1975 Legislative Session: 5th Session, 30th Parliament

HANSARD

The following electronic version is for informational purposes

only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

THURSDAY, MAY 29, 1975

Morning Sitting

[ Page

2807 ]

CONTENTS

Committee of Supply: Department of Health estimates.

On vote 74. Mr. Wallace — 2807

On vote 75. Mr. Wallace — 2807

On vote 76. Mr. McClelland — 2807

On vote 77. Mr. Wallace — 2812

On vote 78. Mr. Rolston — 2814

On vote 79. Mr. Wallace — 2815

On vote 8 1. Mr. McClelland — 2816

On vote 82. Mr. Wallace — 2816

On vote 83. Mr. Wallace — 2818

On vote 85. Mr. Wallace — 2818

On vote 86. Mr. Chabot — 2821

On vote 87. Mr. McGeer — 2821

On vote 88. Mr. McClelland — 2822

On vote 89. Mr. Phillips — 2823

THURSDAY, MAY 29, 1975

The House met at 10 a.m.

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

ESTIMATES: DEPARTMENT OF HEALTH

(continued)

On vote 74: grants for health agencies, $2,600,000.

MR. G.S. WALLACE (Oak Bay): Mr. Chairman, I wonder if the

Minister could give us a very brief breakdown on the $2.6

million which is a very substantial increase. Where is the

increase mainly going?

HON. D.G. COCKE (Minister of Health): Mr. Chairman, a lot of

the grants to health agencies have actually been put together

in a much more presentable way. As you recall, the department

used to be sort of a four-pronged department; different

departments were providing for different agencies. Now the only

ones we are separating out are the mental health agencies. We

are still giving grants from that area.

Let me give you a quick rundown of some of them. Cancer

control is $95,000. Under consultative clinics: Canadian

Arthritis and Rheumatism Society $170,000, up $10,000; cystic

fibrosis is up $5,000; hemophilia is up; cerebral palsy is up

from $475,000 to $650,000. What this government has really

said, in effect, is that innovative services should certainly

be part of the voluntary contribution, but real direct health

services should be supported by government as much as possible.

We are working in cooperation with the voluntary agencies.

For instance, last year the summer programme at the faculty

of dentistry was $104,000. That was free dental service for

children. This year it is up to $160,000. The Downtown

Community Health Society, which works with the poverty-stricken

in the downtown area of Vancouver, is up from $100,000 to

$140,000, and so on down the list.

You remember that some time ago we had a commitment to

improve family planning counselling. Family planning is up this

year from $20,000 to $100,000. I think that is representative

of what we are trying to do in the whole area.

Last year a LIP programme looked after one of the quite

important St. John's Ambulance educational programmes. This

year the LIP people have withdrawn and we are providing $21,000

to take up that vacuum.

I have given you the tone of why and where and so on, and that is it, generally

speaking,

Vote 74 approved.

On vote 75: community health services development,

$391,900.

MR. WALLACE: Again, this sum has increased three-fold. Could

we just have a very brief outline of where the increase is

mainly going?

HON. MR. COCKE: As you know we are now in the development

stage of the pilot projects that we talked about — the ones on

the Queen Charlotte Islands, Houston, Granisle, Grand Forks and

James Bay. They have to have a budget, and now that they are

underway, that is it. Naturally, there wasn't as much money

required before as there is now, but since they have to be

budgeted for, that is what you are looking at.

Vote 75 approved.

On vote 76: local health services, $21,931,994.

MR. R.H. McCLELLAND (Langley): Just a brief question about

the salaries under this vote. It relates to some other votes as

well.

On the medical officer grades there was some negotiation

between Mr. Perry and the British Columbia Medical Association.

It seems that some of the salary increases were quite a lot

lower than what was originally talked about. Is there still

some dispute about salaries for medical officers?

HON. MR. COCKE: Mr. Chairman, as the Member knows, there

wasn't too much negotiation around the doctors because they

wanted to be out of the unit. I would suggest that those

negotiations will take place over the next few months. I think

we can provide the vehicle in which those negotiations on

giving recognition can take place. Generally speaking, local

health services has been an area that had to be improved; this

is the community health service in all of your constituencies,

in all of your towns and municipalities, with the exception of

some of the major ones like Vancouver.

Generally, the medical officers and so on will be properly

taken care of.

MR. McCLELLAND: Just a brief follow-up, Mr. Chairman. If

this was canvassed last evening I apologize, but unfortunately

I had to be out of the House. Are you saying that you think

that in a matter of weeks or months this situation with these

professional employees will be settled?

HON. MR. COCKE: Days.

MR. McCLELLAND: A matter of days?

[ Page 2808 ]

HON. MR. COCKE: Yes.

MR. McCLELLAND: Thank you, Mr. Chairman. If the salary

increases provided for in the budget differ substantially from

what might eventually be negotiated do you expect this will be

taken up through salary contingencies?

HON. MR. COCKE: It would have to be, Mr., Member.

MR. WALLACE: I would just like to ask the Minister just to

comment, particularly, on the part of this vote 76 dealing with

speech and hearing. I know the Minister can't produce speech

therapists out of a hat, but there is a very serious lack of

speech therapists in this province. I have encountered cases

where citizens who have had a stroke and have subsequent speech

impairment have great difficulty in obtaining the services of a

speech therapist once they have left the confines of a

hospital. As the Minister knows, depending on which side of

the brain your stroke occurs, you may or may not have a speech

problem. So there is really a discriminatory situation here

inasmuch as those persons who are unfortunate enough to have a

stroke which affects their speech really don't get as complete

recovery as the other person.

I have had some correspondence with the Minister's Deputy,

who has been very helpful in describing and discussing the

situation, and he mentioned that the Minister had set up a task

force for people with impaired communicative abilities. I

wonder if the Minister would comment on that. Who is on the

task force and what exactly is it doing and when can we expect

some result?

I have just one or two quick other questions. Shall I ask

them all at once? That's one point. Under this vote also I

notice there is a new item, "speech and hearing aide" — I

presume that's personnel — listed as eight positions. I would

be very interested to know just what level of training that

person has who is described as aide and particularly what role

the Minister envisions that particular employee would

fulfil.

I would also like to know about the one item under

"allowances" and the word "et cetera." It always worries a

politician when you are talking about money, and you describe

it as "et cetera" — it goes from $20,000 to $80,000.

HON. MR. COCKE: Sorry, but could you repeat that

question?

MR. WALLACE: It's under the word "allowances" almost at the bottom of

the page, about two-thirds of the way down. The item right below that is "temporary

assistance, including home care." Now it's quoted at $2.2 million. The Minister

had said yesterday, in exchange across the floor, that there was $6 million

in the budget for home care and I wonder if he could tell us what segment of

the total of home care financing is included under this $2.2 million.

Would the Minister comment on these points, please?

HON. MR. COCKE: Yes, the task force for speech and hearing,

Mr. Chairman, is a task force under Dr. John Gilbert, who is

the head of the speech and hearing department at UBC. That task

force has been working in both areas, speech and hearing, and

has produced a report. That report has been discussed in the

community, and out of that report we are setting up certain

programmes. One of the programmes, really, that comes as a

result of that is the programme that we discussed yesterday

with the Member for North Okanagan (Mrs. Jordan).

The aide would be one of the members of the team which is in

these audiometric pilot test areas and will be working in that

development group. The allowance is also for that area.

The medical component of the home care is this. When I

talked about $6 million, which is a global figure, I was

thinking in terms of the Minister of Human Resources (Hon. Mr.

Levi) and the Minister of Health (Hon. Mr. Cocke). But this is

the actual medical nursing aspect of the home care

programme.

MR. P.C. ROLSTON (Dewdney): A quick question to the

Minister. I think we should acknowledge that there are 144 more

health workers in this vote. By George, this is something we

really should compliment him on. But I want to ask him, first

of all, at the start of the vote, if there is $34,000 for a

medical officer 3, presumably that is an increase. How easy is

it now to attract people to get into this? That's maybe halfway

up as far as net income for doctors is concerned. It's not a

lot but it's take-home income compared to the big operating

costs and the other risks that a person in private practice

would have. How easy has it been to induce these people to go

into the public service?

I want to ask a question. I thought you said you had 18

speech therapists; yet there are only 10 in my vote. Is it not

18 rather than 10, or maybe there's some speech therapist...?

We have a new speech therapist in Maple Ridge, for instance,

which we certainly appreciate.

Again, what's the real projected expansion next year for

speech therapists? I note too that there are 44 more public

health nurses. I think there are about two more in my

riding.

But I want to ask some questions about public health

inspectors. We use the word "grace" theologically to describe,

I guess, a case of discretion.

[ Page 2809 ]

This is a very difficult job, Mr. Chairman. A public health

inspector needs grace and wisdom and a very flexible approach.

Often my experience is that they look at things very

clinically, strictly on hygiene, when they're inspecting homes

and day cares and nursing homes. I just wonder if the Minister

could comment on this very difficult policing job of being a

public health inspector today where so many public facilities,

really, can be held up for a while due to his discretionary

powers. Yet it's a very vital role.

Maybe you could comment something on the training of these

people. We are very short of these people. They are in a

tremendously influential position in the community.

AN HON. MEMBER: Time!

MR. ROLSTON: Okay, I'll sit down and hear what the Minister

has to say. But how many new inspectors do we have here?

HON. MR. COCKE: In the first place, you talked about the

number of speech therapists. You count 18; I could 27 speech

therapists I and 2. And you're looking in the wrong column if

you're looking elsewhere.

Mr. Chairman, the second thing is: how do you attract doctors? I think I answered

that question when I answered the Member for Langley (Mr. McClelland) when we

discussed the whole question of the doctor situation. So really if you take

that as your answer.... I would be making a value judgment beyond saying how

attractive this income is and that income is and so on, and I think I mentioned

that.

So far as the public health inspectors are concerned, Mr.

Chairman, they do have a very tough job and we appreciate the

work they do. Beyond that I really can't do much other than to

discuss the matter in question.

MR. WALLACE: Mr. Chairman. There are just one or two other

points in this vote I wanted to canvass.

I'm very interested in the item in the light of what we

talked about yesterday — hearing programmes — under code 041:

hearing aid and equipment, $600,000. That's a substantial sum,

and I presume it's the equipment used in various areas to do

the testing. But since we did talk about hearing aids

yesterday, I wondered to what degree this would not come under

this vote, providing hearing aids for people on social

assistance, presumably. Or would it? I have one or two very

quick items I want to ask as well.

Physiotherapists were mentioned, and I've just had an inquiry in my own riding

about why service is being cut back. I have a lady who is seriously disabled

as a result of polio years ago and who is self-sustaining She teaches music

in her home but she's becoming less and less able to cope with the physical

problems. Apparently, whether this is a local decision or provincial decision,

the service is being cut in half. She can only have it half as often. This is,

in my view, very unfortunate. I wonder if the Minister could comment on the

question of physiotherapy services. Is there any central policy, either for

financial reasons or personnel reasons, that's led to a reduction in the service?

There is another item there I just want to ask about,

because it wasn't in the budget last year and it's $435,000

this year: operation and maintenance of motor vehicles. Where

was that expense shown last year? Also, since there's a very

substantial increase in grants and subsidies from $2.1 million

to $5.2 million — code 0.19 in the vote — I wonder if the

Minister could comment. That's $2.1 million up to $5.2 million

under grants and subsidies. Could we just have a brief outline

of the increase?

MR. McCLELLAND: Mr. Chairman, just a brief follow-up perhaps

on the question the Member for Oak Bay (Mr. Wallace) asked

about the hearing aids — $600,000. There seems to be a problem

with some elderly people particularly who need hearing aids,

since the government did some time ago make a public proposal

that it would supply — or at least it was considering supplying — hearing aids at manufacturer's costs, similar to the

programme in Saskatchewan. The question I'd like to ask is

whether or not the government will actively pursue that

programme. I don't think that was answered — looking at

Hansard — last night.

Certainly there is a problem with the hearing aid dealers.

They don't know where they stand at the moment. They'd like to

have some answers from the Minister. But I think the problem

with the uncertainty about where the government is going in

this programme is that there are a lot of elderly people who

perhaps need service or need new hearing aids now who are not

getting that service and are not going to get their hearing

aid, because they are sort of waiting to find out what the

government is going to do. So they are perhaps going without

and perhaps suffering from a health point of view because of

it.

I think that in fairness to those people the government

should make its position clear and let them know whether it is

going into this programme quickly, or whether it will be come

time.

HON. MR. COCKE: Mr. Chairman, I think I made the case very

clear that the only places we are providing hearing aids at

cost are in the four or five pilot project areas, period.

That's it. We want to see how it works.

Just to answer the Member for Oak Bay's (Mr. Wallace'

s) question at the same time on that, the $600,000 is that very

amount you were talking

[ Page 2810 ]

about, vote 041. That's a returnable sum. In other words, we

have invested or are investing $600,000 in hearing aids just

for those pilot areas, and then of course they will buy them at

cost and that will be returned to the Crown, but it won't come

back to the Department of Health. It goes to the Minister of

Finance under those circumstances. So that really answers both

those questions.

The physio reduction is something we had to contemplate

because we've actually expanded physio, Mr. Member. We have a

great deal more physio. We have physio in the home-care

programme, physio in the out-patient programme in the

hospitals. So what has really happened is that people are

taking greater advantage of physiotherapy. Now it is a matter

of manpower. It really is. That will be expanded as it can

be.

The operation of motor vehicles, Mr. Member. I will have to

take that part as notice because I believe — and I can't give

you an absolutely definitive answer — that there was a question

that that was in another area altogether of government and now

is charged to the Department of Health.

MR. WALLACE: Just one last point. If we're cutting back on

physio, I would hope the Minister would give this top priority

in seeking a solution. It's the same old story: if we can't

give the kind of lady I'm talking about in Oak Bay the proper

kind of physiotherapy, she is going to be shoved in an

institution, and we are back on the old merry-go-round of

having to build beds when people could be looked after in their

own home, and so on, and at less cost.

As I said about speech therapists, I know you can't produce

them out of a hat. But I would hope that the very significant

diminishing of the seriousness of a person's disability by

physio is fully recognized by his department.

The last question: There is very little increase in the

preventive dental programme budget. It goes from $300,000 to

$330,000. The Minister did make a statement a week or two ago

that he was in the process of developing a dental-care

programme for children aged three to 17. He said there would be

a research report costing $150,000 by his department and the

dental college which was to be released around May 1.

Now I may have missed that or it may not have been released,

but I wonder if he could comment briefly on the whole item in

this budget called preventive dental programme, vote 034, and

also comment on the dental-care plans for the children aged

three to 17.

Finally, how are we doing in the province in the very

difficult problem of getting an adequate number of dentists

beyond the metropolitan area? A dental-care programme isn't

much use if we can't provide the number of dentists.

The Minister said this in debate before when he announced

that there would be a programme within the next couple of

years, I think the Minister said. I wonder if he could tell us

the projected figure of costs he had in mind and the question

of getting an adequate number of dentists.

MR. McCLELLAND: I know that public health inspectors have

enough to do now without asking them to do more. However, there

is a problem that has come to my attention. It has to do with

TB x-rays and inspection for typhoid carriers for employment in

cafes and private hospitals, private institutions. Those

inspections are required for government institutions like

Woodlands, I understand, but in these other areas they aren't

required at all. The health inspectors in the valley tell me

that TB x-rays are recommended, but there is no requirement

that they take them in order to get employment in these places.

I think there could be a case here for some uniformity in the

health laws in this regard, Mr. Chairman.

The second thing I would like to ask: last fall the Minister

came down pretty hard on the eyeglass manufacturers and sort of

threatened at that time that if they didn't clean up their act,

the government was going to go into competition with them and

start manufacturing eyeglasses.

Interjection.

MR. McCLELLAND: That's right — move in on the scene. At that

time the Minister said that he was looking at the matter, I

think his word was, "superficially." I wonder if he had got any

further beyond that superficiality and whether we are going

into the eyeglass business in British Columbia.

HON. MR. COCKE: Mr. Chairman, first I'll deal with the

dental report that the Member for Oak Bay (Mr. Wallace)

discussed. That report is now being finished — unfortunately it

wasn't quite ready. We have an 890-odd-page draft but it's

being condensed into a 500-page readable report. I'm meeting on

June 9 with the College of Dental Surgeons to discuss further

the report and its ramifications.

Yes, we do propose a dental programme for children; yes,

that programme will cost money. I project that it will cost

something in the order of maybe $30 million to $35 million

ultimately. But that would be just a rough guess so I'm not

going to tie myself down — that's judging from some of the

statistics that I have to date.

Mr. Chairman, to the Member for Langley (Mr. McClelland),

the TB X-ray is a question that I'll certainly look into. I

think it's a good idea. Although I am told by my medical

officials that the incidence

[ Page 2811 ]

of TB in this province now is very, very, very low indeed,

it's certainly something that I'll discuss with my

officials.

The last thing — the eyeglasses. One of the things that I

had anticipated and that has now happened, and one of the

reasons that I threw that warning out and I am discussing the

whole question — two reasons. One, I wanted the federal

government to continue on with their royal commission on

optometrics — they haven't to date. Remember, it was going full

tilt until that election; then when the federal election was

over we heard nothing more from that royal commission. So what

has happened as a result?

Interjection.

HON. MR. COCKE: I don't know, Mr. Member, but you can't

tell. My voice was a voice in the wilderness because now I

understand that Imperial Optical has circulated a 20 per cent

increase in the last few days — you can imagine what that's

going to do to the cost of glasses. All I'm trying to do as

Minister of Health in this province is to warn people that

there has to be a better way.

Think in terms of a child or a family with five myopic

children — oftentimes this runs in families — where there is a

change of glasses, say, every six or seven months. That often

happens with each child. It becomes an oppressive sort of

situation economically and, frankly, needless under certain

circumstances to the extent that it is.

Anyway I'm just going to continue to soldier on in this area

and try to keep the costs down. I'm not going to say how. Maybe

it would be an idea if we maybe helped somebody in the private

sector to get into the actual base manufacturing. This is the

kind of question that I've discussed with the Minister of

Economic Development (Hon. Mr. Lauk) and will continue to do

so.

MRS. P.J. JORDAN (North Okanagan): To arms, to arms, as that

Minister soldiers on! I can see the headline tomorrow: "Cocke

Soldiers Forth Battling The Optometric Profession." I'd be with

him; I think there are real problems there. But while he's

soldiering in this massive area of health and he is taking up

arms against everybody, would he please take up arms against

ICBC? There is a serious situation arising. I have two examples — I haven't got them with me this morning. They have been taken

up with the department with some considerable confusion.

It revolves around people who are involved in accidents,

have injuries that require physiotherapy and wish to make a

claim for this compensation through ICBC. ICBC, when it

involves physiotherapy, orders them to take the treatment and

it is billed to B.C. Medical. What happens in frequent cases is that there

is a limitation on the number of treatments — I think it is 12

treatments a year. I stand to be corrected on that. But there

is a limit on the number of treatments people can have of

physiotherapy under the medical plan. So if they have their

accident in January, February or even later in the year, they

have their treatment and are supposedly cured — this is charged

to B.C. Medical, not ICBC. Then later in the year if they have

other problems perhaps not related to the accident they have to

pay for physiotherapy treatment themselves.

The point here is that ICBC has a responsibility to meet

that commitments that it makes to individuals in this province

through their policies; one is medical treatment in the case of

claimable accidents. It just seems ridiculous that they should

be able to shunt people back and forth between ICBC and the

Health department. The Health department also has a contract

with people through the payment of their fees for their medical

service, and that is to provide so many medical treatments in

various areas, including physiotherapy, if required every

year.

I would ask the Minister to straighten this matter up

immediately, rise to arms on behalf of those who have been

inconvenienced by ICBC in this area and take the Minister of

Transport and Communications (Hon. Mr. Strachan) aside and tell

him to assume his own responsibilities and let the Minister of

Health assume his responsibilities so that we don't have people

being bounced around like yo-yos between these two departments,

This is a problem at the best of times; it's a very serious

problem when people have been involved in accidents and have,

as most people do, shock reactions and emotional problems.

These last often for many months and then they get into a

hassle like this that's not of their making. I would ask the

Minister for a commitment to take up these arms.

The other question I wanted to ask him was in relation to

mobile dental units. As the Minister is no doubt aware, in the

North Okanagan the previous administration pioneered this

programme. Dr. Grey, the public health dental officer in

Kelowna, and his staff were among the initiators. It was an

excellent programme. Up until recently, I know, it has been

running to capacity.

Then I believe there was a second programme started in the

province. I think that this type of programme is quite apart

from any dental-care programme for children. This meets the

needs of those in the rural areas who simply can't get in to

dentists and who don't have dentists in their area.

Although it was subsidized initially there was a thought

that certainly the administrative costs of it could be

self-supporting. It was essentially staffed by young dentists

who were eager and didn't want to limit themselves to eight or

10 hours a day but were willing to work many long hours a day

imparting

[ Page 2812 ]

community service and also, I'm sure, to get a basic start

in their dental careers.

I would hate to see this programme shunted aside. To my

knowledge there has been no major expansion. I would urge the

Minister to expand this mobile dental-care programme into all

the remote areas of the province. There is certainly a need in

the East Kootenays area. There is a need in the northern parts

of Vancouver Island; the Member for Comox (Ms. Sanford) most

certainly has the need for such a unit in her area. There is a

need in the northern part of the province, just to mention a

few areas.

I hope that the Minister will give a commitment this morning

that this excellent programme will go ahead at a faster rate

than it appears to be at the moment.

HON. MR. COCKE: I think the Member for North Okanagan (Mrs.

Jordan) has brought up two good ideas. As far as the physio

thing with ICBC I will certainly be discussing that. That was

the way with the old insurance companies and I will certainly

look into it with ICBC. We got ripped off for years, as you

know, with medicare by picking up the tab. In any event, I will

certainly see to it that that is what....

MRS. JORDAN: You know that "the NDP does better."

HON. MR. COCKE: On the mobile unit, it is quite correct:

that programme has to be expanded. We hope that with our new

dental programme we can develop that kind of mobility. You are

quite right that you have to have dental care in the more

isolated areas; otherwise you've accomplished nothing.

In B.C., for instance, 48 per cent of the people get to see

a dentist. But those people are not in the north or more

isolated areas. They are in the lower mainland and the lower

end of Vancouver Island.

MRS. JORDAN: Just one more question. Are there still no more

than the two units operational in the province?

HON. MR. COCKE: I believe that is all there are.

MRS. JORDAN: Would the Minister care to give me a time limit

on when he will get some more on the road? Hustle and bustle

the dental units, please, right away.

HON. MR. COCKE: I think that there are more in the

offing.

MRS. JORDAN: Tomorrow? Next week? September?

HON. MR. COCKE: Yes.

MRS. JORDAN: September. Two more units will be hustled and

bustled on the road by next September? You don't want to be

snowed in the whole winter.

MR. McCLELLAND: Mr. Chairman, I hope that this is the

correct vote under which to bring this up. I've just received a

letter from some people in Osoyoos who are concerned about the

closure of an x-ray lab in Osoyoos. If I could just bring the

Minister up to date, the lab was apparently to have closed on

April 30. The letter doesn't indicate to me whether or not it

actually closed on April 20.

HON. MR. COCKE: Could I bring you up to date on that

question? I granted them an appeal. They were in my office

about a week ago. I gave them a further extension. They were

not living up to the standards that were set by their own peers

in their own profession. Their beef is not with the government;

it is with their own profession. It was the Advisory Council of

Labs — all doctors — that brought in that report. I had both

parties in my office in a proper appeal. We were not party to

anything that happened in Osoyoos.

I have given them a further five or six weeks, well into

June. I hope that they bring their laboratory up to the

standards that are necessary in order to protect the people in

B.C.

Vote 76 approved.

On vote 77: division of laboratories, $1,861,270.

MR. WALLACE: Mr. Chairman, I think we have to spend a few

moments of this vote for a variety of reasons but mainly the

fact that this issue was discussed in question period the other

day, emanating from some statements that had been made from the

Consumers' Association of Canada with specific reference to

coliform contamination of milkshakes. I don't think we should

zero in and make a big song and dance just about milkshakes.

The subject is much wider than that. It is the whole question

of public safety in relation to food outlets — milkshakes,

meats, other goods and food. I've talked the matter over with

people who are concerned and professionals in this field.

I wonder if the Minister could perhaps just respond to one

or two points that I would like to make. Again, the number of

personnel required to do a complete and thorough job, I

recognize, is different if they are not available. The cost of

salaries is considerable. I want to recognize that the staff

under this vote has been increased by 25 per cent and there is

a dollar increase of 67 per cent. I recognize that.

The point I'd like to make is that, as the Minister well

remembers, there was a tendency to be too many

[ Page 2813 ]

laboratories developing in the province. In the last annual

report of the medical services commission, on page 8, it

recalls the setting up of the advisory board on laboratories.

This commission was asked to be responsible for ensuring the

availability of quality services, and controlling the expansion

of facilities or provision of new facilities until there was

reasonable utilization of existing facilities. That makes good

sense.

So I'm wondering whether the government itself, in this

particular area of food supervision and inspection, is making

the maximum possible use of existing laboratories, whether

they're private labs or public labs, or whether they are the

two mentioned, the provincial government lab in Vancouver, for

example.

In discussing this matter with pathologists — and I don't

say this to be miserable towards the civil service — but the

fact is that the government lab works civil service hours,

basically — 8:30 to 4:30 Monday to Friday. A lot of this kind

of laboratory testing.... I don't want to transgress on other

votes, but talking about venereal disease, for example — when

doctors want to take specimens or submit material for tests,

the restrictive nature of 8:30 to 4:30 Monday to Friday ...

it's like suggesting that maybe doctors could provide that kind

of service. We know very well that a lot of the need for

testing just can't fit in to that kind of time schedule.

Therefore I'm wondering, first of all, if the Minister would

like to comment on expanding food testing by utilizing more

widely the services of pathologists and technicians in the

existing laboratories in the province, not necessarily

provincial health laboratories.

As the Minister knows, in a variety of towns and cities the

hospital lab in the particular town or city provides services

to the government. When the Minister responded to my question

the other day by saying that laboratory services were

inadequate, I don't really think he quite meant that. Maybe he

did, but only in relation to the provincial government

labs.

I get the impression, both from practising myself and from

discussing the matter with other pathologists in other parts of

the province, that, basically, they are very pleased with the

progress that is being made in laboratory service generally in

this province.

As the Minister knows — he mentioned the x-ray lab in Osoyoos being judged

by its peers — the very same happens in the laboratory field, and the pathologists

quite eagerly have taken on a self-disciplinary role in accreditation of laboratories

to ensure quality control in their work. Again, this is mentioned in the annual

report of the medical services commission, pointing out that they recognize

this responsibility, and they think they are making good progress, Now if that

is the case, if we have the potential to use these private and public labs more

widely for the specific supervision of safety in food distribution, I wonder

if the Minister could tell us to what degree he is consulting with the pathologists

across the province to bring this about.

The second point in that regard is that one lab that I

talked to have certain food retail centres voluntarily asking

for advice from the pathologists as to how often they should

test their meat, their hamburgers or what-have-you. On a

private basis, on a fee-for-service basis, some of these food

centres submit samples on a regular basis to this lab. I think

that shows real responsibility as well as some initiative on

the parts of the parts of the outlets.

Again, I have to ask: what about the other stores or the

other outlets who just plan to spend as little time and as

little money as possible checking on their products? I wonder

if the Minister could give us some general idea of how often

some of these outlets are being checked by his inspectors. He

did mention that you can't have an inspector in every store

once a week, that sort of thing. I'm not asking that. But it

would appear, from the investigations I've done, that a great

deal is left up to the feeling of responsibility which the food

retailer himself or herself has. Some of them are taking this

initiative privately, having a regular check on their products,

but there is not a sufficiently frequent check by government on

other outlets who choose to just carry on in their own way

without really having adequate or frequent checks on their

product.

I notice that in this vote the Minister has increased lab

technicians from 27 to 39, and laboratory aids from 18 to 26.

That's all a step in the right direction.

As I mentioned the other day, with the warmer weather

coming, hopefully, and an influx of tourists and the tremendous

pressure on some of these fast-food places in the months of

July and August, I would wonder if there are any immediate

steps we should be taking in the light of some of these

findings to at least have even temporary increased regulations

during the summer months, perhaps utilizing some of the other

labs other than present government labs to bring this

about.

It seems to me that there is a real potential for an

outbreak one of these times. Then we'll all be saying that we

should have done something about it. I just feel that, under

the circumstances that have been described in the tests done by

the Canadian Consumers' Association, and in the light of my

information that there is potential for more people to do more

testing, providing we can set up some programme in consultation

with these labs I have mentioned, maybe we could prevent a

serious outbreak.

HON. MR. COCKE: Well, Mr. Chairman, I quite

[ Page 2814 ]

agree with the Member that everything has to be done that

can be done. We are in the process at the present time of

discussing with the laboratories and with our own public lab

expansion of programme, and we're doing everything we can do.

The one thing I want to make very clear is that for restaurants

like Dairy Queens, McDonalds and all the rest of them, if you

were to try to keep up with inspections at the rate of

inspecting everything that goes by, it's impossible. For

instance, in Vancouver these places are inspected twice a

month. Basically, you have to see to it that there are sanitary

conditions prevailing. That really is the responsibility of our

department.

For instance, in B.C. It's the federal government and the

Department of Agriculture that do the milk; it's not done in

the Department of Health at all. But we are presently

formulating new ways and means of making sure that people are

eating pure foods. But I just don't want people to get the

feeling that every time they go into a restaurant they are in

jeopardy. They are not. Most of our restaurants come up very

good.

Vote 77 approved.

On vote 78: division of vital statistics, $1,208,660.

MR. ROLSTON: As you know, in British Columbia there are

really two forms of marriage ceremonies. One is by a clergyman

and is commonly called a religious service, and, of course,

there is also solemnization of marriage by a district registrar

or an appointee which is known as a civil service. Over many

years, of course, there have been some very substantial changes

in this province and in society regarding the attitudes about

religious marriage service, not so much on a basis of

conviction, Mr. Chairman, but more on the fact that it's

convenient and it's suitable to be married by a clergyman in a

church.

I am not going to ask the Minister, because he has been

canvassed, certainly by the United Church quite recently and

also by other churches, about the fact that the churches, in a

sense, don't really like being used the way they are as a

convenience because of the 24-hour-a-day operations they run. I

would hope that the Minister could give us some indication as

to the time when we can see some kind of expansion in the hours

of marriage commissioners so that they can be much more

convenient. In Mission it's from 12 until 2 on Monday,

Wednesday and Friday — hardly convenient, Mr. Chairman. Most

people get married, on a weekend, and at night.

I just feel that the time needs to come, and this House needs to recognize

that we now.... I understand that 21 per cent of the people are married by

a commissioner in this province, and that is gradually increasing. Most of the

churches encourage that increase, because the church really doesn't like to

be used by people who really have not even the slightest commitment to the Christian

value system in marriage.

Can we see some kind of a change? Can we advertise, first of

all, way more money? You virtually offer very little at all for

somebody to conduct a marriage in this province. Advertise for

the many people, Mr. Chairman, who do have the aptitude and who

do have the training. Often they are retired people — and I am

thinking of where I live in my riding — people who would gladly

perform weddings on a Saturday out in a park or at a person's

home. But by law they are not allowed to.

I don't see you setting up some great bureaucracy, Mr.

Minister. But, my goodness, I would hope, as our government and

our Premier says that there is wisdom in age, that there are

people who do have the time and the flexibility and they

certainly have the sensitivity and the wisdom to be hired by

the department of vital statistics for an enlarged and far more

sensitive and, time-wise more appropriate — you know, beyond 5

o'clock on a Friday.... I would encourage it. I assure you

that the United Church of Canada would encourage this.

Quite frankly, the Department of Vital Statistics, even to a

clergyman, is often a very secretive part of your department.

We wonder if there is simply a memory system, a repository of a

lot of vital statistics, not really an agency that is, in a

sense, trying to respond to what is really happening out there

in the community.

We, as the government, and, I think, as Members of this

House, are sometimes pretty concerned about what is happening

in Communities. I don't want to single out any particular

community, but we are desperately concerned about the fact that

there is a 26.5 per cent ratio between the number of weddings

and the number of divorces in this province. That is

considerably higher than the next province.

This has some bearing — I don't want to make too much of it — but it does say something, I think, about the attitude our

community has about marriage. It also might say something about

this vote and this particular division of your department, of

your Ministry, which after all, does do the regulating and even

maybe could posture more deliberately about what is happening

in the tragedy of marriage breakdown in this province.

HON. MR. COCKE: Mr. Chairman, we have had briefs on this

subject, and we are looking into them. The whole question of

diversifying the opportunity for marriage is certainly one that

we are concerned about.

As far as the division of vital statistics monitoring

people's morals and so on, or anything like that...what we

are really doing, and all the division

[ Page 2815 ]

of vital statistics is there for, basically, is to provide

the record keeping that is necessary for the province.

Vote 78 approved.

On vote 79: division of venereal disease control,

$462,712.

MR. WALLACE: I just wanted to comment briefly again and ask

the Minister on this point of the availability of laboratory

service, and the point I mentioned about 8:30 to 4:30 Monday to

Friday. People get problems at other times of the day in the

week. This again is a point that pathologists have made to me,

that doctors, generally, just use the laboratory service in the

local hospital rather than the facility that may well be

available at other times during the week under government

financing. This in turn leads to less than complete

notification of cases, which the Minister quite rightly

stresses.

I noticed in a report on April 17, in The Vancouver

Sun , that the rate of increase in venereal disease in

British Columbia is much less than the national average. It is

reported to have increased by 4 per cent last year, compared to

an average annual rate of 15 per cent.

On the other hand, I also noticed a report from the Central

Vancouver Island Health Unit area where Dr. Peter Reynolds,

back in February of this year, reported what he considered

almost an epidemic proportion in the increase in cases of

gonorrhea, from 375 to 435.

I wonder if the Minister would comment as to whether it

might be possible to make the services of the government

laboratories more readily available, more frequently, on a more

accessible basis, so that in fact we can be sure that if there

is some urgent need for immediate laboratory investigation of a

possible case of venereal disease, at least the service is

there and available.

The other point I mention in passing is that we have heard a

lot in this House, earlier on this session, about the education

of our children in the schools regarding the whole question of

sexuality which so often seems to zero-in only on VD. I think

it is pathetic that when people think about educating our

children about their sexual role in society, the first thing

people seem to think about is VD. It's really a small part of

the problem if the facts are looked at objectively. There has

been some tremendous resistance in certain municipalities, I

notice, to this kind of effort by, perhaps, more the Minister

of Education (Hon. Mrs. Dailly) than the Minister of

Health.

I wonder to what degree the Minister of Health is involved with the Minister

of Education in formulating the kinds of programmes that are quite feasible

and practical and not going to do any harm at all. We have two first-rate people,

a lady and a gentleman, teachers in Oak Bay — not only in Oak Bay, they travel

around the schools in School District 61, and just do an excellent job. How

anyone could take offence at the basic factual, mature way in which these two

teachers talk about venereal disease and other related subjects.... I think

it is just something that we in this area have to go on record as praising in

the highest terms.

I've been to the school to listen. They go over the

programme with the parents, and the parents have the choice of

having their children take the programme or not. Complete

freedom of choice. I wonder to what degree the Minister and his

department is furthering this worthy goal in combination with

the Minister of Education.

HON. MR. COCKE: Mr. Chairman, firstly, to my knowledge the

division of labs is not behind in VD testing. I agree we're not

offering tests at 12 o'clock at night, or something along that

line. That's not to suggest that isn't an idea we are looking

at at the present time — the better utilization. As a matter of

fact, the Premier has indicated on one or two occasions, I

believe in the House, that not only the division of labs but

universities and so on should better utilize their space, and

that's precisely what we're doing now.

Going beyond that to the school programme for VD or on that

subject, we make available to the schools personnel, films or

whatever. I must confess that because there seem to be so many

inhibitions out there — that is, when people are dealing with

children — that it does sort of mitigate the work that we can

do. But the work is going on and there has been, as a result of

hard work over the last couple of years, a reduction of VD,

despite one particular isolated area. There has been an actual

reduction in the tendency to increase.

MR. WALLACE: Mr. Chairman, just one last point. I notice a

surprising reduction of one item on this vote. Strangely enough

it's entitled "medical services" and they're down from $20,000

to $ 10,000. Does this reduction show up somewhere else?

HON. MR. COCKE: What number?

MR. WALLACE: Code 008, halfway down the vote. It was $20,000

last year and it's shown as $10,000 this year. Strangely enough

the item is entitled "medical services." I wonder if this money

shows up somewhere else other than in this vote.

HON. MR. COCKE: Mr. Chairman, we have a full-time assistant

director instead and so some of the money is taken out of that.

Therefore it's a salaried situation.

[ Page 2816 ]

Vote 79 approved.

Vote 80: division of tuberculosis control, $1,220,985 —

approved.

On vote 81: division of in-patient care, $4,942,000.

MR. McCLELLAND: Mr. Chairman, I'd just like the Minister, if

he would, to bring the House up to date.

On a number of occasions in the House I've asked questions

about the staff problems at Pearson Hospital. I know that's it

an ongoing problem there and one in which we wouldn't want to

see the patients suffering from lack of services. I'd

just like the Minister to bring us up to date on how those

problems are being met and whether the situation is improving

at Pearson.

HON. MR. COCKE: Mr. Chairman, each time the Member for

Langley (Mr. McClelland) has brought up the question of

staffing we've looking into it; at least I have from my office.

The reports have been, as you know, on one or two occasions

that there has been a shortage of specific personnel.

Generally, as far as I know, the staffing is okay at the

present time. We are, as you know, putting all our hospitals

into sort of a different stream under reorganization and I hope

that because of their closer touch at the rest of the hospitals

it will work out better and there will be better

interchanging.

Vote 81 approved.

On vote 82: Medical Services Plan, $123 million.

MR. WALLACE: Mr. Chairman, we can't just pass a vote of $123

million. I mean, things may be very good.... The Minister's

smiling.

HON. MR. COCKE: How do you avoid it?

MR. WALLACE: I think he has a great deal to be happy about

on this vote, but $123 million is a lot of dough and there are

just one or two points I'd like to clarify.

The cost is going up from $105 million to $123 million but I

wonder if the Minister could give us the projected breakdown,

or at least perhaps a breakdown for the $105 million in terms

of federal money, provincial money and premium money. I tried

to check this out myself but the last annual report is for 1974

which is dated December 16, 1974, and I presume that the report

for 1975 isn't available. If it is perhaps the Minister could

tell us.

I think everybody talks about the rising cost of medical care, and that has

to rise along with everything else in inflationary times, but I think it would

be useful to have the breakdown. As the Minister knows, some of the costs are

shared 50-50 with the federal government, exclusive of things such as chiropractic

and naturopathic and so on. I wonder if he could give us that breakdown.

The other point I would like to ask is that my understanding

is that premium structure for those who pay the full premium

themselves was set in 1965. This is 1975. If government wasn't

dedicated to paying the whole shot in 1965, obviously it set

these premium rates in keeping with general economic factors —

wages, prices, et cetera.

Here we are 10 years later where costs have certainly

doubled or maybe even tripled and the premiums stay the same. I

just ask the question again: since we don't have endless

amounts of money for laboratories or intermediate care of

prosthetic devices and all the other benefits which I have

suggested in this debate to the Minister should be available to

some of our handicapped and our senior citizens and so on, is

it not logical that maybe some of the figures contributed by

the recipient of the service might be raised simply because it

would create more money to be used in some of these other areas

of service which are being completely uncovered by the

government? I am particularly thinking of the ones that I

mentioned, such as the nursing homes, the cost of drugs to the

handicapped person, the child with cystic fibrosis, the hearing

aids, the lenses and all the other devices, prostheses and

appliances which make life just a little bit easier for the

person who has to suffer the disability.

On the same basis I might suggest that there is some relief

of 50 per cent of the premium for individuals with a taxable

income less than $1,000. Once again, would it not be timely to

consider raising that $1,000 allowance? When that rate was set

the $1,000 was probably quite reasonable. But again, with

inflation and changing economic factors would it not...? Or

is the Minister considering raising the level to $1,500 or

$2,000?

HON. MR. COCKE: Let me explain it to you.

MR. WALLACE: That's good.

One or two other points I just want to mention. We have had

some discussion recently about the so-called blacklist. I think

the Minister has answered that fairly adequately. But I think

that in keeping with getting all the facts out on the table,

this annual report also mentions the question of professional

review committees. I think this House and the people of British

Columbia should know that a pattern-of-practice committee

exists. That just simply means that in the computerized age the

pattern of every doctor's practice can quickly be inspected

and, indeed, those physicians whose pattern of practice is

[ Page 2817 ]

far from the middle 80 per cent or whatever of the total are

subject to scrutiny.

The Medical Services Commission report takes cognizance of

the fact that the Minister and his department act

cooperatively to provide the various statistics and other data

which help the peer review committees to function. I think too

often people get the impression that physicians can play fast

and loose with whatever they charge and how they charge for

medical services. I think it's only fair to point out that the

profession seems to be in very considerable harmony under

medicare at the present time. Everything isn't perfect I'm

sure, but this government has recently negotiated increases on

the level of rates that can be charged on a fee-for-service

basis. The fact that the patterns-of-practice committee is

functioning as well as it is in cooperation with the

government is probably why the Minister smiled when I said we

couldn't pass over this item. But I think he should be glad

that at least I'm standing here and acknowledging some of the

good things instead of raising a whole lot of dust about some

other points that probably could be discussed.

The last point: I was just wondering about the projected

figure of $123 million. Does the Minister expect the same

proportionate sharing of costs in the coming year or does he

anticipate any expansion of services provided under medicare

which will not be cost-shared by the federal government. Or,

alternatively, has he any hope that some of these services like

physiotherapy and so on, which, again, help to keep people out

of hospital, which is very costly...is there any evidence

that the federal government might start to share in some of the

medicare services which presently they don't share?

HON. MR. COCKE: Mr. Chairman, there is no evidence that

would indicate that. I have discussed the question with the

Minister, Marc Lalonde.

However, let me first answer your question about the

breakdown. We're talking here not about $123 million; we're

talking about $235 million in the estimates. What you really

have in this is a vehicle for recording revenue — Ottawa, the

premium, subsidy and so on. So let me give it to you in a

broken down situation. The premium subsidy we have proposed

will be about $23 million, premiums will be $94,500,000,

investment interest will be $14.9 million for the premium

subsidy. Wait a minute...that's not premium subsidy. The

federal is $84,081,000. So it works out to $235 million.

You ask if we will raise the premium. What we have actually done is say that

the government will pay a greater proportion. In other words, we know that the

premiums were set in 1965. What we are really doing now as a government is paying

a greater proportion of the total that is going into Medicare. We have no change

of policy in that regard at the present time one way or the other. I think that

just about answers the question.

As far as the professionals go, yes, as a matter of fact

there are one or two people being referred to the review

committee of the profession. That is the way we work. We work

with the profession.

MR. WALLACE: I think the Minister, along with the Minister

of Human Resources (Hon. Mr. Levi), has often used the phrase

about moving the money around. I won't be tedious and

repetitious but we have talked about the dollar a day in

extended care, et cetera, and patients accumulating assets

while they are in extended-care hospitals. The Minister has

made a very flat, categorical statement that the premiums were

set in 1965 and that in the last 10 years the government's

policy has been progressively to pay a larger and larger part

of the total costs. Do I take that as a flat rejection of the

fact that health care is a bottomless pit, that you can't

possibly get all the money you could spend, and that therefore

the challenge is to give equitable assistance to anybody who is

sick and who needs it?

I'm sorry that I have to get on to this again and again and

again, but we have people who are going broke in this province

paying for their own health care. Yet every single person under

Medicare is paying the same fee he paid in 1965. Is that

justice?

I just think that that is not fair. It isn't right that

people finish up in a nursing home and pay $600 or $700 a month

until they finish up on social assistance with the government

looking after them. In the meantime, people like ourselves in

this chamber who are well paid, pay a premium for medical

services which is the same as it was in 1965. We don't buy a

single thing in life these days that costs what it cost in

I agree with the Minister that if we had all the money we

needed to provide these other services, there would be no

reason to take a look at this question of raising the premiums.

Any government that raises any fee knows that it is politically

unpalatable. I'm quite aware of that fact. I just say to the

Minister that there is surely some logic in the argument I am

making that the money could be moved around so that everybody

who needs some measure of assistance gets it.

I just feel that we are doing more than we need do in

financial assistance to certain income groups like ourselves.

Yet we are doing very little for others who are in really bad

need of it.

MR. McCLELLAND: Mr. Chairman, I would like a brief

follow-up. I would hope that the solution to the problem of

those people who are really being cut out of the health

services system — those people who are spending their life

savings, in many instances, in nursing care homes — will not be

simply to raise the

[ Page 2818 ]

fees for people in other parts of the health care system.

That won't help the people in nursing homes and it won't help

the people who are presently in need of other kinds of health

care, I hope that the Minister will continue the commitment of the

Province of British Columbia to pick up an ever-larger share of

the premiums in health care. I think we have already accepted

as a premise that the province will make sure that the people

who are in need of health care will be able to get it. The only

thing that we haven't done so far goes back to the committee

that toured the province, which found out so clearly that the

one major concern to people all over this province was that

grey area of health care that isn't being met. I think we have

accepted the premise in this province that the Minister has

outlined. Now we have to accept the premise that health care is

health care, regardless of what level it happens to be at, and

that everybody deserves fair and equal treatment in this

province in that concern.

Vote 82 approved.

On vote 83: Action British Columbia, $275,000.

MR. WALLACE: A quick question to the Minister. I notice that

the budget is up by more than 100 per cent. I think that is

probably good. Could you just give us a brief outline of what

you project for the future under this programme?

HON. MR. COCKE: This is probably one of the best-spent

pieces of Health department money that there has ever been.

Action B.C. is a continuing programme. Last year it was at the

PNE. It will be there again this year. It is going around doing

preventive work for very few dollars. Frankly, I'm very proud

of that programme.

AN HON. MEMBER: Hear, hear!

Vote 83 approved.

Vote 84: training in the expanded role of nurses, $75,000 —

approved.

On vote 85: emergency health services, $11,000,000.

MR. WALLACE: Mr. Chairman, this is a programme which I would certainly

commend. All I am asking is some general information about the breakdown on

the $11 million in terms of how much is for ambulances and how much is for personnel.

Dr. Ransford has given some very useful information, just within the last week

or so, about the tremendous progress that is being made in providing facilities

for the training of paramedical personnel who travel with the ambulances. This

is a service which has really been overdue in the province.

On the same subject of emergency health services, I wonder

if the Minister could bring us up to date on the other element

that isn't quite so encouraging — the dispute which seems to

exist with the federal government over air-sea rescue services

which, I gather, have been provided to the tune of $260,000 or

some figure in that neighbourhood. I believe the Minister has

received the bill. He said that he doesn't believe the

provincial government should be obligated to pay that bill.

I would like to ask some very specific questions on the

emergency service of this nature. Again we are approaching the

tourist season, and the boating season is upon us. In fact,

around these waters it's never anything else but a lot of

boating. However, in the summer the incidence of accidents and

emergencies increases. Again, I am not suggesting that the

Minister can have a boat half a mile away from wherever a

tragedy might occur, but, on the other hand, the people are

using the waters just as they are using the highways in the

summer time and we have an increase in accidents — drowning and

so on. I just wonder exactly where this government is at in

regard to what it is prepared to provide in the way of

financing, facilities and personnel. Are we at loggerheads with

the federal government? How are we making out in an attempt to

come to an understanding of the best integrated use of all the

services, personnel and ships available?

Perhaps the Minister could mention whether he has a meeting

planned with the federal government or the federal authority

responsible. I think it's really a pity if we have to be in any

real dispute about this particular service. Quite obviously,

lives are involved and every summer we do have people drowning

who might otherwise be saved. I don't really see there should

be tending to be such a differing attitude to deaths on the

waters and of deaths on the highways. We pay a great deal of

respect and concern, and rightfully so, about the accidents and

deaths on the highways, I am not suggesting we shouldn't. But

it seems to me that the attitude to people on the waters....

Certainly the kind of terrible tragedy of the herring fishermen

in the last few months is nothing short of staggering when you

realize the families that must have been left without a

breadwinner as a result of these 12 or 13 sinkings. So I am not

impressed to be told that it seems to be a jurisdictional

dispute. I think that somehow or other....

HON. MR. COCKE: No. I think you are getting it all.... I'll

explain it, anyway.

MR. WALLACE: Okay. Well, maybe it isn't a jurisdictional

dispute. That may be too technical a

[ Page 2819 ]

description. But there seems to be some doubt on the part of

this Minister as to what our obligations are. And I am not sure

that the federal government knows what its obligations are. I

wrote a letter to the federal Minister concerned and I received

about a five-page reply, but I am not sure that at the end of

the five pages I was any further forward than I was when I

first wrote to him.

I won't bore the House with reading out the whole

perambulatory kind of answer I got, with big words and long

sentences, which really just added up to the fact that they

don't seem prepared to do much more than they are doing, and

they are not even sure that they are going to do that. So I say

that here is an area of responsibility which has to be met. I

would like to know from the Minister where we are at the

present time in relation to the federal government.

HON. MR. COCKE: The air-sea rescue service is a federal

government responsibility, and they are carrying out their

responsibility well. My complaint is that when I ask for an air

evacuation, which is an entirely different proposition.... For

example, if some person is acutely ill in a northern community

or in a coast community, or whatever, and I ask the federal

government to use their air-sea rescue service to bring that

person to a hospital, and then they begin to bill us — that's

where I say foul. But that's a dispute that we have.

As far as the fishing fleet this year is concerned, we have

carried the programme which we started last year with the

doctors out there on the fishing grounds.

The breakdown of the emergency health services — it will be

about $1.1 million for ambulances, the balance will be on

training and manpower.

MR. McCLELLAND: Just a couple of questions to the Minister

on this vote. I would like to ask whether it is the practice of

the department to call tenders on all new facilities and

vehicles for the ambulance service. I would like to know where

the service is going to go in the future with regard to

emergency centres in communities, whether the service plans to

develop its own series of emergency centres on a regional basis

or whether they will be localized in individual

communities.

I know in my area, for instance, the emergency centre is set

up in a local motel. I don't know whether that would be the

most prudent use of government money or not. Perhaps it should

be somewhere else, maybe in an existing government building. I

don't know. I just want to ask the Minister where it is going

in the future.

I wonder if the Minister has done any surveys or whether it is too early yet

to find out whether or not the ambulance service, the emergency service, is

being used to any significantly greater degree than the service was used previously,

and whether or not the department or the service has attempted to find any causative

reasons for any difference in use.

Referring back to the budget speech, Mr. Chairman, in which

it was indicated that the $6 million figure was an actual cost

for the current year for the emergency service, the $11 million

budgeted this year will cover air ambulance services as well.

Is that a realistic figure in the Minister's mind? Does it

allow for any inflationary increases in the cost of providing

the ground service? Would that $11 million, in fact, cover the

increased use of both the ground service and the air service?

It seems like a fairly modest increase to me to expand it into

a new service altogether.

Just a technical question to sort of bring me up to date:

I'd like to ask the Minister whether all of the aircraft in the

government fleet are capable of being used as emergency air

service vehicles. Having been in one of the jets on a very

brief occasion when one of the Ministers was kind enough to

take me for a ride, — the whole government has been taking us

for a ride, but this was a rather pleasant arrangement — I

found it difficult to envision those new jets being used for

emergency air ambulance service. Are they all capable of being

used for that utility?

HON. MR. COCKE: Going back to the motel, that's just a

temporary thing. I've heard all about it. I'm not particularly

satisfied, but I am informed that they had no other place to go

for the moment. It will be part of the metropolitan area, and

certainly we'll have some headquarters. It will be based within

the communities at the most appropriate area as far as

dispatching is concerned.

Utilization: we've found that in the areas where they kept

good records prior utilization has not gone up to that extent.

Other areas tell us they have gone way up, but they haven't got

previous records. So we think that since in metropolitan

Vancouver and the Saanich area where they had kept excellent

records the utilization hasn't gone up to that great an extent

in those two areas, I don't really think it has gone up that

much anywhere. Naturally it is being utilized a bit more.

Air ambulance: the only air ambulance work that we are

doing, of course, is some special work and also with our own

aircraft.

You asked about the Citation 500. It is only good for

children, and we use it a great deal for children. It's okay as

long as an adult.... If an adult is prone, then we have to use

the Beech 200, which is also pressurized. So the combination of

the two gives us fair.... Frankly, I am pushing for the day

when we can provide air ambulance throughout this province, but

it isn't here at this point. We certainly have used our

government aircraft miraculously. I can't tell you the number

of lives saved. There have been 40 or 50

[ Page 2820 ]

lives actually, definitely saved, and a great many more that

have been peripheral and may or may not have been saved.

The crews out there and the work they have been doing....

They're callable any time of the day or night. If they are in

the middle of another flight somewhere and they're told about

an air evacuation, it is cancelled and they land their

passengers and on with the.... We use them for ferrying civil

servants around the province. But it is just tremendous the

cooperation we have had from our air crews. I just want to

make sure that everybody knows it.

MR. McCLELLAND: Mr. Chairman, just a brief follow-up. I

assume then that the Minister is saying that he hopes to see

the day that the air ambulance service will have its own

fleet.

HON. MR. COCKE: That's correct.

MR. McCLELLAND: Secondly, I asked about tenders for

ambulances.

HON. MR. COCKE: Tenders for ambulances: now we can't tender.

I went to the purchasing commission and asked the purchasing

commission to let us buy the present ambulances without going

to tenders. How can you go to tenders when you promised to pick

up all the ambulances that the communities have? So you can't

go to tender on it.

MR. McCLELLAND: For new ones.

HON. MR. COCKE: Oh, for new ones? Certainly they will go to

tender.

MR. WALLACE: I just want a little more detail on the $11

million. I think the Minister perhaps overlooked my first

questions.

HON. MR. COCKE: That's $1.1 million for ambulances.

Unfortunately I don't have it broken down but I will do it from

memory: $1.1 million for ambulances.... Really, the balance is

for training and paying personnel.

MR. WALLACE: Out of the $11 million? Would the Minister

consider a breakdown in future? With a bald figure of $11

million, we can't really scrutinize that. Could we have a

breakdown in future estimates, please?

HON. MR. COCKE: Yes.

MR. D.E. SMITH (North Peace River): Just a couple of quick questions

to the Minister. I don't know any other vote I can bring this up under. Really

it is a matter that relates to all of the more rural areas of the province where

health service is not immediately available through the facilities that are

located there.

Quite often we find people involved in tremendous amounts of

expense other than just the care and hospitalization of either

themselves or members of their family. It's not the $1 a day,

Mr. Chairman, that concerns people when they go into the

hospital; it's the extra expense of travel and communication

and visits from members of the family and so on that become

involved.

Without taking the time of the committee I'd like to refer

very briefly to a letter that I forwarded to the Minister on

May 12 concerning a terminal cancer patient from Fort Nelson.

The young lad was 17 or 18 years of age. He contracted terminal

cancer. He had to come to Vancouver for cobalt treatment at the

cancer institute. Unfortunately it was not successful and the

treatment terminated, of course, and the young fellow died.

His father and mother, in trying to provide some comfort

for him in the last few months of his life, incurred a

tremendous amount of expense, including, for instance, such an

item as over $400 in long-distance phone calls, mainly at the

time prior to his arrival in Vancouver for treatment, and at

the suggestions of his attending physician at that time. The

doctor in Fort Nelson, now knowing exactly what he had, or what

the boy's problem was and what treatment should be recommended,

was in constant contact with specialists in Vancouver.

To wrap it up, the family incurred what they considered to

be over $6,000 in expense. Now that wasn't all directly related

to the treatment of the boy but it was related to treatment and

getting members of the family into Vancouver to see him in the

last months of his life.

The chap that's involved has a good-paying job, but he had

to mortgage his home, he had to borrow money from a finance

company and he had to sell property to pay for it. Is there any

fund that would help offset at least a portion of that sort of

expense?

HON. MR. COCKE: Mr. Chairman, it certainly isn't under

emergency health, but it is being looked into right now, I'll

tell the Member. We have to assess, under alternate care,

whether or not the need is sufficient and so on. It is being

looked at at the present time.

MR. SMITH: Mr. Minister, through you, Mr. Chairman, the one

thing that this gentleman brought to my attention the last time

we were talking was this particular problem with telephone

bills that he incurred at the suggestions of the medical

doctors involved on that case — well over $400 worth of bills

in a period of about a month, I believe it was.

[ Page 2821 ]

Vote 85 approved.

On vote 86: salary contingencies, $4,771,513.

MR. J.R. CHABOT (Columbia River): I'm wondering whether the

salary contingencies when we're looking at that $4 million....

Will the Minister be contributing anything financially for the

training of medical students at the University of Calgary from

this vote? We certainly are lacking facilities for the training

....

HON. MR. COCKE: It's under Education.

MR. CHABOT: It's under Education. There won't be any

contribution from your department to subsidize the training of

medical students because of the lack of proper facilities at

the University of British Columbia.

MR. CHAIRMAN: Order, please!

MR. CHABOT: It's under Education, Mr. Minister, you say?

Thank you very much.

MR. McCLELLAND: Mr. Chairman, the Minister indicated earlier

that any negotiated agreement which is reached with the

salaried doctors and the department will be covered under this

vote. I wonder if he could give us an indication of what other

contingencies he sees that might be necessary to be covered

under this vote?

HON. MR. COCKE: Well, Mr. Chairman, I have a $712 million

budget and thousands and thousands of employees in the

department. Naturally we no longer have salary contingencies....

Interjections.

HON. MR. COCKE: Instead of having it under the Minister of

Finance we now have it departmentally, as you know, and so this

is not a particularly large item when you consider the nature

of the budget.

Vote 86 approved.

On vote 87: mental health services, general administration,

$7,489,327.

MR. P.L. McGEER (Vancouver–Point Grey): I'd like to speak

very briefly about just one tiny part of this.

I see that there is a grant to the University of British

Columbia for research.

AN HON. MEMBER: Oh, oh! Conflict of interest.

MR. McGEER: I notice that it's the same this year as last

year, and I look at all the big increases. For example, here

there's one on development of new programmes — almost double

there. Of course, all research is new programmes. I know just a

little bit about some of that research that's been done with

this $30,000 grant and I can tell you that money is extremely

well spent.

Interjection.

MR. McGEER: No, I didn't say there was too much money spent

on education. I said that it might be a little better spent. I

want to say that this money is extremely well spent — many

papers published and that sort of thing.

HON. MR. COCKE: Mr. Chairman, I knew that the Member for

Vancouver–Point Grey would bring this up.

Under the B.C. Medical Centre we are going to set up a

committee on research. That committee will be responsible for

providing funds to certain research projects. We weren't quite

sure what to put in here or there. There is money going to the

B.C. Medical Centre for research of the sort that you are

talking about. I'm quite sure that with your status in the

field and so on you won't have any trouble at all looking after

the research that you want to do by guaranteeing full-time

participation in your basic occupation.

MR. WALLACE: Since the field of mental health is a much more

frequent cause of disability perhaps than some of the more

obvious cases that finish up in an acute-care hospital, I think

that we should spend a few moments on the budget for mental

health.

Interjection.

MR. WALLACE: Well, administration. Okay. The Premier is in a

great hurry today. I don't know what all the rush is. We are

spending $712 million.

I just wonder, under administration, if we are going into

competition with Safeway. I see an interesting item there under

the heading "central stores: store employees, including

stockmen, meat cutters, et cetera." I just wondered under the

administration of mental health who these meat cutters are. It

is just an interesting little question that strikes one very

strangely when you are going through the estimates at 2 a.m. It

is the kind of important item that really hits you. I want an

answer to the question about the meat cutters, but it isn't....

Interjections.

MR. WALLACE: I wonder if the Minister could

[ Page 2822 ]

give us a general quick rundown on the vote for development

of new programmes. In very broad terms what are they, where are

they and so on?

The other item is under 042. I am particularly concerned

about this because it is entitled "assistance for retarded." A

vote of $400,000 last year is not showing up at all on this

year's budget. I assume that that $400,000 for assistance for

the retarded is somewhere else in the budget. I can't imagine

that we would be reducing money for assistance to the

retarded.

It's going into Human Resources? Okay.

The other question I find is under 045, "forensic services,

$1.3 million." I was one of the strong supporters of the

Minister when he set up the forensic psychiatric services

commission Act. Could he tell us if that $1.3 million is all

destined to be spent providing the medical services under the

forensic psychiatric services commission Act? As we all recall,

that was set up to provide adequate psychiatric examination and

treatment of people who fell foul of the law and particularly

to ensure that patients with mental disorders who finished up

in Riverview would have periodic reassessment of their

condition so that they didn't just disappear from society for

20 years.

I wonder, first of all, if that $1.3 million is all related

to that service. If not, what part of the $1.3 million is

created through certain other services?

HON. MR. COCKE: Mr. Chairman, the central stores — that's to

provide the different facilities. I'm not sure why they put

meat cutters there. I suppose they could just have left it at

"stockmen, et cetera." I think some knave put that "meat

cutters" in there. It could have been a number of other things

or occupations as well.

MR. McGEER: Just pressure from George Johnson.

HON. MR. COCKE: I think so. George had a hand in that.

As far as the new programme is concerned, the new programmes

are mainly that big project in Vancouver, the adult psychotic

programme and other community programmes that are going on at

the present time. We are quite happy with those programmes.

The forensic $1.3 million does not include the running of

Riverside. We will transfer the budget from our institutions to

the forensic commission. They will also take that

responsibility but they will have that in addition to the $1.3

million.

Vote 87 approved.

On vote 88: division of nursing education $380,348.

MR. McCLELLAND: I would like to question the Minister about

the absence of the $300,000 for the student nurses, the

$250-a-month bursaries. Has that been shifted or has that

programme come to a stop?

Interjection.

MR. McCLELLAND: Bursaries, Mr. Minister — 100 student nurses

at $250 a month. There was $300,000 in the budget previously,

nothing listed this time around. There is another $120,000

later on for psychiatric nurses at BCIT, which wasn't in the

budget last year.

HON. MR. COCKE: Mr. Chairman, those bursaries are

transferred to expenses, according to my records.

MR. McCLELLAND: Mr. Minister, will the programme be

continuing on the same basis as it was before?

HON. MR. COCKE: Yes.

MR. McCLELLAND: The same kind of repayment arrangements with

the student nurses as well?

HON. MR. COCKE: Just for the 200. They get $150 basic

because we're giving bursaries to all nurses at that rate, so

anything over and above that which the psychiatric nurse is

given would be repayable, but not the basic $ 150.

MR. McCLELLAND: Okay.

MR. WALLACE: Mr. Chairman, since we're dealing with nursing

education, particularly in the mental health field, I just want

to bring to the Minister's attention the kind of situation

which exists due to the lack of instructors and programmes in

psychiatric nursing.

While to some extent the Minister may feel this is

essentially an educational problem, it's of very great

importance. I've had an enquiry, for example, from a lady — an

RN trained in the United Kingdom — who in order to become

registered in this province requires upgrading of her

psychiatric nursing training. She has just had — I was going to

say, the very difficult job — in fact the impossible job of

finding a place where she can get the upgrading training. She

has communicated with the Registered Nurses Association, and

she has communicated with BCIT. I'll read quickly the kind of

information she got from RNABC: "At the present time the only

course offered in psychiatric nursing is the evening programme

offered by the B.C. Institute of Technology from September to

April two evenings a week."

For someone not living in Vancouver this is a very

impractical way in which to take any upgrading

[ Page

2823 ]

training — two evenings a week. With family commitments,

travelling expenses and the very interrupted nature of the

training, it makes it very difficult.

I have pursued the matter further with the RNABC. The

president wrote a very thorough letter back to me, just saying

the same thing:

"The only place where an approved course is offered is at

the British Columbia Institute of Technology. We have

encouraged full-time courses of study, and the B.C. Institute

of Technology are willing to cooperate. But at the moment they

are not able to move because we cannot find an instructor to

teach the course."

It seems incredible to me, Mr. Minister, that while we're

supposed to be enlightened as to the tremendous impact of

emotional disease in our midst and the tremendous capacity for

preventive medicine by treating emotional disorders first, here

we have personnel trying to get training to upgrade their

pre-existing training, and there just doesn't seem to be a

single instructor who can teach psychiatric nursing.

In fairness, and to tell the whole picture, the president

goes on to say:

"There is a drastic lack of people prepared to teach

psychiatric nursing in the province, a situation which has

taken several years to develop and about which the Registered

Nurses Association have raised their concern many times. The

Association proposed a course in post-basic psychiatric nursing

at the University of Victoria last July, and suggested that the

B.C. hospital insurance programme fund this in order to prepare

people to teach psychiatric nursing. This course was approved

by the B.C. Medical Centre provincial council in February of

this year and to my knowledge there has been no word as to the

funding."

I don't know if it's the funding that's the main problem or

the personnel willing to do the teaching, but perhaps the

Minister would care to comment on that. I also had a reply from

the principal of BCIT. He acknowledges that this lady has been

waiting a long time for the course, and he mentions that the

waiting list, as of March 26 this year, included 64 names.

There are 64 nurses seeking to upgrade their training, and they

can't even get a course at BCIT.

He goes on again, so that I don't just read part of the

story:

"The course has been tentatively redesigned to be available

in a concentrated block of not more than eight weeks in order

to serve the needs of clients outside the power mainland.

Unfortunately, the delay in implementing the programme has been

aggravated by factors such as the unavailability of an

instruction.

"Responses to advertisements have not been encouraging,

particularly in terms of qualifications, experience and familiarity with the

required and desirable approach to the province's mental health-care needs with

emphasis on community-based resources and personnel. Shortages of high-quality

instructors for nursing programmes of all types are not uncommon."

This has come to my notice specifically in terms of

psychiatric nursing. I don't know if the same serious problem

exists with other types of nursing, but I know the prevention

that can be carried out by good counselling and psychiatric

nursing and care which physicians don't have the time to carry

out, nor should they when it can be done by other personnel.

Has the Minister decided, first of all, to make the funding

available that I referred to in the letter from the RNABC and,

secondly, what can be done to find instructors?

HON. MR. COCKE: It's a personnel problem, Mr. Member, and I

can't answer it. But I will say that I will look into it. I

can't give you a definitive answer either way.

Vote 88 approved.

On vote 89: community services, $4,375,734.

MR. PHILLIPS: Just a short question with regard to the

psychiatric personnel in the Peace River district that I spoke

to the Minister about. Evidently there is a shortage of

qualified psychiatric people all over the province. What

efforts are being made to solve the problem?

HON. MR. COCKE: We are short in areas and, Mr. Member, I

agree that in your area we are really short of people in that

particular occupation or that expertise. We are considering a

number of different alternatives. You and I could talk about

it, but we haven't been all that effective in being able to

recruit for the more northerly areas. That's just unfortunate,

but it's a fact of life. We are working on it.

MR. PHILLIPS: Well, you said that you weren't aware that the

budget had been cut back. The budget applied for in the area

was $137,000. The budget approved was only $72,000. Maybe you

cut back in the budget because you knew that we couldn't hire

those people. This is what concerns me. Why was the requested

budget cut back when we are in such desperate need for

psychiatric...?

HON. MR. COCKE: It has been over-budgeted for years. What we

will do is increase the budget if we can get the staff. There

is no point in keeping....

[ Page 2824 ]

MR. PHILLIPS: Will you stand up and say that?

HON. MR. COCKE: There is no point in keeping a figure out

there that's not realistic. If you have two staff and you are

budgeting for $115,000, and you know perfectly well you are

only going to spend $70,000, why not say you are only going to

spend $70,000? As a matter of fact, we probably won't spend

$70,000 unless we can get another staff person.

We want more and I have some ideas that I want to try on

people, but there is no point in just glibly whipping out a

couple of ideas here and there. We are suffering in some of the

more isolated areas. I'd like the profession to give a little

bit of leadership in getting out there, and I am talking in

terms of the psychiatric profession. If you were to get

psychiatric service, then you would get the ancillary

service.

MR. PHILLIPS: Well, Mr. Chairman, I don't wish to prolong

this but I am glad the Minister assured me. The information I

have says that the actual budget approved was for $72,896; so

all extra personnel requested were denied, Mr. Minister. Did

you hear what I said? This is the information that was supplied

to me.

HON. MR. COCKE: Yes.

MR. PHILLIPS: It says that the extra personnel required were

denied. This is what they are concerned about. They put in a

request for these people, but the budget was cut back. I would

be happy to inform them, if you assure me that this is the

reason the budget was cut back — because you didn't think you

were going to be able to get the people — that if you can get

them, then the budget will be increased. Now if I have that

assurance, then I can alleviate the worries these people are

having.

HON. MR. COCKE: If you are raising a specific case about a

specific area, I will have to look into it and I will look into

it with you, but I am not going to give any particular

undertaking at this time.

MR. WALLACE: On that same general area, Mr. Chairman, the people in

Kitimat have contacted me because they feel that they have reached a serious

point in their community in the breakdown of service,

particularly in the need for psychiatric services. I recognize

the point the Minister has made. But the community itself in

Kitimat, from the correspondence which I am sure the Minister

received — and I recently wrote to the Minister to find out

where we are at — points out that they themselves are

desperately willing, through a variety of people in different

roles in the community, to help themselves. They are not just

asking for a government to provide some instant solution or a

whole bunch of experts.

They, as a community, are very concerned at the fact that

all kinds of social problems and emotional and mental problems

are going untreated. As a result, the general situation in the

Kitimat community appears to be deteriorating.

I wonder if the Minister has any specific hope that he can

give to the people in Kitimat as to some fairly immediate plan,

or some plan in the near future, or is he planning to go up

there. You know, I sensed a real note of urgency in their

correspondence, if not despair. When there are so many

different people in that community willing to take time to put

together a committee of their own and to research the matter

.... The Minister would agree, I think, that they presented an

excellent brief in outlining what the problem is. At least if

you can do that, that's step No. 1. I just hoped that maybe the

Minister could suggest that there's something in the near

future by which he hopes to alleviate their problem.

HON. MR. COCKE: We've been in touch with them, and they did

present a very fine brief. I hope to be going up there in the

not too distant future. I haven't formalized it yet, but we are

in touch with the Kitimat area.

The House resumed; Mr. Speaker in the chair.

MR. CHAIRMAN: Mr. Speaker, the committee reports

resolutions.

Hon. Mr. Barrett moves adjournment of the House.

Motion approved.

The House adjourned at 12 p.m.

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