1998/99 Legislative Session: 3rd Session, 36th 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 28, 1999

Afternoon

Volume 16, Number 13

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The House met at 2:06 p.m.

Prayers.

Hon. H. Lali: I have two sets of introductions to make today. First of all, in the gallery are three roadbuilding contractors from the Salmon Arm-Sicamous area. I'll be meeting later today with Gerry Hoefsloot, Wayne Mounce and Vicky Bischoff. Would the House please make them welcome.

For my second set of introductions, I have the pleasure to introduce three special guests. Ritu Mahil resides in Victoria and is working on a combined law and public administration degree at the University of Victoria. Ritu is accompanied by her aunt and uncle, Jaswant and Rajwant Chouhan, who are on a six-week visit to British Columbia from Punjab. They both have an interest in politics and are in the Legislature for the first time today. Would the House please give them a warm welcome.

G. Abbott: For the first time, I think, the Minister of Transportation and Highways beat me to the punch on an introduction. I want to join him in welcoming three guests from the contracting community in the Shuswap: Gerry Hoefsloot, Vicky Bischoff and Wayne Mounce. I know they're here to discuss their serious concerns about HCL with the Minister of Transportation and Highways, and I wish them well in those discussions. I'd like the House to make them welcome.

Hon. P. Priddy: I actually have two sets of introductions to do. The first are people who are here to help celebrate the twenty-fifth anniversary of the British Columbia Ambulance Service. I would like to introduce to the House Jim Patterson, who is the president of CUPE Local 873, the Ambulance Paramedics of B.C; and David Babiuk, who is the executive director of the BCAS. Barrie Carlow, the regional support coordinator, has 25 years of service, so he has an anniversary as well; and Paul Gotto, director of provincial operations, again has 25 years of service.

Sarah Moffat, paramedic unit chief from Chemainus, has 18 years of service; Gerry Parrott, regional director for Vancouver Island has 25 years of service; Ed Pfeifle, paramedic unit chief in Victoria, has 25 years of service; and Keith Price, paramedic unit chief in Duncan, has 25 years of service. Please welcome them to the Legislature today.

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Along with my colleague, my second set of introductions is a family that I had the pleasure to join at a wedding last week, when one of their family members was married. As the Minister of Transportation has indicated, Rajwant Singh Chouhan, who is actually a criminal lawyer, and his wife Jaswant Chouhan, who is a retired school principal, are from Ludhiana in Punjab. They're also very good friends. I ask the House to make them welcome.

J. Doyle: Today I'm pleased to introduce a constituent from Columbia River-Revelstoke. He's just completed grade 9 at Golden Secondary School. He is a good student and a young man I am very proud of. He has a summer job and a weekend job, but he's taken a couple of days off to be in Victoria. I'd like the House to join with me in welcoming my son Adam to Victoria.

E. Walsh: I am both proud and delighted to stand today and join the Minister of Health in welcoming my union brothers and sisters from CUPE Local 873, the Ambulance Paramedics of B.C., and also the B.C. Ambulance Service management staff here today. I would ask the House to join with me in welcoming them once again here to the Legislature.

T. Stevenson: In the precinct today are a fair number of people from the Rainbow community.

Interjection.

T. Stevenson: Well, there's one, anyway!

This community is made up of gays, lesbians, transgendered and bisexual people. Today out in front of the Legislature, "Queen Victoria" declared Pride Week. "Queen Victoria," and her consort are here. After talking with her, I understand that she did not have an annus horribilis but rather an "annus terrificus" this year. She's pleased to be here, as well, to participate in a reception at 6 o'clock in the Ned DeBeck lounge with all the Members of the Legislature. I hope the House will make them welcome.

The Speaker: Hon. members, it's not often that I have family here. Would the House join me in welcoming my daughter Jennifer Brewin, who is artistic director at Caravan Farm Theatre, and her partner Arthur Milner, who is a playwright from Ottawa. Would the House please make them welcome.

While I'm at it, I would just like to point out to the members the folder that's on their desks, which has to do with some new literature. Leaflets have been prepared for the Legislative Assembly to describe various aspects of the work that happens here. Some 200 copies are available for each of you for use in your constituency offices.

LAND TITLE AMENDMENT ACT, 1999

Hon. U. Dosanjh presented a message from His Honour the Lieutenant-Governor: a bill intituled Land Title Amendment Act, 1999.

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Hon. U. Dosanjh: I move that the bill be introduced and read for the first time now.

Motion approved.

Hon. U. Dosanjh: This bill contains measures that will make British Columbia's Torrens system the most efficient title registration program in North America. It will enable a completely paperless filing and registration system through the use and application of technologies, policies and procedures necessary to support electronic documents and digital signatures. To achieve this, the bill has two principal objectives. The first is to give legal efficacy to specialized conveyancing instruments, such as deeds and mortgages, that are in electronic form. To do this, the bill resolves questions such as how to sign a paperless document and what constitutes proof of a paperless document.

The second is to provide legal efficacy to digital signatures. Traditionally, a signature is written on the paper docu-

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ment which the signer intends to authenticate. This is not possible if the document only exists in electronic form. The bill provides practical and effective solutions to these and related questions. The introduction of this legislation is very timely. Here in British Columbia and around the world the electronic commerce business environment is growing very fast. This bill is consistent with technical and administrative standards for electronic commerce that are emerging here at home and across Canada. Hence the significance of the bill transcends the title registration program and will lead the way for similar electronic commerce initiatives in the future.

Let me assure you that the bill achieves its objective without detracting from our long-established Torrens principles of title registration. Nor will it change the existing laws and legal policies and practices relating to land transfer instruments. The bill enables electronic filing without detracting from the current paper-based system.

Finally, I point out that the electronic filing system contemplated by the bill will assist commerce, lower conveyancing costs for the homeowner, help the environment by eliminating the wasteful use of paper and improve levels of service for all those who use and rely on our land title program. I move that the bill be placed on orders of the day for second reading at the next sitting of the House after today.

Bill 93 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

PHYSICIAN SUPPLY IN PRINCE GEORGE

P. Nettleton: Dr. Roy Hobbs, a reconstructive surgeon in Prince George, has now left for the United States. Now we hear that Prince George is about to lose another five doctors, leaving as many as 10,000 residents without a family physician this summer. Will the Health minister tell families in northern and rural B.C. why, after all her government's promises, the exodus of doctors is getting worse?

Hon. P. Priddy: As it relates to Prince George -- as the member well knows -- the Northern Interior regional health board is in contact with a number of physicians who are seriously looking at moving to the Prince George area in order to provide support for families in that area. Certainly there is emergency, which is by no means the best way of providing family service, but in the Prince George-Valemount area we have been able, over the last several months, to have six physicians placed there by the provincial recruiting board. I know they're working hard to get physicians into that community.

The Speaker: First supplementary, the member for Prince George-Omineca.

P. Nettleton: It's simply not good enough. The last time the doctors' shortage was on the front page, we had the Premier promising that there would be a long-term guarantee of services for people in the north. Here we are . . . .

Interjections.

P. Nettleton: Listen up. Here we are a year later, and the situation is getting worse. No one is stepping in to take the places of the departing doctors, as we speak. Will the Health minister tell the people of Prince George why they should believe any of her promises, when all they see are services and physicians disappearing?

Interjections.

The Speaker: Members, come to order.

Hon. P. Priddy: For the people of Prince George . . . . They have seen promises fulfilled around a budget increase -- the largest in the province, by the way -- to their regional health board: a promise made, a promise kept, and the largest increase to any regional health board in this province, hon. Speaker. They've seen the commitment to the renovation and extension of their hospital. They've seen that money released; that's a promise made and a promise kept.

So when the government and the health board and the recruiting agency say . . .

Interjections.

The Speaker: Members, members.

Hon. P. Priddy: . . . that they are doing everything they can to get doctors into Prince George, I would hope that the member from Prince George, as well, is talking about it as a community where it is important to work and valuable to work, and that this work will be valued.

COST OF GOVERNMENT ADVERTISING

RE PENSION LEGISLATION

K. Krueger: The Ministry of Labour has launched an advertising campaign to promote its pension suspension bill. This is the same minister who exceeded his Nisga'a propaganda budget by 300 percent. Will the Labour minister tell us how much he is spending on NDP propaganda to defend Bill 58?

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Hon. D. Lovick: The Ministry of Labour is not spending one nickel on NDP propaganda.

Interjections.

The Speaker: Come to order, members.

Hon. D. Lovick: What we are doing is responding to the deliberate misrepresentation campaign that was carried out by the opposition. The amount of money that we are spending . . . .

Interjections.

The Speaker: Members, come to order.

Hon. D. Lovick: You know, at first I thought they were just boorish, but now I realize that it's a limited attention span.

The Speaker: Minister, there's no need . . . . There's no need.

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Hon. D. Lovick: The amount of money . . . .

Interjections.

The Speaker: Members, come to order.

Hon. D. Lovick: I rest my case.

The Speaker: Minister, watch the language, please.

Interjections.

Hon. D. Lovick: How are we doing for time, guys?

The Speaker: I'm sure the members realize that they're using up their own time. If that's the way it wants to be spent, that's the way it can be spent.

Hon. D. Lovick: To answer the member's question, the sum of money involved is some $20,000.

The Speaker: For a first supplementary, the member for Kamloops-North Thompson.

K. Krueger: It's $20,000, while this minister has failed to alert pensioners to the fact that they were being ripped off by pension suspension, and even as the carpentry workers' pension plan proclaimed these suspensions on the minister's own Internet site. Will the minister explain to the workers and pensioners of B.C. why his focus continues to be on self-serving advertising at taxpayers' expense instead of on protecting pensioners?

Hon. D. Lovick: Gosh, we're not even at July yet, but already they've run out of questions. This is what we spent about a dozen hours on during the debate on the bill. All of these questions have been answered; they have been answered at great length. Let me just . . . .

Interjections.

The Speaker: Members, come to order. No one can speak over all these interruptions.

Hon. D. Lovick: I would just remind members opposite, Madam Speaker . . . . To the questioner . . . .

Interjections.

The Speaker: Member for Kamloops-North Thompson, the question has been asked. We need the answer; let's hear the answer.

Hon. D. Lovick: We had no intention, in introducing the legislation, to spend any money whatsoever on an advertising campaign. However, when the official opposition consciously, deliberately and intentionally sets out to mislead people and scare pensioners, we have no choice.

GOVERNMENT POLICY ON

GAMING EXPANSION ON ABORIGINAL LANDS

S. Hawkins: Last week aboriginal groups across the province met to discuss ways of expanding gambling on reserve lands. At the end of the week the aboriginal groups decided to "pursue alternative avenues" for establishing casinos on reserve lands. I want to know, from the Aboriginal Affairs minister, why aboriginal groups are planning an expansion for casinos in this province when just last week his government said they were halting the expansion of casinos and gambling in this province.

Hon. M. Farnworth: Gaming expansion in this province is over; that is it. Gaming in this province, as in every other province in this country, can only take place under the Criminal Code of Canada. As such, the province is charged by the Criminal Code of Canada with conducting and managing gaming in this province.

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Interjections.

The Speaker: Members . . . . Minister, finish your remarks, please.

Hon. M. Farnworth: Aboriginal gaming can only take place if it is sanctioned by the province. As I said at our announcement earlier on, gaming expansion . . . . There will be no new licences issued in the province of British Columbia.

The Speaker: First supplementary, the member for Okanagan West.

Interjections.

The Speaker: Members, come to order.

S. Hawkins: According to a memorandum of agreement on gaming policy signed by the UBCM and the NDP government, local governments now have the ability to "make decisions as to whether new facilities or relocated facilities will be permitted within their boundaries." Assuming that this policy applies equally to B.C.'s aboriginal communities, can the gambling minister, then, confirm that in the face of the government's supposed halt to gambling expansion, we could see more casinos in this province?

Hon. M. Farnworth: The only casinos that are currently in this province are those which are currently existing or those which may get a licence at the end of the AIP process, and there are about seven of those. Those are the only licences that are in the province or that could end up in the province. Of course, casinos may move from community to community. That has been acknowledged all along. That's why I'll be announcing the name of an independent person to set up a process by which those relocations can take place. Key in that is a requirement that any casino relocation has to have community support in whichever community it may be relocated to.

INVESTIGATION INTO ALLEGATIONS

BY VICTORIA AUTO DEALER

G. Plant: Jim Alexander, the owner of Car Connection Auto Sales in Victoria, says that on June 9, Bryan McIver, who works in the Premier's Office, threatened to use the power of the Premier's Office to put his auto dealership out of business.

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Mr. Alexander's allegation, if true, is extraordinarily frightening. I know the government has been looking into it. In fact, they've appointed somebody to investigate the matter. Days and days and days are passing. I ask the Deputy Premier: could we have a progress report on the outcome of the investigation into these allegations?

Hon. D. Miller: No.

The Speaker: First supplementary, the member for Richmond-Steveston.

G. Plant: I think these are important allegations. As I say, if what Mr. Alexander has to say is true, then the power of the Premier's Office is being misused and abused in ways that cause all British Columbians to be afraid.

This is not rocket science, hon. Speaker. This is not the NCHS all over again. This is a simple question. Is Mr. Alexander telling the truth, or does Mr. McIver have an explanation for his conduct? It's long past time for an answer to that question. I repeat my question to the Deputy Premier: does he have a status report? Does Mr. McIver still hold his job? Or are the business people in Victoria and the lower mainland all sitting at their desks waiting for a visit from somebody else from the Premier's Office?

Hon. D. Miller: Two things, hon. Speaker. The member never learned in law school how to listen, and I'm sure the behaviour he just exhibited wouldn't be allowed in a court of law.

Interjections.

The Speaker: Members . . . .

TEAM B.C. TRAVEL COSTS FOR

WESTERN CANADA SUMMER GAMES

G. Abbott: In just a few days' time, 400 amateur athletes from B.C. are going to be going to the Western Canada Summer Games in Saskatchewan. Sadly, the B.C. Lottery Corporation has refused to provide any of the $135,000 in travel costs for Team B.C., because they say that the games don't provide them with sufficient return on value. The minister responsible for B.C. Lotteries has heard from these 400 B.C. athletes. He's heard from Team B.C. Will he tell us why the Lottery Corporation can find $400,000 to defend in court the government's actions over gambling policies but can't find less than half that amount for B.C.'s amateur athletes?

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Hon. M. Farnworth: We're pleased to tell the hon. member that in fact Team B.C. is going to the games, and the money has been found. The second point . . . .

Interjections.

The Speaker: Members . . . .

Hon. M. Farnworth: There are rules and regulations governing how organizations can access money for travel to send teams to events whether they're in British Columbia or in neighbouring provinces. As is the rule, teams are eligible for travel grants that cover costs of travel within British Columbia. However, there are occasions when we have national representation or teams representing the province overseas, and I have asked the Lottery Corporation to review its policies around Team B.C. for games such as these. We will be exploring those options.

At the same time, the money has been found and is available for them -- plus there are other programs which they may be able to access through grants through the Gaming Commission, which they are quite eligible to apply for.

The Speaker: The bell ends question period.

Ministerial Statement

PARAMEDIC APPRECIATION WEEK

Hon. P. Priddy: As Minister of Health, I am pleased to announce the beginning of Paramedic Appreciation Week. I think almost everybody in the Legislature is wearing pins that have been provided for us by paramedics.

It's particularly important this week and this year, because July 1 is the twenty-fifth anniversary of the B.C. Ambulance Service. Today the British Columbia Ambulance Service is the only provincially operated service in Canada. It has 3,300 full- and part-time employees -- women and men -- who respond to almost 400,000 emergency calls per year for ground and air service. Our fleet of 450 ambulances provides services in 167 communities across British Columbia, making BCAS one of the largest ambulance services in North America.

Our government believes that a strong, provincially based ambulance service is a cornerstone of our system of health care delivery. That's why we've invested almost $14 million in new ambulances and enhanced paramedic training for part-time staff in smaller communities and rural areas to ensure that BCAS employees have the knowledge and the medical skills they need to provide effective, emergency medical care to the B.C. public.

Ambulance stations in many B.C. communities are holding open houses and staging displays at locations across the province during Paramedic Appreciation Week. I encourage all of you to take the time to visit an open house, if there's one in your community.

I was pleased to attend an ambulance station open house in Delta yesterday and tour an ambulance station to mark the twenty-fifth anniversary. In honour of Paramedic Appreciation Week, I am pleased to see all of my colleagues, as I say, wearing the twenty-fifth anniversary commemorative pin. Actually, I would like to acknowledge one of our own sitting members, Erda Walsh, MLA for Kootenay, who's been a paramedic for BCAS for the past 17 years and was a regional . . . .

The Speaker: The hon. member will know that we don't name names of our MLAs.

Hon. P. Priddy: Sorry, hon. Speaker.

The member for Kootenay, who has been a paramedic for the last 17 years, was regional vice-president for the Ambulance Paramedics of B.C. Please join me in a round of applause in recognition of these very important front-line providers of health care for British Columbians.

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The Speaker: In response to the ministerial statement, I recognize the hon. member for Vancouver-Quilchena.

C. Hansen: On behalf of the official opposition, we'd certainly like to join the minister in saluting the work of these dedicated professionals from all around the province. Certainly Paramedic Appreciation Week should be going on 52 weeks a year, because I think we all have been in situations where we have had to rely on their services for ourselves or our family members. We join the minister in saluting their hard work and their efforts on behalf of British Columbians.

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Petitions

R. Thorpe: Hon. Speaker, I have the honour to present a petition on behalf of Mr. Chuck Jean and 775 British Columbians who are very concerned about this government's action related to Crown land user fees.

Hon. A. Petter: I ask leave to make an introduction, hon. Speaker.

Leave granted.

Hon. A. Petter: Joining us in the gallery are some members of the grade 5 class of Marigold Elementary School in my constituency. They're here with parents and with their teacher, I believe, Ms. Pommelet. I would like the House to join me in making them very welcome.

E. Gillespie: I ask leave to make an introduction.

Leave granted.

E. Gillespie: I understand that Karen Sanford has joined us in the gallery today. Karen Sanford was the MLA for the Comox Valley and North Island area between 1972 and 1986. She has been visiting with her family this weekend in Victoria to attend her daughter's wedding between ball games in the weekend tournament. Could the House join me in welcoming Karen Sanford.

Tabling Documents

The Speaker: I have the honour to present two reports: the 1998 annual report of the chief electoral officer for the period January 1, 1998, to December 31, 1998; and the report of the conflict-of-interest commissioner in the matter of an application by the MLA for Skeena with respect to the alleged contravention of provisions of the Members' Conflict of Interest Act by the MLA for Matsqui.

Motions without Notice

Hon. D. Lovick: I have, by leave, three motions to move. The first is:

Be it resolved that the Resolution of this House dated April 15, 1998, dealing with Sections A and B of Committee of Supply, be amended by adding to the said Resolution

Section 9.1 as follows:

9.1

Section A is hereby authorized to consider Bills referred to Committee after second reading thereof, and the Standing Orders applicable to Bills in Committee of the Whole shall be applicable to such Bills during consideration thereof in

Section A, and for all purposes

Section A shall be deemed to be a Committee of the Whole. Such referrals to

Section A shall be made upon motion, without notice, by the Government House Leader, and such motion shall be decided without amendment or debate. The consent of the Official Opposition will be necessary for such referrals.]

I move that motion.

Motion approved.

Hon. D. Lovick: By leave, I move that the following bills at committee stage be considered in

section A of the Committee of the Whole, namely: Bill 56, Forest Land Reserve Amendment Act, 1999; Bill 71, Finance and Corporate Relations Statutes Amendment Act, 1999; Bill 72, Water Amendment Act, 1999; Bill 73, Private Post-Secondary Education Amendment Act, 1999; Bill 76, Health Statutes Amendment Act, 1999; Bill 79, Land Reserve Commission Act; Bill 81, Regulatory Impact Statement Act; and Bill 86, Park Amendment Act, 1999.

I move that motion.

Motion approved.

Hon. D. Lovick: By leave, I move that Ms. Erda Walsh, MLA, be substituted for the Hon. Moe Sihota, MLA, and that Mr. Gary Farrell-Collins, MLA, be substituted for Mr. Fred Gingell, MLA, as members of the Select Standing Committee on Public Accounts.

Motion approved.

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Orders of the Day

Hon. D. Lovick: In Committee A, I call the bills that I just listed in the House. I understand that I don't need to read those again. In Committee B, I call Committee of Supply. For the information of members, we will be discussing the estimates of the Ministry of Health.

The House in Committee of Supply B; W. Hartley in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

On vote 36: ministry operations, $7,569,524,000.

Hon. P. Priddy: I would like to make some introductory comments. Just as we begin, I thank the opposition critic for his cooperation in working out what would best manage the process so that everybody gets to ask the questions they need to ask and so that we can do it in a way that allows our staff to be here.

I'm pleased to present the 1999-2000 budget estimates of the Ministry of Health and the Ministry Responsible for Seniors. While I'm sure that there will be many staff in and out of the Legislature over the course of the estimates, I would like to introduce the three people who are currently here. To my right

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is David Kelly, the deputy minister; to my left is Leah Hollins, the associate deputy minister; and directly behind me is Janet McGregor, who is in charge of all of the financial services in our ministry.

Our government has made improving health care for British Columbians a number one priority. We've done that for a very important reason. We believe that good-quality, affordable and accessible health care is a right for all people in this province and that as a government we have a responsibility to protect that right. In fact, we see health care as the most important service any government can provide its people. That's why we have consistently spent more per capita on health care than any other province in Canada.

While other provinces have cut back in health spending, we have increased our health care budget every year for the past eight years, in spite of federal government cuts. Since 1991-92 our health budget has grown by $2.5 billion. This year again we're increasing our health care operating budget by $478 million and our capital budget by $137 million, for a total increase of $615 million this year. This 6.6 percent increase more than doubles last year's increase and brings total government spending on health care to $8 billion for 1999-2000.

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When I talk about health care, I don't just talk about dollars and cents, because to me as the Minister of Health, or to any of us in the room who are parents or grandparents and who have friends and loved ones around us, health care is really about people. It's about taking care of and managing an incredibly complex system so that our children and grandchildren and nieces and nephews will have the same right to accessible, affordable, quality health care that you and I have had. It's about doing everything within our collective power to safeguard and protect medicare for them.

It's about being creative and innovative. We have to dare to change. We have to be creative and we have to take risks if we're going to continue this system -- one that, quite frankly, is the envy of the world. We have to act, because pressures on the system are profound, and fiscally we will be incredibly challenged if we do not find new ways to deal with those pressures. Our population is growing and aging. Baby-boomers are about to join the seniors' ranks in a few years -- that's many of us here in the House. That will mean additional pressures that will further challenge the health care system.

Expensive new technologies and treatments are coming on the scene. There are escalating drug costs with an aging and growing population, and there are both old and newer diseases to contend with.

Life is changing in health care. When I look back over the last ten or 20 or 30 or 40 years, there were some traditional hierarchies. There were traditional roles for physicians and nurses, traditional treatments and traditional hospital stays. But some of these traditions are changing, and we have to change if we're going to save a system that is truly worth our being able to support. We're in transition, and these are indeed challenging times. After years of cumulative federal funding cuts, I think we have been able to stop federal money from leaving the system and have been able to start to move forward.

We've chosen to respond to the challenges facing our health care system by, first, taking actions to fill some of the gaps created by all those years of federal cuts and addressing the immediate health care priorities of the people of this province, which include adding more beds and more nurses and reducing waiting times, and second, by steering our health care system in a bold new direction, towards a new vision for health care in the future.

In the health care system that I and many others envision for B.C., there will be a kaleidoscope of both traditional and non-traditional treatment choices, an array of community-oriented health service agencies integrated closely with local hospitals, and housing alternatives that enable seniors to stay at home, because of home support programs.

We will move somewhat further away from only an acute care system to one which offers a more flexible approach and enables health care professionals of all kinds to work together as a team. It will be a system where highly trained nurses and other professionals take on increasing responsibilities for the health and well-being of people, responsibilities that reflect their tremendous skills and expertise. It will be a system that places a greater focus on prevention and health promotion, to be able to curtail more costly treatment interventions down the road.

People will have the tools and information to make healthy choices about their well-being. It will be a system where people might, for instance, have access to health and treatment advice at the touch of a telephone, night or day. They may be able to talk to a nurse by phone, to provide some reassurance to a distraught parent who is concerned at 2 o'clock in the morning when their child has a temperature of 102 and who doesn't know whether to take them into emergency or not.

Seniors will be able to live at home as long as possible with the kinds of support, such as seniors' centres and community centres, that offer a hub of activity and a range of exercise, nutrition and prevention programs. At least for some people, there will be a caring ear to listen and to help break some of the loneliness and isolation that many seniors live in.

It will be a system where hospitals will be available to treat acute care patients because patients who are chronically ill are being looked after in an innovative community housing program. Hospitals will find more ways to find more ways to expand their roles and their reach into communities, especially in the area of follow-up care. It will be a more integrated and flexible health care system that puts people first, embraces a community approach and encourages innovation. Is this idealistic dreaming? I don't think so. Here in B.C. we are on our way to shaping this vision of the future.

Let me outline some of the major steps we're taking to move our province closer to that vision. I must admit, hon. Chair, that normally in estimates I don't actually do much in the way of introductory comments. But I think that this will be an important discussion this year, so I did want to set some context for that.

Reducing wait times and relieving pressure on hospitals is certainly one of those major steps. One of our immediate priorities right now is to restore British Columbians' confidence in our health care system by continuing to take action to reduce wait times for surgery and for other procedures and to relieve pressure on our hospitals. We know that despite the best efforts of our care providers and administrators, there are B.C. children and adults who are facing unacceptable delays in getting the hospital treatment that they need.

You know, any of us who've had to wait for needed treatment or surgery or -- and I think this is sometimes harder; it was for my family -- who have had to stand by while a friend or a relative waits for surgery knows that the stress of waiting can be agonizing, particularly when the length of the wait is uncertain.

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We want to make sure that as few British Columbians as possible experience this kind of stress. To that end, we've increased funding to local health authorities for acute and continuing care by close to $203 million this year, part of the $4.38 billion allocated to health authorities in this year's budget. These additional dollars will help to reduce wait times by paying for 58,000 more surgeries and specialized procedures in hospitals across the province. That's a 13 percent increase over the treatments and surgeries funded last year.

Since meeting the health care needs of children is always, I think -- for all of us -- our top priority, about $3.25 million of that new funding will be used to increase the number of surgeries performed at B.C.'s Children's Hospital, which of course benefits children all over this province, and to reduce the length of time that young people and sometimes very young people -- babies and toddlers -- must wait for orthopedic, cardiac and other surgeries and procedures.

Almost $15 million of the funding has been allocated to provide 5,000 more chemotherapy treatments and 5,000 more radiotherapy treatments for cancer patients in high-growth areas of the province. This year more than 17,000 British Columbians -- someone that you and I know -- will be diagnosed with cancer. This new funding will help to ensure that each of those patients has access to the treatment they need to fight this disease as hard as they can and enhance every opportunity that they may win.

Approximately $10 million will be used to fund more cardiac surgeries and procedures. Recent statistics from the Heart and Stroke Foundation of B.C. and Yukon show that British Columbia has the best survival outcomes for heart disease in Canada. Now, we believe we can make those outcomes even better by reducing wait times for crucial cardiac treatments. The new funding will pay for 700 more cardiac surgeries, angioplasties, pacemakers and electrophysiology services for British Columbians with heart disease.

There will be another $6 million spent to reduce the waiting times for people needing hip and knee replacement surgeries. These extra funds mean that 1,000 more British Columbians will have access to the orthopedic surgery they need to regain mobility and resume active lives.

We've also put an additional $1.337 million into the budget of the B.C. Cancer Agency's screening mammography program to pay for 38,000 more mammography screenings, so important in the early detection and treatment of breast cancer in British Columbia women. We're adding $2.75 million annually to our health budget to increase the capacity of B.C.'s seven public MRIs, or magnetic resonance imaging scan machines, by more than 50 percent. This funding will pay for 10,000 more MRI scans across B.C. and ensure that thousands more British Columbians are able to benefit from the best and the most timely diagnostic care.

On top of paying for thousands of more surgeries and procedures, our budget includes an additional $21 million to cover the operating costs of almost 500 more long term care beds. The addition of these new long term care beds will free up acute-care beds in our hospitals and help to relieve waiting times. As well, it provides $273.7 million in funding for capital projects to improve and expand B.C.'s acute- and long term care facilities.

Obviously these increased procedures and additional beds will mean an increased demand for skilled and dedicated nurses. That's why our budget also includes new funds to hire 400 more registered nurses this year in hospitals, long term care facilities and communities around the province. This is the first step in our commitment to bring 1,000 more nurses into our health system over the next three years, at a total cost of $50 million. It includes an additional $5 million to increase the number of licensed practical nurses and care aides this year.

More dollars to fund more procedures, more beds, more nurses -- that's an important part of our strategy to relieve the pressures on our hospitals and reduce the amount of time that people have to wait for the treatment they need.

[1455]

At the same time, we're taking other concrete steps to address the public's concern about too-long wait times. We're making it easier for patients to get the most current wait-time figures, so they can make informed choices and receive the most timely care. Patients can now get information on wait times for specialists across the province through our new web site or by phoning the B.C. Health ministry's information line. In addition, we'll be expanding our wait-list registry this year to include all hospitals performing more than 1,000 procedures a year, and we'll be developing a special registry to track specific high-demand procedures.

We've taken action, too, to ensure that British Columbians will continue to have access to the medication and to the medical and ambulance services they need without disruption when the clock ticks forward to one minute after midnight on January 1 of the year 2000. My ministry has invested more than $40 million of its existing operating budget to make the ministry Y2K-ready. We've also given regional health authorities $100 million to prepare hospital computers, equipment, etc., for Y2K.

Criteria for the Y2K funding were based on standards developed by the Year 2000 health authority working committee, which included engineers, biomedical experts, regional health authorities and Ministry of Health staff.

The next major step forward is ensuring that we're getting the best value for every health care dollar. These various steps are important and necessary ones. They're helping us to address the most immediate and urgent health care priorities of people and communities across the province. But as I said earlier, we know that we must go further if we're to guarantee a positive future for our health care system and the health of British Columbians. We must make sure that the system is accessible, affordable and accountable for generations to come.

That means working with health authorities, health care professionals and our other partners to ensure that we're putting our available resources where they're going to make the biggest difference to people and that British Columbians are getting the very best value for every health care dollar spent in this province.

It is essential that our health care be accountable in two important ways. First of all, we must make sure that the money taxpayers are providing is well used and is spent in accordance with standard accounting procedures. But at the same time, we want to ensure that people have confidence in the quality of the health care they are receiving. It's important that British Columbians know that the care and treatment they are receiving meets accepted standards and has been proven to work. I'm absolutely committed to making sure we have accountability in both of those senses.

My ministry has long had processes in place for reporting to the people of B.C. on developments in and outcomes of

[ Page 13998 ]

health programs and services. These range from the annual report of the provincial health officer, which gives an update on the health status of British Columbians, to the annual financial statement of the Medical Services Commission. In addition, each program area of my ministry has produced a detailed workplan setting out specific objectives for the coming year.

One of the most important features of this plan is that it sets out a strategic direction for B.C.'s health care system as a whole, not just for the Health ministry. So some of the strategies identified in the plan will be undertaken by the Ministry of Health, and other activities will involve partnerships and collaborations with health authorities and our other partners.

The strategic plan emphasizes accountability and the creation of standards with respect to quality of care and access to care, including what is an appropriate time a patient should have to wait for surgeries and procedures, and what is appropriate in terms of geographic access to a particular service. We'll be working with care providers to establish good measures of quality and to report those to the public.

We've now finished receiving feedback and comments on the strategic plan from health authorities and others in the field. That feedback has been both very positive and very constructive, and we will be releasing a final version of the plan in the coming weeks. In addition, as part of our larger accountability framework, we've asked health authorities to produce three-year service plans that map out how they will deliver care locally in ways that better meet the needs of the patients they serve. These plans are to include proposals for major changes to local health systems that are consistent with the principles of health reform. Regional health boards began submitting their plans this month.

The community health councils and community health services societies are expected to work together to develop single plans for their areas. Since this is a more complex task, their plans are not expected for about another 12 months -- in June of 2000. Following the submission of their first health service plans, health authorities will be expected to keep their plans up to date and to submit annual reports on their progress in implementing any proposed changes.

[1500]

In developing their plans, we have directed health authorities to use an evidence-based approach to decision-making in determining where health care dollars should be spent -- in other words, to make sure that the services and treatments they're paying for are actually improving health outcomes and providing the best value for money.

As these various planning procedures I've described demonstrate, accountability in health isn't simply measuring and reporting on numbers. Accountability is talking about what good health outcomes are and how we can strive for improvement. That includes encouraging physicians and other health care practitioners to strive to find new and better ways of treating illnesses and health problems, and encouraging health care administrators to strive to find new and better ways of delivering services.

Another major step is finding innovative ways to meet changing health care needs. In fact, we recognize that finding better, more innovative ways to meet British Columbians' changing health care needs is key if we are to guarantee a positive future for our health care system and the health of British Columbians. We've put that realization into action.

The innovation began in a major way with the regionalization of health care decision-making and service delivery. The new regional structure is now in place, and together with people in regions and in communities around the province, we've created a coordinated network of community and regional health authorities. I think the benefits of this regional structure are clear; they are certainly clear in many of the regions that I've visited.

Responsibility for health care decision-making has now been moved closer to the people being served, so their needs can be better addressed. At the same time, my ministry has retained responsibility for standards and policies so that we can continue to make sure that the quality of services available to British Columbians remains consistently high throughout the province.

Now, with regionalization mostly complete, we can step back and take a longer view. We can look at the way health care services are being delivered in this province and concentrate on finding answers to an all-important question: is there a better way? I believe that in many cases the answer is yes, and I don't believe that I'm alone in giving that answer.

There are a great number of examples out there of innovation and action, where health authorities, health practitioners and communities are taking the lead to develop new solutions or adapt existing ones to meet today's challenges. Some of the most innovative are modelling better approaches to the delivery of primary health care, the first point of contact for people entering the system. Strengthening our primary care system is a vital building block in renewing medicare and a powerful way to help individual British Columbians and their families stay healthy.

Let me mention a particularly innovative primary care project that's already underway in the province. This is called the Partnerships for Better Health project. It's a collaborative effort between the Medical Services Plan of B.C. and the capital health region. Under this -- this is wonderful; this is fun -- two-year pilot project, 12,000 households in the Victoria region receive self-care handbooks providing information about more than 180 common health problems. Project participants were given access to a confidential telephone support line staffed by specially trained registered nurses.

The nurses who work out of Saanich Peninsula General Hospital can and do talk to callers about anything from a child's sore throat to: "I have chest pain. Should I go into emergency and seek a physician's support?"

Drawing on a comprehensive database of health care information, the nurse can identify symptoms and talk through self-treatment options with a caller, encourage the caller to get appropriate medical care if the problem is urgent or recommend that the person call 911.

The first-year results of the pilot project are greatly encouraging. More than 75 percent of the participants sur-

[ Page 13999 ]

veyed said that they consulted the handbook to answer health questions. They said that they felt more confident about health care decisions and that they were better able to participate in discussions with their physicians. The phone support line handled more than 1,500 calls in 1998, and 84 percent of the callers followed through with the solution they reached with the nurse. About a third of the callers said that they had intended to go to a hospital emergency room, but 60 percent of those callers changed their minds and were successful after talking with the nurse. MSP billings show a downward trend in emergency visits for minor conditions in that region.

[1505]

The approach used in the Partnerships for Better Health project has two big advantages. The first, and I think maybe the most important, is that it empowers people to take a more active role in their own health care, and it reduces costs associated with avoidable uses of health care services.

We're encouraging health authorities, health professionals and health care organizations to come up with other innovative ways of delivering primary health care through our primary care demonstration project. As part of this federally funded initiative, my ministry will be providing support for up to ten primary care demonstration projects across the province. The demonstration projects selected will use a community-based, integrated, multidisciplinary approach for delivering primary care.

Each primary health care organization will be staffed by a team of physicians and other health care professionals, such as nurses, social workers and nutritionists. These professionals will work together to provide a variety of coordinated health care services, including information on health promotion and illness prevention. Patients will benefit because they will have better access to a wide range of integrated services in one location as well as information on how to keep their families healthy -- that's prevention and health promotion.

Health care professionals will benefit because they will have an opportunity to practise as part of a coordinated multidisciplinary team.

An important focus for me as B.C.'s Minister Responsible for Seniors is to encourage innovative programs and projects aimed at improving the way that we respond to the health care needs of older British Columbians. As you know, 1999 is the International Year of Older Persons -- IYOP, as it's called. I applaud the efforts of the many community groups and service organizations that have chosen to celebrate IYOP with projects and initiatives that address the needs of seniors or recognize the contributions of seniors in their communities.

One of my ministry's major goals is to help seniors maintain their independence -- as we would all want to do, I believe -- and enjoy good health and an excellent quality of life. Let me mention just briefly two innovative joint federal-provincial demonstration projects currently going on that are helping to further that goal.

One project is testing new approaches to help patients, physicians and pharmacists improve patients' use of prescription drugs. The project is focusing on two health conditions that are often inappropriately treated with medications: asthma, and sleep and anxiety disorders. The results of this project will be important for the long term health of British Columbians.

Research has shown that when asthma patients are taught how to use inhaled steroids, or anti-inflammatory drugs for the lungs, and take preventive actions to reduce allergens in the home, their health can be improved and their risk of hospitalization reduced. As a recent report in this province found, elderly people are prone to excessive or inappropriate use of benzodiazepines, or tranquillizers frequently prescribed for sleep difficulties. The long-term use of this medication has been associated with falls and confusion.

We're also testing standardized guidelines for congestive heart failure patients as they move from being cared for in hospitals to being able to be in their own homes. Congestive heart failure is the most common reason for the hospitalization of North Americans over the age of 65. By focusing on the important transition period after a patient leaves the hospital, researchers hope to develop guidelines that will both decrease hospital readmissions and improve the patient's quality of life at home.

Those are all ways of ensuring that our system works better for the patients it is designed to serve, but we recognize that it must also work better for the dedicated physicians, nurses, physiotherapists, audiologists, technicians, support staff and all the other professionals who are truly the heart of the health care system. We have to find better ways to attract them, and more importantly almost, we have to find better ways to keep them here if we're going to ensure a healthy system in the future. Here in B.C. we are working to do that as well.

We have established an active recruitment agency through the Health Employers Association of B.C., called HealthMatch B.C., which is recruiting physicians to remote and rural parts of the province. We plan to expand its services to include other rural health care professionals.

Of course, recruiting physicians to rural and remote areas is only half the solution. That's why we have a number of programs that need to support rural physicians, including financial incentives to compensate for medical and social isolation, locum relief for vacations and education leave, and enhanced payment for continuing medical education.

We're also working with local health authorities and municipal governments to find ways of supporting their health care professionals. In fact, some communities have been particularly inventive in providing incentives to health care professionals, such as offices, housing, transportation to larger centres, regular weekends away -- things that will make it an incentive to stay in a community. That's being done by some municipalities and communities themselves.

[1510]

One of our particular focuses this year is on recruiting and retaining nurses. I do stress both the recruiting and the retaining. As a Health minister, I've talked to many people about their perceptions of our health care system, and I've found that very often people judge their overall health care experience first and foremost by the quality -- and the quantity, sometimes -- of the nursing care they receive. That makes it particularly important that we take steps now to ensure that we have and will continue to have enough nurses with the right mix of skills to continue providing that high quality of nursing that British Columbians have come to expect.

Hiring nurses is part of the answer, and as I said earlier, we're doing that. But it's also essential that we make sure that people continue to consider nursing as a career choice. The reality is that the number of new nurses in the province is declining, and there's a real shortage of nurses in some key areas -- not so much geographic but specialty areas. As well, we must provide better support to nurses who are currently caring for B.C. patients. That includes making sure that nurses have the skills they need to keep pace with the changes going on around them.

[ Page 14000 ]

Recently I convened a task force on recruitment and retention with representatives of the B.C. Nurses Union and the Health Employers Association. The mandate of that task force is to consult widely with people within the nursing profession and to recommend human resource policy changes that will remove obstacles to hiring and keeping nurses. The task force will be looking at issues facing nurses, ranging from career development opportunities to on-the-job mentoring programs for new or young nurses. I'm looking forward to reviewing the preliminary findings of the task force this fall.

In conclusion, the challenges facing our health care system are very real. To overcome these challenges and to make the changes that must be made if our health care system is to continue to provide the quality of health care that British Columbians deserve is going to take some time. It's going to take commitment and partnership from everybody -- from government, from health authorities, from health care providers and from communities. We need to continue to work together at the community level, in the corporate boardroom, in our schools and in our hospitals to transform the way that health care is delivered.

The encouraging news is that here in British Columbia we are making progress. We are taking actions to address the immediate urgent health care priorities of people and communities across this province, to strengthen our acute care system and to reduce waiting times for surgeries and other procedures. We are making sure that British Columbians get the very best value and the best-quality care from every health care dollar spent, by taking steps to improve our planning processes and to make our health care system more accountable.

We're working with our health care partners to find new, innovative and more flexible ways to deliver health care services to meet the changing health care needs of British Columbians and to bring the services closer to people they are designed to serve.

The key now is to keep that progress going, to maintain our momentum, to build on our successes and to continue to tap into new ideas and dare to be creative. We plan to do exactly that over the 1999-2000 fiscal year. We'll continue to move forward to protect and uphold the principles of medicare and to build an affordable, accountable, quality health care system that will meet the real needs of all British Columbians on into the next century.

C. Hansen: I thank the minister for her opening remarks.

I want to start by explaining how we hope to approach Health estimates this year. I've had some discussions with her senior officials and her staff to basically outline the approach that we're going to take, in the hopes that we can ensure that there is a proper review of the work of the ministry and, at the same time, make the most effective use of staff time and resources that have to be available to the minister in the buildings.

First of all, let me say that in past years we've gone a lot more into programs right at the start and then started to look at some of the constituency-by-constituency issues towards the end of the process. We want to reverse that this year, partly to give some of my colleagues an opportunity to raise the issues they hear from their constituencies and to put on the table the real, human face of some of the problems we're facing in health care today.

So for the first part of our estimates this year, we're going to be looking at it on a region-by-region basis. I'll apologize in advance to the minister that we may be jumping around a bit, not because of design but mostly just because of the availability of members who have other responsibilities in the small House and also in committee meetings that are ongoing as we're going through this process.

Before we do that, I want to comment, just very briefly, on the minister's opening comments. Certainly when she talks about the bold new direction for health care and the emerging strategic vision, those words are fine words. I think that somebody who was perhaps not familiar with some of the challenges of B.C. health care today might take reassurance from those words. But I think as we go through these Health estimates we will be trying to point out areas where we feel that the vision is not there, where the accountability is not there and where there is a lack of enunciation of that bold new direction the minister was referring to.

[1515]

The first thing I want to do is to basically express some disappointment that there are some key documents that are not available to us as we embark on this process. Last year when we started in on Health estimates, the minister tabled the annual report of the ministry a week before we started Health estimates. Unfortunately, that was the annual report for the year 1996-97. Here we are a year later, embarking on the spending estimates for the year 1999-2000, and this is the most recent annual report that the minister has tabled in the Legislature.

That's regrettable in a couple of contexts. First of all, this should be the key document in terms of reporting on the work of the ministry. I appreciate the minister's comments that she made in her introductory remarks about the various accountability documents that are there. But the annual report of the ministry should be the key one, and it should be the one that anybody that wants to review the work of the ministry should go to first. Now we have a document . . . . The most recent one that's available is for the year that was basically started three years ago, and I don't think that's acceptable.

Quite frankly, when you start tabling annual reports that are three years old, you might as well send them straight to the archives rather than putting them forward as a legitimate accountability document.

The other thing that's important about the annual report is the number of recommendations that are coming through. I can think of some very specific ones from the auditor general, where he recommends that the annual report be the vehicle through which accountability is upheld and reports are made to the public. I believe that the annual report is something that has to be far more topical. When we get into that

section of the workings of the ministry -- when we get down to communications and issues management -- certainly I will be looking for some commitments from the minister that that particular document will be forthcoming in a much more timely fashion.

The second document that I feel should have been available to us by now, because I think it's a very important issue facing British Columbians and should become the focus of at least a portion of our discussions in Health estimates, is the continuing-care review. The original target deadline for the report of the continuing-care review committee was the end of October last year. That was extended until the end of March of this year for, I think, the right reasons, in that the draft documents that were circulated were not seen to reflect input from caregivers and those who were on the front lines of delivering continuing care. Hon. Chair, I understand that that report is

[ Page 14001 ]

now finished. It has been on the minister's desk since early April, and I find it regrettable that that document has not been made public so that it too can become a legitimate part of the discussions we have.

The third one that I find it unfortunate that we don't have access to is the report card on Better Teamwork, Better Care. Last year in Health estimates, the issue was raised about the requirement for an annual report card on the performance of health authorities. As we go into this first section, which is really going to centre around the work of health authorities, this particular document would obviously have been very valuable to us.

I just want to quote back to the minister her words from July 16 last year, when we were in Health estimates. She said: "I believe the commitment given to Public Accounts" -- being the Public Accounts Committee -- "was that there would be a report card by the end of this calendar year." That is a document that the minister had promised to us by the end of December last year. Perhaps, to turn a phrase that the minister used during question period today, this was a case of a promise made and a promise not kept.

Perhaps that's as good a place for us to start as any -- if the minister could tell the House why that particular accountability document was not prepared and released by the end of December.

[1520]

Hon. P. Priddy: I do apologize to the member. Was your question about all three reports, or was your question about the last one?

C. Hansen: As we proceed through this, I see us starting with regional programs. Later on we will be getting into the issues of continuing care, and even later on in the process we'll be getting into communications programs, which include the annual report. Certainly I will have some very specific questions about the continuing-care review, and I'll have some very specific questions about the annual report when we get to that stage. But given that we're going to embark on regional programs, perhaps we can deal with this one, on the annual report card.

Hon. P. Priddy: I did hear the member read from . . . . I don't know if it was from Hansard or from comments around the Public Accounts Committee. We had made a commitment, I think, to begin to report out, in a report card kind of way, on regional health authorities. We are not at that stage yet. We are working with health authorities. We can report out, hon. member, on wait times in different regions. We can report out on their budgets. We can report out on their progress in a variety of areas. But we cannot in a complete way -- until we finish the strategic plan -- identify very specifically the kinds of things that need to be reported on.

In my meeting with health authority chairs a few weeks ago, actually, we talked about what kinds of things you could actually measure. Could you measure the number of days in hospital after gall bladder surgery? Could you measure the number of people who picked up some kind of infection in hospital? Could you measure the number of rehospitalizations? So we're actually talking with the health authorities about those much smaller things that can be measured.

But in terms of report-carding on the regions, there is the annual report from each region, which is available. There is the wait-time report, which is available. There are the financial reports, which are available -- the financial data, which is available -- and there's the statistical data. All of this information is reported out by the health authorities.

We're not at a report card stage yet, and I don't know, having spent a year in the ministry, whether report card is the right kind of word to use. Nevertheless, we're working with the health authorities on all the things we can measure in -- I always use my own example -- the South Fraser health region and the things we could legitimately measure and report out to the public on, and then how we can add to those this year. The health services plans are coming in; that's another way of measurement. As I say, we have a variety of statistical data, including workload, personnel data, surgical waiting time data and so on, which is all available in print from the regions.

C. Hansen: This particular report card is a very specific document that . . . . As I understand it, a commitment was made to it at the time when the Better Teamwork, Better Care was first announced. So we're going back two years. Just to read to the minister the exchange that took place last year, my colleague from Okanagan West stated: "In the Better Teamwork, Better Care announcement there was a provision for an annual report card on the performance of the health authorities.

We haven't received one yet, and I'm wondering when we can expect that minister's report card." The minister then replies, and I'll quote the minister's own words back to her: "I believe the commitment given to Public Accounts was that there would be a report card by the end of this calendar year." There are other references made to it in the Hansard from last year.

Talking about the various reports that are being done doesn't put it in the context of the ability of the public to assess the work that is being done by health authorities and whether or not the whole regionalization process is working. Certainly it's been going through a lot of turmoil. That whole process of accountability back to the public should be done in a way that allows the public, on a consistent basis across the province, to see whether or not regionalization is working for them in their region.

Perhaps I can ask the minister: in terms of the development of this kind of accountability document, who's putting it together? She mentioned that there were discussions with health authorities. But I must say that I have talked to a lot of health authorities around the province about this very specific document, and basically they are not aware of any initiatives or moves. No one has been asked for input on what might go into this kind of an accountability document. Perhaps the minister can explain: when she indicates that health authorities are working on this kind of accountability, who is it that's working on it?

[1525]

Hon. P. Priddy: Two points: one of them is the . . . . Well, I met with the health authority chairs and some of the staff from health authorities, and we had about a three-hour discussion on exactly what the kinds of things are that we should measure. That was not all that long ago. So I'm a bit puzzled if people say that they haven't had any input or nobody has asked them the question. As well, the ministry is working with the CEOs of those regions to do exactly the same thing.

I will say, though, that the commitment made by the previous minister around a report card is not in that shape. Is

[ Page 14002 ]

it late? Yes, it is. Has it turned out to be way more complex than we thought it would be? Yes, it has. Should it be ready? Probably, but it isn't.

I'm not saying, by the way, that the public does not have access to regional data. They do. But they don't have a piece of paper that says: "In your region, this is what's happening." Although they do have it . . . . For instance, my region is having its annual meeting tomorrow night. They have all of the information laid out for the public around hospital days, hospital stays and seniors, that they've seen. That's all laid out in the annual report that will be presented to the public tomorrow night. But it's not in a consistent way throughout the province. It should be.

That's the work that the ministry is doing with staff and that I've been doing with health authorities. Should it have been done earlier? It probably should have been, but it wasn't. We are trying to make it as easy to read and to measure as we can.

C. Hansen: Could the minister tell us when we should expect this to be completed? This time last year we were told to expect it by the end of the calendar year.

Hon. P. Priddy: We were just having a discussion about what would be both reasonable and achievable, since some of our dates have not been achievable. I'm trying to make sure that I give you an answer that is something actually achievable. My deputy assures me that that information will be available in the 1998-99 annual report.

C. Hansen: That's not very much assurance, considering that we never know when to expect annual reports.

I'm going to come back to this issue. But I do want to move on to some of the constituency issues, so that we can perhaps put a real human face on some of the discussions and problems that British Columbians are experiencing. So I will turn it over to my colleague from Okanagan-Boundary for now.

B. Barisoff: My first question to the minister is: the long term care situation in the Okanagan-Similkameen is actually in a crisis situation. It's gone beyond the realm of being something that we can deal with any longer. According to our figures, we're 365 residential beds short in the South Okanagan. I know that the minister has initiated 60 long term care beds to start, but I'm just wondering what the minister's planning to do with the fact that this would still leave us short 300 long term care beds in Okanagan-Similkameen.

[1530]

Hon. P. Priddy: As the member has stated, there are 60 -- actually, I think 75 -- additional beds for the Okanagan area. There will be a need beyond that. Part of that will be addressed provincially when we look at the principles that we have to use in terms of expanding continuing care, but I think the other

part is that we have to look really creatively at who the partners are in establishing long term care beds. Each bed costs $125,000 to build and $125 a day to operate. You know, there are limited dollars. We can't fill all of those needs immediately throughout the province. So while, yes, there is a need for more beds, there also needs to be better home support, so that people may not need to go into those long term care beds quite as early if they can be supported at home. But it's a beginning -- the 75 beds -- and we will move forward as quickly as we can on additional ones.

But at those kinds of costs, without another partner it becomes difficult to meet all of those needs across the province.

B. Barisoff: Well, I think one of my concerns is that right now, in the present state, acute-care beds are being used -- not only in the South Okanagan, and I'm sure my colleague from Okanagan-Penticton will refer to the situation that's taking place in Penticton -- by long term care people. I'm just wondering . . . . The minister talks about dollars and cents. If you compare what it costs for them to utilize a long term care bed versus an acute-care bed . . . . Can you justify it or tell me what . . . ? There's got to be some answer to that.

Hon. P. Priddy: I wish there was an easy one. There are people in acute-care beds, although we did provide, not all that long ago, $10 million throughout the province to provide some alleviation for that -- for hospitals or health authorities to be able to purchase long term care beds. There are places where long term care beds are being purchased by the health region in order to move people from acutecare beds who don't need to be there -- and don't want to be there, I'm sure -- into more appropriate environments.

But I also go back to the whole idea of what we can do to support seniors in their homes or what we can do to provide some supported housing that isn't nearly at the level of long term care but does provide enough support for seniors to be able to maybe live in a congregate setting, if that's their wish. We have to be able to look more at that as well. But it makes no sense -- and the member is correct -- to have acute-care beds filled with people who don't need acute care.

B. Barisoff: The Okanagan-Similkameen has probably one of the highest per-capita rates of 65-year-old-plus people in the province. And if you compare the funding throughout the province, we probably have one of the lowest per-capita fundings. I'm wondering whether the minister has looked at this inequity that has taken place, probably not only in Okanagan-Similkameen but in the entire Okanagan, and whether there's a move afoot to balance that up with the rest of the province.

Hon. P. Priddy: Yes, there is. In point of fact, that began this year with an attempt around residential beds, if you will -- to provide more dollars to high-growth areas of the province, which the Okanagan-Similkameen is, at least in terms of high growth for seniors. So yes, we have begun that.

B. Barisoff: It's my understanding that the recent announcement of funding for the 60 long term care beds in Okanagan-Similkameen is operational dollars only. As we're still 300 beds short, will any of the remaining beds be funded as new capital projects?

[1535]

Hon. P. Priddy: The member is correct. The extra dollars that were provided this year are operating dollars, either for long term care beds or for other kinds of continuing care services, and the region would make a decision on how they wish to use them.

B. Barisoff: This is a question that I asked last year, but I'm obligated, I think, to put it back on the record again for this year. The Society of Obstetricians and Gynecologists of

[ Page 14003 ]

Canada, along with the Society of Rural Physicians of Canada and the College of Family Physicians of Canada, have -- not just recently -- passed a joint position paper on rural maternity care. I'm just wondering: has the minister examined the benefits of ensuring that our small rural hospitals will be supported and even encouraged in this direction?

Hon. P. Priddy: We have been working with the provincial perinatal group -- which meets or operates out of Vancouver but is made up of folks from around the province -- to ensure that there is support provided for perinatal services in smaller communities.

B. Barisoff: Home support services in rural areas, due to geography and travel time costs, are presently inadequate, particularly in the Grand Forks area. What is the minister doing to remedy this?

Hon. P. Priddy: I'm sorry, member -- I can't speak to Grand Forks specifically, but there was over a 3 percent increase to home support services across the province this year.

B. Barisoff: There's a lack of trained home support workers who can provide home care services, particularly in the west Boundary area. There's a desperate need for trained workers. Courses run alternately between Grand Forks and Castlegar. I think it should be in Grand Forks this year, but for some reason, they're putting it in Castlegar. I guess my question to the minister is: if there's such a need in the west Boundary, particularly in Grand Forks, why would they shift it to Castlegar and not leave it in Grand Forks?

Hon. P. Priddy: When the West Kootenay-Boundary plan comes in -- although I must admit that because it's a CHSS-CHC, it will be longer coming in -- we will look at the reason they have made that decision. That's a decision that's made locally. I do know, from my own teaching of home support workers, that there are lots of ways to offer that, either by distance education . . . . It doesn't always have to be on site. We'll review those plans when they come in, to see if there's a specific reason or rationale behind why it's being offered in one place and not the other -- or indeed whether there's an educational way to be able to provide it in both places.

B. Barisoff: I think that my concern, of course, is that if it was alternating and then all of a sudden, for whatever reason, they chose to go into Grand Forks . . . . I am concerned about it. The long term care situation in Grand Forks, of course, is another one. There are 35 to 40 people on the list in the Grand Forks area, and I'm just wondering whether the minister has looked into that situation to see if there's anything that can be done.

[1540]

Hon. P. Priddy: The local health authority . . . . Let me just have a look at this particular area. Sorry -- I need to check one thing here. The local health authority has the ability to move dollars around. I don't know whether they've made a decision not to purchase beds for those people who are on the wait-list for extended-care beds. But they did get a 3 percent increase in home support -- that was $10 million that went out to the regions -- to be able to move people from acute-care beds into long term care beds.

I don't know if they've made a decision not to use their dollars in that way, but we have been having some very early discussions in early stages with the health authority about some additional intermediate care beds there.

B. Barisoff: One of the issues that I think I've brought up since the day I got here is the Keremeos multilevel-care facility. I know that they're getting closer and closer. I'm sure there's some real concern that if they don't go to working drawings so that they can go to tender early in the fall, they probably won't get it in the ground until next year. Could the minister give me the status of where the Keremeos multilevel-care facility is at?

Hon. P. Priddy: I've checked with staff. They don't have that one with them, but we can have it for you after dinner.

B. Barisoff: I would really appreciate that, because it's been an ongoing thing for the last ten years.

One of the other real concerns that I have, coming from a rural area, is the sustained funding for the rural hospitals, in particular Oliver and Grand Forks. Another one that's been brought to my attention is the one in Princeton. They are all about equal in size. I'm just wondering whether the minister has made any commitment to these small rural hospitals that the acute care beds and the funding will be sustained in the coming years.

Hon. P. Priddy: Yes, funding will be sustained to the smaller hospitals.

B. Barisoff: Maybe the minister could elaborate a little further to assure me and the constituents of Okanagan-Boundary and the Princeton area that the acute-care facilities of these small hospitals will not be depleted and downgraded lower and lower all the time. It seems like every time they turn around, there are a few more beds being taken away from them. I just want to get more of an assurance from the minister than simply that they'll be funded.

Hon. P. Priddy: The funding will be sustained, hon. member. The decision about how that funding is used within that hospital is a decision of the local health authorities, not the ministry. But our commitment is to sustain the funding.

B. Barisoff: I just have to also put on the record that the number of calls that I get about the surgical waiting lists seems to growing almost on a daily basis.

[1545]

I do want to read a letter to the minister. This has to do with the drug called Aricept. It's addressed to myself, of course. It says: "Re: Difficulties experienced trying to access payment for the drug for Alzheimer's -- Aricept." It's from Mrs. Gail Munro. She says that Pfizer, a pharmaceutical company in Ontario, said when they phoned them that if they lived in Ontario, they could actually get that drug for free. The cost of Aricept here -- five milligrams -- is $156.50 for 30 pills. That is a dose of one daily.

Sometimes a higher dose is required, and according to Shoppers Drug Mart in Osoyoos, the cost is roughly the same. She's gone on to say that ten milligrams, cut in half, which . . . . She's tried to cut the cost in half.

The drug has been available for at least a year. It's not been the be-all and end-all for Alzheimer's. The side effects

[ Page 14004 ]

can be severe and require stopping the drug. However, if it does work, it means that a person with Alzheimer's disease can delay institutionalization. Surely the savings from that could go a long ways to pay for the availability of the drug for anyone that needs it.

Now, hon. minister, this lady called me, and from what she's saying, I believe that she feels very strongly that the $156 a month is certainly not going to break her but that a lot of people would end up institutionalizing their loved ones rather than looking after them at home. I'm just wondering whether the minister has looked into this, so that she could, in her case, keep her husband at home for in excess of another year. If you look at the costs of being in acute care or in long term care -- between $500 and $800 per day -- it seems not an awful lot to have these people at home.

It seems almost like a false economy that we wouldn't be looking at cases like this where we'd keep these people at home. It would be a lot better for all concerned and actually be quite a cost saving for the Ministry of Health.

Hon. P. Priddy: Yes, as a matter of fact, I have. At the request of a number of people . . . . People have written in at the request of some of your members, actually. The member for Richmond East has a particular interest in this as well. There are not many provinces -- although you're correct that Ontario does -- that cover it as a first-line drug. Just currently, actually, the therapeutics initiative committee is reviewing Aricept yet again. They have reviewed it twice.

They reviewed it last, I think, in November of 1998 and still did not recommend it for use -- not because it was unsafe, but because they did not believe that there were enough therapeutic and economic benefits to it. However, because of the concerns that people have raised, they are currently reviewing it again at my request.

B. Barisoff: Could the minister give me an indication of when that review would be done and when an answer forthcoming to anybody can . . . ? Is it a week away, a month away, a year away? Do we have any thought of how long it might take?

Hon. P. Priddy: No, I don't. I'm sorry -- I don't know the length of time that those reviews take, but I'll get that information to the member during these estimates.

If I might go back to a question that you asked earlier, member, around Keremeos, I think it's a $7 million project. It's a major replacement and expansion. Expected completion is October '99, I believe. That's planning -- sorry -- for October '99. So it's going ahead.

B. Barisoff: I'd like to say that I've heard that it's in planning. I've got that answer a number of times. I think the people of Keremeos would like to know exactly when they're actually going to be able to go to tender and when they could actually believe that commencement of construction would start. Is the minister saying that construction will be starting in October of 1999?

Hon. P. Priddy: No, I'm not. What I'm saying is that -- as the member knows, it's an approved project -- the planning, the drawings and so on will be completed in October of '99. Then I expect it would go to tender in the following fiscal.

[1550]

B. Barisoff: Not to be critical of the minister or of anybody else, this is a project that has been going on for in excess of ten years. As my colleague from Okanagan-Penticton just said, the planning dollars probably could have built it by now, with the amount of money we've spent.

The next issue that I want to bring forward is an issue that was called in this morning. It's an urgent situation. I'm not going to use the name, but I will give the minister the letter when I'm done. It has to do with a response written to a lady -- who was very desperate this morning -- and her mother. It was a request for funding for transmyocardial laser revasculation in Seattle, Washington. This is a letter from the minister's office. It says: "I can appreciate that this will be a disappointment to you and your patient. If you can provide the documentation that it is no longer an experimental investigational treatment, the plan would be pleased to reconsider the request."

The reason I'm bringing this forward, hon. minister, is the fact that according to the doctor this morning, it is a desperate situation. She probably cannot go through another open-heart surgery type of situation. Rather than using the name, I would ask the minister, if I was to pass this letter on to her, whether she would give me the assurance -- and I know that she's going to be tied up in estimates -- that her staff would immediately look at this, sometime today.

Hon. P. Priddy: I'm just trying to think of who I have and what they can do in the next couple of hours. I will give the member assurance that we will look at the letter immediately. But I would say that we do have a policy that if it is still experimental treatment or surgery, we do not normally fund out of province. But I will have someone look at it immediately.

B. Barisoff: I guess when you get a specialist from anywhere -- from Vancouver, as it happens to be -- who is that concerned about this patient . . . . I appreciate the fact that the minister will look at it immediately.

Summing up some of the things that are taking place in Okanagan-Similkameen . . . . To remind the minister, we do live in rural communities. A big portion of this province is rural. People in those small hospitals in the South Okanagan, as the minister has indicated particularly and like I mentioned before -- the hospitals in Oliver and Grand Forks, and including the one in Princeton . . . . To make sure that we don't forget that these rural communities are important and that we look at most of these things that are happening that . . . .

It's easy to say that they can travel to Kelowna or to Vancouver or to wherever it might be to get some of these services. But I think that ultimately we have to make sure that we look after the rural people of B.C. and particularly some of the issues that I've brought forward. I appreciate the fact that the minister will be looking at these. I'll pass this letter on to her immediately, and I thank the minister for her comments.

Hon. P. Priddy: If the member wants to pass the letter across the floor or has an additional copy -- if you wish to keep a copy -- we can get someone to start on that work immediately.

I appreciate your comments, by the way, about small rural hospitals. I know that sometimes it seems like most of us are city folks and may not have the kind of appreciation . . . . The first hospital I worked in was in northern Ontario; it was

[ Page 14005 ]

actually in a house. Some people couldn't even go upstairs, because there was no elevator to the top floor. People who haven't lived in a small community like that may not have that appreciation, and I appreciate your raising the issues.

P. Nettleton: I have a couple of questions for the minister with reference to issues of a regional nature. My questions should be viewed in the context of the withdrawal of services by the northern and rural physicians, which commenced in excess of a year ago and concluded roughly a year ago.

[1555]

I know that the current minister was involved in addressing that dispute and did play an important role in terms of seeing that impasse resolved. To the minister's credit, that was concluded, and physicians did restore services in a number of the northern and rural communities throughout the province, in particular those communities in and around the area of Prince George. I think, for instance, of Fort St. James, where I reside with my family. It was much to our relief that the dispute was resolved and emergency services were restored.

In terms of the most recent crisis -- if I may use the word crisis, because I think it is that -- residents of Prince George in particular, in this instance, are faced again with a problem which is tied in very much to the whole question of the ability not only to recruit physicians to northern and rural communities but to retain physicians in those communities. Bear in mind that Prince George is a vibrant, thriving northern community that has in excess of 80,000 people, so it's not exactly a small community in that sense.

But in any event, it is still faced with many of the problems of the smaller northern communities. Currently an estimated 5,000 to 10,000 Prince George patients could be without a family physician this summer, because as many as five doctors may be leaving the city in the next few months.

Dr. Peter Gorman, head of the department of general practice at Prince George Regional Hospital, is quoted as saying: "This is totally unprecedented; there has never been a situation like this here before. We have always been able to fill family practice physicians."

Spokesperson Renee Foot of the Northern Interior regional health board, when questioned as to when the board would develop a strategy to recruit doctors, made the comment: "We're not at a point to discuss what strategies we're going to use." This is a spokesperson for the Northern Interior regional health board. Stephanie Slater, communications official with the Ministry of Health, has meanwhile indicated that the ministry does not have a specific plan in place to address the situation.

My only comment -- not only in light of the response of the two spokespersons for the different agencies but in light of our experience in the north in terms of the government's seeming inability or unwillingness to recruit and retain physicians -- is that it's time that the minister directed her staff to develop and implement a strategy to recruit and retain doctors in northern communities such as the communities that I represent. It is not enough to say that the regional board will address this most recent crisis in health care delivery in the Prince George region.

It's not enough to say that doctors themselves are responsible for recruitment. The minister and her ministry must provide leadership, and in coordination with the regional board -- yes -- physicians and other health care providers must move to address the underlying problems which have led to this crisis in health care delivery.

My question, then, to the minister is this: when will the minister act to provide the leadership necessary to provide a strategy to ensure health care delivery for residents of northern British Columbia?

Hon. P. Priddy: I cannot comment on the person from the Northern Interior health board's comments. They puzzle me a bit.

[1600]

We have set up HealthMatch B.C. It was set up and enhanced very much as a result of the Dobbin report. Since then, HealthMatch B.C. has placed physicians in Keremeos, Fraser Lake, Mission, Quesnel, Chetwynd, Princeton, Burns Lake, Ashcroft, Dawson Creek, Lillooet, Kimberley, Cranbrook and Prince Rupert. People are not in Valemount yet, but the contracts are signed. Indeed there is a strategy. That strategy is HealthMatch B.C., and those are the communities that have already benefited.

Now, you're talking about a larger city, which may have a different set of reasons. These are smaller communities, which is what Dobbin addressed and what people were concerned about. I'm not sure about the uniqueness of what we're currently seeing in Prince George. We can't stop people from . . . . The example used earlier in question period was the one of people going to the United States. I think that's a difficult one. We're not in a position to compete with the United States, because we actually have universal health care here.

Can the United States pay more, have people work less and have 40 million people not covered by health care? Sure they can. If that's where people choose to work, that's up to them. We can't do that kind of dollar-for-dollar competition with the United States.

In terms of the uniqueness -- if indeed that is correct, and I have no reason to doubt the member's statement -- of having family physicians leaving Prince George in that number, then . . . . When I asked about the question when I first heard about it, what I understood was that there were actually at least two physicians interested in going to that community. I don't know if that's concurrent with something that the member is aware of as well.

Although these things happen, and you have what I think is somewhat unusual -- five physicians leaving -- the overall physician-to-population ratio in rural and remote parts of British Columbia has actually increased -- not very much, by the way -- a little bit between 1994 and 1998 and is a bit better than it was before.

I have asked the ministry to look at the Prince George situation. I did understand that there were two physicians. As I say, HealthMatch B.C. is a really important strategy and has placed physicians in all of those communities -- both GPs and specialists.

P. Nettleton: I would say that it's small consolation to the residents of Prince George who are faced . . . . Somewhere in the range, as I say, of 5,000 to 10,000 patients are estimated to be likely to be without a physician over the course of the summer. It's some small consolation, I suppose, to know that in fact a number of physicians have moved outside of the cities to the smaller and rural communities.

Again, in light of our most recent experience with the withdrawal of services by physicians -- who pointed again to the problems with reference to recruitment, certainly, and also the retention of physicians -- it seems to me that it's time

[ Page 14006 ]

that . . . . The current minister -- who, as I say, was involved in the dispute with the physicians -- should be working together with health care providers, the regional board, physicians and others involved in health care delivery to ensure that this type of a crisis does not reoccur. For folks in the lower mainland, who are within blocks of major hospitals and other medical facilities -- including ambulances, paramedics and what have you . . . . It's very difficult for folks in the lower mainland to comprehend what residents in smaller communities -- smaller even than Prince George -- deal with on a daily basis in terms of access to health care.

The minister pointed to her experience in rural Saskatchewan. It is my hope that that experience is not so far behind the minister that she has forgotten what it's like to live in a small town in rural Saskatchewan.

Perhaps it would even be helpful if the minister were to travel again to the north and reacquaint herself with some of the people who are directly involved in health care delivery and listen to some of the experiences and frustrations of not only physicians but of others involved in health care delivery, to gain some sense of what is needed to develop, as I say, this overall strategy for a long-term solution.

I should also say that the man who's currently Premier of this province made a commitment about a year ago, during the course of this dispute, that there would in fact be long-term solutions put in place to ensure that northerners did have access -- the kind of access to physicians, and health care generally, to which they have a right and to which folks in the lower mainland have grown accustomed.

[1605]

Hon. P. Priddy: I can't stand here and promise that people won't leave again. I mean, one of the people who's leaving the native health clinic is pregnant. I can't promise that people won't get pregnant or that somebody can replace them for maternity leave. I can't promise that somebody will never leave. The recruitment we've been doing . . . . The communities I read to you are all small communities in remote and rural parts of British Columbia.

What you've indicated is a very different kind of problem -- in a city of, I think, 80,000 people. So what can people from Prince George expect? They can expect HealthMatch B.C. to be working with Prince George. I know that there are two physicians who've been contacted who are interested in going there. I know that people are working on that. I know that the Northern Interior regional health board was given $250,000 in their base a couple of years ago for recruitment and retention purposes.

I also know that, aside from Vancouver and Victoria, Prince George has the next-highest ratio of family physicians to patients in the province. So it's not as if people started out with a very low ratio of patients to family physicians. Only Vancouver and Victoria have a somewhat higher ratio than that.

Do those people need to be replaced? Of course they do. Will we work as hard as we can to do that? Yes, and if there are different recruitment and retention strategies required in a city of 80,000 people, then we'll need to look at that. As you know, the focus in the past has been those smaller rural and remote communities. We'll continue to work with the Northern Interior regional health board to do this.

P. Nettleton: The minister did bring up the issue, and I will make reference, as well, to the specialist who recently left town -- who is, as I understand it, on his way to the United States -- Dr. Roy Hobbs. He had practised plastic and reconstructive surgery in Prince George for some 11 years. He stated that his reason for leaving is because health care is rationed so badly here that patients can't get surgery and surgeons can't work. At the time he gave notice, Dr. Hobbs had a waiting list of 453 patients.

At only seven hours of operating time each week, he was the third such specialist to announce an intention to leave the province in a three-week period during May. My question to the minister is: is the minister listening to what specialists like Dr. Hobbs are saying? What are you doing to address the concerns of specialists like Dr. Hobbs, who are looking southward to other jurisdictions?

Hon. P. Priddy: When I talked earlier about the people who'd been recruited through HealthMatch, of those communities I mentioned, two of those are specialists. We are indeed recruiting specialists as well. The fact that there are 58,000 more surgeries and procedures this year means that there is more OR time and that there are more dollars for those kinds of services. So we are working very hard to address the needs of physicians who indicate that they don't have enough OR time to be able to be able to provide the service to their patients. As I say, a 13 percent increase in surgeries and procedures makes quite a difference, and should to any specialist who's looking for that.

P. Nettleton: Briefly, if I may, I'd like to share an experience with the minister -- a Prince George experience -- and ask for some comment:

"A WCB patient came to the hospital shortly after lunch with a traumatic amputation of his left middle finger requiring further revision amputation. He was booked in the OR, and by the time I came in to see him at 5 p.m., he had already been waiting two to three hours on the OR waiting list, which was totally out of sight. It was unlikely that it would get done that night. The anaesthesiologist was out in the ICU putting in lines and had been out of the OR room for at least an hour before looking after more urgent cases.

"I asked one of the three nurses to come out and help me in the emergency room to do this revision amputation. Not one of the three nurses would come out because they were too busy, they said, doing other work. I asked the emergency room nurses to help me to at least set up the room to do this revision amputation, and none of them could even do that, let alone help me with the case. So I ended up spending a total of almost two hours doing a very short case without any nursing help whatsoever from either the operating room or the emergency room. I ended up doing it in the out-patient department by myself. This is Third World medicine at its best."

This is from a doctor in Prince George. Do you care to comment?

[1610]

Hon. P. Priddy: It's difficult to comment on a letter that describes a particular situation without knowing any of the other circumstances around that. I don't know if the physician has copied that letter. If that letter came to the ministry as well, we can certainly look into the circumstances and get a response. But I will tell you that it's difficult to comment based on that.

P. Nettleton: I would be happy to share this letter -- and a stack of letters very similar in terms of the experiences of doctors and physicians in Prince George -- with the minister. I will certainly do that.

One other issue, if I may: a gentle reminder and a request for an update, with reference to replacement for the Omineca

[ Page 14007 ]

Lodge facility in Vanderhoof. I see the minister smiling; she knows where I'm going. I promise you I'll be bringing you flowers every month until I get a commitment from you. The multilevel-care facility in Vanderhoof -- would you care to perhaps give me an update on that, please?

Hon. P. Priddy: I must admit to the member that I have told lots of people this story. It's actually quite unique, you know: you get flowers ahead of time to remind you that there's a capital proposal coming in for the region. I must admit it's strategically very interesting. I know that the regional health board, whose capital budget we got for next year, listed that as a top capital priority, so that will go into the mix with the other requests for capital for next year. I know how strongly people there are feeling about it.

Gosh, if that's for Omineca, my staff just reminded me, the $43 million hospital in Prince George should have got -- gee, I don't know what -- a garden, a truckload or something. But I do appreciate the strategy. I do know they've submitted it as their top priority, and we'll be looking at that when we look at the mix.

R. Thorpe: I would like to pursue some questions with respect to the south Okanagan and, in particular, the riding that I represent: Okanagan-Penticton. The first subject I'd like to talk about is joint replacements. I would like to know, to start with: has the ministry established regional goals for waiting lists for joint replacements?

Hon. P. Priddy: We don't have that by region, and I'm not sure that that's what we'll actually see. The orthopedic committee, which is currently working -- and just beginning the work -- on the standards, would expect to see standards like a provincial standard, not a standard for a joint replacement in Penticton versus a standard for a joint replacement in Kaslo or somewhere else. It would be a provincial standard that they would come up with.

R. Thorpe: I can appreciate why we would have a provincial benchmark. Surely, to build a provincial benchmark, we're going to need regional benchmarks. We don't have the same demographics of our populations spread equally throughout British Columbia. How can we measure ourselves against one standard for the province -- unless we want people just not to have comfort, or expect them to be able to tell us that demographically it's different in each region of British Columbia?

Hon. P. Priddy: I think that while the demographics may differ in terms of the need of a particular region . . . . There may be more people in a region that has a large number of seniors who require a joint replacement. That's one thing; that's demographics. But I don't think we would have a standard that says that because you have more seniors in your area they should expect to wait longer -- or, of course, if you have fewer seniors in your area they should expect to wait a shorter period of time.

We do need to know the numbers of people and the demographics from that perspective, but I'm not sure it would make sense to me that there should be a different length of time people ought to wait, depending on where they live.

[1615]

R. Thorpe: Can the minister advise, then: are we going to fund differently for each region of the province because we're going to now measure ourselves against the provincial benchmark?

Hon. P. Priddy: Two things. As a sort of background comment, if I might, the provincial orthopedic panel is developing standards for both access and urgency -- not only how long you wait but what kind of orthopedics may be more urgent, if you will, than another one.

It is quite possible that you would fund differently. If you have a higher degree of need in one part of the province and if you have orthopedic money available, then more of that money will probably go to where the need is greater. That's not the same as having a different waiting time or benchmark, but it does mean that if you have more people -- we've seen that in other areas -- there would be more dollars directed to that region. That makes sense.

R. Thorpe: I do understand that if you have a benchmark for the province in which you say everyone should be treated fairly -- which I agree with -- but then you have demographic disparity from one region to another . . . . I thought I heard you say that you were going to fund to that. I don't believe you're funding that way at the present time. When is this new method of funding going to take place?

Hon. P. Priddy: We may be talking about two different things, so let me give you two answers and hope one of those will meet your needs -- or not.

If you're looking at trying to do a benchmark for orthopedic surgery and you know you have additional wait times, then if we found additional dedicated dollars for that -- as we have for cardiac surgery or for MRIs -- then it's quite possible that an area that has a greater need would get a greater amount of the dollars. That's very targeted, though, member. That's very specific -- in this case, about orthopedic surgery.

If you're talking about generalized funding by demographics -- or by population and demographics, because it's really about growth and demographics -- then what we are currently doing . . . . I'm open to ways to do it differently, but I haven't found any yet, except ones that take money away from people. Any new money we put into the regions is based on population and demographics, but that doesn't go back and adjust the base that has been there for the last however many years -- ten years or 20 years or whatever. But for the last five years, any new dollars that were added to the regions were based on population and demographics.

R. Thorpe: What are the acceptable benchmarks for wait-lists for joint replacements in British Columbia today?

Hon. P. Priddy: There are no acceptable or recognized benchmarks anywhere in the country. That's why we've asked our orthopedic panel to do exactly what they did for cardiac, which is to establish benchmarks. There are none here, and there are none in Canada. That's the work of the panel.

R. Thorpe: When will that work be finished?

Hon. P. Priddy: I'm told by staff that we'll probably have our first standards by spring.

[ Page 14008 ]

[1620]

R. Thorpe: I'm sorry -- by spring of the year 2000 is what we're talking about?

How do you establish, in your funding allocations to the various regions, how much money is going to be spent on joint replacements?

Hon. P. Priddy: At least for the area of hips and knees, if you will, in terms of joint replacement, that is money that goes into the base for the health authorities. It's done in consultation with the health authorities, around what their need is and what their capacity is. Can we always meet the need? No, we can't. But we ask what the current need is and what the capacity is to be able to do that. Then that money goes into the base. But at least in tertiary care that money is circled, and that isn't money that can be moved from one place to the other.

R. Thorpe: I believe that the information that you have published on your web site, dated June 23, says that the median wait for hip replacement is 18 weeks and that for knee replacements it's 20.9 weeks. Both of those are increases from a report of May 10. Let me, if I could, now try to paint a picture of what is actually happening in the South Okanagan, particularly with reference to the Penticton Regional Hospital. If I could, let me just read this letter from a Mrs. Dorene King of Summerland, British Columbia, into the record. This letter is dated June 16.

"Dear Mr. Thorpe:

"My name is Dorene King, aged 75 years. I have been waiting over a year for a knee replacement. I am on a 'waiting list' with the orthopedic surgeon Dr. Tatabe. He put me forward on the list as a priority. However, he says it may still be another six months before I can have my operation. I understand the government promised more money for joint replacement surgery, but it seems this money was given to the overall health requirements instead of joint surgery. I am in constant pain with my knee and find it hard to sleep at night. Is there any way you could help this old age pensioner? I need a new knee to enjoy what few years I have left on this earth.

"Thank you kindly for your consideration."

"Yours truly,

Dorene E. King"

We have four orthopedic surgeons in Penticton. I'm just going to go through a few of these, to show the minister what is actually taking place out there. Dr. Tatabe's office has 124 joint surgeries alone on a waiting list. There are four. They only do 181 surgeries a year in the Penticton Regional Hospital.

[1625]

Catherine Garnier, on the wait-list for 15.5 months; Jean Mackie, on the wait-list for 18 months -- priority for eight months, urgent priority for ten months; Cecelia Hudon, priority, wait 13 months; Colette Thomas, priority, wait 16 months; Doris Murray, priority, wait 14 months; Garth Stevenson, 17.5 months; Mary Sutherland, urgent, six months; Gwen Clubine, priority, 12 months; Christina Murray, priority, 16 months; Glen Falladown, 17.5 months; Pauline Nazaroff, 18 months; Helen Chapin, priority, 14 months; Blanche Rothel, 19 months -- and it goes on and on.

I guess my question is because the minister or the government has made several announcements on reducing wait-lists. The reality in the communities -- and in my community -- is that the seniors are not having their surgeries done. They're not having them done in 20.9 weeks; they're not having them done in 18.0 weeks. It's over a year for many of them. How is this government addressing this issue?

Hon. P. Priddy: The first thing that we've worked to do is to try and establish some accurate data in terms of how the information is collected -- how different hospitals and physicians collect their data. But I would not suggest that it's nearly as easy as that, nor would I be disrespectful enough to do that. The other way that we're doing it is by funding 1,000 more orthopedic surgeries this year. I don't know the information that your constituent has been given, but it has not gone into general revenue; it has not gone into the general health base.

It's orthopedic money; it's circled as that, and there are 1,000 new surgeries being done this year. I think that that is a very good first step towards addressing people's needs.

R. Thorpe: How many of those 1,000 surgeries are targeted at the South Okanagan?

Hon. P. Priddy: I don't know that at this current time, but we can have that for you this evening.

R. Thorpe: Thank you. I look forward to getting that this evening.

Is there an action plan to address this severe problem in British Columbia and, in particular, in the area I represent? Is there an action plan to deal with this in your ministry's business plan and in the estimates we're here debating? Is there an action plan to address this issue this year -- how we're going to handle it -- and how we're going to handle it in the future? Is that addressed in your business plan?

Hon. P. Priddy: I guess there are two pieces to this. One of them is through the planning of the South Okanagan board, which submits to us the information about what they intend to do with the dollars, what the unmet needs are, and how they, within their budget, intend to meet those needs. Secondly, as a provincial strategy, we're doing 20 percent more surgeries in this area -- in the orthopedic area -- this year than we did last year. That's an extraordinary number more. That's a very significant increase that I don't think you would actually see anyplace else.

We'll get the information for you after dinner about how many of those are actually in the region that you represent, but I would suggest that the action plan currently is the 20 percent increase in orthopedic surgeries. Part of the long term plan is the work of the orthopedic panel, and part of the long term plan is the plan from your health region -- right? -- which informs the business plans of the ministry in terms of increased surgeries.

But I would also suggest that -- perhaps I digress; I'm always sorry when I do that -- some of the things . . . . Moving away just a little bit, if I can, from the joint replacement surgery, there's a lot more that we as a health community -- both the ministry and local health services, etc. -- can do around the areas of prevention: preventing falls and preventing some of those needs for orthopedic surgery that we see. So there are some prevention and health promotion things that we should be doing as well.

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R. Thorpe: I think that prevention and health education are very good for younger people, but I would say that 99

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percent, if not 100 percent, of those names that I mentioned are senior citizens -- senior citizens that have built this province -- who are in severe pain. I see them in my constituency office, and the pain that these people are going through . . . . Education for prevention is not going to assist these people at this point in their lives. As Mrs. King said, she's 75 years old, and she'd like to enjoy . . . . And let's hope she's here to celebrate her 100th birthday. They want to enjoy some quality of life, which they are being denied because they're in pain all the time.

I want to ask this question again, because I'm not getting comfort from the answer. In your strategic business plan this year, have you identified that there is a crisis in certain parts of British Columbia, based on the demographics, for hip and joint replacements? Have you identified that there is a problem? Are you going to address that problem with results this year? Or is it just going to be more gobbledegook and "we're going to deal with it in the year 2001"?

Hon. P. Priddy: A 20 percent increase in orthopedic surgeries this year, I would suggest, is a plan to address the crisis that you talk about.

Secondly, with the greatest of respect, I realize that the people you're talking about are seniors, and while you may not be able to do as much prevention with seniors, much of what happens with falls either comes as a result of medication that seniors are taking inappropriately -- not intentionally, of course -- or comes because of geography, or comes because if we could do far more balancing activities with seniors, we'd lessen the occasion of falls. So I wouldn't want to suggest that . . . .

At least, I would hope nobody would suggest about me that if I get to be a senior, that's over, and there's no point in doing any prevention and health promotion -- that you can only do that with younger people. I don't think that's accurate either. But a 20 percent increase in orthopedic surgeries this year is indeed a first step in a good plan.

R. Thorpe: Twenty percent of 181 is 36 -- that's what it is. I've probably listed that many people that have been waiting a year already. What I'm trying to suggest is that there is a crisis in this part of British Columbia. It is my responsibility as the MLA for this area to bring that forward to this House. Is the minister then saying that 20 percent is all her government is prepared to do and that there is no other planning or action taking place in the business plan for this year to address waits that are over a year? "It's 20 percent. Those over that, too bad; you wait till we decide to do something else." Is that what's in the action plan?

Hon. P. Priddy: I believe that the member just said that 20 percent would be 36. Is that what you said?

Interjection.

Hon. P. Priddy: The number of additional orthopedic cases in your area is 100, which I would suggest is significantly more than the 20 percent that you've asked about.

R. Thorpe: Perhaps I should advise the minister that I only represent part of the health region that she's referring to. In Penticton it's 181, if you care to check the record. Now, 20 percent of 181 is 36. I don't need a lesson from the minister on how to do math. The lesson I want from the minister here is: what is her ministry going to do to help these seniors that are having to wait over a year to have the surgery done? That's the answer I want. If you're going to do nothing, stand up in this House and tell them that you're going to do nothing.

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Hon. P. Priddy: I don't think the question's any different; I don't think the answer's any different. If the member's asking if we're going to be able to get rid of every single person on every single wait time or reduce the wait-list to nothing in his area for orthopedic surgery, the answer is no. We are not going to be able to do that. But I'm sorry, I object . . . . I shouldn't say object. But I would not suggest that an increase of 20 percent in surgeries is nothing at all. In point of fact, it's the most that's ever been seen in this province.

R. Thorpe: How much in this year's Health ministry budget is being spent on advertising telling people what wait-lists are all about?

Hon. P. Priddy: We've sort of organized our staff, because you wanted to talk about regions, not about advertising budgets or whatever. So if you want to move into different areas, if you could notify me, I'll bring other staff in.

C. Hansen: I think the understanding that I had tried to convey to the ministry was that as questions came up on a regional basis, if perhaps staff weren't available to answer that precise question at the time, we could park that question and come back to it. Certainly, when we deal with communications and issues management later on during this process, we can perhaps deal with the answer on that specific issue.

R. Thorpe: My point was that perhaps we should spend less money on advertising and direct more of the money to the people that need the care now. Instead of giving them the spin on what may or may not happen to them, perhaps we could actually spend the funds on them and get them on to living a productive life.

Let me just say that no one . . . . If the