHELAN: It depends on where you are looking

at it from.

I know some people who are in a lot of trouble, and

they happen to be in my district.

MR. MATTHEWS: A lot of trouble in terms of

health?

MR. WHELAN: It had to be the personal care

homes.

MR. MATTHEWS: Personal care homes? Well, that

is a different

section of the budget.

But what we have in the Province is a situation

where I think we have now 57,200 seniors, that is, people sixty-five plus, and

that population within fifteen years, by the year 2011, will grow to 82,700

people. Our seniors population is going this way, so to some extent, you are

going to see some increased expenditures in the area of home supports and/or

personal care homes and long-term care homes. It is one part of the health

budget that is very challenging and it is going to be more challenging in the

future. And it is one of the reasons why we have to make some of these

adjustments to long-term care rates and that type of thing so that people, to

the maximum extent possible, will pay for the real cost of their care within the

resources they have. What you see here is a slight increase from last year from

$15,700 To $16,100 which is really not a very significant increase in the

budget.

MR. WHELAN: $400,000 is it?

MR. MATTHEWS: Yes, it is very small, $457,000.

MR. WHELAN: I would have assumed - as I

mentioned before - since it was capped at $2,100 instead of being open-ended,

the criteria for allowing people to obtain this money must have changed. Because

if it was capped from - some people were getting $5,000 a month. That was

brought down to $2,100, and the total amount should have dropped significantly,

I would have imagined, anyway.

MR. MATTHEWS: Except that people who were in

the program prior to capping are continuing to be carried at whatever level of

service they had previously. What we found out when we took it over was that

some people had made decisions about their care and had made retrofitting to

their homes and put in ramps and increased the size of their washrooms and done

a lot of things. They made a choice of staying in their own home as opposed to

going to a nursing home because they could get home supports. In order to do

that, of course, they had to spend some money, a lot of them, to adjust their

own houses for living purposes.

We said: Those people, we will leave them on the

program. Originally we wanted to bring all of them down to $2,100. When we got

into it and found out what we were dealing with, it wasn't reasonable to do

that. Now, people who are on the program above that $2,100 stay there as long as

they have a need and as they drop off no new people come on. So we will be able

to decrease. The other part of it is that the seniors' population is going this

way, so you have a decrease in service per individual that we are offering, but

you have an increase in the total population going on the program.

MR. WHELAN: Thank you.

CHAIR: Thank you, Don.

Mr. Hodder.

MR. H. HODDER: I have some general questions,

Lloyd. Some of them have already been addressed, and some have been addressed in

questions that have been asked in the House. I didn't want to repeat any of

these.

One of the things that I've had brought to my

attention by somebody I had a conversation with a couple of days ago, is this:

In the nursing homes - let's say Agnes Pratt or wherever - when you have people

there who are in that home and they pay their $1,500 a month, whatever it is,

then there are, of course, drug costs which are extra to that. I have some

documentation which tells me that if the home goes and gets the drugs, which it

does, then it can get those drugs for, you know - let's just say it charges the

family, say, $150. If the drugs were supplied by the family and delivered to the

home, then these drugs could be supplied to the family for $80 or $85.

I want to ask you a question. What constraints do

we put on nursing homes that their drug costs have to be put to some kind of

test? Or is there any way in which we could say to these places that they have

to go to some kind of public tender? Or is there some way in which we can have

some consistency in the cost so that we don't have presentations of people

saying: Here is what it really costs, here is a quotation I had from another

drug company.

MR. MATTHEWS: People in a nursing home who are

eligible for a government drug card - seniors, because they meet the test that

qualifies them for a card, which is really if you have OAS and GIS income

essentially you get a drug card - people in a nursing home can access their

drugs from any pharmacist they want, although a lot of nursing homes have

arrangements with specific pharmaceutical outlets to supply them.

We pay only the price that we have agreed to as

indicated on the drug formulary that druggists have. So we pay the lowest price

for the drug, the ingredient cost, regardless of whether a person is living in a

home or living in the community. We simply pay the same amount for them, no more

and no less. I don't know - I'm not sure...what you are saying is that a nursing

home patient may be paying $150, say, if they are shopping at Lawton's or

Shopper's,

whereas a family member could buy that for $80 somewhere else?

MR. H. HODDER: (Inaudible) the specific

reference. A gentleman presented me with documentation which I haven't checked

out - I haven't checked it yet so I'm just asking the question. His wife is an

Alzheimer's patient in one of the nursing homes here in town. His drug costs

were $123 or something at the nursing home because they have arrangements

provided. The drugs are brought in and packaged and you put the plastic caps -

that kind of thing.

And the same bills - which he pays extra to the

$1,510 - when he took them to another drug store or pharmacy he was told: `I can

supply you that particular list of drugs for $56.' This is what they have. And

his question to me is: Why do I have to pay an extra $56 when I can go and -

well, it is really about $60 - why do I have to pay that?

MR. MATTHEWS: John, you are the expert on the

drug program. What are we talking about here? Is it reality or fantasy or what?

MR. DOWNTON: I think what we are referring to

here is, most of the people in nursing homes are covered through either social

services or a seniors program and they have to qualify for those programs the

same as any other residents living in the community. However, there are people

living in nursing homes who do not qualify due to their financial circumstances

and they are paying their own way within the homes.

Within the nursing homes, such as in St. John's -

St. Pat's and St. Luke's, the larger homes we are talking about - obviously you

are dealing with a lot of chronic care people and they have gone out and gone to

tender for a service contract for people within the home. So, in order to

control the drugs, where, in a lot of cases here with the Alzheimers patients,

you had to have professional staff going and administering these drugs, what

they do is go out and get a service contract for a monitor dose system whereby

you are looking after the safety of the patients in the home to ensure that they

are getting their drugs and that the staff know exactly what patient you are

giving it to. It is a safety issue. So they have a total pharmacy package

designed for chronic care facilities such as nursing homes.

Now, within the system, the people on social

services and seniors are billed on the basis of our social services drug

program. Obviously, those people who are private paying, it is the marketplace

which determines what the prices are.

So whatever the agreement is with the homes and

their service level - they have some agreement as to the dispensing fee or the

cost of drugs they will pay for those people who don't qualify under our social

services or seniors program. Therefore, these homes, they may be able to go to,

I guess our famous $1.99 Dominion, who have recently been offering those types

of dispensing fees - where the home who is receiving this monitored dose system,

whatever their price would be for dispensing. I guess the problem you are

running into here, they have people going out and purchasing their own drugs to

bring it into the home to try to put it into a system that is already there to

design for the safety of the patients within that home.

So there has to be some discussion. The homes at

the moment have gone to market - this will be the nursing homes themselves in

St. John's - and have asked for proposals. I think part of that proposal will

include not only the people on our programs but also the private paying people

within the homes.

MR. H. HODDER: Is there a mandatory time to

review and a time limit to the tender? You know, if a company, let's say, gets a

proposal, obviously you can't be doing this every six months. Is there a policy

which says that each nursing home must go to the marketplace for tender

proposals? Are they publicly advertised? What constraints are put on them in

terms of the time limits, two years, five years or whatever?

MR. DOWNTON: To set up these systems, the homes

require to put in carts and it is quite an expenditure on the pharmacy to put an

infrastructure in a home to deliver this dosage monitoring system.

The current contract, which has simply closed a

couple of weeks ago, they are now reviewing. I don't think the tender has been

awarded. Normally, I believe the last contract ran for a three-year period or

two, but there is a defined time limit on the contract. I believe it is

twenty-four months - it is either twenty-four or thirty-six, where they are

saying, put this system in, put the capital cost and one has to work it over.

The current contract; I have no idea what the

prices are in the current contract because it hasn't been issued, but I know

that has been an issue and it is one that they are trying to address for the

patients in the home. Now, this is an issue which is the responsibility of the

nursing homes and I am only going on whatnot with you.

MR. H. HODDER: I knew I should ask that

question in the House. The minister didn't know the answer.

MR. MATTHEWS: Oh, Harvey, you would have gotten

a response.

MR. H. HODDER: And I never get answers.

MR. MATTHEWS: Not to tell you that you would

get an answer but you would certainly have gotten a response.

MR. H. HODDER: But going back again -

AN HON. MEMBER: I told you, Question Period was

for getting answers.

MR. H. HODDER: Well, going back to the thing

again, then what you are saying is that this policy is now Province-wide for all

nursing homes?

MR. DOWNTON: The policy, in regard to whether

you are social services or are cash paying, some of the hospitals outside of St.

John's and a number of our homes outside of St. John's are being supplied with

their drugs through hospital pharmacies and they make their arrangements on that

basis. I think the biggest area where we have the greatest concentration of beds

covered through the retail sectors are in the St. John's area and I believe that

is where the Province (inaudible).

MR. MATTHEWS: We have between 1,200 and 1,300

long-term care beds just in the St. John's area out of the 3,000 that we have in

the Province, so this is a big area.

MR. H. HODDER: But it is an issue that arises

from, shall we say, the family members who are putting up the dollars every

month and say, you know: Mom's drug bill this month is, and they pay it from

their own pockets, they are not subsidized by the Province. And, of course,

these people who probably are very price-conscious, as we all would be, are

saying: How come it is this much when, you know, we could get it somewhat

cheaper at - I don't know, maybe it was at the local drugstore, K Mart or

wherever you go; I don't know the particulars; but the question would be: Is

there a requirement that all nursing homes outside of those that are supplied

directly by the Department of Health with their drugs, that these nursing homes,

because they are all subsidized, would go and review their drug supply and the

pricing on a regular basis? Is that part of the funding arrangements?

MR. MATTHEWS: The nursing homes, I would think,

all do things differently. I mean, they all have their own arrangements or

latitude to make their own arrangements for drug purchases. What has happened

over the past two years is that all of the nursing homes in the Province except

the ones in St. John's are now under the jurisdictions of the new institutional

boards, so they now come under the new health care boards.

The six homes in St. John's, I have been working

with them to try and encourage them to come under one administrative board, one

regional board for long-term care in St. John's. As a matter of fact, I met with

all of the board Chairs and CEOs, on Monday was it or Tuesday?

WITNESS: Tuesday.

MR. MATTHEWS: Yes, I met with them this week,

on Tuesday, and hopefully, within the next six months we will have all of these

under one regional board by - one board I should say, much like we did with the

hospitals, but if there is a circumstance where government is paying more for

drugs because they are on an indigent program, then the individual can shop for

them on a private basis, then I agree with you that, that is something we should

address because we should not be paying more for any drug than the lowest

possible price available which is the price on our formulary. And the price, I

understand, John, on our formulary, is the lowest price of the generic

equivalent, if there is a generic equivalent, and if there is not, it is the

lowest price of the drug that is otherwise necessary to use.

WITNESS: The dispensing fee is the difference.

MR. MATTHEWS: The dispensing fee, yes. Well,

there is a big variance in the dispensing fee. You have heard a bit about the

dispensing fee lately in public, and the druggists are putting up quite a

battle. We reduced the dispensing fee from $6.50 to $3.50 that we pay for social

service recipients, but we don't pay the dispensing fee for seniors except those

on social services. So, a senior can go out to a drugstore and have a

prescription filled for whatever the druggist will fill it - the Dominions of

the world. Wal-marts are doing it recently for $1.99. They are now saying it is

a lost leader and they are going to put it up to $3.99, but that is because they

have basically screwed up the industry for - I call them the real druggists of

the world, the people who have been in the business for years. And it has caused

some - I mean, some dispensing companies, I think, pay - some drugstores, well,

drugstores will charge what they like for dispensing fee; you know, we don't pay

it, we pay $6.50 but if you, as a private paying customer, go out, I have no

idea what I would pay if I went out today to have a prescription filled; I mean,

I have a drug program and I don't know they charge me for a dispensing fee. I

never thought to ask, you know.

MR. H. HODDER: Talking about drugs again. I had

a sheet there. I saw where you did - a

section called 'Drugs For Indigents'. I

will get the number here now.

MR. OTTENHEIMER: Page 239.

MR. H. HODDER: Page 239. Drugs for Indigents,

Department of Social Services, and that doesn't include seniors because you have

seniors on the next page over there; $33,928,600, you are down somewhat. I

wanted to ask a question: There are about 70,000 people who are on social

services in the Province - is that right?

MR. MATTHEWS: I guess, if you take the caseload

of 34,000 or 35,000 plus their family members - yes, 70,000 is the figure, I

think.

MR. H. HODDER: A rough calculation is 70,000

people.

MR. MATTHEWS: Yes, the figure I hear Social

Services use.

MR. H. HODDER: That would be $484 per person

per year. Have you done any comparative analysis with other parts of Canada to

see how the Newfoundland average compares to other parts of the country?

MR. MATTHEWS: Utilization-wise?

MR. H. HODDER: Yes.

MR. MATTHEWS: I am not aware of any comparative

figure from other jurisdictions. John, are you? I guess in other jurisdictions

we have probably the leanest and meanest drug program, notwithstanding all the

money we spend that any place in Canada has. Most places in Canada have drug

programs that cover all seniors.

MR. H. HODDER: Yes.

MR. MATTHEWS: British Columbia, I think, has a

program that covers everybody in the province with a deductible.

MR. H. HODDER: Yes.

MR. MATTHEWS: Is there any figure, John, to

compare?

MR. J. DOWNTON: We are very comparable. We are

in the mid-range compared with the other provinces.

MR. MATTHEWS: On utilization?

MR. DOWNTON: Yes.

MR. H. HODDER: I don't think there has been any

work done, though, on -

MR. DOWNTON: On per capita cost?

MR. H. HODDER: That is right.

My point would be that a family of four in this

Province who are on social services, on average, would have a drug bill in a

year of $2,000.

MR. MATTHEWS: Based on $400 per user?

MR. H. HODDER: Four hundred and eighty four

dollars is -

MR. MATTHEWS: Yes, $500. It is closer to $500.

MR. H. HODDER: Yes, $500. Now, knowing that, I

guess, people who are on social assistance, people would say they have higher

costs because of their diet, or lack of diet.

MR. MATTHEWS: Their over-usage.

MR. H. HODDER: Their over-usage and everything

else. My question, though, is: In doing some comparative analysis with other

parts of the country, are we doing any kind of comparative data? And also some

kind of a monitoring and usage and that kind of thing to see if we are really

giving full value for the money we spend?

MR. MATTHEWS: John tells me that, on average,

we are about in the mean figure with other provinces in terms of utilization or

usage. But the program does cover things, though, more than just drugs. It

covers monitors, it covers oxygen, requirements of people. So drugs is the

subheading or the heading. We call it `Drug Program', but it includes more than

pure pharmaceuticals. It includes anything that we provide to a social service

recipient in terms of medical aids that would relate, say, to a drugstore-type

dispensary, something that they would sell in a drugstore, the oxygen, the

inhalers, the monitoring, the monitors that are used and all these sorts of

things. But for the most

part it is drugs.

MR. H. HODDER: Yes, I was going to say, 90 per

cent drugs?

MR. MATTHEWS: John, I would say probably -

MR. DOWNTON: Five million is non-drug items.

MR. MATTHEWS: Yes, you're right. Five million

would be non-drug items, that would be 10 per cent - well, a little more than $5

million, because we spend about $34 million on indigents and $17 million on

seniors. So 5 per cent or 6 per cent or 7 per cent of it is non-drugs, but the

most of it is pharmaceuticals, pure and simple.

MR. H. HODDER: Going now to a more

philosophical thing, I have sensed that the department is moving towards a

closer co-ordination between Health and Social Services, which I think is a good

move. Is there any talk about moving in the direction that some of the other

provinces are moving in, for example, in terms of taking the preventive

measures, which I have great interest in, the preventive parts of medicine, and

co-ordinating that more appropriately with, say, Social Services? Some provinces

are moving towards - for want of a better word, they are calling it a

superministry, which has its own hesitancies but it also has its own

opportunities. Is there any talk of moving towards a superministry - or any

discussions?

MR. MATTHEWS: Some governments like, again, New

Brunswick, has a Department of Health and Community Services.

MR. H. HODDER: Yes.

MR. MATTHEWS: They don't have a social services

department. In those situations I understand what they have done generally is

taken the Social Services' services, moved it over to, say, in with Health, and

took the employment aspects of Social Services and moved it off probably to

employment and labour or some department like that.

Yes, we are thinking of moving in that direction.

In terms of departmental restructuring, that is a question that only the

Premier, I suppose, could appropriately answer, because he has responsibility

for the structure of government. But I suppose it would be interesting to note

that the Assistant Deputy Minister that I lost became the Deputy Minister of

Social Services. I think that is indicative of not necessarily a move in that

direction in and of itself, but of an appreciation for the expertise that Health

and Social Services both can make joint use of in terms of serving a clientele.

The nurses of the Province, the nurses' union,

recently presented me with a model for delivering health and social services in

the Province in the context of what they consider to be community centres type,

where Justice, Health, Education to some extent, and Social Services are all

delivered as a part of a continuum of service care to -

MR. H. HODDER: Patient centre.

MR. MATTHEWS: Well, yes, more (inaudible) -

MR. H. HODDER: Or a person centre - service.

MR. MATTHEWS: A service centre, almost, yes. So

I guess, Deputy, probably you can add to it, but we aren't at a circumstance

where we are anywhere near, to my knowledge, integrating both the departments.

Is there anything else you would like to say to that, Deputy Minister?

DR. WILLIAMS: In New Brunswick they have for

quite a number of years now had a Department of Health and Community Services,

and the income support side of Social Services has moved off into a Department

of Income Support for that. I think it was recognized that there is a lot of

interface between some aspects of what the Department of Social Services does

and some aspects of what the Department of Health does, especially certain

things to do with child care. Some of the things that the Department of Social

Services does up there are of a preventive nature in terms of services to

children, just like we in the Department of Health have a major preventive

thrust in our Community Health branch in the children's area.

I think there is a recognition of that. Between

Mrs. Dawe and myself, we have had some discussions about how we can bring some

of the services that we offer in both departments a little bit together and

co-operate more fully. One of the things we are going to be starting with is

looking at our information systems and see if there is some commonality of

purpose there, and if we can start sharing things in that aspect. We are working

a lot of developments in the whole area of health in the information systems,

because we can't really plan our health systems wisely if we don't have good

information. We are starting to look at outcomes much more than we used to,

things that we do, to see what the benefit of those things are.

We need better information in order to track

people. We can't even track people, for instance, who have had cardiac surgery.

We don't know how well they do. We can't track them over time with our current

information system. There are a lot of things that Social Services, I know, do

with children, and we would like to track them over time to see how they

interface with our system.

We are starting at that point. Obviously, there was

some recognition last year in the Budget when part of the responsibility that

Social Services had in the seniors area was transferred to Health, and some

other segments were on the borderline of being looked at as a part of health

service or a community health service moreso than in Social Services.

I think with Mrs. Dawe there now we are going to be

starting to move in some sense, at our level anyway, in terms of co-operative

efforts, and we have targeted the information area as one area we want to start

looking at. There are other areas, and there is a very - I think especially in

the children's area, there are a lot of commonalities of purpose, and I think we

will start working more closely.

MR. H. HODDER: That is where, by research

(inaudible) on these things.

MR. MATTHEWS: That is right.

MR. H. HODDER: Talking about British Columbia

and what is happening in New Brunswick. I did chat with Joan Dawe briefly on it

when she was here as well. I must say I am pleased with that direction. I think

that is an area where we can get better value for the dollars we spend, and we

can provide better services, track people better and at the end of the day, you

know, health care is not about spending more money, always it is about spending,

you know, any level of care, it is about spending more wisely in many cases.

MR. MATTHEWS: You are absolutely right.

MR. H. HODDER: The arguments we have sometimes

are not about health care at all.

MR. MATTHEWS: The $34 million that we spend on

the indigent's drug program is really an expenditure on behalf of Social

Services. We carry the item in our budget. But it is really a Social Services

program that we fund because, I guess, where the aspects of the drug program are

in terms of the profession itself, and knowing the industry the experts are in

the health care sector in terms of running a drug program.

MR. H. HODDER: But having said that now, I find

it somewhat of a great concern though, that the amount of money you are spending

on promotion of healthy living, in item 2.2.03 is gone down. That is

inconsistent with the philosophy that I saw in the meeting with your department

a year or so ago when we were talking about having an aggressive policy of, you

know, healthy lifestyles and the promotion of them. I think, in offering an

opinion, you can't improve health if you don't improve prevention. And you only

can improve prevention when signal of your commitment is in the dollar

(inaudible) attach to it.

MR. MATTHEWS: Which subhead is that?

MR. H. HODDER: 2.2.03, page 237.

MR. MATTHEWS: Most of the money we spend on

education and prevention is spent through the Community Health Boards.

MR. H. HODDER: Yes.

MR. MATTHEWS: So what you would see here is not

the total picture.

MR. H. HODDER: Okay.

MR. MATTHEWS: This year in the Budget alone we

put an extra $2 million into community health, as an extra block of money. And a

significant part of that, some of it was for things like extra home supports and

home care or for early discharge. But a lot of that was and will be used to

enhance our education and prevention programs. So that figure that you are

looking at is really what we spent directly from the department, if you like.

But the main effort, and there will be more and more of this way in the future -

AN HON. MEMBER: 2.2.01 -

MR. MATTHEWS: 2.2.01. The main effort, and it

will be continuing moreso in the future, will be through the Community Health

Boards. The deputy tells me the figure you are looking at is 2.2.01?

DR. WILLIAMS: That is where they should be

looking at, that's with increases. The other one is the Print Shop, Printing

Services you were looking at.

MR. MATTHEWS: Yes, just for the production of

material.

MR. H. HODDER: Okay. In that area, the main

consistency in the Province in terms of postnatal care and in the monitoring of

children before they reach the Kindergarten entry level to the school system,

you find that in some parts of the Province, public health nurses are having

programs for the preschoolers, in some other parts of the Province the program

is not nearly as available or not available at all.

MR. MATTHEWS: Or not as developed. Deputy.

DR. WILLIAMS: We are working very hard at

defining our core programs in community health. And the community health boards,

and before that, the public health units, when the Department of Health was

running them directly, were fairly consistent across the Province in many of our

programs, and we have identified a series of core programs, and one of them

obviously would be prenatal care, postnatal follow-up, and this type of thing. I

am not aware that there are problems with that particular program, but if there

are I would like to hear about them.

MR. H. HODDER: In Central Newfoundland, when I

was out there recently discussing some of these things, my understanding was, in

terms of the preKindergarten health check, that as a budgetary item, it might

very well be included in yours, and it may be a Social Services matter as well,

because again you have overlapping here, public health nurses - but even some of

the public health nurses. But the public health nurses in that area had

discontinued doing their preKindergarten checks as a budgetary measure.

MR. MATTHEWS: Restraint measure?

MR. H. HODDER: Yes.

MR. MATTHEWS: Yes.

MR. H. HODDER: I think it is important to say

that every child in the Province deserves to have a preKindergarten health

check, and I would like for you to note that and see the deputy is making a note

on it.

MR. MATTHEWS: Harvey, is this information you

have picked up in your Children's Interest Committee work?

MR. H. HODDER: Yes.

MR. MATTHEWS: I gather it would be, because

there is no problem in that area that I have heard of, and the officials haven't

heard of any.

MR. H. HODDER: I think there are decisions

being made at the local level that are not necessarily reflective of government

policy.

The lady behind me here is most anxious to have

something to say about it.

WITNESS: Who is that, Eleanor? Speak up,

Eleanor.

MS GARDNER: In all of the regions of the

Province -

MR. MATTHEWS: I am sorry. Identify yourself,

the resident expert.

MS GARDNER: Eleanor Gardner. In all areas of

the Province there are preschool check programs, but we did have two different

programs running. One was done at age three, and one was done at age four. In

various regions they have made changes to the programs to bring them in line so

that there would only be the one check before school, but not all provinces have

finalized all of those changes. Basically we were running two programs in some

of the regions and only one in others, but every child in the Province is

checked. There is a program there; it is just the types of programs that are

different.

WITNESS: The core program document will bring

that all together so that we will have consistency?

MS GARDNER: That is correct. The core program's

document, which will be ready very soon now, identifies what will be the minimum

that will be required in each of the regions so that there will be one standard.

MR. H. HODDER: The other thing that I think we

should keep in mind there, too, is that the latest research, reference Dr. Julia

O'Sullivan, who is - well, I can't say she is internationally renowned but she

certainly is well known for her research in early learning and the need for

early diagnosis. She indicates that the optimum time for intervention is between

eighteen months and thirty-six months. And every month we are later than that,

we progressively decrease the impact of the intervention that occurs, whether

that is in speech pathology, or whether it is in any kind of learning

disability. And I hold the point of view that many of our preschool entry

checks, where they do occur, if they do occur, consistently are themselves too

late, that we have not seen the child since the mother took the child in at age

maybe three of four months, whatever it is, when we said `goodbye'. And now if

they are checked coming into Kindergarten, we have a wide gap there, and there

is no mandatory health check.

MS GARDNER: All of the children are checked

preschool, but you are correct; age is a factor, and the quote you made is one

of the issues that was discussed in core programs. Some of the program prechecks

that we were using were not really picking up as much in those areas of the

short attention span deficits et cetera; but they have been addressed and will

be in the core programs document with regard to minimum standards. But that area

is being worked on and some of this research is very current so that we have to

keep -

MR. H. HODDER: Very current. In fact, the stuff

that Julia O'Sullivan is doing, I am not sure whether all of it has even been

published here. I talked to her just recently, in fact.

MR. MATTHEWS: Developing as we move, as we

speak.

MR. H. HODDER: Yes. Well, it has been

researched and has been communicated but I am not sure whether it has reached

the bureaucratic institutions where we had to move somebody to go and say: Hey,

this is a good idea.

DR. WILLIAMS: Some ten or twelve years ago when

I was involved in the Community Health branch, in St. John's they were piloting

- that was when Dave Mowat was here, it has been a while ago; and it was called

Health Check 3, which was moving, actually, towards an earlier health check.

Rather than the year they were going into school, they moved it back to age 3.

Actually, they were going to evaluate that and that, but I am not as close to it

as I was, so I don't know where we are in terms of the timing now.

MS GARDNER: Part of the evaluation is what led

to some of the decisions that they are trying to look at for the core programs

document because there is, as well as that research, associated with that

research about the age, is also whether or not we need to be targeting every

child or whether or not we should be testing early for children at high risk, so

that theory is also being incorporated.

MR. H. HODDER: Yes. Again, I think it is back

to what Dr. Bob was saying there about: if you had a procedure whereby you would

be able to monitor people, you know, the high risk, identify them, identify

certain family traits and certain characteristics, then you could target them

and at least then, you would hit the ones with the highest level of probability;

but again, these are issues that are of concern to me as a child-focused ego

person and these are fundamental things in prevention.

MR. MATTHEWS: I guess, on that account, it

might be a good example of one of the reasons why we need, as two departments,

to be working closely together, Social Services and Health, because the high

risk groupings, unfortunately, many times are in the area of the Social Services

purview in terms of other services, so I think you only enforce the concept that

you were questioning about earlier.

MR. H. HODDER: I think, in fact, in some areas,

the Department of Health and Family Services, or you know, the various names,

that the mandate is of a similar nature.

Okay, I do have a couple more things before I have

to leave and attend to a family event, but I wanted to ask a question about -

again, I cross over between Social Services and Health. The

deinstitutionalization program that is occurring, say, with the Waterford

patients: I saw a note the other day which was a note on research done in

Britain. This program has been in place for some time and it talked about then,

a study that said: in some cases, some of these people had ended up in trouble

with the criminal justice system, and so, at the end of the day, we are in

danger of reinstitutionalizing them. I am wondering if we are doing any analysis

of that particular program and how it is working, from a health perspective, not

from a who pays perspective, social services -

MR. MATTHEWS: I guess they are talking mainly

about The Right Futures Program that is really a social services program.

MR. H. HODDER: They give the money but the

health care of these people (inaudible) -

MR. MATTHEWS: Well, the Federal Government was

funding that significantly and they were deinstitutializing an identified subset

of Waterford patients. That program is pretty well, I think, done through Social

Services, with the exception that there are thirty more people whom they

question whether they will bring out or not because the feds are cutting the

funding now. Fifty-cent dollars now become 100 per cent dollar for the

provincial government to find.

In terms of whether or not there has been any work

done to analyze what the health impacts have been on these, I would doubt it,

because these are fairly new programs in deinstitutionalizing people under these

programs. Deputy, I am not aware of any work that has been done to evaluate what

has happened to these people health-wise. I mean, the advocacy groups that I

happened to have a number of meetings with when there was a contemplation of

moving Enriched Needs for these people to Health as well as the seniors. I can

tell you that these advocacy groups such as the Organization for Community

Living (inaudible) Consumers Disabilities Organization, would tell you that this

is absolutely the right way to go.

MR. H. HODDER: I agree.

MR. MATTHEWS: Facts in, case closed, full stop.

But there are a lot of questions as to whether deinstitutionalizing people in a

one-on-one setting is best for that person. I mean, nobody lives -in a family

setting you live with a family, a number of people, and to take a person out of

a group setting and put him in an apartment by himself and give him three or

four caregivers, personally I am not sure that we are doing right by the person

that we are supposedly giving independence to, you know. But I do not know of

any research that has been done.

MR. H. HODDER: My only comment is not to

suggest that there is even one patient, excepting I read an

article in a

magazine somewhere, and the

article was basically, you know, drawing into

question the whole concept of deinstitutionalizing certain high risk patients,

and they were going on some research in Britain. And I suggest that if there is

even one example that has gone wrong in the Province, even if there was one, the

program can certainly be a very successful program. My point is again the

monitoring, the following through and don't deinstitutionalize these people of

any kind of - leave them there. We have to continue to follow up with them all

the time.

MR. MATTHEWS: I guess the positivity or the

negativity of the impacts on people who have come out of the Waterford and gone

into the community as a result of the Right Futures program is probably a

question that Social Services is looking at as they go through it.

MR. H. HODDER: Yes, I would assume that they

would be.

MR. MATTHEWS: They would be taking people out

of the Waterford, as an example - we call it the Waterford - and putting them in

the community and if they end up in the criminal justice system and are being

reinstitutionalized on that basis, I am not sure that we have done them any

favours.

MR. H. HODDER: My last question is for the -

MR. MATTHEWS: Probably, Debbie Sue, can you

answer that? Debbie Sue is the mental health expert, and I had forgotten she is

back there, it is so long since we came here; it must be 10:00 o'clock.

MS DEBBIE SUE MARTIN: My name is Debbie Sue

Martin. I am with Mental Health. I am just following up on the Right Futures

Project. Your concerns are very important because I think a lot of people who

have been deinstitutionalized, whether they have been mentally retarded or

mentally ill, do end up getting in trouble with the law. The people who are

involved in this project, the Right Futures, to date none of them have been

involved with the law, because, as the minister has mentioned, there has been a

very intensive support system set up about the people who are going back to the

community. That seems to be where things break down; if the person goes out into

the community, a lot of times people end up being reinstitutionalized because

the services they need are not there, so they end up going back that way.

There is part of the Right Futures project - a

built-in evaluation of that is being done by an independent group. It is the

Roeher Institute from Ontario, and they have been down for two different site

visits and have been following - right now there are about ninety people who are

out in the community from the Waterford, and those ninety are being followed

fairly intensively to know sort of what has happened with them. As you say, Mr.

Minister, there are some cases where there is sometimes the initial resources

that are required where you need to question whether it is exactly what the

person may need or not. But this particular group of individuals are being

monitored fairly well. To date, I know none of them have had any trouble with

being reinstitutionalized other than coming back for follow-up appointments sort

of thing. So that group - but your point is one that we really need to keep our

eye on, because that may indeed be something that comes as an outgrowth of the

deinstitutionalization.

MR. MATTHEWS: Thank you, Debbie Sue.

MR. H. HODDER: My last question is: the

Transportation subsidy related to transplants - 3.4.03. I see you have decreased

that substantially.

MR. MATTHEWS: (Inaudible).

MR. H. HODDER: Yes, page 242, Special Needs

Assistance, you knocked off $290,000 from it.

MR. MATTHEWS: Oh yes, that's the emergency

transportation. That is a program that we have had in place over the years where

people go outside the Province or travel within the Province for services and

when they have expended over $500 a year, on a personal basis, the program picks

up 50 per cent of the cost beyond that. I am very familiar with it because my

granddaughter has had to travel to Ottawa many times for laser treatment as a

result of being born with a port wine birthmark and they get transportation

assistance under this program. That is one of the programs that we have

essentially reduced or eliminated in this year's budget. It is not a program

that was necessarily based on need inasmuch as you had to meet a means test. It

was based on the amount of money that was being spent, and because it was not a

direct patient services or a program that would affect direct medical care, we

have cut it out of this year's budget. The $100,000 that is left there is really

to tidy up any billings that were not cleaned up and to take care of the first

couple of months in this year's budget because we are now, of course, already

two months into this year's budget.

MR. H. HODDER: Nobody who needs a transplant

and, say, has to go to Halifax to get it, will be denied access?

MR. MATTHEWS: No, you see, once - the medical

part of it, the medical service, that is not affected by this and that is

covered, let us say, under MCP.

MR. H. HODDER: Yes, okay.

MR. MATTHEWS: If persons cannot afford to go

because they don't have the means, and they are indigent, Social Services picks

them up. This program was not necessarily being used by people who are on social

services. You could use it, I could use it, and while I might have some need,

you have no need, Harvey, because you are a wealthy man.

MR. H. HODDER: You have my lotto tickets for

last night and I won?

MR. MATTHEWS: I only use us as an example to

make the point that this -

MR. H. HODDER: (Inaudible) in the House today.

MR. MATTHEWS: There is only you and Chuck Furey

left.

It was a program that anyone could use. If you or I

had to travel and take somebody to Ontario, anything over $500 we would get 50

per cent reimbursement. It was a program that we felt we could curtail to save

some money so that direct patient care could be a better resource.

MR. H. HODDER: Mr. Chair, I have taken up as

much time as I should.

CHAIR: Yes, you are slightly over your ten

minutes. We are slightly past our time where we would normally take a break. Is

it the wish of the committee that we proceed, or take a break? Is there a feel

of how much longer we might go?

WITNESS: It is up to the Chair.

CHAIR: We will take a five-minute break.

MR. DOWNTON: Well, that depends - is there any

coffee or anything here to drink?

WITNESS: It is downstairs in the caucus room.

CHAIR: Well, in that case it will have to be

ten because it is downstairs in the caucus room. That is where the coffee might

be, so we will be back in ten minutes.

Recess

CHAIR: Order, please!

Mr. Oldford.

MR. OLDFORD: I will pass.

CHAIR: Mr. Ottenheimer.

MR. OTTENHEIMER: Thank you, Mr. Chairman.

The Janeway Hospital - and Mr. Minister, my question

has to do with psychiatric services for young people and the significant waiting

lists that exist. It is a concern, I am sure, that the department has. Often, we

find that the waiting lists and the problems associated with these lengthy

waiting lists and the care that young people require is often translated,

unfortunately, in young offenders finding themselves before the criminal justice

system. There is clearly a correlation, it seems to me, between both. I am just

wondering what steps the department has in mind to deal with this perhaps

somewhat critical situation, in looking at what the needs of young people are

and what can be done to help them?

MR. MATTHEWS: I will just comment generally, and

probably, Debbie Sue, you can speak specifically to the situation at the

Janeway.

The Health Care Corporation, of course, has the

responsibility for the Janeway, as for the rest of the hospitals, and they have

the resources, dollars-and-cents-wise, in their budgets, to employ a reasonable

level of child psychologists and psychiatrists. The difficulty, to some extent,

is in recruiting that particular sub-speciality. There is a perceived, and there

is a real, waiting list, to some extent, for those services at the Janeway.

Probably, Debbie Sue, you can tell us what is exactly the seriousness or not so

seriousness of the need at the Janeway, specifically, for my colleague's

information.

MS MARTIN: You are correct in commenting on the

waiting list at the Janeway. It varies depending on who you would talk to, but

it has been quoted as being up to maybe six to eight months to see the

psychiatrist and possibly even longer for seeing other professionals. There have

been some efforts directed towards trying to streamline the system a little bit

in developing - rather than having a departmental approach to care, looking at a

program approach. What we were finding is that people would be on waiting lists

to see the psychologist, to see the social worker, and also to see the

psychiatrist, similar to what happened in terms of nursing homes, people being

on a number of waiting lists, so that the numbers were indeed probably not

reflective of the actual need.

As I say, there has been an amalgamation of services

at the Janeway and they have recently - actually over a year ago - hired an

intake co-ordinator who is specifically trying to address the issues of working

on getting the waiting list down. What happens a lot of times is people put

their name on a waiting list but are not really sure what it is they are looking

for. Sometimes what they are looking for is more services that are provided

through more social issues. Some of the challenges in dealing with the problem

is having people up front who can, for lack of a better word, do a good triage

of what the needs are and get the person hooked up with where they should be. We

have added an additional psychiatrist to the Janeway. There are currently five

psychiatrists at the Janeway and that is the best situation we have been in for

quite some time. As far as we speak, none of those people have any intentions of

moving right now.

We have acknowledged that all through the Province we

have a shortage of services for mental health for children. There are two

initiatives. One that is happening here in St. John's in the middle of June, a

crisis intervention centre is opening, a mental health crisis intervention, that

will indeed take people of all ages from - it could be a teenager having

problems who could come in. That has been one of the gaps in the services.

People call. Sometimes it isn't a big critical problem if they could get some

response at the time, it wouldn't have time - as I think your colleague

mentioned, trying to get in early into some promotion areas. So that is coming

on stream now. It is an eighteen-month evaluation program, and we are hoping as

a result of that to be able to demonstrate some really good changes in terms of

cutting down on the number of people.

In terms of Justice, there is an initiative in Corner

Brook which Mr. Oldford may be familiar with. It is called the Community Mental

Health initiative, and it is a joint initiative of Justice, Health, Education,

and Social Services to try to provide some on- site services for assessments for

kids who are getting into trouble with the law, who also have mental health

needs. That service has been in the sort of start-up phases for the last couple

of months, and, I think, as of June 15, will start to be taking some kids in

there. Prior to that, a lot of times kids ended up coming to St. John's to be

assessed by a psychiatrist, but that will be able to be offered on site now.

The area there is one that we are very concerned with,

and we really hope that the strength of some of the community health boards will

be able to deal with those issues a little bit better, and that is how we are

working through that now. We really don't want to centralize a lot of the

services, because the research shows we need to sort of deliver the service as

close to the community as possible, and also in the context of a family.

MR. OTTENHEIMER: Thank you, Debbie Sue. Is it fair

to say, though, that say, if a child, as a result of a court order or a

probation order, and if psychiatric services are required, will they in fact

jump ahead and they will receive priority?

MS MARTIN: They have, historically, and probably

will continue to. I think, for most of the court-ordered assessments things,

they are done in a fairly timely fashion. The problem arises when there is not

the court - sometimes kids end up getting in trouble with the court, and that is

how they tend to access the service, and they may have indeed been on a waiting

list before. That is why we are hoping to head it off as opposed to only waiting

until it gets to that high demand area. It does get priority within the service,

(inaudible) available resources. Because what ends up happening is an assessment

will be ordered, but it might take - the judge may order it this afternoon. It

may indeed be a day or two before it actually gets done, but it does take

priority.

MR. MATTHEWS: That was the basis of a question in

the House, I think, last Fall, where the suggestion was that people who got in

trouble with the law - or people who were on Social Services, jumped the queue

and got ahead of people who were otherwise on the waiting list. The Justice

system does drive the prioritized list to cause people to get earlier services -

an unfortunate way to have to do it, I suppose.

MS MARTIN: But it is court-ordered and then -

MR. MATTHEWS: It is court-ordered and they have to

(inaudible) respond to that.

MS MARTIN: So they have to be (inaudible), as we

all know.

MR. OTTENHEIMER: There is an order, yes.

MS MARTIN: Thank you.

MR. OTTENHEIMER: Thank you.

On page 239, under Memorial University,

section

3.1.01, we see a reduction of approximately $1 million in grants.

MR. MATTHEWS: Page 239.

MR. OTTENHEIMER: Page 239, at the top.

MR. MATTHEWS: Okay, yes, I have it here.

MR. OTTENHEIMER: Is it, I suppose, a consequence

of this reduction - we see the estimates of (inaudible).

WITNESS: Page 17, Sir.

MR. MATTHEWS: Seventeen? Okay. I'm sorry; go

ahead, John.

MR. OTTENHEIMER: Thank you.

Is it a consequence of this reduction that we will

probably see - is this one of the reasons why it may be necessary to see

increased tuition costs? Clearly, if the funding body has a lower amount in its

estimates - we hear talk recently of not only the medical school but certainly a

lot of the professional schools giving consideration to increased costs at

Memorial. Is this something that you see?

MR. MATTHEWS: Yes, very definitely. There is a

move generally in universities towards differential fees, of course, in all of

the schools, particularly in the business schools, in engineering and so on. In

the medical schools this year, the dental school in the University of Toronto

increased their fee to $8,000; Dalhousie is going to be $6,000-plus this year, I

believe, in terms of fees in the medical school. You may have heard in the media

that the Senate, or the Board of Regents, whoever, at MUN deals with the issue.

We're looking at an increase at the medical school of $6,250. I wouldn't be

surprised if that figure doesn't end up to be higher than that, probably even as

high as $8,000, although I can't predict or prejudge. We believe that up to

$8,000 would be a reasonable tuition fee for medical students at the University

- that is for our own medical students who come in - and on that basis there is

going to be, I would think, a substantial increase, but I can't say for sure

what it would be, because the University has to make that final decision.

We do have ten students whom we are taking in this

year. We have how many over there now from the States?

WITNESS: Five, and we are taking in fifteen this

year.

MR. MATTHEWS: We are taking in fifteen American

students who are paying us $30,000 per seat to access the medical school. That

will assist in terms of revenue shortfall. Ten of those seats were freed up

because New Brunswick withdrew from the program they were working with us.

MR. OTTENHEIMER: The reciprocal arrangement?

MR. MATTHEWS: Yes, so that gave us ten seats. We

are also taking in how many Malaysians?

WITNESS: Five.

MR. MATTHEWS: Five Malaysians in their third and

fourth years, and they will be paying us a like amount for their tuition, so it

is a combination of increased tuition, and students we are taking in from

outside the Province will help generate new revenue and significant revenue over

at the medical school, and these things together, of course, have allowed us to

bring in a budget for the medical school this year somewhat less than we had

budgeted in previous years. It is part of a challenge of - I guess it is a

balance, John, of trying to determine what is a fair tuition.

Medical students will never, ever, come close to

paying the full cost of their education because it is several times higher than

it is at the other schools at the university, just by virtue of a medical

education, but the other thing with the medical students is that there is a 97

per cent graduation rate from the medical school, so once you get in you are

pretty well, almost 100 per cent, guaranteed to come out as a doctor. When you

come out as a doctor you are guaranteed pretty well employment almost anywhere

you want, whether it is here or down in the States or anywhere else, so the

employment opportunities and those sorts of things for a medical student are

significantly better than almost - well, I wouldn't comment on the lawyers but

certainly, I think, they would have a better opportunity.

MR. OTTENHEIMER: There are certainly enough

lawyers around here.

MR. MATTHEWS: What?

MR. OTTENHEIMER: There are certainly plenty of

lawyers around.

MR. MATTHEWS: Yes, I don't think a lawyer comes

out with the expectations that a medical student does, or an engineering

student, or a business student, so I think, to some extent, that has to be

reflected in the cost of the education, the value of it once it is achieved.

MR. OTTENHEIMER: What is the situation now - I

guess it is just an extension of that discussion - of providing rural

Newfoundland with what you would consider to be adequate medical attention?

MR. MATTHEWS: We have always had difficulty in

recruiting doctors to go and stay in rural Newfoundland. We have always relied

very heavily on what we call foreign medical graduates, doctors from Great

Britain, Ireland, South Africa, and places of that nature, and that continues to

be the situation.

We are trying to refocus the medical school on

graduating kids who have an interest in rural medicine. We are doing a number of

things over there to focus on rural medicine as an area for which they are

trying to train people.

In the last few years what has happened is that the

Americans have been in Canada en masse raiding doctors. The reason for that is

because the Americans have been looking at their health care system - I'm sure

you are aware of that, the discussions of trying to bring in the universal

Medicare system down there. In the States when they started to look at it four

or five years ago, they discovered they had a ratio of 80:20 specialists to

family physicians, GPs. Eighty per cent of their doctors were specialists. They

are trying to balance their system to a 50:50 situation, where 50 per cent of

their doctors would be GPs, 50 per cent specialists, which seems to be

appropriate.

So they are in very short supply of family physicians

in the States. In order to meet that need in the short term they are up across

the border here, and everywhere else, offering unbelievable incentives to

recruit physicians, not only out of our medical schools, but out of practices.

Nova Scotia is finding it worse than we are, believe it or not. I don't know if

it is because they are closer to the States. It is a - but what is going to

happen -

MR. OTTENHEIMER: And in the nursing profession, as

well, isn't it?

MR. MATTHEWS: Well, the nursing profession we

don't worry about because we have an oversupply. We hate to see people go but at

least there are employment opportunities. The Deputy Minister and the people who

are in the profession think that within four or five years the situation will

reverse itself. Because once the Americans re-balance their system the

opportunities won't exist down there anymore and we will see some of our own

people, I would think, coming back. Dr. Bob is a physician and he knows I guess

not only the mind-set but the movement-set of physicians. That is factual, I

think?

DR. WILLIAMS: Yes. We think that it will take up

to ten years. They have been at it now for a few years trying to change

post-graduate training programs. It will take seven to ten years for them to

really get a good grip on changing the number of physicians they have versus

specialists versus general practitioners. We still think we have some hard years

of slugging ahead yet before that flow is stemmed.

The flow to other provinces is pretty well stemmed

right now because British Columbia and Ontario, unless you graduated from one of

their medical schools you can't practice there right now.

MR. MATTHEWS: Quebec, the same thing?

DR. WILLIAMS: Quebec is the same, it's very

difficult in Quebec. We have never lost many physicians to Quebec.

What we are seeing now, and I was talking to the

registrar of the medical board yesterday, is a different phenomenon. Dr. Young

has two or three calls a week now from people who are in the U.S. training as

specialists, but they can't get jobs in the U.S. Now they are phoning him to see

if there are any specialist jobs in Newfoundland. We may see some improvement if

this trend holds and some of these people actually decide to come here. Because

if they do get their American boards in the States - and they train for three

years in the States to be specialists. In Canada you have to train a minimum of

four years, but in the U.S. you can train for three years and get what you call

board eligible. You are eligible to write the American boards to be a

specialist.

If the medical board is contemplating licensing these

people as specialists they can't put them on the specialist registrar because

they don't have their Royal College exams in Canada, but they can licence them

as specialists, they can practice as specialists. We may see some improvement of

some of our specialty numbers in some of our district and regional hospitals

where we are still having trouble getting specialists. Yet, at the same time, we

might have more difficulty in staffing our hospitals or practices in rural

Newfoundland where we need general practitioners.

The Americans obviously are paying in American

dollars, and they are paying big dollars. Most of the competition is with

private organizations and people hired by private hospitals or profit hospitals

or not-for-profit hospitals. But they are still private organizations, and the

compensation packages are quite attractive, especially when you convert the

American dollars to Canadian dollars, if you are ever contemplating coming back.

The taxation system is quite a bit different down there so they keep a lot of

what they - I know they have to pay for their health care, and things like that.

The packages are very difficult for even other provinces to compete with what

they are offering. So we are still in for a short-term problem.

MR. MATTHEWS: Even within Canada though, John, I

mean, we start doctors in Newfoundland in the mid-$60,000s, family physicians

going to rural areas, or going anywhere. They go from the mid-$60,000 to the

mid-$90,000 range. Even Saskatchewan, which is sort of next comparable to us,

they start them in the $90,000s and go to about $120,000. So, dollar and

cent-wise we can't compete dollar for dollar with any province in Canada. We

can't even talk in the same conversation with the Americans, what they are

offering.

MR. OTTENHEIMER: Is the incentive package similar,

for example, comparing Newfoundland with Saskatchewan?

MR. MATTHEWS: Deputy?

MR. OTTENHEIMER: I'm thinking like in housing and

such.

MR. MATTHEWS: Housing? We don't get into too much

the provision of housing. The boards do have some flexibility in their board

budgets to help with other incentives. In Newfoundland, and here are the

figures, we start at $67,000 to $85,000 in Newfoundland for an assistant medical

officer which is an entry level; in Manitoba, they start at $89,000 to $110,000;

Saskatchewan, $98,000 to $115,000 so our maximum salary scale is $85,000 at the

entry level once you get up the scale, Saskatchewan's starting salary is $98,000

to $115,000.

MR. OTTENHEIMER: These are in rural parts,

northern (inaudible).

MR. MATTHEWS: Yes, these are you know, rural

parts. So this is why we are trying to do things at the medical school to cause

people to make a commitment to `return of service' we call it, and it is hard.

We had ten bursaries up until last year, $12,500 a year for second, third and

fourth year students you know, and for every $12,500 bursary they will have to

give us a year of service when they are finished. And the year before last, we

could only give away six bursaries - we couldn't even get the medical schools to

take them, because the weren't prepared to make the commitment. Now, we have

changed from ten at $12,500 to six at $20,000 so at least the ones we get the

hook into, it will be harder for them to renege on the commitment. But they come

up from Atlanta or Tennessee or Nebraska somewhere and they say: We will pay off

your bursary and we will give you a signing bonus and we will give you $130,000

U.S., so it is pretty hard to compete.

MR. OTTENHEIMER: Yes, it is a problem.

One final area that I would like to review for

clarification more than anything, and I can anticipate what the response is - it

has to do with the Health Care Facilities on page 245. At the very top there, we

see an allocation of $350,000. So I guess my question is: What are the long-term

plans for health care facilities in terms, I guess, of structure and/or

construction? Do you see it there, Health Care Centres, 4.3.02?

MR. MATTHEWS: Yes, I have it here, $350,000. Yes,

that really is an amount that covers the completion of the redevelopment of the

long-term care facility in Placentia, the Lions Manor. The capital part of the

Health budget, I should have mentioned earlier, is carried in Works, Services

and Transportation, so the $903.6 million is ex capital, it is not including

capital, and the capital budget, which this year is not a great deal, I think is

down around $10 million or $11 million as carried in the Works, Services and

Transportation budget.

Really, we have put a freeze on capital projects this

year except for projects that are substantially completed and there would be no

savings if we held off on them because contracts have been let and the work is

on the way, and the ones that fit that category are the Interfaith Home in St.

Anthony and this one here, the Lions Manor, those are the only two. The big

project we have underway in Gander is on hold because of capital reduction

expenditures this year, and we will see what happen beyond this year.

In St. John's, we are dealing with St. John's as a

separate and distinct structuring thing. In St. John's we are closing down two

or three sites, the Rehab, the Janeway and the Grace and we will take the

operational savings which will be about $25 million to $30 million and will

amortize the $100-plus million we are going to spend on capital out of that

savings, so that's unlike what is happening anywhere else, where in other places

we are just replacing or building new.

MR. OTTENHEIMER: What is the closest projection we

can come to in terms of timing?

MR. MATTHEWS: In St. John'?

MR. OTTENHEIMER: Yes.

MR. MATTHEWS: We feel that the announced date of

December 31, 1998 to have it all done is a good date and we think we will meet

that target date. We should know within the next month or two when we can get

off the Grace site. We are off the Rehab site as of this month or next month?

WITNESS: July 1, isn't it?

MR. MATTHEWS: Yes. At the end of June, we are off

the Rehab site - they are moved over to (inaudible). The next move will be from

the Grace site to both the St. Clare's and Health Sciences sites, and we will be

off that site probably sometime in 1997, I think that would be fair to say.

There was talk we were going to do it by September of 1996 but the Health Care

Corporation can't achieve that and we had to do it properly and in an orderly

fashion. So we will be off the Grace, hopefully, in '97 and certainly before

this year is out, we should have all of the hard planning done in terms of

programming and design for the new space over at the Health Sciences. In fact, I

expect to have that before the end of June. The programming is substantially

done and we should be able to indicate, by way of visual conceptions, as to what

the new space will look like over there. I think, John, what we are going to be

doing over there - my understanding at the moment from the Health Care

Corporation - is we will have to add on some space to take the obstetrics and

gynaecology work, some of the work from the Grace. Then we will have to build a

substantial amount of new space to be the new Janeway, if you like. I think that

construction generally - if you know the Health Sciences - will be on the north

side of the complex, possibly out over the H. Bliss Murphy Cancer Clinic, up in

that area there for the `New Janeway'. That is about the time frame.

MR. OTTENHEIMER: Okay, thank you.

Mr. Chairman, I have no further questions.

CHAIR: Thank you, Mr. Ottenheimer. Are there any

further questions?

AN HON. MEMBER: No questions.

CHAIR: There being no further questions. I now

call for a motion to adopt the estimates of the Department of Health.

On motion, subheads 1.1.01 through 4.3.05 inclusive,

carried.

On motion, Department of Health, total heads, carried.

CHAIR: Well that's about it for this evening.

Thank you, Mr. Minister, and thanks to your officials. It has been a pleasure to

have had you. And thank you kindly for your detailed answers to the various

questions that have been put to you.

MR. MATTHEWS: I would like to thank you, the

Committee, for your courtesy and for your consideration of, not only myself but

the officials. I would like to thank my officials for the considerable quantity

and quality of information that they provided to you because the details, as you

can appreciate, they have infinitely more knowledge of it than I do personally.

As you can see tonight, they are well-informed and certainly able to answer any

question you have either tonight or any time in the future, particularly, John,

if you want to come over any time and talk to me or any of the officials. We are

there to help. We pay more attention to the Opposition MHAs than we do our own

because they have to support us but -

AN HON. MEMBER: Don't bet on it.

AN HON. MEMBER: That's making an assumption.

MR. MATTHEWS: And that's in terms of providing

levels of information. When it comes to the actual dollars, Don, we would not

forget you. I mean, you ask Doug (inaudible) treated this year. That is why he

didn't open his mouth tonight.

CHAIR: Motion to adjourn.

On motion, the Committee adjourned.