1991 Legislative Session: 5th Session, 34th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 10, 1991

Afternoon Sitting

[ Page

12615 ]

CONTENTS

Routine Proceedings

Oral Questions

Lottery grants. Mr. Clark –– 12615

Use of MLA letterhead. Mr. Reid –– 12616

Funding for alcohol and substance abuse prevention program.

Ms. A. Hagen –– 12616

Government advertising restriction. Mr. Blencoe –– 12617

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

On vote 38: minister's office –– 12617

Mr. Perry

Mr. Barlee

Mr. Zirnhelt

Hon. Mr. Weisgerber

Mr. Jones

MONDAY, JUNE 10, 1991

The House met at 2:03 p.m.

Prayers.

MRS. McCARTHY: One of the great traditions of our House is

the British Columbia Youth Parliament, which meets annually. We're

honoured today to have in the gallery the official Leader of the

Opposition, Jason Herbert, from Vancouver South; the Deputy Speaker,

George Nast, who represents Richmond; the Attorney-General, Rhonda

Vanderfluit, who represents the constituency of Vancouver–Point Grey;

and the Minister of Sessional Affairs, Matthew Bissett, who is the

representative for Vancouver–Little Mountain. Will the House please

make them welcome.

MR. ROSE: I'm informed that Mr. Gord Faulkes, 60 grade 7

students from Cedar Drive Elementary School and their parents are here

today from my riding to watch the goings-on. We welcome them. I hope to

be able to meet with them in about an hour.

MR. LOENEN: Mr. Speaker, in your gallery are some special

guests, June and Fred Walchli, the parents of one of our legislative

interns, Julie. They're accompanied by Julie's aunt, Gloria Breault.

Would the House please welcome them.

MR. CLARK: In the precincts today are a group of

schoolchildren from St. Joseph's Elementary School in my constituency.

I'd ask the House to make them welcome.

HON. MR. DUECK: Mr. Speaker, I see in the gallery today my

Member of Parliament, Bob Wenman, with some special guests. Would the

House please make them welcome.

HON. MR. BRUCE: Mr. Speaker, in the gallery today are Mr. and

Mrs. Richard Hill from Ladysmith. They are the owners of Yellow Point

Lodge, which is one of the nicest places you can find to stay anywhere

on Vancouver Island. I'd ask the House to please make them welcome.

Oral Questions

LOTTERY GRANTS

MR. CLARK: Mr. Speaker, I have a question to the Provincial Secretary.

After swearing in her cabinet on April 15, the Premier said the following about

the granting of lottery funds in B.C.: "I don't know that there is

room for abuse. It seems to me there was a lot of tightening up done last year."

Does the minister believe that when the former minister responsible for lottery

grants, the member for Nelson-Creston, can award at least 23 grants to his own

riding, this is evidence of a system that has been tightened up?

HON. MR. VEITCH: I thank the hon. member for his question. In

response to a 1990 review of the Lottery Fund by the auditor-general,

program guidelines were clarified and administrative procedures were

strengthened to allow for fair and consistent treatment of distribution

of the lottery moneys. The ministry is adhering strictly to those

guidelines, Mr. Speaker.

A special ministerial review committee reviews and makes

recommendations on all grants over $150,000 or those which may fall

outside the guidelines. They are done on this basis. All applications

are evaluated by the project officers — staff of the ministry — on the

basis of benefit to the public, assessment of the applicant's ability

to complete the project successfully, the economic benefit to the

community, the applicant's record of public service, previous lottery

grants to the applicant or the community and the availability of

lottery moneys at the time the application is reviewed.

I don't want to get into the numbers game. If the lottery

applications fall within those guidelines, they are handled in that

manner.

MR. CLARK: Supplementary, Mr. Speaker. One of the grants to

the former Provincial Secretary's riding was to a polygamous commune,

whose members say they were forced to vote Socred in the last election

in order to get government grants. Has the Provincial Secretary decided

to investigate the circumstances...?

Interjections.

MR. SPEAKER: Order, please. I really think we should all hear this.

MR. CLARK: Has the Provincial Secretary decided to

investigate the circumstances under which this polygamous commune

received a GO B.C. grant last year?

HON. MR. VEITCH: Mr. Speaker, I don't have very much to do

with polygamists or other types of communes. That would probably fall

more directly within the responsibility of the members on the other

side of the House; they may have more experience with communes than we

do — a free enterprise government. But if the hon. member is talking

about a venture playground, where we issued a grant.... Firstly, I

don't know how the hon. member would know how people vote. We in the

Provincial Secretary's office don't have access to finding out how

people vote, and we don't take that into consideration when we're

issuing grants.

MR. SPEAKER: I must ask for a new question. Has the member got a new question?

MR. CLARK: Yes, Mr. Speaker. This polygamous commune got a

lottery grant for a recreation playground within the commune. Can the

minister assure the House that that grant benefits the people of the

community at large, not just the members of the commune, and therefore

is consistent with the rules applied by the auditor-general?

[ Page 12616 ]

HON. MR. VEITCH: Mr. Speaker, again, I don't know how one

gets into or out of a commune. I don't have much expertise in that

particular area, other than travelling in the eastern bloc at one time

— and I didn't like it very much. But I can tell you that the grant

that I believe the hon. member is referring to is a school, and it is

open to the general public. This is the information that I have been

given, and I assume it's correct.

USE OF MLA LETTERHEAD

MR. REID: Mr. Speaker, I have a question for the Provincial Secretary.

I think this one is pressing and urgent.

Mr. Minister, would you look into the actions that are necessary to

provide this House with recourse to a member who mixes personal

business with the office of an MLA? It has come to my attention that

Trevor Lautens, who has provided quite an

article relative to the

member for Esquimalt–Port Renfrew, advised, in relation to letters of

November 30, 1988, and February 1989, that that member

advised...personal business on MLA letterhead, relative to some actions

of his family business. Would the Provincial Secretary look into that

matter?

MR. SPEAKER: I must ask the member to rephrase the question,

because the way you phrased it is out of order. The way you want to

rephrase it is: has the minister decided? Otherwise it's future action,

and it's out of order.

MR. REID: Has the minister decided to look into this matter,

which is pressing and urgent, relative to a member of this House mixing

personal and business matters?

HON. MR. VEITCH: Mr. Speaker, I obviously haven't had time to

examine the material that the member has available to him, but if it is

a problem of ethics.... I remember that the Leader of the Opposition

suggested we have an ethics committee of this House. Indeed, we do have

a conflict-of-interest and ethics committee, and your information may

very well be referred to that committee as soon as it is struck.

FUNDING FOR ALCOHOL AND SUBSTANCE

ABUSE PREVENTION PROGRAM

MS. A. HAGEN: I have a question to the Minister of Consumer

Services. On May 17 the minister spent 90 minutes with an enthusiastic

delegation of New Westminster students and promised that he would not

abandon the school's successful alcohol and substance abuse program,

which is funded by his ministry. In an emergency letter today to the

program's sponsor, the minister repeats the moral commitment to the

program, but fails to commit any dollars for its continuance. Is the

minister now prepared to state publicly what he stated to these

students — that he is prepared to provide the essential support so that

dedicated staff and students can continue to build this effective

alcohol and substance abuse prevention program?

HON. MR. RABBITT: Mr. Speaker, earlier today I replied to the

principal of the school, and a Mr. Doug Walker of the chamber of

commerce in New Westminster, with regard to this question. I also sent

a copy of my correspondence to the member. In that correspondence I

stated categorically that I would live up to the commitment I made to

those students on May 17. As I informed the member, I also instructed

my ministry as follows: first, to develop a school-based alcohol and

drug awareness program that could be utilized by schools throughout the

province; second, to develop a program based on funds available to my

ministry; third, to have the program ready for implementation for the

new school year this fall; fourth, not to duplicate any existing

programs or services; and fifth, to consider the future summer program

that would coincide with that particular program. In addition, I

indicated very clearly that I considered the New Westminster high

school a priority, and I asked the ministry to consider that when they

implement the program this fall.

[2:15]

MS. A. HAGEN: A further question to the minister. For eight

months New Westminster's community leaders have been having discussions

with your ministry about the future of this program for secondary and

elementary students. In today's June 10 rush letter, you do indeed

indicate that there will be a program ready for implementation in

schools in the new school year this fall. Yet the minister is leaving

this program in jeopardy because he hasn't been able to get his

planning and spending priorities....

MR. SPEAKER: Order, please. Hon. member, questions during

question period. A little

preamble is all right, but the rest should be

saved for estimates.

MS. A. HAGEN: Thank you, Mr. Speaker. Let me proceed to the

question. Has the minister decided that he will act on his promise to

do — and I quote from his letter — "whatever is necessary to see a

program exists in the New Westminster schools in the coming school

year" in time to save this program from cancellation?

HON. MR. RABBITT: The TRY program was a three-year program.

We're now in the fourth year of that particular one, and the ministry

is doing a total evaluation of all the programs they've been funding

for the past three years. One of the programs we are re-evaluating is

this particular one. It was one of several pilot programs done in the

lower mainland — not only in New Westminster but in Burnaby and

Vancouver. We're looking at all of these programs and trying to assess

which ones are delivering the best possible service for the dollars put

into them. Within the next few weeks my staff will be developing and

finalizing the new program which will be implemented this fall.

If you're asking me if I'm going to fund, on an ad hoc basis, a

school program in the summer months to the tune of $12,000 when those

students are not in the school, the answer, hon. member, is no.

[ Page

12617 ]

GOVERNMENT ADVERTISING RESTRICTION

MR. BLENCOE: I have a question for the minister responsible

for the public affairs bureau — the Provincial Secretary. When the

Premier swore in her cabinet on April 15, she said: "Government

advertising will be restricted.... There will be no exceptions to this

restriction, except as determined by the Premier's office." My question

to the minister is: what special circumstances led the Premier, this

minister, and therefore the government, to break their promise and

revert to this government's worst habit of forcing taxpayers to fund

government propaganda, the latest issue of which hit the doorsteps this

weekend?

HON. MR. VEITCH: I'm not a psychiatrist, a psychologist or

anything else, and I can't get inside anybody's cranium — least of all

that member's. Mr. Speaker, I don't know what he's talking about.

MR. BLENCOE: Let's be clear what the Premier said on April

15: "Government advertising will be restricted to tender calls, legal

requirements and items such as public meetings and public hearings."

This is not a tender call or a legally required item. This is clearly

government propaganda.

I want to know why the Premier, who said that she and this

government had changed, has gone back on her promise of April 15 to the

people of British Columbia.

HON. MR. VEITCH: This government has always and always will

be an open government. One of the best ways to remain an open

government is to ensure that the public is always completely and

absolutely informed.

If he is talking about the information that goes out in "B.C.

Reports" explaining the wonderful budget that was introduced recently

in this House, it is a service to the people of British Columbia that

we keep them informed. It does quite a bit to overcome some of the

misinformation that comes from the other side of the House.

MR. SPEAKER: I would remind the second member for Victoria

that if he has a document, he may ask leave to table it, but he may not

just stow it on his desk. Exhibits are prohibited. If you wish to be

recognized, please stow your exhibits.

MR. BLENCOE: Mr. Speaker, it may be a prop but it's propaganda of the worst sort, I can tell you that.

A supplementary question to the minister. It's bad enough that taxpayers

have to pay for this propaganda, but it's worse that they're paying

for untruths and distortions about the government's deficit. A quote from

this propaganda item to the people of British Columbia: "...a small deficit

of $395 million." The question to the minister is: why did the Premier,

and therefore this minister and this government, approve of a publication that

uses taxpayers' money to distort and fib to the people of the province about

the real state of the provincial finances? Why did this government resort to

this?

HON. MR. VEITCH: I know the Minister of Finance spent a lot

of time trying to educate the only member for Vancouver East with

respect to the budget. It would take more time than this House has

available to work on this member so he would come to some kind of

knowledge with respect to the budget.

If you read the document, hon. member, you will find it is in fact

correct. You may have a different opinion, but I suppose that's up to

you. The information is correct, and when the Minister of Finance comes

back he'll give you a lecture as well.

MR. REID: I'd like to give notice of a matter of privilege that I'll be raising at a later date.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

On vote 38: minister's office, $360,045 (continued) .

HON. MR. STRACHAN: At the outset I would like to extend my

condolences to my critic the second member for Vancouver–Point Grey and

his family. I know how he feels; I've been through a similar situation

myself. So if I can open with that comment, I will.

With respect to our agenda today, because of the critic's family

concern, I had not anticipated that we would be doing the Health

estimates today, and I made one appointment for people visiting me from

the Queen Charlotte Islands. I would like to keep that appointment; it

will brief. I'll ask another minister to sit in for me, but I'll make

that comment now so that everyone can be prepared for my brief absence

at 4 p.m.

Just briefly, in opening the estimates, Id like to say that I've had

some time now to visit a few hospitals and associations. I've found the

mood of the health constituency to be generally positive and good.

Naturally they are expressing some concerns, but I don't think there's

anything we can't manage.

I had the good fortune to be at the Royal Columbian Hospital in New

Westminster today, as well as at the B.C. Research Corp. dealing with

another health issue. I had the good fortune to attend the British

Columbia Medical Association conference in Kamloops on Saturday. I met

with their incoming president, Dr. Har Singh, who is a Kamloops

neurosurgeon. Of course, I had a good conversation with the outgoing

president, Dr. Hedy Fry.

Generally, the B.C. Medical Association expressed a concern for

health care in the province in terms of the increasing cost and where

it is going to be. My comments to them were that we had to be more

innovative and efficient and continue to look for better ways of

providing health care services, while maintain-

[ Page 12618 ]

ing some control over the costs. I think they all

agreed with that. It was a very positive afternoon with the B.C.

Medical Association, and I found their response to my comments to be

generally positive.

From what I've heard of the rest of their conference that day, they

are genuinely concerned with the provision of health care in Canada —

not only in our province. They are concerned that if left unchecked and

without appropriate innovations and efficiencies, it may in fact

collapse under its own weight. So it was a generally positive afternoon

spent with those good people, the members of the B.C. Medical

Association.

With those brief comments, Mr. Chairman, I'll take my place and

await further comments from members with respect to the estimates of

the Ministry of Health.

MR. PERRY: Mr. Chairman, at the outset, let me thank the

Minister of Health, the government House Leader and the government for

their courtesy in deferring the estimates debate last week. I'm very

grateful for the courtesy, and I'm also happy to be back here pursuing

the debate.

Since the minister referred to the recent meeting of the B.C.

Medical Association in Kamloops, I wonder if he could give us his views

on the initiative by the incoming president of the B.C. Medical

Association, Dr. Singh, to raise the desirability of user fees for

medical services in British Columbia. Has the government contemplated a

change in policy in a direction that would be presently illegal under

the Canada Health Act?

HON. MR. STRACHAN: I've been advised by my deputy that I got

the name wrong; I talked about Dr. Har Singh. There is a Dr. Har Singh,

who is an assistant deputy minister in the Ministry of Advanced

Education. The name of the incoming president of the B.C. Medical

Association is Dr. Gur Singh. My apologies to Gur for that

mispronunciation.

With respect to Dr. Singh's comments about user fees, it is clearly

not the intention of the government of British Columbia to raise the

issue of user fees. I was questioned by the press on that in Kamloops

on Saturday, in response to Dr. Singh's remarks and his request for a

user-fee program, but my answer was clearly in the negative. We are not

contemplating at this time any change in current policy.

Members will recall that in years past, in a previous

administration, we did have user fees. As the member for

Vancouver–Point Grey correctly pointed out, they in fact are contrary

to the current Canada Health Act. So inasmuch as there is no change

foreseen there, and as we don't feel it would be in the best interest

of British Columbians to enter into such a system or policy, I can

assure this committee that the current policy will remain unchanged,

and that user fees are not contemplated in any fashion by this

administration.

MR. PERRY: Mr. Chairman, I'm reassured by that answer. I

suspect there was perhaps an attempt to run that issue up the flagpole

in Kamloops. The policy that my party has taken against user fees has

been grounded quite firmly in the experience of Saskatchewan, where

under a Liberal administration user fees were introduced in the 1960s

for medical services and appeared to have a discriminatory effect

against poor people and people most likely to need medical service.

There is also the experience in Quebec prior to the introduction of

medicare, where it was learned that when universal access to medicare

became available under the prepaid health insurance system, utilization

of health services by poor people increased.

I'm reassured to know that the government agrees with us on the

wisdom of that policy. I suspect — and I hope — that we share the same

reservations about the administrative costs of implementing an

additional user-fee collection system, which might well outrun any

benefit in revenue. I see the minister nodding, so it's nice to know

that once in a while even we agree on important issues.

This is a minor issue, but one that I think I should clear up now. I

will raise it as delicately as I can. The minister will know that

within the Richard Blanshard Building, a seat of the Ministry of

Health, there has been for some time a firm anti-smoking policy.

Rumours have reached my ears that the policy is occasionally honoured

in the breach by administrators at very high levels and that this has

eroded the morale of some employees of the ministry. I wonder if the

minister could assure the Legislature that the non-smoking policy

within the Ministry of Health will be rigidly enforced from bottom to

top, top to bottom, stem to gudgeon, and that all employees will be

encouraged to respect the ministerial policy.

[2:30]

HON. MR. STRACHAN: Briefly on the previous matter, the member

mentioned the administrative costs of a user-fee program. There is not

only that, of course, but also the policy under the Canada Health Act

with transfer payments — EPF. If we did charge a user fee, it would be

deducted from the EPF payments. So there would be no benefit whatsoever

to the province if we were to enter into this type of extra collection.

With respect to the anti-smoking policy in the Blanshard Building, I

will look into that matter and ensure that the member and also the

people who work in the building have an answer to that question. I

understand what he's getting at. I share his concern.

MR. PERRY: While we're on that topic, it's appropriate that

we recognize some leadership in the anti-smoking field in British

Columbia when we see it. I'd like to acknowledge a very nice recent

example, because it sets an example for government and for politicians.

A 20-year-old man from Delta named Jamie Wills, who works in a gas

station, made the Province

yesterday because of his refusal to sell cigarettes to pregnant women.

I don't know whether his refusal technically violates the law, but it

certainly conforms to the best traditions of public health. I see,

according to the news story, that his boss has supported him. The

minister and I would probably share some admiration for somebody who's

spunky enough to encourage those most vulnerable to cigarette smoke and

who exposes

[ Page

12619 ]

an unwilling victim in such a gutsy way. I'd just like to recognize him in the Legislature.

The

article also points out that, like Coquitlam, a number of

British Columbia municipalities have passed bylaws requiring

restaurants and pubs to post signs warning pregnant women about the

dangers of drinking. This is an old practice in many American states.

It's something for which the Alcohol-Drug Education Service in B.C. and

others have been asking for a long time. I'm aware that the

jurisdiction for alcohol lies in the Ministry of Labour at present, but

I wonder whether the minister would tell us whether he has made

representations in favour of stronger health warnings on alcoholic

beverages in British Columbia, specifically warnings about consumption

during pregnancy. Has he made such representations to the Ministry of

Labour? Of course, many of us have regretted that the alcohol and drug

programs were removed some years ago from the Health ministry, but it

doesn't remove all responsibility from the Health ministry towards this

tremendous health problem.

I notice one practical thing that he might be able to reassure us about today. The Province

article yesterday refers to the need by the Health ministry to approve

a municipal bylaw in Coquitlam requiring warning signs in pubs and

restaurants for pregnant women about alcohol consumption. The

article

suggests that the mayor of Coquitlam expects that bylaw to be approved

by the end of the summer. Perhaps the minister could reassure us that

the bylaw could expect routine approval within the next week or two and

Coquitlam could get on with installing those signs.

HON. MR. STRACHAN: First of all, with respect to the young

lad in Richmond, I agree with the member. I didn't have the advantage

of seeing the newspaper article, but I certainly would agree that the

young lad took a courageous step and stood up with the courage of his

convictions. In terms of better health for not only the expectant

mother but also the baby she was carrying, I would encourage all people

in that situation, whether they feel their employer is behind them or

not, to make their opinion known, particularly to expectant mothers. Of

course, we know that in the United States cigarette manufacturers are

now required to label their cigarette packages with the warning that

smoking may cause damage to expectant mothers and also to the child

that they're carrying.

With respect to the issue of the bylaws, we have taken a positive

stand on this, Mr. Member. We have given our approval to the liquor

control and licensing branch, because they have the mandate to control

all signage within a pub or within any licensed premises. We have told

them that we are certainly in support of all of these bylaws, and we

want them to review the issue with a view to facilitating the

municipality's desire to pass such bylaws.

So we haven't ducked the issue nor set it aside by giving it to Labour

and Consumer Services. We have told them to pursue it with vigour, but they

do have the final word on signage in a licensed facility. They have our sound

encouragement, and we will do anything we can to encourage such signage and

bylaws in municipalities. We are leaving the application to the Ministry of

Labour and Consumer Services. I understand from my notes that they're most

cooperative on this issue.

MR. PERRY: In the spirit of the government's new ostensible

commitment to openness, would the minister care to provide the House

with copies of the recommendations made by the Ministry of Health to

the Ministry of Labour and Consumer Services, so that we know exactly

what has been recommended. When we get to the estimates debate, we'll

be in a position to ask why we haven't seen more expedient action.

HON. MR. STRACHAN: The member has my undertaking that I will

provide the appropriate correspondence, if it deals with that issue

only and nothing of a more sensitive nature. As I have done earlier, I

will find the material the member wants and table it when the committee

rises in the Legislative Assembly at the first possible opportunity.

MR. PERRY: Just before I forget, I'd like to clarify that

there were a number of other documents I requested on Monday, and I

haven't had time to refresh my memory of the list. The ones that come

to mind were documents referred to in the interim supply debate by the

Minister of Finance and the former Minister of Health regarding

unpredicted expenditures on certain drugs under Pharmacare in fiscal

year 1990-91. Has the minister located those documents yet, and if so,

have they been sent to me? Could we clarify that, because I'd like to

refer to them later in this debate?

HON. MR. STRACHAN: I've just been briefed on the issue, and

apparently there is some work being done now. The material is not ready

to be sent. I guess Finance has some concern, but we will endeavour, as

always, to provide the appropriate material at the earliest convenience.

MR. PERRY: Let me turn for a moment to another issue which I

suspect the minister, as I and other members, has been receiving

abundant correspondence on. Like other issues, it seems to come in

waves. The latest wave bids fair to inundating me, perhaps in the next

few weeks. But this issue has been around for a while, and I think it's

fair to ask for some comments on it.

I'm asking about early retirement for nurses. I believe I raised

this issue briefly in last year's debate and perhaps also in 1989. I'd

like to read briefly from a letter I received today from a nurse in

Vancouver, which summarizes the issue rather succinctly:

"Enclosed please find a copy of a letter which I have

sent to the Premier and to the Minister of Health", dated May 28. I and

many other nurses are seeking the support, in this case, of the NDP to

help B.C. hospital nurses achieve a fair retirement package. I have now

been nursing for 36 years without a break in service, and there are

many like me who are literally worn out. Thank you for your attention

to this request."

[ Page 12620 ]

Perhaps the minister has some familiarity with the training and

working conditions that a nurse like her would have experienced. To

have worked 36 years means that she graduated, I guess, in 1955, and in

those days nursing training typically was a matter of working virtually

every day, most nights and often all weekends as well. Often the nurses

were virtually incarcerated in the hospital where they trained, and

they were paid nothing or next to nothing. In those days they went

immediately into very hard work which was very low-paying, for the most

part.

A woman like this who has worked for 36 years has really given an

enormous service to the province, particularly in uninterrupted service

during which, if she raised a family — she doesn't clarify that — she

somehow managed to do while working. If not, she made a phenomenal

contribution simply in her hospital work.

The question I'd like to ask is: where does the ministry stand on

the issue of early retirement for nurses? I'm sure the minister has

received at least as many copies of the form letter as I have, and it

ought to be referred to briefly as well, so that those members of the

public following this debate can perhaps understand the issue. I'll

quote from one of the form letters I've received from another nurse in

Vancouver:

"Presently nurses are in group 4 of the municipal

pension act, with the retirement age being 65 and the early retirement

age being 60. The nurses' union is hoping to change this to group 2 —

retirement at 60 and early retirement at 55 — as is the case with

corrections officers, firefighters and police officers."

Given the nature of the nursing profession, this seems only reasonable. I quote again:

"Hospital nursing is an occupation which requires a

24-hour, seven-day-a-week schedule. Therefore most general-duty nurses

will spend their entire working lives doing shift work. It is well

known that shift work negatively affects one's health and length of

life. In addition, nursing has always been a physically and emotionally

demanding career. In recent years these demands have escalated because

of the increased acuity of the patient population. Moreover, the

nursing shortage, with the resulting increased workload on nurses, has

further compounded the stressors inherent in the profession. In turn,

the increased stressors heighten nurses' personal risk of injury and/or

illness."

There was a good example of that last week in Richmond, I think,

when a psychotic patient attacked and injured two nurses at Richmond

General Hospital. I'm not familiar with the details of the case, but I

presume that the facilities were not really adequate to look after

aggressive psychotic patients.

[2:45]

Mr. Chair, I've read that excerpt from the letter in order to describe

the real issue, which I think is fairly simple. I recognize that this is being

negotiated now as part of a labour negotiation, and what I'm asking from

the minister is to give us some general comments on the ministry's philosophy,

not a specific position in the midst of a labour negotiation. When I look at

this issue it strikes me as fairly simple. Nurses have worked at least as hard

as police and firemen. Nurses work in a rather high-risk profession where, in

the past in particular, the risk of hepatitis was extremely high, the risk of

back injury was extremely high and the risk of other injury and psychological

stress was enormous. Nurses, like firefighters and police, often have to confront

very difficult emotional situations — the death of young patients or unexpected

death.

As I try to look at this issue dispassionately, I can reach only one

conclusion as to why nurses are not included in the same benefits that

firemen, corrections officers and police are. I see the Deputy Minister

of Health waiting for the next line, which is inescapable: it's because

they are predominantly women. There's no other possible explanation for

that inequality in our societal arrangements.

I would like to know how the Minister of Health and the ministry

look at this issue on general principles, so that the public can know —

in the unlikely event that the present government is re-elected — what

direction they might expect to see in the next few years from the

present governing team.

HON. MR. STRACHAN: I appreciate the line of questioning that

the member is pursuing. As I said at the outset of my comments, I had

the opportunity to visit Royal Columbian this morning on my way down

from Prince George to Victoria. I was taken around by the head nurse

through a number of wards at Royal Columbian, and in all instances saw

the excellent care that is given by the nursing profession to those who

are in hospital. I visited everything from pediatrics to emergency to

the head injury section. I appreciate, as I guess as we all do, that

the care given by the nursing profession is indeed first-class and

outstanding, and it is truly appreciated by all who are in hospitals or

are in any way treated by a nurse.

The issue is difficult for me to respond to on an official basis for

two reasons. First, the contract did run out March 31, so negotiations

are continuing now and it would be very difficult for me as one of the

ministers responsible for this issue to make an official comment — so I

can't. The second thing is a parliamentary caution, Mr. Chairman, and

it's this: any change to the nurses' pension or date of pension

availability would be done by statute, so clearly we are discussing the

necessity for legislation here. I don't want to enter into that intense

debate or a debate which would be that specific, because it would be

infringing on our rules and would require that I comment on the

necessity for legislation. So I won't make an official comment for that

reason as well.

In terms of how I feel personally about this and what I can say in

this committee as the Minister of Health, I must admit I have some

sympathy for what the nurses are saying, what the member is presenting

and what nurses have mentioned in their letters. If I can lay out an

unofficial position just from my own heart, that would be it. I have

some sympathy with your comments and their argument, recognizing, of

course, that it would be a tremendous economic cost to the health care

system if we were to anticipate this. But maybe there is an argument

there and a way that in

[ Page

12621 ]

these upcoming negotiations something can be arrived at.

I certainly would not want to pre-empt meaningful negotiations

between parties, so I won't say much further on a formal basis. I will

say that I do have in my own heart and mind some sympathy with the

arguments that have been advanced both by the nurses and by the member

opposite.

MR. PERRY: Well, under the circumstances I appreciate the

minister's comments. Clearly there is agreement that this is an

important issue to be addressed. It's an appropriate one to consider in

the global context of a $1.2 billion deficit budget, where the total

supply of money is limited. Perhaps we can hope that it may be a

priority in the upcoming negotiations. As I look at it, it certainly

strikes me as an important issue of fairness, knowing what I know

personally of the working conditions of older nurses — the conditions

they underwent during their training and the kind of working conditions

they have lived through for decades, usually without complaining very

much. They were a very hard-working group of people who did their work

without expressing their grievances very often. I would certainly see

this as a priority area to be addressed in the upcoming negotiations. I

see some agreement from the minister, so I'm pleased with that.

Let me turn, if I may, to another relatively urgent issue. We spoke

last week and also in the interim supply debate about the issue of

intermediate care in Kaslo. One of the reasons that intermediate care

in Kaslo strikes me as a priority issue — the development of some

intermediate-care capability — is that the home support services are

quite limited. In the debate last Monday — or perhaps it was in interim

supply debate — I raised some examples of the most recent statistics I

had on the hours of home care in the Kaslo district.

Since then I've received notice of an even more significant problem,

perhaps, in the Nelson and district home support area. I'd like to read

some excerpts from a copy of a letter I've received, which was sent to

the hon. Minister of Development, Trade and Tourism, the member for

Nelson-Creston. The letter speaks for itself. It is from the president

of the Nelson and District Home Support Services Society to the member

for Nelson-Creston, copied to me and dated May 22, regarding home

support funding in Nelson:

"The board of directors of our society have asked me

to express their disappointment that almost two months after our

initial contact with your office requesting a meeting, you have

apparently been unable to get any response from the Ministry of Health

regarding this serious funding situation summarized in our one-page

brief faxed to you last month on an urgent basis."

That would have been in April.

"An immediate increase in the hourly rate paid to our society

for home care merely to bring us close to the rate paid to other home support

societies of similar size in the area seems a reasonable and easily justified

request. This situation is adversely affecting, directly or indirectly, IGO

employees and over 400 of our clients in your constituency. Quite frankly, we

are at a loss to know what further we can do if even yourself as our MLA and

a senior cabinet minister are unable to get action from the department involved."

The ministry, of course, is the Ministry of Health.

"We are enclosing another copy of our

summary

outlining the crisis situation we face and how it can easily be solved,

and sincerely hope that you will eventually be able to assist us in

obtaining a favourable outcome."

As I look at this memorandum dated April 17, 1991, to the hon.

member for Nelson-Creston, the local MLA, I find their argument very

convincing. I'll again quote briefly from it and then ask the minister

to explain what's going on. This is a memorandum from the Nelson and

District Home Support Services Society, signed by the president, Tim

Kendrick, on April 17, 1991:

"The problem: service to our home support clients is

at the point of breakdown because the hourly rate of funding we receive

is not enough to hire the bare minimum number of supervisors needed. We

have about 420 clients and 85 home support workers but can only afford

two field supervisors. The caseload continues to grow. The strain of

continual overtime, trying to look after all the clients, has already

led to three senior supervisors leaving at short notice on the point of

breakdown. This turnover means even more stress and less efficiency.

"We cannot continue like this and thus may need to

start refusing service to some clients. This would mean that they would

literally suffer or have to be admitted to care facilities at a vastly

increased cost to the health care system."

They propose a solution. This is one of those rare documents which actually is a brief; it's one page long.

"The solution: to cut through the bureaucratic red

tape and immediately provide the society with a long overdue increase

of at least 50 cents in the hourly home support rate, preferably

retroactive to January 1. This would enable us to hire the one

additional supervisor needed."

They offer a comparison with other home care districts. They say:

"Even a 50 cent per hour increase would only bring our rate up to

$16.04." That's the amount paid to the home support society, of which

probably about half in turn is paid to the worker who is working with

ill people in their homes. Some of it is used for administering the

service, coordinating the workers and doing the initial interviews.

I quote again: "This would still be below the rates already paid to

comparable agencies at Trail, which gets $16.94 per hour; Castlegar,

$16.25 per hour; Grand Forks, $16.17 per hour." Nelson was proposing an

increase from $15.54 to $16.04. "Our request therefore seems both

justified and modest."

Mr. Chair, I have to underline the action to date described in this memorandum.

"Urgent requests by other channels have apparently

fallen on deaf ears. October 31, 1990: letter from Joan Reichardt to

Derek Underwood, continuing care — no result. November 2, 1990:

personal plea from Jana Brych, program coordinator, to the Minister of

Health, copy to the Premier. Letters and promises of research from both

— no result."

I quote the brief conclusion to this memorandum:

[ Page 12622 ]

"Our board believes that in most cases it is best for

our staff to work through normal channels. This situation is

exceptional, however, having already reached crisis point, and we are

therefore appealing to you personally for assistance."

Mr. Chair, I visited that society last October. I remember

discussing with the program coordinator the increasing demands on the

service, which are a very good thing. Let us not mistake increasing

demands for home support as something bad to be curtailed or managed.

Increasing demands for home support mean people can be looked after in

their own home and community rather than in a hospital. Home support

provides a higher level of service to the individual and usually a

significant cost savings over the cost of hospital care. Delivering

more home support enables us not to spend on capital facilities like

hospitals and intermediate-care units. In general, more home support

clients are a good thing. We should not fall into the trap of

penalizing agencies which are increasing their enrolment.

I remember visiting them. The director, Joan Reichardt, described to

me how difficult it was meeting the needs of even the relatively

seriously ill clients they attempted to look after. She described one

young woman with multiple sclerosis who had to be hospitalized because

they could not provide sufficient home care hours to keep her in her

home, even though she desperately wanted to stay there.

The question I've got for the minister is: what is really going on

here? The situation is patently unfair. The difficulty in obtaining a

response from the ministry is alarming, and the fact that the home

support society has felt compelled to raise this matter with the

opposition after months of trying to deal with it through the normal

channels suggests a serious breakdown in communication. What is going

on?

[3:00]

HON. MR. STRACHAN: At the outset, let me describe the home

support services in general throughout the province, as we find it in

the budget. I do want to advise the Legislative Assembly that our

stated "blue book" cost for home support services was $126,623,589 in

fiscal year 1990-91; that has been raised substantially in our budget

for 1991-92, where we are estimating $147,066,193 for home support

services. The percentage change, which is a remarkable increase, is 16

percent in home support services. Let me point out that the letters

going to each individual society have not been sent yet, but they will

be receiving their respective budget notification letters later on next

week. As I said, the change is 16 percent; the increase is $20,442,604.

Of that $20 million increase, $12.8 million is for wages and benefits.

There are some substantial increases going to home support services

throughout the province.

To get the matter of Kaslo on the record, the Victorian Hospital of Kaslo,

in conjunction with the Kaslo and District Health Planning Society, have requested

development of intermediate-care beds at the hospital. The continuing-care division

has investigated the request and is unable to support an intermediate-care facility

for a community of approximately 3,700 people.

The hospital in Kaslo has an approved operating capacity of seven

acute and three intermediate-care beds. Of the seven acute beds, only

three are in use. Hospital care and the administrator of the hospital

are aware of the problems of filling acute beds and would be amenable

to a transfer of three acute beds to continuing care for funding as

intermediate care beds; that bed distribution would be 40 percent acute

— or four beds — and 60 percent intermediate care for six.

At this point, we have trouble justifying building an

intermediate-care facility for Kaslo. We could use the acute bed

surplus in Kaslo for its intermediate care bed needs. I will advise the

committee that the hospital care and continuing care in the hospital

negotiate the transfer of three acute beds for use as intermediate care

beds, and that the demand for home support hours in Kaslo is the same

this year as it was last year.

With respect to the issue in Nelson, we're just getting a briefing

on that now, and I can't comment officially on what the member has

described to the committee in his letter of the

summary of events in

Nelson. But as soon as that material is brought to me in the

Legislative Assembly, I'll be able to provide a more complete answer to

the member's inquiry.

MR. PERRY: I'm happy to wait until the information about

Nelson is available. If it can be brought up either later today or

tomorrow or at a later stage in the debates, that would be quite

satisfactory.

In regard to the Kaslo situation, I'm very pleased to hear that

answer, although I've been searching all through my files for the

letter I'm convinced I sent to the ministry last October. I know the

former Minister of Health stated the other day that he hadn't heard

from me on it. I thought I had written to him last October, and I

haven't been able to turn up the letter. I think there was one.

The observation I made after a visit to Kaslo was that a rational

interim solution was to convert a few beds. I'm delighted if the

ministry will be getting on with that proposal, because it can be a

major benefit to people in Kaslo.

While we're on the subject of home support, by some turn of logic it

leads into a local matter of great concern to me, and that is the

provision of services within the University Endowment Lands in my

constituency. The minister will be aware, probably from the press and

certainly from letters from the parents of Theodore Barber, that by an

anomaly, the University Endowment Lands in the very western tip of

Vancouver but not in the city of Vancouver appear to be the only part

of British Columbia not entitled to the full range of public and

community health services which the rest of the province enjoys.

Although I grew up in that area, I wasn't aware of this — partly

because the city of Vancouver, under a contract with the Ministry of

Health, has provided basic public health services, inspection of

restaurants and home care nurses. That probably constitutes the

majority of demand for service.

[ Page

12623 ]

[Mr. De Jong in the chair.]

But the parents of young Theodore Barber recently encountered the

situation when their son was eligible for tens of thousands of dollars

of appropriate public expenditure to repair a hole in his heart. He was

even sent to Toronto for surgery. Yet when he had a major speech

disorder requiring speech therapy, he was not eligible for speech

therapy.

The parents are students, along with much of the population of that

area. It's not all extremely wealthy people, as some of my colleagues

like to believe; there are many students living on very low incomes in

the University Endowment Lands. They are not eligible under the present

arrangement for services such as occupational therapy, speech therapy

and physiotherapy.

I've recently received a letter concerning a somewhat different

matter, which points out that another child living in the University

Endowment Lands who has a cleft lip and palate was not eligible to

receive speech therapy, but was fortunate enough to receive it briefly

through the courtesy of the University Hospital at UBC. But as the

father of that child puts it: "This window has been closed, and speech

therapy services are no longer available to other children who live on

the University Endowment Lands."

I hope the minister will have received a letter I wrote to him

recently after being apprised of that situation. The solution is fairly

simple. It's to negotiate, when the contract with the city of Vancouver

comes up this month, a renewal of the contract on a basis that's

equitable with the rest of the province and that provides the full

range of community health services.

So I would like to ask the minister to reassure the House that when

the contract comes up for renegotiation with the Vancouver health

department this month, those ancillary services will be provided and we

can be assured that as of July 1 the residents of my constituency in

the University Endowment Lands will have the same access to services as

people elsewhere in B.C.

HON. MR. STRACHAN: I was aware of the situation. I read about

it in the paper, although the situation wasn't totally as stated in the

newspaper report.

However, the member more or less describes the vacuum that seems to

exist in terms of services in that area. But I can tell the member that

we are negotiating now with Vancouver for provision of services to the

residents of Vancouver–Point Grey. I would suspect that the services

offered in Vancouver–Point Grey will be the same as in every other part

of the province when the negotiations are completed.

MR. PERRY: That's another small victory for the people of Vancouver–Point

Grey. While I'm on Point Grey issues, perhaps I can refer again to a somewhat

different issue, which is the brief by the faculty of medicine at UBC to the

Royal Commission on Health. The faculty made what might have seemed a rather

unusual suggestion a few years ago, which is that 2 percent of the annual Health

budget be spent to ensure that the dollars spent in the health care system achieve

the greatest benefit possible.

I have a recent letter from the dean of the faculty of medicine, Dr.

Hollenberg, and one could hardly find a higher source than the dean of

a medical school to make a statement like this. "I suspect a great deal

of what we do in medicine in the treatment of patients has never been

fully validated by objective assessment outcome analysis, particularly

in relation to cost-effectiveness." He points out that his faculty

therefore recommended a commitment of the ministry to allocate 2

percent of the budget towards assessing the effectiveness and

efficiency of the delivery of health services.

I think I pointed out last year that there's nothing new about that

concept. One of the perhaps least known in this country but most

resilient classics in the history of medicine is a book called Effectiveness and Efficiency ,

published in the early fifties or the late forties by Cochrane, based

on lectures delivered for the BBC on the effectiveness of health

services in the United Kingdom. At that time, Cochrane pointed out that

much of what was done was untested, untried and of no proven value, and

here we are 30 or 40 years later in much the same position: relearning

the old lessons over and over again and addressing new technologies

often with a lack of understanding by the public.

I would like to point out that I believe this ministry in British

Columbia has been one of the leaders in North America in attempting to

restrain the inappropriate use of unproven technology. Sometimes I feel

they've been a bit overzealous, and I've told them so many times. But I

think the intent of the ministry over the last few years has been

generally sound in attempting to ensure that new technologies are

introduced only when there were proven benefits and when the return

would justify not only the capital expenditure but the recurrent

operating costs.

However, that philosophy has not permeated widely through the

community; it's getting somewhere perhaps. But faced with the barrage

of propaganda from the press about new health improvements, including

the respectable press and the less respectable press like the National Enquirer ,

it's very difficult to get the message across to the people that bigger

and more is not always better, that sometimes home care is a much more

efficient and humane service to provide, and that raising the wage of a

home care worker from $8 an hour to $9 or $10 an hour might be a much

more useful and efficient investment than buying a fancy new machine

for a million dollars and running it for another couple of million

dollars per year.

[3:15]

I think, therefore, that the suggestion of the dean of medicine at

UBC that the ministry formally commit a set percentage of its budget to

health care assessment and to promoting the public's understanding that

we need to be critical about new technology, new drugs and new

techniques is very sound. I wrestled with that one in my mind when I

first heard it. Is it an arbitrary figure? Of course it is, 2 percent —

it might have been 1.9 or 2.1. Clearly it's arbitrary, but it's

symbolic. It's a large sum of money, and it might actually get us the

[ Page 12624 ]

punch that would allow us to save a much larger percentage over the long haul in our health care costs.

I'd like to see the minister stand up and say he's going to be very

aggressive about that — much more than the ministry has been in the

past; that he's going to learn from some of the overzealous mistakes,

such as MRI scanning in the Vancouver General Hospital; and that in the

remaining short days left to him in this government and then when he

sits on the opposition side, if by any chance he's re-elected — I don't

suppose he will, but if he should grace these benches — he's going to

be a fervent campaigner for cost evaluation and efficiency and

effectiveness evaluation.

HON. MR. STRACHAN: The member gives me a great entry here

from my former Ministry of Advanced Education, Training and Technology,

where an awful lot of money was spent on research. I can assure the

member, and I think past budgets that I introduced to this House will

show, that I was and still am a very strong supporter of research in

British Columbia. Indeed, a couple of days previous to my being

appointed to the portfolio of Advanced Ed in November 1989 I was the

good-news recipient that in fact British Columbia had done extremely

well. We found out that British Columbia, in terms of centres of

excellence and research awards, led Canada. We have about 12 percent of

the population and we received 40 percent of the funding from that

federal program. In all the portfolios that I've been in — and they're

getting to be considerable now — I have been encouraging research,

which is a very wise investment for the province.

One more thing, back to Theodore Barber, the young lad from

Vancouver–Point Grey. Speech therapy services are available for

Theodore Barber, as they are for every other resident in Vancouver and

have been since 1990, when the UEL received services as required from

the Boundary Health Unit and the Coast-Garibaldi Health Unit. We

negotiated that contract in 1990. So the provision of services is there.

Back to the member's comments about research. As he said, his

comments were based on a submission to the royal commission. I

certainly don't want to pre-empt the royal commission in terms of their

assessment of that submission. They will make their recommendations

from all the information that's been provided to them through the

hearings, meetings and submissions that have been made. I wouldn't

attempt to prejudge how they're going to view this issue.

Philosophically, the member and this committee know that I'm strongly

supportive of money invested into research, as it clearly is an

investment.

As the member knows, and as the committee will understand, we have

the B.C. Health Research Foundation. I've been a member of that as

Minister of Advanced Education, and now I am chairman, as the Minister

of Health always is. The budget is $10.75 million for this year,

approximately a 5 percent increase over last year's budget.

We have provided $360,000 to provide an office for health technology assessment.

The health-human resources research unit we've funded to the tune of $540,000, and the health development fund, $2.9 million.

What the submission to the royal commission recommended was a 2

percent increase in our budget. That calculates out to $108 million in

this current budget, which coincidentally is the budget of the

University Hospital. I think I have to say with regret that I don't

know if we could spend that money immediately. As I found out in

Advanced Ed when we discussed the issue of percentage funding for

research and development, it's questionable whether or not Canada has

the appropriate manpower to spend that money in an appropriate way.

We're looking at specially trained people at a professional level, at a

good number of very specially trained technologists and other people

who will assist the professional investigators in research. It's

questionable whether we could spend that at this point. That's just a

peripheral remark on my behalf with respect to the comment of 2 percent

of the Health budget spent on that.

Secondly, I would still advocate from a policy point of view,

although the Ministry of Health does have, as I indicated earlier, a

substantial commitment to health and research.... Perhaps the Ministry

of Advanced Education, Training and Technology is the more appropriate

body to undertake some of that funding.

We must be reminded at all times that good health research doesn't

necessarily come just from medical doctors. It comes from people who

are investigators and specialists from many other disciplines. Many

disciplines in the sciences and social sciences do excellent

investigation with respect to health issues in our province. I wouldn't

confine any research money just to the medical field. If you want

better health results, there's a lot of money that can be spent by a

variety of specialists investigating better ways and better provisions

of health service, and new and better techniques, research methods and

therapies outside of the medical profession. So that's my comment on

that.

I strongly agree with what the member has said. I think I just

philosophically differ in the focus of this type of research. In

research funding, the committee will know that as an administration in

the last five years, we have considerably upped the amount of money

that goes into research and development. We, of course, have advanced

the notion in the strongest terms of the kaon facility at TRIUMF. We

have introduced the $420 million science and technology fund. Over the

five years, we have invested heavily in research in this province, and

that will continue to be a commitment and priority of this government.

I'm sure the member knows that and is aware of what we've done, and he

and this committee have my assurance that research and development will

always be a priority with this government.

MR. PERRY: We're in a somewhat nebulous area. Of course, I

agree with the minister it would be unlikely we could immediately spend

$100 million on health care efficiency research. We might well not be

able to find the appropriate people to conduct studies; and sometimes

even the ideas as to what should be studied

[ Page

12625 ]

aren't that clear. But it's a goal that we should be striving for.

To make it a little less nebulous, let's look at that $10.7 million

budget — if I've got it right — to the B.C. Health Research Foundation

and the 5 percent increase over the previous year. The University of

B.C. has just sent out an urgent alarm to its members describing the

reduction in Medical Research Council funding and the very low success

rate of applicants for new federal Medical Research Council grants in

health research. The reason for the low 17 percent funding rate is not

that the grant proposals are not good or are inadequate; some of them

are, some of them aren't.

But the rate of success has been declining over the last few years.

The reason that it's going down is because the amount of money supplied

to the Medical Research Council has been reduced. In absolute terms, in

actual dollars, the amount has gone down. In real terms the amount has

gone down much more, because health research costs always escalate much

more than the rate of inflation, regrettably. The cost of supplies and

machinery tends to go up much faster than the rate of inflation.

Salaries for technical workers in research have, if anything, probably

lagged behind inflation. I don't know, but I suspect that not salaries

but factors beyond our control are the cause of the inflation.

Equipment made mainly in the United States, Germany, Sweden and England

goes up at incredibly fast rates.

A 5 percent increase in the B.C. Health Research Foundation dollars

amounts to a net decrease in the actual amount of research that we can

buy. To the extent that we have good ideas to study, I don't think we

should be proud of a 5 percent increase in funding in British Columbia,

particularly at a time when federal funding for medical research is

being cut back. We've been through this game before back in the

seventies when the Trudeau government was in power. The then Minister

of State for Science and Technology, Mr. Drury, preferred that there

not be any medical research in Canada. I think the member for

Coquitlam-Moody probably remembers that the then federal minister

wanted to simply let the Americans do the research and we could ride on

the coat-tails. It looks as if maybe we're getting back into that

rather short-sighted view at the federal level.

I think we need a much more vigorous commitment. What I'm really

trying to get at here is that it's not the exact dollar figure. It's

not a commitment to exactly the 2 percent target; it's a commitment to

the long-term idea that health care research will probably not only

improve the quality of the health of British Columbians, but save us

money in the long run.

I'd like to give a very small example that relates to the B.C. Health Research

Foundation projects on asthma research, which, if I recall accurately, have

been generously funded by that body. During my short medical career the conception

and understanding of asthma has been revolutionized, in part by research done

at UBC and St. Paul's Hospital. That research has focused attention on the

fact that treatment for asthma has not been very successful. The number of deaths

due to childhood asthma, if anything, has risen in developed countries around

the world, and something was being done wrong. That research group has had a

profound influence, along with others like it in Canada. Canadians perhaps have

led the world in this field, in understanding that the then modern medical conception

of asthma was rather mistaken and in fostering an improved understanding of

how to treat people better. That message has been very difficult to get out

into the medical world. Doctors are pretty darn stodgy and are very slow to

change on issues like that. That's been proven over and over again. The

research people — Dr. Perry, Dr. Hogg and others at St. Paul's Hospital

and UBC; and Dr. Jody Wright, who recently received a teaching award at UBC

for that kind of work — have had a profound impact on clinical practice, which

will continue and will improve the health of British Columbians and others.

I'd like to see the minister committing himself to something more

than a 5 percent increase in the B.C. Health Research Foundation total

budget. I think that's pretty measly.

HON. MR. STRACHAN: Let me get on the record that the member

may feel 5 percent is measly, and I guess I do for this year, too.

However, over the years the grants awarded to the British Columbia

Health Research Foundation have stayed well ahead of inflation. I make

no apology whatsoever for our commitment to research and development,

and the record shows that. Five percent this year — sure, it could have

been higher. But over the long term our record is solid and clear and

shows a solid commitment to research in health areas. It is clear that

we have maintained this level of funding well above any measures of

inflation.

With respect to the other comments the member made, I couldn't agree

more. He has presented an interesting debate and discussion with

respect to asthma research. I accept that we have some leaders in

British Columbia, and that's good. We will continue to provide them

with the best possible resources in every fashion we can.

[3:30]

MR. PERRY: Before I yield to the member for

Boundary-Similkameen, I'll just follow up with one other very concrete

suggestion. The minister indicated last week that he welcomed

constructive suggestions. I'd like to reiterate one which I made last

year and I think the year before to the then Ministers of Health.

One factor which greatly curtails the ability to promote

constructive health research and the application of new knowledge in

health fields is the extremely difficult funding situation not only of

the UBC faculty of medicine but also of the associated faculties of

nursing and physical and rehabilitation sciences. One of the most

constructive steps the Ministry of Health could take would be to bring

our policy in line with other provinces and allow some direct Health

ministry funding for teaching positions within those faculties.

I can speak best for the faculty of medicine, which I'm familiar

with personally, in which young medical scientists undergo very

sophisticated training at considerable financial sacrifice and usually

end up with no

[ Page 12626 ]

reliable source of funding to teach in a faculty of

medicine. The situation has been very desperate in the last five years

or longer, and we have lost a lot of very good people to clinical

practice — where they cost the taxpayer a lot more money than they

would in a university; they don't work any harder, they just bill a

much larger amount in clinical practice — or to other provinces or

other countries.

If we want to improve the quality of our teaching for young doctors

and other health professionals in B.C., we need reliable support for

those faculties. The universities have been so constrained in the

recent difficult financial times that the resources have not been

directed in that direction. I would like to see the minister indicating

some commitment to perhaps shifting a small portion of that enormous

Health ministry budget towards funding a few more long-term positions,

so that young medical scientists and other professionals in the health

sciences would have security of employment — to know that it's worth

investing in that kind of career, and particularly investing in

teaching careers in the teaching of real excellence and efficient

practice in the health sciences.

HON. MR. STRACHAN: Once again I will say that I'm in

agreement with the member's concerns and advise the committee and also

the member that we have the Barer-Stoddart report, which is advising us

on medical manpower. That will be released or coming to us shortly, and

we are sure that it's going to make recommendations along those lines

of improving research and the investigative process and making better

use of the medical and scientific manpower that we are developing in

the province of British Columbia.

Generally I would say that I welcome the member's suggestions. I

would have no problem at all in instructing our staff, the staff at the

university and also staff within the Ministry of Advanced Education,

Training and Technology to review these issues. When the Barer-Stoddart

report is available to us, maybe we'll feel that the changes that the

member has suggested are appropriate and can be carried out.

MR. BARLEE: I canvassed this very briefly last week when the

minister was unavoidably absent from the House, and the answers I

received from your stand-in were not, I feel, adequate. It's a matter

from my own particular riding — Boundary-Similkameen — and it concerns

a request for an intermediate-care facility in a town. I outlined some

of the reasons last week, and I will go over this again.

First of all, this particular town, Keremeos in the south

Similkameen — I'm sure the minister is familiar with it — is a town of

several thousand people. They have the second-highest percentage of

seniors in the province, after White Rock, according to my figures.

This is a unique community in that it is generally a poor community by

economic standards. Their average income per family is about $10,000

behind other families in British Columbia. That's in the 1980s.

The people in that area have consistently asked the government to

provide some funds for an intermediate-care home. In fact, 1,100

letters were written. These were not form letters; these were

individual letters from various people in the community, which means

virtually everyone of legal age in that community wrote a letter to the

ministry. I think it's very important for several reasons. First, it is

a community that requires this type of help because of the makeup of

its inhabitants. Secondly, I think that the ministry's criteria.... I

have letters from the ministry saying that the request from Keremeos

does not meet the criteria set down by the ministry. Well, I wonder if

the criteria are an accurate reflection of the need of the people in

this particular area. I know that the articulate member for

Vancouver–Point Grey mentioned Kaslo; it seems to me in somewhat the

same boat.

What it requires is this, really. There are people there in their

seventies or early eighties who have been married 50 or 55 years. If

there is no intermediate-care home in Keremeos, they're required to go

usually to Summerland. That's an 80-mile round trip — miles, not

kilometres. It's sometimes simply not possible. So people who have been

partners for 50 years, in many instances, are essentially separated:

one of the partners is in Keremeos, the other in Summerland.

This town requires it for a number of reasons, not just health

reasons; also for economic reasons. The unemployment rate is about 20

percent, about the highest in the province of British Columbia. So in

the criteria I measure by, certainly this town should be considered.

The letters we have received from the ministry have consistently

indicated it does not meet the criteria. I'd like to hear the

minister's answer to that, please.

HON. MR. STRACHAN: I regret to tell the member, Mr. Chairman,

that the criteria have not changed, and neither has the answer. The

community is situated southwest of Penticton, and as the member

indicates, it has a population of approximately 3,700 people, of which

22 percent are over the age of 65, or seniors. For that reason the

community receives well over 10,000 hours of home support annually from

Keremeos and District Home Support Services. It is felt that if there

is an identified need for intermediate-care beds in the south Okanagan,

these beds should be located in the Penticton and Osoyoos-Oliver areas,

due to the availability of support services, the age of the population

and the need for additional beds.

That is the answer to Keremeos. I wish I could be more forthcoming

for the member, but at this point that's our ministry policy, so the

answer is unchanged.

MR. BARLEE: I thank the minister for his answer. My figures

differ somewhat from yours. You say 22 percent; mine say very close to

30 percent. I would like to know when your figures were obtained;

perhaps they're very recent. According to the individuals in the area,

it's considerably above 22 percent.

A letter I just received from the two doctors in Keremeos — there

are two doctors there, Dr. Jeanes and Dr. Partridge — indicate that

they do require an intermediate-care facility. I know you've heard this

story before, but I think what they point out in the bottom line of

their letter is really quite important:

[ Page

12627 ]

"Our seniors should be able to live out their lives

in this valley, without having to move elsewhere to have their health

care needs met."

A government who state that they're keen on decentralization should

give a higher priority to this. There are 3,700 people, and it is

growing at a very rapid clip. A number of seniors are retiring there,

because of the low cost of housing and the relative cheapness of living

in this part of the south Similkameen. It is different from the south

Okanagan in that Oliver, Osoyoos and the Okanagan trough, of which

Summerland is a part, are all contiguous to each other. This means

going over a mountain road, in the middle of the winter, either over

Richter Pass or Highway 3A. In fact, last year two people were killed

doing that precise thing: visiting relatives in a care home in Oliver.

I would like the minister to examine it again, and to check the

figures. And could you possibly tell me where you obtained the figure

of 22 percent?

HON. MR. STRACHAN: To answer the last question first, we've

done recent studies on this issue, because as the member indicates it

has been brought to our attention and has been presented as a concern

to the Ministry of Health. I would expect that the figures I provided

in terms of seniors as a percentage of the population are correct — at

least to within the last couple of months. However, we'll certainly

review our source of information to find out why it doesn't appear to

be corresponding identically to the numbers that the member opposite

has advanced.

[Mr. Ree in the chair.]

With respect to the larger concern of providing intermediate care in

Keremeos, I guess we can say generally that if we know that a

population increase is coming — particularly in the senior population —

then it is of course going to change our thinking with respect to

providing those services. If that population increases, it would make

provision of those services and the expense involved far more

appropriate.

The member has my commitment that we will continue to monitor the

situation. I clearly understand his concern that even in the lovely

southern part of our province — the Boundary area — they do get snow

and inclement weather from time to time and that travel, particularly

over the mountain passes, can be rigorous and at times dangerous. I'll

take those suggestions as noted and pursue the issue on behalf of the

good people of Keremeos.

MR. ZIRNHELT: My question to the minister has to do with the

G.R. Baker Memorial Hospital in Quesnel, where for a year and a half

now there's been a request to consider leasing out unutilized space in

the hospital — some 30,000 square feet — to other Ministry of Health

and related services. Recently the Minister of Government Services said

that she would get involved, and I know there's some resistance to this

because of the supposed inadequacy of space having to do with moving

the administration part of the hospital. I wonder if this minister is

committed to looking into this. The reason I ask is that a $15 million

expansion was put into this hospital in order to free up space to

coordinate Ministry of Health services. Have you looked into this, Mr.

Minister, and what is the result of your investigation?

HON. MR. STRACHAN: The member is discussing the issue of the

present health unit building in Quesnel and its need for major repairs

and renovations. Just to give the committee some background, the G.R.

Baker Memorial Hospital is a community general hospital offering a full

range of services. It has 68 acute-care beds, including four ICU, and

40 extended-care beds. Their '90-91 operating grant was $9,170,451.

A bed-replacement program was completed a few years ago, and the

vacated space was not demolished. So local groups, including the city

of Quesnel and the regional hospital district, in addition to the

hospital, support the use of this space for community health services.

As a result, space and planning facilities management has put the

planning of the proposed health centre on hold, and the hospital will

be asked to prepare a long-range plan of its needs which will clearly

indicate that they can make a long-term commitment to supplying

community health care services.

The long and the short of it, Mr. Chairman, is that we have

requested the hospital to develop a master site plan. I'll advise the

member — I'm sure he's aware of this policy and philosophy — that we

certainly support locating community health services, when it's

economically feasible and appropriate, in combination with hospital

facilities. There's no question about that, and if it's possible for

G.R. Baker Memorial Hospital to make a long-term commitment, that space

will be available in that facility for community health services in

Quesnel. We are certainly prepared to consider the hospital location as

an option.

I might point out that a good friend of mine, Ken Last, is the

administrator there. I knew Ken in McBride and later in Kitimat, and

now he's at Quesnel. He's a first-class fellow, and I'm sure any

recommendations that he and his board arrive at will be considered

seriously and with some positive stance by at least this minister and,

I'm sure, by this ministry.

MR. ZIRNHELT: I trust that there's active coordination going

on with BCBC and the minister responsible for BCBC to ensure some

coordination on this?

HON. MR. STRACHAN: Aye.

MR. ZIRNHELT: I thank the minister for his comments. I'm sure

we'll hear more if they do have a long-range plan that can make space

available.

My next question has to do with the provision of catastrophe relief

for hemophiliacs who contract AIDS from tainted blood that was approved

by the federal and provincial government. I understand the provincial

government has not yet approved a program of compensation. I raise this

because a number of my constituents are in danger. I have received

several letters from one person who never knows when his last

[ Page 12628 ]

day is and who is quite concerned about his family

being able to cope afterwards. Has the minister approved of the program

already approved by the federal government to compensate victims of

this catastrophe?

[3:45]

HON. MR. STRACHAN: That's an extremely sad and devastating

situation the member has described. We are sympathetic towards it.

We're not aware of what other governments have done, but what we have

done is this: as federal aid is supplied to these affected

hemophiliacs, we have not had that aid component deducted from any

provincial payments. So we are recognizing that special assistance is

required, and we are certainly providing that in terms of our policy.

MR. ZIRNHELT: Just to clarify. The province is not in any way hindering the delivery of this catastrophe relief to these victims?

HON. MR. STRACHAN: No, absolutely not. In fact, that is not

our policy at all. It's the opposite. We are not hindering. I can say

that with some assurance.

MR. ZIRNHELT: A supplementary question to that. Is there any provincial funding going into relief for those families?

HON. MR. STRACHAN: Not specifically to those hemophiliacs so

affected. But any provincial assistance given to people with AIDS is,

of course, provided to those hemophiliacs who are so affected.

MR. ZIRNHELT: My next question has to do with the provision

of ambulance services in the Anahim Lake area. The minister may be

familiar with this situation, as it did come before the regional

advisory committee. The situation is such that there have been a number

of lives saved and attributed to the fact that the ambulance attendant

in the area happened to have the required training to deal with the

trauma. It's over a hundred miles to the nearest hospital. More likely

you would have to go 200 miles to the Williams Lake hospital if there

was a serious accident.

The inflexibility and lack of coordination among the various

ministries involved has led to a situation there where the position had

been staffed by a person who is qualified and very much in danger of

losing that, because of being paid only on a fee-for-service basis.

This is a remote outpost. There was virtually no change made to medical

facilities there when major industry was developed, which has been

responsible for a number of accidents — the trucking and sawmilling

industries.

I wonder if the minister can give some assurance that his officials

have discussed this matter with the federal Ministry of Health, which

takes care of native people in the area, with a view to trying to

coordinate some positions there so that a person qualified to deal with

trauma of this sort on a first-aid basis is available in the area.

HON. MR. STRACHAN: First of all, let me tell the committee

that that's one of my favourite parts of the world. I really enjoy the

Chilcotins and the Anahim Lake area; I've been there many a time. My

most recent visit was in January 1990. I have considerable interest and

genuine fondness for the area.

There are currently five active part-time attendants in the area who

respond to about 150 calls each year. As it happens, the unit chief has

been trained to the EMA 2 level, which is of course a desirable thing

for the community to have. They would like the unit chief to be

employed on a full-time basis, which we can't do with the call volume.

Therein lies the problem. I will give the member some assurances that

we will look at this, but this would have an implication on policy

throughout the province. There is obviously a very good part-time core

of people there who are providing an excellent service. We will take

the member's comment and respond in an appropriate manner.

MR. ZIRNHELT: I wonder if you noted the part of my comment

that dealt with the need to coordinate between the federal and the

provincial health services, because there is considerable staffing by

the federal health services there. It seems to me, looking

holistically, that perhaps there could be shuffling of services or

positions so that we could end up with a person with the necessary

qualifications. I'm not speaking here necessarily about any particular

individual, but a position where the person is trained to deal with

this sort of trauma.

HON. MR. STRACHAN: That's a good suggestion, Mr. Chairman.

We'll look at it. I'm aware of that concern. As I said earlier, I've

spent some time in that area and have been apprised of the situation —

particularly of the federal-provincial relationships up there as they

pertain to health care. The concern and the questions are not unknown

to me, and we will have a response for the area.

MR. ZIRNHELT: I'd like to thank the minister for his interest

and concern on that matter. I know that both the chief in council and

the members of the community would appreciate him looking into it.

MR. PERRY: The minister has to leave at 4 o'clock promptly?

HON. MR. STRACHAN: I'll just qualify that: yes, I have guests

who are expected in my office at 4 o'clock. As I said earlier, they're

from the Queen Charlottes. If the member, the critics or the committee

could excuse me and have other members carry on the debate, I would

certainly appreciate that. As I said, the hour for that appointment is

4 o'clock, so we have about six or seven minutes to continue on this

debate. But I thank the member for his courtesy.

MR. PERRY: A few more short snappers then for the minister in

the interval. Virtually anyone from the Queen Charlottes, particularly

in the health field, are friends of mine. I don't know who his visitors

are, but I

[ Page

12629 ]

hope he will take them my greetings when he meets them.

In the short time until the minister slips out, let's go back just

for a moment to debate the anti-smoking strategy. A week ago today....

I would like to pursue that some more, and I'll probably pursue it a

few more times yet in this debate — at least once a day.

I've had a chance to glance in a very cursory way at the remarks of

the minister from June 3, and I note that he reiterated what I referred

to last year as the excessively modest goal of the Ministry of Health

to reduce the percentage of tobacco smokers in B.C. from an estimated

22 percent in 1990 to 20 percent by the turn of the century. That

strikes me as a typical example of a Socred business plan. It's sort of

like establishing a business plan and then going to the bank with a

proposal to lose money every year for the life of the business.

We know that the percentage of smokers is gradually falling no

matter what government does, because smoking is increasingly regarded

as a disgusting habit by society in general. The minister and I agree

on that completely, as did many members of the government side as well

as this side. For once we've got something we can agree on. But when

you think about it, a decline from 22 percent to 20 percent of the

population smoking over ten years is really sort of like setting out

with a large capital investment to lose money for as long as you can,

because it doesn't represent anything.

I argued last year that we could maybe have an ambitious goal like

cutting it to 15 percent or 10 percent. Or we could be really ambitious

and not have any new smokers in the year 2000. Now what disturbs me —

and the reason I raise this — is that without some goal, without some

ambition, there's no hope for change or progress.

I've seen that beautiful little brief, "Tobacco Reduction Strategy,"

produced in the health promotion office in the Ministry of Health. What

a wonderful little document that was. I think I embarrassed some of its

authors last year by praising it so warmly. Maybe they thought I was

making fun of it, but I wasn't. I thought it was one of the most

beautiful little documents I've seen because it was brief — one or two

pages — punchy and incredibly ambitious. If that strategy were

implemented, we would perhaps be the world leaders in controlling

tobacco abuse and putting addiction pushers in their place.

I referred last week to Mr. Bill Neville. I thought somebody would accuse me

of unparliamentary language for mentioning his name in here. It's certainly

a bad name in the health profession and is a name that ought not to be mentioned.

But unfortunately he is still on the loose; he is rampant. He is virtually riding

on the Prime Minister's back, because he is a key lobbyist for tobacco manufacturers.

I know that the minister is as committed as I am. I am not an ex-smoker, but

we share the same passion. I keep wondering: does Bill Neville have his little

finger somewhere in the British Columbia government so that we're not getting

a more ambitious policy? Can the minister give us some assurance that he will,

for once, unchain his bureaucrats? I see them champing at the bit to actually

move somewhere in this direction. Unchain them, and let them go do something

wonderful for the people of B.C.

HON. MR. STRACHAN: God, I can just imagine an unchained bureaucrat.

At the outset, reducing the figure to 20 percent.... I agree with

him, maybe we should change that to ten. Maybe we should set our sights

higher. Maybe we should show more concern. I don't know what changing

the number would do except to change a number. The member has indicated

— and I agree totally with his concerns about smoking — that there is

no one purer than the purified, of which I am.

I'm glad he liked the brochure. I can tell the member that there is

no one from the smoking lobby talking to anyone in the Ministry of

Health nor from any other lobby, because that's not the way I do

business nor would I expect anyone in the ministry to do it. Any

initiatives taken by the fellow mentioned by my critic, if he wants to

take it up with the federal government, he can. Any overtures made to

me, this ministry or anyone in our cabinet would be soundly turned down

immediately, and I can give this committee that assurance.

[4:00]

With respect to the 20 percent, maybe it would be worth our while to

change that number in the material we are providing. I can tell the

committee now that with only 22 percent of the population smoking, we

have the smallest percentage by population of smokers by province in

Canada. Of course, as you get to the real hard-core puffers, it's

pretty hard to talk them out of it. As you decrease to the low 20s, any

thought of getting that number lower becomes more and more difficult

because you are dealing with some very hard-core and committed smokers.

I'm going to be excusing myself for just a few moments now, but for

those of you who do smoke and who are listening, I'm reminded of a

comment by a fellow. As a matter of fact, he was an ambulance attendant

in Valemount and a real good guy. He was really concerned about his

health and everybody else's health, and he said to me: "I want you to

remember that everybody quits smoking sooner or later." This is one of

the thoughts that made me think about quitting smoking. That does have

a tendency to focus your attention on the concern and on the fact that

it's a very serious health issue. We can talk about smoking-cessation

programs and government policy all we want. I'd be more than happy to

do so and will continue to. I assure this committee, members opposite

and members on this side as well that when it comes to this issue, any

cessation strategy has my total and uncommitted support.

As I said, I'm going to exit briefly because I have some good people

from the health industry who are visiting us from the Queen Charlotte

Islands. I don't know if any other members on this side are going to

leap into the breach and discuss health issues, or maybe the debate

will continue from the opposition side of the House. Nevertheless the

staff will stay here, ever on the ready, and any concerns that are

addressed by members will be responded to in the fullness of

[ Page 12630 ]

time and as quickly as possible. With that said, I thank you, and I'll see you soon.

MR. PERRY: I wasn't clear on the procedure. Perhaps one of

the ministers is going to temporarily take the place of the Minister of

Health to respond. Or are the government members sufficiently enjoying

my discourse that they would like me to continue with some long

snappers? I await the Minister of Energy's indication as to how we

should proceed.

MR. CHAIRMAN: If no members are on their feet, I will ask the question.

Interjection.

MR. PERRY: My colleague the second member for Cariboo

suggests a very intriguing line of inquiry, which is the whole subject

of native health. Because we have in our presence the former Minister

of Native Affairs, it seems an appropriate area to pursue. We know in

this province, as in much of the rest of the country, that native

people enjoy a standard of living which is considerably inferior to

non-native British Columbians. Despite the remarks of the former

Minister of Finance about the gravy train, the figures are well

established.

Infant mortality is higher, as is the tuberculosis rate, the rate of

complicated pregnancies and the prevalence of diabetes, arthritis and

severe arthritis, and the problems of child health are generally more

severe. Alcoholism is a major problem, and the treatment facilities

tend to be often little short of pathetic.

I'd like to, if I can ascertain what's happening now on the government side....

AN HON. MEMBER: It's a cabinet shuffle.

MR. PERRY: For those who are only watching on television and

can't understand what's happening, there's a cabinet shuffle apparently

going on right now. Can you advise, Mr. Chairman, to whom I should pose

my questions?

MR. CHAIRMAN: Hon. member, I can understand why maybe a

television audience can't understand, when some members of the House

can't even understand. No member may stand and speak at a desk other

than that assigned, so the minister had to attend at his own desk, and

I'm sure you now appreciate this.

MR. PERRY: I now appreciate that. Thank you, Mr. Chair.

I'll continue that line of questioning. I'd like to ask the minister

and his officials what initiatives are contemplated in the new budget

year for the improvement of native health services.

HON. MR. WEISGERBER: In starting, I'd like to suggest to the

opposition critic and other members who may wish to rise and ask

questions while I'm filling in for the Minister of Health that if in

fact you can ask long questions that can be answered with very short

answers, this will probably move along reasonably well. Otherwise it

will be a short question time.

The question of health in Indian communities in Canada —

particularly those on reserves — is a serious concern. Because of lower

incomes and conditions found with people with lower incomes generally,

the standard of health often is much lower for the native community.

This is particularly true for those Indian people who live on

reserves. First of all, their health care services come under the

federal government. The reserves are often located in very remote areas

where doctors, hospitals and other kinds of health care services that

most of us take for granted are not readily available.

The government of British Columbia is very much concerned with

health care in Indian communities. We understand that no one is static.

People who live on reserves often spend a considerable portion of the

year off reserve, either working or in Vancouver for some other reason.

We've tried to develop some plans not only within the ministry but also

with the federal government to address some of these issues that are of

particular concern to native people.

MR. PERRY: I was privileged to be briefed by the Vancouver

Native Health Society earlier this year about developments in the

funding of a new native health clinic in the downtown east side of

Vancouver to attempt to reach out to a large population of native

people who seem to be marginalized by the present system — or by their

own cultural background. I wonder if the minister could provide us some

update on the status of that Vancouver Native Health Society clinic

proposal.

HON. MR. WEISGERBER: I'm pleased to advise the House that in

this year's budget the ministry has provided an extra $440,000

specifically for a native health access program that will be delivered

by the Vancouver Native Health Society. You might also be interested in

knowing that the ministry has just announced a $1 million contribution

to the B.C. Health Research Foundation. It will be specifically

targeted at native Indian groups for proposals they would put forward

on innovative ways to deal with health care problems in their

communities. The ministry is very much aware of the concerns. Aside

from focusing attention within the ministry, specific programs have

been developed to try and deal with those as well.

MR. ZIRNHELT: I appreciate the minister — with his

familiarity — answering some of the questions. I wonder if he could

tell me if the ministry has considered a similar program to that done

for education, where there is a local agreement negotiated between an

Indian government and the provincial government for the provision of

services. It would simplify and coordinate and would also be a direct

negotiated contract for services between two levels of government, not

unlike the master tuition agreement.

[ Page

12631 ]

MR. GABELMANN: I wonder, Mr. Chairman, if I might have leave to make an introduction.

Leave granted.

MR. GABELMANN: In the gallery are a group of students from

Willow Point Elementary School in Campbell River. I'd like the House to

make them welcome.

HON. MR. WEISGERBER: Certainly we're interested in proposals

similar to the education program from native communities. In fact, the

Nisga'a in the northwest now have their own school board. I'm almost

positive they're providing some health care services by contract to

members of their community.

In many cases it depends on the size and readiness of the community

to enter into those kinds of agreements. I think the education

agreements are a good start. Generally — and I think this goes beyond

the Ministry of Health — there's a philosophy within the government

that looks favourably on the local delivery of government services

through native-run organizations, whether they be in Vancouver or in

remote parts of the province. Certainly another good example of that

has been the delivery of drug and alcohol counselling services through

the native friendship centres and other native-run organizations.

Whenever a band or tribal council comes forward, we look very seriously

at proposals that allow us to see government services delivered by a

native-run organization.

MR. PERRY: Just while the Minister of Health is out, I'm

trying to follow up a few other issues left over from last week. I

don't believe an answer was provided at the time to a rather technical

question I raised — perhaps the officials have it now — about the

provision of very expensive drugs like cyclosporin to people with

unusual conditions. Maybe if the present minister is comfortable with

getting the answer from the officials, I'll raise this one more

generally.

There are a number of drugs coming onto the market now which are

paid for under research protocols while they are experimental and

which, when they reach the market, are phenomenally expensive. One good

example is cyclosporin, which is used widely and routinely in organ

transplantation. The cost of the drug is then paid for by Pacific Organ

Retrieval for Transplantation, or PORT, so that patients don't have to

worry about the upfront expenditure on that drug.

The drug recently has been approved for a wider range of uses, including some

unusual diseases. I see in my file a letter from a young woman with juvenile

rheumatoid arthritis whom I mentioned last week, and also a young woman with

mixed connective-tissue disease that is destroying her lungs and that will eventually

cause her either to require a heart-lung transplant or to die. The drug appears

to be essential in those conditions, but as I understand from their letters,

it has not been covered by Pharmacare, so the expenditure has become enormous.

Both of these young women are suggesting they might have to go onto GAIN in

order to pay for a lifesaving drug.

I'll raise one further example on which I and the Leader of the

Opposition have had correspondence: a newer even more expensive drug

called alpha 1 antitrypsin; the trade name is Prolastin. If I'm not

mistaken, the manufacturer has put this drug on the market at a cost of

around $60,000 per year. I pull that out of my memory; I don't have the

paper in front of me. Obviously an expense of that order is beyond the

means of virtually any British Columbian. Yet the drug is thought to be

potentially lifesaving for people with a severe genetic disorder called

alpha 1 antitrypsin deficiency.

[4:15]

Those people don't really have much of a choice other than facing

potential lung transplantation, which might be less successful and even

more expensive. They don't really have the choice of whether they have

that disease or not. It's determined from the moment of conception as a

random event, and usually their parents aren't even aware that they are

carriers for that genetic condition. So we're talking about a very

small group of people with a condition beyond their control who are

really stuck in a financial bind.

Does the ministry have a policy now on how to deal with these

problems proactively so that people who are extremely vulnerable, like

the young women who have written to me, do not have to resort to

writing to opposition members? Of course, they're exercising their

democratic rights, but I can see from the minister's demeanour that he

can understand that it's a difficult position to put people in.

HON. MR. WEISGERBER: I thank the member for the nice, long question as well.

I'm advised that in British Columbia everyone qualifies for

Pharmacare. If a drug is approved and is approved for the treatment for

which its being used, it would qualify under Pharmacare under the

following formula: the person taking the drug would be responsible, as

you and I are, for the first $375 of drugs on an annual basis; after

that, Pharmacare would pay 80 percent of the cost of those drugs to a

maximum of a contribution by the person getting the drugs of $2,000,

after which Pharmacare would accept responsibility for all of the cost.

It would appear to me that if the drug has been approved for the

purpose for which it is taken, the maximum exposure for any individual

would be $2,375. No one could reasonably be expected to pay more than

that over the year, regardless of the price of the drugs.

MR. PERRY: The minister has made my point for me. Typically,

people with such severe illnesses as juvenile rheumatoid arthritis,

which is often a very crippling disorder and can, at times, produce

quadriplegia, or severe alpha-l-antitrypsin deficiency, or the mixed

connective-tissue disease I referred to.... They produce profound

disability. Often such individuals are on GAIN or GAIN for the

handicapped and may have a monthly income in the range of $675; or if

they're not, their income may be similarly modest. For many people

earning a net income in the range of $6,000 to $8,000 per year, $2,375

per year may be an

[ Page 12632 ]

overwhelming cost. It's compounded, even for those

with more generous government assistance, by the problem of putting up

front the purchase cost for the drug.

To my knowledge, Pharmacare has usually been quite efficient in

turning around payment requests, usually with a turnaround time in the

range of a week when patients request repayment of their up-front

capital costs. But at times the up-front costs are in the range of $600

or $800 a shot. And sometimes Pharmacare falls down. We've had a rash

of complaint telephone calls in the opposition recently about longer

delays in reimbursing Pharmacare costs.

One of the matters which had disturbed me that I raised with the

Minister of Health a week ago was that when we passed on routine

citizen complaints of that kind, we were told they must be raised in

writing to the minister. I hasten to add that my experience with the

director of Pharmacare has always been exemplary in that regard. But it

was admitted that there have been some recent problems. Normally it

wouldn't be a big deal for the average citizen to wait a week or two or

even a month for a bill of $50, but a $600 bill for a person who is on

very limited income is a major impediment.

What I'm getting at, by way of a speech rather than a question, or a

rhetorical question, is the need for a more flexible policy that will

respond proactively and more rapidly.

I see the associate deputy minister watching me. I know he has been

involved in the very difficult matter of deciding how to cover new,

expensive drugs and how to ensure that they're used rationally and to

the maximum benefit. Naturally the province should have some

reservations about entering into treatment which might cost $60,000 per

patient per year. Of course, it's important to remember that these are

the initial costs when the drug is first marketed, and they will often

come down very rapidly, particularly if we could see some enhanced

interprovincial cooperation in bulk purchasing. We might well see

savings in the range of a tenfold reduction for expensive drugs, if

they were purchased in bulk on an interprovincial basis or through

federal government cooperation. It's one of the reasons I happen to

believe that it's still worth holding onto our country. We have some

advantages as a medium-sized country that we don't as a province with a

relatively modest population base.

Let me leave it as a suggestion with the ministerial staff and the

Minister of Energy to relay to his colleague that it would be humane to

this small group of British Columbians — perhaps numbering in the

hundreds at most — who are on unusual, newly introduced or extremely

expensive drugs for rare and very disabling conditions, if we could

design a policy which proactively helps them out first, before they

have to come to their politicians. I think it's within the capability

of the ministry, and I'm pleased to state my confidence in the

ministerial officials in their presence.

HON. MR. WEISGERBER: First of all, I didn't want to downplay

the difficulty that some people may have in paying $2,300 or $2,400

toward the cost of drugs. But in the example that you mention, I think

it's important for people to understand as well that anyone covered by

social services on social assistance has all their drug costs paid.

Many of the people you talk about would find it necessary to go for

social services from the government. I think it's an appropriate

mechanism; it recognizes that difficulty and would deal with it.

There will be some people, though, who find themselves hard-pressed

to make these payments, and delays in refunds are a serious problem for

drugs that have a large price tag on them. That's compounded at certain

times of the year for the Pharmacare program, particularly the end of

the year, since many of us gather up our receipts, hold them for a year

and then send them in. So there is always a period when cheques go out

more slowly.

It's also important to put on the record that the $375 and $2,000

cap is a family unit figure, not an individual figure. The ministry is

working on something called the pharmacy computer network, which I hope

will see a situation fairly soon where usage of the drug has been

recorded in the computer, payments would be made by the person getting

the prescription and the family unit would be on record. It would then

be easy for the pharmacist to determine when the patient had already

paid the maximum, so it would no longer be necessary to bill them a

prescription fee for an amount. This certainly would deal specifically

with the problems you mentioned of late payments coming back or of

people being hard-pressed to find the cash for drugs. The ministry is

working quite aggressively on that, and I hope that in the very near

future we will have some better response to this issue.

MR. PERRY: I find it ironic, particularly because I know this

minister is a relatively thoughtful guy, that I have to make the point

again that our system tends to push people onto social assistance. Here

I am, a member of a party often accused by the government benches of

wanting to put everybody on social assistance, pointing out to the

government that one of the problems of our present system is that if

you're close to the margin, you do better going onto social assistance

or GAIN for Handicapped. If you're a member of the working poor, you

can be hit by that large Pharmacare deductible, which virtually forces

people onto social assistance.

Clearly there are people who have, by virtue of their health status,

found it impossible to survive in the market economy and been forced

onto social assistance, where they do not want to be. If we had a

somewhat more flexible policy of assistance that was tailored to the

genuine medical needs of the patient, we could help people retain their

independence. None of them want to be put in that situation. I don't

know if the minister wants to respond, but I'll leave it at that.

HON. MR. WEISGERBER: My observation of the people on social

services was simply...you used the example of a quadriplegic or someone

in that situation. My response was that the person in such a situation

would very likely be already benefiting from some social service

programs. I'm not suggesting that they

[ Page

12633 ]

should go on social services to get the drug

without deduction; I'm simply stating that the circumstances those

folks would find themselves in would likely give you the expectation

that they wouldn't be paying their deductible because they were already

getting some kind of services.

I'm not going to try to pretend that there aren't circumstances

where the working poor in this country don't find themselves in the

most difficult position. We see those people on social services being

provided with a safety network that's not available to the working

poor. I admire the people who hang in there, face some very tough

situations and do it on their own.

I don't think that raising the level of social services payments is

the answer. I suspect that even if you go to Ontario and find folks who

are getting the equivalent of $25,000 or $35,000 a year, there are

still going to be working poor in Ontario who don't get the same level

of benefits. So I don't think the answer is increasing social services,

and I wouldn't ever put that forward as a remedy. I do think that we

should find ways not only with Pharmacare but in many areas of

graduating what we expect those working people on low incomes to pay. I

don't have any difficulty with that notion at all.

Perhaps it's worth noting that we're now back to the real Minister of Health.

MR. PERRY: Perhaps I spoke too soon about the Minister of

Energy when I said he was a very thoughtful man. Of course, I wasn't

arguing in that question for the issue of social assistance rates per

se; I was arguing for ways to prevent people from needing social

assistance by ensuring that they have access in principle to the same

benefits that other British Columbians take for granted. Just because

the dollar amount of a very expensive drug required for medical

treatment may be much higher for one individual than another, it does

not mean that the individual with a very costly disease should be

forced onto social assistance. That's the exact point I was trying to

make. I don't think they should.

[4:30]

While the Minister of Energy is still in the chamber, I will raise

one other issue I was going to address to him before the Minister of

Health returned. Since the Minister of Energy had been a member of the

Special Committee of Selection, I thought I would again raise the issue

of the report of the Clerk of Committees regarding sittings of the

select standing and special committees of the Legislature and, as he

puts it on the front page of the report, the "activity" — which I think

I've said before is a euphemism for torpor — of the Select Standing

Committee on Health, Education and Social Services.

I was going to address this to the Minister of Energy, since he was a member

of that honourable selection committee, but I see that the present Minister

of Health was also. As he sat on that selection committee doing the people's

business and spending the people's money on his own salary and that of other

members he must have had dreams of what those committees might have done. I

feel for him, Mr. Chairman, because those dreams have been frustrated by the

torpor of that Health, Education and Social Services Committee, which has met

in this parliament four times for about 20 minutes altogether.

The time I was present there last year, it sat for about five

minutes — long enough to elect a convener, but not long enough to

consider my motion as a member that we conduct some business. Through

every possible avenue— letters to the Chair of the committee, to the

subsequent Chair and to the minister — I had proposed a motion on the

order paper that the committee sit to consider some of the complex

issues facing us.

I would like to suggest it again, and I'd like to ask the minister's

opinion. I feel this is a legitimate question, because we're now

debating the issue of his salary as Minister of Health. In the presence

of our distinguished Clerk of Committees, who I know would dearly like

to see those committees function, I'd like to know whether the Minister

of Health thinks it's a good idea for our bipartisan Committee on

Health, Education and Social Services to consider some serious business

before the next election.

I'll give the minister two good examples, Mr. Chairman. One would be

to begin to do some thoughtful consideration of the review of the

Mental Health Act. For a period of several years now, the ministry has

initiated a process to begin the study of the Mental Health Act in

order to bring it up to date with other jurisdictions and to deal with

some outstanding issues of the rights of mentally ill people and the

needs of society to protect itself from people who are seriously

mentally ill and to protect those people themselves. Many British

Columbians have felt that the balance has been out of kilter in that

field, but it's a tremendously complex area.

I frequently get representations from agencies such as the Community

Legal Assistance Society, who are working on a project to review the

Mental Health Act. I recently discussed this matter with Mr. Bill Trott

of the Community Legal Assistance Society and indicated some of my

anxieties that when and if a revised Mental Health Act is brought

forward....

MR. CHAIRMAN: Order, please, hon. member. In the minister's

estimates it is improper to discuss the need for or existing

legislation. All we're dealing with here are the administrative

estimates of the Minister of Health. Likewise, conversation or debate

dealing with what may or may not have taken place in a committee other

than this committee is also unparliamentary.

MR. PERRY: I'm peering at the minister to see whether he's

going to.... I don't mean to challenge your ruling in any way, but I

had the suspicion he wanted to reply or say something anyway.

MR. CHAIRMAN: Hon. member, it's not the Chair's ruling. It is

the procedures that are set out by the authorities and the members of

this chamber. The Chair can only adhere to the authority given to it by

this chamber, not by the Chair itself.

HON. MR. STRACHAN: I'll advise the second member for Vancouver–Point Grey that, prior to his

[ Page 12634 ]

coming to this assembly, I was Deputy Speaker for

four years, and the Chairman's ruling is absolutely correct. It's not

appropriate to discuss legislation nor work that has gone on in another

committee.

But I do hear you, and I guess we can point to the record generally

of some very good committee work that has gone on — not in the area of

your interest, I'll agree, but some that has gone on has been quite

productive over the years.

In terms of your request.... Of course, a motion would have to come

from the Legislative Assembly to strike a committee, and you have every

opportunity to present such a motion on the order paper if you wish.

When we do have a royal commission in place that is going to report to

us, all members, all associations and all of those interested in health

care and health care costs, have, as you know, the opportunity to make

a submission to that commission. That's probably the most appropriate

form of public input that we can seek at this time, which is why we

struck the royal commission in the first place. There's not much more

we can say about the select standing committee that you've been

discussing, and that I've been trying to avoid. To finish on this

issue, I agree with your concern for more input, and I agree with your

concern as a member who's vitally interested in health issues. That's

really all I can say to conclude your comments about the select

standing committee.

[Mr. De Jong in the chair.]

MR. BARLEE: The minister and I were discussing the

possibility of an intermediate-care facility in Keremeos. He quoted the

figure of 22 percent, and I felt that was incorrect. I said that it was

just over 30 percent. According to statistics from the provincial

government, it is just slightly over 32 percent. That might make a

difference as far as the criteria are concerned, so I assume that the

22 percent figure is at least 10 percent out — it may be almost 33

percent now.

HON. MR. STRACHAN: I'd give you a quick bit of arithmetic: if

it was 32 instead of 22, that's not 10 percent. But that's neither here

nor there. It's ten, but it's not 10 percent. I'll take your numbers

under advisement.

Clearly you have a growing seniors population there, so my answer

earlier — we'll look at it — stands, and I guess the best thing to do

for the community in that type of development would be a continued

increase in the seniors population. Given the fine weather, the

reasonably good and affordable accommodation and prices there, I can't

see why that community won't continue to grow. We will look at all of

the concerns you have expressed. Thank you.

MR. JONES: I had not intended to raise this particular issue

in the House, in that it is the kind of thing I would much prefer to

deal with via the ministry through normal channels. But I feel I have

lost control of this issue because it affects two constituencies, and I

had tried to work through the office of a member of the government

side, because the parents of the young woman affected reside in that

community.

This has to do with a young woman who for some 16 years has been a

TPN patient. For the minister — not that I am any expert in this area —

I think that stands for total parenteral nutrition. Let me describe the

situation to you. This is a patient whose digestive system is unable to

absorb nutrition and so, as a result, the individual receives her

nutrition through an in-line catheter. I'm sure it is not the most

convenient thing, but I think it works, and for 16 years this young

woman has effectively been able to feed herself via this method.

The problem arises with this inline catheter because infection sets

in. In this situation with this young woman, there are only a few drugs

that resolve her infection problems with the catheter. As it turns out,

these drugs are incredibly expensive — as much as $400 a gram for these

particular antibiotics. If patients with this kind of infection can

afford it, they purchase the drugs at these very expensive prices and

administer them themselves in the home. However, my understand