1991 Legislative Session: 5th Session, 34th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 3, 1991

Afternoon Sitting

[ Page

12453 ]

CONTENTS

Routine Proceedings

Oral Questions

Bible Fellowship Housing Society. Mr. Sihota –– 12453

Sales tax on imported goods. Mr. Reid –– 12454

Dual entry in school system. Ms. A. Hagen –– 12454

Flight access for physically challenged. Mr. Barlee –– 12454

Chair of Greater Vancouver Regional District. Mr. Loenen –– 12455

Dual entry in school system. Ms. A. Hagen –– 12455

Chair of Greater Vancouver Regional District. Mr. Loenen –– 12455

Contractual obligations of Stena Line. Mr. Blencoe –– 12455

Funding cuts to rural schools. Ms. A. Hagen –– 12455

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

On vote 38: minister's office –– 12456

Hon. Mr. Strachan

Mr. Perry

Ms. Cull

Mr. Peterson

Ms. Edwards

Mr. Lovick

Ms. Pullinger

MONDAY, JUNE 3, 1991

The House met at 2:06 p.m.

Prayers.

HON. MR. SAVAGE: I know there are a number of MLAs who may

wish to rise and welcome the Amadeus Children's Choir, who are from a

number of different constituencies and municipalities in the Fraser

Valley. It is a pleasure to stand here and welcome this great and

well-recognized choir to the Legislative Assembly. Would everyone

please give them a warm welcome.

MR. G. HANSON: Mr. Speaker, in the gallery today is a New

Democratic candidate for the riding of Mackenzie, Howard White. He has

recently been awarded the Stephen Leacock award for literature. Would

you please make him welcome.

MS. SMALLWOOD: Mr, Speaker, I'd like the House to acknowledge

one of my constituents who is with the Amadeus choir, Kim McPherson.

We'd like to give her a special welcome on behalf of her mom.

MR. BLENCOE: Mr. Speaker, in the galleries today is a group

of proud British Columbians and Victorians who have served this

community and the province for many years. They are the former

employees of the Stena Line in Victoria and, of course, of that great

company the B.C. Steamship Company. The employees here today are

members of the Transportation Communications Union, the Seafarers'

International Union and the Canadian Merchant Service Guild. I would

like both sides of the House to welcome them to our House.

MR. ZIRNHELT: In the gallery today is our second son Samuel,

who is visiting us from the Cariboo. Also in the precincts is Leona

Toney of the Ulkatcho band from near Anahim Lake. She's a cultural

coordinator visiting the museum and looking at the archives. Please

make them welcome.

HON. MR. BRUCE: Coming up on June 15-16 in Cowichan will be

an event of significant importance that, of course, will be seen

throughout the sporting world: the tennis tournament between the press

gallery and the members of this House. It will probably be one of the

most viewed spectacles that anyone will ever see on television.

However, one serious aspect is that this particular tournament this

year is going to help the mentally handicapped in the Cowichan Valley.

Centra Gas will be helping to underwrite the sponsorship of this

tournament. In the gallery today are two gentlemen who are helping in a

big way to put this event on: Michael Burton, the vice-president of

marketing for Centra Gas, and Bill Burton, who is the director of

marketing. I would ask that all members, even those who aren't playing,

extend a very heartfelt tennis welcome to these gentlemen.

It's not unusual that I would make introductions in the House, so I thought

that while I was on my feet I'd make one more. I'd like the House to welcome 60

grade 11 students from Brentwood College and the adults who are attending with

them and their teacher, Mr. MacLean — and no, I won't name all their names.

Would you please make them welcome.

MR. SPEAKER: The Chair was prepared to announce the winners

of the tennis tournament in advance, but in deference to your

announcement we won't do that.

MR. REID: Mr. Speaker, far be it from me to interfere with

any major announcement you wanted to make, but I'd certainly like to

add my voice to the special recognition and welcome of the Amadeus

choir, who travelled last year an some international tours on behalf of

British Columbia. In this Year of Music 1991.... I know many of them come

from my riding.

Oral Questions

BIBLE FELLOWSHIP HOUSING SOCIETY

MR. SIHOTA: A question to the Minister of Social Services and

Housing. Can the minister confirm to the House that the Bible

Fellowship Housing Society in Surrey has no B.C. Housing Management

Commission unit allocation for this year?

HON. MR. JACOBSEN: No, I'm not confirming who has or who has not any allocations this year.

MR. SIHOTA: There's a proposed townhouse project in Surrey,

to be built on tax-exempt land provided by statute courtesy of the

Premier when she was the minister responsible. Can the minister confirm

that this project is receiving no assistance whatsoever from his

ministry? Or does he have information that would suggest the project is

receiving assistance from his ministry?

HON. MR. JACOBSEN: I can confirm that every project is

approved on the basis of need and a very thorough method of analyzing

what programs meet the criteria best and satisfy the greatest amount of

need. So that particular project, which I'm not familiar with

individually, would be the same as all of the others. They're judged

fairly and on the basis of need.

MR. SIHOTA: The minister says that he's not familiar with

that specific project. Could the minister confirm he had a discussion

concerning the townhouse complex project with the mayor of Surrey on

May 10?

HON. MR. JACOBSEN: I have telephone conversations with a lot

of mayors and a lot of people. So I'm not sure which particular

projects they may mention to me when we have conversations or which

ones would be talked about. But I don't interfere with the allocations

of any of the particular projects.

MR. SIHOTA: The minister may be aware there's a political

controversy surrounding the matter of these 90 townhouse units being

constructed in Surrey. As a former mayor, I'm sure you know that the

law prevents

[ Page 12454 ]

councils from receiving any new information between

third and fourth reading after the public hearing. The minister made a

call on behalf of the contractor with respect to that project. Could

the minister assure the House that this phone call on behalf of his

constituent, the contractor, to the mayor of Surrey did not constitute

lobbying between third and fourth reading, which as he should know, is

unacceptable?

HON. MR. JACOBSEN: I don't lobby on behalf of any projects or

proposals. Of course, I have concern for housing in British Columbia,

and very often people express a lot of concerns about the fact they

have difficulty with local councils in order to bring forth projects

that are needed to meet the needs of the people within those

communities. But if I talk to any mayor or any other official

concerning housing, I talk in general terms. I don't lobby for any

particular proposal.

[2:15]

MR. SIHOTA: Prior to phoning the mayor of Surrey on behalf of

the contractor, was the minister aware that the contractor in question

had a financial interest in seeing the rezoning application approved?

HON. MR. JACOBSEN: The member suggests that I made a phone

call to help the interests of an individual. I have not made any phone

calls to anyone to help any individuals. Any time that I have discussed

housing with anybody in the municipal field, it has been to ascertain

if there were difficulties or what we might do within municipalities to

get more cooperation in order to provide affordable housing, which is

sorely needed in that community and many other communities.

SALES TAX ON IMPORTED GOODS

MR. REID: Mr. Speaker, I have a pressing and urgent question

for the Minister of Finance. In my constituency this weekend, probably

the most important issue that's affecting my constituents and

constituencies very close to the U.S. border is the 6 percent sales tax

collection process which was apparently announced last Thursday or

Friday by our government. Would you clarify that position, please?

MR. SPEAKER: Order, please. I have to ask the member to

phrase that in the form of a question. Asking a minister to clarify

something is really far too open-ended for question period.

MR. REID: Not intending the question to be open ended, Mr.

Minister, could you indicate whether in fact you will be applying a 6

percent sales tax right away to items crossing the border?

HON. J. JANSEN: The policy respecting the sales — tax collection is for those large-ticket items brought into the country by....

Interjections.

HON. J. JANSEN: Are you people interested in listening to the response, or are you going to sit there waggling your tongues all day?

The situation is that for large-ticket items brought in by common

carrier where there are documented purchases which include GST, customs

duties and, of course, exchange on the dollar, provincial sales tax is

collectable, and that is not a departure from any policy. That is not a

new policy; that is an existing policy.

The question has arisen whether or not sales tax should also be

applied to small purchases of $30, $40 or $50, whatever people buy

across the line. We have not made a policy decision on that, but we

expect that we could not collect that sales tax at the border.

DUAL ENTRY IN SCHOOL SYSTEM

MS. A. HAGEN: My question is to the Minister of Education. On

May 30 the minister announced the cancellation of the dual-entry

program. Has he now decided to provide school boards with the legal and

financial resources necessary to provide a full-day program next

September for those young students who entered school last January?

HON. S. HAGEN: That question is still under consideration, and I'm having work done on it by my staff.

MS. A. HAGEN: This government's imposition and sudden

cancellation of the dual-entry program has left parents in a state of

confusion and affects 14,000 students within the province. Can the

minister assure this House that an announcement regarding these

children being brought back into the mainstream in September with a

full-day program will be made within a very reasonable time — within

the next couple of days? These students, parents and school districts

cannot wait....

MR. SPEAKER: Order, please. The minister answered the

question by saying he would announce it as future policy. You can't,

therefore, put a time-limit on future policy.

FLIGHT ACCESS

FOR PHYSICALLY CHALLENGED

MR. BARLEE: This is to the Minister of Labour. Rick Hansen

would like to be able to fly into Penticton. At the present time he

can't. The Minister of Labour is responsible for this. Has he taken any

steps to ensure equal access to Air B.C. flights to all constituencies,

including for those who are physically challenged? In other words, why

can't these people fly into Penticton?

HON. MR. RABBITT: I was not aware of the situation. I'll get back to the member in due course.

MR. BARLEE: Supplementary to the same minister. The minister

administers

an act that prohibits discrimination in public facilities.

The Council of Human Rights does very valuable work in educating the

public on these issues. Does the minister agree that Air B.C.

[ Page

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needs a little education on this issue as well, and has he been in touch with the council to ensure that?

MR. SPEAKER: The same situation applies. The minister took the question as notice.

CHAIR OF GREATER VANCOUVER

REGIONAL DISTRICT

MR. LOENEN: Mr. Speaker, my question is to the Minister of

Municipal Affairs, Recreation and Culture. I believe that the mayor of

Vancouver, Gordon Campbell, should resign as chairman of the GVRD. It's

increasingly evident to my constituents that he allows his Vancouver

interests to stand in the way of his duties and obligations as chairman

of the GVRD.

MR. SPEAKER: Order, please. I ask the member to take his seat or ask a question.

DUAL ENTRY IN SCHOOL SYSTEM

MS. A. HAGEN: Mr. Speaker, I appreciated your advice a moment

ago. I would like to ask one further question of the Minister of

Education. Can the minister now advise this House when he will tell

14,000 students and their parents of his decision regarding their

future in September?

HON. S. HAGEN: As soon as possible.

Interjection.

MR. SPEAKER: Has the member a question? If the member has a question, I'll accept the question.

CHAIR OF GREATER VANCOUVER

REGIONAL DISTRICT

MR. LOENEN: I do, Mr. Speaker. I was just leading up to that.

The question is: will the minister investigate, to determine whether

under the Municipal Act there is any remedy available to our

constituents in Richmond?

HON. MR. BRUCE: Mr. Speaker, I believe, and this government

believes, in the sacred right of the electors to choose who will

represent them. No, there will not be any investigation; and no, there

will not be any action taken by this government.

CONTRACTUAL OBLIGATIONS

OF STENA LINE

MR. BLENCOE: I have a question for the Minister of

Transportation and Highways. This government's own incompetence has

scuttled the flagship of its privatization program — that is, the

Princess Marguerite — and now Stena, as you know, is closing shop.

Millions of dollars of taxpayers' money has been lost, and potential

millions of dollars in tourism to this community

When the minister was asked last week....

MR. SPEAKER: Order, please. First of all, we are not in committee....

Interjection.

MR. SPEAKER: That would be better.

MR. BLENCOE: I wonder if the minister could tell us today why

this government, in its wisdom, let Stena off its contractual

obligation to provide service to Seattle until November 1991.

HON. L. HANSON: I think the member has not done his homework

or his research as well as he should. He should ask that of the

minister responsible for that issue.

MR. BLENCOE: That is one of the problems. That's why this

great company has gone down the tubes and we're losing millions of

dollars. We don't know who's responsible.

Let me try the Minister of Development, Trade and Tourism, who seems

to have had some role in this. Perhaps that minister can answer the

question. Can the minister tell us why this government allowed Stena

out of its contractual obligation to provide service to this community

till at least November '91, losing hundreds of jobs, millions of

dollars and great benefits to this community? Maybe that minister can

tell us the answer.

HON. MR. DIRKS: Mr. Speaker, we believed, and we still

believe, that there is a viable opportunity there for a private

entrepreneur to set up a ferry service between Victoria and Seattle. We

have been working very diligently with Stena to achieve that very end.

MR. BLENCOE: The people of Victoria and this province would

like some answers. Same question to the minister: why did you let Stena

off its contractual obligation, a contract under law?

FUNDING CUTS TO RURAL SCHOOLS

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

on another matter. As a result of the government's decision to

centralize its decision-making in Victoria, the Creston-Kaslo School

District has lost funding to the tune of $500,000. Dispersion funding

of $200,000 this year, $247,000 next year and $318,000 in the following

year have been lost by that small school district. Mr. Minister, are

you prepared now to review funding formulas and end the cutbacks to

B.C.'s rural school districts, so that districts like Creston will not

face these kinds of budget cuts in the future?

HON. S. HAGEN: I'm sure that the member opposite, my namesake

from New Westminster, would be pleased to be reminded that this

province commits a larger percentage of its total budget to education

than any other province in this country.

With respect to the funding formula, specifically as it relates to

school districts, that funding formula is examined every year and

accepted and approved by the B.C. Teachers' Federation, the B.C. School

Trustees' Association, the minister's advisory council and anybody else

in the world who cares to have input. I have

[ Page 12456 ]

no idea what she's referring to. There's fairness in that formula.

There is ample funding for a quality education for all children in all

districts in the province.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

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

HON. MR. STRACHAN: Have I been recognized? I'm sorry, Mr.

Chairman. What with all the confusion and commotion and people

wandering about, I hadn't heard you.

MR. ROSE: How's your health?

HON. MR. STRACHAN: My health is fine, thank you. Very kind of you to ask. How is yours?

Interjection.

HON. MR. STRACHAN: Good. I understand you were up a little late on Friday.

MR. ROSE: Where were you?

HON. MR. STRACHAN: I was in Prince George.

Mr. Chairman, I am pleased to rise today to present the Ministry of

Health's expenditures and estimates for the 1991-92 fiscal year. The

budget reflects the government's commitment to ensuring that British

Columbians have access to a health care system that is uncompromising

in upholding the standard of excellence. This government continues to

demonstrate fiscal responsibility and effective management, while

maintaining a level of health care responsive to the needs of British

Columbians throughout the province.

For the '91-92 fiscal year, the Ministry of Health's expenditure

will be $5.4 billion, an increase of $591 million, or 12.3 percent,

over last year. On a per capita basis this amounts to $1,680 for each

British Columbian, or about $4,400 for each B.C. family.

Last year represented a significant period in the history of the

delivery of health care in this province. Rapidly advancing

technology, major demographic shifts, an aging population, changing

public expectations and human resource issues within the health

industry are a few of the challenges continuing to face the health

sector. By providing effective leadership and helping health industry

members to work together, government has responded effectively to the

ongoing pressures of the system. As a result, new and innovative

directions in the delivery of health care have been established which

will have lasting impact.

[2:30]

Perhaps one of the most important undertakings this past year was the work

of the Royal Commission on Health Care and Costs. During '90-91 the commission

held hearings in 38 communities throughout our province. They heard 900 briefs,

received 1,800 written submissions and reviewed a considerable volume of academic

research. Their report is due later this year. I am sure we all await the results

of the commission's deliberations with great interest. Providing an opportunity

for public input into the future direction of our health care system is a fundamental

hallmark of an open and responsive government.

In the meantime, we have not been sitting idly by waiting for the

results of the royal commission before addressing the current

challenges facing our health care system. We have continued in our

efforts to support a shift to community-based services. As a result of

this focus, individuals in need of health services are, when

appropriate, more often receiving care in their homes.

I can tell the members of this committee that within the next four

or five days I will be presenting to the people of Prince George and my

area a report dealing with additional services in the community, which

I commissioned as former Minister of State for Cariboo. It's

regrettable that the member for Prince George North is away again, but

she will see that report when it's tendered, probably at the end of

this week.

An additional $7 million was provided last year to increase the

wages of home support workers. Fifteen new adult day care centres were

opened, and increased funding was provided to the Meals on Wheels

program and the home intravenous pilot project. As well, Mr. Chairman,

we saw the opening of two community self-care hemodialysis facilities —

one in Vernon and the other in Nanaimo — and the expansion of a similar

facility in Surrey.

This year $2.8 million will be provided to improve day care for

patients with chronic kidney disorders and will be aimed at developing

new and community based programs. To this end, a new community facility

will be opened in Abbotsford this fiscal year.

As well, the hospital-community partnership program will be expanded

to include a continuing-care program component. This approach will

continue to demonstrate that through effective partnerships,

community-based programs can often represent the best solutions to an

individual's health care needs. Total funding for the community

partnership program for the fiscal year 1991-92 is $29.9 million.

As well in 1991-92, funding has been provided, under community

residential placement through the associate family program, for an

additional 12 children with multiple handicaps who are currently

hospitalized.

This year the government maintained its focus on seniors, and one

should always remember that the title of this portfolio is Ministry of

Health and Ministry Responsible for Seniors. The highlights of our

activities and our focus on seniors included the appointment in June

1990 of the first Seniors' Advisory Council, the chairman being Dr.

Howard Petch, the former president of the University of Victoria, and

as one can appreciate from my past portfolio, a good friend of mine and

a valued resource to the province in terms of the expertise and

leadership he will bring to this advisory committee. We also

established an interim ministry committee on elder abuse to initiate

and coordinate programs through government and provide policy

recommendations. We provided the develop-

[ Page

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ment and provincial distribution of a comprehensive guide to

programs and benefits for seniors. We also awarded $1 million through

the B.C. Health Research Foundation for community-based seniors' health

demonstration projects. This year the ministry will provide funding for

the planning and construction of new units to address the unique needs

of psychogeriatric clients requiring long-term care. We will introduce

standards for adult day care services and develop guidelines for elder

abuse to assist community groups in developing local protocols.

In the area of mental health, this past year marked the first full

year of the mental health plan. Under this significant initiative, the

quality of life of the many British Columbians who have a mental

illness will be improved. Special highlights of this program include $6

million in new base funding added to the mental health services budget

and the first instalment of the $20 million commitment to improving

mental health services. Also, $3 million was approved for new community

care services for mentally handicapped people with mental illness, and

a provincial Mental Health Advisory Council was formed to report on the

initiative's progress.

For children and youth, several other mental health initiatives

exist, including $10 million spent on increasing local availability of

specialized services for children, youth and their families: a $3

million commitment from across government to provide counselling

services for children who have been sexually abused; and the

introduction of a hospital liaison and suicide intervention program in

communities with general hospital wards.

The government's commitment to the mental health plan will continue

in 1991-92, and an additional $4.1 million will increase annual funding

of this plan to over $10 million and will continue to assist in the

appropriate transition from institutions to community settings. As

well, the ongoing public consultation on amendments to the Mental

Health Act will continue.

On the serious topic of AIDS, it continues to be one of the 12 top causes of

death in British Columbia. Our efforts in this area in 1990-91 include the development

of an AIDS strategy to coordinate and enhance efforts to prevent, treat and

research this disease — an AIDS strategy that has received international recognition.

The Ministry of Health spent $16 million on HIV- and AIDS-related activities

in the fiscal year 1990-91, $15 million of which was for direct treatment costs

of hospital, home care and drugs. This translates into an annual cost per AIDS

case of about $52,000. In addition to these services, the AIDS strategy includes

a federal-provincial intravenous drug user cost-sharing agreement, the AIDS street

nurse program and the native AIDS awareness project. In addition to this very

considerable activity and funding with respect to AIDS prevention and treatment,

additional initiatives will take place. In 1991-92 the Ministry of Health will

continue supportive AIDS prevention and treatment and will provide approximately

$1.7 million to establish an operative centre for excellence in HIV and related

viral diseases at St. Paul's Hospital in Vancouver. It is well known that

St. Paul's Hospital is internationally recognized for its expertise in HIV

and AIDS treatment, and will now truly be on the leading edge of research and

treatment.

Prevention and screening in the area of general preventive health.

Certain measures continue to benefit large numbers of British

Columbians at a relatively low cost. Examples include the expansion in

the 1990-91 fiscal year of the number of public health inspectors, the

introduction of compulsory criminal record checks for prospective

employees of child care facilities, expansion of the Dial — a-Dietician

nutrition hotline which currently handles 12,000 calls per year,

community outreach aimed at high-risk pregnant women to provide

counselling on subjects such as fetal alcohol syndrome, and 300,000

influenza vaccinations in 1990-91. These preventive initiatives are a

very important part of addressing the wide-ranging needs of our

population.

Yet another program with a focus on prevention is the

government-supported screening mammography program provided through the

B.C. Cancer Agency and intended to reduce the number of deaths in

British Columbia from breast cancer through the process of early

detection. This program, recognized as a model for Canada and other

countries, has now expanded outside Vancouver to include centres in

Surrey, Victoria, Burnaby and Kelowna. Other sites are planned for this

year. Of special interest is the Kamloops-based mobile breast screening

program currently serving an area bordered by Williams Lake, Princeton,

Golden, Lillooet and extending up Highway 5 to Clearwater.

It is clear that women have their own special health care needs. In

recognition of this, in January 1991 the government announced funding

of $1.2 million to help establish a women's health centre at University

Hospital at the Shaughnessy site. The centre, which is the first of its

kind in British Columbia, will offer one of the most comprehensive

women's health care programs in the country, including a special

self-referral service for victims of sexual assault. Capital funding

for 1991-92 will be provided through the Lottery Corporation.

In terms of public information services, over the past year the

ministry has made several progressive steps in improving the provision

of information and helping to better educate the people of British

Columbia with respect to health issues. Your Better Health magazine,

which was initiated a year ago, has received a tremendous response from

people throughout the province. This health information publication

reached every household in British Columbia through the publication of

five issues over this past year. We will continue to build on the

initial success of this publication this fiscal year. As well, we will

be expanding the distribution network through outlets such as

pharmacies and other key contact points to ensure that we reach the

broadest possible audience with this important health information.

We have also seen other important accomplishments in the area of

public communication and health education. For example, Food Safe, a

program developed to combat food-borne illness and to inform consumers

about safe food-handling practices, is now entering its third year.

Annual reports from the Ministry of Health and the division of vital

statistics were produced and

[ Page 12458 ]

distributed, designed to better inform readers about the activities

of the ministry In support of the establishment of the office of native

health in 1989, a variety of preventive health education materials were

produced, including the production of AIDS awareness and self-esteem

videos, the development of a native Medical Services Plan and

Pharmacare information brochure and the hiring of a native AIDS

educator to assist native organizations in raising AIDS awareness. As

well, in March of this year the Ministry of Health established a new

toll-free information line as part of a continuing effort to make

information about provincial health care programs more accessible.

We also established the office of health promotion, which represents

the commitment of government to ensuring that health promotion

continues to be a high priority. The 1990-91 operating year resulted in

a number of key initiatives in this area, including almost $900,000 in

funding to support 38 communities through the healthy communities

initiative fund and $1 million through the B.C. Health Research

Foundation for community-based health promotion demonstration projects.

I am pleased to announce that two of those are in my riding: one in

Prince George and one in the village of McBride.

We are facilitating the involvement of hundreds of children and

teens in taking action to improve their own health in schools, and we

have been involved in the initiation of a tobacco use reduction

strategy-

One of the most critical services of the Ministry of Health is the

British Columbia Ambulance Service. In 1990-91 the number of ground

ambulance calls rose by 8 percent to over 330,000. The number of air

ambulance calls rose by over 16 percent to 6,500. The staff of the

Emergency Health Services Commission met this extraordinary increase in

demand and continued to provide exceptional — quality ambulance service

and pre-hospital care to the residents of British Columbia.

Mr. Chairman, our acute-care hospitals continue to fill a critical

and acclaimed role in the delivery of health care to British

Columbians. A key partner with government, personnel working within

hospital settings continue to represent one of our most valuable

resources. Several major activities occurred in 1990-91 in an effort to

respond to issues affecting this sector, including a variety of nurse

recruitment, retention and continuing education programs and the

establishment of the Provincial Nursing Advisory Committee,

representing all aspects of the nursing profession and working to

develop a shared vision of health care delivery into the twenty-first

century. In each of the last three years the government has provided

additional funding of about $600,000 to train critical-care nursing

staff.

We have doubled the number of perfusion technologists now being trained in

B.C. for open-heart surgery, and we have allocated funds to expand the open-heart

surgery programs at Royal Jubilee and St. Paul's Hospitals by 100 cases

each for the current fiscal year and each year thereafter. Other initiatives

have also been undertaken in this area. The results show that waiting-times

for British Columbia open-heart patients have been reduced by almost one-half

over the past year, from an average of 20 weeks' waiting-time in February

1989 to less than 11 weeks in December 1990. Almost 600 more cardiac procedures

were performed than in the previous year.

I would like to also mention the Pharmacare triplicate prescription

program, which involves the professions of pharmacy, medicine,

dentistry and veterinary medicine. Through this program, prescriptions

for drugs with potential for abuse, misuse or overuse can be monitored

and areas of concern identified.

Two additional Pharmacare initiatives included the product incentive

program and the rural incentive program. Together those programs have

resulted in improved buying practices and more generic substitutions by

pharmacists, and have helped maintain the viability of small rural

pharmacies. This latter point is very important to the government,

because the people of rural British Columbia should not have to travel

extensively for something as basic as having a prescription filled.

The recent settlement with the British Columbia Medical Association

accounts for $220 million of the increase in the Ministry of Health's

budgeted expenditures. As a result of this settlement, Medical Services

Plan premiums, which are automatically adjusted by formula to cover

one-half of the cost to physician services and all costs of

supplementary services, such as chiropractic, have been increased by an

average of 12.8 percent.

Mr. Chairman, I would like to make it clear that MSP revenue will

amount to only about 14 percent of Ministry of Health spending in this

fiscal year, or approximately $733 million.

[2:45]

In the area of capital development during 1991-92, 17 major

construction projects will commence, with total costs of $150 million.

This will result in an additional 110 acute-care beds, 205

extended-care beds and 136 intermediate-care beds for British

Columbians. In addition, three new health centres will be completed or

will be near completion in Kelowna, Fort St. John and Dawson Creek,

with planning underway for the provision of eight new community health

centres.

In addition to the obvious health benefits of these actions, the

economic benefits of the construction and operation of this new

capacity are significant, particularly in the current economic climate.

It has always been a feature of our government to recognize in times of

declining revenues and economic downturn that one of the most important

measures a government can take is to increase its capital building

program. That has been done in this ministry as well as in the Ministry

of Education and the Ministry of Advanced Education, Training and

Technology.

The Lottery Corporation will also fund two new magnetic resonance

imaging scanners, one at Children's Hospital and the other at St.

Paul's Hospital in Vancouver. In addition, it will also fund a new

computerized tomography scanner at Richmond General Hospital.

Further on the subject of technology, the British Columbia office of

health technology assessment at UBC has been established through

funding from the Ministry of Health. The ministry's purpose in funding

this office is to encourage and facilitate the use of the

[ Page

12459 ]

latest assessment research. Through this office, the health care

community in British Columbia will have access to the results of the

best and latest technology assessment research from around the world.

Research and evaluation is an important aspect of health care. Although

mainly funded by other sources from both within and outside the

provincial government, work in this area in British Columbia warrants

our attention.

The health development fund, which is jointly administered by the

B.C. Health Research Foundation and the Science Council of British

Columbia, will award about $3 million to applicants for major research

equipment, health technology development and health technology

assessment. In addition, now entering the third year of the special

research demonstration projects program of the B.C. Health Research

Foundation, we will see the completion of three competitions now in

progress on the topics of health initiatives for persons with

disabilities, native health and mental health.

I mentioned that enhancements to the health care system must be

scrutinized carefully within the current economic and fiscal climate.

Initiatives offering significant improvements to the delivery of health

care and at the same time resulting in cost savings are, therefore, of

the highest importance. For example, the 1991-92 health budget includes

about $445,000 for the expansion of health services delivered through

private native societies or organizations throughout the province. The

services include the development of native health centres, education of

native health care workers and design and delivery of public education

initiatives for native communities. As well, the travel program

announced in the throne speech and the budget speech will be developed.

It will be designed to assist families living in rural British Columbia

to access required health care services and avoid significant financial

hardship.

In conclusion, I have spoken a great deal about health, but there

are other kinds of health besides physical and mental health; there is

also fiscal and economic health. Without it we cannot afford any of the

social programs which we value so highly in our province, and without

it there would be no health care, social assistance, education or

highways. For these reasons, it is vital that we allocate our health

spending resources efficiently.

Over the past decade we have seen a steady erosion of federal

support for health care. The federal government has been overspending

for years and is now backing away from health care. Other provinces

have been incurring deficits when the economy was relatively strong.

They too must cut services and freeze wages.

In British Columbia the health budget is up 12.3 percent, as I said

earlier. To make this possible, wages have not been frozen, other

public services have not been sacrificed and the fiscal future of the

province has not been placed in jeopardy. The reason for that is sound

fiscal policy and the management skills to implement that policy. The

reason is good government

The lion's share of the $591 million increase in the Health budget is for

remuneration: $405 million will fund higher wages, salaries, fees and benefits

for health care providers — doctors, nurses, technicians, homemakers, facility

staff and others — who provide such excellent care for the residents and citizens

of our province. Historically, the major part of the budget of the Ministry

of Health goes towards the wages, fees, salaries and benefits for health care

providers. Accordingly, most of the ministry's budget increase this year

will be associated with those ongoing costs. The government stands on the record,

however, that at no time will we be prepared to compromise health care services

for higher wages.

My comments today reflect examples of the strong commitment of the

Ministry of Health and this government to maintaining and improving

access to the highest quality of health care. The wide range of

services I have mentioned demonstrate that the health care system in

British Columbia is huge, complex and, frankly, very costly. However,

it is important to acknowledge, once again, that in 1991-92 this system

will continue to provide the best health care that this generous

funding base and devoted professionals can offer. With direction from

the Royal Commission on Health Care and Costs, the cooperation of care

providers and the continued support of the residents of British

Columbia, this system will emerge from the 1990s continuing to provide

the top-quality service that we have come to expect.

I will take my place soon and recognize other speakers who may wish

to comment on the expenditures of the Ministry of Health. I would like

at this time to introduce three staff who are with me today. Seated on

my left is Ms. Krysia Strawczynski, the Deputy Minister of Health. On

my right is Dr. Les Foster and behind Krysia is Chris Lovelace.

I understand as well that my critic, the second member for

Vancouver-Point Grey, has a serious illness in the family, and if at

any time he may want to adjourn these debates, I can assure him of

total cooperation from this ministry and this side of the House. I

understand and have sincere feeling for his personal situation. With

that said, I'll take my place and welcome any argument, debate or

questions that may arise.

MR. PERRY: May I begin by expressing my appreciation to the

minister not only for the opportunity to have the debate as the first

priority in the estimates, but for his consideration in offering to

defer the debate. I'm going to make a brief contribution this

afternoon, then look forward to rejoining the debate with a full

measure of vigour at some future point.

I listened with interest to the minister's comments and will make

some specific responses to them. I'd like to follow up with questions on

a number of the issues he raised, perhaps after I've re-read his

remarks in the next few days and given some further thought to them.

I'd like to begin by exploring one issue relating to the throne

speech — a commitment to additional openness in government. I'd like to

request a number of documents in time for our subsequent debates, but

I'd also like to clarify one issue which has arisen through

communications from constituents.

[ Page 12460 ]

MR. CHAIRMAN: Hon. member, I beg your pardon for interrupting

you. I wonder if you would mind if the member for Langley made an

introduction. Please proceed.

MR. PETERSON: I thank the member for his indulgence. Mr.

Chairman, on your behalf and on behalf of the Minister of Social

Services and Housing, it gives me great pleasure to introduce to the

House 32 grade 7 students from Hatzic Elementary, who are in the House

now with their teacher Mr. Jim Mills. Would the House please join us

and given them a very warm welcome.

MR. PERRY: The matter I wanted to clarify with the minister,

if possible — and hopefully lay it to rest — is that a number of

citizens from around the province have drawn to my attention that

requests for information which previously had been addressed routinely

within the ministry are now being directed to the minister's office.

I'll give as one example a request that my staff made for a document —

the external review of Mount St. Joseph Hospital in Vancouver. I

instructed one of my research staff to request the document, and she

was told by telephone by the director of hospital programs that all

such requests must come in writing to the minister's office.

I know that the minister is a very affable fellow. I found this

surprising, so I hope that he can clear this matter up for us and

reassure me that the ministry's previously relatively open policy with

regard to information remains the same.

HON. MR. STRACHAN: Just a little play on words: the member

said I'm a reasonably affable fellow and asked if I'd clear that up;

well, I am affable, effervescent — whatever.

I'm not aware of any change in policy, Mr. Member, except that it

always has been my personal policy that whenever any Member of the

Legislative Assembly wants information, I be advised so that I can

provide the information expeditiously and that first-class service from

my office is given as openly and as quickly as possible.

MR. PERRY: Mr. Chair, I have no question about the minister's

desire to render the best possible service to the public of British

Columbia. Maybe I can just advise him that as a matter of convenience

to members, it's often more convenient for us simply to speak directly

with the responsible official. We have had to resort to admonitions to

officials, if we were unable to rely on the usual cooperation in

problem-solving that we've enjoyed, that we might have to take other

measures, such as ensuring that those problems found their way into the

media. It would be a lot easier for all parties if we could revert to

the former policy.

HON. MR. STRACHAN: I'll examine the former and the current policy,

and see if there's any change But there's no way at all, Mr. Chairman,

that I want to put any sort of delay or difficulty policy in place that would

impede members in carrying out the responsibility of their duties.

MR. PERRY: Thank you to the minister for that reassurance.

Again, before making some more general remarks, I'd like to request,

for the purpose of the subsequent debate, a number of documents. The

first one is referred to on page 5 of the Hansard Blues from Friday

afternoon. These were documents displayed in the minister's absence by

his colleague the former Minister of Health, the Minister of Finance,

during debate on interim supply relating to increases in the Pharmacare

budget for the past fiscal year. I attempted to secure those documents;

they looked extremely interesting. I asked the Minister of Finance at

the time if he would pass them along to me. He mentioned, at page 6 of

the Blues, that because he didn't have any copies immediately

available, he would make copies and arrange for me to get them at a

later time of the day. I sent a note to him on Friday evening

requesting the documents, but I'm not sure what happened to the note.

If I could obtain those documents and any other breakdown on the

overrun in Pharmacare, it would lead us to some constructive debate. I

can reassure the minister I will not attempt to hold him personally

responsible for that overrun in Pharmacare, but we could fulfil our

obligations to the public quite usefully if we could examine some

details.

[3:00]

There are a few other documents I think it would be useful to have,

reflecting the new spirit of openness in the Speech from the Throne:

the AIDS advisory committee reports or any letters from the AIDS

advisory committee to Ministers of Health over the four years since the

committee was established; the report of the Pharmacare review

committee, even in draft form — it would certainly be appropriate to

discuss this in these estimates; any reports of the minister's ethics

advisory committee not yet released; and the report of the committee to

examine prosthetic services, which was mentioned in estimates debate

last July in response to a question from the member for Oak Bay–Gordon

Head. This member and I have never been able to determine whether that

committee actually exists, but the committee's existence was announced

by the former Minister of Health during the estimates debate last July.

We'd be interested to know about the membership and any reports of that

committee, since it has now existed, even as a phantom committee, for

close to a year. The only other immediate reports I can think of —

there may be others — are the external review of Mount St. Joseph

Hospital, which would be of tremendous interest to me, and external

reviews conducted on the Smithers general hospital in the past. I

believe I have asked for those, and if I have received them I am not

aware of it.

[Mr. Ree in the chair.]

Let me turn for a moment to some of the more general remarks the

minister made, as an outline of what I hope we will cover in the

estimates debate. Mr. Chairman, I want to emphasize how pleased I am

that we now have the chance to hold this debate in front of the people

of British Columbia via television — something we didn't have last

year. Many of the debates in

[ Page

12461 ]

the House are boring, to say the least, frustrating and occasionally

rather embarrassing for all of us. But I hope the estimates debate, for

those interested in the particular field concerned — in this case

Health — will be revealing to people. I think what we're debating is

not so much the total amount of money spent in the health service, but

the way the taxpayers' money is being spent.

I've been pressed — as has the minister and his former minister

colleagues, I'm sure — to declare that health is underfunded in British

Columbia. I believe there are instances where health services have been

underfunded. But I also believe there are instances where they have

been overfunded, or where money could be spent much more efficiently.

Hon. members — I see the member for Okanagan South smiling — like

others, will recall that I moved a motion on the order paper last year

urging that the Select Standing Committee on Health, Education and

Social Services meet to review some of these issues in a non-partisan

way. I relish the endorsement of that concept by the second member for

Richmond, even as I lament that his endorsement might have come earlier

while he was still in the chair of the Health Committee, so that we

wouldn't be embarrassed by the report of our distinguished assistant

Clerk, who is with us today.

The report shows that over the course of the present parliament, the

Committee on Health, Education and Social Services has met four times

and has considered no business. The total sitting time of the four

meetings probably would approximate 20 minutes, if I'm not mistaken. I

think we will have to attempt in these estimates debates to achieve

what we couldn't achieve in the perhaps less partisan atmosphere of a

legislative committee: to examine how the funds available for health

could be better spent.

I agree with the minister that it's important to recognize from the

beginning that we have generally good health service in this province.

The former Premier gained rich political capital, I suppose, by quoting

me as the opposition Health critic in various community papers

endorsing, at least relatively, the state of health care in British

Columbia. I'm not embarrassed to say that we have a good health care

system. It would be shocking if we didn't, in a rich province and

country like this and with the cultural tradition we have. So I'm proud

to stand here, as are other members, and say that we have a good health

care system in British Columbia. We have one of the better health care

systems in the world, and we have, relatively speaking, a reasonably

efficient one.

Interjection.

MR. PERRY: The member for Coquitlam-Moody says the minister's

not so good. Well, let's be charitable; he has been in his position as

Minister of Health only a few weeks now. I'm not prepared to judge him

that rapidly. Perhaps my more senior colleague is a more accomplished

judge of performance than I.

AN HON. MEMBER: More perceptive.

MR. PERRY: More perceptive.

He's got a maximum of four months more, so I'm willing to give him

that time before I make my historical verdict. As a famous person once

said, history will absolve me. I'm not sure: maybe it will, maybe it

won't. But let's give him a chance.

The real question here is how we can determine how best to spend the

money so that our health care system improves rather than

deteriorating. Recognizing that we still have a good system, there have

been serious problems over the last five to ten years which have

gradually worsened. Particularly over the last four or five years under

this government, health services have become less accessible to people

who really need them.

After all, that's one of the factors that drove me into politics. I

was working in medical science only two and a half years ago, working

in a hospital. The deterioration I could see around me in access to

health services is one of the factors that motivated me to enter

politics, which even a few months before I contested a by-election was

the last thing on my mind. That's what has people so concerned: not

that many people in our province don't get excellent service, but that

many people are having increasing difficulty obtaining the health

services that they need.

The other factor that should concern us all is whether we are being

as efficient as we can be. I don't think we are. I think that if we

consulted more effectively, not just in round tables or in Premier's

councils or once-a-year speeches to an AIDS conference which are

speeches, not question-and-answer sessions, not dialogue, but set-piece

speeches.... If we really consulted those people working in the system,

I think we could find many more inefficiencies that could be corrected.

Pharmacare is one of the greatest challenges. It's not numerically

enormous; perhaps there's $50 million of waste that could be pared out

of that system. Fifty million would be a major benefit to the people of

British Columbia in the hospital system. Maybe there's that much —

maybe a little bit more — that could be pared through very careful,

selective administration. Maybe in Medical Services there could also be

significant savings, perhaps of the same order.

But the real question is: how effectively are we finding those

efficiencies? How effectively are we educating our public to utilize

the system as intelligently and as rationally as possible and to ensure

that the service doesn't deteriorate?

I see the member for Omineca listening, and I'm flattered that he's

listening, because he's one of the great orators of the chamber, and

I've enjoyed listening to him at times. I know that he's seen a lot of

British Columbia, and in his short life he's seen a lot of British

Columbia history. He will know — like others in this chamber — that

some services have undergone serious deterioration. When we look at an

older person — the age of many of the members on the government

benches, even a few of the opposition members — facing arthritis of the

hip, perhaps the need for hip surgery.... The potential waiting-time of

a year for routine hip surgery to relieve pain is different from what

it was a few years ago. It was very unusual for people to wait that

long. Older members opposite will

[ Page 12462 ]

probably know that and will have constituents who are alarmed by that.

What we need to address in these debates is how effectively the

government is addressing those questions, not simply to trumpet how

wonderful our system is compared to the American system. All of us who

have roots in the United States, who read about that country or travel

there or have anecdotal experience, know that the real question is not

to compare ourselves to the Americans. They have a notoriously

inefficient, expensive and, one might also say, decadent system, in

which vast amounts of waste are created for useless services for the

very wealthy while the poor and the indigent don't even receive Third

World levels of care.

So we're not comparing ourselves with them. What we're really asking

is how we can best administer our own system. I think that in these

debates we will have a fruitful chance to look at some of those issues.

I'd like to turn to some of the key issues that arose before the

Royal Commission on Health Care, since the minister referred to the

commission. I said at the time of the appointment of the commission in

January or February 1990 that I thought the commission was an excellent

idea. I thought that the timing of the appointment was political — I

still do — but that the commission itself was an excellent idea. I

spent at least 15 days over the last year in hearings of the

commission, listening to input from British Columbians.

All of us who participated in those hearings in any way will agree,

I'm sure, that that commission established a new standard for

commissions of inquiry in Canada by so effectively soliciting input

from the public — even from a public which often was set against the

commission at the start, which was very skeptical, and even cynical,

about the role of the commission. Many of those who were rather cynical

about the course of the inquiry were captivated by the fact that the

commissioners sat up all night reading documents, clearly had read the

submissions before the hearings, and were prepared to ask increasingly

intelligent questions. So I think all of us, regardless of the outcome

of an election, will take very seriously what the commission recommends.

I'd like to talk today not to prejudge their recommendations but

about some of the problems uncovered perhaps more effectively before

that commission than ever in debate in this Legislature. Perhaps the

most striking were the inequalities of access to the health care

system. The commission heard more from people who have had difficulty

than we as members of the Legislature perhaps do, because of its

involve all of the public of British Columbia.

I heard astonishing things that I have never heard before in my medical education,

in my university education and even in my brief political career. Many things

were brought to my attention, but some things that I had never heard of came

before the commission, and themes were developed that brought home to me how

little I'd been prepared in my previous life to understand the problems — for

example, of disabled people. We heard not only the arguments of people like

the deaf community, whom we heard from in the Legislature last week; the week

before we heard from the Canadian Paraplegic Association and from groups representing

people coping with severe disabilities in their own homes. We heard arguments,

for example, that British Columbians....

MR. CHAIRMAN: The Minister of Health on a point of order.

HON. MR. STRACHAN: Just on a point of order and intervention,

I notice the red light is on. I don't have any problem with that, but I

do note that our standing orders allow an opening statement of 30

minutes. I presume the member has only spoken for 15. Is that correct?

I guess this is a 30-minute statement. I'd be more than happy to bring

that to the Chair's attention.

MR. ROSE: Since the minister has offered to be the

intervening speaker, I take it that our friend over here has got a new

lease on life for a while.

[3:15]

MR. PERRY: I hope I'm not testing the minister's patience or

boring him. I'm trying to set the scene for matters that we will raise

during the subsequent debates. Perhaps I'm hoping to interest those

rare British Columbians who are watching this on the television in

coming back for the sequel or the second instalment when we get around

to it, because there will be issues of general interest raised here.

I was talking about people with disabilities. I referred on Friday

night to the report of the assistive devices program task force — a

task force of professionals in the fields of assisted and augmented

communication. Those words were Greek to me, but I met with those

people and heard their presentation to the royal commission. I watched

a severely disabled young man with cerebral palsy He is disabled in his

speech but not in his mind or in the rest of his body. He is able to

function at a very high level as a student at Douglas College but is

inhibited by his inability to speak as a result of a birth defect. I

heard directly from him, through an experiment and demonstration before

the royal commissioners, how effectively he would be able to

communicate if he could afford a $1,000 or $2,000 or $3,000 device into

which he could type and which would speak with a human voice for him.

That brought home to me the significance of the assistive devices

program task force report, which had recommended to government an

integrated, non-profit society which could purchase, maintain and

recycle that kind of equipment so that any such people in the province

could benefit from modern technology

One of the real triumphs of our society is the kind of technology

which allows a person without an effective voice to speak with one. I

therefore found it very frustrating to know that the report sat

gathering dust in the government closets. In fact, it's never even been

released. The task force that prepared it and wanted it to be

circulated has never been able to have that report see the light of

day. Perhaps that's another one the minister might care to table or to

release to the public.

[ Page

12463 ]

I saw the frustration of people who had worked for several years to

achieve a reasonable recommendation to government, to achieve a near

consensus from 14 assistant deputy ministers on the common sense of

their strategy to resolve a significant problem affecting disabled

people. Their frustration is that nothing has happened. I raise that

one now for the minister to respond to perhaps when I sit down, or to

deal with in more depth in coming days.

I heard before the commission tremendous frustration over the

inequities of medical service to people in rural areas and in northern

British Columbia. Having worked in a number of northern communities in

the past — Hudson Hope, Houston, Highway 16, Queen Charlotte City,

Tasu, Whitehorse — I had some glimmer of understanding. In listening to

and reading presentations to the royal commission, I found that the

problem went much further than what I had ever understood. People not

only resent the difficulty of travelling to metropolitan centres like

Vancouver but they resent the fact that it's assumed automatically that

because one lives in a rural or semi-rural area, standards of some

services will be lower. In particular this affects people not with

episodic illness but with chronic illness or chronic disability, like

the parents of young children with severe chronic disabilities like

cerebral palsy or spina bifida, causing paralysis of the lower limbs.

Parents who end up in small communities like Houston, Smithers,

Prince George, McBride or wherever in northern B.C. — even some of the

larger communities like Kamloops, Kelowna or Summerland — find it very

difficult to access a reasonable level of rehabilitative service

equivalent to what they could obtain in the major cities. They argue,

quite rightly, that those are the resource communities which have

formed the core of British Columbia's economy over the years. They pay

taxes equal to everyone else. Why is it automatically assumed they

should not have equal right to health services that can allow the

development of their children to their maximum potential?

I found those arguments very compelling. In fact, I found the

arguments sufficiently compelling to agree with them that it was one of

the clear and obvious areas of underfunding of the health service in

our province.

I heard before the commission arguments that in many ways the

elderly are discriminated against. This is a complex subject that my

colleague the member for New Westminster will want to tackle at length

in the estimates debates.

But strikingly, I heard that children are a neglected part of our society.

Of all things in whom we have the most significant stake in our future, children

are actually discriminated against in the health care system. I've spoken

about that earlier in Health estimates, last year and the year before. For example,

I've spoken about children with thalassemia, a genetic disease that is

life-threatening and that kills children unless they receive very sophisticated

treatment. Last year I spoke about how the parents of those children had to

pay up to $5,000 per year out of pocket to help keep their kids alive. Fortunately,

that problem was corrected, and I thank the previous minister for giving his

attention to that issue.

But that was an example, which others repeated before the

commission, of how children — whom one would assume would be the first

to receive the most generous health services we could possibly afford

in a rich society — are often discriminated against. Sometimes it takes

the form of access to a hospital. For example, sometimes it's a child

from the minister's own constituency sent to the Children's Hospital in

Vancouver for surgery and whose surgery is cancelled the night before.

Occasionally the child has even fasted overnight, and then because of

space problems, can't get into the hospital. Sometimes it's like the

child I mentioned ten days ago requiring a kidney transplant who is

unable to have

interpretation services as a deaf child to understand

what is going on. I found that very disturbing.

The other area of unequal access was for people with chronic illness. Some

were raised before the commission, some not so effectively. Some adults with

chronic illness are so debilitated themselves that it's almost impossible

for them to summon the energy to speak for themselves. A good example of letters

I've received over the last year were from people with chronic spasms of

the neck — torticollis — and spasms of the eye muscles, who've been struggling

to find a way to pay for a modern treatment, which is now licensed, that they

used to receive free because it was experimental. Now that it's licensed,

many of them are having great difficulty struggling to afford it. Or people

with severe rheumatoid arthritis. I will read, later in the debate, a letter

from a young woman with juvenile rheumatoid arthritis, one of the most disabling

conditions anyone can suffer, one of the most difficult for a young person who

struggles with the cost of paying for cyclosporin, a drug that now seems to

have promise to help her.

Those are the kinds of issues I hope we will discuss at length in

these debates, because this is where we should be turning our

attention. Our function in a Legislature is not simply to laud the

accomplishments of doctors, nurses and other health care workers, or

the courage and bravery of patients or the skills of hospital

administrators at keeping within budgets. All of them are doing good

jobs in those areas in the province. Although it's appropriate to give

a friendly nod in the direction of our senior civil servants who

administer the system, it is not our function to sing their praises

unequivocally.

Our job in this Legislature is to find areas where we can improve

things and to try to chart a path for the future more imaginative than

that which the government has chosen. We're going to have some very

good ideas here, and I hope people will stay tuned in. I'll give the

minister a chance to respond to a few of those points before I go on.

HON. MR. STRACHAN: As we've heard, there's a variety of

issues that the member wishes to discuss. At the outset, I would like

to thank him for his kind words and recognition that in British

Columbia we do have an excellent health care system. As a practitioner

himself, he is well aware of the services we do provide. His

[ Page

12464 ]

comments are viewed as complimentary and are ones that I certainly appreciate. I'm sure everyone else in the system does.

The member's first questions dealt with correspondence or reports

that he would like to see. We have a list of those now, and we will

attempt to provide for the member whatever we can. Let me add some

caveats. First of all, reports on hospital reviews are considered to be

the property of the hospital, and I would not be prepared to release

any of that information unless I did have the approval of the hospital,

or perhaps the member could talk to the hospital about that. But that

would be a decision of the hospital board and administration and not of

this ministry.

In other committee reports, I would be prepared to discuss with the

committee chairman their willingness to release information for the

member's benefit, but again that would be subject to the appropriate

committee. In the case, for example, of the ethics committee, you and I

both know Dr. David Boyes, and I don't think it would be appropriate

for me to commit on his behalf any information for public consumption

that he may not feel comfortable releasing. Again it would be my

position, Mr. Member and Mr. Chairman, that any information that could

be released to the member opposite would be done only after approval of

the appropriate committee chairman or other bodies involved with

releasing that information.

I don't think I could argue at all with the member's comment that in

some cases the system is underfunded and in other cases overfunded.

There's no question that when you have a system using one-third of the

taxpayers' money — one-third of our total budget — you're going to find

underspending and maybe overspending. We're looking in this case at an

expenditure of $5.4 billion for this year — well over $1 million a day

in the health care system — and we're bound to find some areas of

concern where we, the member or other members of the community think

that we can be more responsible in our funding.

It is for that reason that my predecessor, the member for

Chilliwack, put in place the Royal Commission on Health Care and Costs.

That is the full title of that commission — Health Care and Costs. We

have instructed that royal commission to look at all those areas, in

particular the area of costs. If there is a concern such as the member

has pointed out — that in some areas we may be overfunding and in other

areas underfunding — we certainly want to be made aware of that

concern. It's our opinion that that royal commission, which has the

mandate to review health costs, will be able to provide that

information for us. I understand that the member has made a submission

to the royal commission, and I thank him for that. I'm sure the royal

commission will be reading with some interest his submission.

There was a comment by the critic with respect to medical manpower. I can advise

the Legislative Assembly and the committee that the deputy ministers from across

Canada are working on a manpower report which will be made public July 1, so

the member can view that see how well we've done and see what we've

done in that case.

In terms of total quality management, we do believe we have a

management system, and we're going to be working on that continually.

That's really one of the mandates of this ministry: to ensure that as

we expend this one-third of the total budget, we inject quality

management into the system and that every dollar that we do spend we

spend wisely and responsibly.

[Mr. De Jong in the chair.]

The member made some comments about the United States of America.

Let me just say that he's correct that in many cases their system does

provide a lot of unnecessary care; but critics will argue that in many

cases it is one of the best care systems in the world. But it's also a

system that leaves 37 million Americans not covered at all by any

medical services plan. So from that point of view, it really can't be

considered a comprehensive system. I certainly would not want to be a

politician in a country like that, where you have such a great number

of people who do not have the benefit of medical services coverage and

who face certain bankruptcy if any serious illness arrives. It really

is regrettable that one of the most advanced countries in the world, in

many terms, has to have a system that is essentially almost Third World

in some respects, quite primitive with respect to a comprehensive care

policy.

The member has indicated that he wants to make suggestions. Let me

tell you, Mr. Chairman, to the member and all members of this assembly,

that I welcome suggestions. I think it's one of the best things we can

do in estimates debate; instead of just asking questions about this,

that or the other thing, to make comprehensive suggestions to us. Let

us know the policy of your party on issues. Let us know how you think

we can improve the system. Let us know of your experience and

suggestions as to how you can improve the system. I can assure you that

it's my policy in this ministry and, you know, in many other ministries

that I've held to always take suggestions. I take comments made as

coming from interested people who want to be constructively critical

and want to really add to the system. As long as we can stay on that

plane, I'm delighted to have the member continue to make suggestions to

me. We will take them seriously, digest them seriously and try to

proceed with them.

As you know, Mr. Chairman, I represent an area that is to some

degree rural, although it has a large central population in the city of

Prince George, where we have a large and very good referral hospital.

But I also represent an area that is quite sparsely populated, running

straight east from Prince George to the Alberta border, including the

small villages of McBride and Valemount. So I am aware, as all members

outside of the lower mainland would be — and obviously as my critic is,

since he has practised in some of these areas — of the concerns that

people have with health care in the sparsely populated areas.

[3:30]

While I have the floor, Mr. Chairman, let me just outline some of

the programs we have in place, as a government, for the provision of

health care services to people who live outside heavily populated areas.

[ Page

12465 ]

First of all, we have a northern and isolation allowance program,

which provides a fee premium for approximately 400 physicians who live

and work in approximately 70 rural and isolated communities. The

expenditure for the provision of those services in rural communities

represents $5.12 million for the 1990-91 expenditures, a 70 percent

increase over the previous year. We have the northern and isolation

travel assistance program, which provides funding to defray direct

travel and accommodation costs for specialists who travel to rural and

isolated communities to hold clinics. That's funded at the rate of

$280,000 for 1991. For $180,000 we have a subsidized physicians

program, which guarantees physicians a minimum income, and five

communities were served this way in 1991. We spent $3.9 million on

special contracts to meet the reasonable needs of rural communities,

and 15 such communities were served in the last fiscal year through the

provision of that expenditure. There was $680,000 for nurse

practitioners' services — 16 communities were served last fiscal year.

And then we also have the UBC psychiatric outreach program, which

provides $760,000 of funding for psychiatrists to travel from Vancouver

to outlying regions to treat patients and to train general

practitioners. That is a total of $10.21 million for rural health care

programs.

I'm sure that all members — particularly a member like myself who

represents an area with sparse population — will say that it could be

more and could be improved. I have no argument with that. If anyone has

any suggestions, I'll be more than happy to discuss them with you; I

welcome your suggestions.

In terms of disability, it has been a concern of mine for some time.

I was employed in the area of working with disabled people prior to

becoming elected in 1979. I also have a personal experience. Many

members will know that the second member for Vancouver–Little Mountain,

who is quadriplegic, was elected to our caucus in 1983 as the second

member for Vancouver–Little Mountain. He is a very outgoing and

energetic politician. Since 1983 members of our caucus have been

assisting our colleague in attending caucus meetings, groups, parties

and visitations. When you assist a person who is in a wheelchair, you

automatically develop an eye for barriers to access. Being one of the

bigger guys in the caucus, I was one of the guys always elected to help

lift our member up stairs and over curbs. I quickly understood the

barriers that exist for the handicapped.

I can assure the member that it has been a policy of our government

for some years now to assist disabled people, people with mobility

problems and people who have trouble with the way buildings are

designed, in any way we can. I can assure the member that we are right

on side on that one. I think in many cases we can demonstrate that we

have been leaders in terms of removing architectural barriers and

are disabled.

The member spoke briefly on the assistive devices program task force. Interestingly

enough, my former ministry, the Ministry of Advanced Education, Training and

Technology, was the coordinating ministry for these disability issues. That

ministry has a very successful vocational rehabilitation program. There was

a task force which was a catalyst in an interministry effort to look at a more

comprehensive range of options for the provision of technical aids. Under the

leadership of the Ministry of Advanced Training and Technology, several ministries

have been working to develop a strategy that builds on existing programs in

government and in the community at large. We're not in a position yet to

comment on the work of this group, as that interministry group has not yet reported

to the Deputy Ministers' Committee on Social Policy, although it will soon.

It will then come to the Cabinet Committee on Social Policy. It's my hope

that we can make a fuller statement on their work when that report comes to

the cabinet committee and eventually to cabinet.

Let's not lose sight of the very good work that's been done by the

Premier's Advisory Council for Persons with Disabilities, which has

been in place now for about two years. It has offered excellent

suggestions to the government on how we can assist, what barriers there

are and what assistive devices exist and what else we can provide to

enhance the quality of life for those British Columbians who are

disabled. We're quite proud of the work that's been done in that sense.

One of the members on that task force, John Morrison, is from Prince

George and was my nominee. He is a very outgoing member of our

community and a member of that committee, one who has offered

remarkable input and good suggestions to the committee.

In terms of support for the elderly and for the children, as you

well know, it has been a feature of our current Premier to accent

services for the family I would expect that you're going to see more

initiatives from many ministries of government that benefit the family,

both the elderly and the children. With respect to the lunch program,

for example, you've already seen an initiative launched by the current

Premier and one which all of us in cabinet support.

I'm going to take my place now, Mr. Chairman. I once again thank the

critic opposite for his thoughtful questioning. I advise you and all

members of the Legislative Assembly that I really see these estimates

as a productive method of discussing health issues, as can be decided

by the Ministry of Health, and discussing a better way of providing

health services in this great province of ours. Any suggestions,

submissions or comments any members of the Legislative assembly want to

make with respect to these issues, I assure you, are welcomed by this

minister.

MR. PERRY: I see my colleague the member for

Surrey-Guildford-Whalley smiling with absolute delight. It's one of the

most congenial expressions I've ever seen on her face in this chamber.

She's obviously delighted to know that the entire philosophy of Social

Credit has changed. The notion that Social Credit was next to godliness

and that it was impossible for anyone else to know what might be

helpful to the people of British Columbia has, I suppose, taken

something of a beating in the last four or five years. I notice even

the minister refers to the current, acting, interim Premier — whatever

the formal title is — and takes pains to

[ Page

12466 ]

distinguish himself from any reference to the former Premier, under

whom he served for four and a half years. There clearly is an attempt

to convince us that somehow the atmosphere has totally changed.

Now when we leave here today, if we are reassured that the minister

will encourage his staff to respond frankly and openly to information

requests rather than having them all bumped up to his office, then

perhaps I'll leave with the same beaming smile that I see on the face

of my colleague. But while I intend to honour that friendly,

cooperative and constructive spirit, I'm afraid that some of the

suggestions I have may be a little more uncomfortable for the minister.

Let's turn to a few.

Just before we leave the assistive devices task force report, let's

not kid ourselves that there has been any leadership from government.

Government and ministries have stonewalled and blockaded any action on

that. Why do you think the assistive devices task force staff members

raised the issue with the opposition? Because after two years they

couldn't get a millimetre — not an inch, a foot, a mile or maybe even a

micron — of movement out of the government. There are still 3,000

people in British Columbia with communication disabilities, whom they

were trying to serve and could be served, for whom there's been

essentially no movement over the course of this Social Credit

government.

This is a time when in the previous fiscal year $1.2 million was

wasted by ministers jetting around the province for their own

convenience and adding to the cost of the ambulance service. It was

nothing to spend $1.2 million to jet a minister from here and there. I

see one of the worst abusers enter the chamber now. He and his seatmate

from Kamloops used to charter separate jets to go back to Kamloops for

an evening or the weekend. They wouldn't ride together; they would take

two separate government jets. Yet the same government refused to lift a

finger to help people with communication disorders.

Why do you think those people came to the opposition? Why do you

think I'm raising it here now? When the opposition was unable to help

them, why do you think they went to the royal commission as a last

desperate measure? They were hoping that Justice Seaton and his

commissioners would be able to achieve something that we in the

opposition couldn't — partly, I might add, because we weren't ever in

session and our committee on health was never allowed to sit.

MR. SERWA: Did you write any letters?

MR. PERRY: Of course I did. Of course I wrote letters to the government.

I have letters back here from the Minister of Health saying he would refer it

to the then Minister of Advanced Education, who is now the Minister of Health,

who was briefly the Minister of Environment, who was part of that revolving-door

circus that has been known as the Social Credit cabinet. And now the minister

has the nerve to sit here and say: "Yes, I was the responsible minister

at that time, and begging your pardon, I did nothing, but I'll be glad to

have useful suggestions." Well, I'm giving you one. Do something about

it. Get that interministerial committee to report to the deputy ministers for

a change, after sitting on their behinds for two years.

[3:45]

I see we have the pleasure of having the Deputy Minister of Health

in the chamber with us. Ask her to get something to happen. Let's see a

little action before the election. Let's see some communication

devices, some of those little machines that will actually allow a

person to talk who can't now talk so that he or she can use a telephone

or go into a restaurant and order a meal, saying, "I'd like my toast

buttered and with jam on it, " by typing in that message, as the royal

commissioners were shown in the demonstration in the hearing in January.

Let's get a little action. Let's have some excitement in B.C. for

the people who really need help, not just for the cabinet ministers

like the disgraced member of the hall of shame, that former

Attorney-General, who burned up hundreds of thousands of dollars

perhaps — or at least tens — jetting around the province. He looked

after himself, but what about people who can't afford $1,000 for a

device like that?

What about the young man in my riding who had a brain injury because

he was attacked by people? He was attacked and wounded in a criminal

injury, and he's had a brain injury since then. He now has to live on a

GAIN pension in a miserable little basement suite in my riding, He

couldn't even get a cushion changed — the fancy cushion he sits on to

keep from getting bedsores. That cushion wears down after a certain

time and is no longer comfortable-It costs a few hundred dollars to

change it, and he couldn't afford that out of his GAIN pension. He

can't get any sympathy out of the bureaucrats in the Ministries of

Health or Social Services. They say: "It's not our problem. We can't

solve that one. There's no program for that. You'll have to pay for it

out of your own pocket." When I ask him, he hasn't got the resources;

he doesn't have the money in his bank account to pay for that cushion.

It would be fine for him to go ahead and get a bedsore and go into

hospital at $500 a day; that would be paid for happily by this

government, because they're so incredibly fiscally inefficient they

don't know what preventive measures are. They don't even listen to

their own good bureaucrats when they try to tell them something

preventive.

Let's get onto another suggestion. I've given you one: let's have a

little action on that assistive devices program task force for a

change, and let's have it before the election — action, not just

promises. Then the people can judge for themselves if they've got

something worth voting on.

How about another suggestion. Let's see a little preventive action

for real in controlling the tobacco addiction industry. I spoke with

the Minister of Health in the corridor the other day after I ran out of

time during a question in question period. Right now we're being

subjected to another addiction-promoting campaign by the tobacco

industry — Mr. Mulroney's best friend Bill Neville. Bill Neville is

going to deliberately encourage people to waste the postal service to

send junk mail to Brian Mulroney. Do you think Brian Mulroney will read

it? Does anyone seriously believe that Brian Mulroney reads any of his

mail from British

[ Page

12467 ]

Columbians, or from anyone else in Canada for that matter? Now we're

going to have cigarette packages with messages in them to waste public

money sending messages to the government urging it to cut down on the

tobacco tax.

This government has raised the tobacco tax; I commend them for that.

Every other government in Canada has raised tobacco taxes, for a darn

good reason: because the tobacco epidemic is deliberately addicting

young people in this province and foisting enormous costs onto the

public of Canada.

Now what about a little action from the minister? He has the power

under the Tobacco Product Act of 1972 to control the labelling and the

wording on packages. I raised that point. I made a very constructive

suggestion. I took an awful lot of time in debates last year, on July

24 and 25, with the former Minister of Health. I urged him specifically

to prevent the introduction of new kiddie packs, which Imperial Tobacco

was flaunting in British Columbia. Imperial Tobacco introduced in this

province new 15-cigarette kiddie packs, deliberately to addict more

young women or girls. We're talking about teenage girls and younger,

age nine and up. That's why they made the 15-cigarette packages — so

they could sell something cheaper to young girls and get them addicted.

The minister had the ability under the Tobacco Product Act to

prevent that with a stroke of his pen — one cabinet regulation. Has he

done anything in that time? There is a constructive suggestion to the

new minister. By the same stroke of his pen with a cabinet regulation

he could prevent the introduction of those sadistic new messages that

Imperial Tobacco and others — the Tobacco Manufacturers' Council and

Mr. Bill Neville, the chief purveyor of addiction in this country — are

now trying to pawn off on Canadians.

The minister could enforce the Tobacco Product Act and ensure that

Benson and Hedges do not get away again with tobacco advertising

without any warning. Last year Benson and Hedges staged an entire

cigarette tobacco advertising extravaganza with their festival of

fireworks — huge posters at every bus stop in Vancouver, television

advertisements, newspaper and magazine full-page advertisements with

not even a hint of a tobacco warning on those advertisements and

contrary to the letter of the law in the Tobacco Product Act. In the

United States, similar advertisements carry stark health warnings — the

du Maurier and Benson and Hedges festivals in the New York Times .

I don't accuse this minister of negligence. He wasn't the minister

at the time. But the former minister was negligent in his duty to

protect British Columbians. There's a useful suggestion for the new

minister. You have the power to act. You could do it this Wednesday in

Cabinet with the stroke of a pen. So I look forward to action, and I

will be the first to stand up and congratulate this minister in this

House as a leader in the fight against tobacco if he can take some

action.

I suggested many other measures in two speeches in the last two years and in

great depth in the estimates debates, which I'll be happy to photocopy and

send over to the minister. Maybe you can tell us, while we're on this point,

what progress there has been on the excellent, far-reaching, innovative and

creative tobacco-reduction strategy produced by the Ministry of Health in January

1990, on which to the best of my knowledge virtually nothing has happened.

There has been great movement from the nonsmoking organizations —

the B.C. Medical Association, nurses, and various other health

advocates — but precious little from the government except the odd

little

article in Your Better Health . Has something more happened in

response to the concrete suggestions I made last year? Let's hear from

the minister.

HON. MR. STRACHAN: With respect to the interministry task

force on the provision of technical aids and assistive devices, I'll

tell the member again that the interministry group is gathering

available data on need in this province. They are gathering data on the

experience of other jurisdictions and will be soon making a

recommendation to the deputy minister's committee that will then flow

to the cabinet committee on social policy, I'm not at this point able

to tell you where that recommendation is, but I can tell you that the

process is in place — as I said earlier before the member began

speaking on this issue. You have my assurance that in the next two or

three days I will advise you — if not in this committee, then

personally — where that report is. As I said earlier, it's with a

different ministry. It's with Advanced Education, Training and

Technology, a very able assistant deputy minister, Joyce Ganong, is

working on it. Although the debate became quite lively on the issue, I

can assure the member that we are looking at that and that we share his

concern — otherwise, we wouldn't have put the interministry committee

together in the first place.

Now with respect to the British Columbia tobacco reduction strategy,

let me also advise you that there is no more vigorous an anti-smoker

than me. That normally is the case when one is a former smoker. It's

true that there's no one purer than the purified, and I count as one of

them, having been a three-pack-a-day smoker, and in a good evening I'd

have a couple of dozen cigars after that, depending on how good the

evening was.

Interjection.

HON. MR. STRACHAN: He really is. It's a terrible habit, a terrible addiction. Some experts will tell you it's more addictive than heroin.

Interjection.

HON. MR. STRACHAN: Lots of dioxins from cigarettes. In any

event, it's a terrible addiction. It's something we have to eradicate,

and I thank the member for his asking me about the British Columbia

tobacco reduction strategy, because now I can report to the committee

the work that we've done.

Currently, 22 percent of British Columbians use tobacco. That's

interesting, because probably 15 years ago that figure would have been

well over 50 percent. The goal set by the Ministry of Health is for

British Columbia to be the first province in Canada to reduce tobacco

use to less than 20 percent of the population before the year 2000.

This goal will be supported by

[ Page 12468 ]

protecting non-smokers from exposure to environmental tobacco smoke

and providing a supportive environment for people who wish to quit

smoking. This will be done by increasing the number of individuals who

stop smoking and by helping non-smokers, particularly youth, to stay

smoke-free. If I'm not mistaken, I think British Columbia now has the

lowest number of smokers of any province in Canada. Is that correct?

Interjection.

HON. MR. STRACHAN: Thank you. I think it is.

The accomplishments are this:

1. We introduced a smoke-free policy for all provincial government

workplaces. Effective October 1, 1990, all provincial government

employees have been enjoying work environments that are free of

environmental tobacco smoke.

2. We provided a grant to the BCMA for a pilot project to encourage physicians to discuss smoking cessation with their patients.

3. Because the average age when people start smoking is 12 years and

few people start smoking after the age of 18, the Ministry of Health is

reviewing legislation to determine how changes in legislation could

decrease sales of tobacco products to children. That's clearly what the

member was getting at.

I will advise you that the member did discuss the Tobacco Product

Act the other day. I had a look at it, and my opinion is that it

doesn't have the impact and isn't as effective as it could be.

Regrettably, though, Committee of Supply is not the place to discuss

legislation, so what I'm saying now is essentially out of order.

However, the member has made a good point. I have reviewed the act.

Maybe I'll discuss it with him privately, but I don't think there's

much more I can say in terms of this debate because of our prohibition

in Committee of Supply against discussing legislation or the need for

legislation.

4. We have participated in a national survey of school smoking

policies, and the B.C. survey results will be used to encourage and

support schools to enact smoke-free policies. One of the real concerns

I have, and that I'm sure all members have, is that when we look at

young people taking up smoking, it appears that young ladies are

participating a lot more than young men are. I have a 17-year-old boy,

and I go to a lot of school functions. I note that young ladies in that

age group are smoking far more than the young men are. I find it tragic

that they would do that. First of all, whatever impression they're

trying to make is certainly negated by the way they smell. If you're a

non-smoker, smokers are really offensive. Why on earth young girls

would want to do that is beyond me.

5. We have continued to provide funding to the National

Clearinghouse on Tobacco and Health, which provides information about

tobacco issues, such as legislation, policies, statistics, health

effects and research findings. With the assistance of the BCMA, we have

distributed smoke-free environment posters to physicians' offices and

provincial health units.

6. We have initiated an amendment to the community care facilities regulations

for child care which now requires all areas used by children in licensed facilities

to be smoke-free.

7. We have provided funds to the B.C. Committee to Reduce Tobacco

Use to conduct a provincewide media campaign during National

Non-Smoking Week, which was January 21 to January 27, 1991. That

campaign supports the theme of National Non-Smoking Week, to increase

So in terms of the member's concern with smoking tobacco, I can

assure him that I am totally supportive of what he says — I am a

vigorous campaigner for any anti-smoking measures — and that as much as

I can in committee, I will address the legislation to do what we can.

We will continue to promote smoking cessation programs and strategies,

and, as I said earlier, to target young women with these cessation

strategies. I hope that clarifies my personal position and also the

position of the government of British Columbia on the issue of

non-smoking.

[4:00]

[Mr. Pelton in the chair.]

MR. PERRY: I will be pleased to respect the rules of the

Legislature by forwarding to the minister a copy of a statement I made

in July 1989 from this seat on a more aggressive anti-tobacco policy in

British Columbia, which includes reasons why the present legislation in

British Columbia — although it may have been pioneering in 1972 under

an NDP government, I might add — perhaps pales by comparison to more

recent legislation. But it does give the minister significant powers

that could be utilized in cabinet.

I will send the minister a copy of that statement later this

afternoon, because I think we could have some action, even in the dying

days of this government, which would protect children. I would

certainly invite the minister to consider making the case to his

cabinet colleagues to introduce as government legislation the two

private bills I introduced last year: the children's tobacco addiction

protection bill and the environmental tobacco smoke bill. These would

give us the most progressive legislation in the country and allow us to

perhaps catch up with our cities, which have gone way ahead of us —

both Vancouver and the Capital Regional District.

Let me change directions in the few minutes left before I have to

leave. I want to return to an issue I raised on Friday about the

cardiac surgery waiting-list. Just before I do, I'd like to reiterate

that if the Pharmacare advisory committee report is available, or even

the documentation referred to by the Minister of Finance on Friday

afternoon on page 5 of the Hansard Blues, I would greatly appreciate

having them for our subsequent debates.

But let me return to the debate we began on Friday morning and

afternoon, when the Minister of Finance strongly recommended to me to

bring up this issue in the presence of the Minister of Health. I raised

the issue of the contrast between the statements of the former Minister

of Health on February 11 at the opening of the new cardiac surgery unit

at Royal Columbian Hospital in New Westminster, which was reiterated in

a letter to the Vancouver Province of

[ Page

12469 ]

February 17 in which the then Minister of Health stated that the

average waiting-time for cardiac surgery in British Columbia had been

reduced from 20 days to 10.5 days.

Subsequently the minister clarified a typographic error which was

not the newspaper's error; it was the minister's error. I pointed out

on Friday that it struck me as unusual that a Minister of Health would

not have picked up an error of that magnitude, because even in the best

of all possible worlds a waiting-time of ten and a half days for

elective cardiac surgery might be a little on the short side. Very few

people would require elective surgery quite that quickly. Ten and a

half weeks would be a respectable accomplishment; 20 weeks is less

marvellous. The real question is: what is the true waiting-period?

We now know that the typographical error concerned the difference

between days and weeks. What the minister meant to say in February was

that the average waiting-time for cardiac surgery had been reduced from

20 weeks to 10.5 weeks. I thought I heard the present Minister of

Health reiterate those figures during his opening remarks.

On Friday I pointed out that at the very time the former Minister of

Health.... Mr. Chair, I see that even you have difficulty keeping up

with the "cabinet shuffles," as they're called. But I think I'm

accurate that it was the then-former Minister of Health and now

Minister of Finance. At the very time he made those statements,

according to the admitting information services for Friday, February 1,

1991, the waiting-list at Vancouver General Hospital showed that the

mean or average waiting-time for elective and urgent patients was 20

weeks. At the time, he was saying that the average provincial wait was

ten and a half weeks, the Vancouver General Hospital wait was 20 weeks.

Because half of the provincial surgery is done in that hospital, that

would mean that the rest of the provincial heart surgery would have

been done with a waiting-time of zero weeks on average, which means

that some people would have had their surgery before their doctors had

even decided it was a good idea. The figures did not ring true or make

sense. I don't have any idea what the true waiting-time is, and that's

what I'm trying to find out for the benefit of hon. members, so we can

let the public know what the truth is.

I now have an admitting information services waiting-list as of

Wednesday, May 1, 1991, from Vancouver General Hospital, which performs

about half of the cardiac surgery in B.C. Again, the hospital tells me

that the waiting-time at St. Paul's Hospital, which does the next

largest number of operations, is probably longer on average than at

Vancouver General. At Vancouver General Hospital, the average

waiting-time as of May 1, 1991, is listed as 24 weeks for

cardiovascular surgery for those patients listed as elective and urgent.

For the benefit of members not familiar with this terminology,

elective does not mean that you can decide whether or not you want the

surgery. It means the surgery has been judged necessary but does not

have to be done immediately. Usually it should be done within a period

of weeks, or else one would not recommend it.

But according to this, the average waiting-time now at that hospital

is 24 weeks. I would like to know from the minister.... If it's

impossible to answer today, I'd like to have a commitment that during

these estimates debates, we will have a clear answer — defensible —

that everyone in British Columbia can agree is the accurate answer for

the average waiting-time.

I will clarify my question at one more level of detail just so

there's no mistaking what I'm after. Some patients with emergency

conditions — hopefully the majority; and I'm satisfied that it is the

majority — are receiving surgery on an emergency basis. There have been

a few regrettable exceptions, but they are clearly exceptions to the

rule. What we are talking about is not the emergency cases, which must

be done on the same day that the doctor recommends the surgery, or

within 24 hours, and where the patient is hospitalized in intensive

care right up until surgery is performed. We are talking about people,

let us say, with a heart valve which is closing off in the main valve

coming out of the heart, the aortic valve, where it may close off over

a period of weeks or months. When it reaches a certain point where the

symptoms become intolerable to the patient or the danger of sudden

death increases, a doctor decides that now is the time to operate, when

it's worth undergoing the risk that the patient may not survive the

surgery. From the time that decision is made and the patient is

recommended for elective or urgent — but not emergency — surgery, what

is the average waiting-time for all of the province of British Columbia?

HON. MR. STRACHAN: Let me repeat what I said earlier during

my opening remarks. That may clarify this for the member, or it may

solve some of the problems he has with his statements.

We talked about an average of 20 weeks waitingtime in February 1989

and less than 11 weeks' waitingtime in December 1990. Almost 520 more

cardiac procedures were performed than in the previous year. The

measurement is derived from those people who have had cardiac surgery

and from how long they had to wait to have it. The member wants

accurate data on the waiting-list, and I can tell him that so do we.

I'm advised that we don't have complete, up-to-date data from those

surgeons performing those procedures. They have been unable to provide

that information to us — at least that's what I'm advised — on a

current basis. To let the member better understand why his figures are

different from ours, it is because we are saying that people who have

had the procedure have waited an average of less than 11 weeks when

measured when a snapshot was taken of that group in December 1990.

Also, let's not lose sight of the fact that we are making efforts

continually to improve our cardiac procedures and lessen the wait-list.

We have doubled the number of perfusion technologists now being trained

in B.C. for open-heart surgery, and we have allocated funds to expand

the open-heart surgery programs at Royal Jubilee and St. Paul's

Hospitals by 100 cases each for the current fiscal year and for each

year thereafter. So, Mr. Chairman, I say in the strongest terms that we

are spending responsibly and appropri-

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ately, and we are currently using a variety of remedies to reduce

the waiting-lists in the province. The member states that he would find

an exceptional waiting-list not acceptable, and I can assure the member

that I agree with him. That's why we're spending money to train more

technologists and also to expand the caseloads at Royal Jubilee and St.

Paul's Hospitals.

MR. PERRY: I will apologize to the minister. I'm going to

have to leave in a moment. I look forward to further discussion. I

appreciate that it's unlikely that the minister can answer this more

precise form of the question right now, but perhaps I can leave it for

him to return to us.

I now have a clearer explanation of the statement made by the former minister in his letter to the Vancouver Province

of February 15. He stated: "Average waiting-times for patients who have

had heart surgery were cut in half over the past year — from 20 days to

10.5 days." He meant "weeks, " though. That clearly includes patients

who required emergency surgery and for whom the waiting-time, by

definition, was zero. In other words, a decision was made that they

must have surgery on an emergency basis. The surgery would usually have

been performed within 24 hours, and in days that counts as zero, so

that will bring down the average waiting-time for all other patients.

I see the assistant deputy minister shaking his head and the

minister shaking his head as a negative. I wonder if I could ask him to

clarify this issue. Would the minister undertake to table or transmit

to me the statistics upon which these figures are based, in simple

tabular form? I don't request every single case, obviously, but a

summary for each of the hospitals involved, or for the number of

patients operated on under emergency, urgent or elective categories, to

give us a realistic picture. I'm simply asking for a realistic picture

of what the average waiting-time is and how it has changed over the

last few years for patients with conditions requiring cardiac surgery

who did not have to be done emergently and therefore were popped into

hospital because there was absolutely no alternative that day. I have

to excuse myself; I have to run right now. But I will read the answer

in the Blues or continue the discussion later.

HON. MR. STRACHAN: I'll tell you right now as you're walking

out the door. It includes urgent and elective in the 11 weeks, not an

emergency. So the 11 weeks, for those who have had it, were those who

are categorized as being urgent or elective, but not emergent. When the

Legislative Assembly reconvenes with Mr. Speaker, I will table a

waiting-time graph for the benefit of the House. Material cannot be

tabled during committee, so I'll wait until the House reconvenes to do

that.

MR. PERRY: I break my own word, Mr. Chairman. Can the minister explain

to us the discrepancy? How can that average be reconciled with the Vancouver

General Hospital's admitting service figures? Does that imply that they

are wrong or that the average waitingtime is zero at St. Paul's Hospital

and the Royal Jubilee Hospital? Arithmetically it just doesn't fit. If he's

going to table the answer to that, then I'll be quite content to wait until

the document is produced.

HON. MR. STRACHAN: The discrepancy is this: the figure the

member is quoting is an average of everyone who was on the

waiting-list. The numbers we use are for those people who have had

surgery, and we then identify how long they had to wait for that

surgery That would account for the discrepancy. But we'll have a fuller

comment to make in the ensuing days if that answer isn't full enough.

MS. CULL: I want to turn to the Victoria Health Project. I

asked the Minister of Finance a number of questions about this on

Friday. He basically directed me to bring these questions to estimates,

and here we are. As the minister knows, the Victoria Health Project was

established a number of years ago — three, I believe — as a pilot

project to provide community based preventive health care services

targeted primarily at senior citizens in the Victoria area. The health

project contains a number of subprojects.

In the last year to 18 months, the health project has been the

subject of international attention. People throughout North America

have been coming to Victoria to look at the Victoria Health Project and

the various sub projects to see exactly what's going on here. It has

proven to be a very successful, well-received project in my community.

I'm fortunate in the community of Oak Bay to have one of the three

wellness centres that are funded under this project.

[4:15]

I have a number of questions about the ongoing funding and the

future of the project. On Friday the Minister of Finance said that one

of the things the government was doing right now was studying it, to

look at how much value the project provided to the community and

"whether we should be incorporating this throughout the province." He

also went on to say that he has assured the stakeholders that funding

is being left in place until the review is completed.

What I'd like to hear from the minister right now is: what is in the

budget this fiscal year for the Victoria Health Project, and what are

the long-term budget plans for this project?

HON. MR. STRACHAN: At the outset let me thank the member for

her interest in the Victoria Health Project. As indicated in the

member's opening comments, this project began some time ago and has

been very successful. I can tell the member that for this fiscal year,

which will end March 31, 1992, we have a total application of funds for

the Victoria Health Project of $3,871,079. We are solidly committed to

the project. I'll give the member more if the member wishes. A brief

breakdown: administration costs are about 10 percent, $387,000; total

program costs — subproject payments, as they're identified — are

$3,484,079. That is our commitment to the project for this coming

fiscal

year.

MS. CULL: I did want to know a little bit about future

budgeting plans, because a problem that has arisen with the Victoria

Health Project started coming

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up last fall. As we began to approach the end of the fiscal year,

people who administer the various subprojects became concerned because

time was running out, and they didn't know whether they would have

funding after March 31, 1991. It wasn't until some time later, the end

of January or early February, when that confirmation was made that some

funding would be available. The minister would understand that with any

kind of project like this, it's very difficult to be even three months

before the end of funding and not know if you're going to be able to

continue. Because this was funded as a pilot project, and the

government repeatedly made that clear, it was unclear to the various

administrators in the project that funding would continue at the end of

the three-year period ending March 31, 1991. They became very uneasy as

to what they should be telling their staff and what they should be

telling their clients.

We got to the point in early 1991 where there was almost a crisis in

some of those subprojects, because people just didn't know whether they

would be able to continue. I would hope the ministry would not repeat

that, because of this incredible uncertainty and anxiety it causes for

the people who work in the project — and also for clients, particularly

when we're dealing with a group like senior citizens, who need some

time to become accustomed to new services and who have to know they can

depend on them. When the rumour started going around that funding might

not be there, they became very concerned.

I would like to know what the ongoing plan is. I would also like to

know from the minister why some of the subprojects only know what their

budget is until June and have been told there is no firm budget for the

end of the year. There are some subprojects that I have talked to. It

may be all of them; I just haven't had a chance to canvass all 11

subprojects. They are still waiting for their budget information at

this point. I gather it has to do with not all of the funds for the

projects coming from the Ministry of Health; there is a three-party

agreement. But since the Ministry of Health is basically in the

driver's seat with two of those three parties in the agreement, perhaps

the minister could answer that.

HON. MR. STRACHAN: First of all, let me describe to a small

degree the Victoria Health Project for the benefit of the committee. I

don't have to describe this to the member, because she's obviously

familiar with the work that is done and with the structure. In terms of

its structure, it's not totally Ministry of Health–driven. There are

more parts to the constituency and more parts to the program: the

Greater Victoria Hospital Society and the CRD are also involved. This

ministry and this minister cannot make unilateral decisions.

With respect to the concern expressed about the budget only being

until June, it was because we were doing a management review of the

project. However, it's appropriate and, I guess, coincidental, because

we never know — at least ministers don't know — when our estimates are

going to come up, at least not in terms of knowing to the date. But the

figures I've given you have just been released and have just been

approved.

You, I, this assembly and this committee are the first to realize

the application of funds for the total fiscal year to March 31, 1992,

which are as stated earlier: a total of $3,871,079, fully approved,

fully in place. That was approved in the last couple of days. Although

I wasn't aware of it until now, at this point we are stating that

there's no mystery to the budget; it's in place and will continue for

this fiscal year. In terms of next fiscal year, of course, I can't

comment on that, because that is definitely in the area of future

policy. But I can tell you that as a project, it will cease to have

that title but will continue simply as a function of the Ministry of

Health, the Greater Victoria Hospital Society and the CRD.

MS. CULL: It is nice to receive this information, as recent

as it is, coming out today. I hoped the minister would undertake to

assure the people in Victoria that next year we will not have to wait

until two months and a bit after the end of the fiscal year to be

assured that a project with this kind of value in the community will

have continuity and will be funded.

I wanted to ask about the progress studies that are in place. I

understand the projects are being reviewed, in addition to the

management review, and I assume the results are now known to the

minister. There are also studies being done on the various subprojects.

One of the things your predecessor said was that funding would be

dependent on the outcome of these studies, and of course that makes

sense. If you're going to fund something, you review it, you make sure

it's effective, and then you carry on.

I've been advised that the full report will not be available in some

cases — particularly the wellness centres — until the fall of 1992,

which puts us quite a ways along in terms of being able to make funding

decisions for even next year. I know you've said this is in the area of

future policy, but I would like to know if I'm correct and to get some

idea of the status of the studies, and whether funding is totally

dependent on them or will be continuing until they are completed.

HON. MR. STRACHAN: The member is correct in terms of the

reviews that are being done. But in this case, it would be our policy

to recognize that where we had a project that did not have a total

review until well after the end of the fiscal year, interim funding

would continue to carry on that portion of it in the next fiscal year.

MS. CULL: Could the minister tell us whether the ministry now

has plans to expand this project, particularly within Victoria, to

groups other than seniors? The Arbutus Society for Children, in

conjunction with a number of groups and organizations in Victoria, made

a presentation on the needs of children in Victoria and basically said

that something very similar to the wellness centres was really needed,

not only for senior citizens but for families and children in this

community.

I think that one. of the successes of the wellness centre approach

has been to pull together in one place information for senior citizens

on health care services. They're not necessarily provided there, as I'm

sure the

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minister is aware, but the information is there for seniors so that

they don't have to try to go all over town phoning all kinds of

different agencies and sometimes dealing with up to four levels of

government to find out what kinds of services they can make use of to

assist them.

I think families and children have an even worse situation here in

Victoria, so I would like to know whether there are any plans to expand

this to serve other groups in our community. I would also like to know

whether the ministry has any plans to extend it now that we've

established that it's successful and, particularly with things like the

quick response team, cost-effective. Is it going to be extended beyond

the capital region?

HON. MR. STRACHAN: Again, it's difficult for me to speak for

the whole partnership, but we are continually looking at other

priorities within the project and within this community.

In terms of other communities, we do have many hospital-community

partnerships throughout the province, and we're always looking at

better ways of service delivery. I've forgotten the third question, but

I can assure the member that this is a policy that is developed as we

review programs. If we see an idea that's successful, we certainly look

at having it put in place in other areas where it can be made

successful. But no community is the same, and what we look at is a

responsible, flexible policy that can assist.

In this case we have a pilot project, in that sense, one which we

were proud to introduce some years ago, which has taught us a lot and

which is continually evolving. We will continue to be innovative and

flexible in all our dealings with those who need care and to engage in

many partnerships — with regional districts, hospital societies or

hospitals — in any way we can to provide the best-quality care to the

people of British Columbia.

MS. CULL: The minister has mentioned the partnership in this

project a couple of times. I want to point out that the ministry and

the Greater Victoria Hospital Society being two of the partners